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Background Complications in the urinary tract related to congenital Zika syndrome have recently been reported. One complication, cryptorchidism, has been reported by the Microcephaly Epidemic Research Group/MERG, in Pernambuco/Brazil. The present article describes for the first time the surgical findings in a case series of boys with Zika-related microcephaly and cryptorchidism, who underwent surgical testicular exploration as a contribution to better understand the possible mechanisms involved in gonads formation and descent. Methods A total of 7 children (11 testicular units), aged 3 to 4 years, were submitted to inguinal or scrotal orchidopexy for the treatment of palpable cryptorchidism between August 2019 and January 2020. Characteristics of the gonads and its annexes related to appendixes, testis-epididymis dissociation, gubernacular insertion, and associated hydroceles and/or hernias were described. Measures in centimetres were taken for volume calculate. Results We found a low prevalence of testicular and epididymal appendix (66.7%), a high prevalence of testis-epididymis dissociation (55.6%), low mean testicular volume for their ages (lower for older boys) and ectopic gubernacular insertion in all cases. There was no evidence of associated hydroceles and/or hernias in any case. No surgical complication was registered or reported, and all explored gonads were properly placed in the scrotal sac. Conclusions We herein describe the surgical findings of these children's orchidopexies and discuss the possible mechanisms of viral action in embryogenesis and postnatal growth and development of the testes and annexes. These children need to be followed over time due to the higher risk of testicular atrophy and malignancy. Surgical timing seems to be relevant to avoid loss of testicular volume.

Com este artigo, os autores procuram estudar as definições e diagnósticos de uma das disfunções mais freqüentes na sexualidade humana: a ejaculação rápida (E.R.). Através de extensa revisão bibliográfica, diversas teorias e métodos foram abordados e, de uma maneira simplificada e de fácil compreensão, apresentados aos leitores. Após uma introdução necessária para melhor familiarização com o problema, foram discutidas as diversas definições existentes para esta condição tão importante para a satisfação sexual dos casais. Mostrou-se também algumas vertentes de pensamento para a etiologia da ejaculação rápida, dos estudos mais tradicionais até os mais recentes artigos publicados.E para finalizar foi apresentado o estado da arte no diagnóstico, detalhando a avaliação das ferramentas mais utilizadas para a formatação de ensaios clínicos, avaliação diagnóstica e seguimento terapêutico.

The genitourinary tract was recently identified as a potential site of complications related to the congenital Zika syndrome (CZS). We provide the first report of a series of cryptorchidism cases in 3-year-old children with Zika-related microcephaly who underwent consultations between October 2018 and April 2019 as part of the follow-up of the children cohort of the Microcephaly Epidemic Research Group, Pernambuco, Brazil. Of the 22 males examined, eight (36.4%) presented with cryptorchidism. Among 14 undescended testis cases, 11 (78.6%) could be palpated in the inguinal region. Seven of the eight children had severe microcephaly. Conventional risk factors for cryptorchidism were relatively infrequent in these children. We hypothesize that cryptorchidism is an additional manifestation of CZS present in children with severe microcephaly. As in our cases, for most of the children, the testes were located in the inguinal region, and the possible mechanisms for cryptorchidism were gubernaculum disturbance or cremasteric abnormality.

The covid-19 pandemic has negatively impacted global health and has caused more than 45 000 deaths. Some possible treatments are being tested in randomised trials. Recently, news that chloroquine/hydroxychloroquine has been successfully used to treat pneumonia associated with covid-19 in reports from China and Europe, associated with the panic of transmission has led to a high public demand for these medications in …

Introduction There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few series, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer. Objective To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon. Patients and methods A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out. Results The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, estimated blood loss and the withdrawal time of the urinary catheter. Conclusion The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity.

The aim of the current study was to perform the translation, cross-cultural adaptation and validation of the Underactive Bladder Questionnaire (UAB-q). The study design included the Portuguese translation, cross-cultural adaptation and validation of the UAB-q in 90 patients from a urology outpatient clinic following international methodology. The psychometric properties tested were the validity, reliability, internal consistency and stability of the instrument. The content validity index at the item (I-CVI) and scale level (S-CVI) were above 0.80 and did not require changes. Regarding the reliability analysis, Cronbach’s alpha was 0.79. The internal consistency and the base time stability (test–retest) had excellent indexes; all were above 0.90. These results indicate that the UAB-q is a valid, reproducible and reliable instrument for screening underactive bladders and is a potentially useful tool to guide health actions and improve the care of underactive patients.

Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Purpose Overactive Bladder (OAB) is a clinical condition characterized by symptoms reported by patients. Therefore, measurement instruments based on reported information are important for understanding its impact and treatment benefits. The aim of this study was to translate, culturally adapt and validate the Urgency Questionnaire (UQ) in Portuguese. Materials and Methods Initially, the UQ was translated and culturally adapted to Portuguese. Sixty-three volunteers were enrolled in the study and were interviewed for responding the Portuguese version of the UQ and the validated Portuguese version of the Overactive Bladder Questionnaire short-form (OABq-SF), used as the gold standard measurement for the validation process. Psychometric properties such as criterion validity, stability, and reliability were tested. Results Forty-six subjects were included in the symptomatic group (presence of “urgency”), and seventeen were included in the asymptomatic group (control group). There was difference between symptomatic and asymptomatic subjects on all of the subscales (p≤0.001). The UQ subscales correlated with the OABq-SF subscales (p≤0.01), except the subscale “time to control urgency” and the item “impact” from the visual analog scales (VAS). However, these scales correlated with the OABq-SF - Symptom Bother Scale. The UQ subscales demonstrated stability over time (p

Foi avaliado o nível de conhecimento de médicos e enfermeiros obstetras sobre a utilização de ácido fólico (AF) para a prevenção dos defeitos do fechamento do tubo neural (DFTN). Estudo descritivo transversal no qual 118 voluntários (95 médicos e 23 enfermeiros), responderam um questionário com 21 perguntas sobre a prevenção dos DFTN. Os dados foram analisados em função do conhecimento relatado, das recomendações preconizadas pelo Ministério da Saúde (MS) e das evidências científicas (EC) disponíveis sobre o assunto investigado. O nível de conhecimento baseado nas EC e nas recomendações do MS foi diferente (4,64 ± 0,20 vs 5,55 ± 0,15; p < 0,001; Média ± EPM). Não houve diferença entre o nível de conhecimento quando comparado à formação dos mesmos, ao tempo que realizam atendimento pré-natal e entre as duas classes de profissionais avalia­dos. Houve diferença entre o nível de conhecimento relatado e o baseado nas EC (6,76 ± 0,18 vs 4,64 ± 0,15; p < 0,001) e o baseado nas recomendações do MS (6,76 ± 0,18 vs 5,55 ± 0,20; p < 0,001), 94,1% dos profissionais conhecem o papel do ácido fólico, contudo, 64,2% relataram não saber quando iniciar a suplementação no pré-natal. Frente ao exposto foi verificado que a grande maioria dos avaliados relatou conhecer a importância do AF na prevenção do DFTN, porém, existe ainda desconhecimento sobre o assunto investigado. The scope of this study was to evaluate the knowledge of obstetricians and obstetric nurses about folic acid in the prevention of neural tube defects (NTD). A cross-sectional study was conducted in which 118 volunteers (95 physicians and 23 nurses) answered a questionnaire with 21 questions about prevention of NTD. The data were analyzed according to the reported knowledge, the recommendations made by the Brazilian Ministry of Health (MOH) and the scientific evidence (SE) available in the literature on the topic. The knowledge based on the SE and recommendations of MOH was different (4.64 ± 0.20 vs. 5.55 ± 0.15, p

This study aimed to assess the burden and quality of life (Qol) of primary caregivers of children/adolescents with meningomyelocele, taking into account the relationship to anxiety and depression symptoms. A cross-sectional approach was taken to analyze the health-related Qol and burden using the Short Form-36 Survey (SF-36) and the Caregiver Burden Scale (CBS), respectively. Depressive and anxiety symptoms were investigated using the Beck Inventories. The Heckman two-step method was used to deal with the selection bias problem. A total of 43 primary caregivers were enrolled in the study. Most of the caregivers were mothers with preliminary education, living in consensual union. Lower scores in general health and vitality were reported in the SF-36. The mean global CBS score was 2.2. Majority of the volunteers (55.8%) were considered non-depressive. There were both positive and negative correlations between the scores of both Beck Inventories and most dimensions of the CBS and SF-36. The Heckman method showed a higher burden among caregivers who had children with fecal incontinence, were living together with a partner, were unemployed and had lower income (P

We evaluated the rate of new contralateral reflux in children with conservatively treated vesicoureteral reflux, and identified predictive factors that could influence the appearance of contralateral reflux after a diagnosis of unilateral reflux on the first voiding cystourethrogram.We retrospectively evaluated 167 children who had been diagnosed with unilateral vesicoureteral reflux on the first voiding cystourethrogram. Patients with bilateral or secondary vesicoureteral reflux and those who had undergone only 1 voiding cystourethrography were excluded from the study. A total of 134 girls and 33 boys were analyzed. Average patient age was 55 months (range 2 to 169). All children had undergone at least 2 voiding cystourethrograms. A total of 84 patients underwent 3 voiding cystourethrograms, 35 underwent 4, 18 underwent 5, 9 underwent 6 and 3 underwent 7.New contralateral reflux was evident on subsequent voiding cystourethrography in 35 patients (21%). Analysis of the presence of new contralateral reflux according to gender, reflux grade, age, side of reflux and bladder function (with or without lower urinary tract dysfunction) revealed that only medium or high grade reflux was a risk factor for new contralateral reflux. In 98 children (59%) vesicoureteral reflux resolved spontaneously. Of these patients 13 had new contralateral reflux and 85 did not (p = 0.017).We identified a 21% incidence of new contralateral reflux in patients with unilateral reflux after the first voiding cystourethrography who were treated conservatively. The main risk factor for contralateral reflux was the presence of medium or high grade reflux. Patients with new contralateral reflux had a lower rate of cure than those without development of contralateral reflux.

The scope of this study was to evaluate the knowledge of obstetricians and obstetric nurses about folic acid in the prevention of neural tube defects (NTD). A cross-sectional study was conducted in which 118 volunteers (95 physicians and 23 nurses) answered a questionnaire with 21 questions about prevention of NTD. The data were analyzed according to the reported knowledge, the recommendations made by the Brazilian Ministry of Health (MOH) and the scientific evidence (SE) available in the literature on the topic. The knowledge based on the SE and recommendations of MOH was different (4.64 ± 0.20 vs. 5.55 ± 0.15, p0.001, Mean ± SEM). There was no difference between the knowledge of respondents compared to their training, the time spent in prenatal care and between the two classes of professionals evaluated. There were differences between the reported knowledge and that based on SE (6.76 ± 0.18 vs. 4.64 ± 0.15, p0.001) and based on the MOH recommendations (6.76 ± 0.18 vs. 5.55 ± 0.20, p0.001). Thus, the conclusion reached was that 94.1% of those evaluated reported knowing the importance of folic acid in preventing NTD, though 64.2% reported that they did not know when to begin administration of the supplement.

Introduction Lack of randomized controlled trials (RCTs) that compare pure laparoscopic radical prostatectomy (LRP) with robot-assisted laparoscopic radical prostatectomy (RALRP) is an important gap of the literature related to the surgical treatment of the clinically localized prostate cancer (PCa). Aim To provide the first prospective randomized comparison on the functional and oncological outcomes of LRP and RALRP for the treatment of the clinically localized PCa. Methods Between 2007 and 2008, 128 consecutive male patients were randomized in two groups and treated by a single experienced surgeon with traditional LRP (Group I-64 patients) or RALRP (Group II-64 patients) in all cases with intent of bilateral intrafascial nerve sparing. Main Outcome Measures Primary end point was to compare the 12 months erectile function (EF) outcomes. Complication rates, continence outcomes, and oncological results were also compared. The sample size of our study was able, with an adequate power (1-beta > 0.90), to recognize as significant large differences (above 0.30) between incidence proportions of considered outcomes. Results No statistically significant differences were observed for operating time, estimated blood loss, transfusion rate, complications, rates of positive surgical margins, rates of biochemical recurrence, continence, and time to continence. However, the 12-month evaluation of capability for intercourse (with or without phosphodiesterase type 5 inhibitors) showed a clear and significant advantage of RALRP (32% vs. 77%, P 17 (38% vs. 63%) were also significantly higher for RALRP ( P = 0.0002 and P = 0.008, respectively). Conclusions Our study offers the first high-level evidence that RALRP provides significantly better EF recovery than LRP without hindering the oncologic radicality of the procedure. Larger RCTs are needed to confirm if a new gold-standard treatment in the field of RP has risen. Asimakopoulos AD, Pereira Fraga CT, Annino F, Pasqualetti P, Calado AA, and Mugnier C. Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy.

Introduction Erectile dysfunction (ED) is highly prevalent among men undergoing hemodialysis. Aim This study was performed to identify the influence of ED on the patient's quality of life (QoL) and to evaluate the influence of depression on erectile function of these patients. Main Outcome Measures For this multicenter cross-sectional study, 275 patients were interviewed through questionnaires: the five-item version of the International Index of Erectile Function was used for diagnosing and classifying ED; the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) for scoring QoL; and the Hospital Anxiety and Depression Scale (HADS) to evaluate depressive symptoms. Linear regression was used to examine the associations between some of the variables and ED. Predialytic biochemical and hematological parameters were determined during the longer interdialytic period. Results Patients had a mean age of 48.6 ± 12.8 years, and the ED prevalence was 72.3%. Advanced age, diabetes and depression score were independent risk factors for the development of ED as confirmed by linear regression ( P P = 0.002, and P P = 0.016), physical composite score ( P = 0.003), bodily pain ( P = 0.042), physical functioning ( P P = 0.005). Furthermore, more severe forms of ED were associated with a lower QoL. After adjustment for some variables, such as age, time under dialysis, hemoglobin, albumin, parathyroid hormone, Kt/V, and depression, linear regression showed that domains related to poorer physical functioning ( P = 0.047) and decreased vitality ( P = 0.009) were significantly related to ED. Conclusion Depression is an important trigger for the development of ED in hemodialysis patients, and this sexual condition is an independent risk factor for their poor QoL. Fernandes GV, dos Santos RR, de Lima LG, de Macedo BS, da Fonte JE, de Carvalho BSP, Coelho SN, and Calado AA. The impact of erectile dysfunction on the quality of life of men undergoing hemodialysis and its association with depression.

OBJETIVO: determinar a prevalência de coilocitose em biópsias penianas de parceiros de mulheres com lesões genitais induzidas pelo HPV e analisar os fatores de risco envolvidos com a infecção peniana. MÉTODOS: foram incluídos neste estudo de coorte transversal 80 parceiros de mulheres com lesões induzidas pelo HPV no período de maio de 2002 a junho de 2003. A média de idade dos pacientes foi de 34,1 anos (variando de 16 a 63). Todos os pacientes negavam ou desconheciam qualquer tipo de lesão genital. Foram submetidos à anamnese específica quanto a presença de sintomas uretrais, passado de doenças sexualmente transmissíveis (DST), número de parceiras sexuais, uso de preservativos e postectomia. Posteriormente foram submetidos à peniscopia com a utilização de soluções de ácido acético e azul de toluidina, tendo sido colhido material para biópsia das lesões de aspecto morfológico sugestivo de contaminação por HPV. A análise estatística foi realizada pelo teste do chi2. RESULTADOS: o exame foi considerado negativo em 24 pacientes (30%). Todos os outros 56 pacientes (70%) apresentaram lesões acetobrancas e azul de toluidina positivas. Destes, 53 foram biopsiados, e 41 pacientes (77,3%) apresentaram biópsia com alterações histológicas sugestivas de infecção pelo HPV. CONCLUSÕES: a prevalência da infecção genital masculina pelo HPV foi de 51,2%, e nenhum fator de risco analisado foi associado com uma maior prevalência da infecção genital pelo vírus. PURPOSE: to determine the prevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions, and to analyze the risk factors associated with the penile viral infection. METHODS: a total of 80 partners of HPV-infected women with genital lesions were included in this transversal cohort study. The study was carried out between May 2002 and June 2003. The mean age was 34.1 years (16 to 63). No patient reported any kind of genital lesion. They answered questions regarding the presence of urethral symptoms, history of sexually transmitted diseases, number of sexual partners, use of condoms, and circumcision. The patients were submitted to peniscopy with acetic acid and toluidine blue solutions and finally to biopsy of the suspected lesions. Data were analyzed statistically by the chi2 test. RESULTS: the examination was considered negative in 24 patients (30%). All remaining 56 patients (70%) showed white lesions and toluidine blue-positive lesions. Of these, 53 were submitted to biopsy and 41 (77.3%) presented histological changes suggestive of HPV infection. CONCLUSIONS: the prevalence of the male genital infection was 51.2% and no risk factor analyzed was associated with an increased prevalence of HPV genital infection.

Purpose Children with unilateral vesicoureteral reflux (UVUR) treated conservatively may develop new contralateral reflux (NCLR). This study evaluates the risk factors to NCLR development; the time to NCLR diagnosis and evaluates the outcome of patients with NCLR. Material and methods 167 children with UVUR in the first VCUG were evaluated retrospectively. In 14 patients reflux was diagnosed by radioisotope and it was not graded. VCUG reflux grades were: I-21, II-70, III-48, IV-13 and V-1. All children had 2 VCUGs performed, 84 had 3, 35 had 4, 18 had 5, 9 had 6 e 3 had 7 VCUGs. Results NCLR was diagnosed in 33 (20%) patients. The gender, age, side of reflux and the presence of LUTD were not predictive of NCLR. Only previous high grade reflux was a risk factor of NCLR development (p Conclusions NCLR occurred in 20% of children with UVUR. Around 90% of NCLR was detected in the 2nd VCUG .The main risk factor for NCLR was an initial high grade of reflux. Children with NCLR had a worse rate of spontaneous VUR resolution than patients that remained with UVUR.

Introdução: Postula-se que o aumento do metabolismo das proteínas da matriz extracelular está associado à fibrose tecidual no contexto de estenose de junção ureteropélvica (EJUP). O manejo ideal da EJUP permanece discutível. Este estudo casocontrole prospectivo teve como objetivo investigar se os níveis urinários de proteínas da matriz extracelular são úteis para discernir os pacientes com hidronefrose obstrutiva daqueles com hidronefrose não obstrutiva em crianças com hidronefrose unilateral secundária à obstrução ao nível da junção pieloureteral. Métodos: Setenta e quatro pacientes foram incluídos no estudo. Concentrações urinárias de metaloproteinases de matriz extracelular (MMP) -1, -2, -9 e -10 e os inibidores de metaloproteinases (TIMP) -1 e -2, valores absolutos e normalizados pela creatinina (Cr) urinária, bem como as características clínicas (grau de hidronefrose, função renal diferencial e t1 / 2) foram registradas nos seguintes grupos de pacientes de mesma idade: 26 crianças com hidronefrose obstrutiva no diagnóstico inicial e durante o pós-operatório da correção cirúrgica (grupo hidronefrose obstrutiva); 22 crianças com hidronefrose não obstrutiva no momento do diagnóstico e após seis meses de observação (grupo hidronefrose não obstrutiva); e 26 crianças sem qualquer condição do trato urinário (grupo controle). Os resultados foram avaliados estatisticamente usando para grupos homogêneos, uma análise de variância unilateral (ANOVA) e para grupos não paramétricos, teste de Mann-Whitney ou teste de Kruskal-Wallis. Resultados: Comparando as amostras iniciais, MMP-1, MMP-2, MMP-10 TIMP-1 e TIMP-2 apresentaram maior concentração no grupo hidronefrose obstrutiva e menor concentração no grupo controle. Os níveis de MMP-9 foram menores no grupo controle, mas maiores no hidronefrose não obstrutiva. A análise das curvas ROC mostrou um perfil diagnóstico melhor para a detecção de hidronefrose obstrutiva para MMP-2/Cr (área sob a curva ASC - de 0,655), TIMP-1/Cr (ASC - de 0,692) e TIMP-2/Cr (ASC de 0,678). A avaliação dos parâmetros no grupo hidronefrose obstrutiva, no pré e pós-operatório apresentou queda na concentração urinária de TIMP-1 e TIMP-2 e aumento na concentração urinária de MMP-1, MMP- 2, MMP-9 e MMP-10. Todas as proteínas analisadas permaneceram estáveis no grupo hidronefrose não obstrutiva no momento do diagnóstico e após seis meses de observação. Conclusão: Demonstramos que os pacientes pediátricos com hidronefrose obstrutiva apresentam concentrações significativamente maiores de MMP-2, TIMP-1 e TIMP-2. Particularmente, os níveis de TIMP-2 foram correlacionados à gravidade da obstrução e, portanto, pode ser um biomarcador urinário útil para alocar corretamente as crianças com EJUP entre o tratamento cirúrgico e o seguimento conservador. Após a pieloplastia, TIMP-1 e TIMP-2 apresentaram diminuição progressiva no pós-operatório, o que também é altamente desejável para marcadores urinários. Introduction: Extracellular matrix proteins have been found to be associated with tissue fibrosis in the setting of ureteropelvic junction obstruction (UPJO). The ideal management of UPJO remains debatable. This prospective case-control study aimed to investigate whether urinary levels of extracellular matrix proteins (associated to tissue fibrosis) are useful to discriminate the severity of urinary obstruction in children with unilateral ureteropelvic junction obstruction (UPJO). Methods: Seventy-four patients were enrolled in the study. Urinary matrix metalloproteinases (MMP) -1, -2, -9, -10 and metalloproteinase inhibitors (TIMP) -1 and -2 as well as clinical characteristics (hydronephrosis grade, differential renal function and t1/2) were measured in the following age-matched groups: 26 children with obstructive hydronephroses HN at initial diagnosis and during six months after dismembered pyeloplasty; 22 children with non-obstructive HN at diagnosis and after six months of observation; and 26 children without any urinary tract condition, as the control group. Results were assessed statistically using for homogenous groups, a one-way analysis of variances (ANOVA) and for nonparametric groups, MannWhitney test or Kruskal Wallis test was performed. Results: Comparing the initial samples, uMMP-1/Cr, uMMP-2/Cr, uMMP-10/Cr uTIMP-1/Cr and u-TIMP-2/Cr had higher concentration in obstructive HN group and lower concentration in control group. The uMMP-9/Cr levels were lower in control group, but higher in non-obstructive HN group. The ROC curves analysis showed a promising diagnostic profile for the detection of obstructive HN for uMMP-2/Cr (area under the curve AUC of 0.655), uTIMP-1/Cr (AUC of 0.692) and uTIMP-2/Cr (AUC of 0.678). The follow-up evaluation in the obstructive HN group, pre- and postoperatively depicted fall in urinary concentration of uTIMP-1/Cr and uTIMP-2/Cr and increase in urinary concentration of uMMP-1/Cr, uMMP-2/Cr, uMMP-9/Cr and uMMP-10/Cr. All analyzed proteins were stable in non-obstructive HN at diagnosis and after six months of observation. Conclusion: We demonstrated that pediatric patients with obstructive HN have significantly higher uMMP-2, uTIMP-1 and uTIMP-2 concentrations. Particularly, uTIMP-2 levels were correlated to severity of the obstruction and therefore, it might be a useful urinary biomarker to correctly allocate children with HN between surgical management vs follow-up. After pyeloplasty, uTIMP-1 and uTIMP-2 presented a progressive decrease postoperatively, which is also highly desirable for urinary markers.

Introdução: A obstrução infravesical (OIV) de longo prazo secundária a hiperplasia prostática benigna (HPB) pode causar alterações funcionais e morfológicas na bexiga. Um dos principais eventos consiste no aumento da deposição de colágeno e perda de complacência vesical, levando a alteração de armazenamento e esvaziamento urinário. O aumento da deposição de colágeno na matriz extracelular (MEC) da musculatura detrusora é a principal razão para a diminuição da complacência vesical. Na bexiga, assim como em outros órgãos, este fenômeno depende da atividade equilibrada de enzimas proteolíticas, incluindo as metaloproteinases (MMP) e os seus inibidores endógenos (inibidores teciduais de metaloproteinases-TIMPs). Como estes fenômenos são desconhecidos na bexiga obstruída, o objetivo deste estudo foi avaliar a expressão gênica de colágeno, MMPs e seus inibidores na bexiga de pacientes com obstrução infravesical. Material e Métodos: Foi realizada uma análise prospectiva e controlada de 43 pacientes com OIV devido a HPB, que foram submetidos à ressecção transuretral da próstata (RTUP) entre 2011 e 2012. Como grupo controle foram selecionados espécimes de músculo detrusor de 10 pacientes que foram submetidos a prostatectomia radical retropúbica devido adenocarcinoma de próstata. Todos estes pacientes tinham idade menor que 60 anos, tamanho de próstata menor que 30 gramas ao ultra-som e escore internacional de sintomas prostáticos (IPSS) menor que 7. Todos os pacientes foram submetidos a estudo urodinâmico pré e pós operatório (após 6 meses). A biópsia de fragmento de músculo da bexiga foi realizada ao final da RTUP e colocada em solução estabilizadora de RNA para quantificação da expressão de colágenos I e III, metaloproteinases de matriz 1, 2 e 9, e inibidores de MMPs (TIMP1, TIMP2 e RECK) na bexiga de pacientes com HPB. Os genes descritos foram avaliados através da técnica de reação em cadeia da polimerase quantitativa em tempo real (qRT-PCR). Resultados: Todos os pacientes com HPB tinham confirmado OIV, através da análise do estudo urodinâmico (média de pressão detrusora no fluxo máximo de 78,5 cmH2O e fluxo urinário máximo de 7,7 ml / s). O gene MMP1 mostrou-se superexpresso em pacientes com HPB (mediana = 1,87). MMP9, TIMP1 e RECK estavam subexpressos na maioria dos casos, enquanto TIMP2, colágeno I e III foram superexpressos (1,5, 4,4 e 1,9 vezes, respectivamente). No que diz respeito às características clínicas e urodinâmicas encontramos que MMP2 foi mais expresso entre pacientes com um baixo IPSS global (0,005) e sem urgência (p=0,035). Colágeno III foi mais expresso em pacientes com contrações vesicais não inibidas (p = 0,049). Os outros genes não mostraram nenhuma correlação estatística com quaisquer características clínicas ou urodinâmicas. Após 6 meses de RTU, pacientes que possuíam expressão aumentada de duas ou mais MMPs, apresentaram resolução da CNI em 66,6% dos casos, contra 14,0% quando apenas uma ou nenhuma MMP estava aumentada (p=0,038) Conclusões: Encontramos um perfil de superexpressão de MMP1, TIMP2, colágenos I e III, e expressão baixa de MMP9, TIMP1 e RECK nos pacientes com OIV. Considerando o escore de sintomas prostáticos e a urgência miccional, encontramos curiosamente uma maior expressão de MMP2 em pacientes menos sintomáticos e sem urgência miccional. Encontramos uma associação entre a maior expressão de colágeno III com HD. A expressão aumentada de duas ou mais MMPs está relacionada à maiores taxas de resolução das CNIs. Introduction: Long-term Bladder outlet obstruction (BOO) secondary to Benign prostatic Hyperplasia (BPH) can cause functional and morphological abnormalities in the bladder, such as increased collagen deposition and loss of compliance, leading to urinary storage and voiding symptoms. A decrease in bladder compliance is known to be correlated with deterioration of renal function. Increased deposition of collagen in the extracellular matrix (ECM) is the primary reason for a decreased compliance. In the bladder, as in other organs, this phenomenon is dependent on the balanced activity of proteolytic enzymes, including matrix metalloproteinases (MMPs) and their endogenous inhibitors, tissue inhibitors of metalloproteinases (TIMPs). The imbalance between MMPs and TIMPs is a key regulator in ECM turnover. Since these mechanisms are unknown in the obstructed bladder, the objective of this study was to evaluate gene expression of collagen, MMPs and their inhibitors in patients with bladder outlet obstruction due to BPH. Material and Methods: We performed a prospective and controlled analysis of 43 patients with BOO due to BPH who underwent transurethral resection of the prostate (TURP) from 2011 to 2012. The control group was comprised of 10 bladder specimens from patients with < 60 years who underwent radical prostatectomy with an International Prostatic Symptom Score (IPSS) < 8 and prostate volume < 30 grams. All patients underwent urodynamic analysis pre and post operatively after 6 months. A biopsy of the bladder muscle was performed at the end of TURP for analysis of collagen, metalloproteinases and TIMPs gene expressions. For this purpose we used the quantitative real time polymerase chain reaction method (qRT-PCR). Results: All patients with BPH had confirmed BOO confirmed through urodynamic analysis (mean detrusor pressure at maximun flow 78.5 cmH2O and mean maximun flow 7.7 ml/s). MMP1 gene showed an important an overexpression in patients with BPH (median = 1.87). A similar phenomenon occurred in a lesser extent to MMP2, to which 13 of 23 subjects had under-expression (mean = 1.2). MMP9, TIMP1 and RECK were under-expressed in the majority of cases, while TIMP2, colagen I and III were over-expressed (1.5, 4.4 and 1.9x respectively) (figure). With regard to clinical and urodynamic characteristics we found that MMP2 was more over-expressed among patients with a low global IPSS (0.005) and without urgency (p=0.035). Colagen III was more over-expressed in patients with non-inhibited bladder contractions (p=0.049), RECK was more over-expressed in patients with a decreased complacence (p=0.049). The other genes showed no statistical correlation with any clinical or urodynamic characteristics. After 6 months of TURP, patients with non-inhibited bladder contractions showed resolution in 66.6% of cases, when had increased expression of two or more (> 02) MMPs in patients compared with 14.0% when only 01 MMP was increased (p = 0.038) Conclusions: BOO is related with an over-expression of MMP1, TIMP2, colagens I and III, and with an under-expression of MMP9, TIMP1 and RECK. Detrusor overactivity is related with higher collagen III expression, this fact may be due to a lower MMP1 expression. A lower global IPSS and no urgency were related to a higher expression of MMP2, sugesting that this gene may be inhibiting collagen deposition in the bladder. The increased expression of two or more MMPs isrelated to greater rates of resolution of non-inhibited bladder contractions