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Objective: To evaluate the incidence of antibody-mediated rejection after the C4d and donor specific antibody detection was provided by Luminex in renal transplantation biopsies; to compare acute antibody-mediated rejection characteristics as related to acute cellular rejection; to evaluate the impact on the incidence of acute antibody mediated rejection after the utilization of cross match test by flux cytometry and the detection of pre-transplantation donor specific antibody in patients with previous history of exposition to alloantigens. Methods: One hundred twenty-four renal transplanted patients were evaluated through the detection of C4d in early biopsies of those presenting graft dysfunction and the detection of antibody against donor when C4d was positive. The acute antibody mediated rejection was treated by plasmapheresis and intravenous immunoglobulin. Rresults: The incidence of acute rejection was 18.8%, being the acute cellular rejection 14.9% and acute antibody mediated rejection 6.6%. When both were compared, the acute antibody-mediated rejection were earlier than the acute cellular rejection (12.5 versus 59.9 days, p = NS), being more frequent in female patients (75 versus 29%, p = 0.05), with deceased donors (75 versus 33%, p = 0.09), with higher dialysis time (87.7 versus 47.4, p = 0.03), greater number of transfusion episodes (4.6 versus 1.4, p = 0.02), greater panel reaction activity (28.0 versus 4.8, p = 0.03) and more frequently in re-transplanted patients (50 versus 5.6%, p = 0.02). Delayed graft function was more frequent in antibody mediated rejection (100 versus 50%, p = 0.02). All patients with acute cellular rejection reversed graft function after treatment, with 100% graft survival after one year. Among patients with acute antibody-mediated rejection, the treatment with plasmapheresis and immunoglobulin was efficient in reducing the titers of donor specific antibody (2605 versus 202 mfi, p < 0.001), but 3/8 of patients evolved to graft loss, making graft survival of 62.5% (p < 0.001). Cconclusions: The routine use of detecting C4d and donor specific antibody increased the incidence of acute rejection. Acute antibody-mediated rejection presented clinical profile and therapeutic response different from acute cellular rejection, identifying a worse prognosis as well as therapeutic success.

Objectives: To discuss the role of bacillus Calmette-Guérin (BCG) immunotherapy in the treatment of superficial bladder cancer after 30 years of clinical experience. Methods: Research on LILACS and PubMed databases, including 31 clinical studies with scientific relevance and importance in the decision-making process. Results: The BCG therapy with induction and maintenance therapy seems to be the best practice in tumors classified as high risk when compared to intravesical chemotherapy. In management of carcinoma in situ, BCG is undoubtedly the therapy of choice, presenting 84.4% of efficacy. As an adjuvant treatment to transurethral resection, there was a 31% reduction in recurrence confirmed in four out of five meta-analyses assessed. The reduction in progression, despite preliminary favorable evidence, still needs further studies to be confirmed. Conclusions: Intravesical BCG is an excellent therapeutic option in cases of carcinoma in situ and it is recommended as an adjuvant treatment in tumors with a high risk of recurrence and progression.

Objectives: to study pathological data from bladders of systemic lupus erythematosus patients, correlate them to clinical events and the use of therapeutic drugs, and compare them to bladder histopathological findings in individuals not affected by systemic lupus erythematosus. Methods: thirty-nine out or inpatients of the Department of Rheumatology at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, diagnosed with systemic lupus erythematosus were clinically and cystoscopically evaluated. Bladder biopsy was also performed. As a normal parameter, bladders taken from 20 corpses collected at the Death Verification Department of São Paulo city, without autolysis or evidence of urinary tract or autoimmune disease were also histologically studied. This group was considered as a Control Group. A correlation among clinical, cystoscopic and histopathological data was carried out. Rresults: the patients’ mean age was 29 years (range 13-62). Thirty-six were females and three were males. Twenty-five patients were asymptomatic during the study period. In the Control Group the age range was 20-65 years. Nineteen were females (95%) and one was male (5%). Cystoscopic examination of the group with systemic lupus erythematosus showed interstitial pattern in 16 cases (41.0%) and normal in 15 (38.5%). The bladder was normal in four patients (10.3%). Chronic unspecific cystitis was observed in 18 (46.2%) patients. In the remaining, several alterations were found, including bladder vasculitis in seven patients (17.9%). The mean number of mast cells in the bladder area was 2.223/mm2. In the Control Group, unspecific cystitis was found in three cases (15.0%). No other abnormalities were found. The mean number of mast cells in this group was 0.777/mm2 (±2.7). Chronic unspecific cystitis, bladder vasculitis and the mean number of mast cells were compared with each other and no statistical differences were found (p > 0.05). There were statistically significant differences between the two groups regarding chronic unspecific cystitis and bladder vasculitis (Z = 2.078 > Z5% = 1.645 and Z = 1.777 > Z5% = 1.645) and also mean number of mast cells (Z = 2.387 > Z5% = 1.673). There were statistically significant differences between the proportion of mast cell infiltrate and presence of suprapubic pain as well as use of antimalarial drugs. The other analysis did not show statistically significant differences. There was no statistical evidence of dependence among the events: cystoscopy with interstitial pattern and chronic unspecific cystitis (p > 0.237); cystoscopy with interstitial pattern and bladder vasculitis(p > 0.325); cystoscopy with interstitial pattern and mast cell infiltrate (p > 0.277). Cconclusions: the bladder in systemic lupus erythematosus may be involved even in the absence of clinical manifestations. The involvement of the bladder in systemic lupus erythematosus was characterized mainly by the finding of chronic unspecific cystitis, bladder vasculitis and mast cell infiltrate. The presence of chronic unspecific cystitis was significantly greater in patients with the disease than in the Control Group, and the same occurred with bladder vasculitis. The number of mast cells/mm2 was higher than normal in patients with systemic lupus erythematosus. This finding was associated to suprapubic pain upon bladder repletion and to use of antimalarial drugs.

Objective: To study bladder involvement in systemic lupus erythematosus patients through clinical and laboratorial evaluation, ultrasonography, radiological and endoscopic examination. Methods: Thirty-nine patients, either outpatients or inpatients at the Department of Rheumatology of Hospital das Clínicas da Faculdade de Medicina from Universidade de São Paulo were evaluated as to clinical and laboratorial data. All patients were submitted to ultrasonographic evaluation of the upper urinary tract, radiological and endoscopic examinations of the middle and lower urinary tracts. Rresults: Mean age of patients varied between 13 and 62 years (median = 29 years). Thirty-six were females and three were males. The disease varied from 6 months to 22 years (median three years and one month). Clinical and laboratory activity of the disease was present in 30 patients. Twenty-two patients had the diagnosis of lupus established for three years or more. Twenty-five patients were asymptomatic and all had received corticosteroids for treatment at least once. Twenty-three received antimalarial drugs; ten received cytostatics, and seven patients received non-steroid anti-inflammatory drugs. Upper urinary tract ultrasonography was normal in all cases but one with staghorn calculus associated with neurogenic bladder secondary to neurological involvement by the disease. Vesicoureteral reflux was observed in two cases. Other two patients had significant post-voiding residual urine, both with neurogenic bladder secondary to nervous system involvement by lupus. The average bladder maximum capacity in an awaken patient was 342 mL, and was decreased in 18.9% of cases. This subgroup of patients presented a greater frequency of urinary symptoms and greater use of cytostatic drugs (Z > Z5%). A pathognomonic cystoscopic pattern of bladder involvement in systemic lupus erythematosus could not be established. Cystoscopic aspects similar to those seen in the initial or minor forms of interstitial cystitis were present in 43.2% of patients. This finding was more frequent when cytostatic drugs were used for treating the disease. Cconclusions: There was bladder involvement in systemic lupus erythematosus, even in asymptomatic patients, demonstrated by the occurrence of cystoscopic abnormalities or by reduced bladder maximum capacity associated with the presence of suprapubic pain, urinary irritation symptoms and the use of cytostatic drugs.

Objective: The aim of this study was to analyze the advantages and disadvantages of clean intermittent catheterization, comparing to indwelling urinary catheter, in the treatment of chronic urinary retention. Methods: This literature review was carried out in order to highlight the best evidences for the choice between treatments. The extensive literature review was made through PubMed and Cochrane National Library. We selected the main articles published between 1950 and 2007, using urinary retention, indwelling urinary catheter, and clean intermittent catheterization as keywords. Results: Twenty five papers were selected, including three meta-analyses evaluating the long-term complications of clean intermittent catheterization, prophylactic intervention, and catheter types. Most articles discussed complications in patients with neurologic dysfunctions. Conclusion: Clean intermittent catheterization is better than indwelling catheter, as it is related to lower complication rates, both short and long-term. Indwelling catheterization was associated with decreased vesical compliance and bladder calculi, among others.

More than 60 thousand new cases of bladder cancer are diagnosedeach year in the United States, accounting for approximately 13thousand deaths annually. In recent decades, the overall incidenceof bladder cancer seems to be rising and this may be due to thelatent effects of tobacco abuse, other non-occupational risk factors,industrial carcinogens, as well as the overall aging of our population.Cultural and socioeconomic factors also contribute substantially tothe etiology of bladder cancer and may play an even more importantrole than the occupational environment. In this paper, it is reviewedthe main established or proposed non-occupational factors associatedwith bladder cancer development.

Objective: To evaluate the effect of sildenafil in Brazilian patientswith erectile dysfunction secondary to spinal cord injury. Methods:Participants were examined at the time of enrollment and two andsix weeks later. Baseline and follow-up data on sexual functionwere collected. After the second week, the initial dose of sildenafil(50 mg) could be adjusted according to efficacy and tolerability.Efficacy was assessed primarily through the scores on questions 3and 4 of the International Index of Erectile Dysfunction. Secondaryanalyses included questions and domains of the index, globalefficacy evaluation, percentage of success in sexual intercourseattempts, answers to the Quality of Life and Erectile FunctionQuestionnaire, and partner’s satisfaction. Results: Ninety-onepatients were evaluated as to efficacy and 94 as to safety. Medianage of patients was 33 years, and median time between spinal cordinjury and study enrollment was three years. Sildenafil produceda significant increase in the mean scores of questions 3 and 4(p < 0.001 in both comparisons), as well as in other questionsand in all domains of the International Index of Erectile Dysfunction.Improved erections were reported by 89% of patients, and theproportion of successful sexual intercourse attempts went from6 to 74% (p < 0.001). Mean scores on the Quality of Life andErectile Dysfunction Questionnaire increased from 60 to 74%(p < 0.001). Ninety percent of 42 women reported being moderatelysatisfied to very satisfied with their partners’ treatment. The mostcommon adverse events were headache (16%), flushing (11%) andnasal congestion (10%). Conclusions: Sildenafil proved to be safeand effective in treating Brazilian men with erectile dysfunctionsecondary to traumatic spinal injury.

Objective: To evaluate possible spinal cord injury in rats followingdifferent doses of intrathecal ketoprofen. Methods: Animalswere divided into four groups of five rats each; 10 μl of anintrathecal solution were injected into the L6-S1 intervertebralspace. Ketoprofen 1% was injected in the first group; ketoprofen0.1% was injected in the second group; ketoprofen 0.01% wasinjected in the third group; and a sodium chloride 0.9% solutionwas injected in the Control Group. Histological sections of thecervical, thoracic, lumbar and sacral spine were analyzed toassess the number of neurons showing morphological changes.Variance analysis of repeated measurements was used forstatistical comparison between groups. The Wald test was usedfor multiple comparisons; the Shapiro-Wilk test (p = 0.0904) wasused for assess normality of data. The statistical significance wasp < 0.05. Results: The 1.0% Dose Group showed a moderatepercentage of thoracic (p = 0.0020) and cervical (p = 0.0210)spinal cord changes, compared to the Control Group. The 0.1%Dose Group showed a moderate percentage of cervical spinalcord changes (p = 0.0399) in comparison to the Control Group.There were no significant differences in the lumbar (p = 0.9878)and sacral (0.7300) spinal cord among the groups. Conclusions:Intrathecal injection of ketoprofen in rats, at a concentration equalto or less than 0.01%, may be used in studies aimed to elucidatecentral analgesia mechanisms produced by this drug.

Objective: Laparoscopic resection is the gold standard for treatmentof benign adrenal lesions. Laparoscopic resection of malignant lesions,however, is controversial, and there are only limited series publishedin the literature. The aim of this study is to describe technical aspectsand oncological results of laparoscopic adrenalectomy for malignantdisease. Methods: Eight patients (five men and three women)underwent laparoscopic adrenalectomy for primary or metastaticadrenal malignancy. The procedures were performed transperitoneallyin two cases and retroperitoneally in 6 cases. Results: The meanincision size was 5 cm (4-9 cm), the mean duration of surgery was135 minutes and the mean blood loss was 250 ml. There was onecase of postoperative pneumonia, which progressed favorably.Histopathological diagnosis was metastasis in four cases and primaryadrenal neoplasm in four cases. There were two cases of systemicrecurrence in patients with metastatic adrenal cancer which originatedfrom breast-cancer in one case and lung cancer in another case. Localrecurrence or implantations on the trocar sites were not observed.All patients with primary adrenal neoplasms and 50% of those withmetastatic lesions of the adrenal were alive at the end of the follow-upperiod. Conclusion: Treatment of adrenal malignant disease can besafely performed through videolaparoscopy in patients with primaryadenocarcinoma or adrenal gland metastasis. The prognosis dependson resectability and biological aggressiveness of the disease.

Objective: To asses graft function and survival after one year inpatients at high risk of acute tubular necrosis (ATN) and to definethe impact of this lesion on allograft function in patients whoutilized an induction protocol with Thymoglobulin (Thymo).Methods: Thymo was utilized as an induction strategy. CD3+cells counting was monitored. Graft function and survival wasdemonstrated. Results: Seventy-eight patients who receivedkidneys from cadaveric donors utilized the referred protocol.Follow-up was 2 years. Cold ischemia time was 19.9 ± 4.8 hours.Thymo total doses was 7.48 ± 3.7. CD3+ cells counting was19.3 ± 22.3. Acute rejection occurred in 14.1% of cases, ATN in66.6% and CMV infection in 55.1%. One-year graft survival noncensoredby death was 95.9%, and serum creatinine was 1.56 ±0.53 mg/dl. Patients who presented ATN had longer length ofhospital stay (18.8 ± 6.1 vs. 10.4 ± 4.3 days, p < 0.010) andworse serum creatinine levels (1.66 ± 0.4 vs. 1.39 ± 0.6 mg/dl,p = 0.003). The only one variable related with graft function wasdonor age (when > 38 years, RR = 3.43, p < 0.001). Conclusion:Thymoglobulin induction provided an excellent graft survival anda low rate of acute rejection and good graft function until 2 yearsafter transplantation, despite high prevalence of ATN.

Ureteral lithiasis is a prevalent problem that may cause painful renalcolic. When interventions are necessary, various techniques may beemployed. Endourological techniques and minimally invasive proceduresare the preferred options to treat lithiasis and they dramatically reducedindications for open conventional ureterolithotomy. The most recentguidelines for treating urinary stones, published in 1997 and based on ameta-analysis of literature data, recommends extracorporeal shockwavelithotripsy as the first option to treat most ureteral calculi. Afterthe publication of this guideline, some studies presented excellent resultsusing narrower endourological instruments, laser energy source, andlaparoscopic ureterolithotomy. These publications support the use ofthe techniques to treat ureteral stones, which will probably be includedin the next updated guideline. Particularly for proximal ureteral calculi,the results of extracorporeal shock-wave lithotripsy and endourologicaltechniques have been inferior when compared to other ureteralsegments, mainly when stones are larger than 10mm. The newapproaches and studies demonstrated better results than those publishedin the 1997 guidelines, which may be altered in relation to treatment ofproximal ureteral stones. This review assesses the results of currentoptions to treat proximal calculi and suggests a treatment algorithm.

This report describes and discusses a new therapeutic laparoscopictechnique for incisional hernia secondary to lumbotomy in a kidneydonor. The transperitoneal laparoscopic approach was used with thepatient placed in left lateral decubitus. Three trocars were placedduring the surgery: the first, a 10-mm trocar at the level of the umbilicalscar; the second, a 5-mm trocar at the mid-clavicular line, 2 cm belowthe navel; and the third, a 12-mm trocar at the midline, between thenavel and the xiphoid process. The peritoneum was detached fromthe abdominal wall laterally to the hernia defect and parallel to thecolon inferiorly until complete exposure of the limits of the hernia ringwas achieved. A polypropylene mesh was placed in the abdominalcavity and fixed along the borders of the previously dissected andprepared hernia ring with titanium staples. Operative time was 148minutes and the patient was discharged 24 hours after the surgery.There was no intraoperative complication and no hernia recurrenceduring a 15-month follow-up. The patient resumed regular activities 3weeks after the surgery. We concluded that the repair of the incisionallumbar hernia in kidney donor via laparoscopic approach was a goodminimally invasive treatment option, with adequate functional andcosmetic results. The technique provided excellent exposure andview of the anatomical structures, with reduced pain, shorter recoverytime and earlier return to activities of daily life.

Com o intuito de estudar a participação do gene ras ativado na tumorigênese humana, pesquisamos a freqüência de mutação pontual no códon 12 do gene K-ras em espécimes cirúrgicos de pacientes portadores de câncer de próstata. Foi utilizado um grupo controle de pacientes com hiperplasia prostática benigna (HPB). Os cortes destinados ao estudo foram submetidos a extração do DNA pelo método da proteinase K. A amplificação do fragmento isolado foi obtida pela reação em cadeia de polimerase seguida por clivagem, utilizando-se a enzima de restrição Mval. A eletroforese em gel de agarose permitiu a verificação da presença de mutações. Constatamos a presença de mutação no códon 12 do gene K-ras em dois dos 15 carcinomas de próstata estudados (13,3%), sendo que nenhuma em pacientes com HPB. A ocorrência de mutação de 13,3% na amostra da população brasileira analisada caracteriza uma incidência intermediária entre as populações japonesa e americana. É pouco provável que a mutação isolada do K-ras seja um evento significativo na carcinogênese prostática nesta população.Aiming to study the participation of activated ras gene on the human tumorogenesis, we have researched the frequency of a punctual mutation in codon 12 of the K-Ras oncogene in surgical specimens of patients with prostate cancer. We used control group of patients with benign prostatic hyperplasia. The pieces addressed to the study was submitted to the extraction of DNA by the proteina kinase method. The isolated fragment amplification was obtained using a polymerase chain reaction followed by clevage with Mval restriction enzime. The electrophoresis process allowed the verification of the mutation presence. We noticed the presence of mutation in codon 12 of the K-ras oncogene in two of 15 prostate carcinomas studied (13.3%). None of the patients with prostatic benign prostatic hyperplasia presented any mutation. The mutation incidence of 13.3% on brazilian population sample analysed demonstrated an intermediary incidence between American and Japanese population. It is unlikely that K-ras mutation isolated has a significant role on the prostatic carcinogenesis in this population.

Objective: To report the experience of treating ureteral calculi byureteroscopy at the Faculdade de Medicina do ABC – SP, with anemphasis on the efficacy and safety of the method. Methods: Aretrospective analysis of 100 ureteroscopies performed fromJanuary 2001 to August 2003 in 98 patients with ureteral calculi.Results: A 91% success rate was observed with a single procedureusing this technique. Intracorporeal lithotripsy was necessary in61% of cases before removing the stone; in the remaining cases, itwas extracted with no disintegration. Endoscopic approach wasimpossible in only one patient who required conversion toconventional open surgery. The double-J stent was inserted in73.7% of procedures. Complications were observed in 8% of cases.Conclusion: The present study demonstrated results comparablewith those reported in large series in the literature. The high successrates, low morbidity, rapid convalescence and lack of estheticconsequences corroborate the role of ureteroscopy as an attractivealternative for treating ureteral calculi.

Objective: The aim of the present study was to assess the influence of video game as warm-up before dry-lab laparoscopic activities. Methods: Eleven medical students participated in this prospective randomized crossover study. Students were divided into two groups. Students in Group 1 had to execute an interrupted suture with the dominant hand using a standardized technique (non-video game group). Students in Group 2 performed the same suture, but after playing a video game match (video game group). After this initial task, groups were crossed. The time spent to complete each task was recorded, and the participants and observers had to judge the performance for each laparoscopic exercise. These variables were used as a measure of performance. Rresults: Mean time for laparoscopic surgery in this subset of inexperienced laparoscopic students was similar between non-video game versus video game groups (254.6 ± 187.7 versus 255.8 ± 183.6; p = 0.875). Subjective impression of observers regarding students’ performance was also similar (p = 0.662), but subjective impression of the participant about his own performance was different between both groups, with 64.7 versus 20.0% of participants that considered their performance good for video game versus non-video game groups (p = 0.044). Cconclusions: In conclusion, video games used as warm-up for laparoscopic practice seem to make inexperienced surgeons more confident and comfortable with the procedures, even though objective measures, as operative time and observers’ impression of surgeons’ performance do not seem to be affected by video game warm-up.

Acute urinary retention is characterized by a sudden interruption of urinary output; urine is retained in the bladder due to either functional or obstructive anatomic factors, and cannot be voided. The main causes of acute urinary obstruction are benign prostatic hyperplasia, constipation, prostate adenocarcinoma, urethral stenosis, clot retention, neurological disorders, following surgery, calculi, drugs, or urinary tract infections. A transvestite patient, aged 55 years, described having had liquid silicone subcutaneously injected in various parts of the body, the last one four years ago. He complained of absent urinary output during the last 14 hours. The physical examination revealed skin deformation due to migration of implants; a hard nodule (characterized as a foreign body) was present in the preputium and a diagnosis of acute urinary retention was made; an unsuccessful attempt to exteriorize the glans for urinary catheterization, was followed by therapeutic cystostomy. Acute urinary retention has not been mentioned in the medical literature as a complication of liquid silicone subcutaneous injection.

The diverticula of female urethra are very uncommon, but more frequently found between the third and fifth decade of life. Diverticula area mostly relate to repeated urinary infections of the periurethral glands or urethra’s trauma. The diverticula may cause infection, calculus formation and rarely endometriosis or cancer. A case of a 65-year old Caucasian female with vaginal mass over six months is herein reported. There was no urinary loss, urethral secretion or urinary symptoms. A cystourethrography showed diverticula with calculus inside. The patient was submitted to surgery and dismissed from the hospital on the first postoperative day. The pathologic examination revealed no malignancy. In six months of follow-up, the patient was continent with no complaints.

Penile fracture with or without urethral injury after coitus presents with severe pain and immediate penile detumescence accompanied by a cracking sound. Hematuria or voiding difficulty are common findings and suggest associated urethral injury. The objective of this report is to describe an unusual complication of coital trauma diagnosed based on clinical findings. The isolated urethral injury is rare but is one of the causes of male coital trauma and may be suspected when patients present urethral bleeding.

The seminal vesicle stone is a rare condition, with few cases reported inthe international literature and no report found in the Brazilian literature,especially considering videolaparoscopic treatment. The importance ofdiagnosis is related to the fact that the seminal vesicle stone can beimplicated in the pathogenesis of type II or III prostatitis. We presenta case of a 36-year-old male who complained of perineal pain andpersistent pollakiuria despite adequate clinical treatment. Bilateralseminal vesicle stones were diagnosed by CAT-scan and transrectalechography. The laparoscopic seminal vesiculotomy resulted in completerelief of symptoms and infection control in a six-year follow-up.

CONTEXT: Adrenocortical virilizing tumors are rare in the pediatric age group. Laparoscopic surgery is the gold standard method for treatment of adrenal functional tumors under 6 cm in size, in adults. There has been very little use of laparoscopy in children and there is no report of its application in the treatment of adrenal carcinoma in childhood. DESIGN: Case report. CASE REPORT: We performed the first laparoscopic resection using retroperitoneal access for the treatment of an adrenocortical virilizing tumor in a pediatric patient. We believe that retroperitoneoscopic access is a viable and promising option for the treatment of adrenal tumors in children.

An important transition is going on in Medicine, characterized byshifting focus on chronic diseases, escalating costs and theemergence of new scientific and technological trajectories.Advances in genomics and stem-cell biology conduct to personalizedtherapies, to new strategies for preventing diseases and torestorative procedures for tissues and organs. The rapid progress inimaging diagnostic, robotics and nanotechnologies enormouslyexpands the perspectives for less invasive procedures. The presentchallenge in biomedical research is clearly translational: to includein clinical practice the advances in basic research and medicaltechnology according to the socio-economic context and developinga new paradigm for education and clinical investigation based oninterdisciplinary approach. The present article analyses this scenariotaking in perspective the IIEP Albert Einstein research and educationalprograms. The neurosciences program, named Instituto do Cérebro,exemplifies the necessity of interdisciplinary integration forestablishing translational research in our milieu.

Considering the Health Care System in Brazil, a developing country,and public healthcare policies, robotic surgery is a reality to veryfew citizens. Therefore, robotic assisted radical prostatectomy isfar removed from the daily practice of the vast majority of Brazilianurologists. Scientific evidence of the superiority of robotic assistedradical prostatectomy does not presently justify public investmentsfor widespread development of robotic centers. Maybe over timeand with reductions in costs, robotic technology will become amore established practice, as observed in other countries, and morefeasible for the Brazilian urological community.

Conventional surgery for the treatment of ureteral calculi isnowadays restricted to a few special situations or when minimallyinvasive treatment fails. Giant uteretal calculus is arare disease. The classical treatment is ureterolithotomy withlarge ureteral incision. We present a case of a 16-year-oldmale who presented a ureteral stone measuring 11 cm. He wassubmitted to open surgery, with lithotripsy and an incision of 2 cmon the mid point of the calculus, which led to a less aggressiveintervention on the ureter to remove the stone. There were nopostoperative complications and the patient was discharged fromhospital after 4 days. We speculate that this technical procedurecould be performed by means of laparoscopy and be even lessaggressive.

CONTEXT: Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN: Case report. CASE REPORT: We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conservative treatment, which has been approached in diverse manners in the literature.

CONTEXT AND OBJECTIVE: Erectile dysfunction has been associated with cardiovascular diseases. The aim here was to evaluate cardiovascular risk through the Framingham Risk Score (FRS) criteria, C-reactive protein (CRP) assays and presence of metabolic syndrome (MS) in men with and without erectile dysfunction diagnosed within a healthcare program. DESIGN AND SETTING: A retrospective case-control study was conducted. The patients were selected from a healthcare program at the Hospital Israelita Albert Einstein, between January and December 2007. METHODS: 222 men were retrospectively selected, and they were divided into two groups: men with erectile dysfunction (n = 111) and men without erectile dysfunction (n = 111). The patients were stratified according to the International Index of Erectile Function-Erectile Function domain (IIEF-EF domain). CRP and FRS were analyzed and the two groups were compared. RESULTS: The CRP levels were significantly higher among men with erectile dysfunction (P = 0.04). Patients with erectile dysfunction also had high FRS (P = 0.0015). CRP and FRS did not correlate with the severity of erectile dysfunction. The presence of metabolic syndrome was greater among men with erectile dysfunction (P < 0.05). The severity of erectile dysfunction was directly associated with metabolic syndrome. CONCLUSION: Men with erectile dysfunction presented higher cardiovascular risk according to the FRS criteria and CRP measurements. Severe erectile dysfunction seemed to have a correlation with metabolic syndrome.

CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.

ABSTRACT Considering the Health Care System in Brazil, a developing country, and public healthcare policies, robotic surgery is a reality to very few citizens. Therefore, robotic assisted radical prostatectomy is far removed from the daily practice of the vast majority of Brazilian urologists. Scientific evidence of the superiority of robotic assisted radical prostatectomy does not presently justify public investments for widespread development of robotic centers. Maybe over time and with reductions in costs, robotic technology will become a more established practice, as observed in other countries, and more feasible for the Brazilian urological community.

The authors report a rare case of a patient with urinary retention following an inguinal herniorraphy, due to extrinsic compression of the bladder by an extensive pelvic hematoma, diagnosed by cystourethrogram and pelvic computadorized tomography. A medical treatment was provided by vesical catheterization for seven days. After this period of time, the hematoma had disappeared and the patient recovered to spontaneous miction.