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Purpose Sexual performance is related to proprioception and pelvic floor muscle strength (PFMS). The aim of this study was to correlate sexual activity and orgasm with PFMS. Materials and Methods A total of 140 healthy continent female were prospectively distributed into 4 groups according to age: Group 1 (G1), 30–40; Group 2 (G2), 41–50; Group 3 (G3), 51–60; Group 4 (G4), over 60 years old. Evaluated parameters were: frequency of sexual activity and orgasm achievement; body mass index (BMI) and objective evaluation of PFMS using perineometer and surface electromyography. Results BMI was higher in G4 compared to G1 (p=0.042). Women who reported sexual activity was significantly higher in G1 compared to G3 and G4 (94.1% vs. 66.7% and 37.5%, respectively; p=0.001). Orgasm was more frequently in G1 compared to G3 and G4 (91.2% vs. 63.9% and 28.1%, respectively; p=0.001), demonstrating that sexual activity and orgasm decrease after age 51. The duration of PFM contraction was significantly higher in women who had sexual intercourse (p=0.033) and orgasm (p=0.018). Conclusions Although the frequency of sexual intercourse and orgasm may decrease with aging, a relationship between sexual activity and PFMS remains apparent, once both sexually active women and those who have orgasms showed better PFM endurance than non-sexually active ones., Graphical Abstract

Purpose: To evaluate the correlation between the pH readings in 24-h urine and the random fasting specimen in patients with urolithiasis using 2 methods. Methods: A total of 114 patients with urinary lithiasis using potassium citrate were prospectively analyzed. All patients collected 24-h urine and an additional sample, after nocturnal fasting, collected on the day they brought the 24-h sample at the lab. Two different methods (test strip and digital meter) were used to determine pH values. Results: The pH analysis using strips in the 24-h urine presented a mean value similar to the one obtained in the fasting sample (6.07 ± 0.74 vs. 6.02 ± 0.82, respectively; P > 0.05). The same behavior was seen considering the readings with a digital pH meter (5.8 ± 0.78 vs. 5.75 ± 0.83; P > 0.05). However, readings conducted in the same specimen with pH meter and test strip were dissonant (P < 0.05), suggesting that the colorimetric method is not reliable in the assessment of urinary pH in this population. Conclusion: pH assessment in a random urinary specimen proved as efficient as the 24-h urine standard method to monitor patients with kidney stones in the use of potassium citrate. Classical test strip analysis is not sensitive enough to evaluate the urine pH in this population and digital pH meter reading is preferred.

Made available in DSpace on 2022-04-29T08:41:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Several studies have demonstrated statistical and texture analysis abilities to differentiate cancerous from healthy tissue in magnetic resonance imaging. This study developed a method based on texture analysis and machine learning to differentiate prostate findings. Forty-eight male patients with PI-RADS classification and subsequent radical prostatectomy histopathological analysis were used as gold standard. Experienced radiologists delimited the regions of interest in magnetic resonance images. Six different groups of images were used to perform multiple analyses (seven analyses variations). Those analyses were outlined by specialists in urology as those of most significant importance for the classification. Forty texture features were extracted from each image and processed with Random Forest, Support Vector Machine, K-Nearest Neighbors, and Naive Bayes. Those seven analyses variation results were described in terms of area under the ROC curve (AUC), accuracy, F-score, precision and sensitivity. The highest AUC (93.7%) and accuracy (88.8%) were obtained when differentiating the group with both MRI and histopathology positive findings against the group with both negative MRI and histopathology. When differentiating the group with both MRI and histopathology positive findings versus the peripheral image zone group the AUC value was 86.6%. When differentiating the group with negative MRI/positive histopathology versus the group with both negative MRI and histopathology the AUC value was 80.7%. The evaluation of statistical and texture analysis promoted very suggestive indications for future work in prostate cancer suspicious regions. The method is fast for both region of interest selection and classification with machine learning and the result brings original contributions in the classification of different groups of patients. This tool is low-cost, and can be used to assist diagnostic decisions. São Paulo State University Júlio de Mesquita Filho, R. Prof. Dr. Antônio Celso Wagner Zanin, 250 - Distrito de Rubião Junior, SP Department of Urology UroScience State University of Campinas Unicamp and Pontifical Catholic University of Campinas PUC-Campinas, Av. John Boyd Dunlop-Jardim Ipaussurama, SP Botucatu Medical School Clinics Hospital Medical Physics and Radioprotection Nucleus, Av. Prof. Mário Rubens Guimarães Montenegro, s/n - UNESP - Campus de Botucatu, SP Department of Radiology Pontifical Catholic University of Campinas, SP Department of Anatomic Pathology and Urology School of Medical Sciences State University of Campinas (Unicamp) Department of Urology Botucatu Medical School São Paulo State University (UNESP), SP Department of Radiology University of Campinas (UNICAMP), SP Botucatu Medical School São Paulo State University Júlio de Mesquita Filho, Av. Prof. Mário Rubens Guimarães Montenegro, s/n - UNESP - Campus de Botucatu, SP Institute of Bioscience São Paulo State University Júlio de Mesquita Filho, R. Prof. Dr. Antônio Celso Wagner Zanin, 250 - Distrito de Rubião Junior, SP São Paulo State University Júlio de Mesquita Filho, R. Prof. Dr. Antônio Celso Wagner Zanin, 250 - Distrito de Rubião Junior, SP Botucatu Medical School Clinics Hospital Medical Physics and Radioprotection Nucleus, Av. Prof. Mário Rubens Guimarães Montenegro, s/n - UNESP - Campus de Botucatu, SP Department of Urology Botucatu Medical School São Paulo State University (UNESP), SP Botucatu Medical School São Paulo State University Júlio de Mesquita Filho, Av. Prof. Mário Rubens Guimarães Montenegro, s/n - UNESP - Campus de Botucatu, SP Institute of Bioscience São Paulo State University Júlio de Mesquita Filho, R. Prof. Dr. Antônio Celso Wagner Zanin, 250 - Distrito de Rubião Junior, SP

Made available in DSpace on 2022-04-28T19:47:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: A low supply of donated organs led to the expansion of criteria for kidney transplantation (KT), and the impact on late glomerular function rates (eGFR) is still uncertain. This study aimed to correlate the histologic findings at time-zero biopsy (TzB) with the final eGFR, to identify criteria that could help achieve a more thorough preimplantation evaluation of the organ. Methods: Records from 395 adult deceased KTs were reviewed. TzBs were analyzed considering histologic criteria by compartment (vascular, interstitial, tubular, and inflammatory) and correlated with the eGFR after 1 year. Results: Among donors, 56.9% were men (mean age 39 years), with the main causes of death being brain trauma (44.2%) and stroke (46.0%). Histologic analysis of TzB revealed 6.0% of glomerulosclerosis; 18.8% presenting vascular alterations; interstitial fibrosis in 54.6%; tubular changes in 76.9%, and nonspecific inflammatory infiltrate in 2.3%. Linear regression analysis showed that the main histologic findings that had impact in the eGFR were interstitial fibrosis (P = .000), followed by tubular alterations (P = .036) and glomerulosclerosis (P = .008). Conclusions: Histologic variables like interstitial fibrosis and tubular alterations show the most significant negative correlation with final eGFR. The effect of glomerulosclerosis may not be as important as formerly suggested in the literature. Urology Department University of São Paulo State Nephrology Department University of São Paulo State Pathology Department University of São Paulo State Urology Department Unicamp

INTRODUCTION AND OBJECTIVE:The low organs supply led to an expansion of criteria for kidney transplantation (KT), and its impact in the late glomerular function rates (eGFR) is still unknown. This ...

Objectives To assess the correlation between hormonal status and pelvic floor muscle strength. Methods A total of 140 continent women were prospectively evaluated, and divided into four groups according to age: group 1 (n = 34) aged 30-40 years; group 2 (n = 38) aged 41-50 years; group 3 (n = 35) aged 51-60; and group 4 (n = 33) aged >60 years. The following parameters were evaluated: demographic data using clinical questionnaire; hypermobility of the bladder neck using swab test; vaginal trophism by gynecological examination; hormonal status of the vagina by cytology; and pelvic floor muscle strength using a perineometer and electromyography. Results There were no statistical differences between pelvic floor muscle strength, demographic characteristics, vaginal trophism and hypermobility of the bladder neck between groups (P > 0.05). There was a larger number of women with vaginal atrophy among those aged >60 years. Vaginal trophism assessed by pelvic examination was highly consistent with the findings of colpocytology (kappa test = 0.888). Electromyography showed that women with hypermobility had lower muscle resistance (endurance) when compared with those without hypermobility. Conclusions Although vaginal atrophy is more intense in women aged >60 years, no difference can be found in the pelvic floor muscle strength during the physiological aging process in continent women. As a consequence, trophism is not the only factor related to pelvic floor muscle strength, and it should not preclude the selection of patients who are referred to prophylaxis.

[Purpose] To investigate the effect of electrical stimulation and pelvic floor muscle training on muscle strength, urinary incontinence and erectile function in men with prostate cancer treated by radical prostatectomy. [Subjects and Methods] One hundred twenty-three males were randomized into 3 groups 1 month after RP: (G1, n=40) control; (G2, n=41) guideline: patients were instructed to perform three types of home exercises to strengthen the pelvic floor and (G3, n=42) electrical stimulation: patients in this group were also instructed to perform exercises as group G2, and also received anal electro-stimulation therapy, twice a week for 7 weeks. The primary outcome assessment was based on the measurement of the recovery of pelvic floor muscle strength between groups. Secondary outcomes were: 1 hour Pad Test, ICIQ-SF, IIEF-5 and IPSS. Data were obtained preoperatively and at 1, 3 and 6 months after surgery. [Results] There was no significant difference in the demographic data among groups. Greater urinary leakage and pelvic floor muscle weakness in the first month compared to pre treatment improved after 3 and 6 months postoperative, without difference among groups. [Conclusion] The muscle strength recovery occurs independently of the therapy employed. Pelvic floor exercises or electrical stimulation also did not have an impact on the recovery of urinary continence and erectile function in our study.

Aim: To determine whether bladder functions deteriorate with age. Methods: Data contained in electronic medical record (INFOMED?) were used in this institutional retrospective review. Analysis was done on the urodynamic studies in women over 18 years old conducted between May 2011 and November 2015. Patients with previous history of pelvic surgery or radiotherapy, neurological disease, vaginal prolapse greater than grade I, congenital urogenital malformations, urinary obstructive disease, diabetes, or the use of any medication that could interfere with bladder function were excluded from the analysis. The urodynamic parameters analyzed were the Maximum Cystometric Capacity (MCC), Voiding Volume (VV), Maximum Flow (Qmax), Bladder Compliance (BC), Detrusor Pressure at Maximum Flow (PdetQmax), Bladder Contractility Index (BCI), Bladder Voiding Efficiency (BVE) and Post-Void Residual Urine Volume (PVR). Patients were further stratified in five groups according to age (A—18 to 40; B—41 to 50; C—51 to 60; D—61 to 70; E—over 70 years old). Results: Out of 3103 urodynamic studies analyzed, 719 were eligible for the study. The average age of patients was 49.3 (+13.2) years old and in all evaluated parameters, statistically significant correlation between age and decline of bladder function was obtained (p < 0.05). Moreover, mathematical equations were presented to estimate the parameters values in relation to age. Conclusions: This study showed a decline in bladder storage function (reduction in MCC and BC) and in bladder emptying function (reduction in Qmax, PdetQmax, VV, BCI and BVE with an increase in PVR) with age.

Made available in DSpace on 2019-10-06T16:00:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-11-01 Dept of Urology Botucatu School of Medicina Univ. Estadual Paulista UNESP Bp Hospital Oswaldo Cruz Hospital Sírio Libanês Hospital Royal Adelaide Hospital AC Camargo Cancer Center Dept of Urology Botucatu School of Medicina Univ. Estadual Paulista UNESP

Made available in DSpace on 2020-12-12T01:44:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-11-01 Background Kidney transplantation is the treatment of choice in patient with end stage chronic kidney disease, offering the best long term survival and greater Quality of Life in this group of patients. Graft volume was correlated with improved renal function in living donor transplantations. The primary aim of this study was to correlate renal volume adjusted to body surface area with renal function one year (estimated glomerular filtration rate; eGFR) after kidney transplantation. Methods This single-center, prospective cohort study included 256 patients who underwent kidney transplantation from January 2011 through December 2015 at Hospital das Clínicas de Botucatu–UNESP. We evaluated three kidney measurements during the bench surgery; the final graft volume was calculated using the ellipsoid formula and adjusted to body surface area. Results In the living donors there was positive correlation between adjusted graft volume and eGFR (r = 0.311, p = 0.008). Multivariate analysis revealed that low rejection rate and increased adjusted graft volume were independent factors correlated with eGFR. In deceased donors, there was no correlation between adjusted kidney volume and eGFR (r = 0.08, p = 0.279) in univariate analysis, but a multivariate analysis indicated that lower kidney donor profile index (KDPI), absence of rejection and high adjusted kidney volume were independent factors for better eGFR. Conclusion Adjusted kidney volume was positively correlated with a satisfactory eGFR at one year after living donor and deceased donor transplantations. Department of Urology Botucatu Medical School São Paulo State University (Universidade Estadual Paulista–UNESP) Urology Department Royal Adelaide Hospital BP Hospital Hospital 9 de Julho Sirio Libanes Hospital Department of Internal Medicine Nephrology Botucatu Medical School São Paulo State University (Universidade Estadual Paulista–UNESP) Department of Urology Botucatu Medical School São Paulo State University (Universidade Estadual Paulista–UNESP) Department of Internal Medicine Nephrology Botucatu Medical School São Paulo State University (Universidade Estadual Paulista–UNESP)

Made available in DSpace on 2020-12-12T01:49:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01. Added 1 bitstream(s) on 2021-07-15T15:07:21Z : No. of bitstreams: 1 S0102-86502019000900213.pdf: 445333 bytes, checksum: 84b11ed52c2a1b01d064ece71fbce78a (MD5) Purpose: To evaluate the effects of tadalafil (TD) in preventing histological alterations of the corpus cavernosum caused by isolated lesions of cavernous nerve (ILCN) and artery (ILCA) in rats. Methods: Fifty male Wistar rats were randomly assigned in five groups: G1: Control; G2: Bilateral ILCN; G3: Bilateral ILCA; G4: ILCN+TD; G5: ILCA+TD. The cavernous bodies were submitted to histomorphometry, immunohistochemistry and biochemical analysis. Results: Nerve density was significantly higher in G2 and G4 compared to control (22.62±2.84 and 19.53±3.47 vs. 15.72±1.82; respectively, p

Department of Veterinary Clinic School of Veterinary Medicine and Animal Science Universidade Estadual Paulista (UNESP)

Made available in DSpace on 2015-10-21T13:09:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-01-01. Added 1 bitstream(s) on 2015-10-22T09:53:14Z : No. of bitstreams: 1 S1677-55382015000100168.pdf: 124431 bytes, checksum: 65f9f1c664186c4ff45bd0bd04f5c2a1 (MD5) Objective: To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB).Materials and Methods: Between January and April 2013, five children underwent SPRRB in our hospital. A single 1.5 cm incision was performed under the 12th rib at mid-axillary line, and an 11 mm trocar was inserted. A nephroscope was used to identify the kidney and dissect the perirenal fat. After lower pole exposure, a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample.Results: SPRRB was successfully performed in five children. The mean operative time was 32 minutes, and mean estimated blood loss was less than 10 mL. The hospital stay of all patients was two days because they were discharged in the second postoperative day, after remaining at strict bed rest for 24 hours after the procedure. The average number of glomeruli present in the specimen was 31.Conclusion: SPRRB is a simple, safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy. Sao Paulo State Univ UNESP, Sch Med, Dept Urol, BR-18618970 Botucatu, SP, Brazil Sao Paulo State Univ UNESP, Sch Med, Dept Urol, BR-18618970 Botucatu, SP, Brazil

BACKGROUND: Several options exist for managing overactive bladder (OAB), including electrical stimulation (ES) with non‐implanted devices, conservative treatment and drugs. Electrical stimulation with non‐implanted devices aims to inhibit contractions of the detrusor muscle, potentially reducing urinary frequency and urgency. OBJECTIVES: To assess the effects of ES with non‐implanted electrodes for OAB, with or without urgency urinary incontinence, compared with: placebo or any other active treatment; ES added to another intervention compared with the other intervention alone; different methods of ES compared with each other. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In‐Process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 10 December 2015). We searched the reference lists of relevant articles and contacted specialists in the field. We imposed no language restrictions. SELECTION CRITERIA: We included randomised or quasi‐randomised controlled trials of ES with non‐implanted devices compared with any other treatment for OAB in adults. Eligible trials included adults with OAB with or without urgency urinary incontinence (UUI). Trials whose participants had stress urinary incontinence (SUI) were excluded. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, extracted data from eligible trials and assessed risk of bias, using the Cochrane 'Risk of bias' tool. MAIN RESULTS: We identified 63 eligible trials (4424 randomised participants). Forty‐four trials did not report the primary outcomes of perception of cure or improvement in OAB. The majority of trials were deemed to be at low or unclear risk of selection and attrition bias and unclear risk of performance and detection bias. Lack of clarity with regard to risk of bias was largely due to poor reporting. For perception of improvement in OAB symptoms, moderate‐quality evidence indicated that ES was better than pelvic floor muscle training (PFMT) (risk ratio (RR) 1.60, 95% confidence interval (CI) 1.19 to 2.14; n = 195), drug treatment (RR 1.20, 95% 1.04 to 1.38; n = 439). and placebo or sham treatment (RR 2.26, 95% CI 1.85 to 2.77, n = 677) but it was unclear if ES was more effective than placebo/sham for urgency urinary incontinence (UUI) (RR 5.03, 95% CI 0.28 to 89.88; n = 242). Drug treatments included in the trials were oestrogen cream, oxybutynin, propantheline bromide, probanthine, solifenacin succinate, terodiline, tolterodine and trospium chloride. Low‐ or very low‐quality evidence suggested no evidence of a difference in perception of improvement of UUI when ES was compared to PFMT with or without biofeedback. Low‐quality evidence indicated that OAB symptoms were more likely to improve with ES than with no active treatment (RR 1.85, 95% CI 1.34 to 2.55; n = 121). Low‐quality evidence suggested participants receiving ES plus PFMT, compared to those receiving PFMT only, were more than twice as likely to report improvement in UUI (RR 2.82, 95% CI 1.44 to 5.52; n = 51). There was inconclusive evidence, which was either low‐ or very low‐quality, for OAB‐related quality of life when ES was compared to no active treatment, placebo/sham or biofeedback‐assisted PFMT, or when ES was added to PFMT compared to PFMT‐only. There was very low‐quality evidence from a single trial to suggest that ES may be better than PFMT in terms of OAB‐related quality of life. There was a lower risk of adverse effects with ES than tolterodine (RR 0.12, 95% CI 0.05 to 0.27; n = 200) (moderate‐quality evidence) and oxybutynin (RR 0.11, 95% CI 0.01 to 0.84; n = 79) (low‐quality evidence). Due to the very low‐quality evidence available, we could not be certain whether there were fewer adverse effects with ES compared to placebo/sham treatment, magnetic stimulation or solifenacin succinate. We were also very uncertain whether adding ES to PFMT or to drug therapy resulted in fewer adverse effects than PFMT or drug therapy alone Nor could we tell if there was any difference in risk of adverse effects between different types of ES. There was insufficient evidence to determine if one type of ES was more effective than another or if the benefits of ES persisted after the active treatment period stopped. AUTHORS' CONCLUSIONS: Electrical stimulation shows promise in treating OAB, compared to no active treatment, placebo/sham treatment, PFMT and drug treatment. It is possible that adding ES to other treatments such as PFMT may be beneficial. However, the low quality of the evidence base overall means that we cannot have full confidence in these conclusions until adequately powered trials have been carried out, measuring subjective outcomes and adverse effects.

Several urethral conditions may require tissue substitution. One collagen-base biomaterial that recently emerged as an option is small intestinal submucosa (SIS). The aim of this study was to compare the results of SIS and buccal mucosa for urethral substitution in rabbits.Thirty-six North Folk male rabbits were randomized into three groups. In all animals, a 10 × 5 mm urethral segment was excised, and the urethral defect was repaired using a one-layer SIS patch (group I [GI]); four-layer SIS (group II [GII]); or buccal mucosa (group III [GIII]). Urethrography was performed preoperatively and after 12 weeks. After sacrifice, graft retraction was objectively measured using Scion Image(®) computer analysis and by calculation of ellipse area. The grade of fibrosis, inflammatory reaction, vascular/epithelial regeneration, and collagen III/I ratio were analyzed by hematoxylin/eosin and Picrosirius red staining.Urethrography confirmed a wide urethral caliber without any signs of strictures after surgery. Urethral fistulae was diagnosed in 8.3% of cases (1 animal each group). Average graft shrinkage was 55.2% in GI; 44.2% in GII; and 57.2% in GIII (p0.05). The intensity of chronic inflammation, fibrosis, epithelium regeneration, and neovascularization was similar in all groups (p0.05). Collagen III/I ratio was higher in GII (GI: 119.6; GII: 257.2 and GIII: 115.0); p0.01.The four-layer SIS is more advantageous than the one-layer SIS and buccal mucosa for urethral substitution in rabbits.

The aim of this study was to evaluate the protective effect of intravesical oxybutynin on the bladder wall of rabbits with detrusor overactivity and partial bladder outlet obstruction (PBOO). Forty-five North Folk male rabbits were randomly distributed into GI, used as control (n = 15), GII-PBOO (n = 14), and GIII-PBOO + intravesical oxybutynin (n = 15). Connective tissue and elastic fibers were quantified as volumetric density on picrosirius red and Weigert’s Fuchsin-Resorcin-stained sections, respectively. In T2, bladder weight was significantly higher in animals in GII and GIII. Smooth muscle bundle diameter was increased by 42% in GII compared with GI (p

Vaginal weight cone (VWC) versus assisted pelvic floor muscle training (APFMT) in the treatment of urinary incontinence (UI) in women.One hundred three incontinent women were randomly distributed into two groups: group G1 (n = 51) treated with VWC and G2 (n = 52), APFMT. The following parameters were performed initially and after treatment: (1) clinical questionnaire, (2) visual analogue scale (VAS), (3) 60-min pad test, and (4) subjective and objective assessment of pelvic floor muscle (PFM).There was a significant decrease in nocturia and urine loss after treatment in both groups (p0.05). In VAS, there was a significant improvement of all parameters in both groups (p0.05). The pad test showed significant decrease in both groups (p0.05). There was a significant increase of PFM strength in both groups (p0.05).There was no difference between groups treated with VWC and APFMT.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:30Z No. of bitstreams: 1 S1677-55382009000500011.pdf: 504354 bytes, checksum: aa6add27c8059b84dc393d4e01b006b1 (MD5) Made available in DSpace on 2013-08-22T18:43:30Z (GMT). No. of bitstreams: 1 S1677-55382009000500011.pdf: 504354 bytes, checksum: aa6add27c8059b84dc393d4e01b006b1 (MD5) Previous issue date: 2009-10-01 Made available in DSpace on 2013-09-30T18:24:56Z (GMT). No. of bitstreams: 2 S1677-55382009000500011.pdf: 504354 bytes, checksum: aa6add27c8059b84dc393d4e01b006b1 (MD5) S1677-55382009000500011.pdf.txt: 21221 bytes, checksum: 0fed1acb165829a7c7c4d11b43949ebb (MD5) Previous issue date: 2009-10-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:38:57Z No. of bitstreams: 2 S1677-55382009000500011.pdf: 504354 bytes, checksum: aa6add27c8059b84dc393d4e01b006b1 (MD5) S1677-55382009000500011.pdf.txt: 21221 bytes, checksum: 0fed1acb165829a7c7c4d11b43949ebb (MD5) Made available in DSpace on 2014-05-20T13:38:57Z (GMT). No. of bitstreams: 2 S1677-55382009000500011.pdf: 504354 bytes, checksum: aa6add27c8059b84dc393d4e01b006b1 (MD5) S1677-55382009000500011.pdf.txt: 21221 bytes, checksum: 0fed1acb165829a7c7c4d11b43949ebb (MD5) Previous issue date: 2009-10-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objective: To evaluate prevalence and risk factors of fecal and urinary incontinence (UI) in Brazilian women. Material and Methods: 685 women older than 20 years of age answered a questionnaire about urinary and fecal symptoms, clinical and obstetric antecedents. They were grouped according to presence or absence of UI. Results: Urinary and fecal incontinence was reported in 27% and 2% of cases, respectively. Mean age of incontinent women was significantly higher than continent ones. Incontinent women had a mean number of micturitions significantly higher than the continent ones. on average, incontinent women had higher rate of pregnancies and vaginal delivery when compared to the continent ones. Body mass index (BMI) was significantly higher in incontinent participants and in women with no UI complaints (27.35 vs. 24.95, p < 0.05). Fecal incontinence prevalence was 2% and occurred exclusively in patients with UI. Conclusions: Vaginal delivery and high BMI have been identified as risk factors for UI development while aging and number of pregnancies may be correlated factors. UNESP School of Medicine Department of Urology, Department of Public Health, and Department of Statistics UNESP School of Medicine Department of Urology, Department of Public Health, and Department of Statistics FAPESP: 11335-3

To evaluate the protective effect of intravesical oxybutynin on the ultrastructure of rabbits with detrusor overactivity (DO). Seventeen North Folk male rabbits were distributed into three groups: GI (n = 5) used as control, GII (n = 5), and GIII (n = 5) with DO. One animal from GII and one from GIII were excluded because they did not develop DO. In GIII, the animals were treated with daily intravesical application of 0.5 mg/Kg of oxybutynin for 30 days. Bladder weight was significantly higher in animals from GII and GIII as compared to GI. After 30 days, cystometric study revealed that vesical capacity was significantly decreased in GII and GIII. Detrusor pressure was significantly higher in GII. Electron microscopy showed increase of intercellular space, cell junctions and caveolae areas asymmetries, mitochondria and cellular degeneration in GII, while in GIII, these alterations have improved after a 30-day treatment. Animals treated with intravesical oxybutynin presented ultrastructural aspect similar to normal.

Purpose: To present our series of patients who underwent laparoscopic correction of iatrogenic lesions and a review of the literature. Patients and Methods: We evaluated 23 patients who underwent laparoscopic correction of iatrogenic lesions. Thirteen patients had open surgery, 6 had an endoscopic procedure, and 4 had a laparoscopic approach as the first surgical procedure. Vesicovaginal fistulas (VVF) developed in seven patients after open abdominal hysterectomies, and 1 patient presented with a VVF after ureterolithotripsy. A urethral cutaneous fistula developed in one patient after a laparoscopic resection of endometriosis nodules, and 1 patient presented with a ureterovaginal fistula after a perineoplasty. Three patients presented with encrusted ureteral stents after ureterolithotripsy. Ureteral stenosis developed in seven patients: three after open abdominal surgery, three after ureteroscopy, and one after pyeloplasty. One patient had a ureteral injury during laparoscopic partial nephrectomy, and two patients had bowel injuries after a tension-free vaginal tape procedure and a laparoscopic radical prostatectomy. Results: All patients underwent laparoscopic correction of the iatrogenic injuries. One patient had an early recurrence of a VVF, and one patient had a recurrence of a ureteral stenosis. There was one conversion to open surgery because of technical difficulties and one major bleeding event that necessitated blood transfusion. A lower limb compartmental syndrome developed in one patient. Conclusion: Despite the small number of patients and different types of surgeries performed, laparoscopic management of iatrogenic lesions seems to be feasible and safe in experienced hands. Its precise role in the management of this stressful condition still needs to be determined.

Vesicovaginal fistula (VVF) is one of the most devastating surgical complications that can occur in women. The primary cause remains an abdominal hysterectomy. Approach to this condition can be transvaginal or transabdominal. Laparoscopic repair of VVF may be an alternative approach to this treating rare condition. We present seven cases of VVF treated with transperitoneal laparoscopic technique and our results.We retrospectively reviewed the charts of 7 women ranging from 37 to 74 years in age (mean age 52.8 years) at our institution who underwent laparoscopic transperitoneal repair of VVF between February 2004 and March 2006. Etiology of the VVF, surgical technique, operative time, length of hospital stay, and complications were reviewed.Six of the seven VVFs we repaired laparoscopically resulted from gynecologic procedures, and one patient presented with a VVF after a ureterolithotripsy. Mean operative time ranged from 130 to 420 minutes (mean 280 minutes), and mean hospital stay was 7 days. In one patient conversion to open surgery was necessary due to prolonged operative time. Two complications occurred: a urinary tract infection in one patient and an inferior limb compartment syndrome in another.Transvaginal laparoscopic repair of VVF is feasible and safe and provides excellent results. It is a good alternative to the abdominal approach. However, advanced laparoscopic skills are mandatory.

The aim of this study was to evaluate the effect of intravaginal electrical stimulation (IES) on pelvic floor muscle (PFM) strength in patients with mixed urinary incontinence (MUI). Between January 2001 and February 2002, 40 MUI women (mean age: 48 years) were studied. Urge incontinence was the predominant symptom; 92.5% also presented mild stress urinary incontinence (SUI). Selection criteria were clinical history and urodynamics. Pre-treatment urodynamic study showed no statistical differences between the groups. Ten percent of the women in each group had involuntary detrusor contractions. Patients were randomly distributed, in a double-blind study, into two groups. Group G1 (n=20), effective IES, and group G2 (n=20), sham IES, with follow-up at 1 month. The following parameters were studied: (1) clinical questionnaire, (2) examiner's evaluation of perineal muscle strength, (3) objective evaluation of perineal muscle by perineometry, (4) vaginal weight test, and (5) urodynamic study. The IES protocol consisted of three 20-min sessions per week over a 7-week period using a Dualpex Uro 996 at 4 Hz. There was no statistically significant difference in the demographic data of both groups. The number of micturitions per 24 h after treatment was reduced significantly in both groups. Urge incontinence, present in all patients before treatment, was reduced to 15% in G1 and 31.5% in G2 post-treatment. The subjective evaluation of PFM strength demonstrated a significant improvement in G1. Objective evaluation of PFM force by perineometer showed a significant improvement in maximum peak contraction post-treatment in both groups. In the vaginal weight test, there was a significant increase in average number of cone retentions post-treatment in both groups. With regard to satisfaction level, after treatment, 80% of the patients in G1 and 65% of the patients in G2 were satisfied. There was no statistically significant difference between the groups. There was a significant improvement in PFM strength from both effective and sham electrostimulation, questioning the effectiveness of electrostimulation as a monotherapy in treating MUI.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:50:30Z No. of bitstreams: 1 S0100-72032004000400008.pdf: 68231 bytes, checksum: 9e9157e59f90ed7a901559fe723073d4 (MD5) Made available in DSpace on 2013-08-22T18:50:30Z (GMT). No. of bitstreams: 1 S0100-72032004000400008.pdf: 68231 bytes, checksum: 9e9157e59f90ed7a901559fe723073d4 (MD5) Previous issue date: 2004-05-01 Made available in DSpace on 2013-09-30T18:24:58Z (GMT). No. of bitstreams: 2 S0100-72032004000400008.pdf: 68231 bytes, checksum: 9e9157e59f90ed7a901559fe723073d4 (MD5) S0100-72032004000400008.pdf.txt: 27933 bytes, checksum: e7b63fd3cc2ba50063904b3623b6d8c4 (MD5) Previous issue date: 2004-05-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:38:57Z No. of bitstreams: 2 S0100-72032004000400008.pdf: 68231 bytes, checksum: 9e9157e59f90ed7a901559fe723073d4 (MD5) S0100-72032004000400008.pdf.txt: 27933 bytes, checksum: e7b63fd3cc2ba50063904b3623b6d8c4 (MD5) Made available in DSpace on 2014-05-20T13:38:57Z (GMT). No. of bitstreams: 2 S0100-72032004000400008.pdf: 68231 bytes, checksum: 9e9157e59f90ed7a901559fe723073d4 (MD5) S0100-72032004000400008.pdf.txt: 27933 bytes, checksum: e7b63fd3cc2ba50063904b3623b6d8c4 (MD5) Previous issue date: 2004-05-01 OBJETIVO: avaliar a concordância dos diferentes parâmetros urodinâmicos comparados à cistometria simplificada, permitindo uma diminuição na relação custo-benefício no diagnóstico da incontinência urinária de esforço (IUE) na mulher. MÉTODOS: foram coletadas e avaliadas retrospectivamente as informações contidas dos prontuários de trinta pacientes acompanhadas, no período de janeiro de 2000 a março de 2001. Todas foram submetidas a exame físico geral e ginecológico. O estudo urodinâmico foi realizado pela técnica convencional, utilizando-se aparelho Dynograph Recorder R-611. A cistometria simplificada foi realizada com auxílio de um equipo em Y de PVC (pressão venosa central), conectado a um sonda de Foley 14 F, que permitia tanto a infusão de soro fisiológico como a captação da pressão intra-vesical. Foram analisados os parâmetros: volume residual, capacidade vesical, complacência, presença de contrações involuntárias do detrusor e perdas urinárias aos esforços. Para determinação da proporção de concordância entre os métodos foram utilizados o teste de concordância de Pearson e o teste de Wilcoxon, para amostras relacionadas. RESULTADOS: a média de idade foi de 50 anos, com extremos variando de 28 a 70 anos. O índice de concordância entre os estudos, na demonstração das perdas urinárias aos esforços, foi de 67%. Para a detecção das contrações involuntárias do detrusor, a proporção de concordância foi de 90%. A média do volume residual encontrado na cistometria simplificada foi de 16,8 ml contra 2 ml da urodinâmica convencional, com diferença significativa (p < 0,01). A média de capacidade vesical máxima no estudo urodinâmico foi de 440,5 ml, enquanto que, na cistometria simplificada, foi de 387 ml (p < 0,05). A complacência vesical foi, em média, significativamente maior na cistometria simplificada (43,0 ml/cmH2O) quando comparada ao estudo urodinâmico (31,5 ml/cmH2O), com p < 0,01. CONCLUSÃO: Avaliações preliminares sugerem que a propedêutica uroginecológica associada à cistometria simplificada é uma opção a ser considerada na avaliação clínica e pré-operatória de pacientes com IUE em substituição à urodinâmica convencional, particularmente onde esta última não se encontra disponível. A cistometria simplificada é um exame acessível que é capaz de detectar contrações involuntárias do detrusor, assim como identificar perdas urinárias com relativa sensibilidade, proporcionando ao examinador noções fidedignas do comportamento vesical. OBJECTIVE: to assess the concordance of different urodynamic parameters with simplified cystometry, thus improving the cost-benefit relationship for stress urinary incontinence (SUI) diagnosis in woman. METHODS: we evaluated retrospectively the medical records of thirty patients treated, from January 2000 to March 2001. All patients had been submitted to physical and gynecological examinations. A conventional urodynamic study had been made using a Dynograph R-611 recorder. Simplified cystometry had used a saline tube with Y connector, connected to a Foley 14 Fr catheter, which allowed measurement of intra-vesical pressure at the same time as physiological saline infusion. The following parameters were analyzed: residual volume, bladder capacity, complacency, involuntary detrusor contractions, and abdominal leak-point pressure. The Pearson test of agreement and the Wilcoxon signed rank test were used to verify the concordance between related samples, with p < 0,05. RESULTS: the average age was 50 years old (28-70). Concordance between studies for stress urinary losses was 67%, and for detrusor involuntary contractions, 90%. The average residual volume was significantly different: by simplified cystometry it was 16.8 ml versus 2 ml by conventional urodynamics (p < 0.01). The average maximum vesical capacity by urodynamic study was 440.5 ml, and by simplified cystometry, 387 ml (p < 0.05). Vesical complacency was on average, significantly larger in simplified cystometry (43.0 ml/cmH2O) than in the urodynamic study (31.5 ml/cmH2O), with p < 0.01. CONCLUSION: preliminary evaluations suggest that the urogynecologic propedeutic associated with cystometry is an option to be considered in the clinical and preoperative assessment of patients with SUI instead of conventional urodynamics, particularly when the latter is not available. Simplified cystometry is an accessible exam that grants comparable results for the detection of involuntary detrusor contractions and for the identification of urinary loss, providing the examiner with trustworthy data on vesical behavior. Universidade Estadual Paulista Faculdade de Medicina Departamento de Urologia Universidade Estadual Paulista Faculdade de Medicina Departamento de Urologia

Treatment of urinary stress incontinence (USI) by intravaginal electrical stimulation (IES) and pelvic floor physiotherapy represents an alternative to other therapies. The purpose of this work was to evaluate the effectiveness of this treatment inpatients with urinary incontinence. From January 1998 to May 2000, 30 women (mean age 54 years) were studied. All patients had USI and 70% urge incontinence; average follow-up was 7 months. Selection criteria were based on clinical history, objective evaluation of perineal musculature by perineometry, and urodynamics. The treatment protocol consisted of three sessions of IES per week for 14 weeks using INNOVA equipment. Physiotherapy was initiated in the fifth week of IES. A significant decrease in the number of micturitions and urgency was observed after treatment ( P

Made available in DSpace on 2015-10-21T13:09:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-04-10. Added 1 bitstream(s) on 2015-10-22T09:53:13Z : No. of bitstreams: 1 WOS000352833400001.pdf: 652279 bytes, checksum: b6fe16ecaddab021569d817c78426d2b (MD5) Background: The aim of this study was to compare pelvic floor muscle (PFM) strength using transvaginal digital palpation in healthy continent women in different age groups, and to compare the inter- and intra-rater reliability of examiners performing anterior and posterior vaginal assessments.Methods: We prospectively studied 150 healthy multiparous women. They were distributed into four different groups, according to age range: G1 (n = 37), 30-40 years-old; G2 (n = 39), 41-50 years-old; G3 (n = 39), 51-60 years-old; and G4 (n = 35), older than 60 years-old. PFM strength was evaluated using transvaginal digital palpation in the anterior and posterior areas, by 3 different examiners, and graded using a 5-point Amaro's scale.Results: There was no statistical difference among the different age ranges, for each grade of PFM strength. There was good intra-rater concordance between anterior and posterior PFM assessment, being 64.7%, 63.3%, and 66.7% for examiners A, B, and C, respectively. The intra-rater concordance level was good for each examiner. However, the inter-rater reliability for two examiners varied from moderate to good.Conclusions: Age has no effect on PFM strength profiles, in multiparous continent women. There is good concordance between anterior and posterior vaginal PFM strength assessments, but only moderate to good inter-rater reliability of the measurements between two examiners. Universidade Estadual Paulista, Departamento de Urologia, Faculdade de Medicina de Botucatu Universidade Estadual Paulista, Departamento de Bioestatística, Instituto de Biociências de Botucatu

Made available in DSpace on 2015-11-03T15:27:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-07-01. Added 1 bitstream(s) on 2015-11-04T10:15:33Z : No. of bitstreams: 1 S1677-55382014000400507.pdf: 146086 bytes, checksum: c353f7291ac4d9b0551065eab3cd67d7 (MD5) Introduction: The aim was to confirm that PSF (probability of stone formation) changed appropriately following medical therapy on recurrent stone formers.Materials and Methods: Data were collected on 26 Brazilian stone-formers. A baseline 24-hour urine collection was performed prior to treatment. Details of the medical treatment initiated for stone-disease were recorded. A PSF calculation was performed on the 24 hour urine sample using the 7 urinary parameters required: voided volume, oxalate, calcium, urate, pH, citrate and magnesium. A repeat 24-hour urine sample was performed for PSF calculation after treatment. Comparison was made between the PSF scores before and during treatment.Results: At baseline, 20 of the 26 patients (77%) had a high PSF score (> 0.5). Of the 26 patients, 17 (65%) showed an overall reduction in their PSF profiles with a medical treatment regimen. Eleven patients (42%) changed from a high risk (PSF > 0.5) to a low risk (PSF < 0.5) and 6 patients reduced their risk score but did not change risk category. Six (23%) patients remained in a high risk category (> 0.5) during both assessments.Conclusions: The PSF score reduced following medical treatment in the majority of patients in this cohort. University of Oxford, Department of Urology Cambridge University Hospitals Trust, Deparment of Urolithiasis Research Cambridge University Hospital Trust, Department of Urology Universidade Estadual Paulista, Departamento de Urologia, Faculdade de Medicina de Botucatu

Made available in DSpace on 2014-10-01T13:08:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-06-01Bitstream added on 2014-10-01T14:03:54Z : No. of bitstreams: 1 S0102-86502014000600400.pdf: 315254 bytes, checksum: 968838f41c97c24ccd152c44e1d30a7c (MD5) PURPOSE: To evaluate the influence of combined clinical therapy and nutritional guidance on the recurrence of urolithiasis. METHODS: From our registry of patients with recurrent urolithiasis we selected 57 who had at least 5-years of follow-up. We collected 24h urine samples in order to analyze Ca, Na, uric acid, citrate, oxalate, and Mg concentrations and to assess urine volume. Patients filled out a clinical questionnaire before treatment, and abdominal radiographs and/or ultrasound were performed both before treatment and during the follow-up period. During follow-up, specific and individualized dietary advice was given based on the individual's metabolic disorders. Patients also received specific pharmacological treatment for their metabolic alterations. Outcome measures were metabolites in urine and the urolith recurrence rate. Pre- and post- intervention values were compared using tests as appropriate. RESULTS: Fifty six of the patients were male and the majority of patients were overweight. The mean BMI was 27 kg/m2. Urinary excretion of calcium, uric acid and sodium decreased significantly over the five year follow-up period. The number of uroliths that formed during the 5-year follow-up also decreased significantly compared to pre-treatment values. CONCLUSION: Individualized dietary advice combined with pharmacological treatment significantly reduces long-term urolithiasis recurrence. Sao Paulo State University Medical School of Botucatu UNESP Medical School of Botucatu UNESP Medical School of Botucatu Department of Biostatistics UNESP Medical School of Botucatu Department of Urology Sao Paulo State University Medical School of Botucatu UNESP Medical School of Botucatu UNESP Medical School of Botucatu Department of Biostatistics UNESP Medical School of Botucatu Department of Urology

Made available in DSpace on 2015-10-21T13:09:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-01-01 The objective of this study was to evaluate the prevalence of urinary metabolic abnormalities in patients with urolithiasis and their potential risk factors.A total of 905 stone patients were evaluated in a prospective trial from February 2000 to January 2012. Inclusion criteria were as follows: history and/or imaging tests confirming at least 2 separate or concurrent stone episodes; creatinine clearance a parts per thousand yen60 mL/min; and negative proteinuria and urine culture. Metabolic study consisted of two 24-h urine collections separated by a period of 3 months for dosing Ca, P, uric acid, Na, K, Mg, oxalate, and citrate. Serum levels of Ca, P, uric acid, Na, K, Cl, Mg, creatinine, and glucose were assessed. Urinary pH and urinary acidification tests were also performed.A total of 735 patients were included, with a mean age of the 40 +/- A 1.0 year; 96.8 % of patients presented diagnosis of one or more urinary metabolic abnormalities. The most prevalent metabolic abnormalities were hypercalciuria (50.8 %), hypomagnesuria (50.1 %), hypocitraturia (35.4 %), and hyperuricosuria (30.7 %). Body weight was significantly higher in patients with hyperuricosuria (81.20 +/- A 15.67 kg vs. 70.17 +/- A 14.13 kg, respectively, p = 0.001). Urinary sodium was significantly higher in patients with hypercalciuria than without (246.97 +/- A 103.9 mEq/24 h vs. 200.31 +/- A 91.6 mEq/24 h, p = 0.001) and hyperuricosuria compared to without (283.24 +/- A 107.95 mEq/24 h vs. 198.57 +/- A 85.3 mEq/24 h, p = 0.001).Urinary metabolic disturbances were diagnosed in 96.8 % of patients in the study. These results warrant metabolic study and follow-up in patients with recurrent lithiasis in order to decrease recurrence rate through specific treatments, modification in alimentary, and behavioral habits. UNESP, Med Sch Botucatu, Urinary Lithiasis Metab Serv, BR-18618970 Botucatu, SP, Brazil UNESP, Med Sch Botucatu, Dept Urol, BR-18618970 Botucatu, SP, Brazil Univ Oxford, Nuffield Dept Surg Sci, Oxford, England UNESP, Med Sch Botucatu, Dept Biostat, BR-18618970 Botucatu, SP, Brazil UNESP, Med Sch Botucatu, Urinary Lithiasis Metab Serv, BR-18618970 Botucatu, SP, Brazil UNESP, Med Sch Botucatu, Dept Urol, BR-18618970 Botucatu, SP, Brazil UNESP, Med Sch Botucatu, Dept Biostat, BR-18618970 Botucatu, SP, Brazil

Made available in DSpace on 2014-12-03T13:10:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-11-01Bitstream added on 2014-12-03T13:22:58Z : No. of bitstreams: 1 S1677-55382013000600847.pdf: 234776 bytes, checksum: 77bda31b1307d119e558ec14f5cd01c7 (MD5) Objective: The aim of this study was to assess pelvic floor muscle (PFM) strength in different body positions in nulliparous healthy women and its correlation with sexual activity.Materials and Methods: Fifty healthy nulliparous women with mean age of 23 years were prospectively studied. Subjective evaluation of PFM was assessed by transvaginal digital palpation (TDP) of anterior and posterior areas regarding the vaginal introitus. A perineometer with inflatable vaginal probe was used to assess the PFM strength in four different positions: supine with extended lower limbs (P1); bent-knee supine (P2); sitting (P3); standing (P4).Results: Physical activity, 3 times per week, was reported by 58% of volunteers. Sexual activity was observed in 80% of women and 82% of them presented orgasm. The average body mass index (BMI) was 21.76 kg/m(2), considered as normal according World Health Organization (WHO). We observed that 68% of volunteers were conscious about the PFM contraction. TDP showed concordance of 76% when anterior and posterior areas were compared (p = 0.00014). There was not correlation between PFM strength and orgasm in subjective evaluation. The PFM strength was significantly higher in standing position when compared with the other positions (p < 0.000). No statistical difference was observed between orgasm and PFM strength when objective evaluations were performed.Conclusions: There was concordance between anterior and posterior areas in 76% of cases when subjective PFM strength was assessed. In objective evaluation, higher PFM strength was observed when volunteers were standing. No statistical correlation was observed between PFM strength and orgasm in nulliparous healthy women. Sao Paulo State Univ, Sch Med, Physiotherapy Serv, Botucatu, SP, Brazil Sao Paulo State Univ, Sch Med, Dept Biostat, Botucatu, SP, Brazil Sao Paulo State Univ, Sch Med, Dept Urol, Botucatu, SP, Brazil Sao Paulo State Univ, Sch Med, Physiotherapy Serv, Botucatu, SP, Brazil Sao Paulo State Univ, Sch Med, Dept Biostat, Botucatu, SP, Brazil Sao Paulo State Univ, Sch Med, Dept Urol, Botucatu, SP, Brazil