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Introduction: Materialism has consistently been associated with mental health problems, such as depression and anxiety, and with a decline in overall wellbeing. This article seeks to deepen the understanding of whether or not the level of materialism is reduced when a sense of gratitude is instilled and, if so, how., Methods: After a thorough literature review, two empirical studies are presented. Study 1 has a quasi-experimental design and a sample of adolescent individuals in a major city in Brazil. Study 2 takes the form of a survey, completed by parents, in the same city., Results: Study 1 demonstrates that a gratitude-based intervention can reduce the subjects' belief that material wealth brings happiness and signifies success. Study 2 suggests that parents who express gratitude have a perception of raising less materialistic children., Discussion: These conclusions add to the theory and practice of consumer psychology and responsible consumption, particularly in relation to the behavior of young people, pointing toward ways to reduce excessive consumption through a simple and easily applied intervention: the stimulus of gratitude., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Battistella-Lima and Veludo-de-Oliveira.)

Consumption of high-fat diets (HFD) is associated with brain alterations, including changes in feeding behavior, cognitive decline, and dementia. Astrocytes play a role in HFD-induced neuroinflammation and brain dysfunction; however, this process is not entirely understood. We hypothesized that exposure to saturated fatty acids can compromise astrocyte viability and mitochondrial function. The C6 (astrocytes) cell line was treated with palmitate or stearate (200 µM and 400 µM) for 6 h. Cell viability, morphology, inflammatory markers, and oxidative stress were evaluated. To assess mitochondrial function, various parameters were measured (membrane potential, mass, respiration, and complex activities). We observed that 6 h of treatment with 400 µM palmitate decreased cell viability, and treatment with 200 µM palmitate changed the astrocyte morphology. Palmitate increased inflammatory markers (TNF-α and IL6) but did not induce oxidative stress. Palmitate significantly decreased the mitochondrial membrane potential and mitochondrial mass. Complex I activity also decreased in palmitate-treated cells; however, no changes were observed in mitochondrial respiration. In conclusion, palmitate, a saturated fatty acid, induces inflammation and impairs mitochondrial function, leading to reduced astrocytic cell viability and changes in cellular morphology. Our study provides valuable insights into the potential mechanisms underlying the relationship between saturated fatty acids, astrocytes, and mitochondrial function in obesity-related brain dysfunction.

The COVID-19 pandemic has severely affected global health, leading to the suspension of numerous routine healthcare services and posing challenges in efforts to control other diseases, such as HIV/AIDS. This study aimed to assess the impact of the COVID-19 pandemic on HIV/AIDS diagnoses and mortality rates in Brazil during 2020 and 2021. The percentage change was calculated to determine whether there was an increase or decrease in HIV/AIDS diagnoses and mortality, considering the average numbers from the last 5 years. Additionally, a Joinpoint regression model and an interrupted time series analysis were applied to assess time trends before and after the onset of the pandemic. Lastly, choropleth maps were prepared. We observed a reduction of 22.4% (2020) and 9.8% (2021) in the diagnosis of HIV/AIDS in Brazil. Conversely, there was a significant increase in the percentage change of late diagnosis of AIDS deaths in 2020 (6.9%) and 2021 (13.9%), with some states showing an increase of over 87%. Decreasing time trends in the diagnosis of HIV/AIDS were identified before the pandemic in Brazil, especially in the Southeast and South regions, and then time trends stabilized after including the pandemic years. Along with the dissemination of COVID-19, there was a reduction in the diagnosis of HIV/AIDS and an increase in late diagnosis AIDS deaths, signaling a serious impact of the pandemic on HIV/AIDS control strategies in Brazil. Therefore, we highlight the need for continuous efforts to control both diseases, that is, maintaining regular health services even in crisis situations., (© 2023. The Author(s).)

This study deals with the photochemical degradation of the model compound tetracycline, an aqueous pollutant derived from the degradation of the bactericide oxytetracycline (OTC), in the innovative photoreactor FluHelik, designed to promote pollutant abatement in liquid phase through H 2 O 2 /UVC and UVC processes. Computational fluid dynamics (CFD) simulations were performed to predict the behavior of the photoreactor in the laboratory scale. The simulations revealed a well-defined helicoidal flow pattern around the UVC lamp in the photoreactor, and the effect of different operational conditions (e.g., flow rate and light intensity) on the reactor's performance was evaluated, allowing to optimize the equipment., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Electrical impedance spectroscopy (EIS) appears a promising label-free methodology for the investigation of processes related to the aggregation of macromolecules in solution. Here, we explore the EIS technique as a convenient tool for studying the irreversible aggregation of human insulin and describing its corresponding fibrillation kinetics. The in situ measurement of the electrical response of pure insulin solutions at 60°C allows for the real-time monitoring of the protein fibrillation as a function of the incubation time. The fitting of the EIS data through an equivalent circuit based on a constant phase element provides a simple set of electric parameters whose abrupt changes can be associated to transitions occurring in the organization of the macromolecules. For establishing the reliability of the method proposed, we have compared the protein aggregation profile collected from the EIS data to that obtained from a conventional fluorescence methodology where Thioflavin T (ThT) is used as a dye probe. The description of the fibrillation process is quite similar in both cases, since characteristic times of the same order were found for the consecutive processes associated to the initial lag phase of insulin fibrillation, to the rapid growth of amyloidal aggregates and to the final saturation step. Our results suggest that in situ EIS can be considered as a promising approach for the real-time label-free monitoring of protein fibril formation., (Copyright © 2017 Elsevier B.V. All rights reserved.)

A trauma to the mature central nervous system (CNS) often leads to persistent deficits, due to the inability of axons to regenerate after being injured. Increasing evidence suggests that pro-inflammatory and pro-apoptotic genes can present a major obstacle to promoting neuroprotection of retinal ganglion cells and consequently succeed in axonal regeneration. This study evaluated the effect of the absence of galectin-3 (Gal-3) on retinal ganglion cells (RGC) survival and axonal regeneration/degeneration after optic nerve crush injury. Two weeks after crush there was a 2.6 fold increase in the rate of cell survival in Gal-3-/- mice (1283±79.15) compared to WT animals (495.4±53.96). However, no regeneration was observed in the Gal-3-/- mice two weeks after lesion. Furthermore, axonal degeneration presented a particular pattern on those mice; Electron Microscopy (EM) analysis showed incomplete axon degeneration while the WT mice presented an advanced stage of degeneration. This suggests that the removal of the nerve fibers in the Gal 3-/- mice could be deficient and this would cause a delay in the process of Wallerian degeneration once there is a decrease in the number of macrophages/microglia in the nerve. This study demonstrates how the absence of Gal-3 can affect RGC survival and optic nerve regeneration/degeneration after lesion. Our results suggest that the absence of Gal-3 plays an important role in the survival of RGC and thus can be a potential target for therapeutic intervention in RGC neuroprotection.

Objective: To validate the application of the bacterial cellulose (BC) membrane as a protecting bar-rier to the urethra., Materials and Methods: Forty female Wistar rats (four groups of 10): Group 1 (sham), the urethra was dissected as in previous groups and nothing applied around; Group 2, received a 0.7cm strip of the BC applied around the urethra just below the bladder neck; Group 3, received a silicon strip with the same dimensions as in group 2; Group 4, had a combination of 2 and 3 groups being the silicon strip applied over the cellulosic material. Half of the animals in each group were killed at 4 and 8 months. Bladder and urethra were fixed in formalin for histological analysis., Results: Inflammatory infiltrates were more intense at 4 months at lymphonodes (80% Grade 2), statistically different in the group 2 compared with groups 1 (p=0.0044) and 3 (p=0.0154). At 8 months, all samples were classified as grade 1 indicating a less intense inflammatory reaction in all groups. In group 2, at 8 months, there was a reduction in epithelial thickness (30±1μm) when com-pared to groups 1 (p=0.0001) and 3 (p<0.0001). Angiogenesis was present in groups 2 and 4 and absent in group 3. In BC implant, at 4 and 8 months, it was significant when comparing groups 4 with 1 (p=0.0159)., Conclusion: BC membrane was well integrated to the urethral wall promoting tissue remodeling and strengthening based on morphometric and histological results and may be a future option to prevent urethral damage., (Copyright® by the International Brazilian Journal of Urology.)

Purpose: This study was to confirm the safety and efficacy of BC dressing when used in surgical male wound healing at the urogenital area., Methods: Open, non-controlled clinical study of phase II. A total of 141 patients, among those children, adolescents and adults with hypospadias (112), epispadias (04), phymosis (13) and Peyronie's disease (12) that had a BC dressing applied over the operated area after surgery. A written informed consent was obtained from all participants. Study exclusion criteria were patients with other alternative treatment indications due to the severity, extent of the injury or the underlying disease. The outcomes evaluated were efficacy, safe and complete healing. The costs were discussed., Results: In 68% patients, the BC dressing fell off spontaneously. The BC was removed without complications in 13% of patients at the outpatient clinic during the follow-up visit and 17% not reported the time of removal. In 3% of the cases, the dressing fell off early. Complete healing was observed between 8th and 10th days after surgery. The BC dressings have shown a good tolerance by all the patients and there were no reports of serious adverse events., Conclusion: The bacterial cellulose dressings have shown efficacy, safety and that can be considered as a satisfactory alternative for postoperative wound healing in urogenital area and with low cost., Competing Interests: Conflicts of Interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Purpose: To analyze the interaction between the cellulose exopolysaccharide (CEC) and urethral tissue when used as a pubovaginal sling., Materials and Methods: Forty Wistar rats were divided into four groups. In groups A and B the cellulose exopolysaccharide (CEC) was implanted around the urethral tissue (bladder neck below the upper margin) and the rats were sacrificed at 30 and 90 days. Similar procedure was used in groups C and D using a polypropylene mesh. After sacrifice bladder and urethra were sent for histological analysis. The histological parameters (inflammatory reaction) by evaluated by quantitative analysis. For collagen deposition analysis it was used stereological method., Results: The cellulose exopolysaccharide (CEC) was inert and well preserved at the implanted region at the time of examination. Morphologic alterations were not found at the CEC implant but some reactions of foreign body type were observed at the adjacent structures. In some areas a process of neovascular formation was observed. Stereological analysis at the suburethral area showed a significant difference in collagen presence in favor of CEC., Conclusions: The CEC implant showed adequate results when used as a suburethral sling with good integration to the host tissue, preserving its architecture.

Objective: To evaluate biocompatibility of a cellulosic exopolysaccharide (CEC) as bulking agent in rabbit urinary bladder., Materials and Methods: The experimental study was developed at the Nucleus for Experimental Surgery or UFPE. The new agent was injected into the bladder of the adult rabbits using a small abdominal incision. Animals were injected with 0.2 mL of dextranomer microspheres (Dx) plus hyaluronic acid and CEC. The animals were studied after 3 days (G1), 90 days (G2), and 11 months (G3). The biocompatibility was evaluated according to the histologic parameters (presence of blood vessels, inflammatory reaction, and collagen deposition) by a quantitative analysis. The Student paired t test was used for continuous variables, and the scores were compared through the chi-square test., Results: Both materials were structurally homogeneous and free from inflammatory cells or blood vessels (G1). In 3-month samples (G2), CEC areas were densely invaded by fibroblasts and blood vessels. Dx areas were fragmented but still homogeneous and free from cells or blood vessels. Samples from 3 and 11 months showed a significant difference in favor of CEC especially concerning preservation of material in the implant site, as well as the presence of neovascularization. This experimental study represents a positive outcome in terms of reflux resolution in the long term. Further studies may be necessary to confirm its efficacy when in clinical use., Conclusion: The CEC exhibited low inflammatory response and integrated with the host tissue better than Dx in the long-term follow-up., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: One of the main problems faced by surgeons involved in male genitalia surgeries, in particular in children with hypospadias, is the type of dressing and its use during the post-operatory period., Materials and Methods: From a multidisciplinary project involving the use of sugarcane biopolymer membrane developed in the last 10 years, produced by bacterial action over sugarcane molasses, we developed a multiperforated pellicle that, when applied around the penis, protects the surgical field. It is a proven inert material that does not induce any reaction on the surgical field and can be left in situ maintaining the same characteristics during a long period of time without the need of replacement. This multiperforated tape can involve several times the penis shaft and due to its adhesiveness it hardly loosens. We compared the use of this dressing with a commercial one (made by polyurethane). Thirty patients with hypospadias were randomly selected for the use of this new type of dressing in the last 18 months. A similar group of patients used a similar commercial dressing made of polyurethane (Tegaderm) according to the same criteria of use. For safety reasons, we applied one or two sutures without the inclusion of the skin using an absorbable suture in order to prevent early detachment. A small gauze was left for 24 hours in order to absorb any possible bleeding. We recommended the irrigation of the dressing with water or saline at least three or four times a day and the patient was allowed to bath. The dressing did not need any special care and if not removed it usually detached spontaneously after 10 to 14 days., Results: The tolerance to the material was satisfactory and there were no adverse reactions on the penile surface. In two cases of the biopolymer group the dressing detached spontaneously on the first and third days, respectively. In two cases of the polyurethane group it was observed major edema. The grade of satisfaction of the patients and their relatives was excellent on the biopolymer group., Conclusion: This dressing produced by a polysaccharide is a promising alternative for the treatment of children and adolescents submitted to genital surgery. Its main advantage is the possibility of several washes along the day without the need of any other manipulation.

Objectives: Suture materials are widely used in urology. The interaction of these materials with the extracellular matrix in the inflammatory process can be estimated by stereology of collagen fibers and the present study was designed to determine the behavior of the bladder tissue of rats to grafts of the biopolymer of sugar cane (BPCA), and the inflammation and intravesical stone formation compared to the polyglactin 910., Materials and Methods: 42 Wistar rats were divided in four groups: Group I (n = 10) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 4 weeks; Group II (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 4 weeks; Group III (n = 12) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 8 weeks; Group IV (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 8 weeks. Bladders collected at necropsy were analyzed for their weight and the presence of grafts and calculi. Sections were prepared for stereological analysis of collagen fibers., Results: The bladder weight was higher in group I, particularly in the presence of bladder stones. The presence of the graft was observed in 100 % (group I), 80 % (group II), 91.6 % (group III) and 30 % (group IV); polyglactin 910 showed an absorption of 70 % in this period. The stereological analysis showed a higher volume density of collagen fibers in group I versus other groups (p < 0.001)., Conclusion: The BPCA was a material with good integration into the bladder of rats; its absorption was slower than that of the polyglactin 910. The presence of urinary stones was lower in bladders with implantation of BPCA, particularly after 8 weeks. There was a greater initial inflammatory response to BPCA graft that was directly related to the increase in bladder weight and the presence of urinary stones, but that equalized the results of polyglactin 910 after 8 weeks.

Objectives: We evaluated retrospectively, the long-term outcome of patients with post-prostatectomy urinary incontinence (PPUI) after placement of the Periurethral Constrictor (PUC)., Materials and Methods: Fifty-six men with severe PPUI were studied, with a mean age of 68.5 years old. Fifty-one men had PPUI due to radical surgery having the device placed around the bulbous urethra, and five individuals with benign prostatic hypertrophy (BPH) had placement around the bladder neck. The mean follow-up was 82.2 months., Results: Twenty-two patients (39.28%) became continent (0 to 1 pad a day) and 34 (60.72%) were incontinent. Complications were as follows: urethral erosion in 15 (26.78%); mechanical malfunction in 2 (3.5%); infection in 2 (3.5%); urinary fistula in 1 (1.7%); Urinary tract infection1 (1.7%). Twenty-three patients needed to have the device removed (41.07%). Success rate (continent me) was 30.35%., Conclusion: In the present series the PUC was not effective for the treatment of severe PPUI in the long-term follow-up.

Purpose: Children and young adults treated with augmentation procedures with total intestinal flaps are at increased risk for specific complications in the long term. The aim of the present study was to demonstrate the long-term results of demucosalized bladder augmentation., Materials and Methods: A total of 183 patients (92 males and 91 females) were treated with bladder augmentation with the use of de-epithelialized intestinal segments. Patient age ranged from 3 months to 53 years, with a mean of 13.51 years (median 11.0). Of the patients 121 (66.1%) presented with neurogenic bladder, 50 (27.3%) with bladder exstrophy, 7 (3.8%) with tuberculosis, 4 (2.2%) with posterior urethral valves and 1 (0.5%) with female hypospadias. A mold over which the de-epithelialized segment of bowel was applied was used in all patients. A total of 151 cases were augmented using sigmoid colon and 32 using ileum. Data from bladder capacity and compliance were used to evaluate the results., Results: Mean followup was 75.6 months (range 2 to 189). A total of 23 cases (12.6%) were considered failures. Mean bladder capacity was 250.0 ml. An increase of 342.4% was observed postoperatively. Median preoperative compliance was 1.6 ml/cm/H2O. An increase of 762.5% was observed during followup. Seven patients presented with bladder stones. Spontaneous bladder perforation was seen in 2 cases., Conclusions: Significant increase in bladder capacity and compliance was achieved and maintained in the long term. The number of complications was lower compared to traditional methods of augmentation.

Objective: To research technical alternatives for permanent gastrostomy that minimizes the drawbacks and complications reported by several authors., Materials and Methods: An experimental model was developed where the material was divided into 2 groups: the study group (SG) composed of 12 half-breed dogs where the proposed technique was applied, and the control group (CG) composed of 10 animals where a gastrostomy as proposed by Webster in 1974 was applied. On the 90th postoperative day, both groups underwent tests for assessing competence concerning leakage. These were performed under general anesthesia and following sacrifice., Results: In the SG, under anesthesia only one animal had leakage through the gastrostomy. Following sacrifice, leakage was observed in 2 animals. In the CG, under anesthesia, 2 animals had leakage and, following sacrifice, only 1 animal did not present leakage. On histopathological analysis of the SG, gastric mucosa was evidenced around the jejunal tubes, with normal features, moderate inflammatory mononuclear infiltrate in jejunal tubes and only slight infiltrate around the gastrostomy stoma. In the CG, ulceration was constant around the external stoma of the gastrostomy tubes. In the corium, the inflammatory infiltrate was less intense than in the SG. The SG proved to be more efficacious than the CG concerning leakage, and this efficacy is attributed to the submucous valvular system., Conclusions: The featured technique showed competence concerning leakage, allowing its clinical applicability as an alternative for permanent gastrostomy.

Purpose: We present long-term results on the use of demucosalized intestine for reconstructive surgery of the bladder., Materials and Methods: A total of 129 bladder augmentations with demucosalized intestine were performed in 123 patients (55% males and 45% females) 3 months to 53 years old during the last 10 years. Of the patients 82 presented with neurogenic bladder, 40 with bladder exstrophy, 3 each with tuberculosis and posterior urethral valves, and 1 with female hypospadias. Sigmoid was used in 104 cases and ileum in 25. In 105 cases a silicone balloon was left inside the augmented bladder for 2 weeks. In the remaining cases bladder mucosa was preserved and no mold was used. A silicone inflatable bladder neck cuff was implanted at the same time as augmentation in 32 patients., Results: Followup ranged from 3 to 135 months (median 51.0). There was a 329% increase in bladder capacity and compliance increased 7-fold. There were 13 (10.1%) cases considered failures, which were treated with reaugmentation using demucosalized ileum (6), different forms of augmentation (5) and no reaugmentation (2). There was no mucus formation, bladder perforation or neoplasia., Conclusions: Based on our study we conclude that demucosalized intestine is a safe alternative for bladder augmentation and can be used for the same indications as total bowel segments.

Purpose: We report long-term followup of a new device for the treatment of urinary incontinence in children., Materials and Methods: A periurethral constrictor was implanted in 29 boys and 13 girls 3 to 17 years old (mean age 10.2, median age 10) during the last 9 years. Of the patients 29 had neurogenic bladder, 12 had bladder exstrophy and 1 had megalourethra. Bladder augmentation was done simultaneously in 34 patients. The device was implanted around the bladder neck in 41 cases and at the bulbous urethra in 1. Continence was achieved in all cases when the device remained in situ., Results: Followup ranged from 4 to 104 months (mean 63, median 75). In 23 patients (82.1%) in the neurogenic group and the patient with megalourethra the device remains in situ and continence is preserved. Clean intermittent catheterization is performed without difficulty. In 4 patients the device was extracted due to erosion or infection. The device was extracted due to erosion and urine extravasation in 10 exstrophy group patients. Two patients have the device and perform post-void catheterization., Conclusions: Based on the data from this long-term study we conclude that the periurethral constrictor is a safe alternative for the treatment of urinary incontinence in children. Like other devices it must be used with caution in cases of bladder exstrophy.

Objective: To assess the value of the silicone modeler in preventing graft retraction in dogs undergoing bladder replacement with de-epithelialized ileum., Materials and Methods: Twelve female dogs underwent total cystectomy and bladder replacement by neobladder made of demucosalized ileal segment, comparing the group with modeler (group I) and the group without modeler (group II). Cystometry data, graft epithelization and radiological assessment (cystography and excretory urography) were analyzed., Results: Neobladder capacity, at 2 months, ranged from 50 to 250 mL (mean 191 mL) and from 5 to 60 mL (mean 22 mL) and at 6 months, from 60 to 270 mL (mean 202.5 mL) and from 5 to 75 mL (mean- 30.5 mL), respectively in groups I and II, with a statistically significant difference between groups. After 30 days, postoperatively the presence of transitional epithelium was observed in all fragments obtained by biopsy., Conclusion: The use of the intravesical silicone modeler prevented the retraction of the neobladder of de-epithelialized ileum.

Background and Purpose: To assess the safety and feasibility of transcontinental telementored and telepresence surgery, we report on two procedures carried out with participation by surgeons in Baltimore in the United States and São Paulo and Recife in Brazil., Patients and Methods: Over a period of 3 months, a laparoscopic bilateral varicocelectomy and a percutaneous renal access for a percutaneous nephrolithotomy were performed. The mentoring surgeon (LRK) was the same for both procedures. He used a 650-MHz personal computer fitted with a Z360 video COder/ DECoder (CODEC) and a Z208 communication board (Zydacron Corp, Manchester, NH) that comprise the core of the telesurgical station. In the first case, a surgical robot, AESOP 3000 (Computer Motion Inc.), was attached to a laparoscope, and the remote surgeon drove the robot via a controller on the remote computer. In the second case, another robot (Percutaneous Access to the Kidney; PAKY) was used for percutaneous needle placement into the renal collecting system., Results: The two procedures were completed successfully. In the first case, the operative time was 25 minutes, with minimal estimated blood loss. The patient was discharged home the next day. At 3-month follow-up, there was no scrotal pain or varicocele. In the second case, access to the urinary tract was achieved with the first needle pass, and percutaneous nephrolithotomy was uneventful. Blood loss was minimal, and the patient was discharged home on the second postoperative day. At 3-month follow-up, the patient was free of urinary stones and of symptoms., Conclusions: The first transcontinental telementored and telepresence urologic surgical procedures have been reported previously. The success observed with the novel surgical techniques has motivated great interest. The cases reported here demonstrate that several types of procedures can be mentored safely and effectively with telemedicine technology.

Objective: To assess the use of demucosalized ileum for bladder augmentation, following the same principles previously used with the sigmoid colon., Patients and Methods: Eleven patients with bladder exstrophy or a neurogenic bladder had their bladders augmented with demucosalized ileum instead of the sigmoid colon, but following the same technique. The use of a Foley catheter with an inflated balloon greatly facilitated the dissection of the mucosa from the muscle. A silicone model, inserted in the bladder, was used to avoid shrinkage of the patch. An animal model was also used for total bladder replacement following the same principle., Results: The mean (range) follow-up was 15.4 (2-25) months. There was a significant increase in bladder compliance in all patients. A bladder of good shape and compliance was obtained in the animal model, with epithelial growth detected in all cases., Conclusions: Demucosalized ileum can be used safely for bladder augmentation in the same way as with the sigmoid colon. The distension of the isolated patch greatly facilitates dissection between the mucosa and muscle. The animal model supported this method of bladder replacement.

Objective: To determine the long-term effects of the periurethral expander, a new device for the treatment of urinary incontinence in children., Patients and Methods: Twenty-five patients (mean age 11.2 years, range 3-22) had a periurethral expander implanted around the bladder neck within the last 41 months. Twelve of these patients had neurogenic bladders as a result of myelomeningocele, 12 had undergone unsuccessful exstrophy reconstructions and one had megalourethra. Bladder augmentations were carried out in 23 of the patients. The mean follow-up was 23 months., Results: Ten patients had the device removed due to erosion and/or infection; patients with exstrophy were more susceptible to complications. Patients with neurogenic bladders use clean intermittent catheterization and the remainder void spontaneously. The mean pressure in the cuff was 58.7 cmH2O., Conclusion: The periurethral expander seems to be a valid option in the treatment of selected cases of urinary incontinence in children and young adults. There were more complications in patients with exstrophy/epispadias and such patients must be considered unsuitable for this treatment.

Purpose: We report the results of the combination of enterocystoplasty and a periurethral expander, a simplified type of artificial sphincter, in the treatment of urinary incontinence., Materials and Methods: The new 1-piece device has an adjustable cuff connected to a port positioned at the subcutaneous space in the abdomen. The cuff is adjusted to the bladder neck and the pins are fixed according to the diameter of the urethra. The port is punctured percutaneously and saline is injected until continence is achieved. Eight boys and 3 girls underwent nonsecretory sigmoid cystoplasty and placement of the device at a single operation. Nine patients had neurogenic bladder and in 2 exstrophy reconstruction had failed. Followup ranged from 4 to 26 months., Results: All patients were continent with improved bladder compliance 6 to 8 weeks after the operation, when the device was activated. In 1 case the device was extracted after 2 months due to frequent episodes of hematuria and edema at the port site. Two patients had erosion of the skin at the port site. Urodynamics were repeated at the time of activation. Maximal urethral closing pressure increased from 16.27 to 157.44%. Two patients needed a second injection to achieve continence. The patients with exstrophy void spontaneously and those with neurogenic bladder are on clean intermittent catheterization., Conclusions: Although more followup is needed, the combination of these procedures seems to offer a new option for the treatment of urinary incontinence in children.

Objectives: To introduce a new technique for intestinal anastomosis when performing demucosalized enterocystoplasty., Methods: In 8 dogs, a vascularized seromuscular patch of sigmoid colon was harvested without opening the bowel lumen. The bowel mucosa was invaginated into the intestinal lumen and the sigmoid musculature was reapproximated. Twelve patients underwent a nonsecretory sigmoid cystoplasty following the same principle., Results: No complications occurred in the experimental animals. The animals were fed normally starting on the first postoperative day. Prolapse of the excess mucosa occurred in 3 cases and disappeared spontaneously. In the clinical group, the postoperative course was normal. Oral intake was resumed on the first day after the operation. The hospital stay was shorter than that of patients in whom the bowel lumen was opened., Conclusions: The use of demucosalized intestinal patches without opening the intestinal lumen appears to be feasible and is expected to reduce perioperative morbidity. Extensive bowel preparation can be reduced, as can the prophylactic use of antibiotics.

We report the results of experimental and clinical studies in which a de-epithelialized segment of sigmoid colon was used to cover the bladder dome where the mucosa was exposed (auto-augmentation) to increase bladder capacity. Experimentally, the technique was performed in 10 healthy female mongrel dogs and the intestinal segments established continuity perfectly over the exposed bladder mucosa. Histology 30 and 60 days postoperatively showed transitional epithelium lining the intestinal segment at the site of implantation. One island of intestinal mucosa was found. The technique was performed in 10 patients, including 9 with neurogenic bladder secondary to myelomeningocele and 1 with posterior urethral valves. Bladder capacity improved in all cases and intravesical pressure was reduced. Followup ranged from 6 to 43 months. The technique is proposed as a valuable alternative to traditional full-thickness patches of the digestive tract and auto-augmentation.

A new surgical technique for primary reconstruction of bladder exstrophy is described. Human cranial dura mater is used as an alloplastic free graft to replace the missing anterior bladder wall. The technique has been successfully applied to 8 patients and the early achievement of good bladder capacity seems to improve urinary continence.