RESUMO
ABSTRACT Purpose: False-negative urodynamic findings may mislead or prevent planned treatments due to unmatched findings with the clinical presentation. We hypothesized that the absence of urodynamic demonstration of SUI or OAB on urodynamics would interfere with clinical outcomes. Materials and Methods: Materials and Methods: We prospectively studied 124 women with (94) or without (30) demonstrable SUI after sling operations. Similarly, 64 women with OAB syndrome with (38) or without (26) demonstrable DO were also compared after treatment with anticholinergic agents. Patients were assessed with the UDI-6 and IIQ-7 questionnaires 3 and 6 months after treatment. Results: Only 76% of SUI patients demonstrated urine leakage during urodynamics. The UDI-6 score was higher in the demonstrable-SUI and demonstrable-DO groups, while the IIQ-7 score was comparable within the incontinence or urgency/frequency groups. Demonstrable and non-demonstrable SUI-operated patients showed similar outcomes. Patients with urgency syndromes with or without demonstrable DO had a similar rate of improvement with anticholinergic therapy. Conclusions: Women with clinical complaints of SUI objectively demonstrated on urodynamics presented the same subjective clinical outcome as those with SUI lacking objective demonstration when measured by the UDI-6 and IIQ-7 questionnaires. Similarly, patients with OAB syndrome with or without demonstrable DO had similar clinical improvement when treated with anticholinergics and measured using the same questionnaires.
Assuntos
Humanos , Feminino , Incontinência Urinária , Incontinência Urinária por Estresse/tratamento farmacológico , Procedimentos Cirúrgicos Urológicos , Síndrome , Urodinâmica , Resultado do TratamentoRESUMO
PURPOSE: False-negative urodynamic findings may mislead or prevent planned treatments due to unmatched findings with the clinical presentation. We hypothesized that the absence of urodynamic demonstration of SUI or OAB on urodynamics would interfere with clinical outcomes. MATERIALS AND METHODS: We prospectively studied 124 women with (94) or without (30) demonstrable SUI after sling operations. Similarly, 64 women with OAB syndrome with (38) or without (26) demonstrable DO were also compared after treatment with anticholinergic agents. Patients were assessed with the UDI-6 and IIQ-7 questionnaires 3 and 6 months after treatment. RESULTS: Only 76% of SUI patients demonstrated urine leakage during urodynamics. The UDI-6 score was higher in the demonstrable-SUI and demonstrable-DO groups, while the IIQ-7 score was comparable within the incontinence or urgency/frequency groups. Demonstrable and non-demonstrable SUI-operated patients showed similar outcomes. Patients with urgency syndromes with or without demonstrable DO had a similar rate of improvement with anticholinergic therapy. CONCLUSIONS: Women with clinical complaints of SUI objectively demonstrated on urodynamics presented the same subjective clinical outcome as those with SUI lacking objective demonstration when measured by the UDI-6 and IIQ-7 questionnaires. Similarly, patients with OAB syndrome with or without demonstrable DO had similar clinical improvement when treated with anticholinergics and measured using the same questionnaires.
Assuntos
Incontinência Urinária por Estresse , Incontinência Urinária , Feminino , Humanos , Síndrome , Resultado do Tratamento , Incontinência Urinária por Estresse/tratamento farmacológico , Urodinâmica , Procedimentos Cirúrgicos UrológicosRESUMO
AIMS: Involuntary Detrusor Contraction (IDC) may alter therapeutic plans; therefore, urodynamic demonstration (UD) is pivotal. We explore if same session repetitions enhance its demonstration and minimize false-negative results. METHODS: Two hundred fifty two women (mean age 47 ± 5.7) had 4 full repetitions of UD with the last round filled with 4°C fluid (Ice-water test). IDC was diagnosed if with at least 3 cm H2O after artifacts were ruled out. RESULTS: 44.4% of the cases showed IDC in the first round of the exam but it could be demonstrated in 88.5% of the women if 4 rounds are taken into account. Only 2 cases showed IDC exclusively in the first round. Nine cases (3.5%) showed IDC in the first round and only on Ice-test, while all other IDC-detected cases revealed it in scattered patterns along the repetitions. Likewise, IDC detection on the second, third and fourth rounds varied widely and unpredictably, many failing to show a consistent pattern of presentation after its detection. IDC wave amplitude did not show any correlation to the detection. CONCLUSIONS: Urodynamic repetition is a necessary procedure where IDC is important to demonstrate, as its false-negative rate is high and its unpredictable pattern of detection may be improved by repetition.
Assuntos
Contração Muscular/fisiologia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária/patologia , Incontinência Urinária por Estresse/diagnóstico , Transtornos Urinários/diagnóstico , Transtornos Urinários/fisiopatologia , Adulto , Idoso , Artefatos , Reações Falso-Negativas , Feminino , Humanos , Pessoa de Meia-Idade , Hipertonia Muscular/fisiopatologia , Músculo Liso/patologia , Prolapso de Órgão Pélvico/cirurgia , Estudos Prospectivos , Recidiva , Reprodutibilidade dos Testes , Temperatura , Infecções Urinárias/cirurgia , UrodinâmicaRESUMO
Objectives Determine what happens to patients after unsuccessful SUI operations and to explore the reasons why these patients change doctors. Materials and Methods One hundred consecutive failed patients treated for SUI were interviewed about the exams requested after persistence of the incontinence as well as the reasons they abandoned their primary doctors through a structured questionnaire. Results Among the patients with cases of anterior colporrhaphy, bladder suspensions or slings, 34.3%, 13.7% and 8.3%, respectively, were not offered any further type of investigative procedures to clarify the failure. Urodynamic evaluations were recommended in 75% of failed slings, and 66.6% of the patients proceeded with these tests. In contrast, only 31% of patients with bladder suspensions and 40% of patients with anterior colporrhaphy were recommended for urodynamic investigations, and only 44.4% and 28.5% of them, respectively, proceeded with the option. Patients´ delusions were reinforced by the doctors’ attitude toward the investigations. Vacuous justifications and the lack of intention to seek improvement were the driving forces causing the patients to change doctors. Conclusion Unsuccessful patients are evaluated in a non-protocol form. Difficulty in clarifying the reasons for surgical failure and the disruption of the doctor-patient relationship are the main reasons why patients abandon them. .
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Incontinência Urinária por Estresse/cirurgia , Satisfação do Paciente , Relações Médico-Paciente , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Falha de Tratamento , Urodinâmica , Bexiga Urinária/fisiopatologia , Bexiga Urinária/cirurgia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/psicologia , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
OBJECTIVES: Determine what happens to patients after unsuccessful SUI operations and to explore the reasons why these patients change doctors. MATERIALS AND METHODS: One hundred consecutive failed patients treated for SUI were interviewed about the exams requested after persistence of the incontinence as well as the reasons they abandoned their primary doctors through a structured questionnaire. RESULTS: Among the patients with cases of anterior colporrhaphy, bladder suspensions or slings, 34.3%, 13.7% and 8.3%, respectively, were not offered any further type of investigative procedures to clarify the failure. Urodynamic evaluations were recommended in 75% of failed slings, and 66.6% of the patients proceeded with these tests. In contrast, only 31% of patients with bladder suspensions and 40% of patients with anterior colporrhaphy were recommended for urodynamic investigations, and only 44.4% and 28.5% of them, respectively, proceeded with the option. Patients' delusions were reinforced by the doctors' attitude toward the investigations. Vacuous justifications and the lack of intention to seek improvement were the driving forces causing the patients to change doctors. CONCLUSION: Unsuccessful patients are evaluated in a non-protocol form. Difficulty in clarifying the reasons for surgical failure and the disruption of the doctor-patient relationship are the main reasons why patients abandon them.
Assuntos
Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Relações Médico-Paciente , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Falha de Tratamento , Bexiga Urinária/fisiopatologia , Bexiga Urinária/cirurgia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/psicologia , Urodinâmica , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
INTRODUCTION: The prevalence of bladder outlet obstruction in men has been overestimated leading to improper clinical results after transurethral resection of the prostate. PATIENTS AND METHODS: 3,830 consecutive male cases submitted for urodynamic evaluation were prospectively analyzed using a Schaefer nomogram. The prevalence of detrusor overactivity and the occurrence of obstruction were prospectively studied using standardized urodynamic practice. RESULTS: Infravesical obstruction was diagnosed in 44.8% of the studied population: 0.7% of the obstructed cases were obstructed at the sphincter zone and 7.9% showed obstruction as a high-pressure, high-flow-rate pattern. Detrusor overactivity was demonstrated in 73.9% of the obstructed cases and in 22% of the unobstructed. Older patients (>60 years) seemed more likely (odds ratio: 2.8) to present detrusor overactivity, but at the same time showed less frequent obstruction. The oldest subjects (>80 years) showed a lower prevalence of obstruction, although overactive bladder was a common finding. CONCLUSION: Infravesical obstruction is less frequent than previously stated. The common assumption that obstruction is the cause of lower urinary tract symptoms in older men is wrong. Older men are more likely to suffer from detrusor overactivity resulting from lower urinary tract symptoms rather than infravesical obstruction. Urodynamic studies seem to be crucial for a proper diagnosis in men considered candidates for surgical treatment.
Assuntos
Prostatismo/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Prostatismo/complicações , Prostatismo/fisiopatologia , Obstrução do Colo da Bexiga Urinária/complicações , Obstrução do Colo da Bexiga Urinária/fisiopatologia , UrodinâmicaRESUMO
OBJETIVO: Analisar a resposta bioquímica nas variáveis volume prostático, valor do antígeno prostático específico (PSA), escores de Gleason, estádio, risco da doença e hormonioterapia. MATERIAIS E MÉTODOS: No período de fevereiro de 1998 a julho de 2001, 46 pacientes com câncer de próstata foram tratados com radioterapia, numa combinação de teleterapia e braquiterapia de alta taxa de dose (BATD). A idade variou de 51 a 79 anos (média de 66,4 anos). O estádio T1c foi o mais freqüente: 30 (65 por cento). O escore de Gleason era abaixo de 7 em 78 por cento dos pacientes. O PSA variou de 3,4 a 33,3, estando abaixo de 10 em 39 por cento das vezes. O volume prostático médio foi de 32,3 cc. Um total de 28 por cento dos pacientes recebeu hormonioterapia. A dose de teleterapia variou de 45 a 50,4 Gy, associada a quatro frações de BATD de 4 Gy. RESULTADOS: O seguimento variou de 6 a 43 meses. Quatro pacientes perderam seguimento e quatro morreram (um por doença). Dos 39 pacientes analisados, 76 por cento apresentaram PSA menor que 1,5. Nenhuma das variáveis analisadas foi estatisticamente significante (p > 0,05) com relação ao controle bioquímico. CONCLUSAO: A utilização de BATD foi eficiente no tratamento do câncer de próstata e, neste estudo, as variáveis consideradas como fatores prognósticos não interferiram no controle bioquímico.
Assuntos
Masculino , Pessoa de Meia-Idade , Humanos , Antígeno Prostático Específico , Braquiterapia/efeitos adversos , Neoplasias da Próstata/terapia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/etiologiaRESUMO
INTRODUCTION: An alternative technique for kidney transplantation is presented for patients in whom the use of pelvic vessels is precluded. PATIENTS AND METHODS: Of 482 cases of kidney or pancreas-kidney transplants, 4 were unsuited to heterotopic grafting, 1 due to multiple operations in the fossae and the 3 others due to extensive vascular occlusive disease. The patients were studied preoperatively by magnetic resonance angiography, which revealed extensive occlusive disease of the distal aorta and/or iliac vessels. RESULTS: The patients received kidneys from living related donors as a third or second transplant opportunity in the orthotopic position (2 cases). Gross dissection of the aorta revealed a thickened wall, impeding direct anastomoses between the recipient's arteries and the donated organ. After a termino-lateral Dacron graft to the aorta, all cases were stented for uretero-uretero anastomosis. Recovery with respect to the renal graft was uneventful for all cases. CONCLUSIONS: Alternative direct grafting from the aorta represents a viable and easy way to perform kidney transplants in patients unsuited to the heterotopic approach.
Assuntos
Aorta Abdominal/cirurgia , Transplante de Rim/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pelve , Fatores de RiscoRESUMO
AIMS: To compare the long-term results of stress urinary incontinence (SUI) treatment involving the fascial or vaginal sling operations. MATERIAL AND METHODS: Two-hundred-thirty-two women were consecutively submitted to fascial or vaginal sling operations due to urodynamic proven SUI. The fascial group had a median age of 47.3 years with a parity of 2.2 and 1.8 surgeries/patient, while the vaginal group demonstrated a median age of 48.5 years with a median parity of 3.1 and 2.2 anterior surgeries/patient. The results were subjectively classified as cured--no further pads, greatly improved--very rare dribbling, improved--eventual dribbling necessitating one pad, no cure--with no urine loss change and worse. The number of pads/day, the presence of urgency or urge-incontinence episodes were all measured. Statistical analysis using Fisher's exact test was employed. RESULTS: The patients were followed up for an average time of 70.3 and 44.9 months, in the fascial and vaginal sling group respectively. Subjective clinical success rate was 93.7% for the fascial sling group and 79.8% for the vaginal one, however, the stratification of the results favored the fascial sling group mostly with 74.4% (94 cases) of the cases with total urinary control and no voiding dysfunctions. Only two cases (1.6%) in this group classified themselves as worsened. On the other hand, the vaginal sling subset revealed cure with total clinical satisfaction and no urinary complaint in 61.5% (62 females) (P > 0.05). Thirteen cases (12.5%) reported recurrence of the urine loss under stress and these constituted the failure group. The average number of pads diminished from 3.3 (+/- 0.8) to 0.2 (+/- 0.2) and from 3.2 (+/- 0.7) to 0.6 (+/- 0.5) after the surgery, for the fascial and vaginal sling operations respectively. Return to daily activities occurred after 9.3 days (+/- 1.2, max: 33, min: 2) for the fascial slings and 5.3 days (+/- 0.2, max: 17, min: 2) in the vaginal group. Surgical complications were compared between the groups. Time to urethral voiding varied according to expertise, demonstrating a diminishing tendency after the initial 20 cases. Female obstruction was observed in 11.1% of the fascial slings and 8.6% after vaginal approach, but none in the vaginal group required urethrolysis. Looking individually, the FS group migrated to the worse results while the VWS group started to lose the efficiency after 6 months. CONCLUSIONS: Sling operations are a safe and efficacious option to treat SUI, however, the results can vary according to the technique employed. Shorter efficacy and fewer complications are observed in vaginal wall sling operations, while durable results, but with a higher rate of voiding dysfunctions compromising the long-term clinical satisfaction may be observed after excessive urethral suspensions, as in fascial sling suspension.
Assuntos
Procedimentos Cirúrgicos em Ginecologia , Incontinência Urinária por Estresse/cirurgia , Vagina/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Retocele/etiologia , Resultado do Tratamento , Obstrução Ureteral/epidemiologia , Obstrução Ureteral/etiologia , Uretra/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Transtornos Urinários/epidemiologia , Transtornos Urinários/etiologia , Urodinâmica/fisiologiaRESUMO
CONTEXT: Antibiotic prophylaxis in transurethral resection of the prostate is a regular practice in urology. However, its prophylactic effect can be questioned when the antiseptic surgical technique is used. Nonetheless, urine culture-oriented antibiotic therapy is the gold standard for avoiding improper medication usage and bacterial resistance. OBJECTIVE: To study the efficacy of antibiotic usage in patients with negative urine cultures, who were submitted to transurethral resection of the prostate. TYPE OF STUDY: Prospective open labeled study. SETTING: Tertiary care referral hospital. PARTICIPANTS: 124 consecutive patients, who were randomly divided into two groups to receive antibiotic prophylaxis or not. MAIN MEASUREMENTS: Cultures from meatus, urine, irrigation and antiseptic fluid, and prostate tissue chips, were compared and analyzed for bacterial sensitivity to the antibiotic used, according to the surgeon's personal criteria. McLennan's test was used for statistical analysis. RESULTS: No statistically significant difference regarding clinical evolution was found between the groups that received or antibiotics or not. Statistical significance was found regarding the occurrence of positive urine cultures during the postoperative period for those not receiving antibiotics, but not in relation to fever, prostate chip culture or bacteremic episodes. Sixty-eight subjects (57.1%) presented positive prostatic tissue culture. There was no specific correlation between the recovered bacteria from the meatus, prostatic tissue chip and urine and the spectrum of the administered antibiotic. Six cases showed the same bacteria in the urine and prostatic tissue chip. Only fifteen cases (25%) in the antibiotic group showed the desired sensitivity directed to the collected bacteria. CONCLUSIONS: Antibiotic prophylaxis for patients whose urine is sterile is debatable in patients who are candidates for transurethral resection of the prostate. Most of the time, the antibiotic agent used is not specific for any of the bacteria recovered from the various sources analyzed.