Involuntary detrusor contractions play an important role in the development of urge incontinence. Also in an in-vitro situation contractions which develop spontaneously can be seen; a parallel with the in vivo observations is likely. In order to study this muscle overactivity we investigated the possibility to induce this phenomenon with oxidative stress using hypochlorous acid (HOCl). Materials and Methods Urinary bladder muscle strips from pigs were mounted in a custom made organ bath and incubated for 20 minutes in Krebs solution. Next HOCl (10µM) was added to the organ bath and the onset of overactive contractions was closely followed. Overactivity was defined as a development of more than 5 phasic detrusor contractions per minute without any other provocation in the 30 minutes following addition of HOCl to the organ bath. Results Of the 50 strips which were used 36 (72%) became overactive after exposure to HOCl during 30 minutes recording. In 76% of the overactive strips overactivity occurred within 5 minutes, in 19% between 5 and 15 minutes, and in 5% it took longer than 15 minutes. The overactivity could be stopped by washing out HOCl for 10 minutes after which still a significant contraction after EFS and ACh stimulation was seen. Conclusions It can be concluded that an oxidative stressor, like HOCl, is capable of inducing smooth muscle overactivity. This model can be used for the development and testing of new treatment modalities for the overactive detrusor. Furthermore, this study provides evidence for a causal relationship between oxidative stress and detrusor overactivity.

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.

OBJECTIVE: The purpose of this study was to compare the effects of castration on cell death rate of the adult rat prostates and to evaluate the benefic action of alpha tocopherol supplementation to avoid apoptosis post-orchiectomy. MATERIAL AND METHODS: Thirty male Wistar rats weighing 250-300g were divided into three groups: group I - they were subjected to bilateral orchiectomy and sacrificed eight weeks after the procedure; group II - subjected to bilateral orchiectomy and alpha-tocopherol supplementation for four weeks preceding the procedure; and group III - subjected to bilateral orchiectomy and alpha-tocopherol supplementation for four weeks preceding the procedure and for eight weeks afterwards. At the end of the experiment, the prostatectomy was performed in all rats. The presence of oxidative stress was determined by assaying the blood level of 8-isoprostane and the occurrence of apoptosis was evaluated by identification of active caspase-3 through immunohistochemical analysis. RESULTS: The statistic analysis of active caspase-3 showed that in the long-term castrated group the detection was higher than in groups were the alpha-tocopherol was supplemented (p=0.007). Analysis of 8-isoprostane levels showed higher concentrations of reactive oxygen species in group I compared to other groups (p<0.05). Groups II and III presented active caspase-3 lower than in group I (p<0.05). CONCLUSION: Our exploratory analyses demonstrate a method to study the aging process and its influence on oxidative stress of prostatic tissue and cells death rate. Based on our results we can suggest that alpha tocopherol supplementation can decrease the apoptotic process as well as the oxidative stress levels induced by androgen deprivation of the prostate gland.

OBJECTIVE: To analyze the impact of low levels of testosterone induced by orchiectomy and the effect of alpha-tocopherol supplementation on oxidative stress in the urethral sphincter. MATERIALS AND METHODS: Forty male Wistar rats weighing 250-300g were divided into four groups with 10 each: Sham group; Orchiectomy group: bilateral orchiectomy; Orchiectomy-pre-Tocopherol group: bilateral orchiectomy preceded by alpha-tocopherol supplementation for four weeks; Orchiectomy-full-Tocopherol group: bilateral orchiectomy with alpha-tocopherol supplementation for four weeks preceding the procedure and for eight weeks afterwards. At the protocol end, animals were euthanized and had the sphincter analyzed stereologically focusing on collagen and muscle fibers percentage. Oxidative stress levels were determined using 8-epi-PGF2. RESULTS: The 8-epi-PGF2 levels were statistically higher (p < 0.0003) in the Orchiectomy group compared to others groups while Sham and Orchiectomy-full-Tocopherol groups presented statistically similar values (p = 0.52). Collagen volumetric densities were significantly lower in Sham and Orchiectomy-full-Tocopherol groups (p < 0.022). Sham group presented statistically greater muscle fiber percent. CONCLUSION: Castration caused oxidative stress in the urethral sphincter complex, with increased collagen deposition. Alpha-tocopherol had a protective effect and its supplementation for twelve weeks provided the greatest protection.

PURPOSE: To evaluate the impact of lower urinary tract symptoms (LUTS) on the quality of life (QoL) in a group of elderly men. MATERIALS AND METHODS: Observational clinical study contained 200 men recruited between March-September 2008 in the community and Urology and Geriatrics ambulatories. The data collected included health and sociodemographic conditions; the International Prostate Symptom Score (IPSS); an anxiety/depression inventory; the World Health Organization Quality of Life -Bref and -Old questionnaires (WHOQoL). Participants were classified according to IPSS: Group I (moderate/severe symptoms) and Group II (absence/mild symptoms) and 100 men were included in each group. RESULTS: The groups were statistically similar in sociodemographic, morbidity, and anxiety/depression scores. Both QoL scales showed significant lower median scores in group I in all parameters, except the global subjective self-evaluation of QoL. The domains social and environmental relations presented the most significative differences (p < 0.0005) in both questionnaires, and final mean WHOQoL-OLD score was lower in group I (p < 0.0005). CONCLUSIONS: For elderly men, moderate to severe LUTS do significantly impact almost all parameters of QoL proposed by the WHO, especially social and environmental relations.

OBJETIVO: traduzir para o português, adaptar culturalmente e validar o questionário Female Sexual Function Index (FSFI). MÉTODOS: dois tradutores brasileiros, cientes dos objetivos desta pesquisa, preparam duas versões do FSFI para o português, as quais foram retro-traduzidas por outros dois tradutores ingleses. As diferenças foram harmonizadas e pré-testadas em um estudo piloto. As versões finais do FSFI e de outro questionário, o Short-Form Health Survey, já vertido e publicado em português, foram simultaneamente administradas a cem pacientes. Foram testadas as propriedades psicométricas do FSFI, como confiabilidade (consistência interna e teste-reteste) e validades de construto. O reteste foi realizado após quatro semanas, a partir da primeira entrevista. RESULTADOS: o processo de adaptação cultural não alterou a versão em português do FSFI comparado ao original. O alfa de Cronbach padronizado do questionário foi 0,96; avaliado por domínios, variou de 0,31 a 0,97. Como medida de confiabilidade teste-reteste, foi aplicado o coeficiente de correlação intra-classes, que foi considerado forte e idêntico (1,0). O coeficiente de correlação de Pearson entre o FSFI e o Short-Form Health Survey foi positivo, mas fraco na maioria dos domínios afins, variando de 0,017 a 0,036. CONCLUSÕES: a versão do FSFI foi traduzida para o português e adaptada culturalmente e é válida para avaliação da resposta sexual das mulheres brasileiras.

PURPOSE: to translate from English into Portuguese, adapt culturally and validate the Female Sexual Function Index (FSFI). METHODS: knowing the objectives of this research, two Brazilian translators have prepared a version each from the FSFI into Portuguese. Both versions have then been retro-translated into English by two English translators. After harmonizing the differences, they have been pre-tested in a pilot study. The final versions from the FSFI and from another questionnaire, the Short-Form Health Survey, which had already been translated and published in Portuguese, have then been simultaneously administered to one hundred patients, to test the FSFI psychometric proprieties concerning reliability (internal consistency and testing-retesting) and construct validity. Retesting was done after four weeks from the first interview. RESULTS: the process of cultural adaptation has not altered the Portuguese version of the FSFI, as compared to the original. The FSFI standardized Cronbach alpha was 0.96, and the evaluation by domains has varied from 0.31 to 0.97. As a measure of test-retest confidentiality, it was applied the intra-class coefficient, which has been considered strong and identical (1.0). Pearson's correlation coefficient between the FSFI and the Short-Form Health Survey was positive, but weak in most of the interrelated domains, varying from 0.017 to 0.036. CONCLUSIONS: the FSFI English version has been translated into Portuguese and culturally adapted, being reliable to evaluate the sexual response of Brazilian women.

Objectives: Classically, it was understood detrusor contractility was affected in bladder areflexia but not in hyperreflexia. We aim to demonstrate that there is some detrusor contractility affectation in bladder hyperreflexias, although it may seem paradoxical at first sight. Methods: Neuro-urologic study was performed in a series of 68 consecutive patients with bladder hyperreflexia (neurogenic detrusor hyperactivity), referred to the unit of functional urology for urodynamic evaluation. All patients underwent clinical history, post void residual determination, cystomanometry, voiding pressure-flow test, videourodynamics and selective EMG of the periurethral sphincter. Detrusor contractile potency was measured with W 80-20. Terminology follows the ICS standard. Data processing was performed using the statistical software SPSS 12.0. Results: This series includes 14 males (58.8%) and 28 females (41.2%), of all ages (adults more frequent). 88.2% of the cases had acquired neurological diseases (trauma 30.9%; medical 33.8%; degenerative 35.3%), and 11.8% congenital neurological diseases (myelodysplasia). Most frequent type of neurological lesion was detrusor-sphincter dyssynergia: 59 cases (79.4%); 22 patients (32.4%) had undergone previous treatment of their vesicourethral dysfunction. The amplitude of detrusor involuntary contractions was wider in detrusor-bladder neck dyssynergia. Detrusor isotonic contractility (W 80-20) was significantly affected, mainly in neurological lesions of traumatic nature and less in degenerative lesions (p = 0.01). Conclusions: We demonstrated that bladder contractility is affected in bladder hyperreflexias (neurogenic detrusor hyperactivity), more important in traumatic lesions without relationship with the type of neurological associated lesion, which could be related to a bladder structural change, or with a change in the central neurological tracts (without requirement of presence of dyssynergia).

Objetivo: Clásicamente se entendía que en las arreflexias vesicales existía una afectación de la contractilidad del detrusor, pero no así en las hiperreflexias vesicales. En nuestro trabajo se pretende demostrar que una afectación en la contractilidad del detrusor se presenta en las hiperreflexias vesicales, aunque a simple vista parezca paradójico. Método: Se realizó un estudio neurourológico en una serie consecutiva de 68 pacientes con hiperreflexia vesical (hiperactividad del detrusor neurogénica), remitidas a la unidad de Urología Funcional para valoración urodinámica. Todos los pacientes fueron sometidos a historia clínica, medición del residuo postmiccional, cistomanometría, test presión detrusor-flujo miccional, videourodinámica y EMG selectiva del esfínter periuretral. La potencia contráctil del detrusor se midió con W80-20. La terminología siguió las normas de la ICS. El procesamiento de los datos se realizó mediante el paquete estadístico SPSS 12.0. Resultados: La serie se refirió a 40 varones (58.8%) y 28 mujeres (41.2%), de todas las edades (más frecuentemente adultos). El 88.2% correspondió a patología neurológica adquirida (traumática 30.9%; médica 33.8%; degenerativa 35.3%), y 11.8 % a patología neurológica congénita (mielodisplasia). El tipo de lesión neurológica más frecuente fue la disinergia detrusor/esfínter periuretral: 59 casos (79.4%); 22 pacientes (32.4%) habían sido sometidos a tratamiento previo de la disfunción vesicouretral. La amplitud de las contracciones involuntarias del detrusor fue mayor en las disinergias detrusor/cuello vesical. La contractilidad isotónica del detrusor (W80-W20) estaba afectada significativamente sobre todo en las lesiones neurológicas de naturaleza traumática y menos en las degenerativas (p=0.01). Conclusiones: Se ha demostrado una afectación de la contractilidad vesical en las hiperrreflexias vesicales (hiperactividad del detrusor neurogénica), más acentuada en las lesiones de naturaleza traumática sin relación al tipo de lesión neurourológica asociada a la hiperreflexia vesical, que podía estar en relación con una alteración estructural vesical, o bien con una alteración a nivel de las vías neurológicas centrales (sin la necesidad de la existencia de una disinergia).

OBJETIVO: Avaliar os efeitos da reeducação postural global (RPG) nos sintomas de incontinência urinária de esforço (IUE) e a qualidade de vida em um grupo de mulheres incontinentes. MÉTODOS: Ensaio clínico aberto, tipo antes e depois, prospectivo, não randomizado. Foram selecionadas 26 mulheres com queixa clínica e estudo urodinâmico compatível com IUE, do Ambulatório de Uroginecologia do Hospital das Clínicas da UNICAMP. A idade média foi de 50,76 anos (23 a 72 anos). Todas as mulheres foram avaliadas por anamnese, exames clínicos e uroginecológico, avaliação postural. Todas foram submetidas a tratamento com RPG, em sessões individuais de 50 minutos semanais por três meses e quinzenais por mais três meses. As pacientes foram submetidas a posturas de alongamento propostas pela técnica, em que se coloca em tensão as cadeias musculares responsáveis pela postura estática e estrutura do corpo. O trabalho ativo da paciente nas correções, aliado à atuação do fisioterapeuta, levam ao reequilíbrio das tensões musculares e reestruturação do corpo, o que pode favorecer as funções, especificamente as relacionadas ao assoalho pélvico. Ao término do tratamento, e após seis meses, as pacientes foram reavaliadas através do questionário de impressão geral de melhora, dos domínios relacionados à IUE do King's Health Questinnaire: impacto da incontinência, em que se avaliam os prejuízos na qualidade de vida; percepção geral da saúde, qual a classificação que a paciente dá para sua saúde no momento e a presença do sintoma de perda por esforço; avaliação funcional do assoalho pélvico (AFA) e número de trocas de protetores diários. RESULTADOS: No término do tratamento, quatro pacientes (16%) estavam curadas, dezoito (72%) melhoraram significativamente e três (12%) falharam. Após seis meses, seis pacientes (24%) estavam curadas, 16 (64%) melhoraram e três (12%) falharam (p <0,001). Ao avaliarmos a qualidade de vida das pacientes, observamos melhora significativa (p <0,05) em todos os domínios questionados, destacando-se percepção geral da saúde, impacto da incontinência e número de episódios de perda. A avaliação do funcional do assoalho pélvico (AFA) e do teste do absorvente (número de troca/dia) também mostrou melhora significativa (p<0,001) nos diferentes tempos de coleta. CONCLUSÃO: Os resultados mostram que a RPG pode ser uma alternativa para o tratamento da IUE.

OBJECTIVE: To evaluate the effect of global postural reeducation (GPR) on stress urinary incontinence (SUI) and quality of life in SUI female patients METHODS: The study design was a prospective non-randomized clinical trial. Twenty-six patients with symptoms of SUI were selected from the Urogynecology Outpatient Clinics of the State University of Campinas (Unicamp), state of São Paulo, Brazil. Age ranged from 23 to 72 years old (mean 50.8). All women were submitted to anamnesis, physical exam, postural evaluation and urodynamic testing. Patients were treated by the GPR in individual 50 minute sessions weekly for three months and twice a month for the next three months. All patients were re-evaluated at the end of treatment and six months later by means of General Impression of Improvement, Incontinence Impact, General Perception of Health, Functional Evaluation of the Pelvic Floor, Number of Leaking Episodes and Pad Use. RESULTS: At the end of treatment 4 (16%) of the patients were cured, 18 (72%) had improved significantly and 3 (12%) failed. At 6 months, 6 (24%) were cured, 16 (64%) improved and 3 (12%) failed (p<0.001). Quality of Life questionnaires presented significant improvement (p<0.05) in all domains, with emphasis on General Perception of Health, Incontinence Impact and number of leaking episodes. The Functional Evaluation of the Pelvic Floor and Pad Use also presented significant (p<0.001) improvement. CONCLUSION: These results may demonstrate that GPR is an efficient alternative for treatment of stress urinary incontinence.

OBJECTIVE: Prospective study to objectively evaluate the benefits of pelvic floor strengthening exercises associated to biofeedback for the treatment of stress urinary incontinence. MATERIALS AND METHODS: Fourteen patients diagnosed with stress urinary incontinence (SUI) were selected for this study. All patients underwent a pelvic floor training associated to biofeedback for 12 consecutive weeks. Urodynamic tests, pad test and bladder diary were analyzed at the beginning of the study, at the end and after 3 months. The King's Health Questionnaire (KHQ) was applied before and after treatment to assess the impact in the quality of life. RESULTS: There was a significant reduction in the pad weight (from 14.21 g to 1 g), number of urinary leakage episodes (from 8.14 per day to 2.57 per day) and daytime frequency (from 7.93 per day to 5.85 per day). At urodynamics the authors observed a significant increase in Valsalva leak-point pressure (from 103.93 cm H2O to 139.14 cm H2O), cistometric capacity (from 249.29 mL to 336.43 mL, p = 0.0015) and bladder volume at first desire to void (from 145 mL to 215.71 mL). Those differences were kept during the first 3 months of follow up. The KHQ revealed significant differences except in the case of "general health perception", which covers health in general and not exclusively urinary incontinence. CONCLUSION: Treatment of SUI with pelvic floor exercises associated to biofeedback caused significant changes in the parameters analyzed, with maintenance of good results 3 months after treatment.