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Clinical and Urodynamic results of the Argus T® sling in moderate and severe male stress urinary incontinence after radical prostatectomy – a 5 year prospective study.
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Carvalho, Adilson P.

; Silva, André B.

; Lebani, Bruno R.

; Pinto, Eduardo R.

; Felipe, Mariana R.

; Skaf, Milton

; Girotti, Marcia E.

; Zequi, Stenio C.

; Sacomani, Carlos A. R.

; Almeida, Fernando G.

International braz j urol

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Ago 2023, Volume 49 Nº 4 Páginas 452 - 461

Resumo: En | Texto: En | PDF: En

ABSTRACT Purpose: Sling as a therapeutic option for male stress urinary incontinence (SUI) has been reviewed in the last two decades, as it is a relatively simpliest surgery compared to artificial urinary sphincter and has the ability to modulate urethral compression. This study aims to evaluate the efficacy, rate of complications, quality of life and the effects on bladder emptying of the Argus T® compressive and ajustable sling in moderate and severe male SUI treatment. Materials and Methods: Men eligible for stress urinary incontinence treatment after radical prostatectomy were recruited and prospectively evaluated, from March 2010 to November 2016. It was selected outpatient men with moderate and severe SUI, after 12 months of radical prostatectomy, who have failed conservative treatment. All patients had a complete clinical and urodynamic pre and post treatment evaluation, by means of clinical history, physical examination, urine culture, 1-hour pad test and ICIq-SF questionnaire. The UDS was performed after 12, 18 and 24 months postoperatively. Results: Thirty-seven men underwent sling surgery, 19 patients (51.4%) with moderate and 18 (48.6%) with severe SUI. The minimum follow-up time was 5 years. Overall, we had a success rate of 56.7% at 60 months follow-up. After surgery, we did not observe significant changes in the urodynamic parameters evaluated during the follow-up. No patient had urodynamic bladder outlet obstruction (BOO) after sling implantation. Readjustment of the Argus T® sling was performed in 16 (41%) of the patients and 51% of the patients reported some adverse event. Conclusion: We demonstrate a long-term efficacy and safety of Sling Argus T® as an alternative to moderate and severe male SUI treatment. Furthermore, in our study bulbar urethra compression does not lead to bladder outlet obstruction.

https://doi.org/10.1590/s1677-5538.ibju.2023.0003

BPH treatment: laser for everyone | Opinion: NO
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Almeida, Fernando G.

; Silva, Luciano Teixeira

International braz j urol

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Abr 2018, Volume 44 Nº 2 Páginas 215 - 218

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/s1677-5538.ibju.2018.02.03 1592 downloads

Overactive bladder – 18 years – Part II
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Truzzi, Jose Carlos

; Gomes, Cristiano Mendes

; Bezerra, Carlos A.

; Plata, Ivan Mauricio

; Campos, Jose

; Garrido, Gustavo Luis

; Almeida, Fernando G.

; Averbeck, Marcio Augusto

; Fornari, Alexandre

; Salazar, Anibal

; Dell’Oro, Arturo

; Cintra, Caio

; Sacomani, Carlos Alberto Ricetto

; Tapia, Juan Pablo

; Brambila, Eduardo

; Longo, Emilio Miguel

; Rocha, Flavio Trigo

; Coutinho, Francisco

; Favre, Gabriel

; Garcia, José Antonio

; Castaño, Juan

; Reyes, Miguel

; Leyton, Rodrigo Eugenio

; Ferreira, Ruiter Silva

; Duran, Sergio

; López, Vanda

; Reges, Ricardo

International braz j urol

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Abr 2016, Volume 42 Nº 2 Páginas 199 - 214

Resumo: En | Texto: En | PDF: En

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

https://doi.org/10.1590/S1677-5538.IBJU.2015.0367 2297 downloads

Initial experience with sacral neuromodulation for the treatment of lower urinary tract dysfunction in Brazil
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Rios, Luis Augusto Seabra

; Averbeck, Marcio Augusto

; França, Wagner

; Sacomani, Carlos Alberto Ricetto

; Almeida, Fernando G.

; Gomes, Cristiano Mendes

International braz j urol

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Abr 2016, Volume 42 Nº 2 Páginas 312 - 320

Resumo: En | Texto: En | PDF: En

ABSTRACT Objectives: We report on the short-term outcomes of sacral neuromodulation (SNM) for treatment of idiopathic lower urinary tract dysfunction in Brazil (procedures performed before 2014). Materials and Methods: Clinical data and surgical outcomes of patients who underwent SNM staged procedures were retrospective evaluated. Urological assessment included a focused medical history and physical examination, measurement of postvoid residual volumes, urodynamics, and bladder diaries. A successful test phase has been defined by improvement of at least 50% of the symptoms, based on bladder diaries. Results: From January 2011 to December 2013, eighteen consecutive patients underwent test phase for SNM due to refractory overactive bladder (15 patients), non-obstructive chronic urinary retention (2 patients), and bladder pain syndrome/interstitial cystitis (1 patient). All patients underwent staged procedures at four outpatient surgical centers. Mean age was 48.3±21.2 (range 10-84 years). There were 16 women and 2 men. Median follow-up was 3 months. Fifteen patients (83.3%) had a successful test phase and underwent implantation of the pulse generator (IPG). Median duration of the test phase was 7 days (range 5–24 days). Mean age was 45.6±18.19 years in responders versus 61.66±34.44 years in non-responders (p=0.242). Mean operative time (test phase) was 99±33.12 min in responders versus 95±35 min for non-responders (p=0.852). No severe complications were reported. Conclusion: SNM is a minimally invasive treatment option for patients with refractory idiopathic lower urinary tract dysfunction. Our initial experience with staged technique showed that tined-lead electrodes yielded a high rate of responders and favorable clinical results in the short-term follow-up.

https://doi.org/10.1590/S1677-5538.IBJU.2014.0603 1287 downloads

Overactive bladder – 18 years – part I
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Truzzi, Jose Carlos

; Gomes, Cristiano Mendes

; Bezerra, Carlos A.

; Plata, Ivan Mauricio

; Campos, Jose

; Garrido, Gustavo Luis

; Almeida, Fernando G.

; Averbeck, Marcio Augusto

; Fornari, Alexandre

; Salazar, Anibal

; Dell'Oro, Arturo

; Cintra, Caio

; Sacomani, Carlos Alberto Ricetto

; Tapia, Juan Pablo

; Brambila, Eduardo

; Longo, Emilio Miguel

; Rocha, Flavio Trigo

; Coutinho, Francisco

; Favre, Gabriel

; Garcia, José Antonio

; Castaño, Juan

; Reyes, Miguel

; Leyton, Rodrigo Eugenio

; Ferreira, Ruiter Silva

; Duran, Sergio

; López, Vanda

; Reges, Ricardo

International braz j urol

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Abr 2016, Volume 42 Nº 2 Páginas 188 - 198

Resumo: En | Texto: En | PDF: En

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

https://doi.org/10.1590/S1677-5538.IBJU.2015.0365 3261 downloads

Acellular human glans extracellular matrix as a scaffold for tissue engineering: in vitro cell support and biocompatibility
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Egydio, Fernanda M.

; Freitas Filho, Luiz G.

; Sayeg, Kleber

; Laks, Marcus

; Oliveira, Andréia S.

; Almeida, Fernando G.

International braz j urol

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Out 2015, Volume 41 Nº 5 Páginas 990 - 1001

Resumo: En | Texto: En | PDF: En

ABSTRACT Objectives: Diseases of the genitourinary tract can lead to significant damage. Current reconstructive techniques are limited by tissue availability and compatibility. This study aims to assess if the decellularized human glans can be used as a biomaterial for penile reconstruction. Materials and Methods: Samples of the glans matrices were descellularized. We evaluate the presence of collagen type I and III, and elastic fibers. Biocompatibility assays were performed to assess the cytotoxic and non-cytotoxic interactions between the acellular matrix and 3T3 cells. The matrices were seeded with mesenchymal stem cells and were assessed for viability and integration of these cells. Biomechanical tests in native tissue, descellularized matrix and seeded matrix were performed to characterize their biomechanical properties. Results: The tissue architecture of the decellularized matrix of human glans was preserved as well as the maintenance of the biomechanical and biological properties. The analyzes of glans seeded with mesenchymal stem cells revealed the integration of these cells to the matrices, and its viability during two weeks "in vitro". Conclusion: The decellularization process did not alter the biological and biomechanical characteristics of the human glans. When these matrices were seeded they were able to maintain the cells integrity and vitality.

https://doi.org/10.1590/S1677-5538.IBJU.2014.0422 57187 downloads

Prostate-Specific Antigen testing in men between 40 and 70 years in Brazil: database from a check-up program
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Zambon, João Paulo

; Almeida, Fernando G.

; Conceição, Raquel Dilguerian O

; Tabone, Viviane Arevalo

; Kashiwagi, Nea Miwa

; Ross, Christina L.

; Carvalho, José Antônio Maluf de

International braz j urol

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Dez 2014, Volume 40 Nº 6 Páginas 745 - 752

Resumo: En | Texto: En | PDF: En

Objectives To evaluate the PSA in a large population of Brazilian men undergone to check up, and correlate the PSA cutoffs with prostate size and urinary symptoms. Materials and Methods This is a cross sectional study performed with men between 40 and 70 years undergone to check-up. All men were undergone to urological evaluation, digital rectal examination, prostate-specific antigen, and ultrasonography The exclusion criteria were men who used testosterone in the last six months, or who were using 5 alpha-reductase inhibitors. Results A total of 5015 men with an average age of 49.0 years completed the study. Most men were white and asymptomatic. The PSA in the three different aging groups were 0.9 ± 0.7ng/dL for men between 40 and 50; 1.2 ± 0.5ng/dL for men between 50 and 60; and 1.7 ± 1.5ng/dL for men greater than 60 years (p=0.001). A total of 192 men had PSA between 2.5 and 4ng/ml. From these men 130 were undergone to prostate biopsy. The predictive positive value of biopsy was 25% (32/130). In the same way, 100 patients had PSA >4ng/mL. From these men, 80 were undergone to prostate biopsy. In this group, the predictive positive value of biopsy was 40% (32/100). The Gleason score was 6 in 19 men (60%), 7 in 10 men (31%) and 8 in 3 men (9%). Conclusions The PSA level of Brazilian men undergone to check up was low. There was a positive correlation with aging, IPSS and prostate size.

https://doi.org/10.1590/S1677-5538.IBJU.2014.06.05 2623 downloads

Uroflowmetry in a Large Population of Brazilian Men Submitted to a health check up program and its correlation with ipss and prostate size
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Zambon, Joao Paulo

; Batezini, Nelson Sivonei da Silva

; Karam Junior, Amir Jamil

; Conceicao, Raquel Dilguerian Oliveira

; Carvalho, Jose Antonio Maluf de

; Almeida, Fernando G.

International braz j urol

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Dez 2013, Volume 39 Nº 6 Páginas 841 - 846

Resumo: En | Texto: En | PDF: En

Purpose The aim of this study was to assess the uroflowmetry data in a large population of asymptomatic Brazilian men submitted to a health check up program and their correlation to IPSS and prostate size. Materials and Methods Asymptomatic men underwent a health check-up program between January and December 2012. The inclusion criteria were men between 40 and 70 years, IPSS ≤ 7, without bladder, prostate, urethral surgery, neurological diseases, urinary tract infection, PSA < 4.0 ng/dL and urinary volume higher than 150 mL. Urological assessment consisted of clinical history, IPSS, digital rectal examination (DRE), prostate specific antigen (PSA), urinalysis, ultrasonography and uroflowmetry. Results A total of 1041 asymptomatic men were included in this study. The average age was 49 years and average maximum flow rate was 17.4 mL/s. In spite of IPSS and prostate size increase with aging, they had a weak correlation with Qmax cutoffs (10 mL/s and 15 mL/s). A total of 85 men (8.3%) had more than 60 years, and even in this group, Qmax was higher than 15 mL/s. Out of 1041 men, 117 had IPSS less than 8 and Qmax less than 10 mL/s. Conclusions In asymptomatic men there is a weak correlation between IPSS, prostate size and uroflowmetric data. The establishment of different normal cutoffs seems to be complicated and uroflowmetry data should be interpreted with caution in order to avoid misdiagnosis.

https://doi.org/10.1590/S1677-5538.IBJU.2013.06.10 4030 downloads

Determining the variables associated to clean intermittent self-catheterization adherence rate: one-year follow-up study
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Girotti, Marcia Eli

; MacCornick, Sarita

; Perissé, Humberto

; Batezini, Nelson S

; Almeida, Fernando G.

International braz j urol

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Dez 2011, Volume 37 Nº 6 Páginas 766 - 772

Resumo: En | Texto: En | PDF: En

PURPOSE: To determine adherence rate and variables associate with patients' adherence to Clean Intermittent Self Catheterization (CISC). MATERIALS AND METHODS: Patients refereed to CISC training program between July 2006 and May 2008, were prospectively evaluated with urodynamic, 3 days bladder diary (BD) and WHOQoL-bref questionnaire. After training to perform CISC, patients were evaluated at 2 weeks, monthly for 6 months and at 12 months with clinical visits and BD. Patients were considered adherent if they were performing at least 80% of the initial recommendation. RESULTS: Sixty patients (50.4 ± 19.9 years old) were trained to perform CISC (21 female and 39 male). Out of them, 30 (50%) had neurogenic and 30 (50%) had a non-neurogenic voiding dysfunction. The adherence rate at 6 and 12 months was 61.7%, 58%, respectively. Patients < 40 years old had adherence rate of 86%. Women and neurogenic patients had higher adherence rate than their counterparts (p = 0.024 and p = 0.016, respectively). In the WHOQoL-bref, patients that adhere to the program had a significant higher score on psychological and social relationships domains. There was not difference in pre and post training WHOQoL-bref scores. Educational background, marriage status, detrusor leak point pressure, Bladder Capacity, number of leakage episodes did not play a role on the adherence rate. CONCLUSION: Patients in CISC program present a reasonable adherence after one year. Women, neurogenic voiding dysfunction and patients under 40 years old were significantly more adherents. The psychological and social relationship status seems to positively interfere on adherence. CISC did not affect patient's QoL evaluated by WHOQoL-bref.

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