RESUMO Introdução: O hiperparatireoidismo persistente pós-transplante está associado a aumento na incidência de eventos cardiovasculares, fraturas e óbitos. O objetivo deste estudo foi comparar as opções terapêuticas disponíveis: paratireoidectomia (PTX) e o agente calcimimético cinacalcete. Métodos: Estudo retrospectivo de um único centro incluiu pacientes transplantados renais adultos que desenvolveram hipercalcemia devido a hiperparatireoidismo persistente. Critérios de inclusão: PTH > 65 pg/mL com cálcio sérico > 11,5 mg/dL a qualquer momento após o transplante, ou cálcio sérico persistentemente superior a 10,2 mg/dL um ano após o transplante. Os pacientes tratados com cinacalcete (n = 46) foram comparados aos pacientes tratados com paratireoidectomia (n = 30). O período de acompanhamento foi de um ano. Dados clínicos e laboratoriais foram analisados para comparar a eficácia e a segurança de ambas as modalidades terapêuticas. Resultados: a PTX controlou a calcemia mais rapidamente (mês 1 x mês 6) e atingiu níveis significativamente mais baixos no mês 12 (9,1 ± 1,2 v.s. 9,7 ± 0,8 mg/dL, p < 0,05); pacientes submetidos à PTX apresentaram níveis significativamente mais altos de fósforo sérico (3,8 ± 1,0 v.s. 2,9 ± 0,5 mg/dL, p < 0,05) e retornaram aos níveis normais de PTH (45 ± 51 pg/mL). O cinacalcete, apesar de controlar o cálcio e o fósforo no longo prazo, diminuiu, mas não corrigiu o PTH (197 ± 97 pg/mL). A proporção de pacientes que permaneceram com PTH acima da faixa normal foi de 95% no grupo cinacalcete e 22% no grupo PTX. Os pacientes tratados com cinacalcete apresentaram melhor função renal (creatinina 1,2 ± 0,3 v.s. 1,7 ± 0,7 mg/dL, p < 0,05). Conclusões: O tratamento cirúrgico foi superior ao cinacalcete para corrigir os distúrbios metabólicos do hiperparatireoidismo, apesar de estar associado a pior função renal no longo prazo. Cinacalcete provou ser um medicamento seguro e bem tolerado.

ABSTRACT Background: Persistent hyperparathyroidism post-transplant is associated with increases in the incidence of cardiovascular events, fractures, and deaths. The aim of this study was to compare both therapeutic options available: parathyroidectomy (PTX) and the calcimimetic agent cinacalcet. Methods: A single center retrospective study including adult renal transplant recipients who developed hypercalcemia due to persistent hyperparathyroidism. Inclusion criteria: PTH > 65 pg/mL with serum calcium > 11.5 mg/dL at any time after transplant or serum calcium persistently higher than 10.2 mg/dL one year after transplant. Patients treated with cinacalcet (n=46) were compared to patients treated with parathyroidectomy (n=30). Follow-up period was one year. Clinical and laboratory data were analyzed to compare efficacy and safety of both therapeutic modalities. Results: PTX controlled calcemia faster (month 1 x month 6) and reached significantly lower levels at month 12 (9.1±1.2 vs 9.7±0.8 mg/dL, p < 0.05); PTX patients showed significantly higher levels of serum phosphate (3.8±1.0 vs 2.9±0.5 mg/dL, p < 0.05) and returned PTH to normal levels (45±51 pg/mL). Cinacalcet, despite controlling calcium and phosphate in the long term, decreased but did not correct PTH (197±97 pg/mL). The proportion of patients that remained with PTH above normal range was 95% in the cinacalcet group and 22% in the PTX group. Patients treated with cinacalcet had better renal function (creatinine 1.2±0.3 vs 1.7±0.7 mg/dL, p < 0.05). Conclusions: Surgical treatment was superior to cinacalcet to correct the metabolic disorders of hyperparathyroidism despite being associated with worse renal function in the long term. Cinacalcet proved to be a safe and well tolerated drug.

OBJETIVO: verificar se as medidas de atenuação de raios-X em Unidades Hounsfied (HU) preveem os cálculos de oxalato de cálcio mono-hidratado (OCM) em pacientes tratados através de nefrolitotripsia percutânea. MÉTODO: 119 pacientes submetidos a tratamento por nefrolitotripsia percutânea foram avaliados prospectivamente entre fevereiro de 2012 e Agosto de 2014. Utilizando cortes tomográficos finos, o maior valor de atenuação de raios-X para um pixel utilizando tomografia convencional sem contraste foi determinado para cada cálculo. Dados laboratoriais foram avaliados antes da cirurgia. Os cálculos extraídos foram analisados utilizando-se espectrofotometria no infravermelho. RESULTADOS: Através de análise por curva ROC (receicer operating characteristic) um valor de corte de 1548 HU e uma idade de 42,5 anos foram utilizadas para determinar a probabilidade de um cálculo ser composto de OCM. Valores superiores de atenuação de raios-X e de idade aumentaram as chances de um cálculo ser composto de OCM. Em geral, as mulheres apresentaram uma maior probabilidade de ter cálculos de OCM do que os homens. CONCLUSÃO: O valor da medida de atenuação máxima em Unidades Hounsfield de um cálculo, como o determinado pela tomografia computadorizada convencional sem contraste, em associação com o gênero preveem a presença de cálculos de OCM em pacientes submetidos a tratamento por nefrolitotripsia percutânea.

OBJECTIVE: To examine whether the Hounsfield Unit value predicts calcium oxalate monohydrate stones in patients who are undergoing percutaneous nephrolithotomy. METHOD: 119 patients who underwent percutaneous nephrolithotomy were prospectively evaluated between February 2012 and August 2014. Using thin cuts, the highest single-energy computed tomography attenuation value within a pixel was measured for each stone. Data regarding age and gender were assessed before surgery. The extracted stones were analyzed using infrared spectrophotometry. RESULTS: By receiver operating characteristics analysis, a cutoff value of 1548 Hounsfield Unit and an age of 42.5 years were used to determine the likelihood of a stone being composed of calcium oxalate monohydrate. A higher Hounsfield Unit value and increased age augmented the chances of a stone being composed of calcium oxalate monohydrate. In general, females had a greater likelihood of harboring calcium oxalate monohydrate stones than males. CONCLUSION: The maximum Hounsfield Unit value, as determined by unenhanced single-energy computed tomography in association with gender, predicts the presence of calcium oxalate monohydrate stones in patients who are undergoing percutaneous nephrolithotomy.

Purpose To validate the Quality of Erection Questionnaire (QEQ) considering Brazilian social-cultural aspects. Materials and Methods To determine equivalence between the Portuguese and the English QEQ versions, the Portuguese version was back-translated by two professors who are native English speakers. After language equivalence had been determined, urologists considered the QEQ Portuguese version suitable. Men with self-reported erectile dysfunction (ED) and infertile men who had a stable sexual relationship for at least 6 months were invited to answer the QEQ, the International Index of Erectile Function (IIEF) and the RAND 36-Item Health Survey (RAND-36). The questionnaires were presented together and answered without help in a private room. Internal consistency (Cronbach’s α), test-retest reliability (Spearman), convergent validity (Spearman correlation) coefficients and known-groups validity (the ability of the QEQ Portuguese version to differentiate erectile dysfunction severity groups) were assessed. Results We recruited 197 men (167 ED patients and 30 non-ED patients), mean age of 53.3 and median of 55.5 years (23-82 years). The Portuguese version of the QEQ had high internal consistency (Cronbach α=0.93), high stability between test and retest (ICC 0.83, with IC 95%: 0.76-0.88, p<0.001) and Spearman correlation coefficient r=0.82 (p<0.001), which demonstrated the high correlation between the QEQ and IIEF results. The correlations between the QEQ and RAND-36 were significantly low in ED (r=0.20, p=0.01) and non-ED patients (r=0.37, p=0.04). Conclusion The QEQ Portuguese version presented good psychometric properties and high convergent validity in relation to IIEF. The low correlations between the QEQ and the RAND-36, as well as between the IIEF and the RAND-36 indicated IIEF and QEQ specificity, which may have resulted from the patients’ psychological adaptations that minimized the impact of ED on Quality of Life (QoL) and reestablished the well-being feeling.

OBJECTIVE: Lymphocele formation following renal transplantation is a frequent complication and may affect as many as 49% of patients. Operative treatment of symptomatic post transplant lymphocele (PTL) consists of wide drainage of the fluid collection into the abdominal cavity by excising its wall, connecting the lymphocele cavity to the intraperitoneal space. Laparoscopic fenestration seems to be the best treatment as it combines satisfying success rates with a minimally invasive approach. The aim of the study was to review a single center experience on the laparoscopic treatment of symptomatic PTL and detail relevant aspects of the surgical technique. MATERIALS AND METHODS: The data of 25 patients who underwent laparoscopic surgical treatment for a symptomatic lymphocele following kidney transplantation were retrospectively reviewed. Demographic data and surgical results were assessed. Detailed surgical technique is provided. RESULTS: Between 1996 and 2008, 991 patients received a kidney transplant at our institution. Twenty-five patients (2.52%) developed a symptomatic lymphocele and laparoscopic drainage was performed. The indications for surgical drainage were graft dysfunction (84%), local symptoms (16%) or both (32%). The mean time until surgical therapy was 14.2 ± 6 weeks. Mean hospital stay was 1.5 ± 0.2 days. Postoperative complications occurred in only 2 patients (8%) (one ureteral injury and one incisional hernia) and required reoperation. After a mean follow-up of 36.2 ± 4 months, only 1 patient had a symptomatic recurrence. CONCLUSIONS: Laparoscopic fenestration is an effective surgical technique to treat symptomatic lymphocele following kidney transplantation with low recurrence rate and long standing results.

CONTEXTO E OBJETIVO: Os estudos com radionuclídeos são os mais adequados para se estimar a função renal. O ácido dimercaptosuccínico marcado com tecnécio-99m (DMSA-99mTc) é o radiofármaco de escolha para imagens de alta resolução dos rins, permitindo, também, estimar massa de parênquima renal funcionante. O objetivo deste estudo foi avaliar um método mais simples para determinar-se a captação renal absoluta (CRA) de DMSA-99mTc antes de nefrectomias e validá-lo utilizando-se as contagens radioativas das próprias peças de nefrectomia como padrão-ouro. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, desenvolvido no Serviço de Medicina Nuclear do Departamento de Radiologia da Universidade Estadual de Campinas. MÉTODOS: Foram estudados 17 pacientes (12 pacientes do sexo feminino, média de idade de 50,8 anos), selecionados para a realização de nefrectomia. A cintilografia renal foi realizada três a quatro horas após a administração venosa de 188,7 MBq de DMSA-99mTc, seis a 24 horas antes da cirurgia. A CRA in vivo foi determinada utilizando-se a radioatividade da seringa antes da injeção (medida com um calibrador de dose) e as imagens da seringa e dos rins, obtidas em uma câmara de cintilação. Após a cirurgia, o valor de referência para a CRA foi determinado medindo-se a radioatividade da peça de nefrectomia com o mesmo calibrador de dose. RESULTADOS: Os valores de CRA foram muito semelhantes àqueles obtidos com o método de referência, conforme foi demonstrado pela análise de regressão linear (r-quadrado = 0,96). CONCLUSÃO: A estimativa da CRA com o método proposto antes de nefrectomiasparece ser acurado e aplicável ao uso rotineiro.

CONTEXT AND OBJECTIVE: Studies using radionuclides are the most appropriate method for estimating renal function. Dimercaptosuccinic acid chelate labeled with technetium-99m (99mTc-DMSA) is the radiopharmaceutical of choice for high-resolution imaging of the renal cortex and estimation of the functional renal mass. The aim of this study was to evaluate a simplified method for determining the absolute renal uptake (ARU) of 99mTc-DMSA prior to nephrectomy, using the radioactivity counts of nephrectomy specimens as the gold standard. DESIGN AND SETTING: Prospective study at the Division of Nuclear Medicine, Department of Radiology, Universidade Estadual de Campinas. METHODS: Seventeen patients (12 females; range 22-82 years old; mean age 50.8 years old) underwent nephrectomy for various reasons. Renal scintigraphy was performed three to four hours after intravenous administration of a mean dose of 188.7 MBq (5.1 mCi) of 99mTc-DMSA, which was done six to 24 hours before surgery. The in vivo renal uptake of 99mTc-DMSA was determined using the radioactivity of the syringe before the injection (measured using a dose calibrator) and the images of the syringe and kidneys, obtained from a scintillation camera. After surgery, the reference value for renal uptake of 99mTc-DMSA was determined by measuring the radioactivity of the nephrectomy specimen using the same dose calibrator. RESULTS: The ARU measurements were very similar to those obtained using the reference method, as determined by linear regression (r-squared = 0.96). CONCLUSION: ARU estimation using the proposed method before nephrectomy seems to be accurate and feasible for routine use.