OBJECTIVE: The incorporation of bowel segments for urinary tract reconstruction may induce intestinal mucosal changes with the development of metabolic, nutritional, gastrointestinal and carcinogenic complications. The early histological and histochemical changes of the intestinal mucosa in contact with the feces-urine mixture, are evaluated in the present study. MATERIALS AND METHODS: Twelve rats (operated group) were submitted to a vesico-colonic anastomosis, and 10 rats (control group) underwent a sham operation (the colon was opened and immediately sutured). On the operated group, the left colon was divided into 3 equal portions and the middle segment was used for the bladder-colonic anastomosis. After 20 weeks, the animals were sacrificed and the entire left colon in each group, as well as the bladder and the vesico-colonic anastomosis in the operated group, was removed. The proximal, middle (anastomotic site in the operated group and sutured portion in the control group) and distal colon were used for histological and histochemical studies. RESULTS: Metaplasia, chronic inflammatory process and fibrosis were significantly greater at the anastomotic site compared to the middle segment of the control group. There were no differences in both groups in terms of dysplasia, atrophy and hypertrophy either on the proximal, middle or anastomotic area and distal portion of the left colon. All animals in the operated group showed a reduced presence of sulfomucin and an increase in the sialomucin content. CONCLUSION: The histological changes observed in this study may suggest a precancerous phenomenon.

Purpose: To analyse the success of transvaginal urethrolysis in resolving voiding dysfunction in patients following an anti-incontinence procedure. Materials and Methods: A retrospective chart review was performed on 20 patients who had undergone transvaginal urethrolysis for urethral obstruction following an anti-incontinence procedure. Preoperatively, a history was taken, pelvic examination and urodynamic were done. Mean patient age was 48 years, and the median time between the anti-incontinence procedure and the urethrolysis was nine months. Four patients had urinary retention and had irritative voiding symptoms. Previous surgery included pubovaginal sling in eleven patients, retropubic urethropexy in three and bladder neck suspension in six cases. Mean length of follow up after urethrolysis was 14 months. The urodynamic study demonstrated voiding flow rate of 9,9ml/s and detrusor pressures at maximum flow of 48cmH2O. Results: Of the 20 patients 14 (70%) had relief of symptoms after a single urethrolysis, while two patients underwent a second transvaginal urethrolysis, with placement of a Martius flap between the urethra and the symphysis. There was no correlation between preoperative parameters examined and the outcome from urethrolysis. Conclusion: Our data support transvaginal urethrolysis for the treatment of urethral obstruction after anti-incontinence surgery. It is effective and minimally invasive technique with good results that should be considered if voiding dysfunction does not resolve spontaneously.

Objetivos: Analizar los resultados de la uretrolisis transvaginal como medida terapéutica para la disfunción miccional, en pacientes sometidas previamente a cirugía anti-incontinencia. Materiales y Métodos: Fue realizado un estudio retrospectivo, en 20 pacientes quienes fueron sometidas a uretrolisis por obstrucción uretral secundaria a una cirugía anti-incontinencia. Pre-operatoriamente fueron realizados historia, examen físico y estudio urodinámico. La edad media de las pacientes fue 48 años. El tiempo de evolución entre la cirugía y la uretrolisis, varió de 3 meses a 8 años. Cuatro pacientes presentaron retención urinaria y las demás referían síntomas irritativos. Las cirugías previas incluían: sling pubo vaginal en 11 pacientes, uretropexia retropúbica en 3 y suspensión del cuello vesical con aguja en 6. El seguimiento posterior a la realización de la uretrolisis fue de 14 meses. La evaluación urodinámica demostró un flujo urinario promedio de 9,9 ml/s y presión detrusora media en el flujo máximo de 48cmH2O. Resultados: Aproximadamente 70% de las pacientes presentaron mejoría subjetiva total de los síntomas. Dos pacientes presentaron falla del método y fueron sometidas a nueva uretrolisis con interposición de flap de Martius. No hubo correlación entre los parámetros clínicos y urodinámicos encontrados en el pre operatorio y los resultados posteriores a la uretrolisis. Conclusión: Tratamos de demostrar que la uretrolisis posterior a cirugía anti-incontinencia es un procedimiento efectivo, mínimamente invasivo que permite resultados satisfactorios para el tratamiento de la disfunción miccional que no se resuelve espontáneamente.

OBJECTIVE: To assess the effects of high-energy shock waves (HESW) on organs adjacent to the kidney, in the growing rat. MATERIALS AND METHODS: We studied 60 Wistar male rats. Upon completing 30 days of age, a radiopaque marker was placed in the animals' left renal cavity. With 40 days of age, after radiologically confirming the markers' position, the rats were divided into 2 groups: control-group - 30 rats that did not receive shock waves; experimental group- 30 rats exposed to 1000 shock waves of 17.2 KV in intensity. The rats were sacrificed 7, 90 and 180 days after exposure to HESW. The bodily growth was assessed and the analysis of macro- and microscopic morphology of liver, spleen, pancreas, lungs and adrenals. RESULTS: There was no statistical difference in the animals' bodily growth. The microscopic morphologic analysis demonstrated significant alterations in spleen (proliferative changes in the red pulp) and liver (cloudy swelling) of the animals submitted to HESW and sacrificed on the seventh day. These changes completely disappeared in subsequent analyses. CONCLUSION: HESW applied to rat did not inhibit the animals' growth and caused transitory histological lesion in spleen (proliferative changes in the red pulp) and in liver (cloudy swelling of hepatocytes). Such changes were observed only in the group that was exposed to HESW and was sacrificed 7 days following the experiment, presenting spontaneous recovery.

OBJECTIVE: We compared the clinical and urodynamic outcome of men with lower urinary tract symptoms with and without previous urodynamic evaluation submitted to transurethral resection of the prostate. MATERIALS AND METHODS: A prospective and randomized study was performed in 315 patients who underwent transurethral resection of the prostate. In 151 patients (group A) with a mean age of 63 years, transurethral resection of the prostate was performed without a prior urodynamic study, and group B, 164 patients with a mean age of 61 years, underwent a urodynamic study prior to surgical procedure. In group B, only obstructed patients were selected for surgery. All patients had I-PSS higher than 15 and underwent at least 2 uroflowmetry and flow was lower than 10 ml/sec. At 6-month follow up, patients in both groups underwent the I-PSS questionnaire and pressure / flow study. RESULTS: The symptomatology and uroflowmetry did not display different behavior between the groups. The mean postoperative score for group A was 8.87 + 3.27 and for group B was 9.32 + 3.14 (p = 0.22). The mean postoperative uroflow for group A was 17.0 + 2.1 mL/s and for group B was 16.6 + 2.2 mL/s (p = 0.15). Postoperative, in group A, 27 patients (17.8%) were obstructed and in group B, 16 patients (9.75%) were obstructed (p = 0.03). CONCLUSION: The study suggests that the previous urodynamic study is not the only factor related to the success of surgical outcome; and therefore, the symptomatology and uroflowmetry associated would be enough during the preoperative routine studies for BPH patients.