OBJECTIVE: Pressure-flow study is the gold standard for diagnosis of bladder outlet obstruction (BOO). A prospective study was carried out to compare urodynamic evaluation and measurement of intravesical protrusion of the prostate for diagnosing BOO. MATERIALS AND METHODS: Patients presenting with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia and suspected BOO were prospectively evaluated through conventional urodynamics and classified according to the bladder outlet obstruction index (BOOI). They also underwent abdominal ultrasound measurement of the intravesical prostatic protrusion (IPP) and prostatic volume. The IPP was classified into three stages: grade I under 5 mm; grade II, between 5 and 10 mm; and grade III over 10 mm. RESULTS: Forty-two patients, mean age 64.8 ± 8.5 years were enrolled. Transabdominal ultrasound determined a mean prostatic volume of 45 ± 3.2 mL. Achieved IPP's values were the following: grade I - 12 (28.5%), grade II - 5 - (12%) and grade III - 25 (59.5%). The results of prostate volume differed significantly between obstructed and non-obstructed men (p = 0.033) and for IPP among obstructed, inconclusive and non-obstructed men (p = 0.016). For IPP, the area under ROC curve was 0.758 (95% confidence interval - 0.601 to 0.876), and the cutoff point to indicate BOO was 5 mm with 95 % sensitivity (75.1 - 99.2) and 50 % specificity (28.2 - 71.8). CONCLUSION: IPP and prostatic volume measured through abdominal ultrasound are noninvasive and accessible methods that significantly correlate to urinary BOO, and are useful in the diagnosis of male urinary obstructive problems.

OBJECTIVE: To evaluate the reliability and responsiveness (internal and external) of the Portuguese version of the ICIQ-SF. We assessed the responsiveness of the ICIQ-SF after surgical procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: Prospective open label study in 2 tertiary referral centers. Sixty-one patients of both genders (54 female and 7 male) were enrolled. Patients were treated using surgical procedures, mostly with synthetic sling (82%). Patients were assessed before surgery and at least 1 month postoperatively using the ICIQ-SF in its translated and validated Portuguese version. Patients also underwent pre-operative urodynamic tests, Stamey incontinence grading and pad usage assessments. After surgery, patients underwent stress tests, Stamey incontinence grading and pad usage assessments. RESULTS: The mean age was 57.2 (± 11.6) years and the mean duration of follow-up was 7.2 months (± 4.5). Objective parameters such as urodynamic tests (by means of VLPP) and pad usage had significant correlation with changes in post-treatment scores on the ICIQ-SF (p = 0.0062 and p < 0.0001 respectively). The responsiveness expressed in terms of standardized effect sizes (SES) and standardized response means (SRM) was large for both questionnaires (p < 0.0001). CONCLUSION: The results showed high responsiveness (large effect sizes I and II) for the Portuguese version of the ICIQ-SF, indicating that this instrument is suitable for measuring outcomes in clinical trials for Brazilian patients with stress urinary incontinence.

INTRODUCTION: Renal cell carcinoma with thrombus in the inferior vena cava and no apparent metastasis requires immediate surgical treatment. Over the last few years, extracorporeal circulation with deep hypothermia and total circulatory arrest have played an increasingly important role in the treatment of diseases not associated with primary cardiovascular disorders, such as cavoatrial tumor thrombus in uterine tumors, adrenal tumors, Wilms' tumor, as well as renal cell carcinoma. CASE REPORT: A 78-year-old patient with renal cell carcinoma and tumoral thrombus in the inferior vena cava and above the supra-hepatic veins underwent right radical nephrectomy and removal of the thrombus from the vena cava with extracorporeal circulation and deep hypothermia with total circulatory arrest without opening the chest. The patient presented good post-operative evolution.

OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73%) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.