We report a case of intrarenal pseudoaneurysm of the right kidney after percutaneous nephrolithotomy (PCNL) in supine position. Diagnosis was established by angiotomography with a 3-D reconstruction. Treatment was successfully achieved by endovascular occlusion using N-butyl-2-cyanoacrylate.

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.

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.

Purpose: To evaluate the urodynamic characteristics of a series of women with stress urinary incontinence presenting various rates of vaginal prolapse. Methods: 92 female patients were included in this study, mean age was 48 years (range 29-75). All patients underwent urogynecologic physical examination (vaginal prolapse was graded) and complete urodynamic study in order to detect the presence of detrusor overactivity. Urodynamic terminology and measurements comply with the ICS (International Continence Society) standards. Statistical significance was established below 0.05. Results: 65 women (70.6%) presented anterior vaginal prolapse and 31 (33.6%) posterior vaginal prolapse. Involuntary contractions of the detrusor muscle appeared in 13 patients (20%) who had an anterior vaginal prolapse and 6 women (19.3%) who had a posterior vaginal prolapse. The existence of involuntary contractions was not associated with the diagnosis of vaginal prolapse. Conclusion: Our study did not show any correlation between existence of vaginal prolapse and detrusor overactivity.

Objetivo: Evaluar la relación entre el prolapso urogenital y la presencia de hiperactividad del detrusor en mujeres con incontinencia urinaria de esfuerzo. Materiales y Métodos: Se evaluaron en forma prospectiva, desde enero 1999 a septiembre 2001, en el ambulatorio de Uroginecología de la Universidad Estatal de Campinas (UNICAMP), 92 mujeres con diagnóstico clínico de incontinencia urinaria de esfuerzo que fueron sometidas a estudio urodinámico. La edad varió entre 29 y 75 años, con una media de 48 ± 10 años. Se analizó la relación entre la presencia de prolapsos urogenitales, sus diferentes grados, y la ocurrencia de hiperactividad del detrusor. Resultados: De acuerdo con el examen clínico y el estudio urodinámico se observaron los siguientes resultados: prolapso anterior en 65 (70,6 %) de las mujeres y prolapso posterior en 31 (33,6 %). La hiperactividad del detrusor estaba presente en 13 de los prolapsos anteriores (20 %) y 6 de los prolapsos posteriores (19,3%). No se observó diferencia significativa en ninguno de los prolapsos examinados en relación a la presencia de hiperactividad del detrusor: anterior (p=0,1639) y posterior (p=0,1849). Conclusión: Los prolapsos urogenitales, en sus diferentes grados, no se relacionan con la incidencia de hiperactividad del detrusor en mujeres con incontinencia urinaria de esfuerzo.

Introduction: Transitional cell carcinoma of the bladder represents a disease of entire urothelial tract. The follow up is very important to detect any lesion that might represent a progression or a local recurrence. Some authors recommend randomized biopsies as a routine workup, others recommend cystoscopies and urinary cytology as the main part of superficial bladder cancer follow up. Patients and Methods: Forty nine patients with superficial bladder cancer were followed up during a ten-year period. Randomized biopsies and urinary cytology were harvested according to the international cancer protocol on bladder cancer. Results: 15 (1%) out of 1.489 randomized biopsies found to be positive to transitional cell carcinoma. Four out (10.5%) of 35 biopsies targeted to suspicious areas were positive to transitional cell carcinoma. 50 (17.4%) out of 288 cystoscopies with urinary cytology found to be positive to transitional cell carcinoma. Sensitivity and Specificity of biopsies (including randomized and targeted) were 31% and 85.2% respectively. Sensitivity and specificity of cystoscopies with urinary cytology were 48% and 86.5% respectively. Conclusion: Randomized biopsies did not show to detect more local recurrence or progression when compared to the urinary cytology. Cystoscopies with urinary cytology have good sensitivity and specificity for detection of tumor recurrence during follow up of transitional cell carcinoma.

Introducción: Los pacientes con tumor de vejiga de tipo Carcinoma de Células Transicionales (CCT) presentan enfermedad generalizada de todo el urotelio. El seguimiento de los pacientes con diagnóstico de CCT superficial es sumamente importante por la potencialidad de progresión tumoral. Algunos servicios de urología defienden la biopsia aleatoria de forma rutinaria, sin embargo, otros servicios juzgan ese método innecesario y utilizan la cistoscopia asociada a la citología urinaria como método de seguimiento. Materiales y Métodos: Fueron analizados, retrospectivamente, 49 pacientes portadores de tumor superficial de vejiga (pTa y pT1), en el periodo de 10 años. El seguimiento de este grupo se realizó a través de exámenes de cistoscopia, trimestrales en el primer año, semestrales en el segundo y tercer año, y anuales en el cuarto y quinto año. Durante las cistoscopias se realizaron análisis de citología de la orina y lavado vesical, biopsias de áreas sospechosas y biopsias aleatórias. Resultados: En el grupo de biopsias aleatorias (total de 1.489) se observaron 15 biopsias positivas (1%) y en el grupo de biopsias de áreas sospechosas (total de 38) hubo 4 biopsias positivas (10,5%). Los resultados se consideraron positivos en presencia de tumor urotelial y carcinoma in situ. La citología y/o el lavado vesical se presentaron positivas en 50 (17,4%) de las 288 cistoscopias realizadas. La sensibilidad de la biopsia, incluyendo las aleatorias y las dirigidas, fue de 31%, y su especificidad, de 85,2%, mientras que la asociación de la citología y el lavado urinario obtuvieron sensibilidad de 48% y especificidad de 86,5%. Conclusión: La biopsia aleatoria no demostró mayor eficiencia en el diagnóstico de recidiva tumoral de CCT superficiales cuando fue comparada a la citología urinaria y el lavado vesical, los cuales presentan buenas tasas de sensibilidad y especificidad.

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.