ABSTRACT Objectives To describe acute and sub acute aspects of histological and immunohistochemical response to PP implant in a rat subcutaneous model based on objective methods. Materials and Methods Thirty rats had a PP mesh subcutaneously implanted and the same dissection on the other side of abdomen but without mesh (sham). The animals were euthanized after 4 and 30 days. Six slides were prepared using the tissue removed: one stained with hematoxylin-eosin (inflammation assessment); one unstained (birefringence evaluation) and four slides for immunohistochemical processing: IL-1 and TNF-α (pro-inflammatory cytokines), MMP-2 (collagen metabolism) and CD-31 (angiogenesis). The area of inflammation, the birefringence index, the area of immunoreactivity and the number of vessels were objectively measured. Results A larger area of inflammatory reaction was observed in PP compared to sham on the 4th and on the 30th day (p=0.0002). After 4 days, PP presented higher TNF (p=0.0001) immunoreactivity than sham and no differences were observed in MMP-2 (p=0.06) and IL-1 (p=0.08). After 30 days, a reduction of IL-1 (p=0.010) and TNF (p=0.016) for PP and of IL-1 (p=0.010) for sham were observed. Moreover, area of MMP-2 immunoreactivity decreased over time for PP group (p=0.018). Birefringence index and vessel counting showed no differences between PP and sham (p=0.27 and p=0.58, respectively). Conclusions The implantation of monofilament and macroporous polypropylene in the subcutaneous of rats resulted in increased inflammatory activity and higher TNF production in the early post implant phase. After 30 days, PP has similar cytokines immunoreactivity, vessel density and extracellular matrix organization.

ABSTRACTThe use of meshes has become the first option for the treatment of soft tissue disorders as hernias and stress urinary incontinence and widely used in vaginal prolapse's treatment. However, complications related to mesh issues cannot be neglected. Various strategies have been used to improve tissue integration of prosthetic meshes and reduce related complications. The aim of this review is to present the state of art of mesh innovations, presenting the whole arsenal which has been studied worldwide since composite meshes, coated meshes, collagen's derived meshes and tissue engineered prostheses, with focus on its biocompatibility and technical innovations, especially for vaginal prolapse surgery.

OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.

Objectives: Voiding dysfunction and urinary retention were frequent complications of sling. More recently synthetic supplies such as polypropylene mesh have been included in the armamentarium for sub urethral support. Methods: A prospective non randomized study was conducted. Sling procedure was performed in 436 consecutive patients with SUI. Patients were divided in groups according to mesh type, being 210 on autologous and 226 on synthetic. Patients were surveyed on voiding condition, continence and satisfaction. Surgical results were assessed according to Blaivas classification. Results were considered significant p<0.05. Results: Mean patient age was 48,4 years. Mean operative time for autologous sling was of 107,6 min versus 20,6min for synthetic. Mean hospitalization was 36h on autologous versus 24h on synthetic and mean follow up was 25 months. We found 87,1% and 92,9% of patients continent in autologous and synthetic group, respectively. Failure was presented by 7% in autologous and 4,8 % in synthetic group (p=0.1961). The global rate of BOO was of 4,5 % (20/436), when analysed by groups we found on autologous a rate of 8.5% (18/210), compared to 0.9% on synthetics (2/226) (p=0.000126). Conclusions: Autologous and synthetic slings presented comparable success rates, however BOO was more common among patients treated by autologous slings.

Introducción: Disfunción en el vaciamiento y retención urinaria son complicaciones frecuentes del cabestrillo. Recientemente se han incluido en el arsenal para el soporte sub-uretral, suministros sintéticos tales como la malla de polipropilenol. Métodos: Se llevó a cabo un Estudio prospectivo no aleatorizado. El procedimiento cabestrillo se realizó en 436 pacientes consecutivos con IUE (Incontinencia Urinaria de Esfuerzo). Las pacientes fueron divididas en grupos según el tipo de malla, en autólogos 210 y 226 sintéticos. Las pacientes fueron evaluadas en cuanto a condición de vaciamiento, continencia y satisfacción. Los resultados quirúrgicos fueron evaluados en función de la clasificación de Blaivas. Se consideró significativo p<0,05. Resultados: La media de edad fue 48,4 años. El tiempo medio operatorio para los Cabestrillo autólogos fue de 107,6 minutos frente a 20,6 min para el sintético. El promedio de hospitalización fue de 36 horas para autólogos frente a 24 horas para los sintéticos y la media de seguimiento fue de 25 meses. Se encontró 87,1% y 92,9% de las pacientes continentes en los grupos autólogos y sintéticos, respectivamente. Fallo en el procedimiento se presentó en un 7% en el grupo autólogo y 4,8% en el sintético (p=0,1961). La tasa global de obstrucción del tracto urinario inferior fue de 4,5% (20/436), cuando se analizó por grupos, encontramos en el grupo autólogo una tasa de 8,5% (18/210), en comparación con el 0,9% en el grupo sintético (2/226) (p=0,000126). Conclusiones: Cabestrillos autólogos y sintéticos presentan las tasas de éxito comparables, sin embargo la obstrucción del tracto urinario inferior fue más común entre las pacientes tratadas con fascias autólogas.

INTRODUCTION: In the case of clinically negative inguinal regions in penile cancer, the treatments proposed might vary from careful observation to radical dissection for all patients. We evaluated the effectiveness of the sentinel lymph node biopsy using lymphoscintigraphy in patients with penile cancer and at least one negative inguinal region. MATERIALS AND METHODS: In 18 patients, biopsy of the sentinel lymph node from the 32 negative inguinal regions and modified radical lymphadenectomy in these regions regardless of the biopsy results was performed. Clinical staging, pathological results of the sentinel and the other lymph nodes removed during lymphadenectomy, tumor behavior, local and inguinal recurrence and specific disease mortality were accessed. RESULTS: The mean age of the study sample was 57.7 years (44 - 81 years) and the sentinel lymph node presented 0% false negative 66% sensitivity, and 79.3% specificity when compared with the modified inguinal lymphadenectomy as the gold standard treatment. CONCLUSION: Sentinel lymph node biopsy is a feasible method of assessing the presence of regional metastasis in patients with penile cancer and clinically negative inguinal regions. However, the optimal lymphoscintigraphy technique is still in evolution and requires further optimization at high volume centers.

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.