Vol. 44 n. 1 Jan . Feb, 2018

Volume 44 | number 1 | January . February, 2018 -Int Braz J Urol Annual Report – 2017

Stage effect of chronic kidney disease in erectile function

Vol. 44 (1): 132-140, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0228 ORIGINAL ARTICLE Márcio Rodrigues Costa 1, Viviane Campos Ponciano 2, Théo Rodrigues Costa 3, Caio Pereira Gomes 1, Enio Chaves de Oliveira 1 1 Escola Médica da Universidade Federal de Goiás, GO Brasil; 2 Mercy Holy House, Goiânia, GO, Brasil; 3 Hospital Geral de Goiânia Doutor Alberto Rassi, GO, Brasil ABSTRACT Purpose: The study aims to assess the influence of the stage of chronic kidney disease and glomerular filtration rate on prevalence and degree of erectile dysfunction. Materials and Methods: This transversal study, conducted from May 2013 to Decem­ber 2015, included patients with chronic kidney disease in conservative treatment, stages III/IV/V. Erectile dysfunction was evaluated by the International Index of Erec­tile Function. Data classically associated with erectile dysfunction were obtained by medical record review. Erectile dysfunction, degree of erectile dysfunction, and other main variables associated with erectile dysfunction were compared between patients with chronic kidney disease on conservative treatment stages III versus IV/V using the Chi-square test. The relationship between score of the International Index of Erectile Dysfunction and glomerular filtration rate was established by Pearson correlation coef­ficient. Results: Two hundred and forty five patients with chronic kidney disease in con­servative treatment participated of the study. The prevalence of erectile dysfunction in patients with chronic kidney disease in stages IV/V was greater than in stage III. Glomerular filtration rate positively correlated with score of the International Index of Erectile Dysfunction. Conclusions: The study suggests that chronic kidney disease progression (glomerular filtration rate decrease and advance in chronic kidney disease stages) worsen erectile function. Hypothetically, diagnosis and treatment of erectile dysfunction may be an­ticipated with the analysis of chronic kidney disease progression. Keywords:  Renal Insufficiency, Chronic; Kidney Failure, Chronic; Erectile Dysfunction [Full Text]...

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Impact on sexual function of surgical treatment in rectal cancer

Vol. 44 (1): 141-149, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0318 ORIGINAL ARTICLE Pedro Costa 1, João M Cardoso 2, Hugo Louro 2, Jorge Dias 1, Luís Costa 1, Raquel Rodrigues 1, Paulo Espiridião 1, Jorge Maciel 2, Luís Ferraz 1 1 Department de Urologia, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal; 2 Departmento de Cirurgia Geral, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal   ABSTRACT   Introduction: The development of new surgical techniques and medical devices, like therapeutical multimodal approaches has allowed for better outcomes on patients with rectal cancer (RCa). Owing to that, an increased awareness and investment towards better outcomes regarding patients’ sexual and urinary function has been recently observed. Aim: Evaluate and characterize the sexual dysfunction of patients submitted to surgical treatment for RCa. Materials and Methods: An observational retrospective study including all male patients who underwent a surgical treatment for RCa between January 2011 December 2014 (n=43) was performed, complemented with an inquiry questionnaire to every patient about its sexual habits and level of function before and after surgery. Discussion: All patients were male, with an average of 64yo. (range 42-83yo.). The surgical procedure was a rectum anterior resection (RAR) in 22 patients (56%) and an abdominoperineal resection (APR) in 19(44%). Sixty three percent described their sexual life as important/very important. Sexual function worsening was observed in 76% (65% with complains on erectile function, and 27% on ejaculation). Fourteen patients (38%) didn’t resume sexual activity after surgery. Increased age (p=0.007), surgery performed (APR) (p=0.03) and the presence of a stoma (p=0.03) were predictors of ED after surgery. A secondary analysis found that the type of surgery (APR) (p=0.04), lower third tumor’s location (p=0.03) and presence of comorbidities (p=0.013) (namely, smokers and diabetic patients) were predictors of de novo ED after surgery. Conclusions: This study demonstrated the clear negative impact in sexual function of patients submitted to a surgical treatment for RCa. Since it is a valued feature for patients, it becomes essential to correctly evaluate/identify these cases in order to offer an adequate therapeutical option. Keywords: Surgical Procedures, Operative; Rectal Neoplasms; Diagnosis [Full...

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Use of photodynamic inactivation for in vitro reduction of prevalent bacteria in Fournier’s Gangrene

Vol. 44 (1): 150-155, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0312 ORIGINAL ARTICLE Nalisson Marques Pereira 1, Luciano Santos Feitosa 1, Ricardo Scarparo Navarro 1, Dora Inés Kozusny- Andreani 1, Naacia Marques Pereira Carvalho 1 1 Departamento de Engenharia Biomédica, Universidade Brasil, São Paulo, SP, Brasil ABSTRACT Fournier’s Gangrene (FG) is an infectious disease caused by several synergic microbes, with high morbidity and mortality rates; therefore, the search for new less invasive and mutilating treatments, with faster recovery, has been proposed. Surgical intervention, the use of several systemic and topic antibiotics, and hyperbaric oxygen therapy are currently the best approach for the treatment of these patients. The use of Photody­namic Inactivation (PDI) aims to lower morbidity and mortality, by reducing bacterial microbiota and speeding wound healing. In the present study, viable bacteria were separated in four groups: Group L-/F- (no irradiation with red laser and absence of me­thylene blue photosensitizer), Group L-/F+ (no irradiation with red laser and presence of methylene blue), Group L+/F- (irradiation with red laser and absence of methylene blue) and L+/F+ (irradiation with red laser associated to methylene blue). In all groups, exposure time to treatment was 5, 10 and 15 minutes. The concentration of methylene blue photosensitizer was 0.1mg/L, and the dose of red laser (660nm wave length) was 176.9mW/cm2. Following irradiation, the reduction of number of bacteria was evalua­ted, and the results were expressed in colony forming units (CFU) and as exponential reduction. As the main results, in the L+/F+ group, there were no Clostridium perfrin­gens and Staphylococcus aureus CFUs and there was a reduction of Escherichia coli that was not observed in the other groups. Keywords: Fournier Gangrene; Methylene Blue; Clostridium perfringens [Full...

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Can baseline serum creatinine and e-GFR predict renal function outcome after augmentation cystoplasty in children?

Vol. 44 (1): 156-162, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0078 ORIGINAL ARTICLE Prempal Singh 1, Ankur Bansal 1, Virender Sekhon 1, Sandeep Nunia 1, M. S. Ansari 1 1  Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India ABSTRACT Objective: To assess cut-off value of creatinine and glomerular filtration rate for aug­mentation cystoplasty (AC) in paediatric age-group. Materials and Methods: Data of all paediatric-patients (<18 years) with small capac­ity bladder, in whom AC was advised between 2005-2015 were reviewed. All patients were divided in two-groups, AC-group and control-group (without AC). Creatinine and e-GFR were assessed at the time of surgery, at 6 months and at last follow-up. Renal function deterioration was defined as increase in creatinine by ≥25% from baseline value or new-onset stage-3 CKD or worsening of CKD stage with pre-operative-CKD stage-3. ROCs were plotted using creatinine and e-GFR for AC. Results: A total of 94 patients with mean-age 8.9 years were included. The mean cre­atinine and e-GFR were 1.33mg/dL and 57.68mL/min respectively. Out of 94 patients, AC was performed in 45 patients and in the remaining 49 patients AC was not done (control-group), as they were not willing for the same. Baseline patient’s characteris­tics were comparable in both Groups. 22 underwent gastro-cystoplasty (GC) and 25 underwent ileo-cystoplasty (IC). Decline in renal function was observed in 15 (33.3%) patients of AC-group and in 31 (63.3%) patients of control-group. Patients having creatinine ≥1.54mg/dL (P=0.004, sensitivity (S) 63.6% and specificity (s) 90.5%) at baseline and e-GFR <46mL/min (P=0.000, S=100% and s=85.7%) at the time of surgery had significantly increased probability of renal function deterioration on follow-up after AC. Conclusion: e-GFR <46mL/min and creatinine ≥1.54mg/dL at time of surgery could serve as a predictor of renal function deterioration in AC in paediatric patients. Keywords: Serum; Delayed Graft Function; Creatinine [Full...

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Management of long segment anterior urethral stricture (≥ 8cm) using buccal mucosal (BM) graft and penile skin (PS) flap: outcome and predictors of failure

Vol. 44 (1): 163-171, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0083 ORIGINAL ARTICLE Gamal A. Alsagheer 1, Atef Fathi 1, Mohamed Sayed Abdel-Kader 1, Ahmed M. Hasan 1, Omar Mohamed 1, Osama Mahmoud 1, Ahmad Abolyosr 1 1 Department of Urology, Qena Faculty of medicine, South Valley University, Egypt ABSTRACT Purpose: To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm. Patients and methods: Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using mul­tivariate analysis. Failure was considered when subsequent urethrotomy or urethro­plasty were needed. Results: Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow- up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complica­tions were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. Conclusion: On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure. Keywords: Urethral Stricture; Oral Mucosal Absorption; Penis [Full...

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Impact of testicular sperm extraction and testicular sperm aspiration on gonadal function in an experimental rat model

Vol. 44 (1): 172-179, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2016.0652 ORIGINAL ARTICLE Leocácio Venícius Sousa Barroso 1, Ricardo Reges 1, João Batista Gadelha Cerqueira 1, Eduardo P. Miranda 1, Rafael Jorge Alves de Alcantara 1, Francisco Vagnaldo F. Jamacaru 2, Manoel Odorico de Moraes 2, Maria Angelina da Silva Medeiros 2, Lúcio Flávio Gonzaga-Silva 1 1 Divisão de Urologia, Universidade Federal do Ceará, CE, Brasil; 2 Departamento de Farmacologi, Universidade Federal do Ceará, CE, Brasil ABSTRACT   Purpose: To assess the impact of sperm retrieval on the gonadal function of rats with impaired spermatogenesis by comparing testicular sperm extraction (TESE) to aspira­tion (TESA). The efficacy of these procedures to sperm obtainment was also compared. Materials and Methods: A pilot study showed impaired spermatogenesis, but normal testosterone (T) production after a bilateral orchidopexy applied to 26 rats, which were randomly assigned into four groups: TESE (n=7), TESA (n=7), SHAM (n=6) and Control (n=6). The T levels were measured through comparative analysis after the orchidopexy. Results: There was no statistical difference in the animal’s baseline T levels after orchi­dopexy in comparison to the controls: the TESE and TESA groups, 6.66±4.67ng/mL; the SHAM group (orchidopexy only), 4.99±1.96ng/mL; and the Control, 4.75±1.45ng/ mL, p=0.27. Accordingly, no difference was found in the postoperative T levels: TESE, 5.35±4.65ng/mL; TESA, 3.96±0.80ng/mL; SHAM, 3.70±1.27ng/mL; p=0.4. The number of sperm cells found through TESE (41.0±7.0) was significantly larger than that found through TESA (21.3±8.1, p=0.001). Moreover, higher tissue weight was found through TESE (0.09±0.02g versus 0.04±0.04g, p=0.04). Conclusions: The testicular sperm capture performed in rats through extraction or as­piration, after orchidopexy, did not significantly decrease the T levels. The amount of sperm found through testicular sperm extraction was higher than that through testicu­lar sperm aspiration. Keywords:  Infertility; Hypogonadism; Testosterone [Full...

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A new technique, combined plication-incision (CPI), for correction of penile curvature

Vol. 44 (1): 180-187, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2016.0578 SURGICAL TECHNIQUE Hamed Abdalla Hamed 1, Mohamed Roaiah 1, Ahmed M. Hassanin 1, Adham Ashraf Zaazaa 1, Mahmoud Fawzi 1 1 Department of Andrology, Faculty of Medicine, Cairo University, Cairo, Egypt ABSTRACT Introduction: Penile curvature (PC) can be surgically corrected by either corporoplasty or plication techniques. These techniques can be complicated by post-operative: penile shortening, recurrent PC, painful/palpable suture knots and erectile dysfunction. Objective: To avoid the complications of corporoplasty and plication techniques using a new technique: combined plication-incision (CPI). Materials and Methods: Two groups (1&2) were operated upon: group 1 using CPI and group 2 using the 16-dot technique. In CPI, dots were first marked as in 16 dot tech­nique. In each group of 4 dots the superficial layer of tunica albuginea was transverse­ly incised (3-6mm) at the first and last dots. Ethibond 2/0, passed through the interior edge of the first incision plicating the intermediate 2 dots and passed out of the interior edge of the last incision, was tightened and ligated. Vicryle 4/0, passed through the exterior edges of the incisions, was tightened and ligated to cover the ethibond knot. Results: Twelve (57.1 %) participants in group 2 complained of a bothering palpable knot compared to none in group 1 with statistically significant difference (P=0.005). Postoperative shortening (5mm) of erect penis, encountered in 9 participants, was dou­bled in group 2 but with insignificant difference (P>0.05). Post-operative recurrence of PC, was encountered in only 1 (4.8%) participant in group 2, compared to none in group 1, with insignificant difference (P>0.05). Post-operative erectile rigidity was normally maintained in all participants. Conclusion: The new technique was superior to the 16-dot technique for correction of PC. Keywords:  Penile Induration; Penis; Erectile Dysfunction [Full...

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Spermatozoa retrieval for cryopreservation after death

Vol. 44 (1): 188-191, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0249 CHALLENGING CLINICAL CASES Fernando Lorenzini 1, Eduardo Zanchet 1, Gustavo M. Paul 1, Ricardo T. Beck 1, Mariana S. Lorenzini 1, Elisângela Böhme 1 1 Centro de Reprodução Humana Curitiba, PR, Brasil ABSTRACT Objectives: To describe the retrieval spermatozoa technique for cryopreservation after death, including the proximal part of vas deferens. Material and Methods: A 28-years old man, with previous history of infertility, who died 12 hours ago, was submitted to spermatozoa retrieval for cryopreservation, with surgical bilateral resection in bloc of the proximal part of vas deferens, testicle and epididymis. At the laboratory, by milking the epididymis and vas deferens, the ex¬tracted fluid was collected; also, three samples of each testicle parenchyma were also harvested. Results: The fluid from the vas deferens showed spermatozoa, mostly with in situ motility. Testicular fragments also presented spermatozoa, mostly with small tail movements or immobile. Conclusion: The inclusion of the proximal part of vas deferens during spermatozoa retrieval after death must be performed, since it contains high concentration of sper¬matozoa, and even in the presence of previous infertility, as was with this patient, it is possible to retrieve spermatozoa. Keywords: Cryopreservation; Spermatozoa; Vas Deferens; Testis [Full...

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Prostate cancer recurrence in vas deferens – fusion image guide as an important tool in dignosis

Vol. 44 (1): 192-195, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0071 CHALLENGING CLINICAL CASES Leonardo Guedes Moreira Valle 1, Antônio Rahal Jr. 1, Priscila Mina Falsarella 1, Juliano Ribeiro de Andrade 1, Oren Smaletz 2, Akemi Osawa 3, Rodrigo Gobbo Garcia 1 1 Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil; 2 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil; 3 Departamento de Medicina Nuclear e Radiologia, Hospital Israelita Albert Einstein, São Paulo, Brasil ABSTRACT The biochemical recurrence after local treatment for prostate cancer is an often chal­lenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites. An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA- 68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence. The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously. High resolution acquired in PET / MR associated with image fusion allows orienta­tion procedures, even in areas of difficult access, with greater accuracy than con­ventional techniques. Keywords: Prostatic Neoplasms; Vas Deferens; Therapeutics [Full...

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Inflammatory pseudotumor of kidney: a challenging diagnostic entity

Vol. 44 (1): 196-198, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0063 RADIOLOGY PAGE Anudeep Mukkamala 1, Robin M. Elliott 2, Nicholas Fulton 3, Vikas Gulani 3, Lee E. Ponsky 1, Riccardo Autorino 1 1 Department of Urology, UH Case Medical Center, Cleveland, Ohio, USA; 2 Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio, USA; 3 Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA No abstract available [Full...

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