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INTRODUCTION AND HYPOTHESIS: Currently, a sling implant is the standard treatment for stress urinary incontinence in women. To be effective, they require an adequate anchoring system. The aim of this study is compare biomechanical features of fixation systems of two mini slings models available on the market (Ophira™ and Mini Arc™) through a tensile test. MATERIALS AND METHODS: Anchoring devices of each sling were surgically implanted in abdominal wall of 15 rats divided into three groups of five animals which were arranged according to the date of post implant euthanasia on 7, 14 and 30 days. Abdominal walls of rats were extracted on bloc containing the anchoring system and were submitted to a tensile strength test to measure the maximum load and elongation until device avulsion from the tissue. The results were compared using Student test t and a 5% cut off was considered significant. RESULTS: The Ophira™ mini sling fixation system demanded a greater maximum load and developed a longer stretch for avulsion from the implanted site at all moments evaluated (p value less than 0.05). CONCLUSION: There were significant differences in fixation patterns of the anchoring systems, which were exclusively related to their designs. The Ophira™ mini sling fixation device provided better fixation to the abdominal wall of rats compared to the Mini Arc™ device, even in the late post implant period.

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The female urethra is probably the most neglected organ in women. Female urethral stricture and primary bladder neck obstruction are rare clinical entities. Traditional and new surgical techniques have been described for the treatment of female urethral stricture. However, they are based on limited data. There is no consensus on best management. The techniques of urethroplasty all have a higher mean success rate (80-94%) than urethral dilatation (< 50%), albeit with shorter mean follow-up. Urethroplasty performed by experienced surgeons appears to be a feasible option in women who have failed urethral dilatation, although there is a lack of high-level evidence to recommend one technique over another.Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck fails to open adequately during voiding. This leads to increased striated sphincter activity or obstruction of urinary flow without another anatomic cause being present, for example an obstruction caused by genitourinary prolapse in women. Watchful waiting, pharmacotherapy and surgical intervention are possible treatments.

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BACKGROUND: This study evaluated the efficacy of 24-week, group-based, behavioral therapy in improving quality of life (QoL) among men treated for localized prostate carcinoma (PC) by means of radical prostatectomy (RP) who presented treatment-related dysfunctions: urinary incontinence (UI) and erectile dysfunction (ED). PATIENTS AND METHODS: Thirty men were assigned to 24-week behavioral group therapy. The intervention was designed to improve QoL by helping participants to identify and effectively manage stressful experiences. It focused on treatment-related sequelae from PC. Differences in variables were compared between the beginning and end of the study by means of Student's t test for paired samples. Multiple analysis was carried out by stepwise multiple linear regression following bivariate Pearson's correlation analysis. This was achieved for all predictors (i.e. general health perception, ED and UI impact) and relevant covariates (i.e. age, work/retirement status, alcohol addiction, attitude towards cancer and surgery, sexual satisfaction, and future plans). RESULTS: In all patients the time elapsed from surgery to attending the behavioral group therapy exceeded 24 months. There was no significant correlation between this time and the predictor variables. General health perception scores decreased by the end of the study (p = 0.000), as did the UI impact score (p = 0.023), thus denoting improvement in both factors. The difference in UI impact scores correlated negatively and significantly with both age (p = 0.04) and work/retirement (p = 0.05). Multiple stepwise regression showed that age was the most important variable (r2 = 26.0%). Considering age and work/retirement simultaneously, there was an increase of 10.3% (r2 = 36.3%). ED increased by the end of the study (p = 0.000), and the difference between the ED scores correlated positively and significantly with sexual satisfaction alone (p = 0.029), which signifies that previous sexual satisfaction had a positive influence over erectile dysfunction (r2 = 15.8%). CONCLUSION: 24-week behavioral group therapy was effective in improving the perceived QoL among men treated for PC. There were changes associated with the therapy, particularly the improvement in UI and ED.

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The aim of this study was to evaluate the prevalence of stress urinary incontinence (SUI) in women in the third trimester of pregnancy. In total, 340 patients attending the Antenatal Clinic at the State University of Campinas (UNICAMP) were interviewed. Overall, 170 women (50%) presented SUI. Stress urinary incontinence did not correlate to either body mass index (BMI) or race. There was no correlation between parity and SUI, but when considering distinct types of effort, urine leakage on coughing (P = 0.0478) and laughing (P = 0.0046) were highly more frequent in multiparous women. One hundred eleven women had had only vaginal deliveries and 68 delivered by cesarean section. There was no difference between the two groups concerning incontinence, but multiparous women (> or = 4) who delivered exclusively vaginally demonstrated 2.0 times more chances to leak urine when compared to nulliparous women. This fact strongly suggests parity to be more relevant than delivery route as a risk factor to stress urinary incontinence. Nulliparous women presented with a high percentage (45.5%) of the symptom, emphasizing the elevated risk of SUI during first pregnancy.

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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 9.9 ml/s and detrusor pressures at maximum flow of 48cmH20. 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.

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The aim of this study was to evaluate a new method to measure urethral resistance among 66 women with urinary incontinence. A stainless steel sphere attached to a guide wire was developed. The sphere is inserted into the bladder and withdrawn through the urethra at a steady rate. Serial measurements with spheres of 5, 6 and 7 mm were performed. The mean urethral resistance as measured by the largest sphere (0.07+/-0.03) was significantly greater than that measured by the medium sphere (0.06+/-0.02, p<0.0001), which was significantly larger than that measured by the smallest sphere (0.04+/-0.01, p<0.0001). There was good correlation of urethral resistance with maximum urethral closure pressure (MUCP) by this technique, but no correlation with Valsalva leak point pressure (VLPP).

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INTRODUCTION: SAFYRE is a new readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). Attempts to restore the normal suburethral hammock using an anatomical approach have been made in recent years. The authors report their experience with this device, which associates the efficacy of slings with readjustability. MATERIAL AND METHODS: A total of 100 consecutive patients with clinical and urodynamic diagnosis of SUI underwent SAFYRE sling procedure. The age range was from 40 to 71, mean age 63 years. Seventy-five patients (75%) presented previous failed anti-incontinence procedures. Physical clinical examination, stress test, pad use and a urodynamic study were performed before the surgery. All the patients presented symptoms of SUI and 30% also reported mild urgency. RESULTS: The average follow up period was 14 months (12-30 months). The mean operative time was of 25 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 3% of the implants, bladder perforation occurred. During the postoperative period, 26 patients developed urgency symptoms. During that follow up period, 92% were found to be continent, 3% reported an improvement and 5% were dissatisfied. CONCLUSION: SAFYRE is a safe and quick procedure that allows for postoperative readjustment. This technique may be an attractive alternative if the good result obtained so far proves to be long lasting.

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The authors quantified the collagen and elastic fibers in the bladder wall of ovariectomized rats with and without estradiol replacement. This study was conducted on 60 3-month-old Wistar rats. Group 1 remained intact; group 2 underwent bilateral ovariectomy and were sacrificed after 30 days; group 3 were sham operated and sacrificed after 30 days; group 4 had a bilateral ovariectomy and after 30 days were started on subcutaneous injections of 17beta-estradiol (10 microg/kg body weight) for 90 days; group 5 were sham operated and after 30 days were on started subcutaneous sesame oil replacement (0.2 ml/day) for 90 days; group 6 had a bilateral ovariectomy and after 30 days were started on subcutaneous sesame oil replacement (0.2 ml/day) for 90 days. Sirius red and Weigert's resorcin-fuchsin were used to stain collagen and elastic fibers on paraffin-embedded rat bladder sections. The M-42 grid system was used to quantitatively analyze the fibers. Ovariectomy had no effect on the volumetric density and absolute volume of the collagen and elastic fibers in the bladder wall of rats, or on the weight of the bladder. Estradiol replacement in castrated animals did not demonstrate any significant difference in the stereological parameters compared to the castrated group without hormonal replacement.

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El trabajo objetiva el análisis retrospectivo de pacientes con traumatismos vesicales, enfatizando los mecanismos de producción, los cuadrois clínicos, el diagnóstico, los índices de trauma, los tratamientos y las eventuales complicaciones. En los últimos ochoaños, fueron atendidos 42 pacientes con traumatismos de la vejiga con una edad media de 32,9 años, siendo la mayoría de sexo masculino (81 por ciento) Los traumatismos cerrados fueron más frecuentes (24 casos- 57,1 por ciento). Un 75 por ciento de ellos (dieciocho pacientes) presentaban fractura de pelvis. Un 42,9 por ciento (18 pacientes), fueron víctimas de heridas penetrantes en el abdomen, la mayoría (77,8 por ciento- 14 pacientes) por heridas de armas de fuego. En la admisión, la hematuria fue el signo observado en el 88,1 por ciento de los pacientes (37 casos) mientras que la hemouretrorragia sólo se observó como signo aislado en 4 pacientes. El RTS medio (Revised Trauma Score) (índice de trauma) calculado fue del 7,31. El diagnóstico se hizo con cistografías, ecografías, laparoscopia, y el lavado peritoneal diagnóstico (lavativa peritoneal). La mayoría de las heridas vesicales fueron intraperitoneales ( 36 pacientes- 85,7 por ciento) que se trataron con sutura quirúrgica a cielo abierto. El tratamiento expectante sólo se hizo en los 6 pacientes en los que pudo comprobarse únicamente heridas extraperitoneales. El ISS (Injury Severity Score) (índice de severidad de lesión) y TRISS medios, fueron respectivamente 24,3 y 0,89. Las complicaciones y el tiempo de internación fueron mayores en los que tenían fracturas de los huesos pelvianos. La mortalidad general fue del 11,9 por ciento (5 pacientes). Las heridas de la vejiga pueden ser diagnosticadas fácilmente con los elementos aportados por los antecedentes, el examen físicoi y el auxilio de los métodos imagenológicos. La evolución de estos pacientes es buena y está relacionada con las heridas asociadas

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El trabajo objetiva el análisis retrospectivo de pacientes con traumatismos vesicales, enfatizando los mecanismos de producción, los cuadrois clínicos, el diagnóstico, los índices de trauma, los tratamientos y las eventuales complicaciones. En los últimos ochoaños, fueron atendidos 42 pacientes con traumatismos de la vejiga con una edad media de 32,9 años, siendo la mayoría de sexo masculino (81 por ciento) Los traumatismos cerrados fueron más frecuentes (24 casos- 57,1 por ciento). Un 75 por ciento de ellos (dieciocho pacientes) presentaban fractura de pelvis. Un 42,9 por ciento (18 pacientes), fueron víctimas de heridas penetrantes en el abdomen, la mayoría (77,8 por ciento- 14 pacientes) por heridas de armas de fuego. En la admisión, la hematuria fue el signo observado en el 88,1 por ciento de los pacientes (37 casos) mientras que la hemouretrorragia sólo se observó como signo aislado en 4 pacientes. El RTS medio (Revised Trauma Score) (índice de trauma) calculado fue del 7,31. El diagnóstico se hizo con cistografías, ecografías, laparoscopia, y el lavado peritoneal diagnóstico (lavativa peritoneal). La mayoría de las heridas vesicales fueron intraperitoneales ( 36 pacientes- 85,7 por ciento) que se trataron con sutura quirúrgica a cielo abierto. El tratamiento expectante sólo se hizo en los 6 pacientes en los que pudo comprobarse únicamente heridas extraperitoneales. El ISS (Injury Severity Score) (índice de severidad de lesión) y TRISS medios, fueron respectivamente 24,3 y 0,89. Las complicaciones y el tiempo de internación fueron mayores en los que tenían fracturas de los huesos pelvianos. La mortalidad general fue del 11,9 por ciento (5 pacientes). Las heridas de la vejiga pueden ser diagnosticadas fácilmente con los elementos aportados por los antecedentes, el examen físicoi y el auxilio de los métodos imagenológicos. La evolución de estos pacientes es buena y está relacionada con las heridas asociadas(AU)

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A total of 30 women with stress incontinence underwent periurethral injection of autologous fat under spinal anesthesia. The fat was harvested from the abdominal wall by liposuction. Preoperative evaluation consisted of history, physical examination, and urodynamic evaluation. For study purposes, some patients also underwent bladder and urethral ultrasonography and magnetic resonance imaging studies. The first 13 patients received a single periurethral lipoinjection, and the following 17 patients received sequential injections when needed at 3-month intervals. Results were assessed by subjective questionnaire performed at 3 and 12 months. All patients had intrinsic sphincteric deficiency. Of the first group, there were only four patients (31%) cured after 1 year of follow-up. On the other hand, in the group that received repeated injections, there were 11 patients (64%) cured with a mean of two injections at 1-year follow-up. Our results show that this procedure warrants continued clinical investigation because it may be useful in selected cases of urinary stress incontinence.

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The analysis of existing diagnostic methods of urinary stress incontinence suggest that it is almost always clinical. Urodynamic evaluation has a place in special situations, as atypical symptom; neurologic disease; recurrent USI after surgery or when it is necessary to confirm the clinical diagnose.

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OBJECTIVE: Vesicoureteral reflux is a risk factor predisposing to infection after renal transplantation. Endoscopic correction of vesicoureteral reflux, a minimally invasive therapy, has been increasingly used with encouraging results. Although recent reports have described the successful use of Teflon paste in the endoscopic treatment of reflux, the choice of the material to be used is controversial. There is a need for finding an ideal substance for endoscopic injection for a simple and safe treatment of reflux. METHODS: Based on the good results of autologous lipoinjection in other situations, we performed lipoinjection for vesicoureteral reflux in 12 renal transplant candidates. There were 10 female and 2 male patients with grade III reflux or higher, accounting for 17 ureters treated by endoscopic lipoinjection. Voiding cystourethrography was performed in the operating room immediately after the procedure and again three months later. RESULTS: In 2 patients (16.2%) there was reduction of the grade of reflux, including the unique ureter that stopped refluxing. In the remaining 10 patients (83.3%) there was no change in the grade of reflux. CONCLUSIONS: These results suggest that although simple and attractive, lipoinjection alone is not a good alternative for endoscopic correction of vesicoureteral reflux.

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A total of 36 patients with bladder stones underwent percutaneous suprapubic cystolithotripsy. The successful rate was 89%. There were 11% failures due to nonfragmentation of the stones by the ultrasound probe. According to the presence of associated diseases 3 groups of patients were established. Two groups underwent concomitant treatments for benign prostatic hyperplasia and urethral stricture. No complications occurred even in patients with concomitant treatment. There was no statistically significant difference when these groups were compared (p > 0.05). Fluoroscopy was not necessary during the procedure. Since the technique is simple, safe and effective, it represents an alternative in the management of bladder stones.

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Nephrectomy is indicated for the removal of highly damaged kidneys. Several times patients are asymptomatic, and although the operation has a low morbidity rate they will refuse it. The development of new endourological techniques of percutaneous access to the kidney in experimental studies on liquefaction and aspiration of tissues, and the idea taken from the old resectoscope models using nonelectrical aids served to inspire our technique of percutaneous nephrectomy. Our patient presented with a nonfunctioning kidney due to ureteral obstruction and ultrasound demonstrated a severe decrease in renal parenchyma. Percutaneous access to the kidney was performed through the conventional manner and the remaining parenchyma was removed with biopsy and Lowsley forceps. Bleeding was minimum and a 22F nephrostomy Foley catheter was kept in place for 72 hours. As far as new instruments are developed, percutaneous nephrectomy represents a surgical option to remove nonfunctioning kidneys in highly selected patients.

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A 24-year-old man had unilateral gross hematuria that required nephrectomy. Pathological examination revealed massive intratubular hemorrhage and frequent deposition of an amorphous and homogeneous material positive for periodic acid, Schiff stain in the corticomedullary junction. This substance had the characteristics of Tamm-Horsfall protein and frequently herniated into the lumen of thin-walled veins of arcuate size. There was no apparent cause for the bleeding. To the best of our knowledge this is the third reported case with these peculiar findings and no apparent cause. We discuss some hypotheses as to the etiopathogenesis of this rare and intriguing condition.

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A technique for correction of penile deformity caused by a short rod-like penile prosthesis is described. This procedure was done in 4 patients and corrected the deformity efficiently, allowing for satisfactory sexual function.

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