Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications

Cross section layer model for flexural design of reinforced concrete elements

No presente trabalho descreve-se um modelo que permite determinar a relação momento-curvatura de uma secção que pode ser constituída por distintos tipos de materiais. A qualidade do desempenho deste modelo depende da capacidade das leis constitutivas implementadas no modelo de simular o comportamento real desses materiais. Por esse motivo, o código computacional foi desenvolvido por forma a ser relativamente simples a implementação de novas leis constitutivas. Este modelo pode ser acoplado a outras ferramentas de cálculo por forma a ser possível traçar a resposta força-flecha de diversos sistemas estruturais. Este programa computacional dispõe de um módulo de préprocessamento de dados por forma a facilitar a interacção entre o utilizador e o modelo de cálculo. O desempenho do modelo é avaliado no presente trabalho.A cross section layer model able of reproducing the moment-curvature relationship of a cross section that can be composed by distinct materials is described in the present work. The model performance depends on capacity of the constitutive laws for fitting the material behavior. The computational code was designed in order to be relatively simple the implementation of new material constitutive laws. This model can be used with other computational tools in order to obtain the force-deflection relationship of several structural systems. To build the data file in a friendly away, a data preprocessor module was developed

Betão reforçado com fibras de aço : recomendações normativas, investigação experimental e numérica

A adição de fibras ao betão aumenta significativamente a ductilidade deste, resultando diversos benefícios em termos de propriedades materiais e estruturais. Nos últimos anos a utilização deste compósito de matriz cimentícia tem aumentado significativamente, quer no volume de material aplicado, quer no tipo de aplicações. Recentemente tem havido um esforço de normalização dos ensaios a efectuar para caracterizar os aspectos mais relevantes do comportamento deste compósito, assim como o estabelecimento de parâmetros a serem utilizados na análise e dimensionamento de estruturas em betão reforçado com fibras de aço (BRFA). Neste âmbito tem-se destacado o grupo de trabalho TC162-TDF, nomeado pela RILEM, cujo trabalho realizado nos últimos anos tem dado contributo significativo para o aumento do conhecimento do BRFA, nas vertentes da caracterização experimental, do dimensionamento e da análise numérica. No presente trabalho é descrita a investigação experimental efectuada no âmbito do desenvolvimento de um BRFA de custo competitivo para pavimentos de edifícios industriais. A caracterização experimental foi efectuada segundo as recomendações do TC162-TDF. Em simultâneo foi desenvolvido um código computacional para aferir a qualidade das simulações numéricas obtidas utilizando-se as leis constitutivas propostas pelo referido grupo de trabalho. A investigação numérica realizada é também descrita no presente trabalho, dando-se especial relevo à parte que permitiu definir os parâmetros "óptimos" que caracterizam as leis que modelam o comportamento pós fendilhado do BRFA, quer em termos de tensão-extensão (σ-ε), quer no formato tensão-abertura de fenda σ-w

Steel fibres for the shear resistance of reinforced concrete beams

Investigação realizada nos últimos anos revela que as fibras de aço podem substituir, pelo menos parcialmente, estribos no reforço ao corte de peças de betão armado. No entanto, tem sido reduzido o uso de fibras de aço com esse fim, dado que as expressões que têm sido propostas são, na sua maioria, suportadas em bases semi-empíricas, desenquadradas dos formatos propostos nos documentos utilizados pelos projectistas. Recentemente a RILEM TC 162-TDF propôs uma formulação baseada no Eurocódigo 2, onde a contribuição das fibras para o reforço ao corte é materializada por intermédio de um termo adicionado aos termos que simulam a contribuição do betão e das armaduras convencionais. No presente trabalho esta formulação é apresentada, bem como algumas expressões que se têm revelado oportunas na estimativa da contribuição das fibras para a resistência ao corte de elementos de betão. Para avaliar o desempenho da formulação proposta pela RILEM foi efectuada uma campanha de ensaios de flexão em vigas. Os resultados apresentados neste trabalho dizem respeito a uma das duas séries que compõem essa campanha.Research carried out in the last years shows that steel fibers have high potential for replacing, at least partially, steel stirrups as a shear reinforcement on concrete elements. The use of steel fibers in this kind of application is, however, reduced. The semi-empirical support of the expressions proposed can be pointed out as the main reason for this state. Recently, RILEM TC-162 TDF proposed a formulation based on the Eurocode 2 where the fiber contribution for the shear resistance is simulated adding a new term to the terms that simulate the contributions of the concrete and steel stirrups. This formulation is described in detail in the present work, and other promising approaches are also presented. To assess the performance of the RILEM formulation, an experimental program composed by two series of bending tests with reinforced concrete beams was carried out. One of these two series is analyzed in the present work

Avaliação da adequabilidade das leis propostas pela Rilem para caracterizar o comportamento fendilhado do betão reforçado com fibras de aço

Nos últimos dois anos têm sido efectuados ensaios de flexão, segundo as recomendações do grupo de trabalho TC 162-TDF da RILEM, para caracterizar o comportamento à flexão do betão reforçado com fibras de aço (BRFA). Os resultados obtidos foram utilizados, em conjunto com um modelo numérico desenvolvido, por forma a avaliar o desempenho das leis constitutivas recomendadas pelo referido grupo. Foi dado especial ênfase à modelação do comportamento do BRFA fendilhado, quer por intermédio de lei tensão-extensão (σ-ε), que por meio de lei tensão abertura de fenda (σ-w). A investigação numérica efectuada é descrita e os principais resultados obtidos são apresentados e comentados.Fundação para a Ciência e a Tecnologia (FCT) - SFRH/BSAB/291/2002-POCTI, POCTI/34793/99 "Cost competitive steel fibre reinforced concrete for industrial pavements

Patient's reactions to digital rectal examination of the prostate

OBJECTIVE: In recent years, there has been a rise in the incidence of prostate cancer (PCa), and routine screening for the disease has become a well accepted clinical practice. Even with the recognized benefit of this approach, some men are still reluctant to undergo digital rectal examination (DRE). For this reason, we designed the present study in order to better understand men's reactions about this method of screening. The aim was to identify possible drawbacks that could be overcome to increase DRE. MATERIALS AND METHODS: We randomly selected 269 patients that were enrolled in an institutional PCa screening program. They were first asked to answer a question regarding their preferred position to undergo the examination. Following this step, they answered a questionnaire in which physical and psychological reactions regarding the DRE were presented. Finally, we used a visual analogical scale (VAS) to analyze the perception of pain during DRE. RESULTS: The supine position was preferred for most patients (53.9%). Before DRE, about 59.4% of patients felt that the exam would be acceptable. After DRE, this figure increased to 91.5% (p < 0.001). Mean VAS score during DRE was 1.69 on a scale with a range between 0 and 10 (0 = no pain; 10 = extreme pain). CONCLUSION: Patient expectations about DRE were negative before examination and changed significantly following the exam. Pain during examination was negligible, contrary to the prevalent belief. These two findings must be clearly presented to patients in order to improve PCa screening acceptance

Penile prosthesis implantation in an academic institution in Latin America

PURPOSE: We performed a retrospective study to analyze the effectiveness of implantable penile prostheses in the treatment of erectile dysfunction. MATERIALS AND METHODS: This study included 249 patients who received implants between 2001 and 2008. A total of 139 patients who underwent penile prosthesis implantation were interviewed. RESULTS: Approximately half of patients had previously used oral drugs before implantation of the prosthesis. About 45% had diabetes, 25.9% had previously undergone radical prostatectomy (RP), and 64% had hypertension. Exchange was performed in 5.7% for fracture, inadequate size, or extrusion. A total of 24.5% of men had immediate postoperative pain, 7.9% had local infection, and 8.6% had other complications. Patients who had previously undergone RP were 3.2 times more likely to experience a postoperative complication than patients who had not (p = 0.061). Eighty-nine (64%) patients returned to having sex as they had before being diagnosed with ED. Ninety-two of the men (66.2%) had sexual intercourse one to two times per week. One hundred twenty patients (86.3%) rated their level of satisfaction as good, excellent or very good, which was similar to the percentage of partners. The mean follow-up was 40 months. CONCLUSION: Higher rates of postoperative infections and mechanical problems with the implant were found in this study as compared to other studies, which was probably associated with the relative lack of experience of the trainees who were performing the surgeries. Patients with a history of RP or diabetes mellitus prior to implantation were at higher risk of postoperative complications

Analysis of the Clinicopathological Characteristics of Patients with Upper Urinary Tract Transitional Cell Carcinoma

OBJECTIVE: To describe the clinicopathological characteristics of patients with upper urinary tract transitional cell carcinomas who are treated surgically and to analyze the occurrence of bladder tumors as well as the development of metastases outside the urinary tract. MATERIALS AND METHODS: The study comprised a retrospective analysis of 25 patients treated between February 1994 and August 2006. The variables analyzed were: patient age, gender, and clinical presentation; diagnostic methods; pathologic characteristics at the primary site of the tumor (pelvis or ureter); tumor stage and grade; and presence of carcinoma in situ, microvascular invasion and squamous differentiation. The Kaplan-Meier method and the Log-Rank test were used for statistical analysis of bladder recurrence-free survival. RESULTS: Eighty-four percent of patients were male, and macroscopic hematuria was the most common clinical presentation. The majority of cases (56%) were infiltrative (T2-T3) and high-grade (76%) tumors. Synchronous or metachronous bladder tumors were found in 72% of cases. Five (20%) patients had a history of bladder tumor before the diagnosis of upper urinary tract transitional cell carcinomas. The mean follow-up period was 36 months (range: 1.5 to 156). During the follow-up period, eleven (44%) patients developed bladder tumors. After five years, the probability of being free of bladder tumor recurrence was 40%. No pathological variable was predictive for bladder tumor recurrence. Four patients presented disease recurrence outside the urinary tract. CONCLUSIONS: The presence of metachronous bladder tumors is more often observed after the diagnosis of upper urinary tract transitional cell carcinomas. All of these patients should undergo rigorous follow-up during the postoperative period. Only patients with infiltrative and high-grade tumors developed metastases outside the urinary tract