Associação entre sintomas e achados ultrassonográficos na hiperplasia prostática benigna.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Dapartamento de Clínica Cirúrgica

PREVALÊNCIA DE HIPOVITAMINOSE D E ASSOCIAÇÃO COM COMPONENTES DA SÍNDROME METABÓLICA EM HOMENS AVALIADOS EM PROGRAMA DE DETECÇÃO DO CÂNCER DE PRÓSTATA

O objetivo deste artigo é avaliar a prevalência de hipovitaminose D e sua associação com componentes da síndrome metabólica (SM) em participantes de programa de rastreamento do câncer de próstata (CAP). Foram revisados dados de prontuários de 545 homens submetidos ao rastreamento de CAP, com idade média 57,95 ± 10,30, na região metropolitana de Feira de Santana-Bahia. Definiu-se como hipovitaminose D a concentração sérica de 25-hidroxivitamina D (25(OH)D) < 30 ng/ml. A SM e seus componentes foram analisados de acordo com os critérios do NCEP/ATPIII revisados pela AHA/NHLBI. A prevalência de hipovitaminose D foi de 33,03% [29,21-37,08%, IC95%]. A prevalência de SM foi maior nos sujeitos com hipovitaminose comparados aos indivíduos sem hipovitaminose, respectivamente 41,11% e 28,00%, (RP= 1,46 [1,16-1,86], p= 0,002). Quando analisados separadamente os componentes da SM, demonstrou-se que hiperglicemia e circunferência abdominal correlacionaram-se com hipovitaminose D, enquanto os demais componentes da síndrome metabólica não diferiram significativamente nos pacientes com e sem hipovitaminose D. Hipovitaminose D tem alta prevalência em homens com idade maior que 50 anos, e correlaciona-se com a síndrome metabólica. A deficiência é mais prevalente nos obesos e diabéticos

Expression of genes associated with collagen deposition in the detrusor of patients with bladder outlet obstruction due to benign prostatic hyperplasia

Introdução: A obstrução infravesical (OIV) associada à hiperplasia prostática benigna (HPB) pode causar alterações morfológicas na bexiga urinária, incluindo o aumento da deposição de colágeno no detrusor. O aumento de colágeno no detrusor está associado a alterações funcionais como diminuição da complacência vesical e detrusor hipoativo. Os mecanismos fisiopatológicos envolvidos nesse processo não estão esclarecidos. Cogita-se que a elevada pressão detrusora, característica da OIV, module a expressão de genes que sintetizam proteínas envolvidas no processo fibrogênico, incluindo o colágeno I (COL I), colágeno III (COL III), o fator de crescimento transformador b1 (TGF- b1), a histona deacetilase-4 (HDAC-4), o fator potencializador de miócito 2 (MEF-2) e o microRNA 29c (miR-29c). Objetivo: Avaliar a expressão dos genes COL I, COL III, TGF-b1, HDAC-4, MEF-2 e miR-29c no detrusor de homens com OIV associada a HPB. Métodos: Foram incluídos 29 homens submetidos a prostatectomia transvesical para tratamento de HPB. Todos foram avaliados com exame urodinâmico no pré-operatório. Nove doadores de órgãos cadavéricos compuseram o grupo controle. Uma biópsia da cúpula vesical foi obtida durante a prostatectomia e ao final da cirurgia para captação de órgãos. Amostras da camada detrusora foram preparadas para análise da expressão dos genes COL I, COL III, TGF-b1, HDAC-4, MEF-2 e miR-29c. A expressão gênica foi avaliada por reação em cadeia de polimerase em tempo real e todas as reações foram realizadas em duplicata. O controle endógeno utilizado para expressão dos genes e do miR-29c foram a beta-2- microglobulina (B2M) e os pequenos RNA nucleolares (RNU-48), respectivamente. Os dados foram analisados com DataAssist Software (Applied Biosystems, USA). As comparações foram executadas por meio dos testes de Mann-Whitney, teste exato de Fischer e coeficiente de correlação de Spearman. Valores de p £ 0,05 foram considerados estatisticamente significativos. Resultados: As expressões de COL I, COL III, MEF-2 e miR- 29c foram similares no detrusor de homens com HPB e controles. As expressões de TGF-b1 e HDAC-4 foram significativamente inferiores no detrusor de homens com HPB comparado aos controles. TGF-b1, HDAC-4 e MEF-2 demonstraram-se superexpressos no detrusor de pacientes com HPB e retenção urinária em comparação aos pacientes com micção espontânea. As expressões de TGF-b1 e HDAC-4 foram inferiores nos pacientes com hiperatividade detrusora em comparação aos pacientes sem hiperatividade detrusora. Os valores de expressão de TGF-b1 e HDAC-4 correlacionaram- se positivamente com a complacência vesical. Conclusões: A subexpressão dos genes TGF-b1 e HDAC-4 parece estar envolvida na fisiopatologia da disfunção vesical associada a OIV em homens com HPB. A subexpressão destes genes associa-se à hiperatividade detrusora e à má complacência vesical. Além disso, a retenção urinária associa-se à superexpressão de ambos TGF-b1 e HDAC-4Introduction: Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) may lead to morphological changes in the bladder, including increased collagen deposition in the detrusor. The increased collagen content in the detrusor is associated with functional abnormalities, such as decreased compliance and detrusor underactivity. The pathophysiological mechanisms involved in this process are not well understood. It has been hypothesized that high detrusor pressure due to BOO influences the expression of genes that synthesize proteins involved in the fibrogenic process, such as collagen I (COL I), collagen III (COL III), transforming growth factor b1 (TGF-b-1), histone deacetylase 4 (HDAC-4), myocit enhancer factor 2 (MEF-2) and microRNA-29c (miR-29c). Objective: Evaluate the gene expression of COL I, COL III, TGF-b1, HDAC-4, MEF-2 e miR-29c in the detrusor of men with BOO due to BPH. Methods: We evaluated 29 men undergoing suprapubic prostatectomy due to BPH. Urodynamic was performed in all patients preoperatively. Nine cadaveric organ donors composed the control group. A bladder specimen from the dome was obtained during the prostatectomy and the organ harvesting surgery. Detrusor biopsies were prepared for gene expression analyses of COL I, COL III, TGF-b1, HDAC-4, MEF-2 e miR-29c. Gene expression was evaluated by quantitative polymerase chain reaction (qPCR) and all reactions were performed in duplicate. Beta-2 microglobulin and small nucleolar RNA-48 were utilized, respectively, as the endogenous controls for gene and miR-29c expression. The data were analyzed in DataAssist Software (Applied Byosystems, USA). Comparisons were performed with Mann-Whitney and Fischer exact tests and the Spearman correlation coefficient. Statistical significance was considered at p £ 0.05. Results: mRNA expressions of COL I, COL III, MEF-2 and miR- 29c were similar in the detrusor of men with BPH and controls. Otherwise, mRNA expressions of TGF-b1 and HDAC-4 were significantly inferior in the detrusor of BPH patients in comparison with controls. TGF-b1, HDAC-4 and MEF-2 demonstrated overexpression in the detrusor of BPH patients with urinary retention in comparison with patients with spontaneous voiding. TGF- b1 and HDAC-4 mRNA expressions were decreased in patients with DO compared to patients without DO. TGF-b1 and HDAC-4 mRNA expression was positively correlated with bladder compliance. Conclusions: Downregulation of TGF-b1 and HDAC-4 gene expression may play role in the pathophysiology of bladder dysfunction in men with BOO due to BPH. Underexpression of these genes is associated with detrusor overactivity and low bladder compliance. Also, urinary retention was associated with overexpression of both TGF-b1 and HDAC-

Botulinum Neurotoxin Type A for the Treatment of Benign Prostatic Hyperplasia: Randomized Study Comparing Two Doses

Purpose. To assess the efficacy and safety of intraprostatic injection of two botulinum neurotoxin type A (BoNT-A) doses for the treatment of benign prostatic hyperplasia (BPH). Materials and Methods. Men with symptomatic BPH who failed medical treatment were randomized to receive 100 U or 200 U of BoNT-A into the prostate. The International Prostatic Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual volume (PVR), PSA levels and prostate volume before injection and after 3 and 6 months were evaluated. Adverse events were compared between the groups. Results. Thirty four patients were evaluated, including 17 in the BoNT-A 100 U group and 17 in the BoNT-A 200 U group. Baseline characteristics were similar in both groups. Both doses produced significant improvements in IPSS, Qmax and PVR after 3 and 6 months and both doses promoted comparable effects. Prostate volume was affected by 200 U BoNT-A injection only after 6 months of treatment. PSA levels were significantly affected in the 100 U group only after 6 months of treatment. In the 200 U group, PSA levels were significantly decreased after 3 and 6 months. The complication rate was similar in both groups. Conclusions. Efficacy and safety of both BoNT-A doses are similar for BPH treatment in the short term followup

Update on complications of synthetic suburethral slings

ABSTRACT Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings

Update on complications of synthetic suburethral slings

<div><p>ABSTRACT Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.</p></div

Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury

Introduction: Spinal cord injury (SCI) is usually a sudden traumatic event and has a negative effect on sexual function. Aim: To evaluate the characteristics of sexual activity in men with SCI and identify predictors of being sexually active and having a satisfactory sex life. Methods: We assessed sexual activity profiles of men with SCI from a Brazilian tertiary rehabilitation center from February to August 2012. All patients older than 18 years with SCI for longer than 1 year were invited to participate. We analyzed age, time since SCI, patient age at SCI, employment status, partner status, completeness of lesion, functional independence, urinary continence, and Sexual Health Inventory for Men (SHIM) score. Main Outcome Measures: The SHIM was used to assess erectile function (EF). Satisfaction with sex life was analyzed as a dichotomous variable. Predictors of an active and satisfactory sex life were identified using univariable and multivariable analyses. Results: We evaluated 295 men with mean age of 40.7 ± 14.5 years. Most patients had a complete SCI (65.1%) and 159 (53.9%) were incontinent. The median SHIM score was 5 (interquartile range = 0–16) and only 71 men (24.1%) had a SHIM score of at least 17. Of these men, 159 (53.9%) were sexually active. Only 63 men (39.6%) were satisfied with their sex life after SCI. In univariable analysis, all variables were associated with an active sex life. Those with a SHIM score of at least 17 had a greater likelihood of being sexually active (odds ratio = 116, 95% confidence interval = 14–432). EF was the only parameter associated with a satisfactory sex life (odds ratio = 1.3, 95% confidence interval = 1.2–1.4). Conclusions: Most men with SCI were sexually inactive and/or dissatisfied with their sex life. Age, duration of SCI, completeness of SCI, continence, having a partner, and good EF were identified as predictors of an active sex life. However, only EF was a predictor of a satisfactory sex life. Gomes CM, Miranda EP, de Bessa J, et al. Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury. Sex Med 2017;5:e148–e155