Quimioterapia Tópica Intravesical

Cerca de 80% dos pacientes com neoplasias vesicais apresentam-se inicialmente com lesões superficiais, que têm baixa tendência à progressão e acompanham-se de prognóstico mais favorável. O comportamento menos agressivo destas lesões permite que as mesmas sejam controladas de forma relativamente segura, através da ressecção transuretral, o que elimina os inconvenientes da cistectomia radical e/ou radioterapia, indicadas em pacientes com tumores infiltrativos

Urinary tract infections

Urinary tract infections have an extremely high clinical prevalence in both the community as well as in nosocomial patients. This behavior justifies the efforts that have been made to disseminate the present knowledge on urinary tract infections to the members of most clinical specialities. In the present review the authors discuss the new concept on the etiology, pathogenesis, diagnosis and treatment of urinary tract infections, with emphasis on the practical clinical approach to such cases.As infecções do trato urinário representam problema de grande relevância clínica, não só pela elevada freqüência com que acometem mulheres e homens vivendo na comunidade, mas também por representar a primeira causa de infecção em pacientes hospitalizados.Na presente revisão, o autor apresenta os conceitos atuais sobre a epidemiologia, os fatores etiopatogênicos, as manifestações clínicas e os métodos de diagnóstico das infecções do trato urinário. Finaliza discutindo as controvérsias e as novas diretrizes que envolvemo tratamento e a prevenção dessas infecções

Retroperitoneoscopic adrenalectomy in pheochromocytoma

Since the first laparoscopic adrenalectomy, the technique has evolved and it has become the standard of care for many adrenal diseases, including pheochromocytoma. Two laparoscopic accesses to the adrenal have been developed: transperitoneal and retroperitoneal. Retroperitoneoscopic adrenalectomy may be recommended for the treatment of pheochromocytoma with the same peri-operative outcomes of the transperitoneal approach because it allows direct access to the adrenal glands without increasing the operative risks. Although technically more demanding than the transperitoneal approach, retroperitoneoscopy can shorten the mean operative time, which is critical for cases with pheochromocytoma where minimizing the potential for intra-operative hemodynamic changes is essential. Blood loss and the convalescence time can be also shortened by this approach. There is no absolute indication for either the transperitoneal or retroperitoneal approach; however, the latter procedure may be the best option for patients who have undergone previous abdominal surgery and obese patients. Also, retroperitoneoscopic adrenalectomy is a good alternative for treating cases with inherited pheochromocytomas, such as multiple endocrine neoplasia type 2A, in which the pheochromocytoma is highly prevalent and frequently occurs bilaterally

Laparoscopic Dismembered Pyeloplasty in 47 Cases

PURPOSE: To evaluate the results of a sequence of 47 laparoscopic Anderson-Hynes pyeloplasties for the treatment of patients with ureteropelvic junction obstruction, independently of the etiology. MATERIALS AND METHODS: Twenty male and 27 female patients diagnosed with ureteropelvic junction obstruction were treated by Anderson-Hynes transperitoneal laparoscopic dismembered pyeloplasty from April 2002 to January 2006. The age of the patients ranged from four to 75 years, with a mean age of 32.3 years. The follow-up ranged between six and 30 months, with a mean follow-up time of 24 months. The outcomes were evaluated through the assessment of symptoms and imaging studies. RESULTS: In 44 (93.6%) of the 47 patients, resolution of the pain and a reduction in ureteropelvic dilation were observed. The mean operative time was 157 minutes (ranging from 90 to 270 minutes). Neither blood transfusion nor conversion to open surgery was required. The mean hospital stay was 2.2 days. The presence of crossing vessels over the ureteropelvic junction was verified in 26 patients (55%), and vessel transposition in relation to the urinary tract was performed in 25 of these cases. In one patient, the crossing vessel was mobilized out of the ureteropelvic junction with a perivascular suture to the renal capsule associated with the pyeloplasty. CONCLUSIONS: The outcome of transperitoneal Anderson-Hynes laparoscopic pyeloplasty used for different causes of pyeloureteral obstruction presented a success rate similar to a previously-published open procedure, with the advantage of being less invasive. This procedure may be considered the first option for the treatment of ureteropelvic junction obstruction

bcg no tratamento de condiloma acuminado genital recidivante

Introdução: O Papiloma Virus Humano é a doença sexualmente transmissível de maior prevalência. O tratamento do Condiloma Acuminado é um grande desafio devido ao elevado índice de recidiva (30-70%) e à inexistência de medicamento eficaz para sua eliminação. Objetivo: Avaliar a eficácia do tratamento com OncoBCG para portadores de condilomas recidivantes por mais de 2 anos. Pacientes e métodos: Foram incluídos pacientes entre 18 e 60 anos, com história de verrugas genitais há mais de 2 anos, atendidos a partir de 01-08-2011, sendo excluídos os portadores de doenças graves, imunodeficiência ou em uso de imunossupressor. O método foi: iniciar com biopsia(s) da verruga(s) com anestesia local, seguida de eletrocoagulação de todas as verrugas e bases das biopsias, e aplicação de solução com 80 mg de Onco BCG dissolvido em 2 ml de solução salina a 0,9%, em toda área genital, inclusive nas áreas cauterizadas. Cobrir a área com plástico por 2 horas, e, depois lavar com água. As aplicações locais de Onco BCG foram repetidas por 8 semanas consecutivas. No final do segundo mês os casos foram reavaliados. Quando havia recidiva clínica um novo procedimento com o mesmo medicamento era feito, porém com 3 aplicações semanais pelo próprio paciente por 8 semanas. Resultado: Dezesseis pacientes completaram seguimento de 2 anos. O índice de cura foi de 68,75%. Dos 11 pacientes curados, 6 (37,5%) usaram uma série de Onco BCG, dois usaram 2 (12,5%) séries, e 3 (18,75%) usaram 3 séries. Dos 5 pacientes não curados, houve redução de número de cauterizações de 5,5 vezes num período médio de doença de 51,6 meses, para 2,4 vezes de cauterizações, num período médio de acompanhamento de 52,3 meses, após uso de Onco BCG. Os efeitos colaterais com o uso do BCG são insignificantes. Conclusão: BCG tópico é boa opção no tratamento para condilomas resistentes, com mínimo efeito colateral e pode ser usado mesmo nos pacientes PPD negativos. No entanto, esse resultado deve ser confirmado com maior casuística e estudo com grupo controle.Introduction: The Human Papilloma Virus (HPV) is the most prevalent sexually transmissible disease. The treatment of Condyloma Accuminatum is a great challenge because of the high recurrence rate and of the lack of any drug efficient in its elimination. Objective: To assess the efficacy of the treatment with Imuno BCG (Bacillus Calmette-Guérin) for bearers of condylomas recurrent for more than 2 years. Patients and Methods: Patients with age between 18 and 60 years, having a history of more than 2 years of genital warts, were included, attended as from 01-08-2011; bearers of serious diseases, immunodeficiency or users of immune-suppressors, being excluded. The procedure adopted began with a biopsy of the wart(s) with local anesthetic, followed by the electro-coagulation of all the warts and bases of the biopsies, a solution with 80 mg of Imuno BCG dissolved in 2 ml of saline solution 0.9% was applied to all the genital area, including the cauterized areas. The area was covered with plastic for 2 hours and afterwards washed with water. The local application of Imuno BCG was repeated for 8 consecutive weeks. At the end of the second month the cases were re-assessed. When there was clinical recurrence a new procedure with the same drug was undertaken, but with 3 weekly applications made by the patient himself for 8 weeks. Result: Sixteen patients completed 2-year follow-up. The cure rate was of 62.5%. Of the 10 patients cured, 6 (37.5%) used one series of Imuno BCG, 1 (6.25%) used 2 series, and 3 (18.75%) used 3 series. Of the 6 patients who were not cured, there was a reduction in the number of cauterizations from 5.5 times (over an average period of the disease of 51.6 months) to 2.4 cauterizations (over an average follow-up period of 52.3 months) after the use Imuno BCG. The collateral effects of the use of Imuno BCG were insignificant. Conclusion: Topical BCG is a good option for the treatment of recurrent condylomas, with minimal collateral effect. It may be used even on PPD-negative patients. However, this result must be confirmed with larger sample populations and control-group studies

Recurrent vesicourethal stenosis after radical prostatectomy: how to treat it?

Vesicourethral anastomotic stricture and urinary incontinence are severe complications of radical prostatectomy because they cause great impact in the quality of life. Three patients that presented these complications after prostate radical surgery were assessed retrospectively. To treat the stenosis of the vesicourethral anastomosis an urolume was placed and later on, an artificial sphincter AMS 800 was implanted to treat the resulting urinary incontinence.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of UrologyUNIFESP, EPM, Department of UrologySciEL