Intravesical Protrusion of the Prostate as a Predictive Method of Bladder Outlet Obstruction

Objective. Pressure-flow study is the gold standard for diagnosis of bladder outlet obstruction (BOO) A prospective study was carried out to compare urodynamic evaluation and measurement of intravesical protrusion of the prostate for diagnosing BOO Materials and Methods Patients presenting with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia and suspected BOO were prospectively evaluated through conventional urodynamics and classified according to the bladder outlet obstruction index (BOO!). They also underwent abdominal ultrasound measurement of the intravesical prostatic protrusion (IPP) and prostatic volume. The I PP was classified into three stages grade I under 5 mm; grade 11, between 5 and 10 mm, and grade III over 10 mm Results Forty-two patients, mean age 64.8 +/- 8.5 years were enrolled Transabdominal ultrasound determined a mean prostatic volume of 45 +/- 3 2 mL. Achieved IPP's values were the following: grade I - 12 (28.5%), grade II - 5 - (12%) and grade III - 25 (59.5%). The results of prostate volume differed significantly between obstructed and non-obstructed men (p = 0.033) and for IPP among obstructed, inconclusive and non-obstructed men (p = 0 016). For IPP, the area under ROC curve was 0.758 (95% confidence interval - 0.601 to 0 876), and the cutoff point to indicate BOO was 5 mm with 95 % sensitivity (75 1 - 99 2) and 50% specificity (28.2 - 71 8). Conclusion IPP and prostatic volume measured through abdominal ultrasound are noninvasive and accessible methods that significantly correlate to urinary BOO, and are useful in the diagnosis of male urinary obstructive problems.34562763

From sea monsters to charismatic megafauna: changes in perception and use of large marine animals

Marine megafauna has always elicited contrasting feelings. In the past, large marine animals were often depicted as fantastic mythological creatures and dangerous monsters, while also arousing human curiosity. Marine megafauna has been a valuable resource to exploit, leading to the collapse of populations and local extinctions. In addition, some species have been perceived as competitors of fishers for marine resources and were often actively culled. Since the 1970s, there has been a change in the perception and use of megafauna. The growth of marine tourism, increasingly oriented towards the observation of wildlife, has driven a shift from extractive to non-extractive use, supporting the conservation of at least some species of marine megafauna. In this paper, we review and compare the changes in the perception and use of three megafaunal groups, cetaceans, elasmobranchs and groupers, with a special focus on European cultures. We highlight the main drivers and the timing of these changes, compare different taxonomic groups and species, and highlight the implications for management and conservation. One of the main drivers of the shift in perception, shared by all the three groups of megafauna, has been a general increase in curiosity towards wildlife, stimulated inter alia by documentaries (from the early 1970s onwards), and also promoted by easy access to scuba diving. At the same time, environmental campaigns have been developed to raise public awareness regarding marine wildlife, especially cetaceans, a process greatly facilitated by the rise of Internet and the World Wide Web. Currently, all the three groups (cetaceans, elasmobranchs and groupers) may represent valuable resources for ecotourism. Strikingly, the economic value of live specimens may exceed their value for human consumption. A further change in perception involving all the three groups is related to a growing understanding and appreciation of their key ecological role. The shift from extractive to non-extractive use has the potential for promoting species conservation and local economic growth. However, the change in use may not benefit the original stakeholders (e.g. fishers or whalers) and there may therefore be a case for providing compensation for disadvantaged stakeholders. Moreover, it is increasingly clear that even non-extractive use may have a negative impact on marine megafauna, therefore regulations are needed.SFRH/BPD/102494/2014, UID/MAR/04292/2019, IS1403info:eu-repo/semantics/publishedVersio

An adjustable male sling for treating urinary incontinence after prostatectomy: a phase III multicentre trial

Objective To evaluate the efficacy and safety of a new adjustable bulbourethral sling (Argus(R), Promedon SA, Cordoba, Argentina) in the treatment of male stress urinary incontinence (SUI) after prostate surgery. Patients and Methods In all, 48 patients with SUI because of prostatic surgery for prostate cancer (39) or benign prostatic hyperplasia (nine) had a new sling implanted in a multicentre trial at six institutions between April 2003 and September 2004. All patients were fully evaluated, including a questionnaire (International Consultation on Incontinence Questionnaire-Short Form, ICIQ-SF, range 0-21), endoscopy, and urodynamic evaluation. The Argus system comprises a 4.2 x 2.6 x 0.9 cm thick silicone foam pad for soft bulbar urethral compression. The pad is attached to the silicone cone columns that, after being passed with needles from the perineum to the abdominal wall, are adjusted with silicone washers to regulate and keep the desired tension against the urethra. The pad and washers are radio-opaque, which allows their position to be assessed during follow-up. The surgical technique was one described previously, with some modifications. Results At a mean (range) follow-up of 7.5 (1-17.5) months, 35 (73%) of the 48 patients were dry, five (10%) were improved, and eight (17%) were incontinent, including four (8%) who needed sling adjustment. The mean (range) ICIQ-SF improved from 19.2 (12-21) to 4 (0-21). There were three (6%) urethral perforations during surgery that were resolved by re-passing the needle. The sling was removed in three men (6%) due to erosion and in two (4%) due to infection. Seven (15%) cases of acute urinary retention resolved spontaneously, except for one that needed the sling loosening. No cases of chronic retention were reported. There was perineal discomfort and mild dysuria soon after surgery that resolved spontaneously after a few weeks. Conclusion This new adjustable male sling safely and effectively controls sphincter incontinence in men after prostate surgery, with an acceptably low complication rate. The early results are encouraging; the Argus is a valid alternative to the artificial urinary sphincter, the standard therapy for this condition.97353353

Parachute technique for partial penectomy

PURPOSE: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly applied approach for best oncological results. We herein propose a simple modification of the classic technique of partial penectomy, for better cosmetic and functional results. TECHNIQUE: If partial penectomy is indicated, the present technique can bring additional benefits. Different from classical technique, the urethra is spatulated only ventrally. An inverted "V" skin flap with 0.5 cm of extension is sectioned ventrally. The suture is performed with vicryl 4-0 in a "parachute" fashion, beginning from the ventral portion of the urethra and the "V" flap, followed by the "V" flap angles and than by the dorsal portion of the penis. After completion of the suture, a Foley catheter and light dressing are placed for 24 hours. CONCLUSIONS: Several complex reconstructive techniques have been previously proposed, but normally require specific surgical abilities, adequate patient selection and staged procedures. We believe that these reconstructive techniques are very useful in some specific subsets of patients. However, the technique herein proposed is a simple alternative that can be applied to all men after a partial penectomy, and takes the same amount of time as that in the classic technique. In conclusion, the "parachute" technique for penile reconstruction after partial amputation not only improves the appearance of the penis, but also maintains an adequate function

Validação do "King's Health Questionnaire" para o português em mulheres com incontinência urinária Validation of the Portuguese version of the King's Health Questionnaire for urinary incontinent women

OBJETIVO: Traduzir e adaptar para o português o questionário de qualidade de vida denominado "King's Health Questionnaire" (KHQ) em mulheres com incontinência urinária. MÉTODOS: Cientes dos objetivos da pesquisa científica, dois tradutores brasileiros prepararam duas versões do KHQ para o português, as quais foram retro-traduzidas por outros dois tradutores ingleses. As diferenças foram harmonizadas e pré-testadas em um estudo piloto. As versões finais do KHQ e de outro questionário, o "Short-Form Health Survey" (SF-36), já vertido e publicado em português, foram simultaneamente administradas a 156 e 119 pacientes, respectivamente. Foram testadas as propriedades psicométricas do KHQ como confiabilidade (consistência interna e teste-reteste) e validade de constructo. O reteste foi realizado em um período de duas semanas, a partir da primeira entrevista. RESULTADOS: O processo de adaptação cultural não alterou a versão em português do KHQ comparado ao original, exceto no modo de administração para pacientes com baixo grau de alfabetização. Neste caso, o questionário mudou de auto-avaliação para ser lido para as pacientes durante entrevista com o pesquisador. Para as outras pacientes, o KHQ foi auto-administrado. O alfa de Cronbach padronizado do KHQ foi de 0,87 e avaliado por seus domínios variou de 0,49 a 0,92. A confiabilidade, medida pelo índice de correlação intraclasses (ICC) foi considerada de moderada a forte em todos os domínios e na escala de medidas de gravidade, variando de 0,53 a 0,81. O coeficiente de correlação de Pearson entre o KHQ e o SF-36 foi considerado de fraco a moderado na maioria dos domínios afins, variando de -0,27 a -0,53. CONCLUSÕES: A versão para o português do KHQ, traduzida e adaptada para seu uso em mulheres brasileiras com queixas de incontinência urinária. Representa um importante instrumento para a avaliação de mulheres incontinentes em pesquisa clínica.<br>OBJECTIVE: To translate into Portuguese and evaluate the condition-specific quality of life King's Health Questionnaire (KHQ) for female urinary incontinence. METHODS: Two Brazilian translators, aware of the aim of the project, prepared two versions of the KHQ into Portuguese, which were back-translated into English by two other English translators. The differences were harmonized and pre-tested in a pilot study. The final version of the KHQ and the "Short-Form Health Survey" (SF-36), which has already been translated and validated into Portuguese were simultaneously administered to 156 and 119 women respectively. KHQ's psychometric properties such as reliability (internal consistency and retest) and construct validity were tested. A retest was performed within 2 weeks from the start date. RESULTS: The cultural adjustment process resulted in no changes in the KHQ Portuguese version, although for low schooling patients the questionnaire had to be read by the researcher during face-to-face interview. For all other patients, the KHQ was self-administered. KHQ's standardized Cronbach's alpha was 0.87 and when assessed by domains ranged from 0.49 to 0.92. Reliability measured by intraclass correlation (ICC) was considered moderate to strong for all domains and the severity measure scale ranged from 0.53 to 0.81. Pearson&acute;s correlation coefficient between KHQ and SF-36 was considered weak to moderate in the majority of the related domains, ranging from -0.27 to -0.53. CONCLUSIONS: The KHQ Portuguese version was translated and adjusted for Brazilian women with urinary incontinence complaints. It represents an important tool for the assessment of incontinent women in clinical trials