Navegando por Palavras-chave "urethra"

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    Correlation between urethral sphincter activity and Valsalva leak point pressure at different bladder distentions: Revisiting the urethral pressure profile
    (Lippincott Williams & Wilkins, 2005-10-01) Almeida, F. G.; Bruschini, H.; Srougi, M.; Universidade Federal de São Paulo (UNIFESP)
    Purpose: We determined the correlation between Valsalva leak point pressure (LPP) and the urethral pressure profile (UPP) in urodynamically selected patients with stress urinary incontinence (SUI) as well as the interference of bladder volume on this correlation.Materials and Methods: A total of 450 consecutive women with SUI were clinically evaluated and underwent urodynamic study. Inclusion criteria were urodynamically demonstrable SUI with normal bladder compliance, sensitivity and capacity. Severe pelvic prolapse, detrusor overactivity and a pattern suggestive of obstruction were excluded. Urodynamic study was performed using a 7Fr 4 channel membrane catheter. LPP was determined at mid bladder capacity and UPP was determined at 50 ml, between 200 and 250 ml, and at bladder capacity.Results: A total of 200 women fulfilled the selection criteria, of whom 30, 114 and 56 had a LPP of 60 or less, between 60 and 120, and greater than 120 cm H2O, respectively. Except for age and the number of pads the 3 groups were well matched in clinical and bladder urodynamic parameters. A progressive correlation of LPP with maximum urethral closure pressure was found when UPP was performed at 50 ml (r = 0.305, p < 0.0001), at 250 ml (r = 0.483, p < 0.0001) and at maximum bladder filling (r = 0.561, p < 0.0001). Urethral functional length did not show a correlation with LPP at a bladder distention of 50 ml (r = 0. 117, p = 0. 100) or 200 ml (r = 0. 167, p = 0.019) but there was a minor correlation at bladder capacity (r = 0.234, p = 0.002).Conclusions: There is a significant correlation between maximum urethral closure pressure and LPP. Patients with a LPP of 60 cm H2O or less have a shorter urethral functional length and lower sphincter activity. Patients with SUI have a more remarkable correlation between UPP and Valsalva LPP when UPP is determined after filling the bladder to more than 200 ml.
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    Histopathological evaluation of urethroplasty with dorsal buccal mucosa: an experimental study in rabbits
    (Sociedade Brasileira de Urologia, 2008-06-01) Souza, Geovanne F. [UNIFESP]; Calado, Adriano A. [UNIFESP]; Delcelo, Rosana [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Macedo Jr., Antonio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: Buccal mucosa is a widely accepted tissue for urethroplasty. The exact healing and tissue integration process, mainly the histological characteristics of dorsal buccal mucosa graft urethroplasty when used dorsally to reconstruct the urethral plate has not previously been assessed, and thus we developed an experimental model to address this question. MATERIALS AND METHODS: In 12 New Zealand rabbits (weight 2.5 kg) we surgically created a dorsal penile urethral defect. A buccal mucosa graft was sutured to the corpora and tunica albuginea, and the ventral urethra anastomosed to this new urethral plate. The animals were divided in three groups and sacrificed 1, 3 and 6 weeks after surgery (groups 1, 2 and 3). A retrograde urethrogram was obtained at autopsy in the last group and the penis analyzed histologically with hematoxylin-eosin and Masson's staining. RESULTS: The urethrograms showed no evidence of fistula or stricture. In group 1 the histopathological analysis showed submucosal lymph-mononuclear inflammatory edema, numerous eosinophils and squamous epithelium integrated into the adjacent urothelium. In group 2 there was no evidence of an inflammatory response but rather complete subepithelial hyaline healing, which was more marked in group 3. CONCLUSION: Healing of buccal mucosa grafts to reconstruct the urethral plate can be achieved by total integration of the squamous epithelium with the urothelium, maintaining the original histological properties of the graft with no fibrosis or retraction.
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    Hypospadias
    (Lippincott Williams & Wilkins, 2012-11-01) Macedo, Antonio [UNIFESP]; Rondon, Atila [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose of reviewHypospadias is one of the most common congenital anomalies in men. We searched the recent literature (since 1 January 2011) using the following keywords in the title or abstract: hypospadia or hypospadias, in order to provide the reader with an updated view of the subject.Recent findingsEarly repair is recommended; distal forms are mainly treated by the tubularized incised plate technique; however, meatal stricture concerns are still noticed, limiting its use on proximal forms. the debate of proximal primary repair in either one or two stages is still ongoing. Minor modifications for preparing the distal bed for the urethroplasty in two stages are presented. One-stage repairs, either with reconstruction of the urethral plate (three-in-one concept) or simply with the onlay to tunica albuginea (Rigamonti), is a viable option with over 70% success in one surgery. the importance of barriers, such as tunica vaginalis and dartos flap, was reassessed and flow rates may indicate obstructive voiding patterns after 1-year follow-up.SummaryFurther experience and comparative studies for distal and proximal hypospadias are required. Long-term data may indicate the appropriate procedure selected for primary repair.
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    Transobturator crossover readjustable sling for severe female incontinence: technique and preliminary results
    (Springer, 2007-11-01) Palma, Paulo; Riccetto, Cassio; Herrmann, Viviane; Dambros, Miriam; Fraga, Rogerio; Grossi, Omar; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP); Lujan Univ
    We present a technique that provides circumferential coaptation of the urethra as a salvage procedure for severe subset of patients. We prospectively evaluated 16 patients who had a transobturator crossover sling. Adjustable hybrid slings were used, and silicone washers were used over the anchoring columns to keep them in place and to facilitate any posterior readjustment. Mean age was 58 years and mean follow-up was 12 months. At presentation, patients had undergone at least two anti-incontinence procedures and wore a mean of six pads daily. There was a mean 93.7% overall cure in symptoms. There was one intraoperative complication (urethra perforation) that was resolved by closing the urethral wall. de novo urge incontinence developed in 2/16 patients. All patients (3/16) who had preoperative urge incontinence achieved resolution after the procedure. the transobturator crossover sling is an effective salvage procedure that may be considered in a selected subset of female patients with a nonfunctional urethra.
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    The tunica vaginalis dorsal graft urethroplasty: Experimental study in rabbits
    (Lippincott Williams & Wilkins, 2005-08-01) Calado, A. A.; Macedo, A.; Delcelo, R.; Figueiredo, LFP de; Ortiz, V; Srougi, M.; Universidade Federal de São Paulo (UNIFESP)
    Purpose: We created an experimental model of urethral defect and then repaired it using a tunica vaginalis graft applied on the dorsal surface of the urethra. We studied the histological and radiological characteristics of free tunica vaginalis graft urethroplasty.Materials and Methods: in 20 New Zealand rabbits a dorsal urethral defect was created by excising a portion of the dorsal urethral surface. the tunica vaginalis graft was placed dorsally over the corpora cavernosa and tied with 4 interrupted sutures. the mucosal margin of the urethral defect was sutured to the graft using 6-zero polydioxanone sutures in continuous fashion. the animals were divided into 4 equal groups and were sacrificed 14 days, and 4, 8 and 12 weeks after surgery, respectively. A retrograde urethrogram was done at autopsy. the penis was sent for histological analysis and an experienced pathologist evaluated the severity of acute and chronic inflammation, foreign body reaction and scar formation.Results: There were no deaths related to the procedure and no intraoperative complications. All rabbits voided spontaneously after surgery. Retrograde urethrograms showed no fistula or stricture. As time after surgery increased, the signs of inflammation response disappeared, and the orientation of collagen fibrils and smooth muscle fascicles resembled that of a normal urethra. the mesothelial lining of the tunica vaginalis gradually became replaced by a more stratified epithelial lining, similar to the urothelial lining of the native urethra.Conclusions: in the current study we noted that a tunica vaginalis graft placed dorsally can be a successful urethral substitute in the animal model.
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    Urethral sensory threshold and urethro-anal reflex latency in continent women
    (Springer, 2007-12-01) Cavalcanti, Geraldo de Aguiar; Bruschini, Homero; Manzano, Gilberto M.; Giuliano, Lydia P.; Nobrega, Joao Antonio M.; Srougi, Miguel; Universidade Federal de São Paulo (UNIFESP)
    Aims the sensory evaluation of the lower urinary tract is summarized in the bladder proprioceptive sensitivity during cystometry. Experimental studies suggest that abnormalities of the urethral innervation and micturition reflex can be related to the presence of continence disturbances. This study aimed to measure the urethral sensory threshold and the urethro-anal reflex latency in healthy volunteers, establishing reading criteria, comparing the results and technique used with the literature and verifying the effect of physiological factors.Materials and methods Thirty healthy female volunteers were studied. They had an absence of genital or urinary complaints and had undergone no previous pelvic or vaginal procedures. the measurement of the urethral sensory threshold and urethro-anal reflex latency were performed as described.Results the determination of the urethral sensory threshold and urethro-anal reflex latency were obtained in 96.6% of the volunteers. the electrophysiological parameters did not correlate with age, parity or number of vaginal deliveries. There was a positive association of the urethral sensory threshold with height. Technical aspects were considered and compared with those in the literature as well as the advantages and limitations of the method.Conclusions the measurement of the urethral sensory threshold and urethro-anal reflex latency presented consistent recordings. the urethral sensory threshold should be analyzed carefully in individuals with height above the population average. Subsequent observations are necessary to clarify their function in patients with continence disturbances and to measure the urethral function, but these values can be used as normal parameters for comparison.