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Orientador: Carlos Arturo Levi D'Ancona / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T07:14:10Z (GMT). No. of bitstreams: 1 Silva_DanielCarlosda_M.pdf: 1747195 bytes, checksum: f3a4238a53971be2f9795ab4204fa65d (MD5) Previous issue date: 2012 / Resumo: Objetvos: Avaliar com realização do estudo urodinâmico, a recuperação da função vesical em pacientes com doença renal crônica sem causa urológica de base com longos períodos de oligúria / anúria, submetidos a transplante renal. Pacientes e Métodos: De abril de 2009 a junho de 2010, 30 pacientes apresentando oligúria / anúria, foram prospectivamente avaliados com estudo urodinâmico. Este foi realizado imediatamente antes e seis meses após o transplante renal. Os critérios de inclusão foram: idade > 18 anos, doença renal crônica sem causa urológica envolvida na sua etiologia, tempo de diálise superior a 12 meses, nome em lista de transplante com doador falecido. Foram excluídos pacientes com alteração no ultrassom de vias urinárias, uretrocistografia miccional e urianálise e com diurese residual de 24 horas superior a 1000ml. Resultados: Observou-se completa recuperação da função vesical após o retorno da diurese, no sexto mês pós-transplante, independente de haver ou não disfuncionalização vesical. As variações nos parâmetros urodinâmicos foram: primeira sensação de enchimento vesical: 88,8 para 168,7ml (p = 0,0005); primeiro desejo miccional: 137,2 para 251,1ml (p <0,0001); capacidade cistométrica máxima: 221,2 para 428,7ml (p<0,0001); complacência vesical: 73,9 para 138,6ml/cm H2O (p =0,03) e fluxo máximo: 8,1 para 15,8ml/s (p <0,0001). O número de Abrams-Griffths nos homens reduziu de 31,8 para 15,2 (p =0,002). Não se observou mudanças significativas na pressão detrusora no fluxo máximo e resíduo pós-miccional. Pacientes com diurese residual de 24 horas menor que 200ml apresentaram alterações urodinâmicas significativamente maiores antes do transplante. Conclusão: Completa recuperação da função vesical foi observada nos pacientes sem doença urológica, seis meses após o transplante renal e retorno do débito urinário / Abstract: Purpose: To evaluate by urodynamic assessment, recovery of bladder function in patients with end stage renal disease without urological causes with long term oliguria, submitted to renal transplant. Patients and Methods: From April 2009 to June 2010, 30 patients presenting defunctionalized bladders were prospectively evaluated with urodynamics. The studies were performed immediately before and six months after renal transplantation. Inclusion criteria were age >18 years-old, end-stage renal disease secondary to non-urological disease, renal substitutive therapy longer than 12 months, waiting for deceased donor organ. Exclusion criteria was: abnormal urinary tract ultrasound, voiding cystourethrography or urinalyses and 24 hours residual diuresis higher than 1000ml. Results: Complete recovery of bladder function was observed after return of diuresis, on the sixth month post transplantation, independently of the presence of bladder defunctionalization. Urodynamics parameters changes from baseline to six months were: first sensation of bladder filling: 88.8 to 168.7ml (p = 0.0005); first desire to void: 137.2 to 251.1ml (p <0.0001); maximum cystometric capacity: 221.2 to 428.7ml (p <0.0001); bladder compliance: 73.9 to 138.6 ml/cm H2O (p = 0.03) and maximum flow rate: 8.1 to 15.8 ml/s (p <0.0001). The Abrams-Griffths number in men reduced from 31.8 to 15.2 (p = 0.002). No significant chances were observed in detrusor pressure at maximum flow rate and post void residual volume. Patients with 24 hours diuresis volume lower than 200ml tended to have more significant abnormalities in urodynamics parameters before transplantation. Conclusions: A complete recovery of bladder function was observed in patients with end stage renal disease, without urological disease, six months after transplant, associated with recovery of urine output by the renal graft / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

La blessure médullaire est un traumatisme aux conséquences désastreuses pour le patient. Au-delà de déficiences motrices immédiatement identifiables (paralysie des membres), l’interruption de la communication entre tissu nerveux sous-lésionnel et centres nerveux responsables de l’intégration et de la régulation des processus physiologiques, conduit souvent à un tableau clinique plus complexe. Parmi ces troubles insidieux, l’altération des fonctions urinaires et intestinales est d’une importance majeure. La régulation de ces fonctions étant sous la dépendance des segments les plus caudaux de la moelle épinière, toute altération du tissu spinal engendrera de manière quasi systématique un fonctionnement anarchique des organes conduisant à des dérèglements socialement handicapants (rétention ou/et incontinence urinaire et fécale). Bien que pour corriger cela, une stratégie basée sur la stimulation électrique fonctionnelle au niveau des racines sacrées, ait déjà été implémentée et commercialisée (Implant Brindley-Finetech), son recours ne demeure que trop marginal eu égard aux contreparties exigées (sections des racines afférentes de la moelle sacrée, avec perte de la sensibilité et des réflexes fonctionnels). Il n’est alors pas surprenant d’observer que les patients continuent à leur préférer des alternatives thérapeutiques (cathétérisme, toxine botulique…). L’objectif de cette thèse est d’évaluer les potentialités d’une stimulation directe de la moelle épinière dans la restauration des fonctions urinaires et intestinales chez le sujet lésé médullaire en proposant l’utilisation d’un nouveau modèle expérimental – le cochon domestique (40-60kg, 3-4 mois d’âge) – et une approche chirurgicale. / Spinal cord injury results in the loss of movement and sensory sensations but also in the disruption of some organ functions. Nearly all spinal cord injured subjects lose bladder control and are prone to kidney failure if they do not apply intermittent (self-) catheterization. Electrical stimulation of the sacral spinal roots with an implantable neuroprosthesis is one option besides self-catheterization to become continent and control micturition. However, many persons do not ask for this neuroprosthetic device (Brindley-Finetech implant) since deafferentation and loss of sensory functions and reflexes are serious side effects and since alternative treatments are available to patients (drugs, botulinus toxin….). This PhD work aimed at investigating various techniques for spinal cord electrical stimulation in order to address dysfunctions in spinal cord injured individuals on lesion levels that have an impact on lower limb movements and bladder, bowel and sexual functions. Orderly recruitment of fibers at the spinal cord level should eventually lead to orderly recruitment of the detrusor muscle without activation of the bladder sphincter. Thereby, low pressure voiding, for example, should be obtained that is currently impossible with existing active implantable medical devices. A new large animal model – the domestic pig – was investigated to overcome size effects of rodent models and be able to translate results and technology more easily to human.