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A Hiperplasia Prostática Benigna (HPB) é a doença benigna mais freqüente na terceira idade. A Ressecção Transuretral (RTU) de próstata constitui-se na técnica operatória mais empregada atualmente para o tratamento da HPB. A anestesia para este procedimento possui características próprias, tornando-se um desafio para o anestesiologista o manejo de suas particularidades. Com o objetivo de avaliar a conduta anestésica, comparando técnicas empregadas, drogas e doses, eventuais complicações e respectivos tratamentos, revisou-se 300 prontuários de pacientes submetidos a RTU de próstata no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HC-FMRP-USP). Optou-se por dois períodos de quatro anos com intervalo de dez anos entre eles (1989-1992 (período 1) e 1999-2002 (período 2)) para tentar estabelecer uma suposta relação entre a evolução das técnicas anestésicas e a possível redução na incidência de complicações. Foram incluídos no estudo apenas os pacientes portadores de neoplasias benignas da próstata. Algumas características dos pacientes (média de idade e estado físico ASA) foram semelhantes entre os grupos. A média de peso foi superior no período 2. Foram pedidos menos exames pré-operatórios para os pacientes do período 1. Quanto ao tipo de anestesia houve um predomínio absoluto, nos dois períodos, da anestesia regional (sendo que o bloqueio raquidiano foi o mais utilizado). O anestésico local mais empregado foi a bupivacaína nos dois períodos. Observou-se uma maior incidência de falhas nos bloqueios realizados no período 1, com maior índice de conversão para anestesia geral. O fato pode em parte ser atribuído ao não uso de agentes opióides nas punções nessa época, que sabidamente melhoram a qualidade do bloqueio. A duração média do procedimento foi maior no período 2 (considerando 45 minutos como tempo padrão). A incidência de eventos adversos intra-operatórios, como como hipotensão, arritmias cardíacas e hipotermia foi semelhante entre os períodos. No entanto, houve um maior número de pacientes com diagnóstico de infarto agudo do miocárdio no pós-operatório de até 24 horas no período1. Provavelmente esse fato aconteceu pela falta de exames complementares e avaliação cardiológica prévia nos pacientes submetidos à cirurgia nesse período. No tocante as transfusões sangüíneas, a proporção entre os períodos foi semelhante, embora fosse prática costumeira no período 1 que os pacientes realizassem autotransfusão prévia. A autotransfusão não se mostrou eficaz, na população estudada, como fator redutor do número de transfusões sangüíneas. Na sala de recuperação anestésica o tempo de permanência foi semelhante entre os períodos, no entanto, observou-se uma maior incidência de eventos adversos no período 1. A mortalidade foi maior no período 2 mas essa diferença não foi estatisticamente significante. Palavras- chave: 1. Anestesia 2. Hiperplasia Benigna da Próstata 3. Ressecção Transuretral de Próstata 4. Síndrome da Intoxicação Hídrica / Benign Prostatic Hyperplasia (BPH) is the most common disease in the third ages. Transurethral Resection of the Prostate (TRP) is the surgery technique most frequently used for the treatment of BPH. Anaesthesia for this procedure has its own features becoming a challenge for the anaesthesiologist to manage with its peculiarities. In order to evaluate the anaesthetic behavior, to compare the techniques used, drugs and doses, possible complications and their treatments, three hundreds of medical records of patients submitted to TRP in the University Hospital, Faculty of Medicine of Ribeirão Preto (FM-USP). Two periods of four years were chosen (1989-1992 (period 1) and 1999-2002 (period 2)) in order to establish some evolution between the anaesthetics techniques used and possible reduction in the incidence of complications. Only patients who had benign prostatic hyperplasia were included in this study. Some patients characteristics were similar between the two groups (mean ages and physical status ASA). Mean weight were higher in the period 2. Less preoperative exams were applied in the period 1. In both periods, the regional anaesthesia was predominant (the spinal anaesthesia was the most used). Hyperbaric bupivacaine was the most commonly used agent for regional anaesthesia in both periods. More failed blocks were seen in the period 1 with an increased number of conversion to general anaesthesia. This fact may be attached with the lack of use of opioids agents in that period, which are known to complement and improve the quality of the block. Mean duration of the procedure were higher in period 2 (taking 45 minutes as standard time). The incidence of intra-operative adverse events like hypotension, cardiac arrhythmias and hypothermia were similar in both periods. However more patients had acute heart infarct in the 24 hours of postoperative period 1. Probably this happens because of the lack of preoperative exams and cardiology evaluation in patients submitted to surgery in this period. The proportion of blood transfusions were similar in two periods although it was usual to make an autotransfusion in the patients of the first period. Autotransfusion previous to the surgery were not an effective method to reduce the number of transfusions. In postanaesthesia care unit the length of stay was similar between the periods but the incidence of adverse events was higher in the period 1. The mortality was bigger in the period 2 but this difference were not significant. Key-words: 1. Anaesthesia 2. Benign Prostatic Hyperplasia 3. Transurethral Resection of the Prostate 4. The TURP Syndrome

Introdução: A hiperplasia prostática benigna (HPB), uma das doenças mais comuns do homem idoso, pode estar associada com sintomas do trato urinário inferior que afetam sua qualidade de vida. A prostatectomia aberta é uma das opções de tratamento. O antígeno prostático específico (PSA) pode estar aumentado em pacientes com HPB, reduzindo sua especificidade diagnóstica para câncer de próstata. O objetivo do estudo é avaliar o comportamento do PSA após a prostatectomia aberta, particularmente, em pacientes com o exame aumentado no pré-operatório. Método: Foi realizado um estudo prospectivo com 130 pacientes submetidos à prostatectomia aberta no HCFMUSP de julho de 2000 a setembro de 2003. Os pacientes foram divididos em dois grupos de estudo. O grupo caso foi composto por pacientes com PSA > = 4,0ng/ml e o grupo controle formado por pacientes com PSA < 4,0ng/ml. Após seis a doze meses das operações foram realizados exame digital retal e PSA. Os pacientes com exame digital retal anormal ou PSA após a prostatectomia > = 4,0ng/ml ou queda percentual do PSA < 70% do valor inicial foram biopsiados. Resultados: Em média, os pacientes apresentaram 71,18 anos e 10,81ng/ml de nível sérico de PSA total. O tamanho da próstata e o peso do adenoma foram, em média, de 122,91cm³ e 76,54g, respectivamente. A necessidade da sonda vesical foi vista em 42,31% (55/130) dos pacientes. O exame digital retal foi anormal em 11,54% (15/130) dos pacientes. A presença de prostatite crônica ocorreu em 49,23% (64/130) das análises histológicas dos espécimes cirúrgicos. Apresentaram PSA aumentado 76,15% (99/130) dos pacientes, formando o grupo caso. Não se encontrou variável que apresentasse diferença estatisticamente significativa entre os grupos para justificar o aumento do PSA. Câncer de próstata incidental foi verificado em 6,51% (8/130) dos pacientes. Em média, a queda percentual do PSA foi de 81,13% do valor inicial após 10,1 meses da operação. Pacientes do grupo caso apresentaram queda de 85,16% e pacientes do grupo controle queda de 67,01% (p = 0,004). Em média, o PSA após a prostatectomia aberta foi de 1,38ng/ml. Pacientes do grupo caso apresentaram média de 1,56ng/ml enquanto que os pacientes do grupo controle tiveram média de 0,73ng/ml (p = 0,001). Observou-se PSA > = 4,0ng/ml após a prostatectomia aberta em 6,56% (8/122) dos pacientes. Houve correlação positiva entre a variação do PSA e o peso do adenoma (r = 0,262, p = 0,004). Foi diagnosticado câncer de próstata em 4,1% (5/122) dos pacientes. Todos pacientes pertenciam ao grupo caso e tiveram PSA > = 4,0ng/ml após a operação. Conclusão: A maioria dos pacientes apresentou PSA pré-operatório aumentado. O comportamento do PSA se caracterizou por queda percentual acentuada após 10,1 meses da prostatectomia aberta. Os pacientes com PSA préoperatório aumentado apresentaram queda mais expressiva, porém com valores mais elevados de PSA após a prostatectomia aberta em relação aos pacientes com PSA pré-operatório normal. / INTRODUCTION: Benign prostatic hyperplasia (BPH), a common aging male disease, is associated with lower urinary tract symptoms that may affect overall quality of life. Open prostatectomy is one of the treatment options. Prostate-specific antigen (PSA) specificity for prostate cancer is impaired because patients with BPH may have elevated PSA. The PSA evolution after open prostatectomy is the objective of this study, particularly, in patients with elevated PSA before operation. Methods: A prospective study was made with 130 patients undergoing open prostatectomy for BPH from July 2000 to September 2003 at HCFMUSP. Patients were divided into two study groups by PSA cut-off value. Patients with PSA > = 4,0 ng/ml integrated case group. Patients with PSA < 4,0ng/ml integrated control group. Digital rectal examination and PSA were repeated after six to 12 months after operation. Biopsy was performed in patients with altered digital rectal examination, PSA > = 4,0ng/ml or PSA reduction less than 70%. Results: Mean patient age was 71,18 years. Total PSA average value was 10,81ng/ml. The mean prostatic volume and adenoma weight was 122,91cm³ and 76,54g, respectively. 42,31% (55/130) of patients had an indwelling catheter. Digital rectal examination was altered in 11,54% (15/130) of patients. Pathologic examinations of the prostatic specimens showed chronic prostatitis in 49,23% (64/130) of them. PSA was elevated in 76,15% (99/130) of patients. They composed the case group. It was not found any factor between study groups that showed significant difference to justify the elevated PSA. Incidental prostate cancer was detected in 6,15% (8/130) of patients. The mean PSA reduction was 81,13% 10,1 months after open prostatectomy. The mean PSA reduction was 85,16% and 67,01% for case group and control group patients, respectively (p = 0,004). PSA average value was 1,38ng/ml 10,1 months after open prostatectomy. PSA average value was 1,56ng/ml and 0,73ng/ml for case group and control group patients, respectively (p = 0,001). Only 6,56% (8/122) of patients had PSA > = 4,0ng/ml after open prostatectomy. It was observed statistical correlation between adenoma weight and PSA change (r = 0,262, p = 0,004). Prostate cancer was detected in 4,1% (5/122) of patients. All of them had elevated PSA after operation and belonged to case group. Conclusions: Most of patients had preoperative elevated PSA. It was observed an important PSA reduction 10,1 months after open prostatectomy. Patients with preoperative elevated PSA had more important reduction but higher postoperative PSA values than patients with preoperative normal PSA.

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-20T15:54:57Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) JORGE HENRIQUETESE COM CORREÇÕES DA BANCA JAN 2017.pdf: 4201838 bytes, checksum: f47ae0fb55a2d648c74ac2facf85217d (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-20T15:55:06Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) JORGE HENRIQUETESE COM CORREÇÕES DA BANCA JAN 2017.pdf: 4201838 bytes, checksum: f47ae0fb55a2d648c74ac2facf85217d (MD5) / Made available in DSpace on 2017-09-20T15:55:06Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) JORGE HENRIQUETESE COM CORREÇÕES DA BANCA JAN 2017.pdf: 4201838 bytes, checksum: f47ae0fb55a2d648c74ac2facf85217d (MD5) Previous issue date: 2016 / Universidade Federal Fluminense. Centro de Ciências Médicas. Instituto Biomédico. Departamento de Morfologia. Anatomia Humana / A uretra masculina humana possui uma macro estrutura uniforme. Apesar disso apresenta evidências clínicas, morfológicas e moleculares ao longo de seus segmentos, que indicam haver diferenças estruturais e patológicas entre os mesmos. A maioria das alterações da uretra prostática (UP), em homens acima dos 50 anos, são consideradas como sendo secundárias à compressão devido ao crescimento de nódulos fibromatosos hiperplásicos do tecido prostático. Os sinais obstrutivos consequentes a Hiperplasia Prostática Benigna (HPB) incluem hesitação para iniciar a micção, redução da força e calibre do jato urinário, bem como, tardiamente, retenção urinária. Para tentar explicar as alterações que ocorreram na estrutura histológica da UP, no processo da HPB, estudamos as variações qualitativas e quantitativas que ocorreram na densidade volumétrica (Vv) do componente fibroso da matriz extracelular (MEC) e do músculo liso da UP de pacientes com HPB submetidos a tratamento cirúrgico. Foram estudadas amostras obtidas da UP de 10 pacientes com HPB sintomática, submetidos à prostatectomia aberta. Os pacientes não tinham história de tratamento prévio, para HPB. A idade dos pacientes selecionados para o presente estudo variou entre 63 a 79 anos. Para fins de comparação, foram usadas amostras controle obtidas durante a necropsia de 10 indivíduos adultos jovens com idades variando de 18 a 25 anos, vítimas de morte violenta sem comprometimento do sistema urogenital e/ou manipulação uretral. Todas as Próstatas do grupo controle apresentavam peso entre 20-25g, sendo consideradas adultas e dentro dos limites da normalidade. As amostras foram fixadas em solução de formol 10% e processadas para inclusão em parafina. Para análise da Vv, foram usadas as técnicas de coloração de tricrômico de Masson e, de Weigert. Também foram submetidas a análise imunohistoquímica. A Vv do componente fibroso da MEC e do músculo liso foi determinada pela análise de 25 campos aleatórios de cada fragmento de UP usando um sistema teste M-42. Os dados quantitativos foram analisados por meio do teste de Kolmogorov-Smirnov e Mann-Whitney. A Vv (%médio±SD) nos grupos controle e HPB foram respectivamente: 20,3±0,3 e 17,12±1,1 para as fibras do sistema elástico (p <0,007); 29,7 ± 1,9 e 25,1 ± 2,4 para colágeno (p <0,03). A Vv do músculo liso apresentou aumento, não significativo, no grupo HPB, 49,9 ± 0,4 e 52,3 ± 2,3. Por outro lado, 21,9±1,5 e 29,1±1,2 para a fibronectina (P < 0. 0001). / The human male urethra has a uniform structure. Despite this, presents morphological, molecular and clinical evidence throughout their segments that indicates pathological and structural differences between them. Most of changes in prostatic urethra (PU) in men over 50 years, are considered to be secondary to compression due to the growth of fibrous hyperplastic prostate tissue nodules. The signs of obstructive Benign Prostatic Hyperplasia (BPH) reflect the decreased distendibility of the prostatic urethra; that includes hesitation to begin urination, reduced force and caliber of the urinary stream, as well as (late) retention. To explain the histological, structural changes that occurred in the prostatic urethra, studies were made to analyse the changes in quality and quantity that occurred in the volumetric density of the fibrous component of the extracellular matrix (ECM) and smooth muscle of the urethra of patients with BPH submitted to surgical treatment. Samples were obtained from the urethra of 10 patients with symptomatic BPH who had undergone open prostatectomy. No patient had a history of previous treatment for BPH. The age ranged from 63-79 years. To compare we used control samples obtained during autopsy of 10 young adults subjects aged 18-25 that died from violent death without involvement of the urogenital system or uretral manipulation. The samples were fixed in formalin 10% and processed for paraffin embedding. For analysis of Vv, were used staining techniques tricomic Masson and Weigert. Were also submitted to immunohistochemical analysis. The Vv fibrous component of MEC and smooth muscle was determined by the analysis of 25 random fields of each fragment of a test system using M-42. Quantitative data were analyzed using the olmogorov-Smirnov and Mann-Whitney test. The Vv (mean ± SD) in the control and BPH groups respectively were: 20.3±0.3 and 17.12±1.1 in the elastic fiber system (p<0.007); and 29.7±1.9 and 25.1±2.4 in the collagen compartment (p<0.03). Smooth muscle cell volume was increased in BPH cases, 49.9±0.4 and 52.3±2.3 (not statistically significant). On other hand was 21.9±1.5 and 29.1±1.2 in the fibronectin (P < 0. 0001).

Introdução: A hiperplasia prostática benigna (HPB), uma das doenças mais comuns do homem idoso, pode estar associada com sintomas do trato urinário inferior que afetam sua qualidade de vida. A prostatectomia aberta é uma das opções de tratamento. O antígeno prostático específico (PSA) pode estar aumentado em pacientes com HPB, reduzindo sua especificidade diagnóstica para câncer de próstata. O objetivo do estudo é avaliar o comportamento do PSA após a prostatectomia aberta, particularmente, em pacientes com o exame aumentado no pré-operatório. Método: Foi realizado um estudo prospectivo com 130 pacientes submetidos à prostatectomia aberta no HCFMUSP de julho de 2000 a setembro de 2003. Os pacientes foram divididos em dois grupos de estudo. O grupo caso foi composto por pacientes com PSA > = 4,0ng/ml e o grupo controle formado por pacientes com PSA < 4,0ng/ml. Após seis a doze meses das operações foram realizados exame digital retal e PSA. Os pacientes com exame digital retal anormal ou PSA após a prostatectomia > = 4,0ng/ml ou queda percentual do PSA < 70% do valor inicial foram biopsiados. Resultados: Em média, os pacientes apresentaram 71,18 anos e 10,81ng/ml de nível sérico de PSA total. O tamanho da próstata e o peso do adenoma foram, em média, de 122,91cm³ e 76,54g, respectivamente. A necessidade da sonda vesical foi vista em 42,31% (55/130) dos pacientes. O exame digital retal foi anormal em 11,54% (15/130) dos pacientes. A presença de prostatite crônica ocorreu em 49,23% (64/130) das análises histológicas dos espécimes cirúrgicos. Apresentaram PSA aumentado 76,15% (99/130) dos pacientes, formando o grupo caso. Não se encontrou variável que apresentasse diferença estatisticamente significativa entre os grupos para justificar o aumento do PSA. Câncer de próstata incidental foi verificado em 6,51% (8/130) dos pacientes. Em média, a queda percentual do PSA foi de 81,13% do valor inicial após 10,1 meses da operação. Pacientes do grupo caso apresentaram queda de 85,16% e pacientes do grupo controle queda de 67,01% (p = 0,004). Em média, o PSA após a prostatectomia aberta foi de 1,38ng/ml. Pacientes do grupo caso apresentaram média de 1,56ng/ml enquanto que os pacientes do grupo controle tiveram média de 0,73ng/ml (p = 0,001). Observou-se PSA > = 4,0ng/ml após a prostatectomia aberta em 6,56% (8/122) dos pacientes. Houve correlação positiva entre a variação do PSA e o peso do adenoma (r = 0,262, p = 0,004). Foi diagnosticado câncer de próstata em 4,1% (5/122) dos pacientes. Todos pacientes pertenciam ao grupo caso e tiveram PSA > = 4,0ng/ml após a operação. Conclusão: A maioria dos pacientes apresentou PSA pré-operatório aumentado. O comportamento do PSA se caracterizou por queda percentual acentuada após 10,1 meses da prostatectomia aberta. Os pacientes com PSA préoperatório aumentado apresentaram queda mais expressiva, porém com valores mais elevados de PSA após a prostatectomia aberta em relação aos pacientes com PSA pré-operatório normal. / INTRODUCTION: Benign prostatic hyperplasia (BPH), a common aging male disease, is associated with lower urinary tract symptoms that may affect overall quality of life. Open prostatectomy is one of the treatment options. Prostate-specific antigen (PSA) specificity for prostate cancer is impaired because patients with BPH may have elevated PSA. The PSA evolution after open prostatectomy is the objective of this study, particularly, in patients with elevated PSA before operation. Methods: A prospective study was made with 130 patients undergoing open prostatectomy for BPH from July 2000 to September 2003 at HCFMUSP. Patients were divided into two study groups by PSA cut-off value. Patients with PSA > = 4,0 ng/ml integrated case group. Patients with PSA < 4,0ng/ml integrated control group. Digital rectal examination and PSA were repeated after six to 12 months after operation. Biopsy was performed in patients with altered digital rectal examination, PSA > = 4,0ng/ml or PSA reduction less than 70%. Results: Mean patient age was 71,18 years. Total PSA average value was 10,81ng/ml. The mean prostatic volume and adenoma weight was 122,91cm³ and 76,54g, respectively. 42,31% (55/130) of patients had an indwelling catheter. Digital rectal examination was altered in 11,54% (15/130) of patients. Pathologic examinations of the prostatic specimens showed chronic prostatitis in 49,23% (64/130) of them. PSA was elevated in 76,15% (99/130) of patients. They composed the case group. It was not found any factor between study groups that showed significant difference to justify the elevated PSA. Incidental prostate cancer was detected in 6,15% (8/130) of patients. The mean PSA reduction was 81,13% 10,1 months after open prostatectomy. The mean PSA reduction was 85,16% and 67,01% for case group and control group patients, respectively (p = 0,004). PSA average value was 1,38ng/ml 10,1 months after open prostatectomy. PSA average value was 1,56ng/ml and 0,73ng/ml for case group and control group patients, respectively (p = 0,001). Only 6,56% (8/122) of patients had PSA > = 4,0ng/ml after open prostatectomy. It was observed statistical correlation between adenoma weight and PSA change (r = 0,262, p = 0,004). Prostate cancer was detected in 4,1% (5/122) of patients. All of them had elevated PSA after operation and belonged to case group. Conclusions: Most of patients had preoperative elevated PSA. It was observed an important PSA reduction 10,1 months after open prostatectomy. Patients with preoperative elevated PSA had more important reduction but higher postoperative PSA values than patients with preoperative normal PSA.

[Truncated abstract] This thesis examines the potential role of dietary intake in the development of two common conditions affecting the prostate gland; prostate cancer and benign prostatic hyperplasia (BPH). Diet is of interest as a potential risk factor for prostate cancer because of geographical variations in prostate cancer incidence and increased prostate cancer risks associated with migration from Asian to western countries. Some geographical variation has been suggested for BPH, but this is less certain. However, both prostate cancer and BPH have potential links with diet through their positive associations with sex hormone levels, metabolic syndrome, increased insulin levels and chronic inflammation. In addition, zinc is an essential dietary micronutrient required for semen production in the prostate gland. The original work for this thesis is presented in six manuscripts of which, four have been published in peer-reviewed journals (at the time of thesis completion). BPH investigated in this thesis is defined as surgically-treated BPH. The following hypotheses were investigated. Regarding foods, nutrients and the risk of prostate cancer and BPH: 1. Increasing intakes of fruits, vegetables and zinc are inversely associated with the risk of prostate cancer and BPH 2. Increasing intakes of total fat and calcium are positively associated with the risk of prostate cancer and BPH. 3. Dietary patterns characterised by high meat, processed meat, calcium and fat content are positively associated with the risk of prostate cancer and BPH. 4. Dietary patterns characterised by high fruit and vegetable and low meat content are inversely associated with the risk of prostate cancer and BPH. v Regarding methodological issues related to the study of diet-disease relationships: 5. Dietary patterns (overall diet) elicited from principal components analysis yield stronger diet-disease associations than when studying isolated nutrients. 6. Remotely recalled dietary intake is reliable enough to be used in studies of chronic disease with long latency periods, such as prostate cancer and BPH. Methods: Data from two studies was used to address the hypotheses above. ... Based on the literature reviewed and the original work for this thesis, the most important dietary risk factors for prostate cancer and BPH appear to be those common to western style diets, i.e. diets high in red meat, processed meat, refined grains, dairy products, and low in fruit and vegetables. This type of diet is likely to result in marginal intakes of antioxidants and fibre, excess intakes of fat and possibly, moderate intakes of carcinogens associated with processed meat and meat cooked at high temperatures. These dietary factors have been linked with biomarkers of inflammation, and they support the hypotheses that chronic inflammation is involved in the development of both prostate cancer and BPH. In addition, this work builds on evidence that zinc is an important factor in prostate health. There is scope for more investigation into the reliability of dietary patterns and the use of nutrient patterns as an alternative to focussing on single food components. Further studies on the reliability of remote dietary intake would also be useful. Because of the latency of chronic disease, it can be theorised that remote dietary recall may uncover more robust diet-disease relationships.

INTRODUCTION Benign prostatic hyperplasia (BPH) is the most common pathological condition of aged men which significantly impairs the quality of life status. Though pharmacotherapy with adrenoblockers and 5-alpha reductase inhibitors markedly decreased the rate of surgical interventions, BPH surgery still constitutes the main workload (around ¼ of total) of urologists in the department. The results of the observational study performed by Barry et al. show that the probability of surgical treatment of BPH during the period of 4 years for subjects with mild symptoms equals to 10%, and in case of moderate and severe symptoms - 24% and 39%, respectively. According to the data of large multicenter study performed with 7,588 men in Asia and Australia, moderate and severe symptoms are present in 29%, 40%, and 56% of men in their fifth, sixth, and seventh decade of life, respectively. Symptoms are the main driving force of BPH treatment, but their correlation with residual urine, objective findings of uroflowmetry and invasive urodynamics is only poor. The association of various parameters with the outcomes of surgical treatment is complicated and still not completely investigated. Therefore finding parameters that predict the outcome of surgical BPH treatment is important. According to the literature, unfavorable outcomes of transurethral resection are present in around 15-30% of men with symptomatic BPH. This is mostly associated with inadequate preoperative evaluation, not fully... [to full text]

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 4 uppsatser.

Patologias prostáticas como a Hiperplasia Prostática Benigna (HPB) e o Câncer de próstata (CaP) apresentam alta incidência, morbidade e mortalidade em indivíduos a partir de 40-50 anos. Fatores ambientais e nutricionais são possíveis fatores envolvidos no desenvolvimento destas doenças. Este trabalho tem por objetivo avaliar o padrão alimentar, perfil antropométrico e perfil lipídico em homens com e sem HPB e CaP e verificar se existe associação entre as variáveis consideradas e a presença de HPB ou CaP na amostra estudada. Foram entrevistados pacientes provenientes do ambulatório de Urologia do Hospital de Clínicas de Porto Alegre (pelo médico da equipe) e preenchida ficha para coleta de dados pessoais e demográficos, história médica e familiar, idade, estágio e grau do tumor, volume da próstata e valor do PSA na época do diagnóstico. Após, os pacientes foram encaminhados à nutricionista para avaliação nutricional (peso, altura, dobras cutâneas, relação cintura/quadril e Recordatório de 24h). O consumo alimentar foi avaliado pelo Recordatório de 24h e analisado pelo programa de apoio à nutrição da Escola Paulista de Medicina – EPM (DIS-EPM, versão 1.5, 2002, UNIFESP). Os pacientes foram orientados a procurar o laboratório de análises clínicas do mesmo hospital para coletar uma amostra sangüínea para dosagem sérica de testosterona total, colesterol total, colesterol HDL e triglicerídeos. O IMC e a circunferência da cintura não apresentaram diferença estatística entre os grupos avaliados. O grupo HPB apresentou consumo menor (p<0,05) de calorias e carboidrato (1875 ± 635 Kcal/dia e 253 ± 105 g/dia) quando comparado ao grupo CaP (2017 ± 476 e 283 ± 75) e ao grupo controle(2179 ± 565 e 302 ± 91). O consumo de fibra alimentar (g/dia) foi significativamente menor (p=0,01) nos grupos HPB (27 ± 12) e CaP (28 ± 10) em relação ao grupo controle (34 ± 15). O consumo aumentado de fibras parece estar relacionado a menor incidência de HPB e CaP. O consumo de calorias e demais nutrientes, o perfil antropométrico e o perfil lipídico não demonstraram relação com estas doenças. / Prostatic pathologies such as Benign Prostatic Hyperplasia (BPH) and Prostate Cancer (PCa) present high incidence, morbidity and mortality among individuals at the age of 40-50 years. Environmental and nutritional factors seem to be involved in the development of these diseases. The objective of the present study is to assess the alimentary pattern, anthropometric and lipid profiles in men with and without BPH and PCa and to verify whether there exists an association among the considered variables and the presence of BPH or PCa in the studied individuals. Urology outpatients from Hospital de Clínicas de Porto Alegre were interviewed by a physician who collected personal and demographic data, medical and familiar history, age, stage and degree of tumor, prostate volume and PSA value at diagnosis. Patients were directed to a nutritionist for nutritional evaluation (weight, height, skin folds, waist/hip ratio and 24-hours recall). Alimentary intake was assessed by 24-hours recall and analyzed by the nutrition support program of Escola Paulista de Medicina – EPM (DIS-EPM, version 1.5, 2002, UNIFESP). Patients were asked to return to the clinical analysis laboratory at the same hospital the following week, in order to collect another blood sample to dose serum total testosterone, total cholesterol, HDL cholesterol and triglycerides. Body Mass Index and waist circumference did not show statistical difference among the assessed groups. The BPH group presented with lower intake (p<0.05) of calories and carbohydrate (1875 ± 635 Kcal/day and 253 ± 105 g/day) when compared tothe PCa group (2017 ± 476 and 283 ± 75) and the control group (2179 ± 565 and 302 ± 91). Fiber intake (g/day) was significantly lower (p=0.01) on BPH (27 ± 12) and PCa groups (28 ± 10) when compared to control group (34 ± 15). Higher intake of fibers seems to be related to lower BPH and PCa incidence. Calories and other nutrients intake, anthropometric profile and lipid profile did not show relation to these diseases.