Made available in DSpace on 2016-04-28T20:18:27Z (GMT). No. of bitstreams: 1 2006-Katia Barao Corgozinho.pdf: 1754960 bytes, checksum: e41b81ec345f919ab44aeb86dc073f65 (MD5) Previous issue date: 2006-01-17 / Perineal urethrostomy is a surgical procedure used in male cats to create a new opening between the pelvic urethra and skin in the perineal region. Indications for it include recorrent urethral obstruction and urethral obstruction that cannot be relieved by catheterization and reverse flushing. Perineal urethrostomy, when indicated and propely perfomed, is benefical to the patient and plagued with few complications. The purpose of this study was perform clinical evaluation of seventeen cats submitted to the perineal urethrostomy and evaluate the surgical complications in six months. This report evaluated the cats in the first day and up to six months after the surgery which were followed with biochemical, radiological analysis and urinalysis in this period, using questionnaires for better organization of the data. Sixteen cats had penile urethral trauma by catheterization and one cat had recurrent urethral obstruction. Complications observed after this procedure included hemorrhage, wound dehiscence, heamaturia or/and straining and urinary bacterial infection. None had urine burns or irritation or was incontinent or died. The most serious complication, urethral stricture, didn`t occur. The penile trauma was the major cause to indicate the urethrostomy. This study concluded that perineal urethrostomy predispose the urinary tract to increased bacterial contamination and subsequent infection. But many cats enjoy a long-term disease-free outcome and the clients consider their cats to have a good quality of life following surgery. / A uretrostomia perineal ? um procedimento cir?rgico realizado em gatos machos com o intuito de criar um novo orif?cio entre a uretra p?lvica e a pele na regi?o perineal. As indica??es dessa t?cnica incluem a obstru??o uretral recorrente e a obstru??o que n?o pode ser aliviada por cateteriza??o e lavagem reversa. A uretrostomia perineal quando indicada e realizada adequadamente, ? ben?fica para o paciente e gera poucas complica??es. O objetivo desse trabalho foi avaliar clinicamente 17 gatos submetidos ? uretrostomia perineal e as complica??es p?s-cir?rgicas no per?odo de seis meses. A an?lise foi efetuada no primeiro dia de atendimento at? o sexto m?s p?s-cir?rgico e os animais foram acompanhados com an?lises bioqu?micas, radiografias e com urin?lise, usando question?rios para melhor organiza??o dos dados. Dezesseis gatos tinham traumatismo na uretra peniana em conseq??ncia da cateteriza??o uretral e um gato apresentou obstru??o uretral recorrente. As complica??es p?s-operat?rias observadas foram hemorragia, deisc?ncia de sutura, hemat?ria/dis?ria e infec??o bacteriana urin?ria. Nenhum paciente teve irrita??o da ferida, queimadura por urina, incontin?ncia ou veio a ?bito. A complica??o mais s?ria, a estenose uretral, n?o aconteceu. A iatrogenia foi a maior causa para a indica??o da uretrostomia perineal nesses animais. Esse estudo indicou que a uretrostomia perineal predisp?e ao aumento da contamina??o bacteriana e infec??o urin?ria. Por?m muitos gatos ficam longos per?odos sem apresentar sinais cl?nicos de doen?a do trato urin?rio inferior e os propriet?rios consideram que seus gatos t?m boa qualidade de vida ap?s a cirurgia.

Introduction: The primary purpose of this research was to determine whether women with stress urinary incontinence (SUI) demonstrate pelvic floor muscle (PFM) strength or endurance deficits and/or changes in the motor control patterns used during maximum voluntary PFM contractions (PFM MVCs) and coughing. A secondary purpose was to determine the effect of age on these parameters. Methods: After first validating the use of vaginal pressure to study the functional output of the PFMs, three studies were carried out to address these objectives. In two studies vaginal pressure and PFM and abdominal muscle electromyography (EMG) data were recorded simultaneously during PFM MVCs and maximum effort coughs in continent women, women with mild SUI and women with moderate to severe SUI in both supine and standing. In the final study, the effect of continence status and age on PFM strength and endurance was measured with vaginal pressure. Results: Changes in vaginal pressure induced by PFM MVCs and coughing were found to reflect changes in urethral pressure. The women with SUI and the continent women were found to be equally able to produce peak PFM EMG and vaginal pressure amplitudes during PFM MVCs and coughs. Compared to the continent women, the women with SUI delayed activating their abdominal muscles during the PFM MVCs. During coughing, vaginal pressure and PFM EMG peaked simultaneously in the continent women, while in the women with SUI vaginal pressure peaked after PFM EMG. During both the PFM MVCs and the coughs, the EMG activity in all of the muscles tested was higher at the onset of vaginal pressure generation in the women with SUI compared to the continent women. No difference was found in PFM endurance between the women with and without SUI. The ability to generate peak vaginal pressure during coughing decreased with age. Conclusions: PFM weakness does not appear to play a significant role in SUI. Rather, the results of this research suggest that a combination of motor control deficits and delays in pressure transmission are associated with SUI in women. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2009-09-21 09:37:12.923

No description available.

Background: Primary urethral carcinoma is a very rare condition, and no large-scale experience with such cases has been published. Treatment will therefore have to follow rules established for the treatment of similar conditions. Patients: Six cases of primary urethral carcinoma (5 male, 1 female) who had been treated at our institution between 1995 and 1999 were retrospectively analyzed. In 3 male cases, a primary urothelial carcinoma of the distal urethra was treated by distal urethrectomy only. In 3 other cases with locally advanced tumors and/or lymph node metastases surgical treatment was followed by adjuvant cisplatinum-containing chemotherapy. Results: In the 3 cases with distal urethral carcinoma, partial urethrectomy with preservation of the penis resulted in cure, with a follow-up of 12–71 months. In the cases with advanced disease, adjuvant chemotherapy after surgery has resulted in complete remissions in all 3 cases, with a follow-up of 4–47 months at present. Conclusions: In localized, noninvasive carcinoma of the distal male urethra, partial urethrectomy seems adequate and the avoidance of penile amputation justified. In advanced cases, after local excision and lymphadenectomy adjuvant chemotherapy which by necessity must follow the guidelines established for the treatment of other urothelial or squamous cell malignancies seems to be beneficial. / Hintergrund: Das primäre Harnröhrenkarzinom ist eine sehr seltene Erkrankung, und in der Literatur gibt es keine prospektiven Serien mit größeren Fallzahlen. Die Behandlung wird sich daher an Erfahrungen orientieren müssen, die bei der Behandlung ähnlicher Krankheitsbilder gewonnen wurden. Patienten: Sechs Fälle von primärem Urethralkarzinom (5 Männer, 1 Frau), die zwischen 1995 und 1999 in unserer Klinik behandelt wurden, wurden retrospektiv analysiert. Bei 3 der männlichen Patienten lag ein primäres Urothelkarzinom der distalen Harnröhre vor, und es wurde eine Urethrateilresektion ohne adjuvante Therapie durchgeführt. In den 3 anderen Fällen mit lokal fortgeschrittenen Tumoren und/oder Lymphknotenbefall wurde nach operativer Behandlung eine adjuvante Cisplatin-haltige Chemotherapie durchgeführt. Ergebnisse: In allen 3 Fällen nach Urethrateilresektion wurde eine komplette Heilung bei einer Nachbeobachtung von 12–71 Monaten erzielt. Bei den fortgeschrittenen Fällen mit lymphogener Metastasierung wurde nach adjuvanter Chemotherapie in allen 3 Fällen eine komplette Remission bei einer Nachbeobachtung von bislang 4–47 Monaten erzielt. Schlußfolgerungen: Beim lokalisierten, nichtinvasiven distalen Urethralkarzinom des Mannes ist eine organerhaltende Strategie gerechtfertigt. In lokal fortgeschrittenen und/oder lymphogen metastasierten Fällen ist nach lokaler Exzision und Lymphadenektomie eine adjuvante Chemotherapie, die sich an den Erfahrungen der Behandlung von anderen Plattenepithel- und Urothelkarzinomen orientieren muß, sinnvoll und erfolgversprechend. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Die Belastungsinkontinenz des Mannes ist eine häufige Komplikation der radikalen Prostatovesikulektomie. Abgewandelte Operationstechniken und Rekonstruktions-verfahren führen zu verbesserten postoperativen Kontinenzraten und weisen auf die Bedeutung einzelner Komponenten am urethralen Verschlussmechanismus hin. Im Vergleich zum weiblichen ist der männliche Harnkontinenzmechanismus nur ansatzweise verstanden. In der vorliegenden Arbeit werden die am urethralen Verschluss beteiligten Komponenten und ihre Verbindungen zu angrenzenden Strukturen makroskopisch und mikroskopisch analysiert und auf ihre funktionelle Bedeutung untersucht. Zehn konservierte Leichname wurden für Untersuchungen des männlichen Urogenitaltraktes genutzt, aus drei Becken wurden Organpakete für die Erstellung von mikroskopischen Schnittpräparaten entnommen. Die histologischen Untersuchungen konnten zeigen, dass die Form des Musculus sphincter urethrae externus im Transversalschnitt von der Schnitthöhe abhängig ist. Seine Fasern strahlen in die Faszie des Musculus levator ani ein. Auch die Fasern des Corpus perineale inserieren in die Faszie dieses Muskels. Anhand dieser Ergebnisse wird die zentrale Rolle des Musculus levator ani im männlichen Harnkontinenzapparat deutlich. Der eigentliche Verschlussdruck wird demnach durch den Musculus levator ani aufgebaut und durch das Corpus perineale von dorsal auf die Urethra übertragen. Die Aufgabe des Musculus sphincter urethrae externus wird nicht als primär aktiv, sondern als dynamisches Widerlager für die membranöse Urethra beschrieben. Außerdem geht die Arbeit auf die noch wenig erforschte Mediatorfunktion der glatten Muskulatur im männlichen Urogenitaltrakt ein. Diese Ergebnisse präzisieren die Vorstellung des Kontinenzmechanismus des Mannes als Zusammenspiel von unterschiedlichen Komponenten und geben Anlass, aktuelle Standardtechniken der Beckenchirurgie zu überdenken und den Fokus auf schonende bzw. rekonstruktive Operationsverfahren zu richten.

The pelvic floor muscles (PFM) form the base of the abdominal canister, and like the other muscle groups around the canister, the abdominal muscles and the diaphragm, they contribute to and are affected by pressures within the canister. But they also have a role in organ support and continence. In urinary incontinence, clinical rehabilitation has targeted the PFM in isolation. It aims to build up strength and endurance of these muscles, but without consideration of the influence of intra-abdominal pressure, and therefore the co-ordination of muscles that generate that pressure, on PFM activity. Strengthening of the PFM has not resolved incontinence for all women, and the benefits are not sustained in the long term. Thus consideration of factors beyond the pelvic floor (PF) may lead to better outcomes for rehabilitation in both the short and long term. Thus these studies aimed to investigate the influences of abdominal muscle activity and spinal posture on the recruitment of the PFM. The studies firstly investigated the association between the abdominal and PFM during voluntary tasks. Further studies examined the effect of automatic recruitment of the PFM and the abdominal muscles with postural disturbances and changes in spinal posture, and whether there was a difference in recruitment between layers of the PFM complex during function. Electromyographic (EMG) studies, using fine wire and/or surface electrodes, were performed to record patterns of muscle activity, while, in selected studies, this was accompanied by pressures recorded within the stomach, urethra, bladder, vagina, anus and rectum, to monitor the effects of the striated muscle activity on intra-abdominal pressure and urethral function. When the PFM were voluntarily contracted in healthy women, there was a co-ordinated response in all the abdominal muscles, which varied with the position of the lumbar spine. Conversely, when the lower abdominal muscles were drawn in towards the spine there was an increase in IAP, urethral pressure and PFM EMG activity. Relaxation of the abdominal muscles and bulging of the relaxed abdominal wall decreased PFM activity and urethral pressure below their resting baselines. Thus, voluntary activation of the abdominal or PFM influences activity in the other muscle group. Other studies investigated the automatic responses of abdominal and PFM during breathing, postural perturbation, sitting and coughing. Quiet breathing was associated with modulation of PFM EMG with greater activity during expiration than inspiration, in association with variations in abdominal muscle activity. Hypercapnoea accentuated these results. Postural perturbations generated co-activation of the PF and abdominal muscles before the onset of deltoid activity with sustained activity through out repeated arm movements. Changes in spinal posture also affected PFM activity. Like the abdominal muscles, PFM were less active when sitting in a slumped position. Similar changes occurred in women with stress urinary incontinence but with lower pelvic floor muscle activity levels. Women with stress urinary incontinence also had less lordosis of the lumbar spine in upright sitting and a trend for greater superficial abdominal muscle activity than continent women. Activity of the superficial, but not deep, PFM during coughing, was affected by different sitting postures, with greater activity during coughing in slumped than in upright postures. Different breathing patterns and changes in posture also affected IAP and abdominal muscle recruitment patterns during coughing. Investigation of PFM activity during functional tasks indicates that factors beyond the PF influence its activity. The findings from these studies indicate that PFM activity is inter-related with spinal posture and abdominal muscle activity. While most of these studies were conducted in healthy women, there are a number of different types of PF problems in women, in which the mechanics of the dysfunction differ from stress urinary incontinence. PFM activity has not been investigated in all types of PF dysfunction. The findings of co-ordinated recruitment of the abdominal and PFM and the effect of spinal posture on PFM function provide some evidence that PFM rehabilitation should not be undertaken in isolation, and that there is a likely advantage from exercising with a neutral lumbar spine. There is a need for further investigation of this co-ordinated muscle recruitment in subjects with different types of dysfunction, not just stress urinary incontinence. Findings from such investigations could then point the way forward to improved rehabilitation methods for people with problems, and more suitable methods of maintaining pelvic floor health.

Thesis (doctoral)--Lund University, 1998. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Thesis (doctoral)--Lund University, 1998. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Orientador: Regina K. Takahira / Banca: Raimundo de Souza Lopes / Banca: André Marcelo Conceição Meneses / Resumo: A obstrução uretral é uma emergência clínica freqüente no atendimento de pequenos animais. Com a evolução do quadro, ocorre parada na filtração glomerular e, consequentemente, desenvolvem-se várias alterações nos equilíbrios hídrico, eletrolítico e ácido-básico, além do acúmulo de metabólitos nitrogenados e toxinas orgânicas. Podem ocorrer modificações histopatológicas nos rins e na bexiga. Objetivou-se, neste estudo, caracterizar prospectivamente as alterações laboratoriais e histopatológicas de ratos apresentando obstrução uretral. Para tanto, foram utilizados 21 ratos Wistar com obstrução uretral induzida. Foram realizados os seguintes exames: hemogasometria venosa e determinação dos níveis de uréia, creatinina, sódio, potássio, cloreto, cálcio e fósforo. As avaliações foram repetidas a cada 8 horas durante 24 horas. Após esse período os animais foram eutanasiados e as bexigas e os rins enviados para exame histopatológico. Entre os exames bioquímicos, foram observadas elevações estatisticamente significativas nos níveis de uréia, creatinina, fósforo, magnésio e potássio, e diminuição nos níveis de cloreto. Com relação à hemogasometria, houve diferença estatisticamente significativa entre os valores de pH, PO2, PCO2, excesso de base, saturação de oxigênio e lactato. O exame histopatológico renal revelou a presença de alterações tubulares e glomerulares, enquanto a análise histopatológica das bexigas demonstrou a presença de hemorragia, separação de fibras musculares e infiltrado inflamatório. Conclui-se que a obstrução uretral provoca alterações que podem ser detectadas nos exames laboratoriais, sendo as mesmas agravadas no decorrer do tempo. Além disso, a persistência durante 24 horas é capaz de levar a alterações morfológicas no trato urinário. / Abstract: Urethral obstruction is a frequent emergency in Veterinary clinics. The persistent urethral obstruction leads to blockage of renal filtration, resulting in several alterations in fluid, electrolyte and acid-base balance, besides the accumulation of nitrogenous metabolic products and organic toxins. Histopathological changes may occur in the kidneys and urinary bladder. Thus, this study aimed to prospectively characterize renal and vesical histopathological alterations in rats due to urethral obstruction. Twenty-one male Wistar rats (Rattus norvegicus) with experimental urethral obstruction were included in the study. Venous gasometry and determination of urea, creatinine, sodium, potassium, chloride, calcium and phosporus were performed. The avaliations were repeted each 8 hours during 24 hours. After that period, the animals were euthanatized for the collection of kidneys and bladder fragments to the histopathological exam. Biochemistry exams demonstrated statiscally significant elevations for the levels of urea, creatinine, phosporus, magnesium and potassium, and a decrease for the levels of chloride. Results of gasometry also demonstrated statiscally significant changes for pH, PO2, PCO2, base excess, oxygen saturation and lactate values. Histopathology analysis revealed kidney alterations in tubular and glomerular elements. The most important alterations found in urinary bladders were transmural hemorrhage, separation of muscle fibers and neutrophilic inflammatory infiltrate. Complete urethral obstruction induces important changes that can be detected by laboratorial exams, and the alterations worsen with the course of time. Besides that, the persistent obstruction during 24 hours is able to cause morphological changes in the kidneys and urinary bladder, which can be detected using histopathological exam. / Mestre

Introdução: Dentre as anomalias congênitas obstrutivas do trato urinário a Válvula de Uretra Posterior (VUP) apresenta elevado risco para a sobrevida do recém-nascido e é a causa mais comum de doença renal crônica terminal na infância. Seu tratamento envolve múltiplas especialidades e necessita seguimento no longo prazo. Com esses aspectos torna-se imperativo a permanente reavaliação de condutas. Objetivo: Descrever os aspectos clínicos e evolutivos dos pacientes portadores de Válvula de Uretra Posterior buscando avaliar a necessidade de adequações ao protocolo de atendimento. Casuística e Métodos: Constituída por 68 pacientes portadores de VUP atendidos no HCFMRP-USP no período entre 1990 e 2015. Foram revistos os dados relativos ao nascimento, encaminhamento, exames complementares, cirurgias realizadas e evolução clínica. Resultados: houve predomínio da raça branca (76,5%) e procedentes da DRS XIII (82,4%). A maioria das crianças vieram encaminhadas de outros hospitais (80,9%), alguns já submetidos à derivação urinária. Quanto à idade ao encaminhamento, 52,7% chegaram após o primeiro ano de vida embora o diagnóstico tenha sido feito em 76,5% antes do primeiro ano. Avaliação ultrassonográfica pré-natal foi realizada em 40 gestantes (48,8%) e oligoâmnio observado em16/40 (40,0%). Dentre os exames complementares para diagnóstico e seguimento ambulatorial ressaltamos a urografia excretora (16,2%), cintilografia renal (70,6%) e renograma (29,4%). Uretrocistografia foi realizada em todos os pacientes. Quanto aos principais procedimentos, derivação vesico-amniótica intrauterina foi realizada em 3 pacientes, cateterismo vesical de demora em 20, derivação alta em 4 pacientes, vesicostomia em 33, ressecção parcial do colo vesical em 9 e cauterização da VUP em 67. Dez pacientes foram transplantados. Discussão e Conclusões: os resultados apresentados são comparáveis àqueles divulgados na literatura pelas melhores instituições quanto ao diagnóstico, procedimentos cirúrgicos e evolução. O que fica evidente são as condições sócioeconômicas e culturais do nosso País onde a obtenção de melhores resultados terapêuticos tropeça em questões sociais e educacionais, necessitando de ações conjuntas visando educação continuada e organização social. Exame pré-natal adequado, diagnóstico precoce e rápido encaminhamento a centros que possam absorver estes pacientes são cruciais para a melhor evolução clínica. O protocolo mínimo de assistência deve ser objeto de difusão aos profissionais de saúde de diferentes especialidades visando o reconhecimento do quadro clínico. É desejável a inclusão, no protocolo de atendimento, de exames laboratoriais com capacidade prognóstica relacionada à evolução para doença renal crônica. / Introduction: Among congenital anomalies of the urinary tract, the posterior urethral valve (PUV) has a high risk for newborn´s mortality and is the most frequent cause of terminal chronic kidney disease in children. Its treatment involves multidisciplinary approach and long-term follow-up is necessary. Therefore, it is mandatory to permanently re-evaluate conducts. Objective: To describe the clinical and evolutive aspects of patients with PUV, aiming to evaluate the need for care protocol adjustments. Patients and Methods: The records of 68 boys with PUV who were treated at HCFMRP-USP between 1990 and 2015 have been reviewed. The data analyzed consisted of information regarding birth, age at referral, complementary exams, surgeries and clinical evolution. Results: There was a predominance of Caucasian (76.4%) and patients have been referred from region DRS XIII (82.4%). Most of the children have already been referred from other hospitals (80.8%), and some of them were already submitted to urinary diversion. Regarding the age of referral, 52.7% arrived after the first year of life, although the children were diagnosed before the first year of life in 70,6% of the cases. Prenatal ultrasound evaluation has been performed in 40 pregnant women (48.8%) and oligohydramnios was found in 16/40 (40,0%). Concerning the complementary exams for diagnosis and outpatient follow-up we highlighted excretory urography (16.2%), renal scintigraphy (70,6%) and renogram (29,4%). Voiding cistourethrography was performed in all patients. Regarding the main procedures, intrauterine vesico-amniotic shunt was performed in 3 patients, temporary drainage of urinary tract with vesical catheterization in 20, higher diversion in 4 patients, vesicostomy in 33, partial resection of the bladder neck in 9 and ablation during cystoscopy of the VUP in 67 patients. Ten patients were submitted to transplantation. Discussion and Conclusions: the results presented are comparable to those published in the literature by the best institutions regarding diagnosis, surgical procedures and patient evolution. What has become evident are the socioeconomic and cultural conditions of our country, where obtaining better therapeutic results stumbles on social and educational issues, requiring joint actions aimed continuing education and social organization. Proper prenatal examination, early diagnosis and early referral to institutions that can absorb these patients are crucial for the best clinical outcome. The minimum protocol of assistance should be disseminated to health professionals of different specialties in order to recognize the clinical picture. It is desirable to include, in the attendance protocol, laboratory tests with prognostic capabilities regarding evolution to chronic kidney disease.