INTRODUÇÃO E OBJETIVOS: O cateterismo vesical intermitente limpo (CVIL) é método consagrado para o esvaziamento da bexiga em pacientes com disfunção vesico esfincteriana. Crianças com disrafismos neuromedulares podem evoluir com disfunção vesico esfincteriana e algumas necessitam do CVIL. Profissionais da saúde que prestam assistência a crianças e adolescentes em programa de cateterismo vesical intermitente não devem pautar suas atenções somente nos pacientes, mas também em seus cuidadores. Os objetivos deste estudo foram: analisar a qualidade de vida do binômio cuidador-criança e identificar fatores envolvidos na adesão e satisfação com o programa de cateterismo vesical intermitente limpo em crianças e adolescentes. MÉTODOS: A população estudada foi de 174 indivíduos sendo oitenta e sete crianças e adolescentes entre um e dezoito anos de idade em programa de CVIL, e oitenta e sete cuidadores principais. Os cuidadores responderam a um formulário com dados sociodemográficos e clínicos da criança ou adolescente e do cuidador e dados gerais relativos à prática do cateterismo vesical. Os cuidadores também responderam a três questionários, dois relativos à qualidade de vida, WHOQOL-bref (do cuidador) e PedsQLTM4. 0 (relato do cuidador referente à qualidade de vida da criança/adolescente) e um relacionado ao impacto na vida do cuidador, a Caregiver Burden Scale (CBS). As crianças e adolescentes responderam o PedsQLTM4. 0 (relato da criança). RESULTADOS: 55,1% dos cuidadores consideraram sua qualidade de vida boa ou muito boa, 47,2% afirmaram estar satisfeitos ou muito satisfeitos com a saúde. Entre as 24 facetas da qualidade de vida avaliada pelo WHOQOL-bref, o maior escore foi para a autoestima. Os fatores: doença crônica do cuidador (p=0,001; p=0,016), crianças com déficit cognitivo (p=0,001; p=0,018) e dependência na realização do CVIL (p=0,013; p=0,029) foram associados à piora na qualidade de vida do cuidador nas questões físicas e psicológicas, respectivamente. O escore global da CBS foi de 1,97±0,51, sendo o maior escore na dimensão ambiente (2,22 ± 0,73). Cuidadores acima de 40 anos apresentaram impacto negativo (p=0,040) na dimensão decepção. A dependência para locomoção da criança/ adolescente, baixa frequência do CVIL e não realizar o CVIL fora do domicílio têm impacto negativo na vida do cuidador na dimensão meio ambiente. Na avaliação da qualidade de vida das crianças/adolescentes obtiveram-se maiores escores em todas as dimensões pelas respostas das crianças quando comparadas às respostas dos seus cuidadores. Crianças independentes do uso de aparelhos para locomoção apresentaram melhor qualidade de vida, na percepção de seus cuidadores, em todos os domínios do PedsQLTM 4.0, com significância (p=0,015) no domínio atividade escolar. Crianças que realizam CVIL via conduto abdominal continente apresentaram melhor qualidade de vida na percepção dos cuidadores e das crianças, comparada com o CVIL por via uretral. 83,9% dos cuidadores relataram benefícios do CVIL, a maioria relacionada à melhora das condições físicas causadas pela disfunção vesico esfincteriana; 98,9% descreveram dificuldades, em geral relacionadas às questões sociais. CONCLUSÕES: O cuidador tem percepção positiva de sua QV, satisfação com a sua saúde e elevada autoestima, com impacto relacionado aos fatores: doença crônica do cuidador, crianças com déficit cognitivo, dependência da criança para a realização do CVIL e locomoção, baixa frequência do CVIL e não realizar o procedimento fora do domicílio. A QV da criança/adolescente é melhor percebida por elas do que pelos seus cuidadores. Crianças/adolescentes que realizam CVIL via conduto abdominal continente apresentaram melhor QV na percepção do binômio. O CVIL foi um procedimento considerado de fácil execução, a diminuição da incontinência urinária foi o principal benefício relatado, e as limitações para aquisição do material foram a principal dificuldade relatada pelo grupo estudado / INTRODUCTION AND OBJECTIVES: Clean intermittent catheterization (CIC) is the established method for bladder emptying in patients with visico sphincter dysfunction. Children with neurospinal dysraphism can develop bladder sphincter dysfunction and some require the CIC. Health professionals who provide care to children and adolescents in clean intermittent bladder catheterization program should not keep their attentions only on their patients but also on their caregivers. The objectives of this study were to analyze the quality of life of the caregiver-child binomial and identify factors involved in adherence and satisfaction with CIC program in children and adolescents. METHODS: The study population was of 174 subjects, eighty-seven children and adolescents aged one to eighteen years old in CVIL program and eighty-seven of the main caregivers. Caregivers responded to a form with demographic and clinical data of the children or adolescents as well as the caregivers and general data related to the practice of bladder catheterization. Caregivers also answered three other questionnaires, two related to quality of life, WHOQOL -BREF (caretaker) and PedsQLTM4.0 (caretaker report related to children and adolescent\'s quality of life) and a questionnaire about the impact on the caretaker\'s life, the Caregiver Burden Scale (CBS). Children and adolescents answered the PedsQLTM4.0 (reported by children). RESULTS: 55.1 % of caregivers considered their quality of life good or very good, 47.2 % said they were satisfied or very satisfied with their health conditions. Among the 24 aspects of quality of life measured by WHOQOL -BREF, the highest score was for self-esteem. Factors: caregiver`s chronic disease (p = 0.001, p = 0.016), children with cognitive impairment (p = 0.001, p = 0.018), and dependence on the performance of CIC (p = 0.013, p = 0.029) were associated with worsening caregiver quality of life in physical and psychological issues, respectively. The overall score for CBS was 1.97 ± 0.51, with the highest score in the environment dimension (2.22 ± 0.73). Caregivers over 40 years old had a negative impact (p = 0.040) in the dimension of disappointment. The children and adolescents\' dependency for mobility, low frequency of CIC and nonperformance of CIC outside the household had a negative impact on the caregivers\' lives regarding the environment dimension. In the evaluation of children and adolescents\' quality of life, higher scores were obtained in all dimensions, considering the responses of children compared to the responses of their caregivers. Independent children \'s use of apparatus for locomotion had better quality of life scores, perception of their caregivers in all areas of PedsQLTM 4.0, with significance (p = 0.015) in the school activity. Children who perform CIC through abdominal continent conduit showed better quality of life as perceived by caregivers and children, compared with urethral CIC. 83.9 % of caregivers reported CIC benefits, most related to improving the physical conditions caused by bladder dysfunction; 98.9 % reported general difficulties related to social issues. CONCLUSIONS: The caregiver has a positive perception of their QoL, satisfaction with their health and higher self-esteem, with related to factors impact: chronic caregiver illness, children with cognitive impairment, the child\'s dependency on the performance of CIC and locomotion, low CIC frequency and not perform the procedure outside home. The child\'s QoL / adolescent is better perceived by them than by their caregivers. Children / adolescents who perform abdominal CIC via stoma had better QoL in the perception of binomial. The CIC was considered a procedure easy to perform, decreased urinary incontinence was the main benefit reported, and the limitations to the acquisition of the material were the main difficulty reported by the study group

Fragestellung: Die Trichterbildung der proximalen Urethra ist ein typischer, aber nicht beweisender Befund bei Frauen mit Streßharninkontinenz. In der Studie wurde geprüft , ob spezifische pathomorphologische Veränderungen des Kontinenzkontrollsystems bei Frauen mit Trichterbildung gehäuft vorkommen und ob der Trichterbildung der Urethra ein diagnostischer Aussagewert zukommt. Methoden: 54 Frauen (mittleres Alter 52±11 Jahre) mit einer klinisch und urodynamisch gesicherten Streßharninkontinenz und ohne vorhergehende urogynäkologische Operationen wurden standardisiert kernspintomographisch (Protonendichte. Gewichtete Aufnahmen, transversale Schnittebene in Höhe der proximalen Urethra) untersucht. Folgende pathomorphologische Veränderungen des Strßharnkontinenzkontrollsystems wurden unterschieden: Urethradefekte, Defekte des M. levator ani und Defekte der Fascia endopelvina. Die Trichterbildung der Urethra wurde beim Pressen mit Hilfe der Introitussonographie diagnostiziert. Ergebnisse: Im Untersuchungskollektiv fanden sich 32 Frauen mit und 22 Frauen ohne Trichterbildung der Urethra. Streßharninkontinenz in Kombination mit einer Trichterbildung war signifikant vermehrt assoziiert mit einer Strukturveränderung des M. levator ani im MRT-Bild (erhöhte Signalintensität) und einem introitussonographisch diagnostizierten vertikalen Deszensus. Defekte der Urethralmuskulatur und der endopelvinen Faszie wurden nicht vermehrt gefunden. Schlußfolgerungen: Die Trichterbildung der Urethra reflektiert eine funktionellen Zustand der Urethra, welcher durch multifunktionelle pathomorphologische Veränderungen des Sreßharnkontinenzkontrollsystems bedingt ist. Die Diagnose Trichterbildung der Urethra besitzt keine diagnostische Relevanz. / Aims of study: Funneling of the proximal urethra is a typical ultrasound finding in stress urinary incontinence but no definitive proof. The study was performed to determine whether women with funneling of the urethra show specific pathomorphologic changes of the continence control system at MR imaging and whether the demonstration of urethral funneling has any diagnostic relevance. Methods: Fifty-four women (mean age 52±11 years) with clinically and urodynamically proven stress urinary incontinence without prior urogynecologic surgery underwent standardized MR imaging (proton-density-weighted sequence, transverse section orientation at the level of the proximal urethra). The following pathomorphologic changes of the stress urinary continence control system were distinguished: urethral defects, defects of levator ani muscle and defects of endopelvic fascia. Funneling of the urethra was confirmed by introital ultrasound during pressing. Results: In the study group were 32 women with and 22 woman without urethral funnelling. Stress urinary incontinence in combination with funneling of the urethra was found to be associated with a significant increase in structural changes of the levator muscle at MR imaging (increased signal intensity) and vertical prolapse at ultrasound. Defects of urethral muscles and defects of endopelvic fascia were not found to be increased. Conclusions: Funneling of the urethra reflects a functional condition of the urethra caused by multifunctional pathomorphologic changes of the stress continence control system. The demonstration of urethral funneling has no any diagnostic relevance.

BPH¡]Benign prostate hyperplasia¡^is one of the most common chronic diseases in aging male around the globe. TURP¡]Transurethral Resection of Prostate¡^remains the gold standard procedure of choice in BPH treatment. But limited literatures regarding the late complication of TURP was available. For understanding the long term follow up result after TURP, and predict the risk factors for re-intervention, we accessed the hospital claims for TURP from the National Health Insurance database, utilizing data from 2001 to 2007 , in 2001, 2002, 2003 TURP cases, we followed each cohort for 5 years to evaluate the late complications. We also examined the association between the characteristics of patient, hospital and the long term prognosis. In this study we found that from 2001to 2003, totally 1,225 patients under went TURP surgery, with the average age 71.52 ¡Ó 7.65 years (47-94 years). Among these cases, 140 patients (11.43%) experienced secondary surgery. Of the 140 secondary surgery patients, 71 received a secondary TURP, 35 received urethral stricture related surgery and 34 received bladder neck contracture related surgery. The study revealed both the characteristics of the patient and the hospital did not show significantly effect to the long term prognosis. In prediction the risk factors of the secondary surgery, the logistic regression analysis revealed those hospitals located at the central part of Taiwan compared to those at northern part of Taiwan showed a relative risk of 0.58, a significant trend of lower risk for secondary surgery. Otherwise, except this geographic location difference, other characteristics of the patient and the hospital show no significantly risk to the post-TURP second surgery. Conclusion of our study, the result of TURP surgery in Taiwan was fairly equal to that in advanced countries. Patient comorbidity, treated in different level, ownership hospitals resulted no significant difference in post-TURP prognosis.

INTRODUÇÃO E OBJETIVOS: O cateterismo vesical intermitente limpo (CVIL) é método consagrado para o esvaziamento da bexiga em pacientes com disfunção vesico esfincteriana. Crianças com disrafismos neuromedulares podem evoluir com disfunção vesico esfincteriana e algumas necessitam do CVIL. Profissionais da saúde que prestam assistência a crianças e adolescentes em programa de cateterismo vesical intermitente não devem pautar suas atenções somente nos pacientes, mas também em seus cuidadores. Os objetivos deste estudo foram: analisar a qualidade de vida do binômio cuidador-criança e identificar fatores envolvidos na adesão e satisfação com o programa de cateterismo vesical intermitente limpo em crianças e adolescentes. MÉTODOS: A população estudada foi de 174 indivíduos sendo oitenta e sete crianças e adolescentes entre um e dezoito anos de idade em programa de CVIL, e oitenta e sete cuidadores principais. Os cuidadores responderam a um formulário com dados sociodemográficos e clínicos da criança ou adolescente e do cuidador e dados gerais relativos à prática do cateterismo vesical. Os cuidadores também responderam a três questionários, dois relativos à qualidade de vida, WHOQOL-bref (do cuidador) e PedsQLTM4. 0 (relato do cuidador referente à qualidade de vida da criança/adolescente) e um relacionado ao impacto na vida do cuidador, a Caregiver Burden Scale (CBS). As crianças e adolescentes responderam o PedsQLTM4. 0 (relato da criança). RESULTADOS: 55,1% dos cuidadores consideraram sua qualidade de vida boa ou muito boa, 47,2% afirmaram estar satisfeitos ou muito satisfeitos com a saúde. Entre as 24 facetas da qualidade de vida avaliada pelo WHOQOL-bref, o maior escore foi para a autoestima. Os fatores: doença crônica do cuidador (p=0,001; p=0,016), crianças com déficit cognitivo (p=0,001; p=0,018) e dependência na realização do CVIL (p=0,013; p=0,029) foram associados à piora na qualidade de vida do cuidador nas questões físicas e psicológicas, respectivamente. O escore global da CBS foi de 1,97±0,51, sendo o maior escore na dimensão ambiente (2,22 ± 0,73). Cuidadores acima de 40 anos apresentaram impacto negativo (p=0,040) na dimensão decepção. A dependência para locomoção da criança/ adolescente, baixa frequência do CVIL e não realizar o CVIL fora do domicílio têm impacto negativo na vida do cuidador na dimensão meio ambiente. Na avaliação da qualidade de vida das crianças/adolescentes obtiveram-se maiores escores em todas as dimensões pelas respostas das crianças quando comparadas às respostas dos seus cuidadores. Crianças independentes do uso de aparelhos para locomoção apresentaram melhor qualidade de vida, na percepção de seus cuidadores, em todos os domínios do PedsQLTM 4.0, com significância (p=0,015) no domínio atividade escolar. Crianças que realizam CVIL via conduto abdominal continente apresentaram melhor qualidade de vida na percepção dos cuidadores e das crianças, comparada com o CVIL por via uretral. 83,9% dos cuidadores relataram benefícios do CVIL, a maioria relacionada à melhora das condições físicas causadas pela disfunção vesico esfincteriana; 98,9% descreveram dificuldades, em geral relacionadas às questões sociais. CONCLUSÕES: O cuidador tem percepção positiva de sua QV, satisfação com a sua saúde e elevada autoestima, com impacto relacionado aos fatores: doença crônica do cuidador, crianças com déficit cognitivo, dependência da criança para a realização do CVIL e locomoção, baixa frequência do CVIL e não realizar o procedimento fora do domicílio. A QV da criança/adolescente é melhor percebida por elas do que pelos seus cuidadores. Crianças/adolescentes que realizam CVIL via conduto abdominal continente apresentaram melhor QV na percepção do binômio. O CVIL foi um procedimento considerado de fácil execução, a diminuição da incontinência urinária foi o principal benefício relatado, e as limitações para aquisição do material foram a principal dificuldade relatada pelo grupo estudado / INTRODUCTION AND OBJECTIVES: Clean intermittent catheterization (CIC) is the established method for bladder emptying in patients with visico sphincter dysfunction. Children with neurospinal dysraphism can develop bladder sphincter dysfunction and some require the CIC. Health professionals who provide care to children and adolescents in clean intermittent bladder catheterization program should not keep their attentions only on their patients but also on their caregivers. The objectives of this study were to analyze the quality of life of the caregiver-child binomial and identify factors involved in adherence and satisfaction with CIC program in children and adolescents. METHODS: The study population was of 174 subjects, eighty-seven children and adolescents aged one to eighteen years old in CVIL program and eighty-seven of the main caregivers. Caregivers responded to a form with demographic and clinical data of the children or adolescents as well as the caregivers and general data related to the practice of bladder catheterization. Caregivers also answered three other questionnaires, two related to quality of life, WHOQOL -BREF (caretaker) and PedsQLTM4.0 (caretaker report related to children and adolescent\'s quality of life) and a questionnaire about the impact on the caretaker\'s life, the Caregiver Burden Scale (CBS). Children and adolescents answered the PedsQLTM4.0 (reported by children). RESULTS: 55.1 % of caregivers considered their quality of life good or very good, 47.2 % said they were satisfied or very satisfied with their health conditions. Among the 24 aspects of quality of life measured by WHOQOL -BREF, the highest score was for self-esteem. Factors: caregiver`s chronic disease (p = 0.001, p = 0.016), children with cognitive impairment (p = 0.001, p = 0.018), and dependence on the performance of CIC (p = 0.013, p = 0.029) were associated with worsening caregiver quality of life in physical and psychological issues, respectively. The overall score for CBS was 1.97 ± 0.51, with the highest score in the environment dimension (2.22 ± 0.73). Caregivers over 40 years old had a negative impact (p = 0.040) in the dimension of disappointment. The children and adolescents\' dependency for mobility, low frequency of CIC and nonperformance of CIC outside the household had a negative impact on the caregivers\' lives regarding the environment dimension. In the evaluation of children and adolescents\' quality of life, higher scores were obtained in all dimensions, considering the responses of children compared to the responses of their caregivers. Independent children \'s use of apparatus for locomotion had better quality of life scores, perception of their caregivers in all areas of PedsQLTM 4.0, with significance (p = 0.015) in the school activity. Children who perform CIC through abdominal continent conduit showed better quality of life as perceived by caregivers and children, compared with urethral CIC. 83.9 % of caregivers reported CIC benefits, most related to improving the physical conditions caused by bladder dysfunction; 98.9 % reported general difficulties related to social issues. CONCLUSIONS: The caregiver has a positive perception of their QoL, satisfaction with their health and higher self-esteem, with related to factors impact: chronic caregiver illness, children with cognitive impairment, the child\'s dependency on the performance of CIC and locomotion, low CIC frequency and not perform the procedure outside home. The child\'s QoL / adolescent is better perceived by them than by their caregivers. Children / adolescents who perform abdominal CIC via stoma had better QoL in the perception of binomial. The CIC was considered a procedure easy to perform, decreased urinary incontinence was the main benefit reported, and the limitations to the acquisition of the material were the main difficulty reported by the study group

No description available.

Einleitung: Fehlbildungen der Nieren und ableitenden Harnwege gehören zu den häufigsten angeborenen Anomalien. Ihr Anteil an den pränatal diagnostizierten Fehlbildungen wird mit bis zu 50% angegeben. Die Behandlung urogenitaler Fehlbildungen hat sich nicht zuletzt unter dem Einfluss der Pränatalen Diagnostik erheblich gewandelt. Nach einer Phase der Übertherapie nach Einführung der pränatalen Diagnostik ergab sich nach modernen diagnostischen Kriterien und im Ergebnis von Langzeitstudien des natürlichen Ganges der Fehlbildungen eine wesentlich differenziertere Indikationsstellung für das aktive therapeutische Vorgehen Fragestellung: In der retro- und prospektiv angelegten Studie sollte untersucht werden, inwieweit die pränatale Diagnostik das postnatale Vorgehen beeinflusst. So sollte untersucht werden, aus welchen pränatalen Befunden welche pränatalen Verdachtsdiagnosen gestellt wurden und wie sich diese zu den definitiven postnatalen Diagnosen verhalten. Des weiteren sollte der Aussagewert einzelner pränataler Befunde herausgearbeitet werden. Besondere Beachtung sollte dabei die Frage finden, inwieweit aus den pränatalen Befunden eine Aussage über die postnatale Therapiebedürftigkeit und schließlich auch für die Prognose der Nierenfunktion möglich ist. Patienten und Methoden: Ausgangspunkt waren 21.616 in der Abteilung für pränatale Diagnostik und Therapie in der Zeit von 1984 bis 1996 untersuchte Schwangerschaften. Unter diesen fanden sich 1.574 Feten mit angeborenen Anomalien mit fraglich kinderchirurgischer Relevanz. 1077 Fälle konnten ausgewertet werden. Mit 990 Fällen dominierten die Fehlbildungen des Urogenitalsystems, von denen 693 in die komplette Analyse mit einbezogen werden konnten. Ergebnisse: Bei 7,28% aller untersuchten Feten fanden sich Organfehlbildungen außerhalb des Zentralnervensystems. Unter diesen dominierten Harntraktfehlbildungen mit 63%. Als häufigste Diagnose wurde pränatal eine "Hydronephrose" angegeben. Dieser Begriff umschreibt jedoch in dem hier verwandten Sinne eine Harntransportstörung jeglicher Ursache. Echte Diagnosen obstruktiver Uropathien wurden lediglich zu 30% in den einzelnen Gruppen gestellt. Die pränatalen Verdachtsdiagnosen bestätigen sich zu zwischen 80 und 90% wenn: - eine isolierte Hydronephrose mit einem Nierenbeckendurchmesser von über 10 mm als Ureterabgangsstenose befundet wurde - die typische Konfiguration einer Multizystischen Nierendysplasie gefunden wurde - aus der Kombination von Oligohydramnion, Megazystis und bilateraler Harntransportstörung des männlichen Feten auf Urethralklappen geschlossen wurde. Lediglich bei der unilateralen multizystischen Nierendysplasie und der subpelvinen Obstruktion wird im pränatalen Befund bezüglich der definitiven Diagnose eine akzeptable Sensitivität und Spezifität erreicht. Alle anderen Diagnosen werden zu 70% postnatal gestellt. Der Einfluss der pränatalen Diagnostik auf das postnatale Management bezieht sich in erster Linie auf die Aufdeckung vorerst symptomloser Fehlbildungen. Eine pränatale Aussage über die zu erwartende Nierenfunktion ist bei einseitigen Fehlbildungen derzeit nicht möglich. Zusammenfassung: Obstruktive Uropathien sind häufige, zumeist benigne Fehlbildungen. Sie sind der pränatalen Diagnostik gut zugänglich. Konkrete Diagnosen mit Aussagen zur postnatalen therapeutischen Relevanz können jedoch nur gestellt werden, wenn sonografisch pathognomonische Konstellationen dies ermöglichen. In allen anderen Fällen muss die pränatal beschriebene Auffälligkeit Anlass zu postnataler sorgfältiger Diagnostik sein, um im präsymptomatischen Intervall die Entscheidung zu konservativer oder operativer Therapie stellen zu können. / Introduction: Among congenital dysplasias the anomalies of kidney and urogenital tract are among the most frequent encountered. Their rate in prenatally made diagnoses is about 50 %. Modern prenatal diagnostic facilities have changed the therapeutic access to these anomalies in the last decade. After a phase of overtreatment in the beginning, nowadays new insights in the natural course of these dysplasias and the results of long-term follow-up studies resulted in a more differentiated apporach. Questions and methods: In this retro- and prospective study we looked for the the influence of prenatal diagnostics on the postnatal course and management. The question was to examine the relationship between the prenatal ultrasound results, the suggested prenatal diagnosis and then the defintive postnatal disease. Of interest was the prognostic impact of typical prenatal sonographic imaging on the postnatal course of the baby. Because of its frequency we focused on anomalies of the kidney and urogenital tract. Patients: Between 1984 and 1996 21.616 pregnancies were examined by ultrasound in our Department of Prenatal Medicine. Among these, 1.574 anomalies of surgical relevance were described. 1.077 cases were available for follow-up including 990 cases of urogenital anomalies. Among these, the records of 693 cases were complete and these patients form the collective of this study. Results: When the CNS was excluded we found organic anomalies in 7,28 % of these cases. Among them 63% were attributed to the urogenital system. The most common prenatal diagnosis was "hydronephrosis". But this term was used only in a descriptive manner because proof of a real obstructive uropathy postnatally was made only in 30% of these cases. Concerning all anomalies of the urogenital tract, the prenatal diagnosis proved correct in the overwhelming majority of cases ( 90%) if these sonographic signs have been described: - diameter fo the renal pelvis of more than 10 mm in isolated hydronephrosis predicted ureteropelvic junction obstruction - typical formation of a multicystic dysplastic kidney - combination of oligohydramnion, megacystis and bilateral kidney anomalies in a male fetus predicted posterior urethral valve disease Sensitivity and specifity in regard to the definitive diagnosis were acceptable in multicystic dysplasia of the kidney and ureteropelvic junction obstruction. In all other cases, the correct diagnosis was made postnatally in 70 %. Therefore, the main value of prenatal sonography was to reveal otherwise symptomless dysplasias. Until now, a prenatal prediction of kidney function in the unilateral case is not possible. Conclusion: Obstructive uropathies are common an in most cases benign anomalies. They are easily detected by prenatal ultrasound. Therapeutical consequences, however, only arise in selected cases if typical sonographic signs can be seen. In the majority of cases, therefore, the main purpose of prenatal diagnostic ultrasound points out the necessity for postnatal diagnostic workup in order to detect and treat severe diseases before symptoms occur.

Introduction : l’innervation et la vascularisation des corps caverneux du pénis sont très difficilement explorables par les techniques de dissection anatomiques classiques. De ce fait, elles demeurent pas très bien connues. La dissection anatomique assistée par ordinateur (CAAD), combinant méthodes immuno-histochimiques et reconstruction tridimensionnelle représente un outil original permettant l’analyse microscopique des artères et des nerfs au sein des corps caverneux. Les objectifs de ce travail étaient donc d’étudier l’innervation et la vascularisation microscopique des corps caverneux par dissection anatomique assistée par ordinateur (CAAD).Matériel et méthodes : Des coupes histologiques sériées de pénis ont été réalisées chez huit cadavres adultes masculins et sur des pièces issues de pénnectomie pour cancer à l’hôpital du kremlin-Bicêtre. Les coupes ont été traitées par des méthodes histologiques (Hématoxyline-Eosine et trichrome de Masson) et immuno-histochimiques pour détecter les fibres nerveuses (anti-S100), les fibres somatiques (anti-PMP22), les fibres adrénergiques (anti-TH), cholinergiques (anti-VAChT) et nitrergiques (anti-nNOS). Les lames ont ensuite été numérisées par un scanner de haute résolution optique et les images bidimensionnelles ont été reconstruites en trois dimensions grâce au logiciel WinSurf. Résultats: La reconstruction tridimensionnelle des coupes histologiques immuno-marquées a permis de décrire l’innervation et la vascularisation des corps caverneux du pénis. Les artères et les nerfs du pénis sont très largement anastomosés entre eux.Les anastomoses entre les artères caverneuses et les artères urétrales se font en dehors de l’albuginée du corps spongieux d’où le terme de « shunts caverno-urétraux » utilisé dans ce travail pour qualifier ces vaisseaux anastomotiques.La vascularisation et l’innervation permettent de distinguer deux compartiments anatomiques distincts au niveau du pénis : une partie proximale (les 2/3 du pénis) autonome dont les artères et les nerfs proviennent du plexus hypogastrique inférieur (supra-lévatorien), et le tiers distal somatique dont les artères et les nerfs proviennent des artères et nerfs dorsaux du pénis (infra-lévatorien).Les communications entre les systèmes autonomes et somatiques (entre le plexus hypogastrique inférieur supra-lévatorien et le nerf pudendal infra-lévatorien) existent donc à quatre niveaux : proximal, intermédiaire, à la racine du pénis et intracaverneuses. Les communications intracaverneuses sont responsables des marquages autonomes observés dans les nerfs dorsaux du pénis. Elles confèrent également aux corps caverneux une sensibilité à peu près semblable à celui du gland au cours de l’acte sexuel.Conclusion: Nos résultats montrent de très nombreuses anastomoses vasculaires et nerveuses dans les corps caverneux entre les systèmes supra et infra-lévatoriens avec 2 régions anatomiques distinctes : les 2/3 proximaux érectiles et le 1/3 distal sensitif. Ces anastomoses permettent d’espérer une certaine plasticité dans la vascularisation et l’innervation du pénis en cas de dysérection. / Introduction: The innervation and the vascularization of the corpora cavernosa of the penis are very difficult searchable by the classical anatomic dissections. Therefore, they remain not very well known. The computer-assisted anatomic dissection (CAAD), combining immunohistochemical methods and three-dimensional reconstruction is a unique tool for the microscopic analysis of the arteries and nerves in the corpora cavernosa.The objectives of this study were therefore to investigate the microscopic innervation and vascularization of the corpora cavernosa by the CAAD.Materials and methods: Serial histological sections of penis were performed in eight adult male cadavers and one piece after penectomy for cancer in the hospital of Kremlin Bicetre. The sections were processed by histological methods (hematoxylin-eosin and Masson trichrome) and immunohistochemistry to detect nerve fibers (anti-S100), somatic fibers (anti-PMP22), adrenergic fibers (anti-TH), cholinergic fibers (anti-VAChT) and nitrergic fibers (anti-nNOS). The slides were then scanned by a high resolution scanner and two-dimensional images were reconstructed in three dimensions using WinSurf software.Results: Three-dimensional reconstruction of immunolabeled histological sections allowed describing the innervation and vascularization of the corpora cavernosa of the penis. The arteries and nerves of the penis are widely anastomosed.The anastomoses between the cavernous arteries and urethral arteries are outside the tunica albuginea of the corpus spongiosum hence the term "cavernous urethral shunts".The innervation of the penis distinguishs two distinct anatomical portions: a proximal portion (2/3 of the penis) is autonomic whose arteries and nerves come from the inferior hypogastric plexus (supralevator), and the third including somatic distal nerves from the dorsal nerves of the penis (infralevator).The communications between autonomic and somatic systems (between the inferior hypogastric plexus and the pudendal nerve) exist in four levels: proximal, middle, crura of penis and intra-cavernous. The intra-cavernous communications are responsible for autonomic fibers observed in the dorsal nerves of the penis.Conclusion: Our results show a large number of vascular and nerve anastomoses in the corpora cavernosa between supra and infralevator sustems with two distinct anatomical regions: the 2/3 proximal erectile portion and 1/3 distal sensorial portion. These anastomoses provide a hope for the plasticity in the vascularization and innervation of the penis in cases of erectile dysfunction.

Abstract Problems of female urinary incontinence and pelvic organ prolapse are common. Traditional operative techniques in the treatment of these conditions have unsatisfactory efficacy outcomes and involve complications. Attempts have been made to solve this problem with synthetic meshes, but with the use of meshes mesh-related complications have appeared. The situation is difficult because the number of different meshes, techniques and instrumentations is numerous. The present study was conducted to investigate the safety issues and complication rates of four structurally different polypropylene meshes used in transvaginal surgery when treating female urinary incontinence and apical or posterior vaginal prolapse. Vaginal mesh exposures were under special interest. Subjective outcome and patient satisfaction of tension-free vaginal tape (TVT) and transobturator tape (TOT) methods in the treatment of female urinary incontinence were reported. Objective and subjective cures of posterior intravaginal sling (PIVS) and Elevate®Posterior procedures were investigated. The incidence of vaginal mesh exposure varied between different meshes. The highest exposure incidence, 16–25%, was found with heavyweight microporous multifilament mesh. The lowest mesh exposure incidence, 0.9%, was seen with lightweight macroporous monofilament mesh. The subjective cures of the TVT and TOT procedures were 84% and 80%, and patient satisfaction rates were 79% and 74%, respectively. The objective cure of posterior IVS was only 69% and patient satisfaction rate 62%, while Elevate®Posterior reached 84–98% objective cure rate, depending on the definition used. Subjective efficacy of this procedure was 86%. According to this study, the use of heavyweight microporous multifilament should be abandoned because of the intolerably high vaginal mesh exposure incidence. The subjective efficacy and patient satisfaction of TVT and TOT procedures are satisfactory. Both objective and subjective cure rates of posterior IVS are poor, whereas the Elevate®Posterior technique with lightweight macroporous monofilament mesh presents promising results. / Tiivistelmä Virtsankarkailu ja emättimen monimuotoiset laskeumat ovat naisilla yleisiä. Näitä vaivoja perinteisillä leikkaustekniikoilla hoidettaessa leikkaustulokset ovat olleet epätyydyttäviä sekä tehon että komplikaatioiden ilmaantuvuuden osalta. Ongelmaa on yritetty ratkaista synteettisien verkkojen avulla, mutta verkkojen käytön myötä niihin on havaittu liittyvän myös ongelmia. Tilannetta hankaloittaa myös erilaisten verkkomateriaalien, tekniikoiden ja instrumentaatioiden runsaslukuisuus. Tässä tutkimuksessa selvitettiin neljän rakenteeltaan erilaisen polypropyleenistä valmistetun verkon turvallisuutta ja komplikaatioiden esiintyvyyttä hoidettaessa verkkoavusteisesti naisen virtsankarkailua ja emättimen pohjukan tai emättimen takaseinämän laskeumaa. Erityisenä kiinnostuksen kohteena olivat verkkoihin liittyvät eroosiot. Virtsankarkailun hoidon subjektiivinen teho ja potilastyytyväisyys selvitettiin käytettäessä tension-free vaginal tape- (TVT) ja transobturator tape (TOT) -tekniikoita. Laskeumien hoidon objektiivinen ja subjektiivinen teho arvioitiin käytettäessä posterior intravaginal sling- (PIVS) ja Elevate®Posterior -tekniikoita. Verkon eroosioiden ilmaantuvuus vaihteli rakenteeltaan erilaisten verkkojen välillä siten, että tiivistä mikroporoottista multifilamenttinauhaa käytettäessä eroosioiden ilmaantuvuus oli 16–25 %, kun taas kevyttä makroporoottista monofilamenttiverkkoa käytettäessä eroosioprosentti oli 0.9. TVT-menetelmällä saavutettiin 84 %:n ja TOT menetelmällä 80 %:n subjektiivinen teho. TVT-potilaista hoitoon tyytyväisiä oli 79 % ja TOT-potilaista 74 %. Posteriorinen IVS saavutti vain 69 %:n objektiivisen tehon pohjukan laskeuman hoidossa. Potilastyytyväisyys oli samaa luokkaa, 62 %. Sen sijaan Elevate®Posterior-menetelmää käytettäessä saavutettiin käytetystä tehon määritelmästä riippuen 84–98 %:n objektiivinen teho. Subjektiivinen teho tällä menetelmällä oli 86 %. Tämän tutkimuksen perusteella tiiviin mikroporoottisen multifilamenttiverkon käyttöön liittyvä verkkoeroosioiden määrä on sietämättömän suuri. Vakiintuneiden TVT- ja TOT-menetelmien subjektiivinen teho ja potilastyytyväisyys ovat hyväksyttäviä. PIVS-metodia käytettäessä sekä objektiivinen että subjektiivinen tulos on huono, kun taas Elevate®Posterior-menetelmän ja siinä käytetyn kevyen verkon käytöstä saadut tulokset ovat lupaavia.

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

But: Cette étude a pour but de comparer : a)la morphologie du plancher pelvien (PP), du col vésical et du sphincter urogénital strié (SUS) par IRM et b) la fonction du PP par palpation digitale (PERFECT scheme) chez les femmes âgées continentes ou avec incontinence urinaire à l’effort (IUE) et mixte (IUM). Méthode: Les femmes ont appris à contracter correctement leur PP et la fonction de leur PP a été évaluée. Une séance d’IRM dynamique 3T a suivi. Résultats: 66 femmes ont participé à l’étude. Les groupes étaient similaires en âge, IMC, nombre d’accouchements vaginaux et d’hystérectomie. La validité et la fidélité des différentes mesures anatomiques utilisées ont été confirmées au début de cette étude. Afin de contrôler l’effet potentiel de la taille du bassin sur les autres paramètres, les femmes ont été appariées par la longueur de leur inlet pelvien. Les femmes avec IUM ont un PP plus bas et un support des organes pelviens plus faible, selon leurs ligne M, angle LPC/Ligne H et hauteur de la jonction urétro-vésicale (UV). Les femmes avec IUE ont un PP similaire à celui des continentes, mais présentent plus d’ouverture du col vésical et un angle UV postérieur plus large au repos que les autres groupes. Il n’y a aucune différence de morphologie du SUS entre les groupes. De plus, selon les résultats du PERFECT scheme, les femmes avec IU ont une force du PP plus faible que les continentes. Les femmes avec IUM montrent aussi une faible élévation des muscles du PP à la contraction. Les femmes avec IUE ont, quant à elle, un problème de coordination à la toux. Conclusion: Les déficits causant l’IUE et l’IUM sont différents, mais supportent tous le rationnel des exercices du PP pour le traitement de l’IUE et l’IUM. Ces résultats supportent le besoin de traitements de rééducation spécifiques aux déficits de chacun des types d’IU. / Aims: The study’s aim was to compare: a) pelvic floor muscle (PFM), bladder neck and urethral sphincter morphologies using MRI and b) PFM function using digital palpation (PERFECT scheme) in continent women, women with stress (SUI) and mixed (MUI) urinary incontinence. Method: Women were taught how to perform PFM contractions correctly and their PFM function was assessed, then each woman completed a dynamic 3T MRI session. Results: 66 women participated in the study. Groups were similar for age, BMI, vaginal deliveries and hysterectomies. Validity and reliability of the different anatomical measures used has been confirmed at the beginning of the study. To control for the potential effect of pelvic size on study parameters, women were matched based on pelvic inlet length. MUI women seemed to have lower PFM resting position and pelvic organ support at rest, based on their M-Line, PCL/H-Line angle and urethrovesical (UV) junction height. However, SUI women seemed to have a PFM morphology similar to that of continent women, but presented a greater occurrence of bladder neck funnelling and a larger posterior UV angle. There were no differences in urethral sphincter morphology between the 3 groups. Functionally, as shown by the PERFECT scheme results, both UI groups had poorer PFM strength on MVC then continent women. The MUI group also showed poor PFM elevation on contraction. Conversely, women with SUI had a timing problem on cough. Conclusion: The deficits in women with SUI and MUI appear to be very different. Notwithstanding, they all support the rationale for PFM exercise treatment in older women with SUI and MUI. However, the findings suggest the need for rehabilitation treatments specificity for each UI type.