Issued also as thesis, Paris.

Thesis (MSc.Med.(Urology))--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Bladder cancer is the second commonest urological malignancy and haematuria is the commonest symptom. Cystoscopy and urine cytology are integral for the investigation of haematuria, while the role of molecular markers such as the NMP22 BladderChek test is still being defined. The BladderChek is a qualitative point of care test developed for the detection of the elevated urinary levels of NMP22 associated with bladder cancer. No studies have been performed in South Africa using the BladderChek nor considered using this test to increase the efficiency of the workup of patients with gross haematuria. The primary aim was to establish the percentage of office cystoscopies done as part of a gross haematuria workup at Charlotte Maxeke Johannesburg Academic Hospital that are unnecessary and may be avoided if the BladderChek is positive under defined conditions. A cross-sectional study of the BladderChek test using prospective consecutive sampling, with special care to limit false positives and negatives, of 64 patients with a history of gross haematuria was conducted. The sensitivity, specificity, positive predictive value and negative predictive value for the BladderChek and the urine cytology were 78.9%, 84.4%, 68.2%, 90.5% and 36.8%, 93.0%, 70.0%, 76.9% respectively. The performance of the BladderChek was not affected by the history of gross haematuria, the stage nor grade of malignancy. Urine cytology detected only one malignancy missed by the BladderChek. Approximately 12.6% of office cystoscopies may be avoided and 78.9% of bladder tumours detected if the BladderChek is selectively applied as in this study. This may “fast-track” patients for transurethral resection of bladder tumour. The BladderChek may be a cost-effective alternative to urine cytology.

Thesis--Rigshospitalet, University of Copenhagen. / Summary in English and Danish. Bibliography: p. 219-[225]

No description available.

Orientador: Viviane Herrmann Rodrigues / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T03:27:58Z (GMT). No. of bitstreams: 1 Castro_EdilsonBeneditode_M.pdf: 1738241 bytes, checksum: ddc9c76f04b9f7476ede4b0a887d468a (MD5) Previous issue date: 2006 / Resumo: Objetivos: Avaliar pelo sistema de quantificação do prolapso dos órgãos pélvicos (POP-Q), preconizado pela Sociedade Internacional de Continência (ICS) os compartimentos vaginais anterior, posterior e apical em mulheres submetidas à colpofixação sacroespinhal para o tratamento do prolapso uterino ou de cúpula vaginal e analisar os sintomas urinários antes e depois da cirurgia. Sujeitos e métodos: Estudo retrospectivo realizado no Setor de Uroginecologia do Hospital Estadual Sumaré da Universidade Estadual de Campinas em 2006. Foram analisados os prontuários de 47 mulheres submetidas à colpopexia sacroespinhal entre março de 2003 e fevereiro de 2006. Foram avaliados os sintomas urinários (incontinência urinária de esforço, urgência, incontinência de urgência, noctúria e enurese noturna) no pré e pós-operatório, considerando-se sintomas presentes ou ausentes e analisados pelo Teste de qui-quadrado de Mc Nemar. Os pontos Aa, Ba, C, D, Ap, Bp, tvl, gh e pb do POP-Q foram avaliados na primeira consulta e na revisão pós-operatória. O Teste de Wilcoxon foi aplicado para comparar os pontos e os estágios do prolapso genital antes e depois da cirurgia. Complicações intra e pós-operatórias foram descritas. Resultados: A média dos pontos do POP-Q no pré e pós-operatório foi respectivamente: Aa (+0,7; -1,7); Ba (+3,2; -1,7); C (+3,2; -7,6); Ap (-0,2; -2,7) e Bp (+2,1; -2,7) (p<0.001). A taxa de cura foi 97,9% para o prolapso apical. Avaliação pré e pós-operatória do compartimento vaginal anterior foi respectivamente: estágio 1 (4,3%; 57,4%), estágio 2 (8,5%; 31,9%), estágio 3 (76,6%; 0%) e estágio 4 (10,6%; 0%). Cistocele ocorreu em 89,4% no pós-operatório. Onze de 12 mulheres que apresentavam urgência miccional tiveram melhora após a cirurgia (p=0,0039) e uma das 45 que não tinham a queixa passou a apresentá-la. Das 8 pacientes que se queixavam de incontinência de urgência, 7 apresentaram remissão do sintoma após a cirurgia (p=0,0082). Houve melhora da noctúria em 7 de 8 casos após a cirurgia (p=0,0399) e 1 dos 39 casos que eram assintomáticos desencadeou o sintoma no pós-operatório. Conclusão: A colpofixação sacroespinhal é um método eficiente para o tratamento do prolapso apical e de parede posterior levando, porém 89,4% das pacientes a apresentarem prolapso de parede anterior estágio 1 e 2 devido ao desvio posterior do eixo vaginal. Ocorreu melhora dos sintomas urinários irritativos (urgência, incontinência de urgência e noctúria) nas pacientes submetidas à fixação sacroespinhal da cúpula vaginal pelo restabelecimento do sistema de sustentação apical posterior / Abstract: Objectives: To evaluate the extent of prolapse of the anterior, posterior and apical vaginal compartments in women undergoing sacrospinous ligament fixation using the pelvic organ prolapse quantification system (POP-Q), recommended by the International Continence Society (ICS) for the treatment of uterine and vaginal vault prolapse and examine urinary symptoms before and after surgery. Subjects and methods: A study was conducted in the Urogynecology Sector of the Sumaré Municipal Hospital of the Universidade Estadual de Campinas in 2006. Medical charts of 47 women undergoing sacrospinous colpopexy between March 2003 and February 2006 were assessed. Urinary symptoms (stress urinary incontinence, urgency, incontinence of urgency, nocturia and nocturnal enuresis) were evaluated in the preoperative and postoperative period, categorizing symptoms as present or absent, and applying the Mc Nemar chi-square test for analysis. Aa, Ba, C, D, Ap, Bp, tvl, gh and pb points of POP-Q were evaluated in the first consultation and postoperative revision. Wilcoxon?s test was applied to compare points and stages of genital prolapse before and after surgery. Intraoperative and postoperative complications were described. Results: Mean POP-Q points in the preoperative and postoperative period were, respectively: Aa (+0.7; -1.7); Ba (+3.2; -1.7); C (+3.2; -7.6); Ap (-0.2; -2.7) and Bp (+2.1; -2.7) (p<0.001). The cure rate was 97.9% for apical prolapse. Preoperative and postoperative evaluation of the anterior vaginal compartment was, respectively: stage 1 (4.3%; 57.4%), stage 2 (8.5%; 31.9%), stage 3 (76.6%; 0%) and stage 4 (10.6%; 0%). Cystocele occurred in 89.4%. Eleven of 12 women with mictional urgency showed improvement of symptom after surgery (p=0.0039) and one of the 45 patients who had no previous complaint, started to suffer from the symptom. Of 8 patients whose complaint was incontinence of urgency, 7 had remission of symptom after surgery (p=0.0082). Nocturia improved in 7 out of 8 cases after surgery (p=0.0399) and the symptom was triggered postoperatively in 1 out of 39 asymptomatic women. Conclusion: Sacrospinous ligament fixation is an efficient method for the treatment of apical and posterior wall prolapse, despite leading to stage 1 and 2 anterior wall prolapse in 89.4% of women due to posterior deviation of the vaginal apex. Improvement in irritative urinary symtoms (urgency, incontinence of urgency and nocturia) took place in patients undergoing sacrospinous ligament fixation of the vaginal vault by reconstitution of the posterior apical support system / Mestrado / Cirurgia / Mestre em Cirurgia

I found that 2.6ml of 0.5% levobupivacaine had similar clinical characteristics as the same volume of 0.5% bupivacaine in spinal anaesthesia. Both were effective for spinal anaesthesia in urological surgery, when a sensory block up to at least T10 dermatome was required. In comparing the use of levobupivacaine alone and levobupivacaine with fentanyl, there were no significant differences in haemodynamic changes and quality of sensory and motor block, when 2.6ml of levobupivacaine alone or 2.3ml of levobupivacaine with fentanyl 15mcg (0.3ml) were used in spinal anaesthesia. Both were effective for spinal anaesthesia in urological surgery. In comparing the use of ropivacaine 10mg and bupivacaine 10mg, both with fentanyl 15mcg in spinal anaesthesia for urological surgery, all the patients achieved adequate level of sensory block up to T10 dermatome or higher. The two drugs were similar in the onset time of motor block, the characteristics of sensory block and haemodynamic changes; however, the duration of motor block was shorter with ropivacaine. I concluded that both studied solutions, ropivacaine-fentanyl and bupivacaine-fentanyl, were effective for spinal anaesthesia in urological surgery and the duration of motor block was shorter with the ropivacaine-fentanyl solution. The dose-response relationship of ropivacaine in spinal anaesthesia for lower limb surgery requiring a sensory block up to at least the T12 dermatome was defined. Anaesthesia was successful in 0, 0, 42, 83 and 100% when ropivacaine at doses of 2, 4, 7, 10 and 14mg respectively were given. The derived values for ED50 and ED95 were 7.6mg and 11.4mg respectively. The cephalic level of sensory block and the degree of motor block increased with larger doses of ropivacaine. Finally, the median effective dose (ED50) of bupivacaine, levobupivacaine and ropivacaine in spinal anaesthesia for lower limb surgery were defined as 5.50mg (95% CI: 4.90--6.10mg), 5.68mg (95% CI: 4.92--6.44mg), and 8.41mg (95% CI: 7.15--9.67mg) respectively. The relative potency ratios were 0.97 (95% CI: 0.81--1.17) for levobupivacaine/bupivacaine, 0.65 (95% CI: 0.54--0.80) for ropivacaine/bupivacaine and 0.68 (95% CI: 0.55--0.84) for ropivacainellevobupivacaine. / In this series of studies, I have shown that levobupivacaine and ropivacaine are effective local anaesthetic agents for spinal anaesthesia in lower limb and urological surgery. This proved my hypothesis. Both are suitable alternatives to bupivacaine for spinal anaesthesia. Furthermore, these studies showed that ropivacaine is less potent than levobupivacaine and bupivacaine and the potency is similar between levobupivacaine and bupivacaine at median effective dose. / Levobupivacaine and ropivacaine are two relatively new local anaesthetics which were developed in view of their potential for less cardiotoxicity in comparison with bupivacaine, the most common local anaesthetic used in spinal anaesthesia for many years. Both are produced in pure S(-) enantiomer form in contrast to bupivacaine which is a racemic mixture. They have been shown to be effective in peripheral nerve blocks, and epidural analgesia and anaesthesia; nevertheless, experience of their use in spinal anaesthesia is limited. The objective of this thesis was to evaluate their use in spinal anaesthesia for surgery in non-obstetric patients. My hypothesis was that levobupivacaine and ropivacaine are effective local anaesthetic agents for spinal anaesthesia in lower limb and urological surgery. In order to test this hypothesis, I conducted five clinical studies on 269 patients who had urological surgery or lower limb surgery under spinal or combined spinal-epidural anaesthesia. First, I investigated the efficacy and clinical characteristics of levobupivacaine and the mixture of levobupivacaine with fentanyl in spinal anaesthesia. Next, I compared the use of ropivacaine-fentanyl with bupivacaine-fentanyl in spinal anaesthesia. Finally, I defined the dose-response relationship of ropivacaine in spinal anaesthesia using traditional dose-response methodology and defined the relative potency among levobupivacaine, ropivacaine and bupivacaine by comparing the defined ED50 in spinal anaesthesia using up-down sequential allocation method. / Lee, Ying Yin. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 133-150). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

Orientadores: Ubirajara Ferreira, Valeria H. A. Cagnon Quitete / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T17:35:54Z (GMT). No. of bitstreams: 1 Reis_LeonardoOliveira_M.pdf: 4339458 bytes, checksum: 1e103884dabb1194ecfd6161caeed83d (MD5) Previous issue date: 2009 / Resumo: A destruição do complexo da distroglicana dependente da metaloproteinase da matriz pode ter papel importante no desenvolvimento e progressão do tumor urotelial. O carcinoma urotelial humano é frequente na bexiga e menos comum no trato urinário superior. Não há um modelo experimental animal bem definido e reprodutível de carcinoma urotelial do trato superior. Objetivos: Propor um novo modelo experimental de carcinoma urotelial que resulta de refluxo vesicoureteral em animais submetidos a tratamento com associação entre n-metil-n-nitrosourea e citrato de sódio intravesicais. Caracterizar a imunolocalização dos receptores de ?-distroglicana e metaloproteinase 9 na bexiga urinária, ureter e pelve renal deste modelo, assim como descrever aspectos morfológicos, imunohistoquímicos e proliferativos nestes órgãos. Metodologia: Cinqüenta ratas Fisher 344 foram divididas em dois grupos: Controle - recebeu 0,30ml de solução salina 0,9% intravesical; MNU-citrato - recebeu 0,15ml de MNU e 0,15ml de citrato de sódio intravesical, ambos em semanas alternadas, nas semanas 0, 2, 4 e 6, totalizando quatro doses. Após 15 semanas de tratamento, a bexiga, os ureteres, e as pelves renais foram coletados para análises morfológicas e imunohistoquímicas. Resultados: O grupo MNU-Citrato apresentou imunoreatividade reduzida de ?-DG e aumentada de MMP-9 e Ki-67. O tratamento associado de MNU e citrato de sódio levou ao desenvolvimento de carcinoma urotelial na bexiga e no trato urinário superior de todos os animais. Conclusões: O modelo proposto induziu lesão maligna de diversos graus em 100 % dos animais, sem comprometimento muscular. A imunolocalização da ?-DG foi muito diminuída em contraposição ao aumento da imunolocalização da MMP-9 nos diferentes órgãos estudados neste modelo e os aspectos morfológicos, imunohistoquímicos e proliferativos ao longo do urotélio (bexiga urinária, ureter e pelve renal) foram muito semelhantes, sendo que ocorreu aumento de apoptose e proliferação celular com expressivo predomínio deste último. Palavras chave: Distroglicana; Metaloproteinase de matriz; Carcinoma urotelial; Modelo animal experimental; Trato urinário superior / Abstract: The dystroglican complex destruction is done by matrix metalloproteinase and plays a critical role in the urothelial carcinoma development and progression. The human urothelial carcinoma is frequent on the bladder and less common on the upper urinary tract. There is no reproducible and well described experimental upper urothelial carcinoma model on this issue. Purposes: Describe a novel experimental upper urothelial carcinoma animal model which results in vesicoureteral reflux in animals submitted to associate treatment with the carcinogen n-methyl-n-nitrosourea and sodium citrate intravesically. Characterize the ?-DG and the MMP-9 immunolocalization in the bladder as well as in the upper urinary tract, and describe morphological, immunohistochemistry and proliferative aspects utilizing a novel experimental model. Materials and Methods: Fifty female Fischer 344 rats were divided into two groups: the control group received a 0.30ml dose of 0.9% physiological saline intravesically every other week for a total of 4 doses; the MNU-citrate group received 0.15 ml of MNU and 0.15ml of sodium citrate intravesically every other week for a total of 4 doses. After 15 weeks of treatment, bladder, ureters and renal pelvis were collected for morphological and immunohistochemistry analyses. Results: The MNU-Citrate group showed reduced ?-DG and increased MMP-9 and Ki-67 immunoreactivities. Associated treatment with MNU and sodium citrate was able to lead to both urinary bladder and upper urinary tract tumors in all animals. Conclusions: The proposed model showed cancer in several grades in 100 % of animals, with no muscular invasion. The immunolocalization was decreased for ?-DG and increased for MMP-9 in the analyzed tissues and the morphological, immunohistochemical and proliferative aspects of the urothelium (bladder, ureter e renal pelvis) were similar. Apoptosis and proliferation were increased, being the last one more intense / Mestrado / Cirurgia / Mestre em Cirurgia

This project was undertaken with the following aims: 1) To generate a data base concerning the management of children with congenital spinal anomalies, who are known to form a significant proportion of the patients being treated in the Department of Paediatric Urology at Red Cross Hospital. 2) To assess the results of the management of these children, with special attention to the goals of therapy, namely preservation of renal function, establishment of urinary continence and protection from urinary tract infection. 3) To compare the treatment methods and results obtained to those reported in the literature. 4) To evaluate critically the treatment methods and results obtained with a view to identifying areas where improvements are possible.