Lincompétence du sphincter urétral (ISU) est la cause la plus fréquente dincontinence urinaire chez la chienne adulte. Elle affecte typiquement les chiennes stérilisées, dâge moyen et de grande race. Son traitement est initialement médical. La phénylpropanolamine (PPA) est le traitement médical de choix et son taux de succès varie de 85 à 97 % de continence. Des études expérimentales antérieures ont démontré lavantage urodynamique dune administration de PPA une fois par jour par rapport à ladministration 3 fois par jour recommandée habituellement. Aucune étude clinique na cependant été réalisée jusquà présent pour confirmer lefficacité de ce protocole de traitement chez la chienne incontinente. Un traitement chirurgical est recommandé en cas de non réponse ou de réponse partielle au traitement médical, si la chienne devient réfractaire au traitement ou développe des effets secondaires, ou si les propriétaires ne souhaitent pas administrer un médicament à long terme. De nombreuses techniques chirurgicales ont été décrites pour traiter lISU chez la chienne mais aucune à lheure actuelle ne permet de garantir un taux de continence complète élevé et ce, à long terme et avec un faible taux de complications. Le traitement de lincontinence urinaire deffort chez la femme est principalement chirurgical et implique le placement dune bandelette sous-urétrale par voie vaginale. Parmi les techniques décrites, la TVT-O offre un très bon taux de succès et présente très peu de complications postopératoires. Les objectifs de ce travail étaient donc dévaluer lefficacité clinique dun dosage quotidien unique de PPA et dadapter la technique TVT-O à la chienne en passant par une étude préliminaire sur cadavres et chiennes Beagles saines pour ensuite lutiliser chez des chiennes incontinentes atteintes dISU, afin den évaluer les effets cliniques, urodynamiques et morphologiques. Dans la première étude, lefficacité clinique de la PPA administrée une seule fois par jour à un dosage de 1.5 mg/kg a été démontrée. En effet, le suivi à long terme (23.9 mois en moyenne) montre que 8 chiennes sur 9 étaient continentes après traitement. Une chienne na pas répondu à la PPA et a été traitée chirurgicalement. Aucun effet secondaire na été observé chez les animaux traités. Dun point de vue urodynamique, ladministration de PPA augmente significativement les valeurs de pression urétrale maximale de fermeture (MUCP). Ladministration de PPA 2 à 3 fois par jour, telle que recommandée habituellement, nest donc pas utile puisquune administration quotidienne unique, plus pratique et moins coûteuse pour les propriétaires, suffit à maintenir la continence chez 89 % des chiennes traitées. La faisabilité de la technique TVT-O a ensuite été évaluée chez la chienne. La dissection de 12 cadavres de chiennes après mise en place de la bandelette montre que la TVT-O est faisable chez la chienne moyennant certaines adaptations. Une épisiotomie est notamment nécessaire chez la chienne contrairement à la femme. Les résultats montrent que la bandelette est située à une distance raisonnable des structures neuro-vasculaires importantes, y compris les vaisseaux fémoraux et le nerf obturateur, minimisant le risque de les léser. Elle est également localisée de manière constante en arrière du muscle élévateur de lanus, en région périnéale, rendant ainsi le risque de lésion vésicale quasi inexistant. La technique apparaît donc peu risquée et reproductible chez la chienne. Lapplication de la TVT-O chez 2 chiennes Beagles continentes nous a ensuite permis dobserver labsence de complications intra- et postopératoires. Dun point de vue urodynamique, la pression intégrée (aire sous la courbe dUPP représentant la résistance urétrale) est augmentée jusquà 4 mois après lintervention. Les vagino-urétrographies postopératoires montrent un déplacement ventral et un rétrécissement de lurètre distal juste en avant du méat urinaire. Dun point de vue histologique, les tissus entourant la bandelette montrent une réaction fibroblastique modérée accompagnée dune réaction inflammatoire lympho-plasmocytaire légère à modérée. La bandelette semble donc relativement inerte et bien tolérée chez le chien. La tolérance de la bandelette est dune importance majeure puisquune réaction inflammatoire excessive peut induire une érosion vaginale ou urétrale pouvant entraîner une infection. La TVT-O a ensuite été réalisée sur 8 chiennes incontinentes atteintes dISU. Après un suivi de 2 semaines à 12 mois (moyenne, 7.3 mois), 7 des 8 chiennes sont continentes. Une chienne a récidivé 2 mois après la chirurgie et a été traitée à la PPA. Dun point de vue urodynamique, MUCP et la pression intégrée sont augmentées significativement après lintervention. Laugmentation de pression se situe principalement au niveau de lurètre moyen. Il apparaît donc que la localisation du pic de pression urétrale postopératoire ne correspond pas à la localisation anatomique de la bandelette. Les vagino-urétrographies, pour la plupart non remarquables, montrent que la bandelette ne modifie pas la position du col vésical puisque les vessies en position pelvienne en préopératoire le restent en postopératoire. Une complication intra-opératoire sest produite chez une chienne chez qui une lésion urétrale caudale a été créée pendant lintervention. Aucune complication postopératoire na été observée. Les résultats cliniques à court et moyen terme de lutilisation de la TVT-O dans le traitement de lISU chez la chienne sont donc très favorables. Lhypothèse dun rétablissement dun support urétral déficient, entraînant une restauration de la fonction urétrale, reste à démontrer.

Orientador: Noeme Sousa Rocha / Resumo: O tumor venéreo transmissível (TVT) é um câncer transmissível, que propaga-se naturalmente entre os cães, pela transferência alogênica de células tumorais, principalmente, durante o coito. Sabe-se que o microambiente tumoral influencia diretamente no comportamento tumoral, além de interagir com o sistema imune do hospedeiro. Face aos escassos estudos relacionados aos eventos celulares envolvidos no microambiente tumoral, o presente estudo teve por objetivo quantificar a expressão de genes relacionados com esse microambiente, tanto em células do TVT in vivo como in vitro, correlacionando-o com a resposta clínica dos animais tratados com vincristina. Para tal, foram incluídos neste estudo 18 cães atendidos no Hospital Veterinário da FMVZ-UNESP, Câmpus de Botucatu, portadores de TVT de ocorrência natural. As amostras tumorais foram coletadas antes do tratamento quimioterápico, cultivadas e submetidas à análise citogenética e quantificação através de RT-qPCR. Observou-se amostras tumorais com reduzido número cromossomos (59) em relação ao cão (78) e o subtipo celular prevalente foi o plasmocitoide, embora células com padrão linfocitoide também tenham sido observadas. Quando comparamos as expressões gênicas, o gene TP53 se mostrou elevado na maioria dos casos, indicando possível alteração nesse gene, enquanto BCL-2, BCL-xL, BAX e RASSF1 apresentaram-se variáveis, dependendo do animal analisado, fato que pode ser devido a alterações genéticas e/ou epigenéticas no TVT, além da possi... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

Orientador: Noeme Sousa Rocha / Banca: Alessandre Hataka / Banca: Ana Maria Barros Soares / Banca: Mirela Tinucci Costa / Banca: Julio Lopes Sequeira / Resumo: Foram analisados 132 casos de tumor venéreo transmissível (TVT) de ocorrência natural, atendidos no Hospital Veterinário de Botucatu, considerando aspectos clínicos e epidemiológicos. Os pacientes eram, em sua maioria, sem raça definida e com idade variando entre um e 18 anos, com maior freqüência na idade de quatro anos. A localização mais freqüente foi a genital, seguida pela nasal; 25% dos pacientes apresentavam metástases. Estas ocorreram mais freqüentemente na pele (31% das metástases), seguida pela localização mamária, em fêmeas, e em linfonodos, nos machos. Foram colhidas amostras de 188 tumores para avaliação citológica por microscopia ótica, microscopia eletrônica de transmissão, imunofenotipagem e estimação de danos no DNA pelo teste do cometa. As massas foram avaliadas de acordo com a localização, em genitais ou extragenitais, com o comportamento biológico, em primárias e não primárias (metastáticas ou recorrentes) e, ainda, de acordo com o tamanho e tempo de evolução clínica. A avaliação citológica incluiu a classificação de acordo com o padrão morfológico predominante, em linfocitóide (18,4%), plasmocitóide (52,5%) ou misto (29,1%). As amostras extragenitais e não primárias foram predominantemente do padrão plasmocitóide. Foram observadas as características de malignidade gerais, citoplasmáticas, nucleares e nucleolares apresentadas. Anisocitose, anisocariose e macrocariose foram observadas em todos os padrões citomorfológicos, assim como a presença de vacúolos citoplasmáticos, basofilia e eosinofilia citoplasmáticas e corpúsculos linfoglandulares. As características citoplasmáticas de malignidade observadas com maior freqüência foram projeções citoplasmáticas e espessamento... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: A hundred and thirty-two dogs with naturally transplanted transmissible venereal tumor (TVT) from ambulatory service of the Veterinary Hospital UNESP, Botucatu, were analyzed for epidemiological and clinical aspects. The animals were predominantly mongrel dogs, with age range between one and eighteen years, and mean of four years. The most usual location was genital, followed by nasal; 25% presents metastasis, the cutaneous location being the most frequent, followed by lymph nodes, in males, and mammary, in females. A sample of 188 tumors were collected for cytologic evaluation in optical microscopy, transmission electron microscopy, immunophenotyping and measure of DNA damage by the Comet test. The masses were classified by location as genital or extragenital, by biological behavior as primary or non-primary (metastastatic or recurrent), and by size and time of clinical evolution. The cytologic evaluation included cytomorphological classification in lymphocyte-like (18.4%), plasma-cell-like (52.5%) and mixed pattern (29.1%). Extragenital and non-primary tumors were essentially plasma cell-like. Malignancy features were noted as general, cytoplasmatic, nuclear and nucleolar. Anisocytosis, anisocariosis and macrocariosis were present in all cytomorphological patterns, as well as cytoplasmatic vacuoles, basophilic and eosinophilic tintorial properties, and lymphoglandular bodies. Cytoplasmatic malignancy criteria most frequently observed were cytoplasmatic projections and cellular membrane thickness. Cells resembling a racket were related to lymphocyte-like pattern. Nuclear buds, perinuclear halos, hyperchromatic nuclei, pseudoinclusions, nuclear membrane thickness and mitosis (normal and abnormal), binucleation, and nuclear lobulations (pleomorphic nuclei) were the most frequents nuclear malignancy criteria. The lymphocyte-like pattern was less related... (Complete abstract click electronic address below) / Doutor

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Submitted by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-08-19T12:20:31Z No. of bitstreams: 1 Publico-11.pdf: 1127586 bytes, checksum: 2b1f52ae36e8b94445b0d0fd436ab4b5 (MD5) / Approved for entry into archive by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-08-19T12:21:53Z (GMT) No. of bitstreams: 1 Publico-11.pdf: 1127586 bytes, checksum: 2b1f52ae36e8b94445b0d0fd436ab4b5 (MD5) / Made available in DSpace on 2016-08-19T12:21:53Z (GMT). No. of bitstreams: 1 Publico-11.pdf: 1127586 bytes, checksum: 2b1f52ae36e8b94445b0d0fd436ab4b5 (MD5) Previous issue date: 2007 / Objetivo: Avaliar os resultados após um ano das cirurgias de faixa de prolene por via transobturatória - TVT-O - realizadas para o tratamento da incontinência urinária de esforço recidivada. Metodologia: Pacientes operadas pela técnica de TVT-O para o tratamento de incontinência urinária recidivada no Setor de Uroginecologia e Cirurgias Vaginais do Serviço de Ginecologia e Obstetrícia do Hospital do Servidor Público Estadual de São Paulo entre dezembro de 2004 e março de 2006, realizaram, com um ano de pós-operatório, avaliação clínica, estudo urodinâmico, teste do absorvente e avaliação de qualidade de vida. Na avaliação subjetiva, classificou-se o grau de perda urinária aos esforços em relação ao pré-cirúrgico em: curadas, com melhora ou com falha da cirurgia e se comparou dados de qualidade de vida pré e póscirurgia. Objetivamente, foram comparados o teste do absorvente e o estudo urodinâmico pré e pós-TVT-O. As complicações cirúrgicas foram avaliadas no intra e pós-operatórios precoce e com um ano da cirurgia. Para todos os testes estatísticos o nível de significância de 5% foi adotado. Resultados: Após um ano da cirurgia, subjetivamente, 90% das pacientes referiam cura, 5% melhora e 5% falha cirúrgica com melhora significativa na qualidade de vida de 94,9% das pacientes. Pelo estudo urodinâmico, 92,5% estavam curadas, 2,5% com melhora e 5% apresentaram falha. O teste do absorvente apresentou cura equivalente a 89,75%, sendo positivo em 4 pacientes, duas destas com bexiga hiperativa. Houve diminuição de 65,7% da queixa de urgência. Dois casos de erosão da uretra pela faixa de polipropileno foram relatados. Conclusões: A cirurgia de TVT-O apresentou alta taxa de cura da IUE recidivada, com baixa morbidade. / Objectives: To evaluate the treatment of feminine recurrent stress urinary incontinence (SUI) with the inside-out transobturator tension-free tape (TVT-O) technique one-year-after the surgeries. Methods: TVT-O was performed on 43 patients that had recurrent SUI between December 2004 and March 2006, 40 of them had been were invited to participate of the study and were evaluated before and one-year-after the procedure by clinic exam, urodynamic test, 20 minutes PAD test and quality of life questionnaire. Exclusion criteria were neurological disease, post void residual greater than 100 ml. Results: The mean follow-up was 15.3 months (11.6-25.7). The mean age was 58 years old (43-78) and 31 patients (77.5%) were menopausal. Thirty-five patients (87.5%) had urge urinary incontinence symptoms associated to SUI and 5 of these (12.5%) had also detrusor overactivity in urodynamics. Ten patients (25%) had intrinsic sphincter deficiency (VLPP <60cmH2O) and 12 patients (30%) had genital prolapse, that required surgical corrections. Three patients (7.5%) had two previous antiincontinence procedures while 37 patients (92.5%) had one surgery before. Objective urodynamic SUI and Pad–test cure rates were 92.5% and 89.7% respectively. Subjective SUI cure was 90%. The King’s Health Questionnaire has shown great improvement in the quality of life in 92.3% of patients. Urge incontinence cure rate was 65.7%. The mean operative time was 23 minutes (10- 38). Intra-operative complications (5%) were one case (2.5%) of vaginal perforation and one case (2.5%) of bleeding. No case of bladder perforation, urethral injure, nerve lesion, haematoma, abscess or blood transfusion was noted. There were 8 cases (20%) of post operative obstruction, four patients (10%) had loosening of the tape, one patient (2.5%) had one side tape cut and one patient (2.5%) had the tape taken off due to urethral invasion. Besides the significantly decrease of urine leakage, no other urodynamic parameters had changed. Conclusion: The inside-out transobturator tape (TVT-O) surgery was effective and safe for treatment of recurrent stress urinary incontinence, improved the quality of life and resulted in few complications rate.

Made available in DSpace on 2014-06-11T19:31:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2005Bitstream added on 2014-06-13T19:41:12Z : No. of bitstreams: 1 amaral_as_dr_botfmvz.pdf: 11010569 bytes, checksum: f799834df6f5beed1bbe0ee377c40fe0 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Foram analisados 132 casos de tumor venéreo transmissível (TVT) de ocorrência natural, atendidos no Hospital Veterinário de Botucatu, considerando aspectos clínicos e epidemiológicos. Os pacientes eram, em sua maioria, sem raça definida e com idade variando entre um e 18 anos, com maior freqüência na idade de quatro anos. A localização mais freqüente foi a genital, seguida pela nasal; 25% dos pacientes apresentavam metástases. Estas ocorreram mais freqüentemente na pele (31% das metástases), seguida pela localização mamária, em fêmeas, e em linfonodos, nos machos. Foram colhidas amostras de 188 tumores para avaliação citológica por microscopia ótica, microscopia eletrônica de transmissão, imunofenotipagem e estimação de danos no DNA pelo teste do cometa. As massas foram avaliadas de acordo com a localização, em genitais ou extragenitais, com o comportamento biológico, em primárias e não primárias (metastáticas ou recorrentes) e, ainda, de acordo com o tamanho e tempo de evolução clínica. A avaliação citológica incluiu a classificação de acordo com o padrão morfológico predominante, em linfocitóide (18,4%), plasmocitóide (52,5%) ou misto (29,1%). As amostras extragenitais e não primárias foram predominantemente do padrão plasmocitóide. Foram observadas as características de malignidade gerais, citoplasmáticas, nucleares e nucleolares apresentadas. Anisocitose, anisocariose e macrocariose foram observadas em todos os padrões citomorfológicos, assim como a presença de vacúolos citoplasmáticos, basofilia e eosinofilia citoplasmáticas e corpúsculos linfoglandulares. As características citoplasmáticas de malignidade observadas com maior freqüência foram projeções citoplasmáticas e espessamento... / A hundred and thirty-two dogs with naturally transplanted transmissible venereal tumor (TVT) from ambulatory service of the Veterinary Hospital UNESP, Botucatu, were analyzed for epidemiological and clinical aspects. The animals were predominantly mongrel dogs, with age range between one and eighteen years, and mean of four years. The most usual location was genital, followed by nasal; 25% presents metastasis, the cutaneous location being the most frequent, followed by lymph nodes, in males, and mammary, in females. A sample of 188 tumors were collected for cytologic evaluation in optical microscopy, transmission electron microscopy, immunophenotyping and measure of DNA damage by the Comet test. The masses were classified by location as genital or extragenital, by biological behavior as primary or non-primary (metastastatic or recurrent), and by size and time of clinical evolution. The cytologic evaluation included cytomorphological classification in lymphocyte-like (18.4%), plasma-cell-like (52.5%) and mixed pattern (29.1%). Extragenital and non-primary tumors were essentially plasma cell-like. Malignancy features were noted as general, cytoplasmatic, nuclear and nucleolar. Anisocytosis, anisocariosis and macrocariosis were present in all cytomorphological patterns, as well as cytoplasmatic vacuoles, basophilic and eosinophilic tintorial properties, and lymphoglandular bodies. Cytoplasmatic malignancy criteria most frequently observed were cytoplasmatic projections and cellular membrane thickness. Cells resembling a racket were related to lymphocyte-like pattern. Nuclear buds, perinuclear halos, hyperchromatic nuclei, pseudoinclusions, nuclear membrane thickness and mitosis (normal and abnormal), binucleation, and nuclear lobulations (pleomorphic nuclei) were the most frequents nuclear malignancy criteria. The lymphocyte-like pattern was less related... (Complete abstract click electronic address below)

No description available.

[Truncated abstract] Approximately 35% of women worldwide have stress incontinence, which is defined as involuntary leakage of urine on effort, exertion, or on sneezing and coughing. There are various surgical techniques for stress incontinence; however, minimally invasive operations are increasingly being chosen by surgeons and their patients. Of these procedures, tension-free vaginal tape (TVT) has a cure rate of approximately 90% and is now perceived as the standard technique for stress incontinence. Reported complications of TVT include arterial laceration, bladder perforation, bowel perforation, de novo urgency, dyspareunia, excessive blood loss, haematoma, nerve injuries, urethral erosion, urge incontinence, urinary tract infection, vascular injury, vaginal mesh erosion, voiding dysfunction and death. Suprapubic urethral support sling (SPARC) is a very similar minimally invasive operation and early indications suggested that the success rate for treating stress incontinence was expected to be identical or better than those obtained with the earlier TVT approach, with possibly fewer adverse perioperative events. Our trial sought to establish equivalence between TVT and SPARC in relation to short-term complications and efficacy. OBJECTIVES The primary outcome was bladder perforation. Secondary outcomes were blood loss, voiding difficulty, urgency, and cure of stress incontinence symptoms. METHOD A randomised controlled one-sided equivalence trial (RCT) was conducted in Perth, Western Australia during 2003 and 2004 by researchers in the School of Population Health, University of Western Australia (UWA) and King Edward Memorial Hospital (KEMH). Patients were recruited from the public Urology/Urogynaecology Clinic at the primary women's hospital and the consultant surgeons' private practices. ... However, acute urinary retention requiring a return to theatre to loosen the tape (TVT 0%, SPARC 6.5%; OR: [infinity], 95% CL: 2.2, [infinity]; p=0.002) and subjective short-term cure (TVT 87.1%, SPARC 76.5%; OR: 2.07, 95% CL: 1.13, 3.81; p=0.03) were statistically significantly different. CONCLUSIONS The results are consistent with clinical equivalence between TVT and SPARC in relation to the incidence of bladder perforation. No statistically significant difference was found between TVT and SPARC in blood loss, urgency or short-term objective cure of stress incontinence at the six week post-discharge visit to the surgeon. However, the tapes were more difficult to adjust correctly in SPARC procedures and a statistically significant number of patients required a return to theatre for loosening of the tape (TVT 0/147, 0% and SPARC 10/154, 6.5%, p=0.002). Compared with SPARC, TVT was statistically significantly higher for subjective short-term cure. In ii relation to vaginal mesh erosion, TVT was lower than SPARC, though not statistically significantly. Overall, voiding difficulty (loosening of the tape), urgency and vaginal mesh erosion were the most important clinical problems. This randomised controlled trial demonstrates the importance of testing new devices which appear to be similar, but which may have clinically relevant differences. A follow up study to assess the long-term efficacy of tension-free vaginal tape and suprapubic urethral support sling and associated complications is planned.

Title: Quality of life of women with urinary stress incontinence Objectives: The aim of this thesis was to assess quality of life of women after conservative therapy and chirurgic therapy of urinary stress incontinence in Brno-město and Brno- venkov district. Methods: We did a questionnaire survey on quality of life by using a standardized questionnaire I-QoL (Urinary Incontinence Quality-of-life questionnaire). The questionnaire survey was conducted in patients after conservative or surgical therapy by TVT or TOT tape. Subjectively perceived quality of life of these patients after completion of the therapy was observed. The results were compared between the groups undergoing conservative and surgical therapy by TVT or TOT tape. Results: After the output assessment of quality of life of patients after the treatment, we found that there is a difference in the quality of life of patients treated conservatively and surgically by TVT or TOT tape. Patients treated surgically had higher quality of life than patients treated conservatively by 9%. We also found that there is a difference in the physical, mental and social scores of the groups. The respondents who were treated conservatively had lower score in all evaluated areas with the greatest difference in the physical area and the smallest difference...