Alexandre Fornari

Evaluation of the Association between Lower Urinary Tract Symptoms and Erectile Dysfunction, Considering its Multiple Risk Factors

AIM To investigate the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), while considering multiple risk factors for ED, including an anthropometric evaluation of central obesity. METHODS A cross-sectional study was carried out with 192 consecutive male subjects (>or=40 years old). Conditions clearly associated with ED, other than obesity and age, were considered exclusion criteria. Men were evaluated routinely for clinical history, received a physical examination, and were subjected to blood analysis for fasting serum glucose, lipid profile, and serum testosterone. Patients with previous known history of diabetes mellitus or hypertension were excluded. Anthropometric measures taken included body mass index (general obesity) and waist circumference, waist-hip index, and sagittal abdominal diameter (visceral obesity). Analyses were performed using bivariate and multivariate models (multiple logistic regression). Age, education, alcohol consumption, smoking, sedentary lifestyle, fasting blood glucose level, dyslipidemia, hypogonadism, general obesity, and visceral obesity were taken into account as potential confounding factors. MAIN OUTCOME MEASURES All men completed the International Index of Erectile Function and International Prostate Symptom Score (IPSS). RESULTS IPSS scores were low, intermediate, and high in 89 (46.4%), 76 (39.6%), and 27 (14.1%) men, respectively. Overall IPSS scores were significantly associated with ED (P = 0.002). In addition, an association between the severity of ED and LUTS was observed (P = 0.008). The mean quality of life assessment in the IPSS revealed a statistically significant difference between individuals with varying degrees of ED (P = 0.008). The logistic regression analyses showed that IPSS scores and ED remained independently associated even after the control for confounding factors (odds ratio = 1.07, 95% CI = 1.02-1.13, P = 0.01). CONCLUSION This study suggests that LUTS are independently associated with ED, taking into account various risk factors for ED, including visceral obesity.

A case of xanthogranulomatous cystitis

We report a case of xanthogranulomatous cystitis (XC) in a 76-year-old man who presented with painless hematuria and a bladder mass on imaging studies. Xanthogranuloma is a chronic inflammatory condition that most commonly involves the kidney. XC is a rare condition of still unknown aetiology with only about 20 cases reported to date. The gold standard treatment is surgical resection. Consideration should be given to this entity in the differential diagnosis of urinary bladder masses.

Urethral catheter removal 7 or 14 days after radical retropubic prostatectomy: clinical implications and complications in a randomized study

PURPOSE To evaluate the hypothesis that a 7-day period of indwelling catheter after radical retropubic prostatectomy is effective and safe without the need of performing cystography. METHODS In the period from January of 2000 to July of 2002, 73 patients underwent radical retropubic prostatectomy, and these patients were prospectively randomized in 2 groups: Group 1-37 patients who had the urethral catheter removed 7 days after the procedure, and Group 2-36 patients who had the catheter removed 14 days after the surgery. The 2 groups were similar, the surgeons and the technique were the same, and no cystography was performed to evaluate the presence of leaks. RESULTS Two patients in Group 1 had bleeding and clot retention after having the catheter taken out in the seventh postoperative day and were managed by putting the catheter back in for 7 more days. Two patients in Group 2 developed bladder neck stricture and were treated by bladder neck incision with success. The continence rate was the same, with 2 cases of incontinence in each group. About 2 pads a day were used by the patients with incontinence. The average follow-up was 17.5 months (12-36 months). No urinary fistula, urinoma, or pelvic abscesses developed after catheter removal. Two patients were excluded from the analysis of this series: 1 died with a pulmonary embolus in the third postoperative day, and 1 developed a urinary suprapubic fistula before catheter withdrawal, which was maintained for 16 days. CONCLUSION Withdrawal of the urethral catheter 7 days after radical retropubic prostatectomy, without performing cystography, has a low rate of short-term complications that are equivalent to withdrawal 14 days after the surgery.OBJETIVO: Avaliar a hipotese de que um periodo de sete dias de sonda vesical de demora apos prostatectomia radical retropubica e efetivo e seguro, sem a necessidade da realizacao de cistografia. METODOS: Entre janeiro de 2000 e julho de 2002, setenta e tres pacientes submetidos a prostatectomia radical retropubica foram prospectivamente randomizados em dois grupos: grupo 1 - 37 pacientes em que a sonda vesical foi removida 7 dias apos o procedimento e, grupo 2 - 36 nos quais a sonda foi removida 14 dias apos a cirurgia. Os dois grupos apresentavam caracteristicas clinicas similares, os cirurgioes e tecnicas foram as mesmas, e nenhuma cistografia foi realizada para avaliar a presenca de vazamentos. RESULTADOS: Dois pacientes no grupo 1 apresentaram sangramento e retencao por coagulos apos a retirada da sonda no setimo dia pos-operatorio, e foram manejados atraves da recolocacao da sonda vesical por mais 7 dias. Dois pacientes do grupo 2 desenvolveram esclerose do colo vesical e foram tratados atraves de incisao do colo vesical com sucesso. A taxa de continencia foi a mesma, com dois casos de incontinencia em cada grupo. Em torno de duas fraldas por dia eram utilizadas pelos pacientes com incontinencia. O seguimento medio foi de 17.5 meses (2 - 30 meses). Nao houve formacao de fistula urinaria, urinoma ou abcesso pelvico apos a retirada da sonda vesical. Dois pacientes foram excluidos da analise desta serie: um faleceu devido a embolia pulmonar no terceiro dia pos-operatorio, e o outro desenvolveu fistula urinaria suprapubica antes da retirada do cateter, que foi mantido por 16 dias. CONCLUSAO: A retirada da sonda vesical 7 dias apos a prostatectomia radical retropubica, sem realizacao de cistografia, tem uma baixa taxa de complicacoes de curto prazo, equivalentes as da retirada da sonda aos 14 dias de pos-operatorio.