André Avarese de Figueiredo

Prevalence of erectile dysfunction in chronic renal disease patients on conservative treatment

Erectile dysfunction (ED), the inability to maintain sufficient penile erection for satisfactory sexual performance, is highly prevalent in the general population, affecting almost 50% of men in the 40-70 years age range, which corresponds to approximately 150 million men worldwide (1,2). More recently, ED has been considered a manifestation of a functional and/or structural abnormality affecting penile circulation as part of a more generalized vascular disorder (2). Erectile dysfunction, therefore, has been associated with signs of generalized arterial disease, as it frequently coexists with diseases with a high component of endothelial dysfunction, such as coronary artery disease, idiopathic systemic arterial hypertension, atherosclerosis, and end-stage chronic kidney disease (ESCKD). ED is also associated with cardiovascular disease risk factors, such as diabetes mellitus, dyslipidemia, and smoking (1-,3). Erectile dysfunction prevalence rates in men with chronic kidney disease (CKD) may reach 70-80%, with similar rates having been reported for those with ESCKD. A number of factors have been implicated in the development of ED in these patients, including the actual presence of a chronic disease, drugs, increased parathyroid hormone (PTH) serum levels, zinc deficiency, decreased testosterone serum levels, increased serum prolactin levels, and psychological factors (3,4).

Abdome agudo: ruptura espontânea de bexiga como um importante diagnóstico diferencial

A case of spontaneous perforation of the bladder in a diabetic female patient is reported. It is a rare clinical condition, that should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumor in the bladder. A general surgeon should be aware of this possibility in the differential diagnosis of an acute abdomen.

Correlation between pelvic floor strength and physical activity level in healthy men

Abstract The male pelvic floor muscles comprise a pair of compound muscle layers referred to as the levator ani. Studies have shown that pelvic floor muscle strength is affected by physical activity. This study aimed to assess male pelvic floor muscle strength through manometry of the external anal sphincter and evaluation of its association with physical activity level, BMI, and rectal pressure in healthy men. To assess physical activity level over the previous week, we used the International Physical Activity Questionnaire 8 (IPAQ). Pelvic floor muscle strength was assessed via anorectal manometry. The results shows a negative correlation between resting pressure and MET, a positive correlation between rectal pressure and resting and maximum pressure. The novel finding of this study is a negative correlation between walking and pelvic floor strength. This study raises new questions about the understanding of the interaction among physical activity, intraabdominal pressure, and pelvic floor strength in the physiology of continence in men.

Prolonged toilet training in children with Down syndrome: a case–control study

OBJECTIVES Children with Down syndrome have delayed psychomotor development, which is a factor that influences the level of difficulty in toilet training. The current study aims to estimate the age toilet training starts and completes in children with DS compared to children with normal psychomotor development and to evaluate the method and type of toilet training most frequently used, as well as its association with lower urinary tract symptoms and functional constipation. METHODS A case-control study was carried out from 2010 to 2015. All parents completed a questionnaire designed to assess the toilet training process. Lower urinary tract symptoms were assessed through the application of the Dysfunctional Voiding Symptom Score. The presence of functional constipation was assessed according to the Rome III criteria. RESULTS The study included 93 children with Down syndrome and 204 children with normal psychomotor development (control group [CG]). The mean age of toilet training onset was 22.8 months in those with DS and 17.5 months in the CG (p=0.001). In children with DS, the mean age when completing toilet training was 56.2 months and 27.1 months in the CG (p=0.001). Among children with DS, females completed toilet training earlier (p=0.02). The toilet training method used most often was child-oriented approach in both groups. No association was observed with the presence of lower urinary tract symptoms or functional constipation and the age of beginning and completing toilet training in both groups. CONCLUSION Children with Down syndrome experienced prolonged toilet training time. Prospective longitudinal studies are essential to gain insight into the toilet training of these children.

Smoking and its association with cryptorchidism in Down syndrome

INTRODUCTION Cryptorchidism is a common and prevalent condition in patients with Down syndrome. Environmental factors, such as smoking, can be associated with malformations during fetal development. The study of the prevalence of cryptorchidism and its association with parental tobacco use in Down syndrome can contribute to alert health care professionals, patients and family members regarding the prevention of the harms caused by cryptorchidism and its possible predisposing factors. OBJECTIVE To evaluate the prevalence of cryptorchidism in Down syndrome and its association with maternal and paternal smoking. METHOD Forty (40) patients of a public clinic specialized in Down syndrome were evaluated, using a semi-structured questionnaire for evaluation of antecedents and sociodemographic characteristics, as well as physical and complementary examinations. RESULTS Cryptorchidism was observed in 27.5% of the patients (95CI 15.98-42.96). Of these, 55% (5/9) were the children of mothers who smoked during pregnancy, and 19.35% (6/31) were the children of mothers who did not smoke during pregnancy (OR = 5.26 [95CI 1.06-25.41]; p=0.032). Similarly, paternal smoking was also observed in greater frequency among the parents of cryptorchid patients compared with subjects with descended testis, 63.36% (7/11) and 31.03% (9/29), respectively (OR = 3.89 [95CI 0.91-16.73]; p=0.060). CONCLUSION The prevalence of cryptorchidism is high in patients with Down syndrome. We can show a strong association between smoking parents and the occurrence of cryptorchidism, especially when it comes to maternal smoking.

Point of care kidney ultrasonography and its role in the diagnosis ofurinary obstruction: a case report

INTRODUCTION Ultrasonography (US) is a rapid, non-invasive and safe procedure that allows the nephrologist to obtain vital information to the bedside, as well as allows to guide the procedures for nephrology practice. CASE REPORT Male patient, elderly with hypertension, diabetes mellitus and chronic kidney disease presents with infraumbilical protrusion that the Point of Care US (POCUS), performed by the nephrologist, proved to be a large bladder with a diverticulum. In addition, the US enabled the nephrologist to diagnose bilateral hydronephrosis, preservation of the cortico-medullary differentiation and echotexture of the right kidney, post-voiding urinary retention, urinary catheter placement and functional and morphological monitoring of the urinary tract after surgical correction of the infravesical obstruction. CONCLUSION POCUS assessment of the renal tract may become the new standard of care among nephrologists by enabling the expansion of clinical information in a timely fashion, allowing faster resolution of cases and permitting the monitoring of the treatment done.