Eduardo Muracca Yoshinaga

Quality of Life and Clinical Symptom Improvement Support Prostatic Artery Embolization for Patients with Acute Urinary Retention Caused by Benign Prostatic Hyperplasia

PURPOSE To show that prostatic artery embolization (PAE) improves quality of life (QoL) and lower urinary tract symptoms in patients with acute urinary retention caused by benign prostatic hyperplasia (BPH). MATERIALS AND METHODS This was a single-center prospective study of PAE in 11 patients with BPH managed with indwelling urinary catheters. International Prostate Symptom Score (IPSS), ultrasound, magnetic resonance (MR) imaging, QoL, and urodynamic tests were used to assess outcomes. Prostate size ranged from 30 to 90 g, and embolizations were performed with 300-500-μm Embosphere microspheres. RESULTS The rate of technical success (ie, bilateral PAE) was 75%, and the rate of clinical success (ie, catheter removal and symptom improvement) was 91% (10 of 11 patients). Postembolization syndrome manifested as mild pain in the perineum, retropubic area, and/or urethra. Ten of 11 patients urinated spontaneously after Foley catheter removal 4-25 days after PAE (mean, 12.1 d). No major complications were observed. Follow-up ranged from 19 to 48 months. In an asymptomatic patient, a discrete area of hypoperfusion suggesting small ischemia of the bladder was observed on 30-day MR imaging follow-up, but the bladder was normal on 90-day MR imaging. After 1 year, mean prostate volume reduction was greater than 30%, symptoms were mild (mean IPSS, 2.8 ± 2.1; P = .04), no erectile dysfunction was observed, and QoL improved significantly (mean, 0.4 ± 0.5; P = .001) using the paired t test. CONCLUSIONS Patients with severe symptoms and acute urinary retention caused by BPH can be treated safely by PAE, which improves clinical symptoms and QoL.

Prostatic Artery Embolization for Treatment of Benign Prostatic Hyperplasia in Patients with Prostates > 90 g: A Prospective Single-Center Study

PURPOSE To describe the safety and efficacy of prostatic artery embolization (PAE) with spherical microparticles to treat lower urinary tract symptoms associated with benign prostatic hyperplasia in patients with prostate volume > 90 g. MATERIALS AND METHODS This prospective, single-center, single-arm study was conducted in 35 patients with prostate volumes ranging from 90-252 g. Mean patient age was 64.8 years (range, 53-77 y). Magnetic resonance imaging, uroflowmetry, and the International Prostate Symptom Score (IPSS) were used to assess clinical and functional outcomes. RESULTS Mean prostate size decreased significantly from 135.1 g before PAE to 91.9 g at 3 months of follow-up (P < .0001). Mean IPSS and quality-of-life index improved from 18.3 to 2.7 and 4.8 to 0.9 (P < .0001 for both), respectively. A significant negative correlation was observed between prostate-specific antigen at 24 hours after PAE and IPSS 3 months after PAE (P = .0057). CONCLUSIONS PAE is a safe and effective treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia in patients with prostate volume > 90 g. Excessively elevated prostate-specific antigen within 24 hours of PAE is associated with lower symptom burden in short-term follow-up.

Hypoxemia after myocardial revascularization: analysis of risk factors

JUSTIFICATIVA E OBJETIVOS: Hipoxemia grave e uma complicacao frequente no pos-operatorio imediato de revascularizacao do miocardio (RM), promovendo aumento da duracao da ventilacao mecânica, da incidencia de infeccoes pulmonares, dos custos e da mortalidade. O objetivo desse estudo foi identificar fatores preditivos de hipoxemia grave em pacientes submetidos a RM. METODO: Foram estudados 481 pacientes adultos submetidos a RM eletiva entre outubro de 2003 e marco de 2004. Considerou-se hipoxemia grave uma relacao PaO2/FiO2 0,2 para exclusao da variavel do modelo de RL e p < 0,1 como sendo significativo. RESULTADOS: O tempo para extubacao dos pacientes com hipoxemia grave foi maior que nos outros pacientes (p < 0,001). Na analise multivariada, as variaveis idade (p = 0,081), peso (p = 0,001), necessidade de CEC prolongada (p = 0,033) e disfuncao ventricular esquerda (p = 0,082) foram identificadas como preditores independentes para hipoxemia grave. CONCLUSOES: Pacientes com idade e peso elevados, disfuncao ventricular esquerda e necessidade de CEC apresentaram risco aumentado para hipoxemia grave apos RM. Nesses pacientes, o uso de estrategias ventilatorias perioperatoria com pressoes positivas expiratorias mais elevadas e manobra de recrutamento alveolar devem ser consideradas tendo como objetivo a prevencao da disfuncao pulmonar pos-operatoria.BACKGROUND AND OBJECTIVES Severe hypoxemia is complication frequently seen in the immediate postoperative period of myocardial revascularization (MR), increasing the duration of mechanical ventilation, the incidence of pulmonary infections, hospital costs, and mortality. The objective of this study was to identify predictive factors of severe hypoxemia in patients undergoing MR. METHODS Four-hundred and eighty-one adult patients undergoing elective MR between October 2003 and March 2004 were enrolled in this study. Severe hypoxemia was defined as PaO2/FiO2 < 150 upon admission to the ICU. The Chi-square test, Students t or Wilcoxon test, followed by multivariate analysis and logistic regression (LR) for parameters with p < 0.25 in the univariate analysis, were used for the statistical analysis. A p > 0.2 was required to exclude the parameter from the LR model, and a p < 0.1 was considered significant. RESULTS Time for extubation was greater in patients with severe hypoxemia (p < 0.001). Multivariate analysis identified age (p = 0.081), weight (p = 0.001), need of prolonged CBP (p = 0.033), and left ventricular dysfunction (p = 0.082) as independent predictors of severe hypoxemia. CONCLUSIONS Older and overweighted patients, those with left ventricular dysfunction, and those who needed CPB presented an increased risk of severe hypoxemia after MR. In those patients, the use of perioperative ventilatory strategies, with elevated positive expiratory pressures and alveolar recruitment maneuver should be considered to prevent postoperative pulmonary dysfunction.

Hipoxemia após revascularização miocárdica: análise dos fatores de risco

JUSTIFICATIVA E OBJETIVOS: Hipoxemia grave e uma complicacao frequente no pos-operatorio imediato de revascularizacao do miocardio (RM), promovendo aumento da duracao da ventilacao mecânica, da incidencia de infeccoes pulmonares, dos custos e da mortalidade. O objetivo desse estudo foi identificar fatores preditivos de hipoxemia grave em pacientes submetidos a RM. METODO: Foram estudados 481 pacientes adultos submetidos a RM eletiva entre outubro de 2003 e marco de 2004. Considerou-se hipoxemia grave uma relacao PaO2/FiO2 0,2 para exclusao da variavel do modelo de RL e p < 0,1 como sendo significativo. RESULTADOS: O tempo para extubacao dos pacientes com hipoxemia grave foi maior que nos outros pacientes (p < 0,001). Na analise multivariada, as variaveis idade (p = 0,081), peso (p = 0,001), necessidade de CEC prolongada (p = 0,033) e disfuncao ventricular esquerda (p = 0,082) foram identificadas como preditores independentes para hipoxemia grave. CONCLUSOES: Pacientes com idade e peso elevados, disfuncao ventricular esquerda e necessidade de CEC apresentaram risco aumentado para hipoxemia grave apos RM. Nesses pacientes, o uso de estrategias ventilatorias perioperatoria com pressoes positivas expiratorias mais elevadas e manobra de recrutamento alveolar devem ser consideradas tendo como objetivo a prevencao da disfuncao pulmonar pos-operatoria.BACKGROUND AND OBJECTIVES Severe hypoxemia is complication frequently seen in the immediate postoperative period of myocardial revascularization (MR), increasing the duration of mechanical ventilation, the incidence of pulmonary infections, hospital costs, and mortality. The objective of this study was to identify predictive factors of severe hypoxemia in patients undergoing MR. METHODS Four-hundred and eighty-one adult patients undergoing elective MR between October 2003 and March 2004 were enrolled in this study. Severe hypoxemia was defined as PaO2/FiO2 < 150 upon admission to the ICU. The Chi-square test, Students t or Wilcoxon test, followed by multivariate analysis and logistic regression (LR) for parameters with p < 0.25 in the univariate analysis, were used for the statistical analysis. A p > 0.2 was required to exclude the parameter from the LR model, and a p < 0.1 was considered significant. RESULTS Time for extubation was greater in patients with severe hypoxemia (p < 0.001). Multivariate analysis identified age (p = 0.081), weight (p = 0.001), need of prolonged CBP (p = 0.033), and left ventricular dysfunction (p = 0.082) as independent predictors of severe hypoxemia. CONCLUSIONS Older and overweighted patients, those with left ventricular dysfunction, and those who needed CPB presented an increased risk of severe hypoxemia after MR. In those patients, the use of perioperative ventilatory strategies, with elevated positive expiratory pressures and alveolar recruitment maneuver should be considered to prevent postoperative pulmonary dysfunction.

MP71-18 LOW-VOLUME PROSTATE IN BENIGN PROSTATIC HYPERPLASIA (BPH): A RISK FACTOR FOR SYMPTOMATIC BLADDER DIVERTICULA REQUIRING SURGICAL TREATMENT

INTRODUCTION AND OBJECTIVES: to evaluate the association between prostate volume, age, and occurrence of bladder diverticula requiring surgical treatment on patients with symptomatic BPH. METHODS: we performed a retrospective search on our prospectively collected database searching for patients with BPH managed surgically between Jan/10 and Oct/14. Analyzed data comprised age at, prostatic volume measured on abdominal ultrasound, type of prostatic surgery, and presence of bladder diverticula requiring surgical treatment ( 3cm and/or symptomatic). Patients were divided in regards to diverticula requiring surgical treatment. Groups were compared using Student T test and Chi-square/Fisher exact test. Logistic regression was performed to seek for associations between the presence of the symptomatic diverticula and preoperative parameters. Significance was set at p<0.05. RESULTS: A total of 1532 patients were surgically treated for BPH in the analyzed period and 41 (2.6%) had symptomatic bladder diverticula. Mean diverticula size was 6.8 2.9cm and mean number of diverticula per patient was 1.5 0.8 (1-5). Treatment of the diverticula was performed laparoscopically in 13 (31.8%) patients, by endoscopic incision in 14 (34.1%), and by open resection in 14 cases (34.1%). Patients with treated diverticula did not differ from the other cohort in regards to age (66.9 8.3 vs. 68.5 8.8 years, respectively; p1⁄40.16) and surgical technique (p1⁄40.11). Mean prostate volume was significantly lower in the treated diverticula group (53.6 45.0 vs. 80.7 51.9g, respectively; p<0.01). Prostate volume and age distributions among patients with and without diverticula are depicted in figures 1A and B. Logistic regression revealed only prostate volume to significantly impact the presence of symptomatic diverticula requiring surgical treatment (OR1⁄4-0.03; 95% CI 0.955 e 0.988; p1⁄40.01). Roc curve analysis revealed a significant association with an AUC of 0.73 (p<0.001)(fig.1c). CONCLUSIONS: In patients with BPH, there is a significant association between prostate volume and risk of symptomatic bladder diverticulum. Bladder diverticula requiring surgical treatment are more common in patients with low prostate volume.

Hipoxemia después de la revascularización miocárdica: análisis de los factores de riesgo

JUSTIFICATIVA E OBJETIVOS: Hipoxemia grave e uma complicacao frequente no pos-operatorio imediato de revascularizacao do miocardio (RM), promovendo aumento da duracao da ventilacao mecânica, da incidencia de infeccoes pulmonares, dos custos e da mortalidade. O objetivo desse estudo foi identificar fatores preditivos de hipoxemia grave em pacientes submetidos a RM. METODO: Foram estudados 481 pacientes adultos submetidos a RM eletiva entre outubro de 2003 e marco de 2004. Considerou-se hipoxemia grave uma relacao PaO2/FiO2 0,2 para exclusao da variavel do modelo de RL e p < 0,1 como sendo significativo. RESULTADOS: O tempo para extubacao dos pacientes com hipoxemia grave foi maior que nos outros pacientes (p < 0,001). Na analise multivariada, as variaveis idade (p = 0,081), peso (p = 0,001), necessidade de CEC prolongada (p = 0,033) e disfuncao ventricular esquerda (p = 0,082) foram identificadas como preditores independentes para hipoxemia grave. CONCLUSOES: Pacientes com idade e peso elevados, disfuncao ventricular esquerda e necessidade de CEC apresentaram risco aumentado para hipoxemia grave apos RM. Nesses pacientes, o uso de estrategias ventilatorias perioperatoria com pressoes positivas expiratorias mais elevadas e manobra de recrutamento alveolar devem ser consideradas tendo como objetivo a prevencao da disfuncao pulmonar pos-operatoria.BACKGROUND AND OBJECTIVES Severe hypoxemia is complication frequently seen in the immediate postoperative period of myocardial revascularization (MR), increasing the duration of mechanical ventilation, the incidence of pulmonary infections, hospital costs, and mortality. The objective of this study was to identify predictive factors of severe hypoxemia in patients undergoing MR. METHODS Four-hundred and eighty-one adult patients undergoing elective MR between October 2003 and March 2004 were enrolled in this study. Severe hypoxemia was defined as PaO2/FiO2 < 150 upon admission to the ICU. The Chi-square test, Students t or Wilcoxon test, followed by multivariate analysis and logistic regression (LR) for parameters with p < 0.25 in the univariate analysis, were used for the statistical analysis. A p > 0.2 was required to exclude the parameter from the LR model, and a p < 0.1 was considered significant. RESULTS Time for extubation was greater in patients with severe hypoxemia (p < 0.001). Multivariate analysis identified age (p = 0.081), weight (p = 0.001), need of prolonged CBP (p = 0.033), and left ventricular dysfunction (p = 0.082) as independent predictors of severe hypoxemia. CONCLUSIONS Older and overweighted patients, those with left ventricular dysfunction, and those who needed CPB presented an increased risk of severe hypoxemia after MR. In those patients, the use of perioperative ventilatory strategies, with elevated positive expiratory pressures and alveolar recruitment maneuver should be considered to prevent postoperative pulmonary dysfunction.