Ricardo Garcia de Freitas

Topical treatment for phimosis: Time span and other factors behind treatment effectiveness

OBJECTIVE To study the factors that may influence the effectiveness of 0.2% betamethasone/hyaluronidase cream in the treatment of phimosis. METHODS We treated 427 patients (3-10 years old, mean 6.33) in a prospective, randomized, blind study, with 214 patients on a 4-week and 213 patients on an 8-week course. All patients were seen once monthly at least for 6 months after the end of treatment. The penis was photographed to allow objective evaluation of treatment response. The therapeutic response was graded as total success when there was complete exposure of the glans; partial success when there was exposure of half of the glans, impeded by balanopreputial adherence or ring fibrosis at the prepuce; and therapeutic failure when patients had no or less than 50% glans exposure. RESULTS After treatment 92.1% of patients showed total or partial success, but during follow up (mean 9.36 months, range 6-13) 29.5% failed to maintain this (22.6% and 37.6% for 8- and 4-week treatment, respectively). During treatment, 13.6% presented side effects or complications: prepuce ardor (6.1%), hyperemia (4.6%), paraphimosis (0.0098%). Intervention or interruption of treatment was unnecessary. The two groups were statistically similar in all parameters, but time of treatment=8 weeks, previous urethral meatal exposure and no previous balanoposthitis increased the chance of total success. Surgery was indicated for failure or relapse in 181 patients (42.38%). CONCLUSION Treatment with topical 0.2% betamethasone/hyaluronidase cream for 8 weeks is effective and safe, especially if the urethral meatus is exposed and there is no previous balanoposthitis. Rescue treatment is not recommended, as the results were not encouraging.

To Circ or Not to Circ: Clinical and Pharmacoeconomic Outcomes of a Prospective Trial of Topical Steroid versus Primary Circumcision

PURPOSE To compare the efficacy and costs of circumcision versus topical treatment using a prospective pharmacoeconomic protocol. MATERIALS AND METHODS We treated 59 patients (3-10 years of age) randomized into two groups: 29 underwent an 8-week course of topical treatment with 0.2% betamethasone-hyaluronidase cream twice a day; and 30 underwent circumcision. Topical treatment success was defined as complete exposure of the glans. In cases of treatment failure, circumcision was performed and its cost imputed to that of the initial treatment. The pharmacoeconomic aspects were defined according to the Brazilian National Public Health System database and the Brazilian Community Pharmacies Index. RESULTS The two groups were statistically similar for all clinical parameters evaluated. Topical treatment resulted in complete exposure of the glans in 52% of the patients. Topical treatment was associated with preputial pain and hyperemia. However, treatment suspension was unnecessary. Minor complications were observed in 16.6% of the surgical group patients. The mean cost per patient was US

The Ochoa urofacial syndrome: recognize the peculiar smile and avoid severe urological and renal complications

53.70 and US

Continent urinary reconstruction in rhabdomyosarcoma: A new approach

125.20, respectively, for topical steroid treatment (including the costs related to treatment failure) and circumcision. The total costs were US

V748: Dorsal Tunica Vaginals Graft to Reconstruct the Urethral Plate for Complex One-Stage Onlay Urethroplasty

2,825.32 and US

Síndrome urofacial de Ochoa: reconheça o sorriso peculiar e evite complicações urológicas e renais graves The Ochoa urofacial syndrome: recognize the peculiar smile and avoid severe urological and renal complications

3,885.73 for topical treatment and circumcision, respectively. CONCLUSIONS Topical treatment of phimosis can reduce costs by 27.3% in comparison with circumcision. Therefore, topical treatment of phimosis should be considered prior to the decision to perform surgery.

The Ochoa urofacial syndrome: recognize the peculiar smile and avoid severe urological and renal complications Síndrome urofacial de Ochoa: reconheça o sorriso peculiar e evite complicações urológicas e renais graves

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients’ medical records were reviewed and patients’ urological status clinically reassessed. At last evaluation patients’ mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.