Rogerio Simonetti

Male infertility in spinal cord trauma

Every year there are 10 thousand new cases of patients victimized by spinal cord trauma (SCT) in the United States and it is estimated that there are 7 thousand new cases in Brazil. Eighty percent of patients are fertile males. Infertility in this patient group is due to 3 main factors resulting from spinal cord lesions: erectile dysfunction, ejaculatory disorder and low sperm counts. Erectile dysfunction has been successfully treated with oral and injectable medications, use of vacuum devices and penile prosthesis implants. The technological improvement in penile vibratory stimulation devices (PVS) and rectal probe electro-ejaculation (RPE) has made such procedures safer and accessible to patients with ejaculatory dysfunction. Despite the normal number of spermatozoa found in semen of spinal cord-injured patients, their motility is abnormal. This change does not seem to be related to changes in scrotal thermal regulation, frequency of ejaculation or duration of spinal cord damage but to factors related to the seminal plasma. Despite the poor seminal quality, increasingly more men with SCT have become fathers through techniques ranging from simple homologous insemination to sophisticated assisted reproduction techniques such as intracytoplasmic sperm injection (ICSI).

Paraurethral leiomyoma in a female causing urinary obstruction

We report a case of paraurethral leiomyoma in a female patient, in which the first symptoms were dysuria and sensation of incomplete voiding. The physical examination revealed a mass in the anterior vaginal wall. The diagnosis was made through ultrasonography and pelvic MRI and confirmed by transvaginal ultrasound-guided needle biopsy. The surgical excision was accomplished without opening the urinary tract. A review of the relevant published studies and a suggestion for the appropriate management of these cases are included.

Magnetic resonance imaging urodynamics: technique development and preliminary results

OBJECTIVES In this preliminary study we report the development of the video urodynamic technique using magnetic resonance imaging (MRI). MATERIALS AND METHODS We studied 6 women with genuine stress urinary incontinence, diagnosed by history and physical examination. Urodynamic examination was performed on multichannel equipment with the patient in the supine position. Coughing and Valsalva maneuvers were performed at volumes of 150, 250 and 350 mL. Simultaneously, MRI was carried out by using 1.5 T GE Signa CV/i high-speed scanner with real time fluoroscopic imaging possibilities. Fluoroscopic imaging was accomplished in the corresponding planes with T2-weighted single shot fast spin echo sequences at a speed of about 1 frame per second. Both studies were recorded and synchronized, resulting in a single video urodynamic examination. RESULTS Dynamic MRI with cine-loop reconstruction of 1 image per second demonstrated the movement of all compartment of the relaxed pelvis during straining with the concomitant registration of abdominal and intravesical pressures. In 5 patients, urinary leakage was demonstrated during straining and the Valsalva leak point pressure (VLPP) was determined as the vesical pressure at leak subtracted from baseline bladder pressure. Mean VLPP was 72.6 cm H2O (ranging from 43 to 122 cm H2O). CONCLUSIONS The concept of MRI video urodynamics is feasible. In a clinical perspective, practical aspects represent a barrier to daily use and it should be recommended for research purposes.

Morphological and functional response to injury to the external urethral sphincter – similarities and differences between male and female rats

The objective of this study was to evaluate the similarities and differences of the urethral morphological and functional changes following external urethral sphincter EUS injury in male and female rats.

Future Pharmacotherapies for Male Lower Urinary Tract Symptoms

Lower urinary tract symptoms (LUTS) in men are a prevalent condition with complex and multifactorial etiology. Different types of symptoms overlap among them and treatment has evolved to a more holistic and individualized approach. Advances in the understanding of LUTS pathophysiology has led to the development of new drugs and compounds to treat male LUTS. Recently, new drugs, such as phosphodiesterase type 5 inhibitors and beta3 adrenergic agonists, have been approved for the treatment of LUTS and have just made it to clinical practice. New agents for intraprostatic injection, for instance PRX302 and NX-1207, are currently under evaluation in clinical trials with promising results. Rho-kinase inhibitors, transient receptor potential channel blockers and activators of soluble guanylyl cyclase are examples of compounds targeting different pathways involved in the pathophysiology of male LUTS, which have been tested in experimental studies. New advances in pharmacotherapy may also allow combination of drugs to achieve synergistic effect.