Salvador Vilar Correia Lima

NONSECRETORY SIGMOID CYSTOPLASTY: EXPERIMENTAL AND CLINICAL RESULTS

We report the results of experimental and clinical studies in which a de-epithelialized segment of sigmoid colon was used to cover the bladder dome where the mucosa was exposed (auto-augmentation) to increase bladder capacity. Experimentally, the technique was performed in 10 healthy female mongrel dogs and the intestinal segments established continuity perfectly over the exposed bladder mucosa. Histology 30 and 60 days postoperatively showed transitional epithelium lining the intestinal segment at the site of implantation. One island of intestinal mucosa was found. The technique was performed in 10 patients, including 9 with neurogenic bladder secondary to myelomeningocele and 1 with posterior urethral valves. Bladder capacity improved in all cases and intravesical pressure was reduced. Followup ranged from 6 to 43 months. The technique is proposed as a valuable alternative to traditional full-thickness patches of the digestive tract and auto-augmentation.

Combined Use of Enterocystoplasty and a New Type of Artificial Sphincter in the Treatment of Urinary Incontinence

PURPOSE We report the results of the combination of enterocystoplasty and a periurethral expander, a simplified type of artificial sphincter, in the treatment of urinary incontinence. MATERIALS AND METHODS The new 1-piece device has an adjustable cuff connected to a port positioned at the subcutaneous space in the abdomen. The cuff is adjusted to the bladder neck and the pins are fixed according to the diameter of the urethra. The port is punctured percutaneously and saline is injected until continence is achieved. Eight boys and 3 girls underwent nonsecretory sigmoid cystoplasty and placement of the device at a single operation. Nine patients had neurogenic bladder and in 2 exstrophy reconstruction had failed. Followup ranged from 4 to 26 months. RESULTS All patients were continent with improved bladder compliance 6 to 8 weeks after the operation, when the device was activated. In 1 case the device was extracted after 2 months due to frequent episodes of hematuria and edema at the port site. Two patients had erosion of the skin at the port site. Urodynamics were repeated at the time of activation. Maximal urethral closing pressure increased from 16.27 to 157.44%. Two patients needed a second injection to achieve continence. The patients with exstrophy void spontaneously and those with neurogenic bladder are on clean intermittent catheterization. CONCLUSIONS Although more followup is needed, the combination of these procedures seems to offer a new option for the treatment of urinary incontinence in children.

A wet dressing for hypospadias surgery

INTRODUCTION One of the main problems faced by surgeons involved in male genitalia surgeries, in particular in children with hypospadias, is the type of dressing and its use during the post-operatory period. MATERIALS AND METHODS From a multidisciplinary project involving the use of sugarcane biopolymer membrane developed in the last 10 years, produced by bacterial action over sugarcane molasses, we developed a multiperforated pellicle that, when applied around the penis, protects the surgical field. It is a proven inert material that does not induce any reaction on the surgical field and can be left in situ maintaining the same characteristics during a long period of time without the need of replacement. This multiperforated tape can involve several times the penis shaft and due to its adhesiveness it hardly loosens. We compared the use of this dressing with a commercial one (made by polyurethane). Thirty patients with hypospadias were randomly selected for the use of this new type of dressing in the last 18 months. A similar group of patients used a similar commercial dressing made of polyurethane (Tegaderm) according to the same criteria of use. For safety reasons, we applied one or two sutures without the inclusion of the skin using an absorbable suture in order to prevent early detachment. A small gauze was left for 24 hours in order to absorb any possible bleeding. We recommended the irrigation of the dressing with water or saline at least three or four times a day and the patient was allowed to bath. The dressing did not need any special care and if not removed it usually detached spontaneously after 10 to 14 days. RESULTS The tolerance to the material was satisfactory and there were no adverse reactions on the penile surface. In two cases of the biopolymer group the dressing detached spontaneously on the first and third days, respectively. In two cases of the polyurethane group it was observed major edema. The grade of satisfaction of the patients and their relatives was excellent on the biopolymer group. CONCLUSION This dressing produced by a polysaccharide is a promising alternative for the treatment of children and adolescents submitted to genital surgery. Its main advantage is the possibility of several washes along the day without the need of any other manipulation.

Nonsecretory Intestinocystoplasty: A 15-Year Prospective Study of 183 Patients

PURPOSE Children and young adults treated with augmentation procedures with total intestinal flaps are at increased risk for specific complications in the long term. The aim of the present study was to demonstrate the long-term results of demucosalized bladder augmentation. MATERIALS AND METHODS A total of 183 patients (92 males and 91 females) were treated with bladder augmentation with the use of de-epithelialized intestinal segments. Patient age ranged from 3 months to 53 years, with a mean of 13.51 years (median 11.0). Of the patients 121 (66.1%) presented with neurogenic bladder, 50 (27.3%) with bladder exstrophy, 7 (3.8%) with tuberculosis, 4 (2.2%) with posterior urethral valves and 1 (0.5%) with female hypospadias. A mold over which the de-epithelialized segment of bowel was applied was used in all patients. A total of 151 cases were augmented using sigmoid colon and 32 using ileum. Data from bladder capacity and compliance were used to evaluate the results. RESULTS Mean followup was 75.6 months (range 2 to 189). A total of 23 cases (12.6%) were considered failures. Mean bladder capacity was 250.0 ml. An increase of 342.4% was observed postoperatively. Median preoperative compliance was 1.6 ml/cm/H2O. An increase of 762.5% was observed during followup. Seven patients presented with bladder stones. Spontaneous bladder perforation was seen in 2 cases. CONCLUSIONS Significant increase in bladder capacity and compliance was achieved and maintained in the long term. The number of complications was lower compared to traditional methods of augmentation.

Experience with demucosalized ileum for bladder augmentation

Objective To assess the use of demucosalized ileum for bladder augmentation, following the same principles previously used with the sigmoid colon.

Acute toxicity, cytotoxicity, genotoxicity and antigenotoxic effects of a cellulosic exopolysaccharide obtained from sugarcane molasses

The acute toxicity, cytotoxicity, genotoxicity and antigenotoxic effects of BC were studied. Cytotoxicity of BC was evaluated in cultured C3A hepatoma cells (HepG2/C3A) using a lactate dehydrogenase (LDH) activity assay. Acute toxicity was tested in adults Wistar rats treated with a single dose of BC. The genotoxicity of BC was evaluated in vivo by the micronucleus assay. BC (0.33-170 μg/mL) added to C3A cell culture medium caused no elevation in LDH release over the background level recorded in untreated cell wells. The treatment with the BC in a single oral dose (2000 mg/kg body weight) caused no deaths or signs of toxicity. BC attenuated CP-induced and inhibition the incidence of MNPCE (female: 46.94%; male: 22.7%) and increased the ratio of PCE/NCE (female: 46.10%; male: 35.25%). There was no alteration in the LDH release in the wells where C3A cells were treated with increasing concentrations of BC compared to the wells where the cells received the cell culture medium only (background of approximately 20% cell death), indicated that in the dose range tested BC was not cytotoxic. BC was not cytotoxic, genotoxic or acutely toxic. BC attenuated CP-induced genotoxic and myelotoxic effects.

Periurethral constrictor: late results of the treatment of post prostatectomy urinary incontinence

OBJECTIVES We evaluated retrospectively, the long-term outcome of patients with post-prostatectomy urinary incontinence (PPUI) after placement of the Periurethral Constrictor (PUC). MATERIALS AND METHODS Fifty-six men with severe PPUI were studied, with a mean age of 68.5 years old. Fifty-one men had PPUI due to radical surgery having the device placed around the bulbous urethra, and five individuals with benign prostatic hypertrophy (BPH) had placement around the bladder neck. The mean follow-up was 82.2 months. RESULTS Twenty-two patients (39.28%) became continent (0 to 1 pad a day) and 34 (60.72%) were incontinent. Complications were as follows: urethral erosion in 15 (26.78%); mechanical malfunction in 2 (3.5%); infection in 2 (3.5%); urinary fistula in 1 (1.7%); Urinary tract infection1 (1.7%). Twenty-three patients needed to have the device removed (41.07%). Success rate (continent me) was 30.35%. CONCLUSION In the present series the PUC was not effective for the treatment of severe PPUI in the long-term follow-up.

Total bladder replacement with de-epithelialized ileum: experimental study in dogs

OBJECTIVE To assess the value of the silicone modeler in preventing graft retraction in dogs undergoing bladder replacement with de-epithelialized ileum. MATERIALS AND METHODS Twelve female dogs underwent total cystectomy and bladder replacement by neobladder made of demucosalized ileal segment, comparing the group with modeler (group I) and the group without modeler (group II). Cystometry data, graft epithelization and radiological assessment (cystography and excretory urography) were analyzed. RESULTS Neobladder capacity, at 2 months, ranged from 50 to 250 mL (mean 191 mL) and from 5 to 60 mL (mean 22 mL) and at 6 months, from 60 to 270 mL (mean 202.5 mL) and from 5 to 75 mL (mean- 30.5 mL), respectively in groups I and II, with a statistically significant difference between groups. After 30 days, postoperatively the presence of transitional epithelium was observed in all fragments obtained by biopsy. CONCLUSION The use of the intravesical silicone modeler prevented the retraction of the neobladder of de-epithelialized ileum.

Characterization of the deposition of collagen fibers and Lithogenic potential in bladder of rats submitted to a sugar cane biopolymer graft

OBJECTIVES Suture materials are widely used in urology. The interaction of these materials with the extracellular matrix in the inflammatory process can be estimated by stereology of collagen fibers and the present study was designed to determine the behavior of the bladder tissue of rats to grafts of the biopolymer of sugar cane (BPCA), and the inflammation and intravesical stone formation compared to the polyglactin 910. MATERIALS AND METHODS 42 Wistar rats were divided in four groups: Group I (n = 10) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 4 weeks; Group II (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 4 weeks; Group III (n = 12) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 8 weeks; Group IV (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 8 weeks. Bladders collected at necropsy were analyzed for their weight and the presence of grafts and calculi. Sections were prepared for stereological analysis of collagen fibers. RESULTS The bladder weight was higher in group I, particularly in the presence of bladder stones. The presence of the graft was observed in 100 % (group I), 80 % (group II), 91.6 % (group III) and 30 % (group IV); polyglactin 910 showed an absorption of 70 % in this period. The stereological analysis showed a higher volume density of collagen fibers in group I versus other groups (p < 0.001). CONCLUSION The BPCA was a material with good integration into the bladder of rats; its absorption was slower than that of the polyglactin 910. The presence of urinary stones was lower in bladders with implantation of BPCA, particularly after 8 weeks. There was a greater initial inflammatory response to BPCA graft that was directly related to the increase in bladder weight and the presence of urinary stones, but that equalized the results of polyglactin 910 after 8 weeks.

Eficácia da membrana de celulose bacteriana no tratamento de úlceras venosas de membros inferiores: estudo randomizado e controlado

Objective to evaluate the efficacy of Bacterial Cellulose (BC) membrane dressings in the treatment of lower limb venous ulcers. Methods we carried out a prospective, randomized, controlled study of 25 patients with chronic venous ulcer disease in the lower limbs from the Angiology and Vascular Surgery Service of the Federal University of Pernambuco Hospital and from the Salgado Polyclinic of the County Health Department, Caruaru, Pernambuco. We randomly assigned patients to two groups: control group, receiving dressings with triglyceride oil (11 patients) and experimental group, treated with BC membrane (14 patients). We followed the patients for a period of 120 days. Results There was a reduction in the wound area in both groups. There were no infections or reactions to the product in any of the groups. Patients in the BC group showed decreased pain and earlier discontinuation of analgesic use. Conclusion BC membrane can be used as a dressing for the treatment of varicose ulcers of the lower limbs.