RCAAP Repository

Introduction: In this study, we evaluated the initial results of this procedure in our hospital, aiming to evaluate retrograde intrarenal surgery efficacy and safety and possible success predictors of this technique. Material and Methods: After collecting data from the medical records and imaging studies of all patients undergoing retrograde intrarenal surgery in 2014 e 2015 at Centro Hospitalar de São João, and applying our exclusion criteria, we analyzed the data of 138 patients (total of 179 retrograde intrarenal surgery). The primary outcomes of our study were the immediate success rate, assessed by the surgeon’s perception intraoperatively, and postoperative success rate, assessed by image control. Residual lithiasis was considered significant in the presence of calculi > 3 mm. Results: The overall success rate was 67.0%, considering the surgeon’s perception. Considering the image control, the success rate was 66.7% for calculi smaller than 150 mm2 and located outside the ICG, but smaller in other locations or bigger calculi. In the univariate analysis, stone burden, calculi number and location were statistically significant predictors of retrograde intrarenal surgery success. Conclusion: Location in the ICG was considered a predictor of retrograde intrarenal surgery failure and, in this location, RIRS was more effective for calculi < 150 mm2; this differenced was not encountered for calculi outside the ICG. It is a safe intervention, which allows a staged use.

Human schistosomiasis, the second most devastating parasitic disease, is common in developing countries, but rare in Europe. Urogenital tract involvement is mainly due to Schistosoma haematobium infection. Schistosomiasis has long been associated with malignant neoplasia. Some authors have hypothesized a causal relationship between schistosomiasis and carcinoma of the bowel, kidney, bladder and prostate. To data only 17 cases of concomitant prostatic adenocarcinoma and gland schistosomiasis have been described. As an uncommon example of a potential complication of an untreated schistosomiasis, we report a case of an incidentally diagnosed urinary schistosomiasis after a radical prostatectomy for prostate adenocarcinoma in a 62-year-old African man living in a non-endemic area.

Introduction: Transrectal ultrasound guided prostate biopsy (TRUS-Bx), according to the literature, can lead to urinary tract infections in up to 11% and sepsis in up to 2% of patients. We evaluate whether an original way to apply povidone-iodine rectal preparation just prior to TRUS-Bx can reduce infectious complications. Material and Methods: Between January 2014 and September 2016, 94 men in private office were prospectively randomized to two groups, before TRUS-Bx: • Rectal cleansing (an original transrectal “prostate massage” for about half a minute with 2.5 mL of betadine dermic solution 100 mg/mL) (n=47) or • No cleansing (n=47). All of the patients received prophylactic antibiotics: levofloxacin 500 mg PO for 7 days, beginning the day before procedure. Patients completed a telephone interview 4 days after undergoing the biopsy and went to the office 2 weeks after biopsy. The primary end point was the rate of infectious complications. An infectious complication when one or more of the following events occurred: 1) fever greater than 38.0Cº, 2) urinary tract infection or 3) sepsis (standardized definition). Student t test and multivariate regression analysis were used for data analysis. Results: Infectious complications developed in 6 cases (12.7%) in the non-rectal preparation group: five patients had fever without sepsis (11%) and one had sepsis (2%). In the povidone-iodine rectal preparation group there were no infectious complications (0.0%). Multivariate analysis did not identify any patient subgroups at significantly higher risk of infection after prostate biopsy. Of the 94 men who underwent TRUS-Bx 45 (47.9%) were diagnosed with prostate cancer and 3 (3.2%) had ASAP in the result. The hospital admission rate for urological complications within 30 days of the procedure was 1%, and only for infection related reasons (sepsis). Conclusion: The administration of quinolone-based prophylactic antibiotics and the simple use of 2.5 mL of povidone-iodine dermic solution in a transrectal prostate massage for Introduction: Transrectal ultrasound guided prostate biopsy (TRUS-Bx), according to the literature, can lead to urinary tract infections in up to 11% and sepsis in up to 2% of patients. We evaluate whether an original way to apply povidone-iodine rectal preparation just prior to TRUS-Bx can reduce infectious complications. Material and Methods: Between January 2014 and September 2016, 94 men in private office were prospectively randomized to two groups, before TRUS-Bx: • Rectal cleansing (an original transrectal “prostate massage” for about half a minute with 2.5 mL of betadine dermic solution 100 mg/mL) (n=47) or • No cleansing (n=47). All of the patients received prophylactic antibiotics: levofloxacin 500 mg PO for 7 days, beginning the day before procedure. Patients completed a telephone interview 4 days after undergoing the biopsy and went to the office 2 weeks after biopsy. The primary end point was the rate of infectious complications. An infectious complication when one or more of the following events occurred: 1) fever greater than 38.0Cº, 2) urinary tract infection or 3) sepsis (standardized definition). Student t test and multivariate regression analysis were used for data analysis. Results: Infectious complications developed in 6 cases (12.7%) in the non-rectal preparation group: five patients had fever without sepsis (11%) and one had sepsis (2%). In the povidone-iodine rectal preparation group there were no infectious complications (0.0%). Multivariate analysis did not identify any patient subgroups at significantly higher risk of infection after prostate biopsy. Of the 94 men who underwent TRUS-Bx 45 (47.9%) were diagnosed with prostate cancer and 3 (3.2%) had ASAP in the result. The hospital admission rate for urological complications within 30 days of the procedure was 1%, and only for infection related reasons (sepsis). Conclusion: The administration of quinolone-based prophylactic antibiotics and the simple use of 2.5 mL of povidone-iodine dermic solution in a transrectal prostate massage for

  Introduction: Spermatic cord liposarcomas are rare diseases, with only a few reported studies published. In this study we present 2 clinical cases of spermatic cord liposarcoma. Case Report: Case 1: A 76-years-old man was evaluated for a painless left inguinal mass. Imaging studies demonstrated a solid mass, of 38 x 31 cm, located in the left inguinal region. Case 2: A 55-years-old men, evaluated for a painless left scrotal mass, with imaging studies demonstrating a solid lesion of 28 x 27 mm near the left testicle. Both patients underwent left radical orchiectomy, with wide local excision. Histological examination revealed liposarcoma in both situations and the patients performed adjuvant radiotherapy. The patients remain free of disease during follow-up, of eight years in case 1 and four years in the case 2. Conclusion: The recommended treatment of spermatic cord liposarcomas is radical orchiectomy with wide local excision. Adjuvant radiotherapy can reduce de incidence of local recurrence. Considering the recurrence probability, a long follow- up period is recommended for these patients.

Horseshoe kidney is a common congenital renal anomaly and is often associated with urinary tract infections and renal calculi as a consequence of anatomical changes that impair the efficient drainage of the urine. The treatment of urinary stones in these cases becomes a challenge due to the underlying anatomical abnormalities requiring an adaptation of the techniques normally used for the treatment of renal lithiasis. We report the case of a 44-year-old woman with a past history of Cohen left ureteral reimplantation due to vesico-ureteral reflux in childhood and renal lithiasis. The patient had two 12 and 10 mm stones in the upper calix of the left hemi-kidney, with a narrow infundibulum. A flexible ureteroscopy with laser Holmium lithotripsy was performed by placement of a ureteral sheath over the narrowed infundibulum and the patient was left stone-free at the end of the procedure. It is important, in cases of horseshoe kidney stones, to think and adapt the various techniques available for the treatment of renal lithiasis, and to choose the one that will provide a higher success rate with fewer complications.

Robotic surgery allows complex oncological renal surgery with at least equivalent safety and outcomes profiles when comparing to open and laparoscopic approach. We describe a robotic partial nephrectomy of an endophytic tumor with intraoperative ultrasound support and 10th month follow-up outcome.

Introduction: The posterior urethral valves (PUV) are an important cause of congenital urinary tract obstruction affecting male children. Our aim in this study was to characterize the evolution of a children group with PUV with identification of possible risk factors to chronic kidney disease (CKD). Methods: Retrospective analysis of PUV children diagnosed between January 1999 and January 2017 in a level III hospital. Data collected included: clinical, analytical and imagiological findings, treatment and evolution. Statistical tests were realized using: Excel 2016® e Epi Info 7®, with p < 0.05 considered significant. Results: During the studied period, we identified 23 cases of VUP. The diagnosis was prenatal in 16 and four of seven were diagnosed before age one. The clinical presentation was: acute renal failure (n= 11), isolated urinary tract infections (UTI) (n= 4) and poor urinary stream (n= 3). Median creatinine was 151 μmol/L. All 23 children presented renal and upper urinary tract dilatation, (bilateral in 22), 21 had parenchymal changes and 19 had thickened wall bladder. Cistouretrography confirmed the diagnosis and revealed vesicoureteral reflux (VUR) in 15 cases, bilateral in 10. The main treatment was valve ablation by endoscopic fulguration, performed in all cases, one of them with a previous vesicostomy. The mean follow-up was 7.5 years. During that time, 14 presented recurrent UTI’s, seven remained with VUR and 11 with bladder dysfunction. Some needed other surgical procedures, like VUR correction (n= 3) and unilateral nephrectomy (n= 2). Five cases (21.5%) presented CKD stage ≥ 3, with four cases needing dialysis around 9.3 years of mean age. The recurrent UTI’s and bilateral VUR were associated with evolution to that stage (p 0.03 and p 0.049 respectively). Conclusion: PUV remains a frequent aetiology of CKD, despite timely and accurate diagnosis and treatment.

A sangria, realizada através do uso de sanguessugas ou a flebotomia, foi uma prática médica comum desde a antiguidade até ao final do século XIX, por um período superior a 2000 anos. Só no início do século XX, cerca de um século depois de ter sido demonstrado o seu efeito nefasto, o seu uso se tornou residual. Mesmo assim, vários livros de medicina ainda a referiam como tratamento eficaz para diversas patologias.1 Compreende-se que os conhecimentos médicos na época eram diferentes, mas como é possível que algumas das melhores mentes da época se deixaram enganar durante tanto tempo? Como se perpetuou a utilização de um tratamento que na maioria dos casos era prejudicial? Como demorou tanto tempo depois de avaliado o seu efeito até deixar de ser utilizada e recomendada? Será que actualmente não se fazem tratamentos que estão de acordo com a concepção fisiopatológica actual mas que se virão a demonstrar no futuro ineficazes ou até nefastos? Muito do que é feito na medicina actual, nomeadamente tratamentos cirúrgicos, é baseado num nível baixo de evidência e em estudos metodologicamente incorrectos.2,3 Não admira que quando se testa a prática comum, cerca de 40% do que é feito não tem benefício ou é prejudicial.4 São estas “sangrias” modernas que têm que ser detectadas e abandonadas. Para as detectar tem de se avaliar de forma sistemática os procedimentos através de estudos de iniciativa do investigador, respondendo a questões clínicas da prática médica diária, utilizando metodologias correctas e outcomes relevantes para os doentes. Para as abandonar, a investigação deve ser avaliada e os conhecimentos gerados devem ser rapidamente difundidos. Para atingir este objectivo são fundamentais as revistas com revisão por pares. Nestas a investigação é apreciada de forma crítica pelos revisores de forma a selecionar e aperfeiçoar a apresentação das investigações, antes da sua publicação e divulgação. A Acta Urológica Portuguesa é uma dessa revistas, comprometida a publicar artigos de qualidade científica, nas diversas áreas da Urologia. Uma crítica apontada por colegas que submetem artigos de investigação à Acta Urológica é que o processo de revisão é muito demorado. A crítica é justa pois o processo, desde a submissão até a uma decisão final sobre o manuscrito, demora mais do que seria desejável. Todos os passos podem optimizados, mas o passo mais frequentemente responsável pela demora é a revisão do artigo pelos revisores. Os revisores fazem um trabalho essencial para o funcionamento da revista, de forma totalmente pro bono. A Acta Urológica Portuguesa tem uma equipa de revisores de qualidade, mas que por motivos diversos, incluindo aumento do número de artigos submetidos, não tem conseguido responder a todas as solicitações com a celeridade desejável. Nesse intuito faz-se um repto público para que quem estiver motivado para colaborar com a Acta Urológica, como revisor, envie um email (apurologia@mail.telepac.pt) manifestando esse desejo, juntamente com Curriculum Vitae, contactos e áreas de interesse. Assim, a Acta Urológica Portuguesa será mais eficiente no cumprimento dos seus objectivos e contribuirá na progressiva erradicação das “sangrias” modernas.

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Modified inguinal lymphadenectomy allows for correct staging in most cases of penile cancer without palpable inguinal lymph nodes. Currently, it is possible to reproduce the classic surgical technique by video assisted surgery, with similar oncological results and smaller rate of complications. In this article, we report the case of a patient with penile cancer subjected to a total penectomy (pT3NxMx), where bilateral video assisted modified inguinal lymphadenectomy (VMIL) was conducted, being described surgical technique of right VMIL. In this article surgical steps are described (patient positioning, blunt dissection of deep Scarpa fascia, identification of anatomical boundaries, identification of femoral vessels, identification and isolation of saphenous vein until the fossa ovalis, excision of lymph nodes and closure). The great advantage of VMIL is the reduction of post-operatory complications, particularly the low rate of wound dehiscence and lower limb edema, allowing for a much quicker recovery when compared with the classical approach.

Le présent article, dont le titre est: «De l'avoir et de l'aliénation», se propose d'attirer l'attention sur quelques uns des principaux traits qui peuvent caractériser les rapports entre ces deux notions. Après un bref examen de la possibilité d'un usage idéologique de la distinction établie entre «être» et «avoir», l'auteur considère cette dichotomie dans le cadre du problème éthique et ontologique de l'orientation de l'homme dans le monde. «Etre» et «avoir» correspondent à deux catégories bien différentes d'envisager le fondement à partir duquel se détermine la conduite humaine. Celui qui se définit par l'«avoir» se détermine à partir d'un autre qui, à vrai dire, est lui aussi quelque chose d'étranger. Le pouvoir fondé sur cet «avoir» se présente, en quelque sorte, comme une illusion, dans la mesure où, en effet, celui qui le détient exerce sa «domination» au prix d'une dépendance réelle vis-à-vis de ce qu'il possède. Le «possesseur», dès qu'un regard immédiat est surmonté, apparaît, en réalité, comme «possédé». L'aliénation s'étend, par conséquent, aux deux membres de la relation définie par l'«avoir». Une allusion sommaire est égalemente faite à cette conception de la réversibilité de la relation d'aliénation que l'on peut retrouver déjà chez HEGEL, notamment dans ses références à la dialectique du «seigneur» et de l'«esclave», et chez le jeune MARX. L'«avoir» en tant que catégorie ayant une signification dans le domaine éthico-ontologique se présente donc comme une modalité fondamentale de l'aliénation. Celui qui se définit par 1'«avoir» n'est que par reflet et dépendance: il ne possède pas vraiment un être propre.

Decorreu em Oxford de 3 a 7 de Setembro de 1973 o «V Congresso Internacional de Estudos Bíblicos». O primeiro realizou-se há 16 anos. É de notar a periodicidade regular de 4 anos, que também está prevista para outros que se seguirão.

A 21 e 22 de Dezembro de 1972, realizou-se em Alcobendas, perto de Madrid, o II Encontro de Directores de Faculdades de Teologia de Portugal e Espanha e dos Centros de Estudos Teológicos nelas filiados para estudo de dois temas previamente escolhidos: Departamentos e Exames.

La plus grande partie de l'histoire de l'humanité échappe à l'investigation de l'historien mais durant des milliers de siècles les groupes humains ont laissé des vestiges de leurs activités soit enfouis, soit dispersés à la surface du sol. Vestiges relativement abondants lorsque le chercheur se penche sur des cultures proches de la période historique mais qui se raréfient progressivement à mesure que l'on s'en éloigne.

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En attirant l'attention du lecteur de 1974 sur cet ouvrage de 1790 aujourd'hui introuvable, ou presque, nous sommes parfaitement conscients d'un anachronisme paradoxal. N'entendons-nous pas dire souvent que la dévotion au Coeur de Jésus aurait perdu de son attrait? Il nous a semblé, au contraire, en lisant et méditant ces admirables Entretenimentos, y découvrir une saveur existentielle et mystique en parfaite harmonie avec les aspirations de nos contemporains.

O ritual de baptismo do manuscrito Chigi C V 134, da Biblioteca Vaticana, é incontestavelmente um dos mais originais que nos legou a Idade Média, não só pela disposição dos ritos, mas sobretudo pela originalidade dos textos que insere, muitos dos quais inéditos. Só é pena que a sua história não seja conhecida, nomeadamente o país de origem, pois seria de todo o interesse saber em que meio espiritual e geográfico foi elaborado.

Os graffiti da triclia da Basílica dos Apóstolos in catacumbas — hoje catacumbas de S. Sebastião — são o testemunho inequívoco de que, já na segunda metade do séc. III, peregrinos iam a Roma venerar o túmulo dos Apóstolos Pedro e Paulo e invocar a sua protecção. Eis algumas dessas invocações.

I. Introducción a los TextosII. Los TextosIII. Contenido doctrinalÍndice alfabético de los Textos

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