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Urology has rapidly evolved during the last decades, incorporating new technologies faster than most specialties. The challenge to maintain a competent workforce that is prepared to deliver proper contemporary treatment has become increasingly difficult and newly graduated urologists throughout the world typically lack the skills to practice many urological subspecialties. We performed a survey to evaluate the practice patterns and educational aspirations in functional urology (FU) among Brazilian urologists.A web-based survey was sent to board-certified Brazilian urologists to collect data on clinical practice and training aspirations in four subareas of FU: female urology, urodynamics, postprostatectomy incontinence (PPI), and neurourology. We evaluated urologists' clinical and surgical workload in each subarea and investigated educational training aspirations to identify areas and training formats of interest.A total of 366 urologists (mean age 47.7 + 10.7 years) completed the survey. Mean time since completion of residency was 17.9 + 11.9 years. Of the respondents, 176 (53%) perform urodynamics, 285 (83.1%) SUI surgeries, 159 (47.6%) PPI surgeries, 194 (58.1%) third line OAB procedures, 168 (48.9%) pelvic organ prolapse (POP), and 88 (26.3%) bladder augmentation. Mid-urethral sling is the most performed SUI surgery and transobturator is the preferred route (64.0%). For those performing POP surgery, 40.5% use mesh in at least 50% of their cases, and the vaginal route is used in most cases (75.4%) for apical prolapse. For PPI, 64.6% use artificial sphincter in most surgeries and only 8.1% perform at least 5 surgeries/year. Being fellowship-trained and working in an academic hospital are associated with a higher chance of being active in FU. Most urologists are interested in receiving training in PPI, female SUI, and POP and a hands-on course is the preferred educational method (81%).Most urologists in Brazil are involved in the evaluation and treatment of FU patients, but few have a large volume of patient visits and surgical procedures. Completing a fellowship program and working in an academic practice are associated with a higher chance of being a FU practitioner. There is a high interest in training for PPI, female SUI, and POP.

Aims To report on the impact of lower urinary tract symptoms (LUTS) on treatment‐related behaviors and quality of life in Brazilian adults greater than or equal to 40 years. Methods Data were from a computer‐assisted telephone survey conducted in Brazil between 1 September and 31 December 2015 (Brazil LUTS study). Participants were adults greater than or equal to 40 years with landlines living in major cities from five geographical regions in Brazil. Participants rated how often they experienced individual LUTS during the previous month and associated bother, and the impact on quality of life (QoL), treatment seeking, treatment, treatment satisfaction, and treatment discontinuation. Multiple logistic regression models were adjusted to analyze the simultaneous effects of predictor variables on each dependent variable. Results When the presence of LUTS was defined as symptoms occurring less than half the time or more, one‐quarter of respondents sought treatment but 6% fewer actually received treatment. Of these, around 25% reported dissatisfaction with treatment and almost 10% reported treatment discontinuation. The occurrence of some symptoms and, in particular, the resultant bother were significantly related to worse QoL and to treatment‐related outcomes, such as treatment seeking, actual treatment, treatment dissatisfaction, and treatment discontinuation. Symptoms of all three categories were associated with all these domains for both sexes. Conclusions This is the first population‐based study carried out in South America showing that treatment seeking and treatment rates for LUTS are low. Since the LUTS prevalence is high, this reinforces the importance of a comprehensive medical assessment, focusing on the resulting bother, for more appropriate and personalized patient management.

AIMS: To describe the uropathogens and antimicrobial resistance patterns in women with singular, sporadic urinary tract infection (UTI) versus those with recurrent UTI (rUTI) in a urogynecologic population. METHODS: This was a cross-sectional analysis of women treated for a UTI by a urogynecologic provider in a one-year time frame. Subjects were divided into two groups: 1) sporadic UTI - no history of rUTI and a single infection in the study timeframe and 2) rUTI - history of rUTI and ≥2 UTIs in the study time frame. Our primary outcome was the difference in uropathogens between groups. Secondary aims were to investigate host characteristics associated with recurrent E.coli infections and resistant uropathogens in the rUTI cohort. RESULTS: We had 265 women with 163 (61.5%) in the sporadic UTI group and 102 (38.5%) in the rUTI group. The most common uropathogens were E. coli (57.3%) and Klebsiella (11.7%). In the rUTI group, only 27/102 (26.5%) had all E. coli infections. There were differences between groups regarding age (p=0.03) and proportion of neurogenic bladder (p=0.01), intermittent self-catheterization (p

Aims We performed the first large population-based study to evaluate lower urinary tract symptoms (LUTS) in Brazil. The study objective was to assess the prevalence and bother of LUTS in the population aged ≥40 years in five major cities of Brazil. Methods This study was conducted as a telephone survey with assessment of LUTS using a standardized protocol, which included the International Prostate Symptom Score (IPSS) and, for overactive bladder (OAB), the OAB-V8 questionnaire. Participants were asked to rate how often they experienced individual LUTS and the degree of associated bother. Results Of the 5184 participants, 53% were women, and the age group with most participants (34%) was 50-59 years. The prevalence of LUTS (symptoms occurring less than half the time or more) was 75%: 69% in men and 82% in women. There was a statistically significant association between the frequency and bother intensity of each symptom (P

Aims Investigate the effect of a novel cell-based therapy with skeletal muscle-derived mononuclear cells (SMDMCs) in a rat model of stress urinary incontinence. Methods Male Wistar-Kyoto rats' hind limb muscles were enzymatically dissociated, and SMDMCs were isolated without needing expansion. The cell population was characterized. Twenty female rats underwent urethrolysis. One week later, 10 rats received periurethral injection of 106 cells (SMDMC group), and 10 rats received saline injections (Saline group). Ten rats underwent sham surgery (Sham group). Four weeks after injection, animals were euthanized and the urethra was removed. The incorporation of SMDMCs in the female urethra was evaluated with fluorescence in situ hybridization for the detection of Y-chromosomes. Hematoxylin and eosin, Masson's trichrome staining, and immunohistochemistry for actin and myosin were performed. The muscle/connective tissue, actin and myosin ratios were calculated. Morphological evaluation of the urethral diameters and fractional areas of the lumen, mucosa, and muscular layer was performed. Results SMDMCs population was consistent with the presence of muscle cells, muscle satellite cells, perivascular cells, muscle progenitor cells, and endothelial cells. SMDMCs were incorporated into the urethra. A significant decrease in the muscle/connective tissue ratio was observed in the Saline group compared with the SMDMC and Sham groups. The proportions of actin and myosin were significantly decreased in the Saline group. No differences were observed in the morphometric parameters. Conclusions SDMSC were incorporated into the rat urethra and promoted histological recovery of the damaged urethral sphincter, resulting in decreased connective tissue deposition and increased muscle content.

Urinary incontinence is a prevalent condition worldwide and causes a tremendous impact on a woman's quality of life. While conservative and non-surgical therapies are options for treatment, surgery for stress urinary incontinence (SUI) is common. Options include colposuspension, slings (pubovaginal and midurethral), and periurethral bulking. While evidence supports each of these options in the treatment of SUI, each is associated with various rates of success and unique adverse event profiles. Urgency urinary incontinence (UUI) is initially treated with behavioral modification and pharmacologic means, with surgery reserved for those with refractory symptoms or significant complications from medication use. At present, intravesical onabotulinumtoxinA injections, percutaneous tibial nerve stimulation, and sacral neurostimulation are all viable options for refractory UUI/overactive bladder. As with surgical interventions for SUI, each of these is, likewise, associated with unique outcomes and adverse event profiles. Herein, we summarize the findings and conclusions from the 6th International Consultation on Incontinence (ICI) regarding surgical treatment of urinary incontinence in women.

AIMS To compare the impact of the different routes for clean intermittent catheterization on the quality of life of children with lower urinary tract dysfunction. METHODS In this cross-sectional study, all children and adolescents under treatment in our clinic from August 2011 to May 2012 who were on CIC for bladder dysfunction were included. To evaluate the technical difficulty and the discomfort associated with the procedure we used a standard visual analog scale. Quality of life was measured using the Pediatric Quality of Life Inventory Version 4.0. RESULTS A total of 70 children including 38 (54.3%) boys and 32 (45.7%) girls with a mean age of 11.8 ± 3.6 years (range 5 to 18 years) were evaluated. The mean daily number of catheterizations was 4.2 ± 1.1. CIC was performed through the urethra in 51 (72.9%) subjects and a stoma in 19 (27.1%). A 45 (64.3%) were assisted by a caregiver to perform a catheterization. No differences in both difficulty and discomfort for performing CIC were observed between groups. Children who performed CIC through a stoma had a better quality of life scores for the physical (P = 0.015) and social functioning domains (P = 0.011). CONCLUSION The quality of life of children and adolescents performing CIC appears to be affected by the route of catheterization, with a worse performance for those using urethral catheterization.

Aims We assessed the lower urinary tract symptoms (LUTS) and urodynamic findings in patients with neuromyelitis optica spectrum disorders (NMO-SD), a recently defined neurological disease. Methods We prospectively evaluated seven men and 23 women (mean age 41.1 ± 13.5 years) with an established diagnosis of NMO-SD who were invited to participate irrespective of the presence of LUTS. Neurological evaluation was assessed with the Expanded Disability Status Scale (EDSS) and LUTS were evaluated with the Overactive Bladder questionnaire (OAB-V8) and the International Prostate Symptom Score (I-PSS). All patients underwent videourodynamics, transabdominal urinary tract sonography, urine culture, and serum creatinine levels. Results The mean time of disease duration was 33.8 ± 30.8 months. Neurological evaluation showed a mean EDSS score of 5.3 ± 1.8. The most frequent videourodynamic findings were detrusor-sphincter dyssynergia (DSD) and detrusor overactivity (DO) in 11 (36.6%) patients, DSD without DO in seven (23.3%) and DO without DSD in six (20.0%) patients. Voiding dysfunction assessed by I-PSS and OAB-V8 increased with the degree of neurological impairment (P = 0.018; r = 0.42 and P = 0.006; r = 0.48 respectively). Patients with DSD had higher I-PSS (18.5 ± 11.4 vs 7.0 ± 9.2; P = 0.029) and OAB-V8 scores (22.8 ± 15.8vs 9.1 ± 7.8; P = 0.008), and worse neurological impairment (mean EDSS 5.9 ± 1.8 vs 4.5 ± 1.5; P = 0.027). Conclusions Most patients with NMO-SD have LUTS and voiding dysfunction, with DSD and DO as the main urodynamic findings. The severity of the neurological disease is a predictive factor for the occurrence of voiding dysfunction and detrusor-sphincter dyssynergia. Neurourol. Urodynam. 35:39–43, 2016. © 2014 Wiley Periodicals, Inc.

Aims We evaluated the effect of botulinum toxin type A (BTX-A) injections in the trigone on the antireflux mechanism and evaluated its short-term efficacy. Materials and Methods Between April and December 2006, 21 patients (10 men and 11 women) were prospectively evaluated. All were incontinent due to refractory NDO and underwent detrusor injection of 300 units of BTX-A, including 50 units into the trigone. Baseline and postoperative evaluation after eight weeks included cystogram, urinary tract ultrasound and urodynamics. Results At baseline, 20 patients had no vesicoureteral (VUR) and one had grade II unilateral VUR. Postoperative evaluation revealed no cases of de novo VUR and the patient with preinjection VUR had complete resolution of the reflux. Ultrasound showed 5 (23.8%) patients with hydronephrosis before BTX-A injection and only one (4.8%) at the followup evaluation (p=0.066). After treatment, 9 (42.8%) patients became dry, 11 (52.4%) were improved and one (4.8%) had no improvement. Improved patients received antimuscarinic treatment and 8 (38.1%) became dry, with a final total continence rate of 80.1%. Cystometric capacity increased from 271±92 to 390±189 ml (p=0.002), reflex volume varied from 241±96 to 323±201 ml (p=0.020) and maximum detrusor pressure reduced from 66±39 to 38±37 cm H2O (p

Aim To evaluate serum PSA levels of patients with spinal cord injury (SCI) submitted or not to CIC in comparison to those of the general population. Methods We retrospectively studied 140 men with SCI admitted in our department from January 2005 to May 2009. Thirty-four SCI patients had PSA levels available, comprising 21 under CIC and 13 without CIC. Patients under CIC performed it 4–6 times a day and mean time of catheterization was 72.4 months (range 30–192). The most common etiology of SCI was fall from height (33%), followed by car/motorcycle crashes (15%). Control group was composed by 670 healthy men that were referred to our service to evaluation of Kidney donation or cancer prostate screening. We used Student's t-test and variance analysis (ANOVA) for age and PSA comparison between the groups. Results Overall, patients with SCI and controls had similar mean age (54 vs. 57 years old, P = 0.11) and mean PSA level (1.81 vs. 1.95 ng/ml, P = 0.66). SCI patients were divided into with and without CIC. Patients without CIC had similar mean age (60 vs. 57 years old, P = 0.11) and similar PSA values when compared to controls (1.72 vs. 1.95 ng/ml, P = 0.89). Patients under CIC were compared to controls with similar age (50 vs. 47 years, P = 0.0332) and their PSA levels were greater (1.86 vs. 0.79 ng/ml, P = 0.026). Conclusion Clean intermittent catheterization increased PSA levels approximately doubling its value. Neurourol. Urodynam. 30: 1522–1524, 2011. © 2011 Wiley Periodicals, Inc.

We assessed the lower urinary tract symptoms (LUTS) and urodynamic findings in patients with neuromyelitis optica spectrum disorders (NMO-SD), a recently defined neurological disease.We prospectively evaluated seven men and 23 women (mean age 41.1 ± 13.5 years) with an established diagnosis of NMO-SD who were invited to participate irrespective of the presence of LUTS. Neurological evaluation was assessed with the Expanded Disability Status Scale (EDSS) and LUTS were evaluated with the Overactive Bladder questionnaire (OAB-V8) and the International Prostate Symptom Score (I-PSS). All patients underwent videourodynamics, transabdominal urinary tract sonography, urine culture, and serum creatinine levels.The mean time of disease duration was 33.8 ± 30.8 months. Neurological evaluation showed a mean EDSS score of 5.3 ± 1.8. The most frequent videourodynamic findings were detrusor-sphincter dyssynergia (DSD) and detrusor overactivity (DO) in 11 (36.6%) patients, DSD without DO in seven (23.3%) and DO without DSD in six (20.0%) patients. Voiding dysfunction assessed by I-PSS and OAB-V8 increased with the degree of neurological impairment (P = 0.018; r = 0.42 and P = 0.006; r = 0.48 respectively). Patients with DSD had higher I-PSS (18.5 ± 11.4 vs 7.0 ± 9.2; P = 0.029) and OAB-V8 scores (22.8 ± 15.8vs 9.1 ± 7.8; P = 0.008), and worse neurological impairment (mean EDSS 5.9 ± 1.8 vs 4.5 ± 1.5; P = 0.027).Most patients with NMO-SD have LUTS and voiding dysfunction, with DSD and DO as the main urodynamic findings. The severity of the neurological disease is a predictive factor for the occurrence of voiding dysfunction and detrusor-sphincter dyssynergia.

To evaluate serum PSA levels of patients with spinal cord injury (SCI) submitted or not to CIC in comparison to those of the general population.We retrospectively studied 140 men with SCI admitted in our department from January 2005 to May 2009. Thirty-four SCI patients had PSA levels available, comprising 21 under CIC and 13 without CIC. Patients under CIC performed it 4-6 times a day and mean time of catheterization was 72.4 months (range 30-192). The most common etiology of SCI was fall from height (33%), followed by car/motorcycle crashes (15%). Control group was composed by 670 healthy men that were referred to our service to evaluation of Kidney donation or cancer prostate screening. We used Student's t-test and variance analysis (ANOVA) for age and PSA comparison between the groups.Overall, patients with SCI and controls had similar mean age (54 vs. 57 years old, P = 0.11) and mean PSA level (1.81 vs. 1.95 ng/ml, P = 0.66). SCI patients were divided into with and without CIC. Patients without CIC had similar mean age (60 vs. 57 years old, P = 0.11) and similar PSA values when compared to controls (1.72 vs. 1.95 ng/ml, P = 0.89). Patients under CIC were compared to controls with similar age (50 vs. 47 years, P = 0.0332) and their PSA levels were greater (1.86 vs. 0.79 ng/ml, P = 0.026).Clean intermittent catheterization increased PSA levels approximately doubling its value.

Aims We assessed the lower urinary tract symptoms (LUTS) of patients with Parkinson's disease (PD) and their association with different clinical parameters. Methods We prospectively evaluated 110 patients (84 men), with a mean age of 61.8 ± 9.6 years. Mean duration of the disease was 12.3 ± 7.2 years. Neurological impairment was assessed by the Hoehn–Yahr and the Unified Parkinson Disease Rating scales. LUTS were assessed by the International Continence Society questionnaire. We evaluated the impact of age, PD duration, neurological impairment, gender, and use of anti-Parkinsonian drugs on the voiding function. Results On multivariate analysis, voiding dysfunction increased with the neurological impairment, but not with patient's age or disease duration. Quality of life (QOL) was affected by the severity of LUTS, and the symptoms with the worst impact were frequency and nocturia. Sixty-three (57.2%) patients were symptomatic. They did not differ with the asymptomatic as to age and disease duration, but had more severe neurological impairment. No impact on LUTS was associated with the use of levodopa, anticholinergics, and dopamine receptor agonists. Men and women were similarly affected by urinary symptoms. Conclusions The severity of the neurological disease is the only predictive factor for the occurrence of voiding dysfunction, which affects men and women alike. Neurourol. Urodyn. 28:510–515, 2009. © 2009 Wiley-Liss, Inc.