PURPOSE:To evaluate the viability of random pattern dorsal skin flaps in rats after injection of adipose-derived stem cells (ADSC). METHODS:Thirty five adult male Wistar EPM rats (weight 250-300 g) were distributed, at random, in two groups. I-Control (flap elevation with injection of saline solution) with fifteen animals and II-Experimental (flap elevation with injection of ADSC ) with fifteen animal. The ADSC were isolated from others five adult male rats. A dorsal skin flap measuring 10x4 cm was raised and a plastic barrier was placed between the flap and its bed in both groups and the injection (cells or saline solution) were perfomed immediately after the surgery. The percentage of flap necrosis was measured on the seventh postoperative day. RESULTS:The ADSC were able to replicate in our culture conditions. We also induced their adipogenic, osteogenic and chondrogenic differentiation to verify their mesenchymal stem cells potentiality in vitro. The results were statistically significant showing that the ADSC decreased the area of necrosis (p<0.05). CONCLUSIONS:The cells demonstrated adipogenic, osteogenic and chondrogenic differentiation potential in vitro. The administration of adipose-derived stem cells was effective to increase the viability of the random random pattern dorsal skin flaps in rats.

Purpose: To evaluate the effects of the adipose-derived stem cells (ADSC) in the viability of random skin flap in rats.Methods: Thirty five adult male Wistar rats (weight 250-300 g) were used. ADSC were isolated from adult male rats (n=5). ADSC were separated, cultured and then analyzed. A dorsal skin flap measuring 10x4 cm was raised and a plastic barrier was placed between the flap and its bed. After the surgical procedure, the animals were randomized into two groups (n=15 each group), group control and group ADSC. In all groups the procedures were performed immediately after the surgery. The percentage of flap necrosis was measured on the seventh postoperative day. Results:The ADSC were able to replicate in our culture conditions. We also induced their adipogenic, osteogenic and chondrogenic differentiation, verifying their mesenchymal stem cells potentiality in vitro. The results were statistically significant showing that the ADSC decreased the area of necrosis (p<0.05). Conclusion:The cells demonstrated adipogenic, osteogenic and chondrogenic differentiation potential in vitro. The administration of adipose-derived stem cells was effective to increase the viability of the random skin flaps in rats.

Introduction and Objective Recurrent urinary tract infections (R‐UTIs) have a negative impact on quality of life and contribute to antimicrobial resistance. Long‐term antibiotic therapy is the main treatment alternative but, in some cases, this approach may not be accepted by the patient, is ineffective or poorly tolerated. In selected women, electrofulguration (EF) of trigonal lesions has been shown to reduce urinary tract infection (UTI) episodes. Methods Between August 2006 and December 2017, 73 women with R‐UTI had their data collected prospectively and analyzed. We evaluated the rate of UTIs during the initial 2 years of follow‐up after fulguration based on symptoms and a positive urine culture. All patients failed with multiple antibiotic courses and were offered endoscopic electrofulguration of the entire trigonal and bladder neck mucosa with a rollerball probe. We present our long‐term results using a strategy of complete fulguration of the trigone in women with R‐UTIs. Results The median age was 64 years (range: 17–76 years) and the median follow‐up time after EF was 4.2 years (range: 2.5–14 years). Overall, 70 patients (96%) remained free of UTI episodes during the first year of follow‐up, at 2 years of follow‐up, 57, 53% remained infection‐free. Currently, UTIs are typically sparse, mild, and caused by multisensitive bacteria. Conclusions Complete trigonal and bladder neck mucosal fulguration promoted a significant reduction of UTI episodes during the first 2 years of follow‐up. Prospective controlled studies are needed to determine the role of EF in women with R‐UTI.

Objective Chronic trigonitis (CT) is usually diagnosed through cystoscopy which is invasive and expensive. Thus, an accurate non‐invasive diagnostic method is necessary. The objective of this study is to determine the efficacy of transvaginal bladder ultrasound (TBU) for CT diagnosis. Methods Between 2012 and 2021, 114 women (17–76 years old) with recurrent urinary tract infection (RUTI) and history of antibiotic resistance were evaluated with TBU by a single ultrasonographer. As a control group, TBU was performed in 25 age‐matched women with no previous history of UTI, urological or gynecological conditions. All patients with RUTI had undergone a cystoscopy with biopsy for diagnostic confirmation at the time of trigone cauterization. Results Thickening of trigone mucosa (>3 mm) was detected in all patients with RUTI and represented the most relevant criteria for trigonitis diagnosis on TBU. Other TBU findings in CT are: irregular and interrupted mucosa lining (96.4%), free debris in the urine (85.9%), increased blood flow at doppler (81.5%), mucosa shedding and tissue flaps. Biopsy showed CT with erosive pattern (58%) or non‐keratinizing metaplasia (42%). Diagnostic agreement index between TBU and cystoscopy was 100%. In the control group, normal trigone mucosa is ultrasonographically regular, continuous, with thickness ≤3 mm and there is no debris in the urine. Conclusions TBU proved to be an efficient, inexpensive and minimally invasive method to diagnose CT. To our knowledge, this is the first article that reports the use of transvaginal ultrasound as an alternative method for diagnosing trigonitis.

No campo da saúde, a empatia é definida como um atributo com dimensões emocionais e cognitivas que possibilita uma compreensão das experiências interiores e da perspectiva do paciente como um indivíduo singular, somada à capacidade de comunicar esse entendimento ao paciente. A função da empatia médica seria identificar e compreender os sentimentos do doente, promovendo aumento na confiança, na lealdade e no respeito entre médico e paciente. Este estudo teve como meta avaliar a empatia de residentes entre o terceiro e o quinto ano da Universidade Federal de São Paulo, buscando verificar as possíveis diferenças entre a empatia dos clínicos e cirurgiões e sua relação com o perfil profissional.

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Introduction: Surgical training models prepare the resident for a more ethical surgical practice as well as providing a less steep learning curve. In urology, there are well-known models of pyeloplasty simulation, urethro-vesical anastomosis and nephrectomy, which have helped in the training of urology residents ( 1 – 3 ). Learning laparoscopic prostatectomy is a difficult surgery and requires advanced surgical skill from the surgeon ( 4 ), requires operate without a direct view of the surgical field in a two-dimensional space and with longer instruments ( 5 ). Laparoscopic prostatectomy step by step makes the surgeon's learning curve less difficult, lead to less intraoperative complications, such as blood loss, while also enabling shorter operative time and less positive surgical margins ( 6 ). The objective of surgical models is to simulate surgical procedures in a reliable way thus preparing the surgeon for his daily practice, surgical simulations in animal models have been described to compensate for inadequate clinical exposure ( 7 ). The canine model of prostate cancer has many similarities with humans. Despite trying to develop a model that is as credible as possible, there are ethical issues in several countries, such as Brazil, that do not allow the use of live dogs for scientific experimentation and there is a difficulty in not standardizing the animals used ( 8 , 9 ). The swine surgical training model is widely known, accepted and used as a valuable tool in the teaching of new surgeons ( 10 ). The porcine video laparoscopic prostatectomy model allows the urologist in training to exercise the skills required in a real surgical situation, practicing them in a single session ( 10 ). We will present an experimental model in pigs for training urology residents in laparoscopic radical prostatectomy with current techniques ( 11 – 13 ). The limitations found are that the prostate has no limits as well defined as in humans, the urethra is long and coiled, the fat surrounding the pelvic organs is scarce and there is no postoperative follow-up for evaluating functionality after the procedure, as well as the effectiveness of the surgery with surgical margins. However, it is similar in surgical model presented, it is reproducible and can provide a realistic simulation environment to the beginner surgeon. Material and Methods: In this paper, according to the institutional protocol approved by the institutional ethics and research committee FMUSP n° 964/2017 and protocol was in accordance with current international regulations for the use of animals in Re...

A laparoscopia consiste em acesso cirúrgico realizado por meio de diminutas incisões na parede abdominal seguidas de estabelecimento de pneumoperitônio, representando um avanço na recuperação pós-operatória em relação a cirurgia aberta. Modelos de treinamento em cirurgia videolaparoscópica utilizando de modelos inanimados, animados e envolvendo uso de realidade virtual (RV) foram desenvolvidos para facilitar a curva de aprendizado. Esses modelos procuram permitir aos cirurgiões em treinamento adquirir competências básicas em laparoscopia, tais como a coordenação mão-olho, destreza na utilização das pinças e melhora da percepção de profundidade na imagem bidimensional (2D). Os elevados custos dos modelos de treinamento têm levado instituições e cirurgiões a procurarem modelos menos onerosos, tais como caixa de treinamento e simuladores de RV. No entanto, não oferecem a mesma experiência de aprendizado que o treinamento VLP em porcos ou em cadáveres. Os custos para realização do pneumoperitônio e para utilização de equipamentos do set de vídeo são elevados. Buscando reduzir esses custos e a complexidade do treinamento VLP em cadáveres, desenvolveu-se um modelo de polietileno sem a necessidade de estabelecimento de pneumoperitônio.