MARCOS FIGUEIREDO MELLO
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- Ureteral clipping for the treatment of a non-functioning upper kidney moiety associated with a massive ureterocele: step-by-step description of a novel technique(2019) LOPES, R. I.; MELLO, M. F.; KOYLE, M. A.; LORENZO, A. J.Objective The objective of this video is to illustrate feasibility of the ureteral ligation for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys. Materials and methods In this video, one case is presented to demonstrate this novel technique. A nine-year-old boy presented with progressive lower urinary tract symptoms. Radiological workup depicted a duplex kidney on the left side with the absence of function on the upper pole and hydroureteronephrosis with a massive ureterocele. Laparoscopic ureteral transection, drainage, and ligation of both extremities of the enlarged ureter (upper pole ureter) were performed. Results Immediately after ureteral ligation, ultrasonic evidence of ureterocele decompression and improved hydroureteronephrosis was observed. This patient remained asymptomatic without postoperative complications after 3 years. De novo reflux was not observed. Conclusion Ureteral ligation, as demonstrated in the video, is a good approach for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys. Compared with the current standard techniques (incision/puncture), ureteral ligation has the clear advantage of not causing 'de novo reflux' or unsuccessful deobstruction, and is not as surgically demanding as other reconstructive/ablative techniques. The disadvantage is the need of regular clinical and ultrasonographic follow-up.
- EMG biofeedback or parasacral transcutaneous electrical nerve stimulation in children with lower urinary tract dysfunction: A prospective and randomized trial(2019) REIS, Joceara Neves dos; MELLO, Marcos Figueiredo; CABRAL, Beatriz Helena; MELLO, Luiz Figueiredo; SAIOVICI, Samuel; ROCHA, Flavio Eduardo TrigoAims Evaluate the efficacy of biofeedback and parassacral electric nerve stimulation (TENS) for the treatment of children with lower urinary tract (LUT) dysfunction. Methods A prospective, randomized study was approved by our Hospital Ethics Committee. We enrolled 64 children, 43 girls and 21 boys, average age of 9.39 years. The initial evaluation consisted of history, physical examination, urine analyses, voiding diary, uroflow, and ultrasound. Dysfunction voiding symptom score (DVSS) questionnaires were applied pre- and post-treatment. The children were divided into two treatment groups independent of the predominant type of voiding dysfunction (dysfunctional or overactive bladder): biofeedback group and TENS group. The criteria for assessing the effectiveness of the techniques was the resolution of daytime and nighttime symptoms including urinary leakage, improvements in voiding diary, DVSS, and changes in uroflow. After 6 months, the children were reassessed with the same work-up of baseline. Results Regarding daytime symptoms, results for complete response were similar between the two groups (P = 0.483); 54.9% of children treated by the biofeedback group and 60.6% in the TENS group. The same have been observed in the nighttime incontinence with complete resolutions in 29.6% and 25%, respectively (P = 0.461). Analyzing the voiding diary, uroflow and DVSS questionnaires both groups had significant improvement (P = 0.001) after treatment. The biofeedback group required fewer sessions than TENS group, 10.9 and 18.1, respectively (P < 0,001). Conclusions Both biofeedback and the TENS are equally effective for treating non-neurogenic voiding dysfunction. Biofeedback seems to require a lower number of sessions to obtain similar results of the TENS.