The role of membranous urethral afferent autonomic innervation in the continence mechanism after nerve sparing radical prostatectomy: a clinical and prospective study

Purpose: We evaluated the somatic and autonomic innervation of the pelvic floor and rhabdosphincter before and after nerve sparing radical retropubic prostatectomy using neurophysiological tests and correlated findings with clinical parameters and urinary continence. Materials and Methods: From February 2003 to October 2005, 46 patients with prostate cancer were enrolled in a controlled, prospective study. Patients were evaluated before and 6 months after nerve sparing radical retropubic prostatectomy using the UCLA-PCI urinary function domain and neurophysiological tests, including somatosensory evoked potential, and the pudendo-urethral, pudendo-anal and urethro-anal reflexes. Clinical parameters and urinary continence were correlated with afferent and efferent innervation of the membranous urethra and pelvic floor. We used strict criteria to define urinary continence as complete dryness with no leakage at all, not requiring any pads or diapers and with a UCLA-PCI score of 500. Patients with a sporadic drop of leakage, requiring up to 1 pad daily, were defined as having occasional urinary leakage. Results: Two patients were excluded from study due to urethral stricture postoperatively. We evaluated 44 patients within 6 months after surgery. The pudendo-anal and pudendo-urethral reflexes were unchanged postoperatively (p = 0.93 and 0.09, respectively), demonstrating that afferent and efferent pudendal innervation to this pelvic region was not affected by the surgery. Autonomic afferent denervation of the membranous urethral mucosa was found in 34 patients (77.3%), as demonstrated by a postoperative increase in the urethro-anal reflex sensory threshold and urethro-anal reflex latency (p <0.001 and 0.0007, respectively). Six of the 44 patients used pads. One patient with more severe leakage required 3 pads daily and 23 showed urinary leakage, including 5 who needed 1 pad per day and 18 who did not wear pads. Afferent autonomic denervation at the membranous urethral mucosa was found in 91.7% of patients with urinary leakage. Of 10 patients with preserved urethro-anal reflex latency 80% were continent. Conclusions: Sensory and motor pudendal innervation to this specific pelvic region did not change after nerve sparing radical retropubic prostatectomy. Significant autonomic afferent denervation of the membranous urethral mucosa was present in most patients postoperatively. Impaired membranous urethral sensitivity seemed to be associated with urinary incontinence, particularly in patients with occasional urinary leakage. Damage to the afferent autonomic innervation may have a role in the continence mechanism after nerve sparing radical retropubic prostatectomy.

Optimal control problems with nonsmooth mixed constraints

In this paper we present a weak maximum principle for optimal control problems involving mixed constraints and pointwise set control constraints. Notably such result holds for problems with possibly nonsmooth mixed constraints. Although the setback of such result resides on a convexity assumption on the extended velocity set, we show that if the number of mixed constraints is one, such convexity assumption may be removed when an interiority assumption holds. © 2008 IEEE.

Effect of airborne particle abrasion protocols on surface topography of Y-TZP ceramic

This study aimed to evaluate Y-TZP surface after different airborne particle abrasion protocols. Seventy-six Y-TZP ceramic blocks (5×4×4) mm3 were sintered and polished. Specimens were randomly divided into 19 groups (n=4) according to control group and 3 factors: a) protocol duration (2 and 4 s); b) particle size (30 μm, alumina coated silica particle; 45 μm, alumina particle; and 145 μm, alumina particle) and; c) pressure (1.5, 2.5 and 4.5 bar). Airborne particle abrasion was performed following a strict protocol. For qualitative and quantitative results, topography surfaces were analyzed in a digital optical profilometer (Interference Microscopic), using different roughness parameters (Ra, Rq, Rz, X-crossing, Mr1, Mr2 and Sdr) and 3D images. Surface roughness also was analyzed following the primer and silane applications on Y-TZP surfaces. One-way ANOVA revealed that treatments (application period, particle size and pressure of particle blasting) provided significant difference for all roughness parameters. The Tukey test determined that the significant differences between groups were different among roughness parameters. In qualitative analysis, the bonding agent application reduced roughness, filing the valleys in the surface. The protocols performed in this study verified that application period, particle size and pressure influenced the topographic pattern and amplitude of roughness.

Changes on facial profile in the mixed dentition, from natural growth and induced by Balters' bionator appliance

Objective: The purpose of this study was to evaluate the facial profile changes induced by Balters' bionator appliance in Class II division 1 patients, at mixed dentition stage. Methods: The sample consisted of 28 prepubertal individuals at stages 1 and 2 of skeletal maturation (CVM), which were divided in two groups. The experimental group consisted of 14 individuals (7 boys and 7 girls, initial mean age of 8y12m) which were treated with Balters' bionator appliance for 14.7 months. The effects of treatment were compared to a control group of 14 subjects (7 boys and 7 girls, initial mean age of 8y5m) with Class II malocclusion, division 1, not orthodontically treated, which were followed up for 15.4 months. The statistical analysis was performed using Student's t test, at a significance level of 5%. Results: The results showed that the Balters' bionator appliance promoted a significant increase on the mentolabial angle, in addition to demonstrating a tendency to reduce the facial skeletal convexity, to restrict the maxillary growth and to increase the nasolabial angle and the lower anterior facial height. Conclusion: It can be concluded that the Balters' bionator appliance improved the facial profile of children treated at mixed dentition stage. © 2013 Dental Press Journal of Orthodontics.

Análise não suave e aplicações em otimização

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O teatro, a educação e a experiência de si

Pós-graduação em Artes - IA

Uma investigação da influência do parâmetro de barreira na solução do problema de fluxo de potência ótimo

Pós-graduação em Engenharia Elétrica - FEB

Revisão e análise cladística das espécies de Physoclypeus Hendel, 1907 (Diptera, Lauxaniidae)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Classificação fuzzy de vertentes por krigagem e TPS com agregação de regiões via diagrama de Voronoi

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Produção de exopolissacarídeos por Lactobacillus helveticus autócne isoldao de soro-fermento natural

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo de parâmetros de fermentação na produção de biopolímeros por bactérias isoladas do solo e caracterização química dos grupamentos acetila e piruvato nos biopolímeros obtidos

Pós-graduação em Engenharia e Ciência de Alimentos - IBILCE

Qualidade microbiológica e ocorrência de leveduras em diferentes amostras de queijo tipo minas frescal

Pós-graduação em Engenharia e Ciência de Alimentos - IBILCE

Alterações cefalométricas do perfil facial decorrentes do crescimento natural e induzidas pelo aparelho de Herbst no tratamento da classe II divisão 1, em fase pré-puberal

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação clínica pelo escore de Apgar modificado, concentração de lactato e glicemia em neonatos da espécie ovina

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

As responsabilidades decorrentes do desvio de poder na Administração Pública

Pós-graduação em Direito - FCHS