Introduction and Objective:Circumcision is one of the oldest surgical procedures and one of the most frequently performed worldwide. It can be done by many different techniques. This prospective series presents the results of Plastibell® circumcision in children older than 2 years of age, evaluating surgical duration, immediate and late complications, time for plastic device separation and factors associated with it. Materials and Methods: We prospectively analyzed 119 children submitted to Plastic Device Circumcision with Plastibell® by only one surgeon from December 2009 to June 2011. In all cases the surgery was done under general anesthesia associated with dorsal penile nerve block. Before surgery length of the penis and latero-lateral diameter of the glans were measured. Surgical duration, time of Plastibell® separation and use of analgesic medication in the post-operative period were evaluated. Patients were followed on days 15, 45, 90 and 120 after surgery. Results: Age at surgery varied from 2 to 12.5 (5.9 ± 2.9) years old. Mean surgical time was 3.7 ± 2.0 minutes (1.9 to 9 minutes). Time for plastic device separation ranged from 6 to 26 days (mean: 16 ± 4.2 days), being 14.8 days for children younger than 5 years of age and 17.4 days for those older than 5 years of age (p < 0.0001). The diameter of the Plastibell® does not interfered in separations time (p = 0,484). Late complications occurred in 32 (26.8%) subjects, being the great majority of low clinical significance, especially prepucial adherences, edema of the mucosa and discrete hypertrophy of the scar, all resolving with clinical treatment. One patient still using diaper had meatus stenosis and in one case the Plastibell® device stayed between the glans and the prepuce and needed to be removed manually. Conclusions: Circumcision using a plastic device is a safe, quick and an easy technique with low complications, that when occur are of low clinical importance and of easy resolution. The mean time for the device to fall is shorter in children under 6 years of age and it is not influenced by the diameter of the device.

Methods: all had prostate-specific antigen, Gleason scores and clinical stage recorded prior to treatment. Biochemical relapse was defined as prostate-specific antigen (PSA)>0.4ng/mL for radical prostatectomy, and any elevation equal or higher than 2ng/mL over the PSA nadir for implanted patients. To analyze the effect of treatment on biochemical recurrence-free survival (BRFS), Kaplan-Meier curves and Cox regression were generated. Mean follow-up time was 56.1 months for patients with the implant, and 26.6 months for those operated on. BRFS in 5 years was 69% (95% CI: 58.18-77.45) for the whole cohort. Discussion: when stratified according to treatment, survival of patients who had undergone brachytherapy (79.70%) was higher to those operated on (44.30%; pvalue=0.0056). Upon multivariate analysis, independent predictors were iPSA (HR: 2.91, 95% CI: 1,32-6,42), Gleason score (HR: 2.18, 95% CI: 1,00-4,81) and treatment modality (HR: 2.61, 95% CI: 1.18-5,75). Risk of biochemical failure was higher with surgery than brachytherapy, which may be related to the failure criteria adopted, which is different for each therapy, as well as the high rate of histological progression between preoperative prostate biopsy and surgical specimen. Conclusion: it was found that brachytherapy is a good therapeutic option for low risk prostate cancer.

RESUMO -Meningoceles intra-sacrais são lesões raras, que podem determinar sintomas de compressão radicular. Descrevemos o caso de uma paciente de 18 anos, com queixa de incontinência urinária, acometida por esta patologia. Após avaliação neuro-urológica e estudo uro-dinâmico, foi demonstrada arreflexia do detrusor, sendo aventada a hipótese de disrafismo espinhal. O diagnóstico de meningocele intra-sacral oculta foi evidenciado através de ressonância magnética. A paciente foi submetida a abordagem cirúrgica com boa recuperação pós-operatória. No presente artigo, é feita breve revisão da literatura, e são discutidas as apresentações clínicas possíveis, os achados neuro-radiológicos e o tratamento cirúrgico. PALAVRAS-CHAVE: coluna, cirurgia, meningocele intra-sacral. Occult intrasacal meningocele: case reportABSTRACT -Intrasacral meningoceles are rare conditions that can cause symptoms of nerve root compression. We report a case of a 18-year-old female, who presented with urinary incontinence. The neurological and urological evaluation revealed lack of detrusor muscle reflex. This finding supported the hypothesis of spinal disraphism. Magnetic resonance image revealed an intrasacral meningocele. The patient was submitted to surgical excision of the lesion without postoperative complications. In the present paper, the pathogenesis, clinical picture, neuroradiological findings and surgical treatment are discussed. O termo meningocele intra-sacral oculta foi utilizado pela primeira vez na literatura por Enderle (1932) 1 , para descrever uma dilatação meníngea intra-sacral, identificada à mielografia. Embora considerado inadequado por alguns autores 2-6 , seu uso foi consagrado para definir lesões císticas intra-sacrais compostas de tecido fibroso semelhante a duramáter, geralmente acompanhado pela aracnóide, ocupando o canal sacral dilatado e ligado à extremidade do saco dural por trajeto fistuloso que, usualmente, permite fluxo livre de líquido cefaloraquidiano (LCR) [5][6][7] . Vários sinônimos têm sido utilizados para definir esta mesma lesão: meningocele intrasacral oculta 3,4,[8][9][10][11][12] , cisto intra-sacral 4,6,9 , cisto intraespinhal sacral 9 , expansão do espaço subaracnóideo 3,4,6,9 , cisto extradural meníngeo com ausência de fibras nervosas 7,9,12 , meningocele intra-sacral 2,4,9,10,12 . Mais frequentemente, a lesão torna-se sintomática na idade adulta, sugerindo crescimento lento após o nascimento 2,4,10 . A compressão radicular pelo cisto parece ser a causa dos sintomas, determinando dor lombar baixa, eventualmente com irradiação no trajeto radicular. Os fatores compressivos ou displásicos incidentes na região pélvica que prejudicam a função neural autonômica, produzem o complexo sintomático, podendo ocorrer disfunção vesical e disfunção erétil [2][3][4]7,8,10,11 . A estocagem e eliminação periódica da urina deve-se à complacência ou contração da bexiga, à função dos esfincteres externo e interno e à contração da musculatura da uretra e do assoalho pélvico. A motilidade da bexiga é controlada pelo ...

No abstract

No abstract