RESUMO
OBJECTIVE: To evaluate the effect of endoscopic surgery on sexual function in patients with upper urinary tract (UUT) lithiasis. MATERIAL AND METHODS: We conducted an observational, prospective, longitudinal study with a single cohort of cases undergoing ureteroscopy (URS), retrograde intrarenal surgery (RIRS), or endoscopic combined intrarenal surgery (ECIRS). Patients' sexual response was assessed with questionnaires in the 30 days prior to surgery, and at one and three months after surgery. The International Index of Erectile Function (IIEF-t) was used in male patients, and the Female Sexual Function Index (FSFI) was used in female patients. RESULTS: Seventy patients - 34 men and 36 women - completed the study. Among men, the IIEF-t did not show significant difference between baseline scores (64.1⯱â¯7.50) and those obtained at 3 months (63.8⯱â¯9.51), with a non-significant decrease (pâ¯=â¯0.054) at the first month (61.4⯱â¯10.4). Subdomains did not worsen at 3 months, and desire (IIEF-SD) improved from 7.3⯱â¯1.9 to 8.0⯱â¯1.8. Among women, the FSFI-t did not change significantly after surgery: baseline score (27.3⯱â¯4.1), 1-month score (26.8⯱â¯3.7) and 3-month score (27.5⯱â¯4.2). No subdomain worsened at the third month. CONCLUSION: Endoscopic surgery for UUT is a safe technique in both sexes with no negative effect on sexual function. There are no differences between the baseline IIEF-t and FSFI-t scores and those obtained at 3 months.
RESUMO
PURPOSE: To evaluate the new treatment strategies in renal cell carcinoma (RCC) that affects the graft in renal recipients. ACQUISITION OF EVIDENCE: A literature review is made, analyzing all the published cases of conservative surgery in renal graft RCC. SYNTHESIS OF EVIDENCE: A total of 51 partial nephrectomies in renal graft patients have been described, with a graft survival rate of 88% and a recurrence rate of 6%. Most of the patients (75%) were asymptomatic at the time of diagnosis, and the mean lesion size was 2.8 cm. Enucleation was the most frequent technique employed. 77% of all immunosuppressor regimens included cyclosporine A. Six patients with graft RCC were subjected to radiofrequency ablation and two patients underwent percutaneous cryoablation, with a single case of relapse and a graft survival rate of 100%. CONCLUSIONS: Nephron-sparing surgery is a good management option in renal graft RCC, affording good oncological control and graft survival. Modification of immunosuppression with the withdrawal of cyclosporine A and the introduction of mTOR inhibitors is an adequate measure in such patients.