Descriptive Study of Gender Dysphoria and Sexual Behavior in a Disorder of Sex Development Group.

Disorder of Sex Development (DSD) refers to a heterogeneous group of congenital conditions in which chromosomal, gonadal, and anatomical sex are atypical. Typically, the diagnosis is made at birth or infancy and interventional actions are necessary in many cases. The repercussions in adult life, more specifically in the field of sexuality, have not been not widely studied yet. This study shows research data that seek to identify in a group of individuals with DSD (XX DSD, XY DSD, Chromosomal DSD), who are being monitored in the departments of pediatric surgery and urology of a hospital in the period from 2000 to 2019, and to verify the consequences on sex life after puberty. The sample has 16 participants (7 XY DSD, 4 XX DSD, and 5 Chromosomal DSD), aged between 16 and 50 years, single, with high school education, residents of the state capital and countryside of the state. The results depict the presence of a case of Gender Dysphoria; postponement of sexual debut for almost 3 years compared to the national average; a single sexual relationship for those who have already had a sexual experience with penetration; penis size below the general population average; presence of masturbatory activity in most participants. The presence of sexual attraction and masturbation indicate sexual desire. The group has a late onset of sexual life (almost 3 years after the national average). A recurrent feature in this group is that, even having already performed a penetrative sexual act, there is no continuation in their sexual life. The main noticeable aspect about Gender Dysphoria is the presence of only one case of incongruence in the Chromosomal DSD group. The limited sample prevents us from sufficient statements for generalization.

Laparoscopic ureteral reconstruction in infant with congenital mid ureteric valve.

Congenital mid ureteric valve (MUV) stenosis is a very rare cause of ureteric obstruction and hydronephrosis (HN) in children. We describe how we manage laparoscopically one case of a patient with congenital MUV. We describe a 6-month-old boy born with antenatal left HN, with an anteroposterior diameter (APD) of 1,5 cm. Follow-up renal ultrasound at 3 months of age showed an increase in left kidney HN, approximately 2.5 cm below the PUJ associated with distal stenosis. Renal scintigraphy with DTPA showed an obstructive pattern. Urography scan showed an abrupt reduction in the caliber of the mid left ureter Based on a preoperative diagnosis of MUV stenosis, we performed a laparoscopic left ureteroplasty. Abrupt tapering of the left ureter at 3 cm from the PUJ was identified. Proximal ureter repair was performed before the resection of the narrowing segment. The two edges of the ureter were spatulated and continuous anastomosis was performed without tension. An antegrade JJ stent was inserted after the posterior part of the anastomosis was done. Patient made an uneventful recovery and was discharged on the first postoperative day. Laparoscopic ureteroplasty is a complex but feasible option to treat patients with congenital MUV stenosis.

Ileal Continent Reservoir: A Feasible Option for Bladder Augmentation and Urinary Diversion.

OBJECTIVE: To present the results of technique of continent urinary diversion, described by Macedo, that allows the configuration of a tunnel with a flap of the ileal tube at the same segment created for the reservoir. METHODS: From January 2006 to November 2016, 29 patients were underwent a urinary diversion by Macedo's technique. Patients' demographics, hospitalization time, surgical time, follow up, continence rate, reservoir capacity, and postoperative complications were evaluated. RESULTS: Sixty-nine percent were male and the median age was 16.9 years. The main etiology was meningomyelocele (69.1%). The mean surgical time was 4.2 hours (standard deviation [SD] 0.9 range 2.9-6.3). The median length of hospital stay was 10 days (interquartile range: 11.3 range 5-51). The mean follow up was 3.3 years (SD 2.2 range 0.3-9.8). Procedure in the bladder neck was performed in 12 patients (41.3%). A continence rate of the catheterizable conduit was 82.8%.The reservoir capacity increased from 134.4 to 364.4 ml (P <.0001). The continence rate improved significantly (20 vs 74%, P <.0001). There was no change in glomerular filtration rates in the long term (143.1 vs 147, P = .45). Morbidity rate was 58% (25 complications in 17 patients), 72% occurred within the first 60 days and 60% were classified as Clavien-Dindo I or II. CONCLUSION: Except for publications from the original author, this is the first series described. The outcomes are similar, adding important data with respect to this technique. They show that the ileal reservoir is feasible, reproducible, and with good results.

Volumetric and histological findings in intra-abdominal testes before and after division of spermatic vessels.

PURPOSE: Increased use of video laparoscopy in the diagnosis and treatment of the impalpable testis has encouraged use of the 2-stage Fowler-Stephens orchiopexy. To date, however, few limited studies exist to indicate whether clipping and division of the spermatic vessels alone may cause histological abnormalities in the intra-abdominal testis. MATERIALS AND METHODS: We evaluated histology and volume of 44 intra-abdominal testes in 35 patients between 4 months and 14 years old at stages 1 and 2 of the Fowler-Stephens procedure. RESULTS: There was a significant reduction in the number of spermatogonia and seminiferous tubules 6 months after ligation and division of the spermatic vessels. No differences were found in the number of Sertoli cells or testicular volume before and after clipping and division of the spermatic vessels. CONCLUSIONS: Ligation of the spermatic vessels during stage 1 orchiopexy for intra-abdominal testicles is associated with a significant reduction of spermatogonia. However, no significant changes were observed in the volumetric characteristics of the testicles. Further studies are necessary to evaluate the repercussions of these changes in future fertility.

Plano de açäo do corpo de monitores do Departamento de Cururgia da Universidade Federal do Rio Grande do Sul / Working planning of the monitors of the Universidade Federal do Rio Grande do Sul Surgical Departament

Os autores apresentam sua proposta de planejamento das atividades da monitoria de cirurgia. Um dos princípios básicos é a aceitaçäo do monitor como um potencial docente, sendo valorizada, portanto, a sua capacitaçäo didático-metodológica. O incentivo ao ensino da cirurgia, à pesquisa e às atividades de extensäo säo açöes prioritárias dos monitores

Linfoma gástrico primário: conceitos atuais / Primary gastric lymphoma: current concepts

Apresentam-se os aspectos mais importantes na abordagem do linfoma gástrico primário (LGP), enfatizando a investigaçäo diagnóstica e o tratamento. O diagnóstico diferencial entre LGP e carcinoma gástrico deve ser estabelecido no pré-operatório devido às diferenças quanto ao comportamento biológico, investigaçäo diagnóstica, tratamento e prognóstico destas patologias. No paciente cuja biópsia endoscópica mostra linfoma, deve-se realizar investigaçäo detalhada para descartar linfoma sistêmico, incluindo hemograma, provas de funçäo hepática, Rx de tórax, ecografia e/ou tomografia computadora, linfografia retroperitoneal, punçäo ou biópsia de medula óssea, cintilografia hepato-esplênica e óssea. O tratamento de escolha para a maioria dos casos é cirurgia seguida de radioterapia, com adiçäo de quimioterapia para os casos com indicadores de mau prognóstico (linfonodos positivos, tipo histiocítico difuso). As classificaçöes de Rappaport e a "Working Formulation" säo apresentadas, salientando que as recentes descobertas na Imunologia e citogenealogia dos linfomas apontam algumas incorreçöes na primeira, que tende a ser substituída pela segunda. Como ilustraçäo, é relatado o caso de um paciente com LGP do tipo linfócito pouco diferenciado, estágio II-E, tratado com cirurgia, radioterapia e quimioterapia