Spontaneous hydrocele resolution after hyperbaric oxygen treatment: a clinical case report.

Hyperbaric oxygen is considered an adjunctive treatment to medical and surgical care. We present a unique case in which a male patient with decompression illness affecting inner ear and spinal cord presented a worsened unilateral hydrocele synchronously with the neurological pathology. At the Diving and Hyperbaric Medicine Department, the patient was initially recompressed using a modified United States Navy Treatment Table 6A; on the following days he was treated for decompression illness using hyperbaric oxygen. Hyperbaric oxygen treatment has not been used for the treatment of hydrocele, but disappearance of the hydrocele occurred during the time he was treated with hyperbaric oxygen for decompression illness. He was discharged on Day 8, free of symptoms, having a normal neurological examination.

Flow resistive forces index (QRF): Development and clinical applicability assessment of a novel measure of bladder outlet resistance, aiming to enhance the diagnostic performance of uroflowmetry.

BACKGROUND: Currently, the diagnostic ability of uroflowmetry, the most widely used urodynamic test available for initial assessment of patients with lower urinary tract symptoms (LUTS), is considered limited by its inability to accurately discriminate between the underlying mechanisms of this condition. To improve the diagnostic accuracy of uroflow, we developed a mathematical formula that calculates the flow resistive forces index (QRF), a novel measure of bladder outflow/urethral resistance, and assessed its clinical applicability compared to the maximum flow rate (Qmax ). MATERIALS AND METHODS: A cross-sectional observational study was conducted in a cohort of 61 adult men presenting with voiding dysfunction symptoms, who all underwent free uroflowmetry followed by pressure flow study. The development of the mathematical formula which contains five key uroflowmetry variables (voided volume, flow time, Qmax , average flow rate, and peak flow time) was based on the assumption that urine volume momentum changes during voiding, the concept of diphasic uroflow pattern (acceleration/deceleration), and the urethral resistance factor (URA) equation. Study subjects were classified either as obstructed or nonobstructed according to established urodynamic criteria (linearized passive urethral resistance relation, LinPURR; Abrams-Griffiths number, AGN [also called bladder outlet obstruction index, BOOI]; and URA). Univariate linear correlations, binary logistic regression model, and receiver operating characteristic (ROC) curve statistical analysis were employed (SPSS-22, MedCalc, GraphPad [P < .05]). RESULTS: Outflow obstruction was diagnosed in 50.8% (1 in 2) patients. Univariate analysis, and bivariate linear correlation, binary logistic regression, and ROC curve analyses showed that the QRF was a strong independent predictor of bladder outlet/outflow obstruction (BOO), significantly outperforming Qmax . CONCLUSIONS: QRF index accurately predicts BOO, significantly outperforming the currently widely used bladder outlet obstruction estimator Qmax . Despite potential study limitations (mainly small cohort size and lack of control group), we anticipate that with further study and proper clinical validation, QRF could become a valuable complement to uroflowmetry.

Delayed Successful Surgical Repair of Penile Fracture: A Case Report.

Penile fracture is a very rare urological emergency resulting from traumatic rupture of the tunica albuginea of one or both corpora cavernosa, usually during sexual intercourse. Immediate surgical treatment is the current standard of care with lower risks of late complications, including erectile dysfunction, penile curvature, and tunical scar formation. We, hereby, report an over delayed presentation (23 days) of a penile fracture, which was successfully managed surgically. Our case emphasizes on the fact that there are not any "lost" cases and surgical treatment should always be offered to penile fracture, independently of delayed presentation.

Prostate Cancer Predictive Simulation Modelling, Assessing the Risk Technique (PCP-SMART): Introduction and Initial Clinical Efficacy Evaluation Data Presentation of a Simple Novel Mathematical Simulation Modelling Method, Devised to Predict the Outcome of Prostate Biopsy on an Individual Basis.

INTRODUCTION: We developed a mathematical "prostate cancer (PCa) conditions simulating" predictive model (PCP-SMART), from which we derived a novel PCa predictor (prostate cancer risk determinator [PCRD] index) and a PCa risk equation. We used these to estimate the probability of finding PCa on prostate biopsy, on an individual basis. MATERIALS AND METHODS: A total of 371 men who had undergone transrectal ultrasound-guided prostate biopsy were enrolled in the present study. Given that PCa risk relates to the total prostate-specific antigen (tPSA) level, age, prostate volume, free PSA (fPSA), fPSA/tPSA ratio, and PSA density and that tPSA ≥ 50 ng/mL has a 98.5% positive predictive value for a PCa diagnosis, we hypothesized that correlating 2 variables composed of 3 ratios (1, tPSA/age; 2, tPSA/prostate volume; and 3, fPSA/tPSA; 1 variable including the patient's tPSA and the other, a tPSA value of 50 ng/mL) could operate as a PCa conditions imitating/simulating model. Linear regression analysis was used to derive the coefficient of determination (R2), termed the PCRD index. To estimate the PCRD index's predictive validity, we used the χ2 test, multiple logistic regression analysis with PCa risk equation formation, calculation of test performance characteristics, and area under the receiver operating characteristic curve analysis using SPSS, version 22 (P < .05). RESULTS: The biopsy findings were positive for PCa in 167 patients (45.1%) and negative in 164 (44.2%). The PCRD index was positively signed in 89.82% positive PCa cases and negative in 91.46% negative PCa cases (χ2 test; P < .001; relative risk, 8.98). The sensitivity was 89.8%, specificity was 91.5%, positive predictive value was 91.5%, negative predictive value was 89.8%, positive likelihood ratio was 10.5, negative likelihood ratio was 0.11, and accuracy was 90.6%. Multiple logistic regression revealed the PCRD index as an independent PCa predictor, and the formulated risk equation was 91% accurate in predicting the probability of finding PCa. On the receiver operating characteristic analysis, the PCRD index (area under the curve, 0.926) significantly (P < .001) outperformed other, established PCa predictors. CONCLUSION: The PCRD index effectively predicted the prostate biopsy outcome, correctly identifying 9 of 10 men who were eventually diagnosed with PCa and correctly ruling out PCa for 9 of 10 men who did not have PCa. Its predictive power significantly outperformed established PCa predictors, and the formulated risk equation accurately calculated the probability of finding cancer on biopsy, on an individual patient basis.

Bilateral metachronous testicular chloroma: a rare clinical entity.

Testicular chloroma is an unusual form of extramedullary acute myeloid leukemia. We present a rare case that after chemotherapy relapsed with the appearance of metachronous testicular chloroma and we suggest prophylactic radiotherapy.

Augmentation Phalloplasty Patient Selection and Satisfaction Inventory: a novel questionnaire to evaluate patients considered for augmentation phalloplasty surgery because of penile dysmorphophobia.

OBJECTIVES: To introduce a novel questionnaire by which we attempted to identify the most suitable candidates for augmentation phalloplasty surgery for penile dysmorphophobia and to objectively estimate the outcome. METHODS: A total of 45 physically normal young adult men who presented with complaints of a "small penis" and were seeking surgical correction were included in the study. In addition to the ordinary evaluation, all completed the questionnaire devised by our department, the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI). The APPSSI aims to quantitatively assess the severity of the condition and the degree of the patient's willingness to undergo penile augmentation and to numerically measure the postoperative result. The APPSSI consists of four questions, with each having five possible answers (scale 0 to 4). Questions 1 through 3 were asked preoperatively (suitability assessment) and questions 1, 2, and 4 postoperatively (outcome evaluation). The eligibility threshold for surgery was a preoperative score of 6 or less. The preoperative scores ranged from 0 (surgery justified) to 12 (surgery not justified), and the postoperative scores ranged from 0 (disappointed) to 12 (excited). The Student t test was used for statistical analysis, and P <0.05 was considered to indicate statistical significance. RESULTS: Of the 45 patients, 13 (28.8%) with an APPSSI score of 6 or less (mean 3.18) underwent penile lengthening (n = 7), lengthening-enlargement (n = 4), or celioplasty-penile lengthening (n = 2). Postoperatively, the score increased by 4.36 (mean 7.54, P <0.001), and the condition improved by 25% to 50% in 11 patients, 66.6% in 1, and remained unchanged (0%) in 1 patient. CONCLUSIONS: The APPSSI questionnaire properly identified patients who significantly benefited from augmentation phalloplasty. Nevertheless, because of the small sample size and nonrandomized study, the questionnaire's validation requires a larger number of patients tested in a randomized manner by more researchers to become a valuable clinical instrument and patient eligibility criterion for this type of surgery.

Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: considerations regarding patient selection, outcome evaluation and techniques applied.

OBJECTIVES: To report on the efficacy and safety of augmentation phalloplasty procedures in physically normal young men, to introduce a patient selection and outcome evaluation questionnaire as well as, to propose a surgical technique modification. METHODS: Eleven (11) out of 28 psychosomatically normal men (25-35 years) who presented complaining of penile dysmorphophobia (subjective perception of small penis), were subjected to: (a) penile lengthening (suprapubic skin advancement--ligamentolysis): n=5, (b) penile lengthening and shaft thickening (free dermal-fat graft shaft coverage): n=3 and (c) panniculectomy--suprapubic lipectomy and penile lengthening: n=2. A self administered questionnaire was employed in order to facilitate selection of the patients qualifying for the operation as well as to evaluate the outcome. In addition, a technical modification regarding dermal-fat graft handling was applied. RESULTS: The postoperative course was uneventful with minor complications. The mean penile length gain (flaccid--stretched penis) was 1.6 cm (1-2.3 cm) [p=0.0014], the mean circumference gain was 2.3 cm [p=0.003] at the base and 2.6 cm [p=0.0012] subcoronaly. Significant (20%-53%) [p<0.0001] sexual self-esteem and functioning improvement was reported by the majority (91%) of patients. CONCLUSIONS: Although penile size alteration was not spectacular or satisfying the patients' "great" expectations, the substantially uneventful clinical course coupled with the significant improvement in sexual self-esteem and function and the highly accepted outcome by the patients, render augmentation phalloplasty reasonable treatment modality for the management of strictly selected and thoroughly informed young adults who suffer from penile dysmorphophobia.

Size of external genital organs and somatometric parameters among physically normal men younger than 40 years old.

OBJECTIVES: To estimate the sizes of the external genital organs in physically normal adult males younger than 40 years old, as well as to correlate the resulting values with age and a number of somatometric parameters, to provide data that could be clinically applicable by the practicing urologist. METHODS: Fifty-two physically normal men, 19 to 38 years old, underwent tape measurements of penile dimensions in the flaccid-stretched state (total, shaft, glanular lengths), penile shaft volume calculation, and ultrasonographic testicular volume estimation. The resultant values were correlated with age, height, weight, body mass index, waist/hip ratio, and index finger length. RESULTS: The mean testicular volume was 16.9 +/- 4.7 cm(3), with the right testis (17.5 +/- 5.8 cm(3)) measuring slightly larger than the left (15.85 +/- 4.9 cm(3); P = not significant). The mean total penile length was 12.18 +/- 1.7 cm, the mean penile shaft length was 7.76 +/- 1.3 cm, the mean glanular length was 4.4 +/- 0.4 cm, and the mean penile shaft volume was 46.5 +/- 17.2 cm(3). Among the various correlations performed, the penile lengths (total, shaft, glanular) to index finger length (P <0.05) and to penile shaft volume (P <0.001) were statistically significant. CONCLUSIONS: Data on the size of the external genital organs among physically normal young adult men were provided and a novel formula for penile shaft volume calculation was proposed. Age and somatometric parameters were not associated with the size of the genitalia, excluding the index finger length, which correlated significantly with the dimensions of the flaccid, maximally stretched, penis.