Psychological impact and sexual dysfunction in men with and without spinal cord injury.

INTRODUCTION: The World Health Organization recognizes sexual health as a fundamental right that should be guaranteed to all individuals. Sexual dysfunction affects various aspects in the lives (physical, psychic, and social) of affected persons. AIMS: To assess the different types of sexual dysfunction, the quality of life (QOL), depression, anxiety, and levels of self-esteem observed in 165 men with sexual dysfunction, both with and without spinal cord injury (SCI). METHODS: Case control study of 85 men with SCI and sexual dysfunction, and 80 men without SCI that have sexual dysfunction. MAIN OUTCOMES MEASURES: The Sexual Health Evaluation Scale, the Fugl-Meyer Life Satisfaction Questionnaire scale, the Hospital Anxiety and Depression Scale, the Evaluation of the Sexual Health Scale, and Rosenberg's Self-esteem Scale were all used for data collection. RESULTS: Of the members in group A (with SCI), 89.4% (76) showed erectile dysfunction, and 75.2% (64) reported anejaculation. In group B (without SCI), 75 (96.8%) showed erectile dysfunction, and 58.7% (47) had disorders of sexual desire. In group A, 16.47 % (14) showed signs of depression, and 35.3% (30) had signs of anxiety. In group B, 30% (24) had elevated scores regarding depression, and 48.75% (39) had high scores for anxiety. All of the participants reported a high general QOL and a high satisfaction with their QOL but reported that their satisfaction with their sexual lives was only at the acceptable level. Social QOL is significantly higher in the SCI group (t Student P=0.031). The QOL, self-esteem, and anxiety and depression levels are significantly correlated. CONCLUSIONS: Men with sexual dysfunction strive to adapt to their situations, with the relationship between the type of sexual dysfunction and the QOL, mood (depression), and self-esteem all being important considerations. Sexuality and employment status are the areas where men with spinal cord injuries report less satisfaction.

Sertoli cell tumor, a rare testicular tumor, our experience and review of the literature.

OBJECTIVE: We report two new cases of Sertoli cell testicular tumors, and a Cochrane and Medline search of cases published worldwide. METHODS: We reviewed our series of testicular tumors, the stromal tumor incidence, clinical presentation, treatment and prognosis, and the experience reflected in the literature. RESULTS: The prevalence of testicular tumors in our health area is of 0.09%, and 2.3% of them are Sertoli cell neoplasms. This figure is slightly higher than the found in other series in which Sertoli tumors range from 0.4% to 1.5% of testicular malignancies in adults and reach 4% in children. CONCLUSIONS: Sertoli cell tumor has an incidence not exceeding 4%. The most common symptom is a painless mass; in cases with endocrine manifestation, up to 10% are malignant depending on the age of the patient.

Sexual dysfunction in Spanish women with breast cancer.

PURPOSE: To determine whether there are changes in sexuality after breast cancer, to better understand the sexual function of women with breast cancer, and to investigate the potential relationship between sexual dysfunction and socio-demographic and clinical variables. METHODS: A cross-sectional study. This study included 514 women with breast cancer between 21- and 66-years-old. The cases were gathered between June 2016 and January 2017. The instruments used were the questionnaire on Women's Sexual Function and a questionnaire to collect socio-demographic and clinical data. RESULTS: The average age (± standard deviation, SD) of participants was 46.34 ± 8.28 years. Their average age at date of diagnosis was 42.26 ± 8.56 years, and the average time suffering from cancer was 4.05 ± 5.23 years. There were significant differences (p = 0.002) in the presence of sexual dysfunction before (32.1%) and after (91.2%) cancer. The primary sexual dysfunctions were due to penetration pain (50.6%), lubrication (50.6%), dysfunctional desire (44.6%), and dysfunctional excitement (44.6%). Two-thirds of participants were satisfied with their sexual relations. The women who presented most sexual dysfunction were those that had a bilateral mastectomy (p = 0.009) and those who received chemotherapy, radiotherapy and hormonal-therapy (p < 0.001). CONCLUSION: Sexual function was changed in women with breast cancer. The main problems included penetration pain, desire, lubrication, and dysfunctional excitement. It is important that Health professionals recognize which circumstances influence the sexual function of women with breast cancer and to make interventions that facilitate sexual adjustment.

Retroperitoneal fibrosis: single-centre experience from 1992 to 2010, current status of knowledge and review of the international literature.

OBJECTIVE: The aims of this study were to investigate retroperitoneal fibrosis in a Spanish hospital and present a review of the international literature to attempt to elucidate a diagnostic and therapeutic approach to this unusual pathology. MATERIAL AND METHODS: A database search was performed in the pathology department and in the documentation service using the key words "retroperitoneal fibrosis" and "Ormond's disease", limiting the search to the years 1990-2010. Cases in which secondary retroperitoneal fibrosis was considered were excluded. In addition, a PubMed literature search was performed using the terms "retroperitoneal fibrosis" and "Ormond's", limiting the search to 1985-2011. RESULTS: Twenty-two patients were diagnosed with idiopathic retroperitoneal fibrosis (IRF) or Ormond's disease. The most common symptom at the time of diagnosis was flank pain. With regard to laboratory findings, five patients (22.7%) had anaemia and eight (36.3%) had renal failure. Computed tomography (CT) was performed in 20 patients (90.9%) and the most common finding observed was retroperitoneal mass. Eighteen patients were started on corticosteroids, in six cases in association with azathioprine. Three patients had recurrence at 12, 24 and 72 months, respectively, and 15 patients required emergency surgery. Nine open surgical procedures were performed. CONCLUSIONS: At present, IRF is considered an autoimmune disease that presents with local and systemic signs and symptoms. CT and magnetic resonance imaging are the two tests of choice in IRF diagnosis and follow-up. [(18)F]Fluorodeoxyglucose positron emission tomography is starting to be used for assessment and treatment response. A combination of medical and surgical treatment is usually applied. It is essential to administer corticosteroids alone or in association with other immunosuppressive drugs such as azathioprine. Laparoscopic ureterolysis, or robotic ureterolysis, if available, is the technique of choice.

[Quality of life of males with spinal cord injury and sexual dysfunction]. / Calidad de vida del varón con lesión medular traumática y disfunción sexual.

AIMS: the aims of this study are to assess the quality of life (QOL) of males with spinal cord injury (SCI) and to know their sexual health. We also analyze the links among clinic and sociodemographic variables, the sexual health of males with SCI and their QOL. METHOD: This is a transversal cross-sectional study that was made in the hospital of Paraplegics of Toledo. The sample included 45 men presenting SCI and sexual dysfunction. Life Satisfaction Checklist and Sexual Health Measurement Scale were used to gather data. RESULTS: The 97, 8% of all participants are interested in having sexual relationships; the 70% of all participants have a steady sexual couple while the 51% often maintain sexual relations. The 86% of the sample admit to suffer from erectile dysfunction and the 71% can't ejaculate. The score of the group which has erectile dysfunction are significantly low in sexual QOL (p t-Student 0.000) and in general QOL (p t-Student 0.001). The sample had an average in general QOL of 34,27 (standard deviation: 2,8), in social QOL 20,16 (SD:2,7), in sexual QOL 7,62 (SD:2,7) and in economic QOL 7,71 (SD:2,6). There isn't a significant relationship among the QOL and the etiology, the degree and the time of evolution of the SCI. CONCLUSIONS: The individuals who have participated in this study generally experienced a good general QOL, but their sexual life is the aspect which causes them a greater dissatisfaction. In fact, those who suffer from erectile dysfunction show less satisfaction with their general and sexual QOL.

Tuberculous orchiepididymitis during 1978-2003 period: review of 34 cases and role of 16S rRNA amplification.

Genitourinary tuberculosis was diagnosed in 543 patients in Spanish hospital from 1978 through 2003. Of the 371 male 34 (9.2%) had orchiepididymitis. Mean age was 52.7 years and the presenting symptom was scrotal swelling and/or pain. Over 50% of cases involved the right ovotestis. Associated renal tuberculosis and active disease in extraurological organs presented in 64% and 19.2% of cases, respectively. Diagnosis was established by culture of Mycobacterium tuberculosis recovery from urine and/or purulent scrotal exudate. Genomic amplification techniques aided the diagnosis in 8 patients. Treatment was rifampin, isoniazide, and pyrazinamide or ethambutol. Eight patients required combined medical and surgical treatment.

Tumor de células de sertoli. Un extraño tumor testicular. Nuestra experiencia y revisión de la literatura / Sertolli cell tumor, a rare testicular tumor, our experience and review of the literature

OBJETIVO: Aportamos dos nuevos casos de tumor testicular de células de Sertoli, realizando búsqueda en Medline y Cochrane de los casos publicados a nivel internacional.MÉTODOS: Revisión de nuestra serie de neoplasias testiculares, incidencia de los tumores estromales, presentación, clínica, tratamiento y pronóstico, así como de la experiencia reflejada en la literatura. RESULTADOS:La prevalencia de los tumores testiculares en nuestra área de salud es del 0,09 %, suponiendo el tumor de Sertoli el 2,3 % de ellos. La incidencia es levemente superior a la informada en otros trabajos, con cifras del 0,4% al 1,5% de los tumores testiculares en el adulto y hasta el 4% en los niños. La presentación más habitual es la masa testicular indolora, pudiendo existir semiología secundaria a la producción hormonal.CONCLUSIONES: El tumor de células de Sertoli presenta una incidencia no superior al 4% de las neoplasias testiculares. La clínica más habitual es la tumoración indolora, existiendo casos de manifestaciones endocrinas que varían según la edad del paciente Hasta un 10% de ellos se comportan de manera maligna(AU)

OBJECTIVE: We report two new cases of Sertoli cell testicular tumors, and a Cochrane and Medline search of cases published worldwide.METHODS: We reviewed our series of testicular tumors, the stromal tumor incidence, clinical presentation, treatment and prognosis, and the experience reflected in the literature.RESULTS: The prevalence of testicular tumors in our health area is of 0.09%, and 2.3% of them are Sertoli cell neoplasms. This figure is slightly higher than the found in other series in which Sertoli tumors range from 0.4% to 1.5% of testicular malignancies in adults and reach 4% in children.CONCLUSIONS: Sertoli cell tumor has an incidence not exceeding 4%. The most common symptom is a painless mass; in cases with endocrine manifestation, up to 10% are malignant depending on the age of the patient

Linfedema genital crónico gigante. Contribución de 2 casos, abordaje quirúrgico y revisión de la literatura / Chronic giant genital lymphedema: contribution of 2 cases, description of surgical approach and literature review

Objetivo. Exponer una descripción detallada de la técnica quirúrgica para el linfedema genital crónico gigante. Comentar otras opciones quirúrgicas de extirpación y reconstrucción. Método. Se presentan los casos de 2 varones con linfedema genital crónico gigante de más de 2 años de evolución, con gran afectación funcional y un estado de ánimo y autoestima bajos. Se realiza una descripción por pasos de la técnica quirúrgica y los cuidados posteriores. Resultados. Se realizó la extirpación completa del linfedema genital crónico gigante hasta tejido sano, la disminución de la oquedad condicionada por la extirpación, con flaps de piel y tejido celular subcutáneo, y la reparación del defecto de la piel con injertos cutáneos libres de espesor parcial obtenidos del abdomen. El resultado estético fue muy bueno y se obtuvo un magnífico resultado psicológico, con mejoría de la autoestima y el estado de ánimo. Conclusiones. El tratamiento quirúrgico en casos avanzados es la única opción posible. Con la técnica descrita se obtienen buenos resultados (estéticos, funcionales y psicológicos) (AU)

Aim. To provide a detailed description of the surgical technique for the chronic giant genital lymphedema. To explain other surgical methods of removal and reconstruction. Method. Based in 2 males with a chronic giant genital lymphedema with more than 2 years of evolution, with high functional impairment, low mood and low self-esteem. Description, step by step, of the surgical procedures and postoperative care. Results. The removal of the chronic giant genital lymphedema up to healthy tissue was performed. Reduction of the cavity conditioned by the removal, with flaps of skin and subcutaneous tissue. Repair of skin defect with partial thickness skin grafts obtained from the abdomen. Very good aesthetic result and splendid psychological outcome with improved self-esteem and mood. Conclusions. Surgical treatment in advanced cases is the only option. With the described technique good results (aesthetic, functional and psychological) are obtained (AU)

Calidad de vida del varón con lesión medular traumática y disfunción sexual / Quality of life of males with spinal cord injury and sexual dysfunction

Objetivos Valorar la calidad de vida (CDV) del varón con lesión medular (LM). Conocer el estado de salud sexual del varón con LM. Analizar la relación de las variables clínicas, sociodemográficas y estado de salud sexual del varón con LM con la CDV. Método Se trata de un estudio observacional y transversal, realizado en el Hospital Nacional de Parapléjicos de Toledo con 45 varones con LM y disfunción sexual. Para la recogida de datos se utilizaron la escala de satisfacción con la Vida (LISAT-8) y la escala de valoración de la salud sexual. Resultados El 97,8% de los participantes del estudio tienen interés para mantener relaciones sexuales; el 70% tiene pareja sexual estable; el 51% mantiene relaciones sexuales con regularidad. El 86% de la muestra refiere tener disfunción eréctil (DE) y el 71% an aeyaculación. El grupo que tiene DE puntúa significativamente menos en CDV sexual (p-valor t de Student 0,000) y en CDV general (p-valor t de Student 0,001). La muestra obtuvo en CDV general una media de 34,27 (DT: 2,8), en CDV social 20,16 (DT: 2,7), en CDV sexual 7,62 (DT: 2,7) y en CDV económica 7,71 (DT: 2,6). No existe relación significativa entre la CDV y la etiología, el grado, el tiempo de la LM. Conclusiones Los participantes perciben una CDV general buena, siendo la vida sexual el aspecto con el que refieren estar menos satisfechos. De hecho los que tienen disfunción eréctil están menos satisfechos en su vida general y en su vida sexual (AU)

Aims: the aims of this study are to assess the quality of life (QOL) of males with spinal cordinjury (SCI) and to know their sexual health. We also analyze the links among clinic and sociodemographic variables, the sexual health of males with SCI and their QOL. Method: This is a transversal cross-sectional study that was made in the hospital of Paraplegics of Toledo. The sample included 45 men presenting SCI and sexual dysfunction. Life Satisfaction Checklist and Sexual Health Measurement Scale were used to gather data. Results: The 97, 8% of all participants are interested in having sexual relationships; the 70% of all participants have a steady sexual couple while the 51% often maintain sexual relations. The 86% of the sample admit to suffer from erectile dysfunction and the 71% can’t ejaculate. The score of the group which has erectile dysfunction are significantly low in sexual QOL(p t-Student 0.000) and in general QOL (p t-Student 0.001).The sample had an average in general QOL of 34,27 (standard deviation: 2,8), in social QOL20,16 (SD:2,7), in sexual QOL 7,62 (SD:2,7) and in economic QOL 7,71 (SD:2,6). There isn’t a signifi cant relationship among the QOL and the etiology, the degree and the time of evolution of the SCI. Conclusions: The individuals who have participated in this study generally experienced a good general QOL, but their sexual life is the aspect which causes them a greater dissatisfaction. Infact, those who suffer from erectile dysfunction show less satisfaction with their general and sexual QOL (AU)

Tratamiento quirúrgico en un caso de linfedema escrotal / Surgical treatment in a case of giant scrotal lymphedema

OBJETIVO: El linfedema escrotal (LE) es una patología rara en nuestro medio. Presentamos un caso de linfedema escrotal gigante y realizamos una revisión bibliográfica de la literatura existente en la base de datos Medline en los últimos 10 años.MÉTODO: Presentamos el caso de un varón con linfedema escrotal gigante (43x 40 Cm.), de cuatro años de evolución y de etiología incierta.RESULTADO: Fue tratado quirúrgicamente, mediante exéresis completa escrotal y reconstrucción mediante injertos cutáneos, con resultado exitoso.CONCLUSIONES: El LE es una entidad rara, sobre todo en países industrializados. Independientemente de la causa, si el linfedema es severo, el tratamiento quirúrgico es la opción terapéutica más adecuada. La resección completa hasta tejido sano y la reconstrucción quirúrgica es el tratamiento de elección, cuando afecta a todo el escroto, siendo necesario el uso de injertos cutáneos de piel fina para su reconstrucción(AU)

OBJECTIVE: Scrotal lymphedema (SL) is a rare clinical pathology with multiple etiologies. We report a case of idiopathic giant scrotal lymphedema and review the existing medical literature in Medline from the last ten years.METHODS: We report the case of a male patient with a giant scrotal lymphedema (43x 40 cm) of unknown etiology developed over four years.RESULTS: The patient was treated by scrotal excision and reconstruction with skin graft plasty, with a successful result.CONCLUSIONS: Scrotal Lymphedema is a rare entity, especially in industrialized countries. If the lymphedema is severe, surgery is the most appropriate therapeutic option, whatever the cause is. Complete resection up to healthy tissue and surgical reconstruction is the choice. Thin skin grafts are necessary for reconstruction when it affects the entire scrotum(AU)

Hematoma espontáneo perirrenal en enfermo VIH(+) sobre riñón pélvico / Spontaneous perineal hematoma in pelvic kidney in an HIV(+) patient

OBJETIVO: Presentar un nuevo caso de hematoma perirrenal espontáneo sobre un riñón ectópico (pélvico) en un enfermo VIH(+). MÉTODO/RESULTADOS: Realizamos una revisión bibliográfica de las posibles etiologías recogidas en la literatura del hematoma espontáneo perirrenal pélvico y, en especial, de los tres casos que hemos encontrado descritos en enfermos VIH(+). CONCLUSIÓN: En este caso no hemos podido comprobar la existencia de ninguno de los procesos relacionados en la literatura: presentando una evolución favorable mediante un tratamiento conservador (AU)