Urogenital Tuberculosis.

Urogenital tuberculosis is the second most frequent form of extrapulmonary tuberculosis. Starting with a pulmonary focus, 2 to 20% of patients develop urogenital tuberculosis through hematogenous spread to the kidneys, prostate, and epididymis; through the descending collecting system to the ureters, bladder, and urethra; and through the ejaculatory ducts to the genital organs. Urogenital tuberculosis occurs at all age ranges, but it is predominant in males in their fourth and fifth decades. It is a serious, insidious disease, generally developing symptoms only at a late stage, which leads to a diagnostic delay with consequent urogenital organ destruction; there are reports of patients with renal failure as their initial clinical presentation. Although the condition has been long recognized by nephrologists, urologists, and infectious disease specialists, urogenital tuberculosis is still largely unknown. Even when suggestive findings such as hematuria, sterile pyuria, and recurrent urinary infections are present, we rarely remember this diagnostic possibility. Greater knowledge of the features of urogenital tuberculosis then becomes relevant and should emphasize the importance of an early diagnosis.

Penetrance and clinical features of pheochromocytoma in a six-generation family carrying a germline TMEM127 mutation.

CONTEXT: The phenotype of familial pheochromocytoma (PHEO) associated with germline TMEM127 mutations (TMEM127-related PHEO) has not been clearly defined. OBJECTIVE: This study aimed to investigate the penetrance, full phenotypic spectrum and effectiveness of clinical/genetic screening in TMEM127-related PHEO. DESIGN, SETTING, AND PARTICIPANTS: Clinical and genetic screening, and genetic counseling were offered to 151 individuals from a six-generation family carrying a TMEM127 germline mutation in a referral center. INTERVENTION AND MAIN OUTCOME MEASURES: TMEM127 genetic testing was offered to at-risk relatives and clinical surveillance for pheochromocytoma was performed in mutation-positive carriers. RESULTS: Forty seven individuals carried the c.410-2A>C TMEM127 mutation. Clinical data were obtained from 34 TMEM127-mutation carriers followed up for 8.7 ± 8.1 years (range, 1-20 y). Pheochromocytoma was diagnosed in 11 carriers (32%) at a median age of 43 years. In nine patients, symptoms started at 29 years (range, 10-55 y) and two cases were asymptomatic. Tumors were multicentric in five (45%) and bilateral in five (45%) patients. Six patients (54%) had at least one adrenomedullary nodule less than 10 mm. No paragangliomas, distant metastases, or other manifestations were detected. Cumulative penetrance of pheochromocytoma was 0% at 0-20 years, 3% at 21-30 years, 15% at 31-40 years, 24% at 41-50 years, and 32% at 51-65 years. The youngest case was diagnosed at 22 years and the earliest symptoms were reported at age 10. CONCLUSIONS: Tumor multicentricity, nodular adrenomedullary hyperplasia, and the occurrence of symptoms more than a decade earlier than the age at diagnosis are novel findings in TMEM127-related PHEO. The high penetrance of pheochromocytoma in this condition validates the benefits of genetic testing of at-risk relatives. We thus recommend that TMEM127 genetic testing should be offered to at-risk individuals at age 22 years and mutation carriers should undergo clinical surveillance annually.

Prostate biopsy in patients with long-term use of indwelling bladder catheter: what is the rationale?

OBJECTIVE: Acute urinary retention (AUR) is expected to occur in 2% to 39% men with benign prostatic hyperplasia. To date, no study has elucidated the effect of long-term use of indwelling bladder catheter on serum prostate specific antigen (PSA) levels and on the incidence of prostate cancer (CaP). The aim of the present study is to analyze the incidence of CaP in patients with long-term use of indwelling bladder catheter and determine some practice patterns on this issue. MATERIALS AND METHODS: The study comprised a retrospective analysis of data from 1,651 patients who had undergone transrectal ultrasound (TRUS)-guided prostate biopsy from July 2004 to June 2009. Among these patients, 198 (12%) were using an indwelling bladder catheter during the biopsy for at least 1 month. The incidence of CaP was recorded according to total PSA levels. Other variables such patient age, free/total PSA rate, PSA density, prostate volume, and duration of catheter use was also analyzed. Men with a digital rectal examination suspicious for cancer were not considered for analysis. RESULTS: Median patient age was 71 years (37 to 89 years). Overall, 25% of patients presented a CaP diagnosis. CaP incidence according to the PSA levels was 0%, 18.9%, 24.5%, and 40.6% for patients with PSA ≤4.0, 4.1-10.0, 10.1-20.0, and >20.0 ng/ml, respectively. When prostate volume was analyzed together, we demonstrated that only 1 (2.4%) patient with PSA below 10.0 ng/ml and prostate volume >60 g had CaP. Median total PSA, PSA density, and prostate volume were statistically different between patients with and without CaP. CONCLUSIONS: Prostate biopsy should not be indicated for all patients with diagnosis of BPH and AUR who present an elevated PSA level. Patients with PSA below 10.0 ng/ml, and prostate volume >60 g should only undergo biopsy in selected cases. Patients with PSA >20.0 ng/ml and a prostate volume ≤60 g are at higher risk of CaP diagnosis.

Combined expression of BUB1B, DLGAP5, and PINK1 as predictors of poor outcome in adrenocortical tumors: validation in a Brazilian cohort of adult and pediatric patients.

BACKGROUND: A recent microarray study identified a set of genes whose combined expression patterns were predictive of poor outcome in a cohort of adult adrenocortical tumors (ACTs). The difference between the expression values measured by qRT-PCR of DLGAP5 and PINK1 genes was the best molecular predictor of recurrence and malignancy. Among the adrenocortical carcinomas, the combined expression of BUB1B and PINK1 genes was the most reliable predictor of overall survival. The prognostic and molecular heterogeneity of ACTs raises the need to study the applicability of these molecular markers in other cohorts. OBJECTIVE: To validate the combined expression of BUB1B, DLGAP5, and PINK1 as outcome predictor in ACTs from a Brazilian cohort of adult and pediatric patients. PATIENTS AND METHODS: BUB1B, DLGAP5, and PINK1 expression was assessed by quantitative PCR in 53 ACTs from 52 patients - 24 pediatric and 28 adults (one pediatric patient presented a bilateral asynchronous ACT). RESULTS: DLGAP5-PINK1 and BUB1B-PINK1 were strong predictors of disease-free survival and overall survival, respectively, among adult patients with ACT. In the pediatric cohort, these molecular predictors were only marginally associated with disease-free survival but not with overall survival. CONCLUSION: This study confirms the prognostic value of the combined expression of BUB1B, DLGAP5, and PINK1 genes in a Brazilian group of adult ACTs. Among pediatric ACTs, other molecular predictors of outcome are required.

The role of nephrectomy of the atrophic kidney in bearers of renovascular hypertension.

PURPOSE: Evaluation of the beneficial effect of nephrectomy of the atrophic kidney on blood pressure (BP) and renal function. MATERIALS AND METHODS: A retrospective study of 51 patients with renovascular hypertension (RVH), bearers of atrophic kidney due to severe stenosis or occlusion of the renal artery. Average age was 47.1 +/- 15 years, the median creatinine clearance was 54 mL/min, average systolic BP (SBP) 149.6 +/- 22.5 mm Hg, average diastolic BP (DBP) 90.8 +/- 17 mm Hg and the median number of hypotensors 3 (1 to 5) per patient per day. Blood pressure and serum creatinine were analyzed from 12 to 60 months after the nephrectomy. RESULTS: There was a significant improvement in the average SBP in the periods from 12 to 36 months (p < or = 0.028) and for the average DBP from 12 to 48 months after the nephrectomy (p < or = 0.045), accompanied by a significant reduction in the use of hypotensors from 12 to 48 months (p < 0.05). One year after the nephrectomy, there was a 69% improvement in blood pressure and 63.8% improvement in renal function of patients. CONCLUSION: The removal of atrophic kidney in patients with RVH is a safe procedure which presents benefits for the control of arterial hypertension and renal function in bearers of renovascular hypertension.

The role of nephrectomy of the atrophic kidney in bearers of renovascular hypertension

PURPOSE: Evaluation of the beneficial effect of nephrectomy of the atrophic kidney on blood pressure (BP) and renal function. MATERIALS AND METHODS: A retrospective study of 51 patients with renovascular hypertension (RVH), bearers of atrophic kidney due to severe stenosis or occlusion of the renal artery. Average age was 47.1 ± 15 years, the median creatinine clearance was 54 mL/min, average systolic BP (SBP) 149.6 ± 22.5 mm Hg, average diastolic BP (DBP) 90.8 ± 17 mm Hg and the median number of hypotensors 3 (1 to 5) per patient per day. Blood pressure and serum creatinine were analyzed from 12 to 60 months after the nephrectomy. RESULTS: There was a significant improvement in the average SBP in the periods from 12 to 36 months (p ≤ 0.028) and for the average DBP from 12 to 48 months after the nephrectomy (p ≤ 0.045), accompanied by a significant reduction in the use of hypotensors from 12 to 48 months (p < 0.05). One year after the nephrectomy, there was a 69 percent improvement in blood pressure and 63.8 percent improvement in renal function of patients. CONCLUSION: The removal of atrophic kidney in patients with RVH is a safe procedure which presents benefits for the control of arterial hypertension and renal function in bearers of renovascular hypertension.

High penetrance of pheochromocytoma associated with the novel C634Y/Y791F double germline mutation in the RET protooncogene.

CONTEXT: Previous studies have shown that double RET mutations may be associated with unusual multiple endocrine neoplasia type 2 (MEN 2) phenotypes. OBJECTIVE: Our objective was to report the clinical features of patients harboring a previously unreported double mutation of the RET gene and to characterize this mutation in vitro. PATIENTS: Sixteen patients from four unrelated families and harboring the C634Y/Y791F double RET germline mutation were included in the study. RESULTS: Large pheochromocytomas measuring 6.0-14 cm and weighing up to 640 g were identified in the four index cases. Three of the four tumors were bilateral. High penetrance of pheochromocytoma was also seen in the C634Y/Y791F-mutation-positive relatives (seven of nine, 77.7%). Of these, two cases had bilateral tumors, one presented with multifocal tumors, two cases had large tumors (>5 cm), and one case, which was diagnosed with a large (5.5 x 4.5 x 4.0 cm) pheochromocytoma, reported early onset of symptoms of the disease (14 yr old). The overall penetrance of pheochromocytoma was 84.6% (11 of 13). Development of medullary thyroid carcinoma in our patients seemed similar to that observed in patients with codon 634 mutations. Haplotype analysis demonstrated that the mutation did not arise from a common ancestor. In vitro studies showed the double C634Y/Y791F RET receptor was significantly more phosphorylated than either activated wild-type receptor or single C634Y and Y791F RET mutants. CONCLUSIONS: Our data suggest that the natural history of the novel C634Y/Y791F double mutation carries a codon 634-like pattern of medullary thyroid carcinoma development, is associated with increased susceptibility to unusually large bilateral pheochromocytomas, and is likely more biologically active than each individual mutation.

A better understanding of urogenital tuberculosis pathophysiology based on radiological findings.

PURPOSE: To assess the radiological findings of urogenital tuberculosis (UGT) in patients at different disease stages, for a better understanding of its pathophysiology. PATIENTS AND METHODS: We retrospectively reviewed the radiological exams of 20 men (median age 41 years; range: 28-65) with urogenital tuberculosis diagnosis. The patients were classified in the following groups: (1) bilateral renal tuberculosis with predominantly parenchymatous involvement; (2) unilateral renal tuberculosis; (3) unilateral renal tuberculosis with bladder tuberculosis and (4) bilateral renal tuberculosis with bladder tuberculosis. RESULTS: One AIDS patient had multiple bilateral renal tuberculosis abscesses (group 1). Six patients had unilateral renal tuberculosis with hydronephrosis due to stenosis and thickening of the collecting system, without involvement of the bladder or contralateral kidney (group 2). Six patients had bladder tuberculosis with diffuse thickening of the bladder wall, with one very low or no function kidney while the other kidney was normal (group 3). Seven patients had bladder tuberculosis associated to a very low or no function kidney with the other kidney with high-grade vesicoureteral reflux-associated ureterohydronephrosis (group 4). In two patients, sequential exams showed evolution of tuberculosis from a unilateral renal and ureteral lesion to contracted bladder and dilatation of the contralateral kidney secondary to high-grade reflux. CONCLUSIONS: UGT may have variable radiological presentations. However, in two of our cases we have seen that tuberculosis involvement of the urinary tract may be sequential. Further evidences are necessary to confirm this hypothesis.

Are total prostate-specific antigen serum levels in cirrhotic men different from those in normal men?

OBJECTIVES: To determine the serum total prostate-specific antigen (tPSA) levels in cirrhotic men and compare them with those in noncirrhotic men. METHODS: We prospectively evaluated 113 cirrhotic patients listed for liver transplantation using the serum tPSA, total testosterone level, and Child-Pugh liver function score according to age and severity of liver disease. The tPSA levels were compared with those of 661 healthy men. The Mann-Whitney U test was used for statistical analysis, with a significance level of .05. RESULTS: The median age of the cirrhotic and noncirrhotic patients was 55 years (range 28-70) and 58 years (range 46-70), respectively (P < .01). However, when stratified by age group (<49, 50-59, and >60 years), this difference was not significant. The median serum tPSA level was 0.3 ng/mL (range 0.04-9.9) and 1.3 ng/mL (range 0.04-65.8) in the cirrhotic and noncirrhotic group, respectively (P < .0001). Stratifying both groups according to age, the cirrhotic patients had significantly lower tPSA levels than did the noncirrhotic patients. According to the Child-Pugh score (A, B, and C), Child-Pugh class C patients had significantly lower tPSA levels than did Child-Pugh class A patients and also had lower testosterone levels than did Child-Pugh class A and B patients. The tPSA levels correlated significantly with the testosterone levels in the cirrhotic patients (P = .028). CONCLUSIONS: The results of our study have shown that cirrhotic patients have approximately 4 times lower serum tPSA levels than noncirrhotic men. Patients with more severe liver disease have lower tPSA and testosterone levels than patients less affected. The tPSA levels in cirrhotic men are affected by the total testosterone levels.

Use of subinguinal incision for microsurgical testicular biopsy during varicocelectomy in men with nonobstructive azoospermia.

OBJECTIVE: To describe a subinguinal technique of microsurgical testicular biopsy performed during subinguinal varicocelectomy in men with nonobstructive azoospermia. DESIGN: Prospective clinical study. SETTING: Andrology laboratory at tertiary care hospital. Male infertility section, department of urology, at tertiary care hospital. PATIENT(S): Ten azoospermic men with clinical varicocele. INTERVENTION(S): Subinguinal microsurgical testicular biopsy and microsurgical varicocele repair. MAIN OUTCOME MEASURE(S): Safety, feasibility, and effectiveness of subinguinal testicular biopsy during varicocele repair. RESULT(S): All testes were easily delivered through the subinguinal incision, and testicular biopsies were successfully performed under microscopic view. After a median follow-up of 9 months, none of the patients had any discomfort, pain, or presented with testicular atrophy. No intraoperative or postoperative complications were observed. There was no incidence of wound infection or scrotal hematoma. CONCLUSION(S): The subinguinal approach is a safe and effective option for testicular biopsy during varicocele repair in men with nonobstructive azoospermia. This technique may be an attractive alternative to traditional biopsy because it obviates scrotal violation.

Urogenital tuberculosis: update and review of 8961 cases from the world literature.

The AIDS epidemic caused unexpected worldwide levels of tuberculosis, even in developed countries where the incidence used to be low. Patients with urogenital tuberculosis in developed countries have fewer specific symptoms and lower rates of delayed diagnoses compared with patients from other countries. As a result, the disease tends to be less serious, with more patients presenting without significant lesions of the upper urinary tract on diagnosis. These data point to a correlation of the timing of diagnosis with the severity of urogenital tuberculosis. A systematic search for urogenital tuberculosis, regardless of symptoms, is warranted for early detection.

Urogenital tuberculosis: patient classification in seven different groups according to clinical and radiological presentation.

PURPOSE: To describe and classify 80 cases of urogenital tuberculosis in seven groups of similar clinical and radiological presentation. MATERIALS AND METHODS: 80 patients (56 males, 70%; median age 34 years; age range 12 to 75) with urogenital tuberculosis were retrospectively reviewed. The patients were divided in seven groups: 1) Bilateral parenchymatous renal lesions; 2) No or minimal changes on radiographic examination; 3) Unilateral renal tuberculosis; 4) Contracted bladder; 5) Contracted bladder with renal failure; 6) Tuberculosis on a transplanted kidney; 7) Isolated genital tuberculosis. RESULTS: 1) Seven (8.8%) patients had multiple bilateral parenchymatous renal lesions with fever and malaise, characteristic of miliary tuberculosis. Three of these patients had AIDS. 2) Six (7.5%) cases had an early diagnosis, with minimal or no radiographic lesions. Two did not have any urologic symptoms. 3) Twelve (15%) patients had unilateral renal tuberculosis with partial (1 case) or total non-function kidney. 4) Thirty-seven (46.3%) patients had contracted bladder associated with unilateral partial (1 case) or total non-function kidney. 5) Ten (12.5%) patients had end stage renal disease due to tuberculosis with contracted bladder. 6) Four (5.0%) patients had tuberculosis on a transplanted kidney, with graft loss in half the cases. 7) Four (5.0%) patients had prostate or epididymis tuberculosis without associated renal lesion. CONCLUSIONS: Urogenital tuberculosis is a destructive disease of the urogenital tract with variable clinical and radiographic presentation. A classification according to similar patterns correlating with disease stage is feasible although early diagnosis is the only prevention of the most severe forms.

Urogenital tuberculosis: patient classification in seven different groups according to clinical and radiological presentation

PURPOSE: To describe and classify 80 cases of urogenital tuberculosis in seven groups of similar clinical and radiological presentation. MATERIALS AND METHODS: 80 patients (56 males, 70 percent; median age 34 years; age range 12 to 75) with urogenital tuberculosis were retrospectively reviewed. The patients were divided in seven groups: 1) Bilateral parenchymatous renal lesions; 2) No or minimal changes on radiographic examination; 3) Unilateral renal tuberculosis; 4) Contracted bladder; 5) Contracted bladder with renal failure; 6) Tuberculosis on a transplanted kidney; 7) Isolated genital tuberculosis. RESULTS: 1) Seven (8.8 percent) patients had multiple bilateral parenchymatous renal lesions with fever and malaise, characteristic of miliary tuberculosis. Three of these patients had AIDS. 2) Six (7.5 percent) cases had an early diagnosis, with minimal or no radiographic lesions. Two did not have any urologic symptoms. 3) Twelve (15 percent) patients had unilateral renal tuberculosis with partial (1 case) or total non-function kidney. 4) Thirty-seven (46.3 percent) patients had contracted bladder associated with unilateral partial (1 case) or total non-function kidney. 5) Ten (12.5 percent) patients had end stage renal disease due to tuberculosis with contracted bladder. 6) Four (5.0 percent) patients had tuberculosis on a transplanted kidney, with graft loss in half the cases. 7) Four (5.0 percent) patients had prostate or epididymis tuberculosis without associated renal lesion. CONCLUSIONS: Urogenital tuberculosis is a destructive disease of the urogenital tract with variable clinical and radiographic presentation. A classification according to similar patterns correlating with disease stage is feasible although early diagnosis is the only prevention of the most severe forms.

Urogenital tuberculosis in a patient with AIDS: an unusual presentation.

BACKGROUND: A 38-year-old man with AIDS presented to hospital with a 3-month history of fevers, bilateral lumbar pain, dysuria and increased urinary frequency. Six years earlier he had received 6 months' treatment for pulmonary tuberculosis. At presentation, he was on antiretroviral therapy with a combination of efavirenz, stavudine and lamivudine. INVESTIGATIONS: Physical examination, evaluation of HIV viral load, CD4 count, measurement of serum hemoglobin concentration, white blood cell count, urinalysis, urine culture for usual pathogens, direct smear and urine culture for Mycobacterium tuberculosis, chest radiography, abdominal CT, measurement of serum creatinine concentration and estimated creatinine clearance. DIAGNOSIS: Urogenital tuberculosis. MANAGEMENT: The patient's symptoms and radiological abnormalities persisted despite antibiotic therapy for presumed bacterial infection. After urine culture had confirmed M. tuberculosis infection, he was administered pharmacological treatment comprising isoniazid, rifampin, pyrazinamide and ethambutol for 2 months, with isoniazid and rifampin given for a further 7 months. His symptoms improved within a few days of initiating treatment. Six months after treatment started, CT revealed a nonfunctioning right kidney and a functional left kidney with areas of scarring. The patient refused right nephrectomy, and completed his pharmacological treatment. No evidence of disease recurrence was observed during 2 years of follow-up.

Age-related increase of reactive oxygen species in neat semen in healthy fertile men.

OBJECTIVES: The effects of advancing paternal age on the male reproductive system are well known, but its effects on fecundity remain controversial. Although oxidative stress is associated with poor semen quality and function, a relationship with advancing male age has not been established. The objective of this study was to analyze the relationship between male age and seminal reactive oxygen species (ROS) levels in men presenting for voluntary sterilization. METHODS: We prospectively evaluated 98 fertile men who were candidates for vasectomy. These were divided into 2 age groups: less than 40 years (n = 78) and 40 or more years (n = 20). We used 46 infertile patients as positive controls. Standard semen analysis, seminal leukocyte count and ROS levels were measured in all samples. Fertile men with leukocytospermia were excluded. RESULTS: The mean age of the men was 35.1 +/- 5.6 years. Men 40 years and older had significantly higher ROS levels compared with younger men (P <0.001). We observed a positive correlation between seminal ROS levels and age (r = 0.20; P = 0.040). In addition, ROS was negatively correlated with sperm concentration (r = -0.48; P <0.001) and motility (r = -0.21; P = 0.030). CONCLUSIONS: Reactive oxygen species levels are significant higher in seminal ejaculates of healthy fertile men older than 40 years. ROS levels in whole ejaculate are significantly correlated to age among fertile men. Because ROS are clearly implicated in the pathogenesis of male infertility, these data suggest that delayed fatherhood may reduce the chances of pregnancy as men become progressively less fertile with age.

Impact of clinical varicocele and testis size on seminal reactive oxygen species levels in a fertile population: a prospective controlled study.

OBJECTIVE: To investigate: 1) the impact of clinical varicocele on reactive oxygen species (ROS) levels in neat and washed semen in a proven fertile population; and 2) the correlation between ROS levels, testicular volume, and varicocele grade in the same population of fertile men. DESIGN: Prospective controlled clinical study. SETTING: Andrology laboratory at tertiary-care hospital. PATIENT(S): One hundred fourteen healthy fertile men (81 normal fertile and 33 fertile with clinical varicocele) and 30 infertile patients (control subjects). INTERVENTION(S): Standard semen analysis and measurement of sperm ROS production. MAIN OUTCOME MEASURE(S): Seminal parameters, seminal ROS levels, seminal leukocyte levels, clinical varicocele, and testis size. RESULT(S): Thirty-three of the 114 (29%) fertile men had clinical varicocele (grade 1, n = 14; grade 2, n = 11; and grade 3, n = 8), and the remaining 81 (71%) had a normal physical examination. Levels of ROS and semen quality did not differ significantly between the fertile men with or without varicocele. No significant differences in ROS levels in neat and washed semen were observed compared with fertile men with grades 2 and 3 varicocele and with fertile men with varicocele grade 1. The ROS levels in neat and washed semen were not significantly correlated with varicocele grade in fertile men. No significant correlations between ROS levels and testis volume were observed between the fertile groups. CONCLUSION(S): The presence of clinical varicocele in fertile men is not associated with higher seminal ROS levels or abnormal semen parameters. Levels of ROS are not correlated with varicocele grade or testis volume in the same population of fertile men.

EUS-guided alcohol ablation of left adrenal metastasis from non-small-cell lung carcinoma.

BACKGROUND: EUS presents an alternative access to the left adrenal, making it possible to perform echo-guided needle biopsies. OBJECTIVES: We present a case of EUS-guided therapy as alcohol ablation of left adrenal metastases. DESIGN AND PATIENT: A 52-year-old man was admitted to the hospital complaining of abdominal pain. CT scan revealed an invasive process in the left upper lobe of the lung and a mass in the left adrenal area that was considered highly suspicious for left adrenal metastases from the patient's lung carcinoma. Cytopathologic examination of EUS-guided FNA confirmed the diagnosis of left adrenal metastasis. Because the patient's main clinical symptom was disabling abdominal pain, we considered the possibility of injection of alcohol into the left adrenal metastases under EUS guidance to ablate the metastatic lesion and potentially relieve the abdominal pain. EUS-guided alcohol ablation was performed successfully. RESULTS AND MAIN OUTCOME MEASUREMENT: On follow-up 3 days after EUS-guided left adrenal ablation, the patient had no abdominal pain. He remained without abdominal pain after 30 and 60 days of follow-up. LIMITATION: New technique with limited data. CONCLUSION: EUS-guided alcohol ablation of left adrenal metastases in patients with non-small-cell lung cancer may provide palliation of cancer-related abdominal pain. There may be potential for combining this (minimally invasive and easily performed EUS-guided therapeutic) technique for ablation of solitary adrenal metastasis in patients with lung cancer with other modalities (e.g., surgery, radiation, or chemotherapy) directed toward the primary pulmonary malignancy and adjacent mediastinal disease.

The short-term effect of surgical treatment for stress urinary incontinence using sub urethral support techniques on sexual function

OBJECTIVES: To evaluate the impact of surgical treatment of stress urinary incontinence on the sexual function of women and to identify whether such treatment can improve their sexual function and overall quality of life. MATERIALS AND METHODS: 64 heterosexual women with such indication were studied using the Female Sexual Function Index (FSFI) questionnaire, modified by introducing one question to evaluate the impact of urine loss. This was applied preoperatively and six months after surgery. RESULT: Among these 64 patients, 60.94 percent had regular sexual activity, while 39.06 percent did not. Among sexually active patients, 59 percent had urine loss during sexual intercourse and, of these, 87 percent had urine losses in half or more of sexual relations. There were no statistically significant differences in assessments of desire, arousal, lubrication, orgasm, satisfaction and pain, or in totaling the scores, between the preoperative period and six months after surgical treatment. However, the scores for urine losses during sexual intercourse were significantly better after the operation. CONCLUSIONS: Analysis of the results allowed the following conclusions to be reached: Urine lost during sexual activity was frequent among patients with stress urinary incontinence. Suburethral support surgery did not jeopardize sexual activity. Patients cured of stress urinary incontinence did not present improvement in sexual function.

Development of normal reference values for seminal reactive oxygen species and their correlation with leukocytes and semen parameters in a fertile population.

Although reactive oxygen species (ROSs) are clearly implicated in the pathogenesis of male infertility, few studies have attempted to define the basal levels of ROSs in fertile men. Levels of ROSs are highly influenced by the presence of leukocytes and are associated with decreased seminal parameters. The objective of our study was to determine the normal ROS reference values in neat and washed semen of a fertile population and to correlate the leukocyte concentrations with seminal parameters. We evaluated 114 fertile men seeking vasectomy and 47 subfertile patients as a positive control. All samples were subjected to semen analysis and Endtz testing; chemiluminescence assay was used to determine ROS levels. All seminal parameters were significantly higher in the fertile men than in the subfertile patients. In nonleukocytospermic samples, ROS levels were lower in the fertile men than in the subfertile patients in neat (0.29 [0.18, 0.54] vs 0.94 [0.38, 1.51]) (P = .001) and washed semen (5.73 [1.90, 14.71] vs 23.4 [9.46, 115.55]) (P = .001). Similarly, in samples with leukocytes (Entdz, less than 1 x 10(6)/mL), ROS levels were lower in the fertile men in neat (0.75 [0.27, 1.71] vs 2.0 [0.97, 27.41]) (P = .001) and washed semen (15.85 [4.18, 62.16] vs 239.83 [33.4, 1193.75]) (P < .0001). As expected, samples with leukocytes had significantly higher ROS values in washed and neat semen. In the fertile population, ROSs were positively correlated with leukocytes and negatively correlated with sperm count and motility. In semen samples without leukocytes, the normality cutoff of ROSs was 0.55 x 10(4) counted photons per minute with 76.4% area under the curve (AUC) in the neat samples and 10.0 x 10(4) counted photons per minute with 77% AUC in the washed samples. In semen samples with leukocytes, the cutoff for ROSs in neat samples was 1.25 with 72.7% AUC and 51.5 with 81% AUC in the washed samples. We defined the cutoff levels of ROSs in a fertile population. Seminal leukocyte levels below 1 x 10(6)/mL were associated with increased ROSs. ROS levels were positively correlated with leukocytes and negatively correlated with sperm motility and concentration. Patients with normal seminal parameters and lower seminal leukocyte levels may benefit from therapeutic interventions that improve semen quality.

EUS for locoregional staging of prostate cancer--a pilot study.

BACKGROUND: This was a pilot study on EUS for locoregional evaluation of prostate cancer. OBJECTIVE: Our purpose was to evaluate radial and linear-array EUS in locoregional prostate cancer staging. DESIGN, SETTING, PATIENTS: From April to December 2005, 23 patients were referred to the Department of Urology with a confirmed or highly suspected diagnosis of prostate cancer on the basis of cytohistologic examination of fragments obtained by transrectal US-guided biopsy or transuretheral means. After institutional review board approval, informed consent was obtained from all patients. INTERVENTION: An endosonographer and a radiologist with expertise in prostate imaging performed radial and linear EUS examinations without knowledge of the stage of prostate cancer of the referred patients. MAIN OUTCOME MEASUREMENTS: Systematic prostatic evaluation by EUS. All patients underwent prostatectomy, and the surgical specimens were analyzed and correlated with EUS findings. RESULTS: Mean age was 65.91 years, and the mean prostate-specific antigen level was 27.73 ng/mL. Histopathologic study of the surgical specimen revealed adenocarcinoma in 20 of 23, atypical adenomatous hyperplasia in 2 of 23, and sclerosing adenosis in 1 of 23. Staging by EUS for T stage showed different sensitivity (S), specificity (E), and accuracy (A) according to the degree of tumor invasiveness as follows: T1 (S: 51.3%, E: 53.2%, A: 49.1%); T2 (S: 100%, E: 91.67%, A: 95%); T3 (S: 100%, E: 100%, A: 100%). In 3 (3/23) patients EUS did not find a defined lesion, but the surgical specimen showed T1 stage cancer. EUS staging for N stage showed 62.5% sensitivity, 58.33% specificity, and 60% accuracy for N0. Regarding N1, 58.3% sensitivity, 52.50% specificity, and 60% accuracy were found. LIMITATIONS: Uncontrolled, nonrandomized study. CONCLUSIONS: EUS presented high sensitivity, specificity, and accuracy for prostate cancer staging.