Consensos em HPV Masculino da Sociedade Portuguesa de Andrologia, Medicina Sexual e Reprodução: Seguimento / Consensus on Male HPV from the Portuguese Society of Andrology, Sexual Medicine and Reproduction: Follow-up

Os doentes com lesão genital por HPV, assim como os parceiros de doentes HPV positivo, apresentam normalmente um stress psicológico superior às reais consequências médicas da lesão. O seguimento desses doentes deve basear-se na educação e no aconselhamento. Os testes de tipagem molecular HPV não são recomendados como teste de seguimento, ou para rastreio dos parceiros. Aconselha-se o desenvolvimento e a implantação de protocolos próprios, por parte dos centros ou unidades que acompanhem esses doentes. (AU)

Patients with genital HPV lesion, as well as partners, usually present higher psychological stress, than the actual medical consequences of the lesion. Follow-up of these patients should be based on education and counseling. HPV molecular tests are not recommended as a follow-up test, or for screening partners. Development and implementation of protocols, by the centers or units, that follow these patients, are recommended. (AU)

Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical / Pharmacological venous thromboembolism prophylaxis in radical prostatectomy

ANTECEDENTES Y OBJETIVO: El tromboembolismo pulmonar es una de las causas más comunes de muerte no quirúrgica en pacientes sometidos a cirugía urológica abdominopélvica. Desde el inicio de la profilaxis para la enfermedad tromboembólica venosa los episodios de trombosis venosa profunda y tromboembolia pulmonar han descendido considerablemente. Nuestro objetivo es analizar los predictores de la enfermedad tromboembólica, la variabilidad clínica en la utilización de la profilaxis farmacológica para esta enfermedad y los resultados de su aplicación. MATERIAL Y MÉTODOS: Estudio retrospectivo multicéntrico de 610 pacientes intervenidos mediante prostatectomía radical entre diciembre de 2013 y noviembre de 2014 en 7hospitales generales de España, Italia y Portugal. Se clasificó a los pacientes según sus características basales en grupos de riesgo trombótico y grupos de riesgo hemorrágico. Se evaluaron los eventos tromboembólicos venosos que se presentaron en los diferentes grupos. RESULTADOS: La edad media fue de 65,22años (48-78). El índice de masa corporal medio fue de 26,7 y la mediana del riesgo de ASA fue 2. En todos los pacientes se inició la deambulación en las primeras 24h. En el 4,1% se utilizó compresión neumática intermitente y en el 84,6%, profilaxis farmacológica con heparinas de bajo peso molecular. Solo en el 3,4% se utilizó la combinación de profilaxis mecánica con la farmacológica. Se observó disminución de la incidencia de eventos tromboembólicos en los pacientes que recibieron profilaxis farmacológica, con una reducción absoluta del riesgo del 6,8%. No se objetivó aumento del riesgo hemorrágico en los pacientes que recibieron profilaxis tromboembólica. CONCLUSIONES: En este estudio sobre pacientes sometidos a prostatectomía radical no hubo diferencia en las complicaciones hemorrágicas derivadas del uso de profilaxis farmacológica para la enfermedad tromboembólica venosa. La profilaxis farmacológica reduce el riesgo de presentar un evento tromboembólico en pacientes sometidos a prostatectomía radical, si bien este riesgo no se asocia con la técnica de abordaje

BACKGROUND AND AIM: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. MATERIAL AND METHODS: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. RESULTS: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. CONCLUSIONS: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique

Pharmacological venous thromboembolism prophylaxis in radical prostatectomy. / Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical.

BACKGROUND AND AIM: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. MATERIAL AND METHODS: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. RESULTS: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. CONCLUSIONS: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique.

Premature Ejaculation: From Physiology to Treatment.

Objective: To review in literature about the concept of premature ejaculation from physiology to treatment. Materials and methods: A literature search conducted with Pubmed and Cochrane. Results: An accurate clinical history is the best diagnostic method, and in the majority of the cases it is enough to differentiate between primary and acquired premature ejaculation. Nowadays the treatment is not curative but is effective in increasing the Intravaginal Ejaculatory Latency Time, improving the couple's sexual satisfaction. Conclusion: Although PE is the most frequent sexual dysfunction, it is still sub-diagnosed. Combining behavioural techniques with pharmacotherapy is the best way of treatment.

[Fulminant Emphysematous Pyelonephritis Secondary to Urothelial Neoplasia with Reno-Colic Fistula]. / Pielonefrite Enfisematosa Fulminante Secundária a Neoplasia Urotelial com Fístula Renocólica.

The emphysematous pyelonephritis is a uncommon and potentially fatal entity. The recognition of this condition enables the early correct management of patients. Diabetes and ureteral obstruction are the main risk factors identified. We present the case of a patient with no relevant risk factors or prior medical history, in which the reason of admission to the emergency department was back pain, eventually evolving into septic shock in the early hours. The imaging tests identified the presence of peri-renal and subcutaneous gas which guided the medical team to the right diagnosis (emphysematous pyelonephritis secondary to fistulized urothelial neoplasia) and the optimal surgical treatment. However, in the post-operative period the patient died, as the clinical condition and laboratory test results performed during the admission were predicting. It should also be mentioned that this same case illustrated a bacteraemia by Sphingomonas Paucimobilis (acquired in the community) with cavitated damage to lungs (probable septic embolism).

A pielonefrite enfisematosa é uma entidade pouco frequente e potencialmente fatal. O reconhecimento desta patologia permite a correta orientação precoce dos doentes. A diabetes e a obstrução ureteral são os principais fatores de risco identificados. Apresenta-se o caso de uma doente saudável, sem fatores de risco conhecidos, em que o motivo de ida ao serviço de urgência foi apenas uma dor lombar, acabando por evoluir com quadro de choque séptico nas primeiras horas. Os exames imagiológicos permitiram identificar a presença de gás perirrenal e subcutâneo o que orientou o correto diagnóstico (pielonefrite enfisematosa secundária a neoplasia urotelial fistulizada) e tratamento cirúrgico. Contudo, e como o estado clínico e analítico à admissão e no pós-operatório faziam prever a doente acabou por falecer. De referir ainda que este mesmo caso documenta uma bacteriemia por Sphingomonas paucimobilis (adquirida na comunidade) com lesões cavitadas a nível pulmonar (provável embolismo séptico).

Influence of secondary diagnoses in the development of urinary incontinence after radical prostatectomy.

OBJECTIVE: To study whether there are factors related to secondary diagnoses (SDg) present in patients with prostate cancer that influence the development of urinary incontinence after radical prostatectomy (RP). MATERIALS AND METHODS: A retrospective multicenter observational study was performed reviewing the medical records of 430 men who underwent RP due to organ-confined prostate cancer in 9 different hospitals. Two study groups were distinguished: Group A (GA): Patients without urinary incontinence after RP; Group B (GB): patients with any degree of post-surgical urinary incontinence. RESULTS: Average age at surgery was 63.42 years (range 45-73). 258 patients were continent after surgery and 172 patients complaint of any degree of incontinence after RP. A higher percentage of healthy patients was found in group A (continent after surgery) than in group B (p = 0.001). The most common SDg prior to surgery were hypertension, lower urinary tract symptoms, dyslipidemia, diabetes mellitus and erectile dysfunction, but none did show a greater trend towards post-surgical incontinence. CONCLUSIONS: A better health status prior to surgery is associated to a lower incidence of new-onset urinary incontinence after radical prostatectomy. However, no correlation was found between the most common medical disorders and the development of post-surgical urinary incontinence.

Pararenal sclerosing PEComa.

Small renal or pararenal masses and retroperitoneum lesions are extremely difficult to diagnose. Imaging technology is a precious diagnostic tool; however, it places physicians in a difficult position since many lesions are not precisely diagnosed. Clinical and radiological findings can guide suspicion towards the diagnosis; however, in our current practice most diagnoses are based on histological findings. We aim to present a pararenal sclerosing perivascular epithelioid cell tumour (PEComa), a rare entity, whose diagnosis is only possible through invasive approaches and histological analysis. This rare lesion not only is difficult to diagnose but also has an uncertain behaviour, which is of major importance concerning its follow-up and prognosis. This case report is an attempt to add more data that will help establish criteria for diagnosis and follow-up of this rare disease.

Adrenal ganglioneuroma: a rare incidental finding.

The widespread use of imaging technology as a diagnostic tool has resulted in the identification of many previously unknown, clinically benign lesions. The current era of easy access to imaging studies places physicians in a difficult position, since many lesions are not precisely diagnosed by imaging. For example, the accurate diagnosis of non-functioning adrenal lesions remains a clinical challenge. This report describes a patient with the incidental CT finding of an uncommon adrenal ganglioneuroma. Clinical and radiological findings can guide suspicion towards this rare lesion; however, the actual diagnosis is based on histological findings. Specific characteristics of adrenal ganglioneuromas that would allow their diagnosis without invasive procedures have not been established. This case report is an attempt to add more data that will help to establish diagnostic criteria for this rare disease.