Prótesis penianas: descripción de una serie de implantes con y sin dilatación de cuerpos cavernosos / Penile prostheses: Description of a series of implants with and without dilatation of the corpora cavernosa

INTRODUCCIÓN: El implante de prótesis penianas (PP) es el tratamiento de elección en la disfunción eréctil (DE) refractaria. Tiene una alta tasa de satisfacción (75-100%) y una tasa de complicaciones que varía entre el 2,1-28,8%. La técnica quirúrgica estándar incluye la dilatación de los cuerpos cavernosos (CC) previo a la inserción de los cilindros. Este procedimiento requiere tiempo y es el paso crítico para la ocurrencia de complicaciones. El objetivo de este estudio es describir los resultados de una serie de PP implantadas utilizando las técnicas con y sin dilatación de los CC. MATERIALES Y MÉTODOS: Ciento veinte pacientes con DE refractaria en quienes fue implantada una PP por 2 cirujanos en diferentes centros. Se evaluaron comorbilidades, características operatorias, satisfacción y complicaciones postoperatorias. RESULTADOS: El promedio de edad fue de 61±9,6 años. Las comorbilidades más prevalentes fueron: antecedente de prostatectomía radical, hipertensión arterial y diabetes mellitus. Se instalaron 42 prótesis maleables y 78 hidráulicas. Once pacientes habían tenido previamente una PP. La mediana de tiempo operatorio fue de 70 minutos (35-140). La satisfacción reportada fue de un 95,8%. Diez pacientes presentaron complicaciones. En el grupo en que la cirugía se realizó sin dilatación de los CC (n=80), el tiempo operatorio fue menor que en quienes sí se realizó dilatación de los CC (62,5minutos [35-105] versus 90 minutos [60-140], respectivamente, p < 0,0001). No hubo diferencia en la ocurrencia de complicaciones (p = 0,73) ni en los niveles de satisfacción (p = 0,196) al comparar la técnica con y sin dilatación de los CC. CONCLUSIÓN: En nuestra serie se evidenció un menor tiempo operatorio con la técnica sin dilatación de CC, pero no hubo diferencias en las complicaciones encontradas. Se requiere un estudio prospectivo y aleatorizado para hacer recomendaciones respecto a la dilatación de los CC

INTRODUCTION: Penile prosthesis (PP) implantation is the treatment of choice for refractory erectile dysfunction (ED). They show a high satisfaction rate (75%-100%) and a complication rate that varies between 2.1% and 28.8%. The standard surgical technique includes dilatation of the corpora cavernosa (CC) prior to the insertion of the cylinders. This step takes time and is critical for the occurrence of complications. The aim of this study is to describe the results of a series of PP implanted using the techniques with and without dilatation of the CC. MATERIALS AND METHODS: One-hundred and 20 patients with refractory ED in whom a PP was implanted by 2 surgeons in different centers. Comorbidities, operative characteristics, satisfaction and postoperative complications were evaluated. RESULTS: The average age was 61±9.6 years. The most prevalent comorbidities were: history of radical prostatectomy, high-blood pressure and diabetes mellitus. Forty-two malleable and 78 hydraulic prostheses were implanted. Eleven patients had a previous PP. The median operative time was 70 minutes (35-140). The satisfaction reported was 95.8%. Ten patients presented complications. In the group in which the surgery was performed without dilatation of the CC (n=80), the operative time was shorter (62.5 minutes [35-105] versus 90 minutes [60-140] respectively, p < 0.0001). There was no difference in complications (p = 0.73) or levels of satisfaction (p = 0.196) when comparing the technique with and without dilatation of the CC. CONCLUSION: In our series, a shorter operative time was observed with the technique without dilatation of the CC, but there were no differences in complications. A prospective and randomized study is required to make a stronger recommendation regarding to dilatation of the CC

[Penile prostheses: Description of a series of implants with and without dilatation of the corpora cavernosa]. / Prótesis penianas: descripción de una serie de implantes con y sin dilatación de cuerpos cavernosos.

INTRODUCTION: Penile prosthesis (PP) implantation is the treatment of choice for refractory erectile dysfunction (ED). They show a high satisfaction rate (75%-100%) and a complication rate that varies between 2.1% and 28.8%. The standard surgical technique includes dilatation of the corpora cavernosa (CC) prior to the insertion of the cylinders. This step takes time and is critical for the occurrence of complications. The aim of this study is to describe the results of a series of PP implanted using the techniques with and without dilatation of the CC. MATERIALS AND METHODS: One-hundred and 20 patients with refractory ED in whom a PP was implanted by 2 surgeons in different centers. Comorbidities, operative characteristics, satisfaction and postoperative complications were evaluated. RESULTS: The average age was 61±9.6 years. The most prevalent comorbidities were: history of radical prostatectomy, high-blood pressure and diabetes mellitus. Forty-two malleable and 78 hydraulic prostheses were implanted. Eleven patients had a previous PP. The median operative time was 70minutes (35-140). The satisfaction reported was 95.8%. Ten patients presented complications. In the group in which the surgery was performed without dilatation of the CC (n=80), the operative time was shorter (62.5minutes [35-105] versus 90minutes [60-140] respectively, p<0.0001). There was no difference in complications (p=0.73) or levels of satisfaction (p=0.196) when comparing the technique with and without dilatation of the CC. CONCLUSION: In our series, a shorter operative time was observed with the technique without dilatation of the CC, but there were no differences in complications. A prospective and randomized study is required to make a stronger recommendation regarding to dilatation of the CC.

Macrozoospermia associated with mutations of AURKC gene: first case report in Latin America and literature review / Macrozoospermia asociada con mutaciones del gen AURKC: primer caso clínico en Latinoamérica y revisión de la bibliografía

A Chilean 35-year-old male patient with a history of primary infertility made an appointment at the Unit of Reproductive Medicine at Clínica Las Condes, Santiago, Chile. Multiple semen analyses revealed abnormal sperm morphology as the most prevalent finding. Multiflagellated and macrocephalic spermatozoa were observed and indicated a possible macrozoospermic phenotype. The constant presence of abnormal sperm morphology led the scope of the study to include Aurora Kinase C (AURKC) gene sequencing. The patient was diagnosed with a homozygous mutation of this gene. The mutation was detected in exon 6, type c.744C>G+/+ (P.Y248*) variant. As previously described in the Human Gene Mutation Database (HGMD), this pathogenic variant is associated with macrozoospermia. Although this mutation is not the most frequently observed, it is the first of its kind reported in Latin America

Un chileno de 35 años con antecedentes de infertilidad primaria consultó en la Unidad de Medicina Reproductiva de la Clínica Las Condes, Santiago, Chile. Múltiples espermiogramas revelaron una morfología anormal de los espermatozoides como la anomalía más relevante. Se observaban espermatozoides multiflagelados y macrocefálicos, lo que indicaba un fenotipo de macrozoospermia. La uniformidad del patrón observado condujo a ampliar el enfoque del estudio hacia la secuenciación del gen cinasa Aurora C (AURKC). Al paciente se le diagnosticó una mutación homocigota de este gen. La mutación fue detectada en el exón 6, con la variante c.744C>G+/+ (P.Y248*). Como se ha descrito anteriormente en la Base de Datos de Mutaciones de Genes Humanos (HGMD), esta variante patogénica se asocia a macrozoospermia. Aunque esta mutación no es la que se observa con más frecuencia, es la primera de su tipo notificada en Latinoamérica

Macrozoospermia associated with mutations of AURKC gene: First case report in Latin America and literature review.

A Chilean 35-year-old male patient with a history of primary infertility made an appointment at the Unit of Reproductive Medicine at Clínica Las Condes, Santiago, Chile. Multiple semen analyses revealed abnormal sperm morphology as the most prevalent finding. Multiflagellated and macrocephalic spermatozoa were observed and indicated a possible macrozoospermic phenotype. The constant presence of abnormal sperm morphology led the scope of the study to include Aurora Kinase C (AURKC) gene sequencing. The patient was diagnosed with a homozygous mutation of this gene. The mutation was detected in exon 6, type c.744C>G+/+ (P.Y248*) variant. As previously described in the Human Gene Mutation Database (HGMD), this pathogenic variant is associated with macrozoospermia. Although this mutation is not the most frequently observed, it is the first of its kind reported in Latin America.