Relationship between sexual position and severity of penile fracture.

The objective of the study was to evaluate the relationship between the sexual position and severity of penile fracture (PF). We studied 90 patients with PF. The mechanism of injury and the sexual position was assessed. We divided our sample by the etiology of the fracture in six groups: (a) masturbation or penile manipulation; (b) 'man-on-top' position; (c) 'doggy style' position; (d) 'woman-on-top' position; (d) blunt trauma; and (e) 'rolling over' fracture. We used the χ2-test for contingency analysis of the populations under study (P<0.05). The patient's age ranged from 18 to 66 years (mean 39 years). Investigation of the injury mechanism identified sexual trauma as the main etiological factor, involved in 69 cases (76.5%). The sexual position at the time of injury varied, with 23 cases (25.5%) occurring in the 'man-on-top', 37cases (41%) in the 'doggy style' and 9 cases (10%) in the 'woman-on-top'. We do not observe differences between the severity of the PF between the 'doggy style' and 'man-on-top' (P=0.9595), but the 'doggy style' had more severity of PF when compared with 'woman-on-top' (P=0.0396) and penile manipulation (P=0.0026). The 'man-on-top' and 'doggy style' positions showed more associations with bilateral fractures of the corpus cavernosum and urethral lesions.

Genetic imbalances in 26 cases of penile squamous cell carcinoma.

To obtain more information on chromosomal changes in the up-to-now poorly studied tumor class of penile squamous cell carcinoma (SCC), we performed a comparative genomic hybridization study of 26 cases of this rare tumor. DNA sequence copy number alterations (CNAs) very similar to those detected in other SCC types, such as oral and esophageal SCC, were noted. The most common copy number gains were found in 8q24, 16p11-12, 20q11-13, 22q, 19q13, and 5p15, and the most common deletions were detected in 13q21-22, 4q21-32, and along the X chromosome. Classifying the patients according to the number of CNAs showed a possible correlation with clinical outcome.

Determination of telomerase activity in squamous cell carcinoma of the penis.

Telomerase activity was studied in 51 penile carcinomas, and detected in all samples from 3 patients with verrucous carcinoma, in 85.4% (41/48) of invasive carcinomas, in 81.8% (9/11) of adjacent non-cancerous skin and in 80% (8/10) of adjacent non-cancerous corpus cavernosum. All skin and corpus cavernosum samples from patients with prostatic carcinoma were found to be telomerase negative. Our results indicate a correlation between frequency of telomerase activity and grade of penile carcinoma. The finding of telomerase activity in skin and corpus cavernosum samples adjacent to tumor suggests that unidentified local factors may modulate telomerase activity in normal tissues.

[Penile cancer: flow cytometry study of ploidies in 90 patients]. / Cancer du pénis: étude de la ploïdie par cytométrie de flux chez 90 patients.

OBJECTIVE: To evaluate prospectively 90 consecutive cases of squamous cell carcinoma of penis, referred to our Institute, by flow cytometry analysis of cellular DNA content. To compare deoxyribonucleic acid (DNA) flow cytometry with clinical and pathological variables to determine the prognostic significance of this analysis to guide the selection of patients at high risk for development of lymph node metastases. PATIENTS AND METHODS: We determined the nuclear DNA of tissues in fresh biopsy specimens of 80 patients diagnosed histologically as invasive squamous cell penile carcinoma and in fresh biopsy specimens of 10 patients with verrucous carcinoma of penis. Samples were analyzed with a FACScan flow cytometer, equipped with a doublet discrimination module, using the CellFIT software package for data acquisition and analysis. RESULTS: The DNA pattern was diploid in all samples excised from patients with verrucous carcinoma. According to histological type the frequency of aneuploidy was 5.5% (1 of 18) in well differentiated carcinoma, 28.8% (17 of 59) in moderately differentiated carcinoma and 66.6% (2 of 3) in poorly differentiated carcinoma. CONCLUSION: The frequency of DNA aneuploidy showed correlation with histological type of invasive squamous cell carcinoma of the penis. Preliminary analysis suggests that patients with high DNA index may be at increased risk of metastatic involvement.

[Cancer of the urethra in women: experience of the National Institute of Cancer of Brazil: 1992-1997]. / Cancer de l'urètre chez la femme: expérience de l'Institut National du Cancer du Brésil: 1992-1997.

OBJECTIVE: Describe the results of surgery, radiation therapy and chemotherapy for treatment of primary malignant neoplasms of female urethra. PATIENTS AND METHODS: Since 1982, 31 patients with urethral cancer were evaluated at our institution (follow-up ranging from 0 to 127 months). Ten patients were treated with external beam irradiation and 1 patient received preoperative therapy after surgery. Two patients refused treatment and 1 received chemotherapy. Three patients presented with disseminated metastatic disease at the first examination received exclusively palliative treatment. RESULTS: Five patients have survived from 3 to 10 years following treatment without recurrence. Of 31 patients 18 developed distant metastases during the first 24 months of follow-up irrespective of treatment employed. CONCLUSION: With exception of primary melanoma, prognosis was not related to histologic features. Patients who underwent surgery and radiotherapy had a better survival rate than did those who received radiotherapy alone. Total urethrectomy with appendico-vesicostomy can be an alternative surgical method for entire urethral ivnasive lesions without cystourethrectomy and preserving urinary continence.

Clinical implications of natural killer cytotoxicity in patients with squamous cell carcinoma of the penis.

Impairment of natural cytotoxicity mediated by natural killer (NK) cells may play a role in the pathogenesis of penile carcinoma. The aim of this study was to examine the NK activity profile and its prognostic significance in patients with squamous cell carcinoma of the penis. The NK activity was measured in peripheral blood mononuclear cells (PBMCs) from 39 patients diagnosed histologically as having invasive squamous cell penile carcinoma and 4 patients with verrucous carcinoma of the penis. Of 39 patients with invasive squamous cell carcinoma, 4 had undergone previous penile amputation. According to the prognosis, the patients with invasive squamous cell carcinoma were divided into two groups: with metastasis and without metastasis. The patients were evaluated in relation to clinicopathologic variables using univariate analyses. NK cell activity was significantly decreased in all patients with penile carcinoma when compared with the control groups (p < 0.0001). There was no statistically significant difference between the groups with and without metastasis. We conclude that there is a decrease in NK activity in PBMCs from patients with penile carcinoma and that the presence of advanced disease or metastatic involvement is not responsible for this reduction.

[The value of biopsy of the inguinal lymph nodes in patients with epidermoid carcinoma of the penis]. / Intérêt des biopsies des ganglions inguinaux chez les patients atteints d'un carcinome épidermoïde de verge.

Twenty-four inguinal biopsies were performed in 16 patients with invasive squamous cell carcinoma of the penis. All patients had suspicion of inguinal metastatic involvement. Five patients (31.25%) had inguinal lymph nodes involved with tumor. Among 11 patients with negative biopsies, 8 were evaluated during careful follow-up. Only 3 patients remained free of tumor at 57.61 and 80 months respectively after negative biopsy.

Verrucous carcinoma of the penis: retrospective analysis of 32 cases.

Between 1972 and 1987, 34 patients with verrucous carcinoma of the penis were referred to our national cancer institute. We analyzed retrospectively the followup of 32 patients treated by surgery, exclusive radiotherapy and neoadjuvant chemotherapy. No patient died or had recurrent verrucous penile carcinoma. Lymph nodes removed from 15 patients without previous treatment did not reveal metastatic invasion. Neoadjuvant chemotherapy allowed for more limited surgery in 3 of 6 patients treated.

Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases.

Between 1960 and 1987, 414 patients with invasive squamous cell carcinoma of the penis were referred to the Brazilian National Cancer Institute. Inguinal metastases were demonstrated by lymphadenectomy in 39% of the 23 patients with stage N0, 49% of 92 with stages N1 and N2, and 100% of 18 with stage N3 disease. We analyzed the followup of 350 patients who underwent surgical treatment. In 224 patients (64%) amputation or some form of penile surgery was done initially, while 102 (29%) underwent amputation and lymphadenectomy, and 24 (7%) underwent palliative surgery for advanced squamous cell carcinoma. The statistics revealed a better 5-year survival rate for the patients who underwent lymphadenectomy concomitantly with penile surgery compared to those who underwent delayed lymphadenectomy (p < 0.001). Patients in whom systematic lymphadenectomy was negative had a better prognosis than those with positive systematic lymphadenectomy results (p < 0.001). The latter patients had a better prognosis compared with those in whom delayed lymphadenectomy was positive (p = 0.0103). Patients with well and moderately differentiated carcinoma had a higher survival rate at 5 years than did those with poorly differentiated carcinoma (p < 0.001 and p = 0.003, respectively). All deaths from metastatic disease occurred within 24 months among the patients who underwent systematic lymphadenectomy and within 5 years after simple penile surgery. In the short term, surgical debulking combined with reconstruction techniques allowed for improved quality of life in patients with advanced local-regional disease.

[Uretero-ureterocolic fistula 10 months after enterocystoplasty (Mainz pouch)]. / Fistule urétéro-urétéro-colique 10 mois après entérocystoplastie (poche de Mainz).

We report a case of delayed uretero-ureterocolic fistula after radical cystectomy with bladder substitution. This unusual late complication occurred 10 months postoperatively. The patient developed metabolic hyperchloremic acidosis. Progressively urinary volume diminished and finally the patient stopped to void physiologically. The complex urinary fistula had to be corrected surgically.

Analyses of 200 lymphadenectomies in patients with penile carcinoma.

From 1972 to 1987, 200 consecutive lymphadenectomies were performed in 112 patients with squamous cell carcinoma of the penis. A Gibson incision provided exposure of the iliac and inguinal lymph nodes with a low morbidity rate (5% flap necrosis, 15% wound infection, 16% lymphedema and 9% lymphocele). The controversy surrounding the necessity of iliac lymphadenectomy is discussed, since 305 iliac lymph nodes examined did not have metastatic invasion.