Outbreak of equine pythiosis in a southeastern region of Brazil: Environmental isolation and phylogeny.

Pythiosis is a disease caused by the oomycete Pythium insidiosum, mainly reported in equines, dogs and humans and directly transmitted through contaminant zoospores in aquatic environments. We report the first outbreak of equine pythiosis in five equines. Wound samples were submitted for diagnostic testing including mycological culture and nested PCR. Treatment approaches consisted of conventional and alternative therapies. Microbiological analyses were performed using water samples from the riverbanks close to where the animals had grazed. All animals were positive for P. insidiosum cultures, and two animals responded successfully to alternative therapy (ozone therapy). After culture and molecular analysis of environmental samples, the presence of P. insidiosum in one section of the Tietê River was confirmed through a 99% sequence identity. Phylogenetic analyses using the cytochrome oxidase II gene showed that the animal isolates clustered in clade I and the environmental isolates clustered in clade III. Although the environmental and wound isolates belonged to different genetic clades, we concluded that the Tietê River is an important source of infection by P. insidiosum and that research concerning environmental isolation of P. insidiosum from rivers and lakes should be strongly facilitated in Brazil.

Downregulation of miR-29b is associated with Peyronie's disease.

BACKGROUND: Peyronie's disease (PD) is characterized by the formation of fibrous plaque in tunica albuginea, causing several problems in patients. The etiology of this disease is not fully understood, and there are few effective treatments. To better understand the molecular pathways of PD, we studied miR-29b, a microRNA that could be involved with this illness. MicroRNAs are endogenous molecules that act by inhibiting messenger RNA. MiR-29b regulates 11 of 20 collagen genes and the TGF-ß1 gene, which are related to PD progression. METHODS: We compared miR-29b expression in 11 patients with PD and 14 patients without PD (control group). For the patients with PD, we utilized samples from the fibrous plaque (n = 9), from the tunica albuginea (n = 11), and from the corpus cavernosum (n = 8). For the control group, we utilized samples from the tunica albuginea (n = 14) and from the corpus cavernosum (n = 10). MiR-29b expression was determined by q-PCR. RESULTS: We found a downregulation of miR-29b in the fibrous plaque, tunica albuginea and corpus cavernosum of patients with PD in comparison with the control group (p = 0.0484, p = 0.0025, and p = 0.0016, respectively). CONCLUSION: Although our study has a small sample, we showed for the first time an evidence that the downregulation of miR-29b is associated with PD.

Impact of COVID-19 Pandemic on the Sexual Function of Health Professionals From an Epicenter in Brazil.

INTRODUCTION: The pandemic caused by the COVID-19 resulted in worldwide social isolation and leading to significant personal distress, particularly among health professionals on the front lines. Those factors' relevance and their impact on sexual function in this population have not yet been established. AIM: To evaluate the impact of the pandemic on sexual function in healthcare professionals and medical students at a reference center in the treatment of COVID-19 in Brazil. METHODS: A cross-sectional analysis with online questionnaires about sexual function was sent to health professionals and medical students from the HC-FMUSP medical complex. The questionnaire evaluated Total Sexual and Masturbatory Frequency prior and during the pandemic, libido and sexual satisfaction changes with a detailed inquire about demographics and personal factors. An objective assessment of sexual function was also made using the validated sexual quotient questionnaires. MAIN OUTCOME MEASURES: Differences in intercourse frequency, libido, and overall sexual satisfaction, in a sample of healthcare professionals particularly vulnerable to the pandemic effects. RESULTS: A total of 1,314 responses were available with a mean age of 37 years. Worsening of sexual satisfaction was reported by 44.5% of the participants, with the following associated factors: Lower libido, missing Nightlife, Higher Masturbatory Frequency, and isolation from the partner. Remaning sexualy actively and having higher sexual frequency appear to decrease the chance of worsening sexual function. Worsening of Libido was reported by 37% and had several associated factors, including missing of Nightlife, older age, isolation from the partner among others. Being male and sexually active was associated with a smaller chance of reporting lower libido. CONCLUSION: We were able to observe a sharp drop in Libido and General Sexual Satisfaction. Although an increase in pornography consumption and masturbatory frequency did occur, these factors were not associated with greater sexual satisfaction. The impact of COVID-19 on this population's sexual health is not to be underestimated and should be further studied in the follow-up of the pandemic. Neto RP, Nascimento BCG, Carvalho dos Anjos Silva G, et al. Impact of COVID-19 Pandemic on the Sexual Function of Health Professionals From an Epicenter in Brazil. Sex Med 2021;9:100408.

Audiovisual Sexual Stimulation Improves Diagnostic Accuracy of Penile Doppler Ultrasound in Patients With Erectile Dysfunction.

INTRODUCTION: Although penile Doppler ultrasound (PDU) is a useful tool in evaluating erectile dysfunction (ED), an optimal erectile response might be limited because of an increased sympathetic discharge. Audiovisual sexual stimulation (AVSS) has been suggested to help improving PDU performance. AIM: To evaluate the use of AVSS as a tool to improve diagnostic accuracy of PDU studies. METHODS: A total of 40 men (mean age: 61.8 ± 10.2 years) with ED were enrolled. PDU sessions were performed in a randomized fashion as follows: session A under intracavernous injection (ICI) alone and session B under ICI and AVSS with 7-day interval between sessions. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured 5, 10, 15, and 20 minutes after ICI. MAIN OUTCOME MEASURE: Comparisons between PSV, EDV, and RI values were performed with and without AVSS. Univariable and multivariable analyses including clinical and demographic parameters were performed to evaluate predictors of an abnormal PDU. RESULTS: 23 patients performed the first session without AVSS, and 17 performed the first session with AVSS. EDV and RI were better in AVSS session (p = 0.022 and 0.019). PSV was not influenced by AVSS (p = 0.768). The proportion of patients whose diagnosis was changed because of the AVSS was 4 of 40 (10.0%, 95% confidence interval [CI]: 2.8-23.7%). Of 12 patients with venous leak observed on the PDU without AVSS, 3 turned into normal after AVSS (25.0%, 95% CI: 5.5-57.2%). Of 4 men with arterial insufficiency observed on the PDU on ICI alone, 1 became normal after AVSS (25.0%, 95% CI: 0.6-80.6%). International Index of Erectile Function-5 scores were lower in patients with abnormal PDU (6.3 ± 3.3 vs 12.0 ± 5.8, p=0.003). On multivariable analysis, DM and International Index of Erectile Function-5 scores were the only independent predictors of abnormal PDU studies. CLINICAL IMPLICATIONS: False diagnoses of venous leak during PDU with ICI could be a result of an increased adrenergic discharge during the examination. Routine AVSS may be helpful to avoid error in diagnosis. STRENGTH & LIMITATIONS: The study has randomized the use of AVSS in different session orders. Only one previously published study has used this strategy to control the accommodation effect in repeat studies, a common source of bias in the PDU literature. The main limitation is the absence of a rigidity assessment and a redosing protocol. CONCLUSION: Adding AVSS during PDU improves ICI response and may help clinicians evaluate penile hemodynamics more accurately. Carneiro F, Nascimento B, Miranda EP, et al. Audiovisual Sexual Stimulation Improves Diagnostic Accuracy of Penile Doppler Ultrasound in Patients With Erectile Dysfunction. J Sex Med 2020;17:249-256.

Low-intensity shockwave therapy for erectile dysfunction in kidney transplant recipients. A prospective, randomized, double blinded, sham-controlled study with evaluation by penile Doppler ultrasonography.

OBJECTIVES: To study the efficacy of Low intensity Extracorporeal Shockwave Therapy (Li- ESWT) for the treatment of erectile dysfunction (ED) in kidney transplanted men. METHODS: Twenty men (mean age = 53.7 years) were selected. This was a double-blinded, prospective, randomized, sham-controlled trial. The ESWT protocol was based in a 2 treatment sessions per week for 3 weeks. The sham treatment was performed using the same device replacing the effective probe for one that emits zero energy. Baseline and follow-up assessment was performed with International Index of Erectile Function Questionnaire (IIEF) score and Erection Hardness Score (EHS) after 1, 4 and 12 months. Penile Doppler was performed before and after treatment. RESULTS: A total of 20 patients were recruited, 10 patients in each group. Baseline scores were similar. The mean EHS in after 1 month were 2.5 ± 0.85 (Li-EWST) and 2.4 ± 0.7 (Sham therapy), p = 0.724 . After 4 months it was 2.4 ± 0.7 and 2.6 ± 0.84, p = 0,0004 (between the moments) . The baseline IIEF score was 14.9 ± 3(Sham Theraphy) and 10.9 ± 5.1 (Li-EWST). The mean IIEF score after 1 month was 15.6 ± 6.1 (Li-EWST) and 16.6 ± 5.4 (Sham therapy). The mean IIEF score after 4 months was 17.2 ± 5.7 (Li-EWST) and 16.5 ± 5 (Sham therapy), p < 0.0001 (between the moments). IIEF score improvement was higher than 5 in 70% (ranged from 0-10) and in 10% (ranged from 1-14) in Li-ESWT and Sham groups, respectively. The mean change in IIEF score after 12 months was 4.8 in Li-ESWT group .Penile Doppler parameters were similar between groups and did not present improvements. CONCLUSIONS: Li-ESWT is a treatment with clinical efficacy. Despite evidences suggesting neoagiogenesis, our short protocol had no impact in penile Doppler parameters.

Impact of Camera Deviation on Penile Curvature Assessment Using 2D Pictures.

BACKGROUND: An accurate curvature assessment (CA) is required in the decision-making process for patients with Peyronie's disease. In-office CA following induced erection is the gold standard for CA, although penile photography is commonly used due to its convenience. Camera deviations during 2D image acquisition might affect CA accuracy. AIM: To investigate the impact of camera angle deviations on CA. METHODS: 2D pictures were taken from 5 models with a known uniplanar curvature (40°, 45°, 60°, 90°, and 120°). The model was kept on a fixed point and the camera was rotated around it. Pictures were taken with every 10° increase in camera deviation from the optimal position. The camera rotated to a maximum of 90° deviation in both the vertical and horizontal planes. The pictures were analyzed by 2 different urologists using a goniometer. The expected apparent curvature (AC) and the corresponding picture assessment error (PAE = AC - real model curvature) were also calculated for each picture using trigonometry principles. MAIN OUTCOME MEASURE: Assessing PAE magnitude and patterns was our primary outcome. Secondary outcomes were intraobserver, interobserver, and observer-AC intraclass correlation coefficient (ICC). RESULTS: 100 pictures were analyzed. Intraobserver reliability was high (ICC = 0.99) for both urologists. Interobserver and observer-AC correlation were also high (ICC = 0.996 and ICC = 0.992, respectively). When the camera rotated in the horizontal axis, the PAE underestimated the curvature for models with curvatures smaller than 90° and overestimated the reading of the 120° model. When the camera rotated in the vertical axis, PAE had an inverse effect. The PAE showed a tendency to increase exponentially with higher deviation, reaching almost 100% for a deviation of 80°. Nevertheless, analyzing its magnitude regardless of the curvature, PAE was always <5% for camera deviations of 0-20°. CLINICAL IMPLICATIONS: If using picture-based CA, clinicians should attempt to take a picture perpendicular to the curvature plane for the most accurate measurement in degrees. Many clinicians request that patients take 3 pictures in a standard fashion (craniocaudal, lateral, and frontal), and if this technique is to be used, an extra picture is recommended. STRENGTH & LIMITATIONS: In our controlled environment, we were able to isolate CA errors due to camera angles from other confounders such as erection hardness. As a consequence, however, our results cannot be easily generalized. CONCLUSION: PAE due to non-optimal camera position is a complex phenomenon that affects CA depending on the rotation axis and the degree of penile curvature. Nevertheless, PAE is always <5% for camera deviations of 0-20°. Nascimento B, Cerqueira I, Miranda EP, et al. Impact of Camera Deviation on Penile Curvature Assessment Using 2D Pictures. J Sex Med 2018;15:1638-1644.

Gastrointestinal and pulmonary nematodes in calves naturally infected in the cities of Botucatu and Manduri, in the Brazilian state of São Paulo / Nematódeos gastrintestinais e pulmonares em bezerros naturalmente infectados nos municípios de Botucatu e Manduri, estado de São Paulo

This study aimed to determine the occurrence of gastrointestinal and pulmonary parasites in calves and to evaluate seasonal and age patterns in parasitism. For this, we used 140 clinically healthy crossbreed calves (two to 12 months old) that belonged to two private farms in the municipalities of Botucatu (n=53) and Manduri (n=87), São Paulo state, Brazil. The calves were monitored for 12 months (from September 2014 to August 2015). Fecal samples were collected directly from the rectum every three months. Fecal egg counts were determined using the modified McMaster technique with a sensitivity of 50 eggs per gram of feces (EPG). Coproculture was performed on pooled samples to identify Strongylida infective larvae. First-stage larvae of Dictyocaulus viviparus were extracted by a modified Baermann method. The data showed non-normal distribution (Shapiro-Wilk) and the nonparametric Kruskall-Wallis test was employed to evaluate the EPG data by seasons and age groups. Dunn's post-test was used for multiple comparisons (P<0.05). The calves from Manduri farm showed significantly higher fecal egg counts (P<0.0001) in the winter when compared to other seasons. At Botucatu farm, young calves (2-3 months old) showed significantly higher EPG than old calves (8-12 months) (P=0.01). The prevalence and overall mean of animals positive for Strongylida type-eggs were 81.1% and 340 in Botucatu, respectively, versus 83.9% and 854 in Manduri, respectively. Furthermore, we found Strongyloides spp., Moniezia spp., and Trichuris spp. eggs and Eimeria spp. oocysts. The prevalent genera in all coprocultures in decreasing order were: Cooperia spp., Haemonchus spp., Oesophagostomum spp., and Trichostrongylus spp. First-stage larvae of Dictyocaulus viviparus were found only in Botucatu farm samples throughout the year, except in spring.(AU)

O objetivo deste estudo foi investigar os parasitas gastrintestinais e pulmonares que acometem bezerros bem como a possível influência de fatores climáticos e da idade no parasitismo. Para isso, durante um período de 12 meses (setembro de 2014 a agosto de 2015), amostras de fezes foram coletadas a cada três meses diretamente da ampola retal de 140 bezerros mestiços (dois a 12 meses de idade), clinicamente saudáveis, pertencentes a duas propriedades leiteiras localizadas nos municípios de Botucatu (n=53) e Manduri (n=87), estado de São Paulo. Realizou-se a contagem de ovos por grama de fezes pela técnica de McMaster modificada com sensibilidade de 50 ovos por grama de fezes (OPG). Coproculturas foram realizadas em pool de amostras para a obtenção das larvas infectantes (L3). Larvas de primeiro estágio de Dictyocaulus viviparus foram recuperadas pela modificação da técnica de Baermann. Os dados não se apresentaram normalmente distribuídos (Shapiro-Wilk), e o teste não paramétrico de Kruskal-Wallis foi utilizado para avaliar os dados de OPG em relação às estações do ano e faixa etária. Para comparações múltiplas, empregou-se o pós-teste de Dunn. Foi verificado que em Manduri, no inverno, houve um aumento significativo (P<0,0001) na contagem de OPG em comparação as demais estações do ano. Em Botucatu, os animais com dois a três meses de idade apresentaram maiores contagens de OPG quando comparados aos animais de oito a 12 meses de idade (P=0,01). A prevalência e a média global de animais positivos para ovos do tipo Strongylida, em Botucatu, foi de 81,1% e 340, respectivamente, e em Manduri foi de 83,9% e 854, respectivamente. Em adição, de maneira geral, foram encontrados ovos de Strongyloides spp., Moniezia spp., Trichuris spp. e oocistos de Eimeria spp. Foram recuperadas, em ordem de prevalência, larvas infectantes de Cooperia spp., Haemonchus spp., Oesophagostomum spp. e Trichostrongylus spp. Larvas de D. viviparus foram recuperadas somente na propriedade de Botucatu durante todo o ano, com exceção da primavera.(AU)

Recurrent Penile Fracture-Case Report and Alternative Surgical Approach.

INTRODUCTION: Penile refracture is an exceedingly rare event, with very few published studies. To the best of our knowledge, this is the first documented case in the literature of penile fracture with 3 same-site recurrences. AIMS: To describe the case of a 25-year-old Caucasian man with recurrent penile fracture ultimately treated with resuture and patch reinforcement. METHODS: Patient history (clinical and surgical) and literature review. RESULTS: After the 3rd same-site recurrence, patch reinforcement over the sutured area was performed. The patient had an uneventful recovery and no recurrences to date. CONCLUSION: There is no evidence indicating the superiority of non-absorbable sutures. Bovine pericardium reinforcement over the sutured area was used to minimize the chance of another recurrence. More studies are necessary to investigate its safety and efficacy in this scenario. Nascimento B, Guglielmetti GB, Miranda EP, et al. Recurrent Penile Fracture-Case Report and Alternative Surgical Approach. Sex Med 2018;6:263-266.

Fluoroquinolones and the Risk of Achilles Tendon Disorders: Update on a Neglected Complication.

OBJECTIVE: To evaluate the current evidence and to identify associated risk factors that increase the incidence of this complication. Fluoroquinolone (FQ) has been considered the first-line therapy for uncomplicated urinary infections. FQ has been associated with Achilles tendon disorders, especially during the first month of treatment. METHODS: Data sources searched included PubMed, MEDLINE, and Scopus from January 1988 to June 2017. RESULTS: A total of 79 articles were used, with ciprofloxacin representing the most common drug. CONCLUSION: We found that male gender, advanced age, normal body mass index, chronic renal failure, and concurrent use of corticosteroids increase the risk of Achilles tendon disorders.

Low serum testosterone is a predictor of high-grade disease in patients with prostate cancer.

OBJECTIVE: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. METHOD: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. RESULTS: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). CONCLUSION: Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.

Low serum testosterone is a predictor of high-grade disease in patients with prostate cancer / Baixa testosterona sérica é prognóstica de doença de alto grau em pacientes com câncer de próstata

Summary Objective: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. Method: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. Results: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). Conclusion: Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.

Resumo Objetivo: Avaliar a relação entre testosterona sérica total (TT) e grau do câncer de próstata (CP) e o efeito da raça e de características demográficas sobre essa associação. Método: Foram analisados 695 pacientes submetidos a prostatectomia radical (PR), dos quais 423 tinham medidas dos níveis séricos de TT. Os pacientes foram classificados como portadores de hipogonadismo ou eugonadismo com base em dois limites de testosterona: limite 1 (300 ng/dL) e limite 2 (250 ng/dL). Avaliou-se a relação entre nível de TT e escore Gleason (GS) ≥ 7 em amostras de PR. Os resultados foram avaliados por análises univariada e multivariada, com ajuste para raça e outros fatores prognósticos demográficos. Resultados: Do total de 423 pacientes, 37,8% apresentavam hipogonadismo com base no limite 1, e 23,9% com base no limite 2. Os pacientes com hipogonadismo, independentemente do limite de referência, tiveram uma chance maior de GS ≥ 7 (OR 1,79, p=0,02 e OR 2,08, p=0,012, respectivamente). Na análise multivariada, após ajuste para idade, TT, índice de massa corporal (IMC) e raça, baixo TT (p=0,023) e idade (p=0,002) foram considerados fatores de risco independentes para GS ≥ 7. Entre os indivíduos negros, baixo TT sérico foi mais preditivo de doença de alto grau em comparação com os brancos (p=0,02). Conclusão: O hipogonadismo é independentemente associado a escores mais altos de GS no CP localizado. O efeito dessa associação é significativamente mais pronunciado entre homens negros, o que poderia explicar, em parte, as características agressivas do CP observadas nessa população.

Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve.

INTRODUCTION: Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. MATERIALS AND METHODS: Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. RESULTS: By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p < 0.001) was obtained, being necessary 4.26 (∼five sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. CONCLUSIONS: This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to a more difficult training tasks level.

Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve

Introduction Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. Materials and Methods Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. Results By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p < 0.001) was obtained, being necessary 4.26 (∼five sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. Conclusions This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to ...

Long-term Treatment Outcomes Between Surgical Correction and Conservative Management for Penile Fracture: Retrospective Analysis.

PURPOSE: Early surgical management is the standard of care for penile fracture. Conservative treatment is an option with recent reports revealing lower success rates. We reviewed the data and long-term outcomes of patients with penile injury submitted to surgical or conservative treatment. MATERIALS AND METHODS: Between January 2004 and February 2012, 42 patients with penile blunt trauma on an erect penis were admitted to our center. We analyzed the following variables: age, etiology, symptoms and signs, diagnostic tests, treatment used, complications and erectile function during the follow-up. One patient was excluded due to missing information. Thirty-five patients underwent surgical repair and 6 patients were submitted to conservative management. RESULTS: Mean follow-up was 19.2 months (range, 7 days to 72 months). The mean elapsed time from trauma to surgery was 21.3±12.5 hours. Trauma during sexual relationship was the main cause (80.9%) of penile fracture. Urethral injury was present in five patients submitted to surgery. Dorsal vein injury occurred in three patients with false penile fracture and concomitant spongious corpus lesion was present in three patients. During follow-up, 31 cases (88.6%) of the surgical group and four cases (66.7%) of the conservative group reported sufficient erections for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining two patients (33.3%) from the conservative group developed erectile dysfunction and three patients (50%) developed penile deviation. CONCLUSIONS: Surgical approach provides excellent functional outcomes and lower complications. Early surgical management of penile fracture provides superior results and conservative approach should be avoided.

Interactions between lower urinary tract symptoms and cardiovascular risk factors determine distinct patterns of erectile dysfunction: a latent class analysis.

PURPOSE: An epidemiological association between lower urinary tract symptoms and erectile dysfunction is well established. However, interactions among multiple risk factors and the role of each in pathological mechanisms are not fully elucidated MATERIALS AND METHODS: We enrolled 898 men undergoing prostate cancer screening for evaluation with the International Prostate Symptom Score (I-PSS) and simplified International Index of Erectile Function-5 (IIEF-5) questionnaires. Age, race, hypertension, diabetes, dyslipidemia, metabolic syndrome, cardiovascular disease, serum hormones and anthropometric parameters were also evaluated. Risk factors for erectile dysfunction were identified by logistic regression. The 333 men with at least mild to moderate erectile dysfunction (IIEF 16 or less) were included in a latent class model to identify relationships across erectile dysfunction risk factors. RESULTS: Age, hypertension, diabetes, lower urinary tract symptoms and cardiovascular event were independent predictors of erectile dysfunction (p<0.05). We identified 3 latent classes of patients with erectile dysfunction (R2 entropy=0.82). Latent class 1 had younger men at low cardiovascular risk and a moderate/high prevalence of lower urinary tract symptoms. Latent class 2 had the oldest patients at moderate cardiovascular risk with an increased prevalence of lower urinary tract symptoms. Latent class 3 had men of intermediate age with the highest prevalence of cardiovascular risk factors and lower urinary tract symptoms. Erectile dysfunction severity and lower urinary tract symptoms increased from latent class 1 to 3. CONCLUSIONS: Risk factor interactions determined different severities of lower urinary tract symptoms and erectile dysfunction. The effect of lower urinary tract symptoms and cardiovascular risk outweighed that of age. While in the youngest patients lower urinary tract symptoms acted as a single risk factor for erectile dysfunction, the contribution of vascular disease resulted in significantly more severe dysfunction. Applying a risk factor interaction model to prospective trials could reveal distinct classes of drug responses and help define optimal treatment strategies for specific groups.

Penile enlargement with methacrylate injection: is it safe?

CONTEXT Penis size is a great concern for men in many cultures. Despite the great variety of methods for penile augmentation, none has gained unanimous acceptance among experts in the field. However, in this era of minimally invasive procedure, injection therapy for penile augmentation has become more popular. Here we report a case of methacrylate injection in the penis that evolved with penile deformity and sexual dysfunction. This work also reviews the investigation and management of this pathological condition. CASE REPORT A 36-year-old male sought medical care with a complaint of penile deformity and sexual dysfunction after methacrylate injection. The treatment administered was surgical removal. Satisfactory cosmetic and functional results were reached after two months. CONCLUSIONS There is a need for better structured scientific research to evaluate the outcomes and complication rates from all penile augmentation procedures.

Penile enlargement with methacrylate injection: is it safe? / Aumento peniano com injeção de metacrilato: isto é seguro?

Penis size is a great concern for men in many cultures. Despite the great variety of methods for penile augmentation, none has gained unanimous acceptance among experts in the field. However, in this era of minimally invasive procedure, injection therapy for penile augmentation has become more popular. Here we report a case of methacrylate injection in the penis that evolved with penile deformity and sexual dysfunction. This work also reviews the investigation and management of this pathological condition.

A 36-year-old male sought medical care with a complaint of penile deformity and sexual dysfunction after methacrylate injection. The treatment administered was surgical removal. Satisfactory cosmetic and functional results were reached after two months.

There is a need for better structured scientific research to evaluate the outcomes and complication rates from all penile augmentation procedures. .

O tamanho peniano é uma grande preocupação para homens em diversas culturas. Apesar da grande variedade de possíveis métodos para o aumento peniano, nenhum ganhou aceitação unânime por especialistas no assunto. Mas na era dos procedimentos minimamente invasivos, a terapia de injeção para aumento peniano tem se tornado mais popular. Aqui relatamos um caso de injeção de metacrilato no pênis que evoluiu com deformidade peniana e disfunção sexual. Este trabalho também revisa a investigação e gerenciamento desta afecção.

Um homem de 36 anos procurou atendimento médico com queixa de deformidade peniana e disfunção sexual após injeção de metacrilato. Remoção cirúrgica foi realizada como tratamento. Após dois meses, satisfatórios resultados cosmético e funcional foram alcançados.

Trabalhos científicos mais bem estruturados para avaliar as taxas de complicação e resultados de todos os procedimentos para aumento peniano são necessários. .

Evaluation of the hypothalamus-pituitary axis response to exogenous GnRH, estradiol benzoate, and LH during the postpartum period in Nellore cows.

The objective was to evaluate when the LH reserve was re-established in postpartum Nellore (Bos indicus) cows by evaluating the response of the hypothalamic-pituitary axis responsiveness to exogenous GnRH or estradiol benzoate (EB). Additionally, we tested the influence of dietary supplementation (SUPL) and calf removal (CR) on the duration of postpartum anestrus. Ninety multiparous lactating Nellore cows were randomly assigned to eight groups. The EB and GnRH groups received 1.0 mg EB (N = 7), and 50 µg lecireline (N = 16), respectively. Additional cows were given the same hormones, and subjected to either nutritional supplementation (EB-SUPL, N = 9; GnRH-SUPL, N = 16), or calf removal at 72 hours after calving (EB-CR, N = 4; GnRH-CR, N = 13). The remaining two groups were the LH (12.5 mg, N = 14) and control groups (saline, N = 11). Hormones were administered weekly from 7 (±5) days postpartum to first ovulation (detection of a CL during a weekly ultrasonographic examination). Blood samples were collected just before and 2 hours (GnRH, LH, and control groups) or 18 hours (EB groups) after hormone or saline (control) administration. Ovulation occurred as early as 15 days postpartum in the GnRH group. The mean ± SEM intervals (days) from calving to first ovulation were EB, 87.7 ± 4.2; EB-CR, 20.3 ± 1.2; EB-SUPL, 60.3 ± 3.2; GnRH, 40.4 ± 2.1; GnRH-CR, 21.0 ± 1.1; GnRH-SUPL, 26.4 ± 1.1; LH, 35.6 ± 1.1; and control, 60.9 ± 2.1. We concluded that there was sufficient LH in the pituitary gland (of Nellore cows) from the second week postpartum to induce ovulation in response to exogenous GnRH. Additionally, calf removal and nutritional supplementation reduced, by 2 to 4 weeks, the interval from calving to an LH increase and ovulation induced by GnRH or EB.