Characterization of a novel automated microfiltration device for the efficient isolation and analysis of circulating tumor cells from clinical blood samples.

The detection and analysis of circulating tumor cells (CTCs) may enable a broad range of cancer-related applications, including the identification of acquired drug resistance during treatments. However, the non-scalable fabrication, prolonged sample processing times, and the lack of automation, associated with most of the technologies developed to isolate these rare cells, have impeded their transition into the clinical practice. This work describes a novel membrane-based microfiltration device comprised of a fully automated sample processing unit and a machine-vision-enabled imaging system that allows the efficient isolation and rapid analysis of CTCs from blood. The device performance was characterized using four prostate cancer cell lines, including PC-3, VCaP, DU-145, and LNCaP, obtaining high assay reproducibility and capture efficiencies greater than 93% after processing 7.5 mL blood samples spiked with 100 cancer cells. Cancer cells remained viable after filtration due to the minimal shear stress exerted over cells during the procedure, while the identification of cancer cells by immunostaining was not affected by the number of non-specific events captured on the membrane. We were also able to identify the androgen receptor (AR) point mutation T878A from 7.5 mL blood samples spiked with 50 LNCaP cells using RT-PCR and Sanger sequencing. Finally, CTCs were detected in 8 out of 8 samples from patients diagnosed with metastatic prostate cancer (mean ± SEM = 21 ± 2.957 CTCs/mL, median = 21 CTCs/mL), demonstrating the potential clinical utility of this device.

High-Throughput Automated Microscopy of Circulating Tumor Cells.

Circulating tumor cells (CTCs) have the potential of becoming the gold standard marker for cancer diagnosis, prognosis and monitoring. However, current methods for its isolation and characterization suffer from equipment variability and human operator error that hinder its widespread use. Here we report the design and construction of a fully automated high-throughput fluorescence microscope that enables the imaging and classification of cancer cells that were labeled by immunostaining procedures. An excellent agreement between our machine vision-based approach and a state-of-the-art microscopy equipment was achieved. Our integral approach provides a path for operator-free and robust analysis of cancer cells as a standard clinical practice.

Erectile dysfunction treated with intracavernous stem cells: A promising new therapy?

In the past decades, great interest has been shown in the development of new therapies for erectile dysfunction. Stem cell therapy has generated promising results in numerous preclinical trials in animal models, which is why has led to the development of the first clinical trials in humans. The main cause involved in the pathophysiology of erectile dysfunction is vascular damage related to endothelial and neuronal injury. The interest in stem cell therapy is justified by their capability to differentiate into specific damaged tissues, including endothelium and nervous tissue, and induction of the host own cell proliferation. Despite the great effort of the many studies carried out to date, knowledge about biological effects, therapeutic efficacy and safety of stem cells therapy for erectile dysfunction is still very limited.

Erectile dysfunction treated with intracavernous stem cells: A promising new therapy? / Células madre vía intracavernosa para el tratamiento de la disfunción eréctil: ¿una nueva modalidad terapéutica?

In the past decades, great interest has been shown in the development of new therapies for erectile dysfunction. Stem cell therapy has generated promising results in numerous preclinical trials in animal models, which is why has led to the development of the first clinical trials in humans. The main cause involved in the pathophysiology of erectile dysfunction is vascular damage related to endothelial and neuronal injury. The interest in stem cell therapy is justified by their capability to differentiate into specific damaged tissues, including endothelium and nervous tissue, and induction of the host own cell proliferation. Despite the great effort of the many studies carried out to date, knowledge about biological effects, therapeutic efficacy and safety of stem cells therapy for erectile dysfunction is still very limited

En las últimas décadas, ha habido gran interés en el desarrollo de nuevos tratamientos para tratar la disfunción eréctil. El tratamiento con células madre ha arrojado prometedores resultados en numerosos estudios preclínicos en modelos animales, lo cual ha generado el desarrollo de los primeros ensayos clínicos en seres humanos. Puesto que la principal causa implicada en la fisiopatología de la disfunción eréctil es una lesión vascular asociada con lesión endotelial y neuronal, el interés por el tratamiento con células madre se justifica por la capacidad que tienen para diferenciarse en los distintos tejidos dañados, incluyendo endotelio y tejido neuronal, y en la inducción de la reparación de las propias células del huésped. A pesar del gran esfuerzo de los distintos estudios realizados hasta el momento actual, el conocimiento sobre los efectos biológicos, la eficacia terapéutica y la seguridad del tratamiento con células madre aún se encuentra muy limitado

[Use of tadalafil in the rehabilitation of patients with a history of posterior urethral injury in the context of pelvic fracture]. / Uso de tadalafilo en la rehabilitación de pacientes con antecedente de lesión de uretra posterior en el contexto de fractura pélvica.

OBJECTIVE: To evaluate the tadalafil effect in the treatment of erectile dysfunction as a consequence of posterior urethral injury. MATERIAL AND METHODS: This is a retrospective study that included patients with posterior urethral injury caused by previous pelvic fracture; our patients received emergency urethral alignment and urethroplasty between 8 to 10weeks after trauma. To assess the degree of erectile dysfunction pre- and post-treatment, we applied the questionnaire of International Index of Erectile Function (IIEF-5). Statistics Wilcoxon test and descriptive statistics were performed. RESULTS: Eight patients were included in this study, with an average age of 32.5years; the IIEF scale prior to treatment was on average 8.5 points and increased to 12.36 points with a value of P=.011. DISCUSSION: These eight patients showed erectile dysfunction at the time of IIEF assessment, this due to emergency urethral realignment arising from the trauma caused by pelvic fracture. Treatment with inhibitors of 5-phosphodiesterase (iPDE5) is the first-line treatment in patients with erectile dysfunction because it is efficient, non-invasive and well tolerated. In this study we found results indicating good response to this treatment in 7 out of the 8 patients (87.5%). Only one patient showed no improvement after treatment, due to the presence of risk factors such as age (65years), tobacco use, and high blood pressure. CONCLUSION: The 87.5% of patients with urethral injury medicated with tadalafil were rehabilitated.

Uso de tadalafilo en la rehabilitación de pacientes con antecedente de lesión de uretra posterior en el contexto de fractura pélvica / Use of tadalafil in the rehabilitation of patients with a history of posterior urethral injury in the context of pelvic fracture

Objetivo. Evaluar la utilidad del tadalafilo en el tratamiento de la disfunción eréctil a consecuencia de una lesión uretral posterior. Material y métodos. Estudio retrospectivo que incluyó pacientes con lesión uretral posterior a consecuencia de fractura de pelvis, tratados en primera instancia mediante realineamiento uretral de urgencia y posteriormente uretroplastia término-terminal entre las 8-10 semanas posteriores al trauma. Para evaluar el grado de disfunción eréctil previa y postratamiento con tadalafilo se aplicó el cuestionario Índice Internacional de Función Eréctil (IIEF-5). Se realizó la prueba estadística de rangos de Willcoxon y estadística descriptiva. Resultados. Se incluyeron 8 pacientes en este estudio, los cuales tuvieron una media de edad de los 32,5 años. La escala IIEF previa al tratamiento con tadalafilo estuvo en promedio de 8,5puntos y tuvo un aumento postratamiento de 12,36 puntos, con una valor de p=0,011. Discusión Los 8 pacientes incluidos mostraron disfunción eréctil al momento de la evaluación IIEF, esto debido al realineamiento uretral de urgencia y derivada del trauma ocasionado por la fractura de pelvis. El tratamiento con inhibidores de la 5-fosfodiesterasa (iPDE5) es el de primera línea en pacientes con disfunción eréctil debido a que es eficiente, no invasivo y bien tolerado. En este estudio encontramos resultados que indican buena respuesta a este tratamiento en 7 de los 8 pacientes (87,5%). Solo un paciente no mostró mejoría con el tratamiento, sobresaliendo la presencia de factores de riesgo, como la edad (65 años), el tabaquismo y la hipertensión arterial. Conclusión. Se rehabilitó el 87,5% de los pacientes con lesión uretral medicados con tadalafilo (AU)

Objective. To evaluate the tadalafil effect in the treatment of erectile dysfunction as a consequence of posterior urethral injury. Material and methods. This is a retrospective study that included patients with posterior urethral injury caused by previous pelvic fracture; our patients received emergency urethral alignment and urethroplasty between 8 to 10 weeks after trauma. To assess the degree of erectile dysfunction pre- and post-treatment, we applied the questionnaire of International Index of Erectile Function (IIEF-5). Statistics Wilcoxon test and descriptive statistics were performed. Results. Eight patients were included in this study, with an average age of 32.5 years; the IIEF scale prior to treatment was on average 8.5 points and increased to 12.36 points with a value of P=.011. Discussion. These eight patients showed erectile dysfunction at the time of IIEF assessment, this due to emergency urethral realignment arising from the trauma caused by pelvic fracture. Treatment with inhibitors of 5-phosphodiesterase (iPDE5) is the first-line treatment in patients with erectile dysfunction because it is efficient, non-invasive and well tolerated. In this study we found results indicating good response to this treatment in 7 out of the 8 patients (87.5%). Only one patient showed no improvement after treatment, due to the presence of risk factors such as age (65 years), tobacco use, and high blood pressure. Conclusion. The 87.5% of patients with urethral injury medicated with tadalafil were rehabilitated (AU)

Computed tomography scan in supine and prone positions: an alternative method to detect intramural gas in emphysematous cystitis and to evaluate efficacy after adjuvant continuous intravesical irrigation treatment.

OBJECTIVE: To evaluate the efficacy of continuous intravesical irrigation with saline plus amikacin as adjuvant therapy and to evaluate the computed tomography (CT) scan in supine and prone positions (CystoCT scan) as an alternative diagnostic and evaluation method of intramural gas in emphysematous cystitis (EC) before and after treatment. METHODS: Consecutive patients with a diagnosis of EC who were hospitalized between March 2006 and January 2011 were investigated. The diagnosis was made by CystoCT scan. Treatment consisted of intravenous antibiotics, control of concomitant diseases, and placement of a 3-way urinary catheter for continuous irrigation of 500 mg of amikacin diluted in 1 l of saline given on days 0, 3, and 7. Treatment was considered successful when there was an absence of gas in the bladder wall, the urine culture was negative, there was clinical improvement, and there was an absence of toxicity. RESULTS: Eleven patients were hospitalized with a diagnosis of EC during the study period. Four were excluded from the study, 2 due to the lack of confirmation of the diagnosis with the CystoCT scan. Treatment was successful in all patients; for 6 (86%) this was achieved in 3 days and for 1 (14%) in 7 days. No toxicity was reported. CONCLUSIONS: Continuous intravesical irrigation with saline plus amikacin as adjuvant treatment of EC is an inexpensive, effective, and safe tool that might help conventional treatment and provide a rapid recovery. The CystoCT scan is an alternative method to diagnose and evaluate intramural gas in EC patients. These findings should be challenged in a randomized, multi-centre, placebo-controlled clinical trial.

Identification of viral infections in the prostate and evaluation of their association with cancer.

BACKGROUND: Several viruses with known oncogenic potential infect prostate tissue, among these are the polyomaviruses BKV, JCV, and SV40; human papillomaviruses (HPVs), and human cytomegalovirus (HCMV) infections. Recently, the Xenotropic Murine Leukemia Virus-related gammaretrovirus (XMRV) was identified in prostate tissue with a high prevalence observed in prostate cancer (PC) patients homozygous for the glutamine variant of the RNASEL protein (462Q/Q). Association studies with the R462Q allele and non-XMRV viruses have not been reported. We assessed associations between prostate cancer, prostate viral infections, and the RNASEL 462Q allele in Mexican cancer patients and controls. METHODS: 130 subjects (55 prostate cancer cases and 75 controls) were enrolled in the study. DNA and RNA isolated from prostate tissues were screened for the presence of viral genomes. Genotyping of the RNASEL R462Q variant was performed by Taqman method. RESULTS: R/R, R/Q, and Q/Q frequencies for R462Q were 0.62, 0.38, and 0.0 for PC cases and 0.69, 0.24, and 0.07 for controls, respectively. HPV sequences were detected in 11 (20.0%) cases and 4 (5.3%) controls. XMRV and HCMV infections were detected in one and six control samples, respectively. The risk of PC was significantly increased (Odds Ratio = 3.98; 95% CI: 1.17-13.56, p = 0.027) by infection of the prostatic tissue with HPV. BKV, JCV, and SV40 sequences were not detected in any of the tissue samples examined. CONCLUSIONS: We report a positive association between PC and HPV infection. The 462Q/Q RNASEL genotype was not represented in our PC cases; thus, its interaction with prostate viral infections and cancer could not be evaluated.

Prospective study of prostate cancer's detection rate at our hospital in Northeast Mexican patients with PSA values between 2.6 y 4 ng/ml.

UNLABELLED: SUMMAR OBJECTIVES: To find the detection rate of prostate cancer (PCa) in our population with PSA values between 2.6 and 4 ng/ml. METHODS: We included 33 consecutive patients with a median age of 66 years, that had a Transrectal Ultrasound (TRUS) guided biopsy with PSA between 2.6-4 ng/ml. Patients were divided into 2 groups. Group 1: patients with normal Digital Rectal Examination (DRE) and Group 2: Patients with DRE with asymmetry not definitive of PCa. EXCLUSION CRITERIA: known history of PCa, intraepithelial neoplasia or Positive DRE. Statistical analysis/ Chi square, t-student and Fischer exact test. RESULTS: Twenty eight percent of the patients had positive biopsy for PCa. Fifty six percent were Gleason 6 and 44% Gleason 7. Group 1 had 59%(20) and Group 2 41% (13) in. In Group 1 16% had positive biopsy for PCa vs 46% in group 2 (p 0.04) RR 3.07. CONCLUSIONS: There are traces that the detection rate in our population could be lower in comparison with what has been reported in the literature. DRE is crucial in the initial evaluation; asymmetry could increase 3 fold the risk of having PCa.

Estudio prospectivo sobre la tasa de detección de cáncer de próstata en nuestro hospital en pacientes del Noroeste de México con antígeno prostático específico entre 2, 6 y 4 ng/ml / Prospective study of prostate cancer’s detection rate at our hospital in Northeast Mexican patients with PSA values between 2.6 y 4 ng/ml

OBJETIVO: Encontrar la tasa de detección de Cáncer Prostático (CaP) en nuestra población con Antígeno Prostático Específico (APE) entre 2.6 y 4 ng/ml.MÉTODOS: Se incluyeron 33 pacientes consecutivos, mediana 66 años. se les realizó biopsia transrectal guiada por ultrasonido (BTR-US) con APE entre 2.6 y 4 ng/ml. Se dividieron en 2 grupos. Grupo 1: pacientes con tacto rectal (TR) normal. Grupo 2: pacientes con ligero aumento en la consistencia de la próstata. Criterios de exclusión: CaP, neoplasia intraepitelial o TR evidente de CaP. Análisis estadístico: t de student, Fischer y X2.RESULTADOS: El 28.3% (9) fue positiva para CaP. El 56% (5) presentó CaP Gleason 6 (3+3) y el 44% (4) Gleason 7 (3+4). El 59% (20) se incluyeron en el Grupo 1 y 41% en el Grupo 2. En el grupo 1 16%(3) presentaron CaP vs 46% (6) del grupo 2 (p 0.04), RR=3.07.CONCLUSIÓN: Hay indicios de que la tasa de detección del CaP en la población de estudio pueda ser menor a lo reportado en la literatura. El TR es importante en la evaluación inicial, pequeñas anormalidades incrementan 3 veces el riesgo de CaP(AU)

OBJECTIVES: To find the detection rate of prostate cancer (PCa) in our population with PSA values between 2.6 and 4 ng/ml.METHODS: We included 33 consecutive patients with a median age of 66 years, that had a Transrectal Ultrasound (TRUS) guided biopsy with PSA between 2.6-4 ng/ml. Patients were divided into 2 groups. Group 1: patients with normal Digital Rectal Examination (DRE) and Group 2: Patients with DRE with asymmetry not definitive of PCa. Exclusion criteria: known history of PCa, intraepithelial neoplasia or Positive DRE. Statistical analysis: Chi square, t-student and Fischer exact test.RESULTS: Twenty eight percent of the patients (9) had positive biopsy for PCa. Fifty six percent (5) were Gleason 6 and 44% (4) Gleason 7 (3+4). Group 1 had 59% (20) and Group 2 41% in. In Group 1 16% (3) had positive biopsy for PCa vs 46% (6) in group 2 (p 0.04) RR 3.07.CONCLUSIONS: There are traces that the detection rate in our population could be lower in comparison with what has been reported in the literature. DRE is crucial in the initial evaluation; asymmetry could increase 3 fold the risk of having PCa(AU)

The use of Butea superba (Roxb.) compared to sildenafil for treating erectile dysfunction.

OBJECTIVE: To evaluate the effect of an extract of Butea superba (Roxb.) (BS) compared to sildenafil for treating erectile dysfunction (ED). PATIENTS AND METHODS: An open label study was carried out among 32 men with organic ED to evaluate the response on the International Index of Erectile Function 5 (IIEF-5) to BS, a 'natural health' product (100 mg), compared to 50 mg of sildenafil (a phosphodiesterase-5 inhibitor). After a 1-week wash-out, responders to BS received either 100 mg starch or 100 mg of another batch of BS (double-blind). RESULTS: Of the patients in the BS group, 27 (84%) responded positively, compared with 26 (81%) in the sildenafil group. When assessing the score alone, 12 (38%) had a better score after taking BS, compared to seven (22%) after sildenafil, and eight (25%) had the same score. The results were surprising and could not be repeated in the double-blind part of the study, where no effect of BS was recorded. CONCLUSIONS: A 'natural' health product containing BS was more effective than sildenafil in the first part of the study, but in the second, using another batch of BS, the positive result could not be repeated and no effect was recorded. The conclusion is that the first preparation of BS was most likely blended with a phosphodiesterase-5 inhibitor, later confirmed by the supplier of BS (a natural health products company) after their own analysis.

[Does circumcision affect male's perception of sexual satisfaction?]. / Genitoplastia feminizante en hiperplasia suprarrenal congénita; una o dos etapas quirúrgicas?

SUMMARY OBJECTIVES: To evaluate the effect of circumcision on sexual satisfaction perception in males with stable sexual partners. METHODS: Twenty two heterosexual male adults, sexually active with a stable partner, scheduled for circumcision for medical (MR) or esthetic reasons (ER) at our clinic between June 2005 and June 2006 were included in this study. Men with severe erectile dysfunction (ED) were excluded from the study. These men were surveyed to assess erectile function, penile sensitivity, esthetical penis' appearance, sexual activity and overall satisfaction before the procedure and 12 weeks after. Categorical scores were evaluated with Chi square. RESULTS: Surgical indications were: Phimosis 50%, balanitis 18.2%, condyloma 13.6% and esthetics 13.6%. After the procedure 82% of patients referred an upgrade on the quality of their sexual intercourse, 4.5% referred it diminished and 13.5% referred no change at all. 95.5% of the patients felt better with the appearance of their penis. Almost all areas of sexual satisfaction weren't statistical significant except for the improvement in erectile function (p 0.0007) and perception of sexual events (p 0.04). This improvement on erectile function was reported as shifts from mild to normal on International Index of Erectile Function 5 scores. Premature ejaculation was observed in 31.8%(7) before the procedure and diminished to 13.6%(3). CONCLUSION: Because of our statistic limitations and mix indications for circumcision in the study, we cannot conclude that circumcision might bring certain benefit on sexual satisfaction by itself but certainly does not bring deleterious effects and, when dissatisfaction is associated with local problems, some benefit could be expected.

¿Tiene la circuncisión algún efecto en la percepción de la satisfacción sexual masculina? / Does circumcision affect male’s perception of sexual satisfaction?

OBJETIVO: Evaluar el efecto de la percepción de la satisfacción sexual en hombres, con parejas sexuales estables, posterior a la circuncisión.MÉTODOS: Veintidós hombres heterosexuales, adultos, sexualmente activos con pareja sexual estable que fueron programados para circuncisión en nuestro servicio entre Junio del 2005 y Junio del 2006 por razones medicas o estéticas fueron incluidos en este estudio. Hombres con disfunción eréctil severa fueron excluidos. Los pacientes fueron encuestados para evaluar la función eréctil, la sensibilidad del pene, la apariencia estética, etc. Esta encuesta fue realizada antes del procedimiento y 12 semanas después. Los resultados en cada rubro fueron evaluados con Chi cuadrada.RESULTADOS: Las indicaciones quirúrgicas fueron: Fimosis 50%, Balanitis 18.2%, Condiloma 13.6 % estética 13.6%. Posterior al procedimiento el 82% de los pacientes refirió aumento en la calidad de sus encuentros sexuales, 4.5% refirió que disminuyó y 13.5% que no se modificó. Noventa y cinco por ciento refirió sentirse mejor con la apariencia de su pene. Casi todas los rubros de la satisfacción sexual evaluados en las encuestas no presentaron diferencias estadísticamente significativas a excepción de la mejora en la función sexual (p=0.0007) y la percepción de eventos sexuales (p=0.04). Esta mejora en la función eréctil fue considerada como un cambio en categoría en la clasificación del índice internacional de la función eréctil 5. En 31.8%(7) de los pacientes reporto eyaculación prematura la cual disminuyo a 13.6% (3).CONCLUSIONES: Debido a nuestras limitaciones estadísticas y las indicaciones quirúrgicas heterogéneas para la realización del procedimiento en este estudio, no podemos concluir que la circuncisión traiga consigo un beneficio en la satisfacción sexual por el simple hecho de retirar el prepucio pero definitivamente no provoca efectos deletéreos y cuando la insatisfacción está asociada a problemas locales, puede esperarse algún beneficio(AU)

OBJECTIVES: To evaluate the effect of circumcision on sexual satisfaction perception in males with stable sexual partners.METHODS: Twenty two heterosexual male adults, sexually active with a stable partner, scheduled for circumcision for medical (MR) or esthetic reasons (ER) at our clinic between June 2005 and June 2006 were included in this study. Men with severe erectile dysfunction (ED) were excluded from the study. These men were surveyed to assess erectile function, penile sensitivity, esthetical penis’ appearance, sexual activity and overall satisfaction before the procedure and 12 weeks after. Categorical scores were evaluated with Chi square. RESULTS: Surgical indications were: Phimosis 50%, balanitis 18.2%, condyloma 13.6% and esthetics 13.6%. After the procedure 82% of patients referred an upgrade on the quality of their sexual intercourse, 4.5% referred it diminished and 13.5% referred no change at all. 95.5% of the patients felt better with the appearance of their penis. Almost all areas of sexual satisfaction weren’t statistical significant except for the improvement in erectile function (p 0.0007) and perception of sexual events (p 0.04). This improvement on erectile function was reported as shifts from mild to normal on International Index of Erectile Function 5 scores. Premature ejaculation was observed in 31.8%(7) before the procedure and diminished to 13.6%(3).CONCLUSION: Because of our statistic limitations and mix indications for circumcision in the study, we cannot conclude that circumcision might bring certain benefit on sexual satisfaction by itself but certainly does not bring deleterious effects and, when dissatisfaction is associated with local problems, some benefit could be expected(AU)

Population based prostate cancer screening in north Mexico reveals a high prevalence of aggressive tumors in detected cases.

BACKGROUND: Prostate Cancer (PCa) is the second most frequent neoplasia in men worldwide. Previous reports suggest that the prevalence of PCa in Hispanic males is lower than in Africans (including communities with African ancestry) and Caucasians, but higher than in Asians. Despite these antecedents, there are few reports of open population screenings for PCa in Latin American communities. This article describes the results of three consecutive screenings in the urban population of Monterrey, Mexico. METHODS: After receiving approval from our University Hospital's Internal Review Board (IRB), the screening was announced by radio, television, and press, and it was addressed to male subjects over 40 years old in general. Subjects who consented to participate were evaluated at the primary care clinics of the University Health Program at UANL, in the Metropolitan area of Monterrey. Blood samples were taken from each subject for prostate specific antigen (PSA) determination; they underwent a digital rectal examination (DRE), and were subsequently interviewed to obtain demographic and urologic data. Based on the PSA (>4.0 ng/ml) and DRE results, subjects were appointed for transrectal biopsy (TRB). RESULTS: A total of 973 subjects were screened. Prostate biopsy was recommended to 125 men based on PSA values and DRE results, but it was performed in only 55 of them. 15 of these biopsied men were diagnosed with PCa, mostly with Gleason scores > or = 7. CONCLUSION: Our results reflect a low prevalence of PCa in general, but a high occurrence of high grade lesions (Gleason > or = 7) among patients that resulted positive for PCa. This observation remarks the importance of the PCa screening programs in our Mexican community and the need for strict follow-up campaigns.

[Does circumcision has an effect on female's perception of sexual satisfaction?]. / Tiene algún efecto la circuncisión en la percepción de la satisfacción sexual de la mujer?

OBJECTIVE: To evaluate sexual satisfaction on women who have experienced sexual intercourse with the same partner on non-circumcised and circumcised states. MATERIAL AND METHODS: A total of 19 women between 19 and 53 y/o, median age 30, in which their sexual partner was programmed for circumcision were included in this study. The survey was a validated version on the Changes on Sexual Functioning Questionnaire (CSFQ). General sexual satisfaction, pain during vaginal penetration, desire, vaginal orgasm, vaginal lubrication, sexual frequency changes in oral and/or anal sexual activities and esthetical perception on circumcised penis were surveyed before the procedure and 2 months after. RESULTS: Changes on Vaginal lubrication during intercourse were significant (p = 0.004), it diminished from 78% to 63%. There were no statistically significant differences on general sexual satisfaction, pain during vaginal penetration, desire, vaginal orgasm. CONCLUSIONS: Circumcision has either negative or positive effect on female's partner perception of sexual satisfaction.

[Localization and size as prognostic factors of response to treatment with 5% imiquimod cream in non circumcised males with penile condyloma acuminata]. / Localización y tamaño como factores pronósticos de respuesta al tratamiento con imiquimod crema al 5% en hombres no circuncidados con condiloma acuminado peneano.

OBJECTIVES: To evaluate the relevance of size and location of penile condylomatous lesions as prognostic factors to Imiquimod 5% cream treatment response in uncircumcised men. METHODS: Twenty-two patients with condylomatous lesions in the glans, prepuce and penile shaft were included in this study. Size was no exclusion criteria. Patients with lesions on scrotal, suprapubic, inguinal or perineal area were excluded from this study. Treatment with Imiquimod 5% cream 3 times per week was given and follow up was at the first and second week and afterwards every second week. Response was classified as complete when all lesions disappeared, partial when lesions diminished in more than 50% of its original size and absence of response if no change was seen or if they diminished less than 50% of its original size. RESULTS: Six patients were excluded from the study because they did not come for follow up. Mean age was 33 years (24-51). Sevenly five (12) percent of the patients had a complete response, 18.7% (3) did not have response and 6.3% (1) had partial response. A complete response was observed in 75% (9) of patients with lesions on glans and prepuce. The same response rate was observed in patients with penile shaft lesions. There was complete response in patients with lesions as big as 7 cm and as small as 0.3 cm. Response was observed between the first and fourth week. Non responders were classified after 12 weeks of treatment and alternative treatment was advocated. CONCLUSIONS: Site and size of penile lesions of condyloma acuminata had no relevance as prognostic factors for treatment response of Imiquimod 5% cream. If Imiquimod was the treatment selected, alternative therapeutic approaches should be advised if no response is seen after the fourth week of treatment.

Localización y tamaño como factores pronósticos de respuesta al tratamiento con Imiquimod crema al 5% en hombres no circuncidados con condiloma acuminado peneano / Localization and size as prognostic factors of response to treatment with 5% imiquimod cream in non circumcised with penile condyloma acuminata

Objetivo: Evaluar la importancia del tamaño y la localización como factores pronósticos en la respuesta al tratamiento con imiquimod crema al 5% de lesiones condilomatosas en el pene no circuncidado. Métodos: Se incluyeron 22 pacientes con lesiones condilomatosas en el glande, el prepucio o en el cuerpo del pene sin importar su tamaño. Los pacientes con lesiones en escroto, región púbica, ingles o región perianal fueron excluidos del estudio. Se les dió tratamiento con imiquimod crema al 5% 3 veces por semana y se evaluó la respuesta en la primera semana y en las semanas pares. Se catalogó como respuesta completa la desaparición total de las lesiones, respuesta parcial, cuando las lesiones disminuyeron en mas de un 50% y sin respuesta si no se modificaron o disminuyeron en menos del 50% de su tamaño inicial. Resultados: Seis pacientes fueron excluidos del estudio por falta de apego al tratamiento. La edad de los 16 pacientes restantes osciló entre los 24 y 51 años (media de 33). El 75%(12) de los pacientes tuvo una respuesta completa, 18.7%(3) sin respuesta y 6.3%(1) con respuesta parcial. En los pacientes con lesiones en el glande o prepucio hubo 75%(9) de respuesta completa al igual que en el grupo de los pacientes con lesiones en el cuerpo (4). Hubo respuesta completa tanto en pacientes con lesiones de 7cm como en las de 0.3 cm. Se observó que los pacientes que presentaron respuesta, fue entre la primera y la cuarta semana. Los pacientes sin respuesta fueron clasificados así después de 12 semanas y otras alternativas terapéuticas fueron sugeridas. Conclusiones: Tanto el tamaño como la localización del condiloma acuminado en el pene no tienen relevancia como factores pronósticos en la respuesta al tratamiento tópico con imiquimod crema al 5%. Si el Imiquimod es el tratamiento de elección, otras alternativas deberán considerarse cuando este no es efectivo después de la cuarta semana del inicio de su primera aplicación (AU)

Objectives: To evaluate the relevance of size and location of penile condylomatous lesions as prognostic factors to Imiquimod 5% cream treatment response in uncircumcised men. Methods: Twenty-two patients with condylomatous lesions in the glans, prepuce and penile shaft were included in this study. Size was no exclusion criteria. Patients with lesions on scrotal, suprapubic, inguinal or perineal area were excluded from this study. Treatment with Imiquimod 5% cream 3 times per week was given and follow up was at the first and second week and afterwards every second week. Response was classified as complete when all lesions disappeared, partial when lesions diminished in more than 50% of its original size and absence of response if no change was seen or if they diminished less than 50% of its original size. Results: Six patients were excluded from the study because they did not come for follow up. Mean age was 33 years (24-51). Seventy five (12) percent of the patients had a complete response, 18.7% (3) did not have response and 6.3% (I) had partial response. A complete response was observed in 75% (9) of patients with lesions on glans and prepuce. The same response rate was observed in patients with penile shaft lesions. There was complete response in patients with lesions as big as 7cm and as small as 0.3 cm. Response was observed between the first and fourth week. Non responders were classified after 12 weeks of treatment and alternative treatment was advocated. Conclusions: Site and size of penile lesions of condyloma acuminata had no relevance as prognostic factors for treatment response of Imiquimod 5% cream. If Imiquimod was the treatment selected, alternative therapeutic approaches should be advised if no response is seen after the fourth week of treatment (AU)