Adult circumcision and male sexual health: a retrospective analysis.

We aimed to evaluate possible associations of circumcision with several sexual dysfunctions and to identify predictors for the development of these outcomes post-operatively. Telephone surveys about sexual habits and dysfunctions before and after intervention were conducted post-operatively to patients that underwent circumcision in Centro Hospitalar Vila Nova de Gaia/Espinho during 2011. McNemar test was used for a matched-pairs analysis of pre- and post-operative data. Odds ratios, adjusted in a multivariate analysis, explored predictors of de novo sexual dysfunctions after circumcision. With intervention, there was an increase in frequency of erectile dysfunction (9.7% versus 25.8%, P = 0.002) and delayed orgasm (11.3% versus 48.4%, P < 0.001), and a significant symptomatic improvement in patients with pain with intercourse (50.0% versus 6.5%, P < 0.001). Significant predictors for de novo erectile dysfunction were diabetes mellitus (OR 9.81, P = 0.048) and lack of sexual desire (OR 8.76, P = 0.028). Less than three sex partners (OR 7.04, P = 0.007) and low sexual desire (OR 7.49, P = 0.029) were significant predictors for de novo delayed orgasm.

[Ambulatory surgery in urology: first numbers of a successful program]. / Cirurgia do ambulatório em urología: primeiros números de um programa de sucesso.

The ambulatory surgery includes those surgical procedures that require a small period of post-operative recovery so that the patients will be discharged from the hospital in the same day of the surgical intervention. In Urology, the vast amount of pathology that allows the cure with medium and low complexity surgical procedures makes this specialty a privileged one in which ambulatory surgery is concerned. In this paper the authors propose to describe how their Urology group works in the ambulatory field. 472 patients where reviewed in an evaluation period from January 2006 to April 2008. The medical appointment protocol is summarized as well as the most common surgical procedures and complications. Annually we operate an average of 200 ambulatory patients and this represents about 22% of the hole surgical activity of the Urology group. The majority of the surgeries are circumcisions and vasectomies (always associated with other small procedures). There is a 5 hours weakly period where a total of 5 to 6 patients are operated. Surgical complications represented 1.6% of total procedures, all of them late ones. With this specific ambulatory program our service managed to reduce drastically the waiting time for this kind of procedures (now-a-days is about 3-4 weeks), with a satisfaction rate of about 95%. According to the great outcomes, low complications rate and great acceptance of the patients, the development of this unit is without doubt a winning project in patients care.

[Bulbourethral sling. The experience of our service]. / Sling bulbouretral. Experiencia del servicio.

OBJECTIVES: The authors present the clinic results obtained with the bulbourethral sling application with pubic bone anchorage (Invance) in patients with stress urinary incontinence. MATERIAL AND METHODS: From July to December 2003, 10 slings were implanted in men between the 60's and the 83 years old (average 72.6 years), whose incontinence appeared after prostatic surgery (retro pubic radical prostatectomy, perineal radical prostatectomy, radical cystoprostatectomy with Camey II neobladder, transurethral resection, transvesical prostate adenomectomy). RESULTS: After 9 months follow-up (3 to 7 months), 8 patients (80%) are continent (without need of using any pad) and 2 (20%) show minimum leakage with effort (need of 1 to 2 daily pads). All are satisfied with the surgery result. Two patients referred perineal pain, which was solved with Paracetamol. There was no case of perineal haematoma, infection, rejection or urethral erosion. CONCLUSION: The bulbourethral sling with bone anchorage is a rather invasive procedure, of easy technical execution, with high continence rates and associated to low morbidity. Although the presented results been an incentive to the technique prolongation, it would be necessary a higher tracking: and higher global experience in order that this sling affirm and transform itself in an alternative to the artificial sphincter in selected cases.

[Acute renal ischemia--unusual cause of lumbar pain]. / Isquemia renal aguda--causa rara de lumbalgia.

Acute renal artery occlusion is rarely found in daily clinical practice. Its rarity and inespecific clinical presentation are responsible for late diagnosis or diagnostic errors, with symptoms frequently being erroneously attributed to other more common entities. There is no consensus in what concerns therapeutic options. Multiple treatment modalities are described in the available literature. Some defend anticoagulant therapy and support measures only while others recommend other more invasive alternatives reaching even open surgery. The authors present two additional case reports of acute embolic renal ischemia. A thorough literature review is also presented comprehending etiological, clinic, diagnostic and therapeutic aspects.

Sling bulbouretral. Experiencia del servicio / Bulbourethral sling. The experience of our service

Objetivos: En el artículo los autores presentan los resultados clínicos verificados en los pacientes portadores de incontinencia urinaria de stress, tras el uso del sling bulbouretral de fijación en el hueso púbico (Invance ®).Material y métodos: Entre Junio de 2003 y Diciembre de 2003, fueron implantados 10 slings en hombres con edades comprendidas entre los 60 y los 83 años (media 72,6 años), los cuales presentaban incontinencia tras cirugía prostática (prostatectomía radical retropúbica, prostatectomía radical perineal, cistoprostatectomía radical con neovejiga Camey II, resección transuretral o adenomectomía prostática transvesical). Resultados: Tras seguimiento de 9 meses (7 a 13 meses), 8 pacientes (80 %) están continentes (no necesitando utilizar compresas) y 2 (20%) presentan pérdidas mínimas al realizar algún esfuerzo (con la necesidad de una a dos compresas diarias). Todos ellos están satisfechos con el resultado de la cirugía realizada. Dos pacientes presentaron dolor perinanal que respondió con el uso de paracetamol. No se verificó ningú ncaso de hematoma perinanal, infección, rechazo o erosión uretral. Conclusión: El sling bulbo uretral con fijación ósea, es un procedimiento quirúrgico poco invasivo, de fácil ejecución técnica, con tasas de continencia elevadas y asociado a baja morbilidad. A pesar de los resultados positivos presentados por nuestro equipo, que pueden resultar un estímulo para la continuación de la técnica, consideramos que será necesario un mayor seguimiento y una mayor experiencia global para que esta técnica quirúrgica se afirme y se transforme en una alternativa a la utilización del esfínter artificial (AU)

Objectives: The authors present the clinic results obtained with the bulbourethral sling application with pubic bone anchorage (Invance®) in patients with stress urinary incontinence. Material and methods: From July to December 2003, 10 slings were implanted in men between the 60’s and the 83 years old (average 72,6 years), whose incontinence appeared after prostatic surgery (retro pubic radical prostatectomy, perineal radical prostatectomy, radical cystoprostatectomy with Camey II neobladder, transurethral resection, transvesical prostate adenomectomy). Results: After 9 months follow-up (3 to 7 months), 8 patients (80%) are continent (without need of using any pad) and 2 (20%) show minimum leakage with effort (need of 1 to 2 daily pads). All are satisfied with the surgery result. Two patients referred perineal pain, which was solved with Paracetamol. There was no case of perineal haematoma, infection, rejection or urethral erosion. Conclusion: The bulbourethral sling with bone anchorage is a rather invasive procedure, of easy technical execution, with high continence rates and associated to low morbidity. Although the presented results been an incentive to the technique prolongation, it would be necessary a higher tracking: and higher global experience in order that this sling affirm and transform itself in an alternative to the artificial sphincter in selected cases (AU)

Isquemia renal aguda - causa rara de lumbalgia / Acute renal ischemia - unusual cause of lumbar pain

La oclusión aguda de la arteria renal raramente se encuentra en la práctica clínica diaria. Su rareza y presentación clínica inespecífica son responsables por diagnóstico tardío o incluso por errores de diagnóstico, con síntomas que frecuentemente son atribuidos a otras entidades más comunes. No existe consenso en cuanto al abordaje terapéutico. Se describen modalidades de tratamiento múltiples en la literatura disponible. La terapia anticoagulante y medidas de apoyo son defendidas por algunos mientras otros recomiendan alternativas más invasivas, existiendo incluso autores que recomiendan cirugía abierta. Los autores presentan dos casos adicionales de isquemia renal aguda embolica. También es presentada una revisión exhaustiva de la literatura englobando aspectos etiológicos, clínicos, diagnósticos y aspectos terapéuticos (AU)

Acute renal artery occlusion is rarely found in daily clinical practice. Its rarity and inespecific clinical presentation are responsible for late diagnosis or diagnostic errors, with symptoms frequently being erroneously attributed to other more common entities. There is no consensus in what concerns therapeutic options. Multiple treatment modalities are described in the available literature. Some defend anticoagulant therapy and support measures only while others recommend other more invasive alternatives reaching even open surgery. The authors present two additional case reports of acute embolic renal ischemia. A thorough literature review is also presented comprehending etiological, clinic, diagnostic and therapeutic aspects (AU)

[Imperforate syringocele of the Cowper's glands laparoscopic treatment]. / Siringocele imperforado de las glándulas de Cowper. Tratamiento por vía laparoscópica.

OBJECTIVES: The authors present a clinical report of an imperforate syringocele diagnosed on a male patient and treated by laparoscopic surgery. MATERIAL AND METHODS: A forty-four year old patient attends the emergency room with acute urinary retention. With a former history of mild obstructive voiding symptoms, he presented, at rectal examination, a bump on the left rectal wall. This patient also underwent urethrocistoscopy, sonography and retrograde urethrography. To establish the diagnose, Computerized Tomography (CT) scan and MRI were used. RESULTS: The syringocele marsupialization by laparoscopic surgery, allowed the resolution of the clinical problem, with a good outcome. The patient was discharged 48 hours after surgery, with no need of a vesical catheter. A six month follow-up showed no recurrence. CONCLUSIONS: The syringocele is a rare deformity which usually is asymptomatic. Of acquired or congenital etiology, it can be classified in four different morphological types: simple, perforate, imperforate and ruptured. The most frequent treatment is the marsupialization of the syringocele by endoscopic surgery, leaving a broad opening of the cavity to the urethra. Some authors recommend an open surgery excision, specially in the presence of an abscess. The laparoscopic approach becomes a minimally invasive alternative with good therapeutically outcome. In the incidentally discovered asymptomatic patients, an expectant approach is the correct approach.

Siringocele imperforado de las glándulas de Cowper. Tratamiento por vía laparoscópica / Imperforate syringocele of the Cowper’s glands laparoscopic treatment

OBJETIVO: Los autores presentan el caso clínico de un siringocele imperforado, diagnosticado en un adulto y tratado por cirugía laparoscópica. MATERIAL Y MÉTODOS: Paciente de 44 años que acude al Servicio de Urgencia por retención urinaria aguda y antecedente de leves síntomas obstructivos del aparato urinario inferior. Presenta al toque rectal tumefacción de la pared rectal izquierda. El enfermo fue sometido a uretrocistoscopia, ecografía y uretrografía retrógrada. El diagnóstico se obtuvo conTomografía Computerizada y Resonancia Magnética Nuclear. RESULTADOS: La marsupialización del siringocele por vía laparoscópica permitió la resolución del cuadro clínico con buena evolución post-operatoria. El paciente tuvo alta hospitalaria a las 48 horas sin necesidad de sonda vesical. Tras seis meses de seguimiento se encuentra asintomático.CONCLUSIONES: El siringocele es una deformidad rara que habitualmente no provoca síntomas. Puede ser de etiología congénita o adquirida, clasificándose en tres tipos morfológicos: simple, imperforado, perforado o roto. El tratamiento más frecuentemente utilizado es la marsupialización por vía endoscópica dejando una abertura amplia de la cavidad para la uretra. Algunos autores recomiendan su escisión por cirugía abierta, especialmente cuando forma absceso. El abordaje laparoscópico constituye una alternativa mínimamente invasiva con buenos resultados. En los casos asintomáticos diagnosticados incidentalmente se debe optar por una actitud expectante

OBJECTIVES: The authors present a clinical report of an imperforate syringocele diagnosed on a male patientand treated by laparoscopic surgery. MATERIAL AND METHODS: A forty-four year old patient attends the emergency room with acute urinary retention. With a former history of mild obstructive voiding symptoms, he presented, at rectal examination, abump on the left rectal wall. This patient also underwent urethrocistoscopy, sonography and retrograde urethrography.To establish the diagnose, Computerized Tomography (CT) scan and MRI were used. RESULTS: The syringocele marsupialization by laparoscopic surgery, allowed the resolution of the clinical problem, with a good outcome. The patient was discharged 48 hours after surgery, with no need of a vesical catheter. A six month follow-up showed no recurrence. CONCLUSIONS: The syringocele is a rare deformity which usually is asymptomatic. Of acquired or congenitaletiology, it can be classified in four different morphological types: simple, perforate, imperforate and ruptured. The most frequent treatment is the marsupialization of the syringocele by endoscopic surgery, leaving a broad opening of the cavity to the urethra. Some authors recommend an open surgery excision, specially in the presence of an abscess. The laparoscopic approach becomes a minimally invasive alternative with good therapeutically outcome. In the incidentally discovered asymptomatic patients, an expectant approach is the correct approach

[Inverted papillomas--cases at our service and review of the literature]. / Papilomas invertidos--casuística del servicio y revisión de la literatura.

Inverted papillomas are rare tumours representing about 2.2% of all urothelial tumours (benign or malignant). Inverted papillomas are predominantly seen in the bladder but these tumours have also been described in other locations, all over the urinary tract. The authors report six additional cases of such tumours describing the individual characteristics of each case, presenting symptoms, treatment employed and follow up available. A review of the literature relative to aetiology, clinical signs and symptoms, diagnostic criteria, treatment options and outcome has also been carried out.

Tumor fibroso solitario. Dos casos adicionales con implicaciones urológicas / Solitary fibrous tumour. Two additional case reports with urological implications

El término tumor fibroso solitario designa una entidad patológica bien definida. Inicialmente descrito como tumor pleural, el aparecimiento de estas neoformaciones en otras localizaciones ha comenzado a ser descrito con mayor frecuencia. Actualmente se acepta la posibilidad de que estas neoplasias se puedan desarrollar virtualmente en todos los departamentos anatómicos. La rareza de esta patología no ha permitido hasta el momento esclarecer su histogénesis, así como otros aspectos relacionados con el comportamiento clínico, aspectos de tratamiento y de definición de pronóstico. El diagnóstico diferencial es importante, particularmente cuando la localización es extratorácica, para evitar confundirlo con neoplasias mesenquimatosas notablemente más agresivas. Los autores presentan dos casos adicionales de este tipo de neoplasia. En el primer caso la neoplasia se localizaba en la pelvis y fue responsable por uropatía obstructiva, descubierta accidentalmente en el transcurso de un traumatismo renal. El segundo caso es referente a un tumor de este tipo histológico localizado a nivel del cordón espermático. A propósito de los mismos se realiza una revisión del tema, teniendo como base la literatura disponible (AU)

Solitary fibrous tumour is a well defined pathological entity originally described as a tumour of the pleura, but the occurrence of this neoplasm has increasingly been described at other sites. At present the development of these tumours is recognized as possible in virtually all anatomical sites. The rarity of this type of pathology has not allowed up to the present time clarification of the histogenesis, clinical behaviour, treatment and prognosis of these tumours. Differential diagnosis becomes important, especially in extra-thoracic sites so as not to mistake them for much more aggressive mesenquimal tumours. Two additional cases of this neoplasm are presented, one of them responsible for obstructive uropathy, accidentally found in a patient suffering renal trauma. The second tumour was located in the spermatic cord. A review of the theme is presented based on the available literature (AU)

Papilomas invertidos - casuística del servicio y revisión de la literatura / Inverted papillomas - our service experience and a review of literature

Los papilomas invertidos son neoformaciones raras, responsables de aproximadamente 2,2 por ciento de las neoplasias uroteliales (benignas o malignas). Son generalmente localizadas a nivel vesical, aunque existen casos descritos de otras localizaciones en el sistema excretor urinario.Los autores presentan seis casos de esta variedad de neoformación, señalando las características clínicas de cada uno, su forma de presentación, características de las neoplasias, actitudes terapéuticas y su evolución. Es realizada también una revisión de la literatura, sobre la clínica, criterios de diagnostico, tratamiento y pronóstico. (AU)

[Solitary fibrous tumor. Two additional cases with urologic implications]. / Tumor fibroso solitario. Dos casos adicionales con implicaciones urológicas.

Solitary fibrous tumour is a well defined pathological entity originally described as a tumour of the pleura, but the occurrence of this neoplasm has increasingly been described at other sites. At present the development of these tumours is recognized as possible in virtually all anatomical sites. The rarity of this type of pathology has not allowed up to the present time clarification of the histogenesis, clinical behaviour, treatment and prognosis of these tumours. Differential diagnosis becomes important, especially in extra-thoracic sites so as not to mistake them for much more aggressive mesenquimal tumours. Two additional cases of this neoplasm are presented, one of them responsible for obstructive uropathy, accidentally found in a patient suffering renal trauma. The second tumour was located in the spermatic cord. A review of the theme is presented based on the available literature.