Rare Case of Complete Androgen Insensitivity Syndrome.

Androgen insensitivity syndrome is a rare X-linked recessive condition in which patients present a female phenotype. After complete androgen insensitivity syndrome (CAIS) diagnosis, the timing of gonadectomy should be evaluated, considering the risks and benefits of this procedure. This paper reports an uncommon case of complete androgen insensitivity syndrome diagnosed belatedly in an adult patient. Surgical treatment was deemed necessary due to the elevated risk of gonadal malignancy.

Accidental insertion of double-J in the inferior vena cava in a patient with retroperitoneal fibrosis: a case report.

Background: Implantation of the double-J stent is a common procedure in urology. The function of this device is to maintain the flow of urine from the ureteropelvic junction to the urinary bladder when the ureter is blocked or partially blocked for some reason. Once in place, the stent may cause low back pain, hematuria, symptoms of urinary irritation, a reduction in labor capacity, infection and calcification which are side effects that are easy to manage. However, severe complications can occur, such as the insertion of the stent into the circulatory system, such as the vena cava, which, although uncommon, is one of the most severe and difficult to manage. This work reports the case of a patient with the accidental insertion of a double-J stent into the inferior vena cava. Case Description: An 80-year-old female patient with repeated urinary tract infections using a double-J stent due to stenosis of the right distal ureter distal presenting retroperitoneal fibrosis secondary to previous radiotherapy. The patient had Lynch syndrome, ovarian and uterine cancer, colorectal cancer, and nephrolithiasis. She had been submitted to multiple previous surgeries. Due to the possibility of viral infection by coronavirus disease 2019 (COVID-19), chest computed tomography was performed, which suggested the insertion of the double-J stent in the inferior vena cava, confirmed by abdominal computed tomography. As the distal end of the stent was within the bladder, the decision was made to remove the stent by cystoscopy, with the implantation of a new stent using fluoroscopic control for the confirmation of its trajectory. No intraoperative or postoperative complications occurred and the patient is currently in outpatient follow-up. Conclusions: Situations such as this require caution during the implantation of the drainage device, with the occurrence of resistance indicating the need to discontinue the procedure and perform a new assessment with imaging exams. No intraoperative or postoperative complications occurred and the patient is currently in outpatient follow-up.

A Rare Case of Spontaneous Steinstrasse.

Spontaneous steinstrasse ("stone street") is a collection of stones within the ureter and is a rare and understudied event. Factors such as infection, altered kidney function, and degree of obstruction are used to define the most adequate therapeutic option. Treatment can be either conservative or surgical. The decision of which depends on the clinical presentation. This paper reports a rare case of a 59-year-old patient with spontaneous steinstrasse examined at a urology clinic. Surgical intervention was required because of altered kidney function. The patient is currently undergoing follow-up for the metabolic investigation.

Impact of COVID-19 on Outpatient Care for Urological Conditions at a University Hospital.

INTRODUCTION: The 2019 coronavirus (COVID-19) rapidly spread throughout the world, with diverse negative consequences in all fields, including the continuity of treatment for patients with other diseases. The public hospital for high-complexity procedures affiliated with the São José do Rio Preto School of Medicine, São Paulo, Brazil, normally has a high annual quantity of outpatient appointments. However, the consequences of COVID-19 led to a reduction in the number of appointments, exams, and outpatient procedures. The aim of the present study was to evaluate the impact of the pandemic on outpatient care for individuals with urological conditions at a university hospital. PATIENTS AND METHODS: A retrospective, descriptive, cross-sectional study was conducted involving the analysis of all outpatient appointments for individuals with urological conditions at the Urology Clinic of the São José do Rio Preto Hospital, São Paulo, Brazil, between January 2019 (pre-pandemic period) and December 2020 (after the first year of COVID-19). The variables of interest were sex, age, and affected organs of the genitourinary system. RESULTS: Among the 4,972 outpatient appointments involving patients with urological conditions in 2019, 70.7% involved males and the largest portion of patients were in the seventh decade of life (40.02%). Among the 4,584 outpatient appointments in 2020, 69.9% involved males and the largest portion were in the seventh decade of life (47.07%). Significant differences were found in the number of outpatient appointments between 2019 and 2020 in all age groups (p < 0.0001). The most affected organs of the genitourinary system in both 2019 and 2020 were the prostate (46.07% and 56.31%, respectively), bladder (30.56% and 22.48%, respectively), and kidney/ureter (22.85% and 19.68%, respectively), with no significant differences between the two years. CONCLUSION: The COVID-19 pandemic exerted an impact on outpatient care for individuals with urological conditions at a university hospital, leading to a reduction in the number of appointments. No change was found with regard to the sex of the patient. In contrast, an increase was found in the number of patients 60 years of age or older during the year of the pandemic. The most affected organs of the genitourinary system were the prostate, bladder, and kidney/ureter in both years analyzed.

Impact of the COVID-19 Pandemic on Surgical Treatment of Patients With Urological Diseases at a University Hospital.

BACKGROUND: The coronavirus disease 2019 (COVID-19) appeared in China and spread quickly to other regions of the country and around the world, changing the way of life of individuals and the routine of healthcare systems. OBJECTIVE: The aim of the present study was to investigate the impact of the pandemic on the surgical treatment of patients with urological diseases at a university hospital. MATERIALS AND METHODS: A retrospective analysis of the charts of patients with urological diseases submitted to surgical treatment between January 2019 and December 2020 was conducted. The variables of interest were age, sex, and most performed surgical procedures (double-J stent placement, cystoscopy, vasectomy, removal of double-J stent, ureterolithotripsy, endoscopic bladder procedure, kidney transplant, and endoscopic prostate procedure). RESULTS: Around 59.03% of patients with urological diseases who had surgery in 2019 were male; placement of the double-J stent accounted for 35.85% of all surgeries; 3556 surgical procedures were performed. In 2020, 57.22% of the patients were male, placement of the double-J stent accounted for 38.34% of all surgeries, and 3093 surgical procedures took place. Analyzing the types of surgery conducted in 2019 and 2020, a significant reduction occurred in the number of procedures in 2020 (p = 0.000). CONCLUSION: The pandemic exerted an impact on the surgical treatment of patients with urological diseases at a university hospital. No significant changes occurred with regard to the sex and age of the patients, but a significant difference was found in the number of surgical procedures performed.

Clinical and Molecular Profile of Patients With Condyloma Acuminatum Treated in the Brazilian Public Healthcare System.

Condyloma acuminatum is a common clinical outcome of human papillomavirus (HPV) in men. A prospective investigation was performed of the clinical and molecular profile of 122 patients with condyloma acuminatum treated by the Brazilian public healthcare system. The patients were evaluated clinically. The fragments were submitted to molecular analysis for the identification of HPV genotypes. A total of 104 (85.2%) patients presented multiple warts and 18 (14.8%) presented a single wart. The predominant location was the body of the penis (48.4% of cases of multiple warts and 7.4% of cases of single warts), and 49 (40.2%) cases were recurrences and 73 (59.8%) were initial occurrences. Regarding sexual activity, 56 patients (45.9%) had multiple partners and 65 (53.3%) had a single partner. The most frequent genotype was HPV6 (70%). In conclusion, the most frequent anatomic location of condyloma acuminatum was the body of the penis in the present sample. The present findings suggest that the natural history of infection by HPV is not yet completely known and that greater care is needed to ensure clinical safety in the follow-up of these patients due to the oncogenic potential.

Impact of the Pandemic on the Diagnosis and Treatment of Patients With Urological Tumors at a University Hospital.

Background The rapid dissemination of the coronavirus 2019 (COVID-19) had dramatic effects on individuals and healthcare systems in 2020. At our tertiary hospital, surgeries were recommended for patients at high oncological risk, with the prioritization of the maintenance of care and treatment of cancer. We aimed to assess the impact of the pandemic on the diagnosis and treatment of patients with urological tumors under the care of a university hospital. Materials and methods A retrospective analysis was performed of the charts of patients with urological tumors (prostate, kidney, bladder, and testicle) under the care and treated surgically at the Hospital de Base in 2019 and 2020, independently of ethnicity. The results were compared by the chi-square test (with a significance level of 5%). Results A discrete increase occurred in the quantity of appointments in 2020 (n = 5,846) compared to 2019 (n = 5,726). The most frequent types of cancer in 2019 and 2020 were, respectively, prostate (70.97% and 73.37%), bladder (18.07% and 12.52%), kidney (7.96% and 8%), and testicle (29.24% and 70.76%). Analyzing 279 surgeries performed on patients with prostate tumors, a 12.7% increase occurred in the year of the pandemic. Analyzing 271 surgical procedures on patients with bladder cancer, no considerable change occurred. Conclusion The analysis of the impact of the pandemic on the diagnosis and treatment of patients with urological tumors at a university hospital revealed a discrete increase in the number of outpatient appointments and a slight reduction in the number of patients and surgical procedures in the year of the pandemic (2020). More surgical procedures were conducted on patients with prostate cancer in 2020. More patients with bladder cancer sought medical care in the year of the pandemic, and practically the same quantity was submitted for surgical treatment. There was no statistically significant difference among types of cancer.

Giant Abdominoscrotal Hydrocele in Adult: A Rare Entity.

Abdominoscrotal hydrocele is an uncommon condition characterized by an hourglass-shaped scrotal hydrocele with an intra-abdominal component connected by an isthmus within the inguinal canal. We report a rare case of an adult patient with giant abdominoscrotal hydrocele. Despite recent trends toward less invasive treatments, in this case, the surgical approach through an inguinal incision was the better therapeutic option with a satisfactory outcome.

Anxiety in candidates for radical prostatectomy in a university hospital.

OBJECTIVE: Metabolic changes caused by anxiety can interfere in both the surgery itself and the recovery process. One way to reassure the patient is to clarify how the procedure will be performed and discuss the possible complications. This study aimed to investigate the anxiety level of candidates for radical prostatectomy at a university hospital. METHODS: Thirty-four patients with a diagnosis of prostate cancer were studied prospectively. Data collection involved the administration of the Hospital Anxiety and Depression Scale and a radical prostatectomy knowledge test. RESULTS: The results showed that 94.1% of the patients reported having received clarifications from the physician or healthcare team regarding the surgery and 23.5% reported having received information on the probability of a medical error during surgery. The most cited postoperative complications were sexual impotence and urinary incontinence. A significant association was found between the total Hospital Anxiety and Depression Scale score and the complications cited (p=0.0004); patients who marked a larger number of possible complications had a higher Hospital Anxiety and Depression Scale score. CONCLUSION: The present study demonstrates that the explanations given by the multidisciplinary health team are not achieving their maximum potential in terms of lowering patient anxiety.

Sexual Health Teaching in Basic Science Courses Among Medical Students.

INTRODUCTION: Sexuality is a multifaceted and makes up part of the lives of all individuals. AIM: To evaluate the teaching of sexual health to students in the basic cycle of an undergraduate course in medicine. METHODS: A descriptive, cross-sectional study was conducted using primary data on the teaching of sexual health in the first 4 years of the course. The students were contacted personally and given a self-administrated questionnaire on the teaching of sexual health. The questionnaire was based on studies conducted with physicians and medical students regarding their educational background in sexual health. The degree of satisfaction regarding the learning process was determined using a ten-point scale; on which, a score of 1 to 5 indicated dissatisfaction and of 6 to 10 satisfaction. MAIN OUTCOME MEASURES: The main outcome measure was a self-administered questionnaire addressing the teaching of sexual health in the first 4 years and how this knowledge affected relationships with patients. RESULTS: A total of 216 students answered the questionnaire. Only 27.27% and 22% of the students in the first and second years, respectively, reported having classes related to sexual medicine, whereas 38.1% (third year) and 54.40% (fourth year) had such classes. Regarding satisfaction, the weighted mean was 4.55 and the modes were 5 and 6. In the evaluation of their expectations about learning sexual health, 46 (67.6%) reported feeling non-confident, 18 (26.5%) did not answer the question, and 4 (5.9%) reported feeling confident. CONCLUSION: This study revealed a gradual progression in the offer of content related to sexual medicine to students throughout the medicine course, with weighted means of 2.6 (first year), 2.82 (second year), 3.58 (third year), and 4.55 (fourth year). However, the findings indicate that the teaching of this subject remains deficient and students feel unsatisfied and unprepared for their future practice of medicine. Teixeira Santos AU, Fava Spessoto LC, Fácio FN. Sexual Health Teaching in Basic Science Courses Among Medical Students. Sex Med 2021;9:100309.

Testicular Pouch Hibernoma: A Case Report.

Hibernomas are rare lipomatous tumors derived from brown adipose tissue. Only two cases of hibernomas in the scrotum have been reported in the literature so far. Brown adipose tissue is responsible for thermogenesis in hibernating mammals and embryos. In adult humans, reminiscent brown tissue is most frequently located in the axial skeleton, scapular waist, and neck. This case report describes the finding of a testicular pouch hibernoma in a 34-year-old male who presented with a nodule in the scrotum, which was initially suspected to be a lipoma. The diagnosis was confirmed by histopathological analysis, and the patient was treated by surgical excision. Despite its rarity, hibernoma should be part of the differential diagnosis for lipoma, the most frequent benign mesenchymal neoplasm worldwide.