Gender reassignment surgery - a 13 year review of surgical outcomes

PURPOSE: The aim of this study is to thoroughly report on surgical outcomes from 332 patients who underwent male to female gender reassignment surgery (GRS). MATERIAL AND METHODS: Records from 332 patients who underwent GRS from 1995 to 2008 were reviewed. All patients were submitted to penile inversion vaginoplasty with glans-derived sensate clitoroplasty. Mean age was 36.7 years (range 19-68 years). Surgical complications were stratified in 6 main groups: genital region, urinary tract, gastrointestinal events, wound healing disorders and unspecific events. RESULTS: Progressive obstructive voiding disorder due to meatal stenosis was the main complication observed in 40% of the patients, feasibly corrected during the second setting. Stricture recurrence was found in 15%. Stricture of vaginal introitus was observed in 15% of the cases followed by 12% and 8% of vaginal stenosis and lost of vaginal depth, respectively. Rectal injury was seen in 3% and minor wound healing disorders in 33% of the subjects. CONCLUSION: Regarding male to female GRS, a review of the current literature demonstrated scarce description of complications and their treatment options. These findings motivated a review of our surgical outcomes. Results showed a great number of adverse events, although functionality preserved. Comparision of our outcomes with recent publications additionally showed that treatment options provide satisfying results. Moreover, outcomes reaffirm penile inversion vaginoplasty in combination with glans-derived sensate clitoroplasty as a safe technique. Nevertheless, discussing and improving surgical techniques in order to reduce complications and their influence on patient's quality of life is still strongly necessary and theme of our future reports.

Impact of infection on the secretory capacity of the male accessory glands

INTRODUCTION: Studies that compare the impact of different infectious entities of the male reproductive tract (MRT) on the male accessory gland function are controversial. MATERIAL AND METHODS: Semen analyses of 71 patients with proven infections of the MRT were compared with the results of 40 healthy non-infected volunteers. Patients were divided into 3 groups according to their diagnosis: chronic prostatitis NIH type II (n = 38), chronic epididymitis (n = 12), and chronic urethritis (n = 21). RESULTS: The bacteriological analysis revealed 9 different types of microorganisms, considered to be the etiological agents, isolated in different secretions, including: urine, expressed prostatic secretions, semen and urethral smears: E. Coli (n = 20), Klebsiella (n = 2), Proteus spp. (n = 1), Enterococcus (n = 20), Staphylococcus spp. (n = 1), M. tuberculosis (n = 2), N. gonorrhea (n = 8), Chlamydia tr. (n = 16) and, Ureaplasma urealyticum (n = 1). The infection group had significantly (p < 0.05) lower: semen volume, alpha-glucosidase, fructose, and zinc in seminal plasma and, higher pH than the control group. None of these parameters was sufficiently accurate in the ROC analysis to discriminate between infected and non-infected men. CONCLUSION: Proven bacterial infections of the MRT impact negatively on all the accessory gland function parameters evaluated in semen, suggesting impairment of the secretory capacity of the epididymis, seminal vesicles and prostate. These findings were associated with an infectious related significant increase of semen pH. None of the semen parameters evaluated can be suggested as a diagnostic tool for infection.

Lissencephaly, abnormal genitalia and refractory epilepsy: case report of XLAG syndrome / Lisencefalia, genitália ambígua e epilepsia refratária: relato de caso da síndrome XLAG

INTRODUCTION: X-linked lissencephaly with ambiguous genitalia (XLAG) is a recently described genetic disorder caused by mutation in the aristaless-related homeobox (ARX) gene (Xp22.13). Patients present with lissencephaly, agenesis of the corpus callosum, refractory epilepsy of neonatal onset, acquired microcephaly and male genotype with ambiguous genitalia. CASE REPORT: Second child born to healthy nonconsanguineous parents, presented with seizures within the first hour of life that remained refractory to phenobarbital, phenytoin and midazolam. Examination identified microcephaly, axial hypotonia, pyramidal signs and ambiguous genitalia. EEG showed disorganized background activity and seizures starting at the right midtemporal, central and occipital regions. MRI showed diffuse pachygyria, moderate thickening of the cortex, enlarged ventricles, agenesis of the corpus callosum and septum pellucidum. Karyotype showed a 46,XY genotype. Additional findings were hypercalciuria, vesicoureteral reflux, patent ductus arteriosus and chronic diarrhea.

INTRODUÇÃO: Lisencefalia com genitália ambígua ligada ao X (XLAG) é doença genética recentemente descrita, causada por mutação no gene aristaless-related homeobox (ARX) (Xp22.13). Os pacientes apresentam lisencefalia, agenesia de corpo caloso, epilepsia refratária com início no período neonatal, microcefalia adquirida e genótipo masculino com genitália ambígua. RELATO DE CASO: Segundo filho de pais não-consangüíneos, apresentou crises na primeira hora de vida que permaneceram refratárias a fenobarbital, fenitoína e midazolam. Apresentava microcefalia, hipotonia axial, sinais de liberação piramidal e genitália ambígua. EEG demonstrou atividade de base desorganizada, crises convulsivas com início nas regiões temporal-média, central e occipital direitas. RNM demonstrou paquigiria difusa, moderado espessamento do córtex, ventrículos aumentados, agenesia de corpo caloso e septo pelúcido. Cariótipo evidenciou genótipo 46,XY. Achados adicionais foram: hipercalciúria, refluxo vésico-ureteral, ducto arterioso persistente e diarréia crônica.

Effects of the polypropylene mesh implanted through inguinotomy in the spermatic funiculus, epididium and testis of dogs

OBJETIVO: Investigar os efeitos da tela de polipropileno implantada por inguinotomia no funículo espermático, epidídimo e testículo de cães. MÉTODOS: Foram utilizados 18 cães (12-23 Kg) distribuídos em três grupos: Grupo A (n=7): lado esquerdo (com tela) e lado direito (sem tela); Grupo B (n=7): lado esquerdo (sem tela) e lado direito (com tela) e Grupo C (n=4): sem manipulação cirúrgica (Grupo controle). Após 60 dias, os animais foram submetidos a remoção bilateral do funículo espermático, do epidídimo e testículos e encaminhados para estudo histológico. Durante a re-operação foi realizada avaliação macroscópica. RESULTADOS: No lado com tela observou-se 100% de aderência à parede posterior do canal inguinal, assim como no funículo espermático. Observou-se congestão do plexo pampiniforme em três animais. Verificou-se reação inflamatória crônica e de corpo estranho em 100% dos funículos espermáticos. Do lado que não recebeu a tela observou-se reação inflamatória crônica em 71% dos animais. Todos os animais apresentaram reação inflamatória crônica no ducto deferente do lado com tela e em 11 animais no lado sem tela. Essas alterações não foram encontradas no Grupo C. Ocorreu uma redução estatisticamente significante na diferença de diâmetro do lúmen do ducto deferente no lado com tela. No epidídimo e testículo, as alterações macro e microscópicas não foram significantes, porém um animal apresentou redução acentuada da espermatogênese no lado com tela. CONCLUSÃO: A tela de polipropileno em contato com o funículo espermático de cães causa reação inflamatória crônica intensa e redução significante do diâmetro do lúmen do ducto deferente.

Sarcoidose na infância com manifestacões raras: vasculite, acometimento do sistema nervoso central, ósseo e genital / Sarcoidosis in childhood with rare manifestations: vasculitis, central nervous system, bone and genital involvement

Sarcoidose é uma doenca granulomatosa sistêmica de ocorrência rara em criancas. Vasculite associada à sarcoidose é incomum e pode acometer vasos de pequeno a grande calibres. Envolvimento sintomático do sistema nervoso central e periférico ocorre em 5 por cento a 10 por cento dos pacientes e acometimento ósseo em 3 por cento a 13 por cento. Sarcoidose do trato geniturinário é extremamente rara. Descrevemos o caso de uma crianca de 12 anos com diagnóstico de sarcoidose associada à vasculite, acometimento do sistema nervoso central, ósseo e genital. O amplo espectro de manifestacões clínicas raras neste caso ilustra o caráter multissistêmico e multifacetário da sarcoidose.

Genitourinary changes in hamsters infected and reinfected with Trypanosoma cruzi

Authors describe genitourinary changes in male hamsters infected and reinfected with Trypanosoma cruzi. Changes in genital organs have been described in human and in experimental chagasic infection. Genital dysfunctions in chronic chagasic patients affect ejaculation, libido and sexual potency, and testis biopsies may show arrested maturation of germ cells, oligozoospermia and azoospermia. Sixty-five male hamsters were inoculated and reinoculated with 2x10 trypomastigotes of T. cruzi VIC strain, and 22 non-infected animals constituted the control group. Animals were necropsied and fragments from testis, epididymis, seminal vesicle and bladder were collected and stained with hematoxylin-eosin. Peroxidase anti-peroxidase procedure was utilized to detect tissue parasitism. T. cruzi nests were found in testis, epididymis and seminal vesicle of these hamsters. Such parasitism plays a role in the origin of genital lesions observed in humans and laboratory animals during chronic chagasic infection