Gender reassignment surgery in male-to-female transsexualism: A retrospective 3-month follow-up study with anatomical remarks.

INTRODUCTION: Greater acceptance of sexual minorities has enabled people with transsexualism access to adequate treatment and social integration. Gender reassignment surgery is a complex phase in the care of transsexual patients. In response to a greater volume of patients, surgical techniques have evolved and the outcome in patients with male-to-female transsexualism is now a very accurate imitation of female genitalia, enabling sexual intercourse with orgasm. AIM: To evaluate the results of surgical reassignment of genitalia in male-to-female transsexuals. METHODS: A retrospective 3-month follow-up study of patients' opinions following gender reassignment surgery in 129 patients having a primary procedure (eight of whom had later sigmoideocolpoplasty) and five patients undergoing reoperation following an initial unsuccessful procedure at other units. All patients were male transsexuals. The surgical techniques are described in detail. MAIN OUTCOME MEASURES: Sexual functions and complications 3 months after surgery. RESULTS: All patients were satisfied with the first phase operation. Thirteen patients (9.7%) underwent successful sigmoideocolpoplasty. Main complications were as follows: rectal lesions developing during preparation of the vaginal canal (1.5%); bleeding from the stump of the shortened urethra in the first 48 hours postoperatively requiring secondary suturing (4.5%); temporary urinary retention requiring repeated insertion of urinary catheters for up to 6 days (5.2%); and healing of the suture between the perineum and the posterior aspect of the vaginal introitus healing by secondary intention (5.2%). The neoclitoris had erogenous sensitivity in 93.9% of patients and 65.3% reached orgasm in the first 3 months. CONCLUSIONS: Surgical conversion of the genitalia is a safe and important phase of the treatment of male-to-female transsexuals.

Influence of tumour-associated symptoms on the prognosis of patients with renal cell carcinoma.

OBJECTIVE: To evaluate the prognostic significance of symptoms related to renal cell carcinoma (RCC) in comparison with incidentally detected tumours in a group of long-term observed patients. MATERIAL AND METHODS: The study included 396 patients operated for RCC between 1982 and 2001. The patients were classified according to age, gender, detection mode, pathological stage and grade, tumour size, nodal involvement and Eastern Cooperative Oncology Group (ECOG) performance status. Special attention was given to the analysis of duration and quality of symptoms. The endpoint of the study was overall survival, which was assessed with univariate and multivariate analyses using the Kaplan-Meier method, log-rank test and Cox proportional hazards model. RESULTS: Of the 396 patients, 135 (34%) and 261 (66%) presented with incidental and symptomatic RCC, respectively. Compared with incidental cases, symptomatic tumours had significantly larger size (p < 0.0001), and higher pathological stage (p < 0.0001) and grade (p < 0.02). Five-year survival in patients with incidental and symptomatic tumours was 88.1% and 59.4% (p < 0.0001), respectively. In relation to the quality of symptoms, the 5-year survival in patients with local and systemic symptoms was 75.4% and 44.4% (p < 0.0001), respectively. In the group of patients with a history of tumour-related symptoms shorter and longer than 3 months, the 5-year survival was 62.2% and 55.6% (p < 0.0001), respectively. Multivariate analysis found tumour size [hazard ratio (HR) 1.22, p = 0.05] tumour grade (HR 1.44, p = 0.002), tumour stage (HR 1.35, p = 0.001), presence of symptoms (HR 1.36, p = 0.004) and ECOG (HR 1.25, p = 0.005) to be independent prognostic variables. CONCLUSION: Preoperative somatic symptoms and performance status in patients with RCC provide readily available prognostic information in addition to tumour size, stage and grade.

Calcium dobesilate for the treatment of erectile dysfunction in men with diabetes mellitus.

Calcium dobesilate has shown to improve endothelial function. This proof-of-concept clinical trial was done to check whether it may improve erectile dysfunction in diabetic men. Male diabetic patients with a diagnosis of erectile dysfunction were randomized to receive either calcium dobesilate 1 g twice per day or placebo for 6 weeks. The International Index of Erectile Function (IIEF) was chosen as the primary efficacy measurement. Statistical procedures included a pre-scheduled adaptive interim analysis to recalculate sample size. Relevant, but not significant differences in the mean change from baseline in the primary end-point (IIEF questions 3, 4 and 7) favouring dobesilate with respect to placebo were observed. Such differences reached statistical significance in some secondary end-points, including IIEF global as well as the erectile function and intercourse satisfaction domains' scores. Some patients experienced an important placebo effect. Results suggest that dobesilate may be of help to treat diabetic erectile dysfunction. Co-administration with phosphodiesterase inhibitors warrants further investigation.