Compensated hypogonadism in men with sickle cell disease.

OBJECTIVE: To evaluate the prevalence of hypogonadism in a population of men with SCD and characterize its aetiology. Sickle cell disease (SCD) is associated with the development of hypogonadism, but there is still controversy regarding its aetiology and clinical implications. METHODS: We performed a cross-sectional study of 34 men with SCD aged > 18 years. Sociodemographic and clinical data, including anthropometric measurements (weight, height and BMI), were obtained. Early morning, blood samples were collected and total testosterone (TT), free testosterone (FT), luteinizing hormone (LH), follicle stimulating hormone (FSH), a complete blood count and haemoglobin electrophoresis were measured. Eugonadism was defined as T ≥300 ng/dL and LH ≤9.4 mUI/mL; primary hypogonadism as T < 300 ng/dL and LH > 9.4 mUI/mL; secondary hypogonadism as T < 300 ng/dL and LH ≤ 9.4 mUI/mL; and compensated hypogonadism as T ≥ 300 ng/dL and LH > 9.4 mUI/mL. RESULTS: Median age was 33 (26-41) years, and SS genotype was the most frequent (73.5%). The prevalence of eugonadism, compensated hypogonadism and secondary hypogonadism was 67.5%, 26.4% and 5.88%, respectively. No men with primary hypogonadism were identified in our sample. Those with compensated hypogonadism had also higher FSH levels (>7.8 mUI/mL, P < .0001). CONCLUSION: In our study population of men with SCD, a high prevalence of compensated hypogonadism was identified, which is a controversial and distinct clinical entity that warrants monitoring and further research.

Brazilian consensus in enuresis-recomendations for clinical practice.

INTRODUCTION: Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. MATERIALS AND METHODS: The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. RESULTS AND DISCUSSION: Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Applicability of Laparoscopic Nephrectomy in the Treatment of Multicystic Dysplastic Kidney: Sorting Out Surgical Indication.

Introduction We evaluated the applicability of laparoscopic nephrectomy in the treatment of multicystic dysplastic kidney (MCDK) in children, including procedures performed by resident physicians or trainees in surgical urology. Methods We retrospectively evaluated the medical records of 20 children with MCDK who underwent laparoscopic nephrectomy over a six-year period. Data collected included gender, laterality of the affected kidney, age at the time of surgery, the largest diameter of the multicystic kidney and associated urological diagnoses, surgical, and postoperative data. All surgical procedures were performed transperitoneally. Results The mean age at the time of surgery was 46 months with a slight predominance of girls. The right side was the more affected side, and the average diameter of the affected kidney at the time of surgical excision was 5.8 cm. Other changes in the urinary tract were found in five children. The mean operative time was 133 minutes. On pathological examination, on average, the pieces measured 4.8 cm and weighed 18.1 g. There were no operative complications. The average length of hospital stay was 37.35 hours. Conclusion Laparoscopic nephrectomy was confirmed as an applicable treatment for MCDK. The technique was easy to perform, safe and efficient, even when performed by trainees in pediatric urology.

Brazilian consensus in enuresis-recomendations for clinical practice

ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Tumores testiculares e paratesticulares na infância / Testicular and paratesticular tumors in chilhood

Este estudo visa apresentar os dados referentes à idade, manifestação clínica, diagnóstico histopatológico e evolução de pacientes pediátricos portadores de neoplasia testicular e paratesticular tratados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Procedeu-se a análise retrospectiva dos prontuários médicos de pacientes, com idade até 18 anos, portadores de neoplasia testicular primária e/ou paratesticular diagnosticados no período compreendido entre janeiro de 1984 a agosto de 2000. Foram atendidos 17 pacientes com idade entre 3 meses e 17 anos (mediana = 3 anos). O acometimento da gônada direita foi semelhante ao da esquerda (n=8 para cada lado), com 1 paciente apresentando tumor bilateral. A manifestação clínica mais frequente foi a de massa escrotal indolor. Nos tumores testiculares houve predomínio das neoplasia de células germinativas (n = 11), e 2 tumores de células de Leydig. Todos os tumores extratesticulares eram rabdomiossarcomas. Apesar da baixa incidência de neoplasia testicular e paratesticular na infância, esse diagnóstico deve ser considerado nos pacientes com massa escrotal indolor.