Study of the ureter structure in anencephalic fetuses

Purpose The objective of this paper is to analyze the structure of the ureter in normal and anencephalic human fetuses. Materials and Methods We studied 16 ureters from 8 human fetuses without congenital anomalies aged 16 to 27 weeks post-conception (WPC) and 14 ureters from 7 anencephalic fetuses aged 19 to 33 WPC. The ureters were dissected and embedded in paraffin, from which 5 µm thick sections were obtained and stained with Masson trichrome, to quantify smooth muscle cells (SMC) and to determine the ureteral lumen area, thickness and ureteral diameter. The samples were also stained with Weigert Resorcin Fucsin (to study elastic fibers) and Picro-Sirius Red with polarization and immunohistochemistry analysis of the collagen type III fibers to study collagen. Stereological analysis of collagen, elastic system fibers and SMC were performed on the sections. Data were expressed as volumetric density (Vv-%). The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was done using the Image Pro and Image J programs. For biochemical analysis, samples were fixed in acetone, and collagen concentrations were expressed as micrograms of hydroxyproline per mg of dry tissue. Means were statistically compared using the unpaired t-test (p < 0.05). Results The ureteral epithelium was well preserved in the anencephalic and control groups. We did not observe differences in the transitional epithelium in the anencephalic and control groups. There was no difference in elastic fibers and total collagen distribution in normal and anencephalic fetuses. SMC concentration did not differ significantly (p = 0.1215) in the anencephalic and control group. The ureteral lumen area (p = 0.0047), diameter (p = 0.0024) and thickness (p = 0.0144) were significantly smaller in anencephalic fetuses. Conclusions Fetuses with anencephaly showed smaller diameter, area and thickness. These differences could indicate ...

Structural analysis of testicular appendices in patients with cryptorchidism

Objectives Report the incidence and structure of testicular appendices (TAs) in patients with cryptorchidism, comparing their incidence with epididymal anomalies (EA) and patency of the vaginal process (PVP) and analyzes the structure of TAs. Material and Methods We studied 72 testes of patients with cryptorchidism (average of 6 years), and 8 testes from patients with hydroceles (average of 9 years). We analyzed the relations among the testis, epididymis and PVP and prevalence and histology of the TAs. The appendices of 10 patients with cryptorchidism and 8 with hydrocele were dissected and embedded in paraffin and stained with Masson trichrome; Weigert and Picro-Sirius Red with polarization and immunohistochemistry analysis of the collagen type III fibers to observe collagen. The stereological analysis was done with the software Image Pro and Image J, using a grid to determine volumetric densities (Vv). Means were statistically compared using the ANOVA and unpaired T test (p < 0.05). Results Of the 72 testes with cryptorchidism, 20 (27.77%) presented EA, 41 (56.9%) had PVP and 44 (61.1%) had TAs. Of the 44 testes with cryptorchidism and appendices, 30 (68.18%) presented PVP and 11 (25%) presented EA. There was no alteration of the epithelium in the appendices of patients in both groups. Stereological analysis documented the prevalence of ESFs (mean of 1.48%), prevalence of veins (mean of 10.11%) and decrease (p = 0.14) of SMCs in the TAs of patients with cryptorchidism (mean = 4.93%). Collagen III prevailed in the TAs of patients with cryptorchidism. Conclusion The testicular appendices presented significant structural alteration in the patients with cryptorchidism, indicating that TAs present a structural remodeling. .

Stereological and biochemical analysis of the urethral edges in patients submitted to end-to-end anastomosis for bulbar urethral stricture

PURPOSE: To study the morphologic alterations in the proximal and distal urethral edges from patients submitted to end-to-end bulbar urethroplasty. MATERIALS AND METHODS: We analyzed 12 patients submitted to anastomotic urethroplasty to treat bulbar strictures less than 2.0 cm in length. After excision of the fibrotic segment to a 28Fr urethral caliber, we obtained biopsies from the spongious tissue of the free edges (proximal: PROX and distal: DIST). Controls included normal bulbar urethras obtained from autopsies of 10 age matched individuals. The samples were histologically processed for smooth muscle cells (SMC), elastic system fibers and collagen. Stereological analysis was performed to determine the volumetric density (Vv) of each element. Also, a biochemical analysis was performed to quantify the total collagen content. RESULTS: Vv of SMC was reduced in PROX (31.48 ± 7.01 p < 0.05) and similar in DIST when compared to controls (55.65 ± 9.60%) with no statistical difference. Elastic fibers were increased in PROX (25.70 ± 3.21%; p < 0.05) and were similar to controls in DIST (15.87 ± 4.26%). Total collagen concentration in PROX (46.39 ± 8.20 μg/mg), and DIST (47.96 ± 9.42 μg/mg) did not differ from controls (48.85 ± 6.91 μg/mg). Type III collagen was similarly present in all samples. CONCLUSIONS: After excision of the stenotic segment to a caliber of 28Fr, the exposed and macroscopically normal urethral edges may present altered amounts of elastic fibers and SMC, but are free from fibrotic tissue. When excising the peri-stenotic tissue, the surgeon should be more careful in the proximal end, which is the most altered.

Epidemiological aspects of penile cancer in Rio de Janeiro: evaluation of 230 cases

PURPOSE: To determine epidemiological characteristics of penile cancer in Rio de Janeiro, its associated risk factors and clinical manifestations. PATIENTS AND METHODS: Between 2002 and 2008 we evaluated 230 patients at three public institutions, considering age, ethnicity, birthplace, marital status, educational level, religion, tobacco smoking, presence of phimosis and practice of circumcision. RESULTS: The ages ranged from 25 to 98 years, with an average of 58.35 years. Of the 230 patients, 167 (72.7 percent) were from the southeast region of Brazil (which includes Rio de Janeiro) and 45 (19.5 percent) were from the northeast of the country. Most patients were white (67.3 percent), married (58.6 percent), smokers (56.5 percent) and had not completed primary school (71.3 percent). The predominant religion was Catholic (74.8 percent). Of the 46 (20 percent) circumcised patients, only 1 (2.2 percent) had undergone neonatal circumcision. Grade I tumors were present in 87 (37.8 percent) of the patients, grade II in 131 (56.9 percent) and grade III in 12 (5.3 percent). Lymphovascular embolization was observed in 63 (27.3 percent) and koilocytosis in 124 (53.9 percent) patients. Of the total, 41.3 percent had corpora cavernosa or corpus spongiosum infiltration, and 40 (17.4 percent) had urethral invasion. Prophylactic lymphadenectomy was performed on 56 (36.1 percent), therapeutic lymphadenectomy on 84 (54.2 percent) and hygienic lymphadenectomy for advanced disease on 15 (9.7 percent) patients. The median time between the lesion onset and clinical diagnosis was 13.2 months. The mean follow up was 28.8 months. CONCLUSION: Most of our patients were born in this state and had low socioeconomic status. Most of them were white men, married, smokers, uncircumcised, of the Catholic faith and in their sixties or older. Their disease was in most cases diagnosed only in the advanced stages.

Relation between the area affected by Fournier's gangrene and the type of reconstructive surgery used: a study with 80 patients

OBJECTIVE: To assess the affected skin area and the reconstructive techniques used in 80 patients affected by Fournier's gangrene. MATERIALS AND METHODS: Eighty patients ranging in age from 19 to 85 years (mean = 51) affected by Fournier's gangrene were studied. When admitted to the emergency room the patients were submitted to clinical and laboratory examinations to analyze the gravity of the case. All patients were submitted to an extensive debridement of the lesion, urinary derivation by cystostomy and colostomy whenever necessary. RESULTS: Only 13 patients (16.25 percent) died. From the 67 remaining patients, in 44 (65.6 percent) debridement was restricted to the scrotum, in 10 (14.9 percent) there has been scrotum and penile lesions and in 13 (19.3 percent) there has been a debridement of the scrotum and the perineal region. In 11 cases (16.4 percent) there was no need for reconstructive surgery with wound closing by second intention, in 16 cases (23.8 percent) reconstructive surgery was performed with mobilization of local skin, in 19 (28.3 percent) we have used skin grafts, 20 patients (29.8 percent) needed reconstructive surgery with the use of skin flaps and in 1 case (1.4 percent) there has been the use of skin flaps and grafts simultaneously. CONCLUSIONS: Fournier's gangrene is a serious pathology and should be treated aggressively with an extensive debridement of the area with necrosis. The use of precocious reconstructive surgery of the genitals present good results and tends to greatly reduce the length of hospital stay and improve the psychological conditions of these patients.