Long-term follow-up of penile curvature correction utilizing autologous albugineal crural graft

PURPOSE: Peyronie's disease is an acquired connective tissue disorder of the penile tunica albuginea with fibrosis and inflammation. The disease produces palpable plaques, penile curvature and pain during erections. Usually it results in impairment of the quality of life. Our objective is to review the long-term results of the albugineal grafting harvested from the penile crura for the treatment of severe penile curvature. MATERIALS AND METHODS: Thirty-three patients with Peyronie's disease were submitted to a grafting with tunica albuginea from the penile crura for the correction of penile curvature. The results were evaluated after 6 months of the procedure. Variables studied were overall satisfaction with the procedure, correction of the penile curvature, erectile capacity, penile shortening and the presence of surgical complications. RESULTS: Mean follow-up after surgery was 41 months. Complete correction of the curvature was achieved in 30 patients (90%). The mean preoperative curvature was 91.8 degrees and median plaque length was 2 cm (ranged from 1 to 5 cm). Three patients (9%) experienced recurrence of the penile curvature and required a new procedure. In 30 men (90%) the procedure fulfilled their expectations and in 31 patients (93.9%) their opinions were that sexual partners were satisfied with the penile correction. Penile shortening or augmentation was referred in 6 (18.1%) and 1 (3%) patient, respectively. CONCLUSION: Our series demonstrated that grafting the albugineal defect after incision of the tunica albuginea with tunica from the crus for the correction of penile curvature is safe and results in satisfactory straight erections duringa long-term follow-up.

Rastreamento e diagnóstico de câncer de próstata / Screening and diagnosis of prostate cancer

Não existem até o momento provas contundentes que a população coberta pelo plano de saúde UNIMED-POA deva ser submetida ao rastreamento sistemático do câncer de próstata com o intuito de reduzir a mortalidade decorrente deste tipo de câncer, uma vez que não existem estudos desenhados no Estado do Rio Grande do Sul que contemplem este aspecto. Recentemente, dois grandes estudos randomizados que visavam a esclarecer se o rastreamento populacional poderia reduzir a mortalidade por câncer de próstata concluíram: em estudo realizado nos Estados Unidos (prostate, lung, colorectal and ovary trial), não houve diferença na mortalidade da população rastreada ou não; no estudo europeu (European randomized of screening for prostate cancer), houve uma redução de 20 por cento da mortalidade da população rastreada em relação à não rastreada. Cabe ressaltar que ambos os estudos apresentaram, entre outros problemas, viés de seleção dos pacientes, onde mais de 50 por cento do grupo teoricamente não rastreado efetivamente realizou exames antes ou durante o estudo. Sendo assim, permanece recomendada realização de rastreamento nas diretrizes da Associação Americana de Urologia, Associação Europeia de Urologia e Sociedade Brasileira de Urologia.

So far, there is no compelling evidence that the local population covered by the health plan UNIMED-POA should be submitted to systematic screening for prostate cancer in order to reduce mortality resulting from this type of cancer, as no studies in Rio Grande do Sul have been performed to address this particular issue. In other countries, two large randomized studies aimed at clarifying whether such screening could reduce mortality from prostate cancer were conducted recently: the prostate, lung, colorectal and ovary trial in the United States, and the European randomized screening for prostate cancer. In the former, there was no difference in mortality between screened and non-screened groups; in the latter there was a 20 percent reduction in mortality in the screened as compared to the non-screened group. It should be highlighted that both studies had many design problems including biased selection of patients, as more than 50 percent of the supposedly non-screened group was in fact submitted to medical tests either before or during the trial. Therefore, screening still should be performed according to the guidelines of the American Association of Urology, European Association of Urology and the Brazilian Society of Urology.