Spermatic cord torsion: a retrospective analysis

ABSTRACT Objective To evaluate the time interval and possible delay in transportation to referral units for the treatment of testicular torsion. Methods We retrospectively analyzed all cases of spermatic cord torsion surgically treated at a university hospital between January 2018 to December 2021. We evaluated the time intervals, including pain onset until the first presentation (D1), interhospital transference time (D2), pain onset until urological evaluation in a tertiary service (D3), urological evaluation until surgery (D4), and time from pain onset to surgical treatment (D5). We analyzed demographic and surgical data, orchiectomy rates, and time intervals (D1-D5). Torsions presented to the first medical presentation within 6h were considered early for testicular preservation. Results Of the 116 medical records evaluated, 87 had complete data for the time interval analysis (D1 to D5) and were considered the total sample. Thirty-three had D1 ≤6h, 53 had D1 ≤24h (includes patients in the D1 ≤6h subgroup), and 34 had D1 >24h. The median time intervals of the total samples and subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were D1 = 16h 42min, 2h 43min, 4h 14min and 72h, D2 = 4h 41min, 3h 39min, 3h 44min and 9h 59min; D3 = 24h, 6h 40min, 7h and 96h; D4 = 2h 20min, 1h 43min, 1h 52min and 3h 44min; D5 = 24h 42min, 8h 03min, 9h 26min and 99h 10min, respectively. Orchiectomy rates of the total sample, subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were 56.32%, 24.24% (p<0.01), 32.08% (p<0.01), and 91.18% (p<0.01), respectively. Conclusion Late arrival at the emergency department or a long interhospital transference time determined a large number of patients who underwent orchiectomy. Thus, public health measures and preventive strategies can be developed based on the data from this study aiming to reduce this avoidable outcome.

Testicular decompression and tunica vaginalis flap in human acute testicular torsion: modified step-by-step technique description and preliminary outcomes

ABSTRACT Objective To report the effects of a tunica vagina flap on testicular compartment syndrome. Methods This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. Results Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. Conclusion The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma.

Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: a systematic review

ABSTRACT Purpose: A systematic review of the literature with available published literature to compare ileal conduit (IC) and cutaneous ureterostomy (CU) urinary diversions (UD) in terms of perioperative, functional, and oncological outcomes of high-risk elderly patients treated with radical cystectomy (RC). Protocol Registration: PROSPERO ID CRD42020168851. Materials and Methods: A systematic review, according to the PRISMA Statement, was performed. Search through the Medline, Embase, Scopus, Scielo, Lilacs, and Cochrane Database until July 2020. Results: The literature search yielded 2,883 citations and were selected eight studies, including 1096 patients. A total of 707 patients underwent IC and 389 CU. Surgical procedures and outcomes, complications, mortality, and quality of life were analyzed. Conclusions: CU seems to be a safe alternative for the elderly and more frail patients. It is associated with faster surgery, less blood loss, lower transfusion rates, a lower necessity of intensive care, and shorter hospital stay. According to most studies, complications are less frequent after CU, even though mortality rates are similar. Studies with long-term follow up are awaited.

COVID-19: The impact on urolithiasis treatment in Brazil

ABSTRACT Introduction: It has been more than a year since the first case of Covid-19 was diagnosed in Brazil, and its most problematic feature is the oversaturation of the healthcare system capacity. Urolithiasis is a disease that requires timely and appropriate management. The present study aimed to evaluate the impact of the pandemic in hospital admissions for urolithiasis in the Brazilian public healthcare system. Materials and Methods: In this cross-sectional study, hospital admissions were obtained from the Brazilian Public Health Information system. All hospital admissions associated with urolithiasis diagnosis (ICD-10 N20) between March 2017 and February 2021 were analyzed. Results: During the COVID-19 outbreak, there was a significant decrease in hospital admissions (p<0.0001). More than 20.000 patients probably did not have the opportunity to undergo their surgeries. The impact of the COVID-19 outbreak on women's admissions was significantly more intense than for men, reducing from 48.91% to 48.36% of the total (p=0.0281). The extremes of age seemed to be more affected, with patients younger than 20 years and older than 60 years having a significant reduction in access to hospital services (p=0.033). Conclusions: In conclusion, we have noticed a considerable reduction in overall admissions for the treatment of urolithiasis in the Brazilian public healthcare system during the first year of the Covid-19 pandemic. Women and individuals older than 60 years were especially affected. In contrast, we noted a rise in urgent procedures, comparing with the average of the corresponding period of the three previous years. Recovery plans will be needed while returning to activities to handle the impounded surgical volume.

Fibroblast growth factor receptor 3 gene (FGFR3) mutations in high-grade muscle-invasive urothelial bladder cancer in a Brazilian population: evaluation and prevalence

ABSTRACT Objective To understand the feasibility of FGFR3 tests in the Brazilian public health context, and to sample the mutational burden of this receptor in high-grade muscle invasive bladder cancer. Methods A total of 31 patients with high-grade muscle-invasive bladder cancer were included in the present study. Either transurethral resection of bladder tumor or radical cystectomy specimens were analyzed. Formalin-fixed paraffin-embedded tissue blocks were sectioned, hematoxylin and eosin stained, and histologic sections were reviewed. Total RNA was extracted using the RNeasy DSP formalin-fixed paraffin-embedded kit. Qualitative results were displayed in Rotor-Gene AssayManager software. Results Six patients were excluded. From the samples analyzed, four (16.7%) were considered inadequate and could not have their RNA extracted. Two patients presented FGFR3 mutations, accounting for 9.5% of material available for adequate analysis. The two mutations detected included a Y373C mutation in a male patient and a S249C mutation in a female patient. Conclusion FGFR3 mutations could be analyzed in 84% of our cohort and occurred in 9.5% of patients with high-grade muscle invasive bladder cancer in this Brazilian population. FGFR3 gene mutations are targets for therapeutic drugs in muscle-invasive bladder cancer. For this reason, know the frequency of these mutations can have a significant impact on public health policies and costs provisioning.

Testicular torsion and climate changes in macroregions of São Paulo, Brazil / Torção testicular e diferenças climáticas nas macrorregiões do estado de São Paulo, Brasil

ABSTRACT Objective: To analyze the association between climate changes in the macroregions in the state of São Paulo and testicular torsion treated cases. Methods: The cases were selected in the Brazilian Public Health Data System Database from January 2008 to November 2016. All surgical procedure records were identified by the Hospital Admission Authorization document. Two codes were selected to process the search: testicular torsion (surgical cure code) and acute scrotum (exploratory scrototomy code). The macroregions were grouped in five areas linked to climate characteristics by International Köppen Climate Classification. Results: A total of 2,351 cases of testicular torsion were registered in the period. For the areas B, C and E (testicular torsion n=2,130) there were statistical differences found in association of testicular torsion cases and decreased temperature (p=0.019, p=0.001 and p=0.006, respectively), however, in analyses for the areas A and D statistical differences were not observed (p=0.066 and p=0.494). Conclusion: Decrease in temperature was associated with testicular torsion in three macroregions of São Paulo. The findings support the theory of cold weather like a trigger in occurrence of testicular torsion in a tropical climate region.

RESUMO Objetivo: Analisar a associação entre mudanças climáticas nas macrorregiões do estado de São Paulo e os casos tratados com torção testicular registrados. Métodos: Os casos foram selecionados no Banco de Dados do Sistema de Dados de Saúde Pública do Brasil de janeiro de 2008 a novembro de 2016. Todos os registros de procedimentos cirúrgicos foram identificados pelo documento de Autorização de Internação Hospitalar. Dois códigos foram selecionados para processar a busca: torção testicular (código de cura cirúrgica) e escroto agudo (código de escrototomia exploratória). As macrorregiões foram agrupadas em cinco áreas ligadas às características climáticas pela Classificação Internacional de Clima Köppen. Resultados: Foram registrados 2.351 casos de torção testicular no período. Para as áreas B, C e E (torção testicular n=2.130), foram encontradas diferenças estatísticas na associação dos casos de torção testicular e diminuição da temperatura (p=0,019, p=0,001 e p=0,006, respectivamente), mas nas análises das áreas A e D não foram observadas diferenças estatísticas (p=0,066 e p=0,494). Conclusão: A diminuição da temperatura foi associada à torção testicular em três macrorregiões de São Paulo. Os resultados apoiam a teoria do clima frio como um gatilho para ocorrência de torção testicular em uma região de clima tropical.

Prostate cancer awareness in the city of São Paulo / Conhecimento da população da cidade de São Paulo a respeito do câncer de próstata

ABSTRACT Objective: To evaluate awareness of prostate cancer in the population of the city of São Paulo. Methods: A total of 392 adults were randomly interviewed on public spaces in the city of São Paulo, and answered a questionnaire that addressed demographic questions and specific knowledge about the prostate cancer. A score was used to assess awareness of cancer in general, and of prostate cancer, considering satisfactory knowledge a score of 6 points. Results: The mean age was 36.9 years (standard deviation of ±12.6) and 58.2% of participants were male. No previous contact with information related to prostate cancer was reported by 45.5% of participants. For these cases, a greater proportion was observed among men aged over 50 years. As to the score, the mean was 3.7 (standard deviation of ±1.3), with a positive correlation among higher scores, higher income and education level. Less than 5% of participants believed they should only search for prostate cancer screening when symptomatic. Finally, among the less frequent responses to risk factors for prostate cancer, is "ethnic origin" (2.8%). Conclusion: Even though most participants did not have a satisfactory score, the level of awareness demonstrated in this study seems superior to that of other populational series. Hence it suggested the assessed population understood some essential concepts in prostate cancer, such as the importance of screening and the follow-up. The efforts made by the Sociedade Brasileira de Urologia on educational campaigns partially explain this. However, working in some concepts, like identifying risk factors for prostate cancer, might optimize screening outcomes.

RESUMO Objetivo: Avaliar o conhecimento da população da cidade de São Paulo em relação ao câncer de próstata. Métodos: Foram entrevistados randomicamente 392 adultos em espaços públicos da cidade de São Paulo, os quais responderam a um questionário que abordava questões demográficas e de conhecimentos específicos sobre o câncer de próstata. Um escore foi utilizado para avaliar o conhecimento de câncer em geral e do câncer de próstata, considerando um conhecimento satisfatório com escore de 6 pontos. Resultados: A média de idade foi de 36,9 anos (desvio-padrão de ±12,6), e 58,2% dos participantes eram do sexo masculino. Ausência de contato anterior com informações relacionadas ao câncer de próstata foi relatada por 45,5% dos participantes. Nesses casos, maior proporção foi observada entre os homens com mais de 50 anos. Quanto ao escore, a média foi 3,7 (desvio-padrão de ±1,3), com correlação positiva entre maiores escores e maiores renda e escolaridade. Menos de 5% dos participantes acreditavam que só deveriam procurar o rastreamento do câncer de próstata quando sintomáticos. Por fim, entre as respostas menos frequentes aos fatores de risco para câncer de próstata, encontrou-se "etnia" (2,8%). Conclusão: Embora a maioria dos participantes não tenha apresentado escore satisfatório, o nível de conhecimento revelado neste estudo parece superior ao de outros estudos populacionais. Assim, sugere-se que a população avaliada tenha compreendido alguns conceitos essenciais do câncer de próstata, como a importância do rastreamento e do acompanhamento. Os esforços da Sociedade Brasileira de Urologia nas campanhas educacionais explicam parcialmente isso. No entanto, trabalhar em alguns conceitos, como identificar fatores de risco para câncer de próstata, pode otimizar os resultados do rastreamento.

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs.≥ 75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

Bladder cancer trends and mortality in the brazilian public health system

ABSTRACT Introduction Considering the lack of data on BC trends in Brazilian population, mainly as a result of the difficulty on gathering data, the present manuscript provides an overview of bladder cancer incidence, hospitalization, mortality patterns and trends using the Brazilian Data Center for The Public Health System (DATASUS). Materials and Methods All hospital admissions associated with BC diagnosis (ICD-10 C67) between 2008 and 2017 were analyzed. Distributions according to year, gender, age group, ethnicity, death, length of hospital stay, and costs were evaluated. Demographic data was obtained from the last Brazilian national census. Results From 2008 to 2017 there were 119,058 public hospital admissions related to BC. Patients were mostly white males aged 60 to 79 years-old. Mortality rates for patients who have undergone surgery was 6.75% on average, being 7.38% for women and 6.49% for men. Mortality rates were higher when open surgeries were performed compared to endoscopic procedures (4.98% vs 1.18%). Considering only endoscopic procedures, mortality rates were three times higher after urgent surgeries compared to elective ones (2.6% vs 0.6%). Over the years the cystectomy/transurethral bladder resection (C/T) ratio significantly decreased in all Brazilian Regions. In 2008, the C/T ratio was 0.19, while in 2017 it reduced to 0.08. Conclusions Despite BC relatively low incidence, it still represents a significant social economic burden in Brazil, as it presents with recurrent episodes that might require multiple hospitalizations and surgical treatment. The set of data collected might suggest that population access to health care has improved between 2008-2017.

Mortality after radical cystectomy is strongly related to the institution's volume of surgeries / Mortalidade pós-cistectomia radical está fortemente associada ao volume de cirurgias da instituição

ABSTRACT Objective: To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center. Methods: This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay. Results: A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy /year) had a 17.5% in-hospital mortality rate. Conclusion: There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.

RESUMO Objetivo: Analisar as taxas de mortalidade e os dados de hospitalização após cistectomia radical em cada unidade pública de saúde de São Paulo na última década, levando em conta o número de cirurgias realizadas por unidade. Métodos: Este estudo incluiu pacientes do Departamento de Informática do Sistema Único de Saúde de São Paulo submetidos à cistectomia radical entre 2008 e 2018. Os dados analisados incluíram o nome da instituição, o número de procedimentos/ano, taxas de mortalidade hospitalar e tempo de internação hospitalar. Resultados: Foram registrados 1.377 cistectomias radicais no sistema público de saúde de São Paulo no período. Um total de 91 instituições realizou pelo menos uma cirurgia na década analisada. O número de cistectomias realizadas por instituição durante os anos analisados variou de uma a 161. Apenas 45,6% dos pacientes foram operados em instituições com volume cirúrgico maior do que cinco cistectomias radicais/ano. Ao todo, 684 pacientes foram operados em instituições com maior volume cirúrgico. Houve 117 óbitos hospitalares, representando taxa de mortalidade de 8,5% para o estado de São Paulo na última década. Enquanto instituições com o maior volume (seis cistectomias radicais/ano) apresentaram mortalidade de 6,1%, as instituições com menor volume (<1 cistectomia radical/ano) apresentaram taxa de mortalidade de 17,5%. Conclusão: Houve forte relação entre o volume institucional de cistectomia radical e a taxa de mortalidade hospitalar após cistectomia radical em São Paulo, no período de 2008 a 2018. Infelizmente, não se observa no Brasil tendência de centralização de procedimentos complexos, como tem ocorrido em países desenvolvidos nas últimas décadas.

Penile cancer trends and economic burden in the Brazilian public health system / Tendências e carga econômica do câncer de pênis no sistema público de saúde brasileiro

ABSTRACT Objective: To gather information on penile cancer epidemiologic trends and its economic impact on the Brazilian Public Health System across the last 25 years. Methods: The Brazilian Public Health System database was used as the primary source of data from January 1992 to December 2017. Mortality and incidence data from the Instituto Nacional de Câncer José Alencar Gomes da Silva was collected using the International Classification of Diseases ICD10 C60. Demographic data from the Brazilian population was obtained from the last census by the Brazilian Institute of Geography and Statistics, performed in 2010 and its 2017 review. Results: There were 9,743 hospital admissions related to penile cancer from 1992 to 2017. There was a reduction (36%) in the absolute number of admissions per year related to penile cancer in 2017, as compared to 1992 (2.7versus 1.7 per 100,000; p<0.001). The expenses with admissions related to this condition in this period were US$ 3,002,705.73 (US$ 115,488.68/year). Approximately 38% of the total amount was spent in Northeast Region. In 1992, penile cancer costed US$ 193,502.05 to the public health system, while in 2017, it reduced to US$ 47,078.66 (p<0.02). Penile cancer incidence in 2017 was 0.43/100,000 male Brazilian, with the highest incidence rate found in the Northeast Region. From 1992 to 2017, the mortality rates of penile cancer in Brazil were 0.38/100,000 man, and 0.50/100,000 man in the North Region. Conclusion: Despite the decrease in admissions, penile cancer still imposes a significant economic and social burden to the Brazilian population and the Public Health System.

RESUMO Objetivo: Reunir informações sobre as tendências epidemiológicas do câncer de pênis e seu impacto econômico no Sistema Único de Saúde nos últimos 25 anos. Métodos: O banco de dados de informações do Sistema Único de Saúde foi utilizado como fonte primária de dados de janeiro 1992 a dezembro 2017. Os dados demortalidade e incidência do Instituto Nacional de Câncer José Alencar Gomes da Silva foram coletados usando a Classificação Internacional de Doença CID10 C60. Os dados demográficos da população brasileira foram obtidos do último censo do Instituto Brasileiro de Geografia e Estatística, realizado em 2010, e em sua revisão, de 2017. Resultados: Ocorreram 9.743 internações relacionadas ao câncer de pênis de 1992 a 2017. Houve redução (36%) nas internações anuais absolutas em 2017 em comparação com 1992 (2,7 versus 1,7 por 100.000; p<0,001). Os gastos com internações neste período foram de US$ 3,002,705.73 (US$ 115,488.68/ano). Cerca de 38% do valor total foi gasto na Região Nordeste. Em 1992, o câncer de pênis custou US$ 193,502.05 ao sistema público, enquanto em 2017 reduziu para US$ 47,078.66 (p<0,02). A incidência em 2017 foi de 0,43/100.000 brasileiro do sexo masculino, com a maior taxa de incidência encontrada na Região Nordeste. De 1992 a 2017, as taxas de mortalidade por câncer de pênis foram de 0,38/100.000 homem, sendo 0,50/100.000 homem na Região Norte. Conclusão: Apesar da diminuição nas hospitalizações, o câncer de pênis ainda impõe uma carga econômica e social significativa à população brasileira e ao Sistema Único de Saúde.

HRQOL related to urinary diversion in Radical Cystectomy: a systematic review of recent literature

ABSTRACT Introduction: The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical cystectomy (RC) and urinary diversion with ileal conduit (IC) or a neobladder (NB). Objective: Review all recent data comparing QoL outcomes after radical cystectomy with NB and IC diversions. Evidence Acquisition: A systematic search in PubMed/Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement in December 2018. All articles published from January 01, 2012 to December 31, 2018, were included. A study was considered relevant if it compared QoL outcomes using validated questionnaires (EORTC QLQ C30, FACT-G, FACT-BL, FACT-VCI, and BCI). Evidence Synthesis: In 11 included studies, a total of 1389 participants were accounted (730 NB and 659 IC cases). The studies were conducted in 8 different countries, two were prospective, and none was randomized. There were two studies favoring results with a neobladder, 3 with incontinent diversion and 6 with no differences. The EORTC-QLQ-C30 was the most used instrument (5 studies) followed by FACT VCI and BCI (3 studies each). Given the heterogeneity of data and lack of prospective studies, a meta-analysis was not performed. Conclusion: No superiority of one urinary diversion was characterized. It seems that the choice must be individualized with an extensive preoperative orientation of the patient and their relatives. That will probably influence how the patient accepts the new condition.

Lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis

OBJECTIVES: To assess the prevalence and interrelationship between lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis (MS). METHODS: In a cross-sectional study, we evaluated 41 men (mean age 41.1±9.9 years) with MS from February 2011 to March 2013, who were invited to participate irrespective of the presence of lower urinary tract symptoms or sexual dysfunction. Neurological impairment was assessed with the Expanded Disability Status Scale; lower urinary tract symptoms were evaluated with the International Continence Society male short-form questionnaire, and sexual dysfunction was evaluated with the International Index of Erectile Function. All patients underwent transabdominal urinary tract sonography and urine culture. RESULTS: The mean disease duration was 10.5±7.3 years. Neurological evaluation showed a median Expanded Disability Status Scale score of 3 [2-6]. The median International Continence Society male short-form questionnaire score was 17 [10-25]. The median International Index of Erectile Function score was 29 [15-46]. Twenty-nine patients (74.4%) had sexual dysfunction as defined by an International Index of Erectile Function score <45. Voiding dysfunction and sexual dysfunction increased with the degree of neurological impairment (r=0.02 [0.02 to 0.36] p=0.03 and r=-0.41 [-0.65 to -0.11] p=0.008, respectively). Lower urinary tract symptoms and sexual dysfunction also displayed a significant correlation (r=-0.31 [-0.56 to -0.01] p=0.04). CONCLUSIONS: Most male patients with MS have lower urinary tract symptoms and sexual dysfunction. The severity of the neurological disease is a predictive factor for the occurrence of voiding and sexual dysfunctions.

PSA kinetics before 40 years of age

ABSTRACT Purpose: The baseline PSA has been proposed as a possible marker for prostate cancer. The PSA determination before 40 years seems interesting because it not suffers yet the drawbacks related to more advanced ages. Considering the scarcity of data on this topic, an analysis of PSA kinetics in this period seems interesting. Materials and Methods: A retrospective assay in a database of a private diagnostic center was performed from 2003 to 2016. All subjects with a PSA before 40 years were included. Results: 92995 patients performed PSA between the ages of 21 - 39. The mean value ranged from 0.66 ng / mL (at age 22) to 0.76 ng / mL (at age 39) and the overall mean was 0.73 ng / mL. As for outliers, 3783 individuals presented a baseline PSA > 1.6 ng / mL (p95). A linear regression model showed that each year there is a PSA increase of 0.0055 ng / mL (β = 0.0055; r2 = 0.0020; p < 0.001). A plateau in PSA between 23 and 32 years was found and there were only minimal variations among the ages regardless of the evaluated percentile. Conclusion: It was demonstrated that PSA kinetics before 40 years is a very slow and progressive phenomenon regardless of the assessed percentile. Considering our results, it could be suggested that any PSA performed in this period could represent the baseline value without significant distortions.