Study of testosterone as a predictor of tumor aggressiveness in patients with prostate cancer

Purpose A growing body of evidence suggests that low testosterone can be an independent predictor of adverse clinicopathological features and worse prognosis in prostate cancer (PCa) patients. However, this association is still incompletely understood and the results are divisive. The aim of this study was to analyze testosterone as a predictor of aggressive disease in subjects with clinically localized PCa. Materials and Methods A cohort was conducted including the patients submitted to radical prostatectomy in our institution during a period of four years. The patients had clinically localized disease and their total testosterone (TT) was routinely measured preoperatively in the morning before surgery. They were stratified in groups with low (< 300 ng/dL) and normal TT (≥ 300 ng/dL). Tumor aggressiveness was inferred based on preoperative PSA levels, pathological Gleason score (lower, equal or greater than 7), TNM stage and surgical margins status. Results After analyzing 164 patients we found a significant association between mean preoperative TT and extraprostatic disease (379 for pT3 vs. 421 ng/for pT2 - p < 0.001, AUC > 0.99). Conversely, men with high Gleason score had similar mean TT compared to those with lower scores. Preoperative low TT (defined as TT < 300 ng/dL) could not be statistically correlated with either preoperative PSA levels, pathological Gleason score, extraprostatic extension, positive surgical margins or seminal vesicles involvement. Conclusions This study indicates that testosterone may be a useful predictive tool once pathological extraprostatic extension was somewhat signaled by lower TT levels preoperatively. However, it does not consolidate a clear association between aggressive tumor biology and hypogonadism. .

Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure

PURPOSE: To analyze the influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence. MATERIALS AND METHODS: A prospective cohort was conducted including 66 patients submitted to TOT from March 2006 to May 2009. Urethral hypermobility was defined as mobility ≥ 30º on Q-tip test, and Valsalva leak point pressure (VLPP) was classified as greater than 60 cmH2O or 60 and less on preoperative urodynamics. These parameters were compared through well defined postoperative objective and subjective success criteria. Intensity of urinary leakage and quality of life was analysed by ICIQ-SF. Statistical analysis was accomplished and the results rendered significant if p < 0.05. RESULTS: Mean follow up was 10 months (3 to 28). Mean age was 55 years (33 to 80), 70% were white and 30% African descendent, mean body mass index was 27 (21 to 38), average vaginal and abdominal deliveries were 2.8 and 0.5 respectively. A quarter had prior stress incontinence surgery. Patients with urethral hypermobility had higher objective success rates (98% versus 81.25%, p = 0.04). The subjective success rate was also greater in the hypermobility group (84% versus 62.5%), but statistical significance was not reached (p = 0.07). VLPP had no influence on either objective or subjective postoperative success rates (p = 0.17 and 0.34, respectively). In the subgroup analysis, those with low mobility and high VLPP had worse objective success rates in comparison to the group with hypermobility and low VLPP (p = 0.04) and also in relation to the remaining of the studied population. Other possible prognostic factors (previous surgery, mixed incontinence, gestational status) had no influence on success rates. CONCLUSIONS: High urethral mobility, regardless of the sphincteric status indicated by VLPP, is a favorable prognostic factor for tension-free transobturator tape procedure. No relationship was demonstrated between postoperative success rates and VLPP.

Schistosomiasis mansoni of the bladder simulating bladder cancer: a case report / Esquistossomose mansônica simulando câncer de bexiga: relato de caso

The relationship between bladder tumors and Schistosoma haematobium is well known, but only sporadic cases of bladder infection due to Schistosoma mansoni have been reported. In this case, a 48-year-old woman with macroscopic hematuria, dysuria and a palpable abdominal mass was investigated. Ultrasound showed a large exophytic mass in the bladder. Transurethral resection of the bladder revealed viable eggs of Schistosoma mansoni. The patient was treated clinically with oxamniquine and surgery was performed to resect the large mass. This case shows that schistosomiasis Mansoni in the bladder can simulate bladder cancer.

É bem conhecida a relação entre tumor vesical e Schistosoma haematobium, porém somente casos esporádicos de infecção vesical por Schistosoma mansoni foram relatados. Neste caso, uma mulher de 48 anos com hematúria macroscópica, disúria e massa abdominal palpável foi investigada, ultra-sonografia mostrou uma grande massa exofítica na bexiga. A ressecção transuretral de bexiga evidenciou ovos viáveis de Schistosoma mansoni. A paciente foi tratada clinicamente com oxaminiquine e uma cirurgia foi realizada para ressecar a grande massa. Este caso mostra que a esquistossomose mansônica vesical pode simular um câncer vesical.

Associaçäo entre inibidores de protease e urolitíase / Indinavir associated nephrolithiasis

Introduction: The use of protease inhibitors, mainly the indinavir, drug recently introduced for the treatment of patients with the human immunodeficiency virus (HIV), has shown formations of crystals and urinary calculi as side effects. Surch conditions are found in 4 percent of patients using indinavir. Case Report: An HIV positive 32 years old male patient taking indinavir and AZT is presented. During treatment, the patient presented left flank pain and left uretero-hydronephrosis at renal ultrasound. Retrograde pyelography showed an image compatible with ureteral calculi. Six month later the patient presented for consultation and an intravenous pyelography and renal ultrasound were normal. Probably, the calculous had passed spontaneously. Conclusions: The benefits of the protease inhibitors for HIV positive patients are enormous and their use are rapidly increasing. Thus, physicians should be aware of this benign complication. Most of these cases are benign and the treatment should be analgesia and oral and parenteral hydration. Patients using indinavir must be advised to maintain adequate hydration

Cisto epidérmico escrotal gigante / Giant epidermoid cyst

Massas escrotais sempre apresentam uma preocupaçäo diagnóstica, pela possibilidade de uma entidade neoplásica. Doença rara, os cistos epidérmicos, em geral múltiplos, podem apresentar-se com grande volume, levando à confusäo diagnóstica. Este caso relata paciente que apresentava massa escrotal, paratesticular, de 8 cm de diâmetro, que revelou-se ser um cisto epidérmico