Expanded criteria for Video Endoscopic Inguinal Lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes

Introduction Open inguinal lymphadenectomy is the gold standard for the treatment of inguinal metastasis in patients with penile cancer (PC). Recently the Video Endoscopic Inguinal Lymphadenectomy (VEIL) was proposed as an option to reduce the morbidity of the procedure in patients without palpable inguinal lymph nodes (PILN), however the oncological equivalency in patients with PILN remains poorly studied. The aims of this video are the demonstration of VEIL in patients with PILN and present the preliminary experience comparing patients with and without PILN. Materials and Methods The video illustrates the procedure performed in two cases that were previously underwent partial penectomy for PC with PILN. Data from the series of 15 patients (22 limbs operated) with PILN underwent VEIL were compared with our series of VEIL in 25 clinically N0 patients (35 limbs operated). Results The comparison between the groups with and without PILN found, respectively, these outcomes: age 52,45 × 53,2 years, operative time 126,8 × 95,5 minutes, hospital stay 5. × 3.1 days, drainage time 6.7 × 5.7 days, 9 resected lymph nodes on average in both groups, global complications 32% × 26%, cellulitis 4.5% × 0%, lymphocele 23% in both groups, skin necrosis 0% × 3%, myocutaneous necrosis 4.5% × 0%, pN+ 33% × 32%, cancer specific mortality 7% × 5% and mean follow-up 17.3 × 35.3 months. None of the variables presented p < 0.05. Conclusions VEIL is a safe complementary procedure for treatment of PC, even in patients with PILN. Oncological results in patients with PILN seem to be appropriate but are still very premature. Prospective multicenter studies with larger samples and long-term follow-up should be conducted to determine the oncological equivalence of VEIL compared with open surgery in patients with PILN. .

Topical betamethasone and hyaluronidase in the treatment of phimosis in boys: a double-blind, randomized, placebo-controlled trial

PURPOSE: To compare the efficacy of three different formulations containing Betamethasone Valerate versus placebo in the topical treatment of phimosis. As a secondary goal, we compared the outcomes after 30 and 60 days of treatment. MATERIALS AND METHODS: Two hundred twenty boys aged 3 to 10 years old with clinical diagnosis of phimosis were enrolled. Patients were randomized to one of the following groups: Group 1: Betamethasone Valerate 0.2 percent plus Hyaluronidase; Group 2: Betamethasone Valerate 0.2 percent; Group 3: Betamethasone Valerate 0.1 percent or Group 4: placebo. Parents were instructed to apply the formula twice a day for 60 days and follow-up evaluations were scheduled at 30, 60 and 240 days after the first consultation. Success was defined as complete and easy foreskin retraction. RESULTS: One hundred ninety-five patients were included at our final analysis. Group 1 (N = 54), 2 (N = 51) and 3 (N = 52) had similar success and improvement rates, all treatment groups had higher success rates than placebo(N = 38). After 60 days of treatment, total and partial response rates for Groups 1, 2 and 3 were 54.8 percent and 40.1 percent, respectively, while placebo had a success rate of 29 percent. Success and improvement rates were significantly better in 60 days when compared to 30 days. CONCLUSIONS: Betamethasone Valerate 0.1 percent, 0.2 percent and 0.2 percent in combination with Hyaluronidase had equally higher results than placebo in the treatment of phimosis in boys from three to ten years-old. Patients initially with partial or no response can reach complete response after 60 days of treatment.

Parachute technique for partial penectomy

PURPOSE: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly applied approach for best oncological results. We herein propose a simple modification of the classic technique of partial penectomy, for better cosmetic and functional results. TECHNIQUE: If partial penectomy is indicated, the present technique can bring additional benefits. Different from classical technique, the urethra is spatulated only ventrally. An inverted "V" skin flap with 0.5 cm of extension is sectioned ventrally. The suture is performed with vicryl 4-0 in a "parachute" fashion, beginning from the ventral portion of the urethra and the "V" flap, followed by the "V" flap angles and than by the dorsal portion of the penis. After completion of the suture, a Foley catheter and light dressing are placed for 24 hours. CONCLUSIONS: Several complex reconstructive techniques have been previously proposed, but normally require specific surgical abilities, adequate patient selection and staged procedures. We believe that these reconstructive techniques are very useful in some specific subsets of patients. However, the technique herein proposed is a simple alternative that can be applied to all men after a partial penectomy, and takes the same amount of time as that in the classic technique. In conclusion, the "parachute" technique for penile reconstruction after partial amputation not only improves the appearance of the penis, but also maintains an adequate function.

Patient position and semi-rigid ureteroscopy outcomes

Introduction: Two positions have been reported for ureteroscopy (URS): dorsal lithotomy (DL) position and dorsal lithotomy position with same side leg slightly extended (DLEL). The aim of the present study was to compare the outcomes associated with URS performed with patients in DL vs. DLEL position. Material and Methods: A total of 98 patients treated for ureteral calculi were randomized to either DL or DLEL position during URS, and were prospectively followed. Patients, stone characteristics and operative outcomes were evaluated. Results: Of the 98 patients included in the study, 56.1 percent were men and 43.9 percent women with a mean age of 42.6 ± 16.8 years. Forty-eight patients underwent URS in DL position and 50 in DLEL position. Patients' age, mean stone size and location were similar between both groups. Operative time was longer for the DL vs. DLEL group (81.0 vs. 62.0 minutes, p = 0.045), mainly for men (95.2 vs. 63.9 minutes, p = 0.023). Mean fluoroscopy use, complications and success rates were similar between both groups. Conclusions: Most factors associated with operative outcomes during URS are inherent to patient's condition or devices available at each center, and therefore cannot be changed. However, leg position is a simple factor that can easily be changed, and directly affects operative time during URS. Even though success and complication rates are not related to position, placing the patient in dorsal lithotomy position with an extended leg seems to make the surgery easier and faster.

Racial differences in prostate cancer prevalence / Análise da prevalência de câncer de próstata entre as diversas etnias

Objetivo: Analisar descritivamente as diferenças etnicas na prevalência de câncer de próstata no Brasil. Materiais e métodos: Entre 1922 e 1997, 1773 homens foram submetidos a toque retal (TR), dosagem de PSA e questionário padrão (AUA-IPSS). Foram classificados etnicamente em amarelos (45 casos), brancos (1180 casos) e negróides (210 casos). Em 347 homens não foi possível definir a etnia. Os pacientes foram orientados a submeter-se a biópsia de próstata quando o PSA e/ou o TR estivessem alterados. Avaliou-se também o estádio clínico e escore de Gleason na ocasião do diagnóstico, sendo que as etnias foram comparadas quanto à prevalência de câncer. Resultados:Foram feitas 346 biópsias e diagnosticados 51 tumores (14,7 porcento de positividade nas biópsias). Dos tumores, 4 (7,8 porcento) apresentavam PSA normal, 16 (31,4 porcento) PSA entre 4,1 ng/ml e 10 ng/ml e 31 (60,8 porcento), PSA>10 ng/ml. A prevalência de câncer em brancos foi de 2,4 porcento e em negróides de 5,5 porcento (p<0,05). A média de idade para brancos foi de 62,3 ± 0,4 anos e para negróides 62,4 ± 0,7 anos (p>0,05). O PSA mediano para brancos foi 3 ng/ml e para negróides 3,3 ng/ml (p>0,05). Os negróides apresentaram maior prevalência de TR alterado (18,9 porcento versus 11,7 porcento, p<0,05). A instrução mediana de brancos foi 3 e a de negróides 2 (p<0,05). A prevalência de tumores clinicamente localizados foi de 61,3 porcento. Conclusões: A prevalência de câncer de próstata em negróides é maior do que em brancos (5,5 porcento versus 2,4 porcento). O PSA mediano foi similar em ambas etnias. Os negróides apresentaram maior prevalência de toque retal alterado (18,9 porcento versus 11,7 porcento).

Evaluation of the influence of protein p53 in penile carcinoma / Avaliaçäo da influência da proteína p53 no câncer de pênis

Introduçäo: A expressäo da proteína p53 e a sua influência no comportamento biológico do carcinoma epidermóide do pênis (CEP) foram estudadas em relaçäo aos seguintes parâmetros: grau histológico, estadio clinicopatológico, e fatores prognósticos, tais como curva de sobrevida e risco de morte pelo tumor. Material e métodos: De 1979 a 1995, 55 pacientes com CEP tratados cirurgicamente foram estudados retrospectivamente. A presença da proteína p53 foi verificada nos espécimes cirúrgicos do tumor primário e de suas metástases mais respresentativos pela análise imunohistoquímica. A intensidade da expressäo da p53 foi determinada pelo número de núcleos corados nas células tumorais, classificando-a em 4 grupos: grupo 1 - até 25 por cento; grupo 2 - de 26 a 50 por cento; grupo 3 - de 51 a 75 por cento; grupo 4 - mais de 75 por cento de núcleos corados. A relaçäo entre a expressäo da p53 nas células tumorais e os parâmetros estudados foi analisada. Resultados: Taxas elevadas de expressäo da p53 correlacionaram-se com graus menores de diferenciaçäo celular (p=0,053). Doze pacientes faleceram em decorrência do tumor durante este estudo. Nossos dados mostram que quanto maior a expressäo da p53 no tumor, pior é o prognóstico (p=0,025). Näo houve relaçäo significativa entre a presença da p53 e o estadio clinicopatológico do tumor. Conclusäo: Nossos dados mostram que existe expressäo significativa da p53 no CEP. Quanto maior a expressäo da p53, pior o prognóstico para o paciente e maior a agressividade biológica do tumor. O tumor se torna mais agressivo de acordo com a intensidade da proteína no núcleo das células tumorais.