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.

The learning curve of bilateral laparoscopic varicocelectomy: a prospective study / A curva de aprendizado da varicocelectomia laparoscópica bilateral: um estudo prospectivo

ABSTRACT Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients with abnormal seminal analysis. The learning curve for this frequently performed procedure has not yet been described. In the present study, we investigated the learning curve of a single urologist in training performing his first 21 laparoscopic varicocelectomies using qualitative and quantitative tools to evaluate his performance during the process. Our results show that 14 bilateral laparoscopic varicocelectomies are enough to achieve the plateau of the learning curve.

RESUMO Varicocele ocorre em 15% dos homens e em 35% dos homens inférteis. Desde 1992, a correção cirúrgica com varicocelectomia laparoscópica é o padrão ouro para o tratamento de pacientes sintomáticos ou com análise seminal anormal. A curva de aprendizado para esse procedimento frequentemente realizado ainda não foi descrita. No presente estudo, investigamos a curva de aprendizado de um único urologista em treinamento realizando suas primeiras 21 varicocelectomias laparoscópicas usando ferramentas qualitativas e quantitativas para avaliar seu desempenho durante o processo. Nossos resultados mostram que 14 varicocelectomias laparoscópicas bilaterais são suficientes para atingir o platô da curva de aprendizado.

Tratamento cirúrgico de linfedema penoescrotal em um paciente com doença de Milroy: relato de caso / Surgical treatment of penoscrotal lymphedema in a patient with Milroy's disease: case report

Introdução: A doença de Milroy manifesta-se como linfedema de membros inferiores e região genital, o que provoca prejuízos físicos e sociais. Relato de Caso: Reporta-se um caso de linfedema penoescrotal severo em um paciente com doença de Milroy. Foi realizada a ressecção cirúrgica do tecido afetado e a reconstrução com retalhos locais e enxerto de pele. Discussão: A doença de Milroy é rara, de caráter autossômico dominante. Sua apresentação clínica é progressiva e decorre da hipoplasia dos vasos linfáticos dos membros inferiores. O tratamento em casos avançados é iminentemente cirúrgico. Conclusão: No caso apresentado, o tratamento cirúrgico é uma boa opção. O uso de retalho paraescrotal para escrotoplastia associado ao enxerto para cobertura do pênis proporciona bom resultado funcional.

Introduction: Milroy disease manifests itself as lymphedema of the lower limbs and genital region, which causes physical and social damage. Case Report: A case of severe-scrotal lymphedema in a patient with Milroy disease. Surgical resection of the affected tissue and reconstruction with local flaps and skin graft were performed. Discussion: Milroy disease is a rare autosomal dominant disease. The clinical presentation is progressive and results from hypoplasia of the lymphatic vessels of the lower limbs. Treatment in advanced cases is mainly surgical. Conclusion: In the case of a patient with Milroy disease and severe penoscrotal lymphedema, surgical treatment is a good option. The use of parascrotal flaps for scrotoplasty associated with a graft to recover the penis provides a good functional result.

Perspectivas do homem submetido à penectomia / Perspectives of man submitted to penectomy / Perspectivas del hombre sometido a la penectomía

Objetivo: o presente artigo objetiva descrever as perspectivas do paciente submetido à penectomia e conhecer as perspectivas deste paciente após a penectomia. Métodos: trata-se de um estudo de caso realizado em um hospital federal na cidade do Rio de Janeiro com dois pacientes que estiveram internados no ano de 2017 e foram submetidos a penectomia. A coleta de dados foi realizada no ano de 2018 através de uma entrevista semiestruturada. Os participantes foram amparados pelos princípios éticos estabelecidos pela resolução 466/ 2012 do Conselho Nacional de Saúde, sendo que este estudo foi aprovado sob o número 2.769.381. Resultados: constatou-se que a penectomia nestes estudos de caso era a única terapêutica. Com isso, o desejo de estar com a família e prolongar a vida foram determinantes na adesão ao tratamento. Conclusão: concluiu-se que mesmo com as mudanças no corpo, a penectomia foi realizada na perspectiva de prolongar a vida

Objective: this article aims to describe the perspectives of patient submitted submitted to penectomy and to know the perspectives of this patient after the penectomy. Methods: its a case study realized in a federal hospital of Rio de Janeiro city with two patients who were admitted to the hospital during 2017 and underwent to penectomy surgery. The data collection was realized during 2018 with a semi-structured interview. The participants were protected by the ethics principles established by the resolution 466/ 2012 of the National Health Council and this study was approved under the number 2.769.381. Results: it was found that penectomy in this case studies was the only therapy. Thereby, the desire of being among their family and to extend their life was determinants to adhere the therapy. Conclusion: it was concluded that even with the changes in their body, the penectomy was realized to extend the life

Objetivo: el presente artículo objetiva describir las perspectivas del paciente sometido a la penectomía y conocer las perspectivas de este paciente después de la penectomía. Métodos: se trata de un estudio de caso realizado en un hospital federal en la ciudad de Río de Janeiro con dos pacientes que estuvieron internados en el año 2017 y fueron sometidos a penectomía. La recolección de datos se realizó en el año 2018 através de una entrevista semiestructurada. Los participantes fueron amparados por los principios éticos establecidos por la resolución 466/2012 del Consejo Nacional de Salud, siendo que este estudio fue aprobado bajo el número 2.769.381. Resultados: se constató que la penectomía en estos estudios de caso era la única terapéutica. Con ello, el deseo de estar con la familia y prolongar la vida fueron determinantes en la adhesión al tratamiento. Conclusión: se concluyó que incluso con los cambios en el cuerpo, la penectomía se realizó en la perspectiva de prolongar la vida

Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture?

SUMMARY INTRODUCTION Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates. METHODS A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively. RESULTS The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 - both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity. CONCLUSION By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure.

RESUMO INTRODUÇÃO Devido à espongiofibrose e processos inflamatórios subjacentes à patogênese da estenose uretral, pode-se pensar que a relação de linfócitos neutrofílicos (NLR) pode fornecer informações essenciais sobre o curso da doença e as possibilidades de recorrência. O objetivo do nosso estudo é avaliar a correlação entre NLR e taxas de recorrência. MÉTODOS Quinhentos e doze pacientes submetidos à uretrotomia interna visual direta (DVIU) devido à estenose uretral em nossa clínica entre as datas de fevereiro de 2010 e janeiro de 2018 foram avaliados retrospectivamente. RESULTADOS A mediana de acompanhamento para os grupos não recorrentes e recorrentes após a DVIU foi de 30 e 36 meses, respectivamente. Durante o seguimento, 280 (54,7%) dos pacientes tiveram recidivas e 232 (45,3%) não tiveram recidivas. O tempo médio de recorrência após a DVIU foi de 6,5±1,4 mês, com variação de 1-36 meses. A média da RNL no grupo sem recorrência foi de 2,02±0,87 com mediana de 1,9 e 3,66±2,30 com mediana de 3 no grupo com recidiva. Uma diferença estatística altamente significativa foi observada entre dois grupos em termos de contagem de neutrófilos e NLR (p: 0,000 - ambos). A área sob o valor da curva para NLR foi de 0,767 com um erro padrão de 0,021 (IC 95% 0,727-0,808). Valor de corte de NLR determinado como 2,25 com uma sensibilidade de 70%, especificidade de 67,7%. CONCLUSÃO Ao utilizar a RNL, as características inflamatórias do tecido uretral podem ser previstas e possíveis recidivas após a cirurgia podem ser estimadas. Dessa forma, técnicas de uretroplastia aberta podem ser usadas em casos com valor significativo de NLR em vez de procedimento endoscópico recorrente.

Urological surgery in epidermolysis bullosa: tactical planning for surgery and anesthesia

Epidermolysis bullosa (EB) is characterized by extreme fragility of the skin and mucosae. Anesthetic and surgical techniques have to be adapted to those children and routine practice may not be adequate. Urological problems are relatively common, but surgical techniques adapted to those children have not been well debated and only low evidence is available to this moment. Herein we discuss the specifics of anesthetic and surgical techniques chosen to treat a six year old EB male presenting with symptomatic phimosis.

Is Diagnostic Cystoscopy Painful? Analysis of 1,320 Consecutive Procedures

Objective To prospectively evaluate self-reported pain levels associated with diagnostic cystoscopy. Materials and Methods Patients who underwent diagnostic cystoscopy and subsequently graded their pain level during the procedure were enrolled. Pain was graded on a Likert visual analog scale (VAS) of 1-10 where 0 = no pain and 10 = excruciating unbearable pain. Local lidocaine gel 2% was used as intraurethral lubricant. Results Data from 1320 consecutive cystoscopies (929 males, 391 females, age range 15-93 years) between 6/2009-1/2010 were analyzed. This was the first cystoscopy for 814 patients. The overall mean VAS was 2.74 ± 1.51 (range 0-9) for rigid cystoscopy and 2.48 ± 1.53 (range 0-10) for flexible cystoscopy (P = 0.004). The reported mean pain level for first-time cystoscopy was significantly higher than that for repeat cystoscopy (2.8 ± 1.6 vs. 2.2 ± 1.4, P < 0.001), regardless of gender or type of cystoscope. Men reported significantly higher pain levels than women 2.6 ± 1.5 vs. 2.4 ± 1.4 (P < 0.04). The highest mean pain level was reported by men (3.4 ± 1.6) and women (2.5 ± 1.6) for rigid cystoscopy compared to flexible cystoscopy (2.5 ± 1.4 and 1.1 ± 1.9, respectively, P < 0.001). Pain levels > 5 were reported in 75 (5.7%) cystoscopies. Conclusions Cystoscopy was not associated with distressing levels of pain. Pain levels during first cystoscopies were higher than those for repeated ones. Using a flexible cystoscope is associated with a lower pain level in both men and women and it should be used for both genders. .

Analysis of 27 cases one stage repair of penile hypospadias with urethroplasty improved transverse cutting island prepuce flap / 中华全科医师杂志

Twety seven children with penile hypospadias were treated using urethroplasty with transverse cutting island prepuce flap with local vascular pedicle from the dorsal penile rampant skin,and stabed hole at nonvascular region in middle of pedicle,reversed tubed flap through the penis to the ventral,anastomosed with the primary distal urethral.All cases were repaired successfully one stage,two cases with urethral fistula and one case with extemal orifice stricture of urethra.The appearance of the penis were satisfactory.It is suggested that one stage repair of penile hypospadias with urethroplasty improved transverse cutting island prepuce flap(Duckett's technique),the area of tubed flap sutured cling venial tunica albuginea penis,and bilateral is covered with vascular pedicle,greatly reduces the occurrence of urethral fistula.

The comparing of the semen quality of different operation method of varicocele with 561 cases / 中国基层医药

Objective To research the effect to the semen quality of the three operation methods of superiority of highly selective varicocele high ligation,transinguinal canal and laparoseopic of renovated polomo management of varicocele.Methods 561 patients in our hospital who charged by infertility had the operation were analyzed retrospectively and were recruited with primary varicocele above grade II for this study.These patients were divided into three group according to three kinds of operation methods of varicocele :group A was treated with highly selective varicocele high ligation and had 300 patients;group B was treated with transinguinal canal operation and had 181 patients; and group C was treated by laparescopic of renovated polomo operation with 80 patients.Through the comparing of the fertility ability of the three operation methods,to evaluate the therapeutic effect of the three methods.Results The increasing rates of the quality of semen in group B was higher than other groups if patients' ages were lower than 30.The increasing rates of the quality of semen in every group was also higher if patients' ages were lower than 30.No difference was found between three groups in natural conception rate (P＞0.05).Conclusion The methods of highly selective varieecele high ligation would be a better choice in the management of patients with primary varicecele because of higher quality of semen.