Erectile function after partial penectomy for penile cancer

ABSTRACT Purpose: To evaluate the erectile function in patients who underwent partial penectomy and identify factors associated with penile functional status. Materials and Methods: We identified patients who underwent partial penectomy due to penile cancer between 2009 and 2014. Clinical and pathological characteristics included patient age at the time of diagnosis, obesity, hypertension, dyslipidemia, diabetes, smoking, metabolic syndrome, Eastern Cooperative Oncology Group (ECOG) status, penile shaft length, tumor size, primary tumor stage (pT), clinical nodal status, and local recurrence. Erectile function was assessed prospectively with the International Index of Erectile Function (IIEF-5) at least 3 months after partial penectomy. Results: A total of 81 patients met analysis criteria. At the diagnosis, the median age was 62 years (range from 30 to 88). Median follow-up was 17 months (IQR 7-36). Of total patients, 37 (45%) had T2 or higher disease. Clinically positive nodes were present in 16 (20%) patients and seven (8.6%) developed local recurrence. Fifty patients (62%) had erectile dysfunction (ED) after partial penectomy, 30% had moderate or severe erectile dysfunction scores. Patients with ED versus without ED were similar in baseline characteristics except for age, penile shaft length, and presence of inguinal adenopathy (p <0.05). Multivariate analysis using logistic regression confirmed that older patients, shorter penile shaft length, and clinically positive lymph node were significantly associated with ED. Conclusion: Partial penectomy due to penile cancer provides adequate local control of the disease, however, proper counselling is important especially in relation to ED consequences. Preservation of penile length yields to more optimal erectile recovery.

Tratamento não cirúrgico do traumatismo renal contuso / Non-surgical treatment of blunt renal trauma

Os rins são os órgãos do trato geniturinário (TGU) mais acometidos por traumas acidentais. Excluindo-se os pacientes com indicação de cirurgia imediata, todos os demais deverão ser submetidos a um correto estadiamento da lesão renal, visando instituir a terapêutica adequada e como fator deprognóstico da sua doença.

The kidney is the most commonly injured urologic organ and may be treated success fully without operative intervention. Blunt renal trauma continues to promote discussion in trauma and urology circles. Renal exploration is reserved for those patients who become unstable or who develop complications.

Fatores de risco associados à deiscência aponeurótica no fechamento da parede abdominal / Risk factors associated to aponeurotic dehiscence in abdominal wall closure

RACIONAL: A deiscência aponeurótica do abdômen após intervenções cirúrgicas responde por índices de morbi-mortalidade em torno de 9 por cento a 49 por cento e apresenta incidência aproximada de 0,5 por cento a 3 por cento. OBJETIVO: Identificar os fatores de risco mais prevalentes e elaborar aspecto epidemiológico do perfil dos pacientes susceptíveis à esta complicação. MÉTODOS: Foram estudados no período de março a agosto de 2005 15 pacientes que estiveram internados e que apresentaram deiscência aponeurótica abdominal, provenientes da emergência ou admitidos para procedimentos eletivos. Foram pesquisados o sexo, peso e IMC, albumina sérica, linfócitos, causa do atendimento cirúrgico, co-morbidades existentes, terapias associadas, caráter da operação, incisão e fios utilizados, tempo de pós-operatório, achados cirúrgicos relacionados e total de procedimentos no sítio operatório. RESULTADOS: Identificou-se a desnutrição e infecção do sítio cirúrgico como os principais fatores de risco, e o perfil do paciente com esta complicação foi: sexo masculino, entre 25 e 45 anos, atendido de urgência ou emergência com quadro de abdômen agudo não-traumático, desnutrido. A infecção do sítio cirúrgico, ocorreu principalmente na primeira semana de pós-operatório. CONCLUSÃO: A desnutrição e a presença de infecção cirúrgica foram os fatores de risco que mais influenciaram na ocorrência da deiscência aponeurótica.

BACKGROUND: Abdominal aponeurotic dehiscence post surgical procedures corresponds to 9 percent-49 percent morbid-mortality rates, presenting an incidence approximately to 0,5 percent - 3 percent. AIM: To identify the most prevalent risk factors and formulate an epidemiological archetype of patients susceptible to the respective complication. METHODS: From March until August of 2005, fifteen hospitalized patients for emergency treatment or elective procedures, presenting abdominal aponeurotic dehiscence were submitted to the study. Items described for each person were sex, weight and BMI, serum albumin, lymphocytes, interventional reason, morbidity, associated therapies, surgical intervention description, incision and sutures, postoperative follow-ups, surgical findings related, and total of surgical interventions on the wound. RESULTS: Malnutrition and surgical site infection were considered the main risk factors associated to aponeurotic dehiscence and the archetype patient reveals to be men, aging 25 to 45 years old, admitted as an emergency, presenting non-traumatic acute abdomen, and malnutrition. Surgical site infection occurred mainly during the first postoperative week. CONCLUSIONS: Malnutrition and surgical site infection were the most important risk factors related to the occurrence of aponeurotic dehiscence.