Validation of a population coronary disease predictive system: the CASSANDRA model.

BACKGROUND: The use of validated multivariate cardiovascular predictive models in a population setting is of interest for public health policy makers. We aimed to validate the estimations of the CASSANDRA model (coronary heart disease (CHD) incidence and CHD risk distribution), considering the population changes in age, sex and CHD risk factors prevalence in a 10-year period. METHODS: We compared the projected CHD incidence estimated with CASSANDRA with that observed in the Girona Heart Registry (REGICOR) for 1995-2004 and 2000-2009 in the population of Girona (Spain) aged 35-74 years. We used official age and sex distributions for this population. Baseline cardiovascular risk factors prevalence and the distribution of cardiovascular risk were obtained from three cross-sectional studies performed in 1995, 2000 and 2005. To validate the future distribution of cardiovascular risk, we tested the yearly CHD risk variance over the study period. RESULTS: No significant differences between the estimated and observed annual CHD incidence per 100 000 men were found in 1995-2004 (CASSANDRA=457.8 and REGICOR=420.3, incidence rate ratio (IRR) (95% CI)=0.92 (0.89 to 0.96)) and in 2000-2009 (441.4 and 409.6, respectively, IRR=0.93 (0.90 to 0.96)). However, overpredictions of 18% and 22%, respectively, were observed in women (198.8 and 160.4, IRR=0.82 (0.77 to 0.86), and 197.1 and 152.8, IRR=0.78 (0.74 to 0.83), respectively). No significant differences were found in the CHD risk variance in the three different cross-sectional studies. CONCLUSIONS: The CASSANDRA model produces valid estimates, particularly in men, of the future burden of disease and in the distribution of cardiovascular risk in individuals aged 35-74 years.

Experiencia en el tratamiento de las fístulas rectouretrales post-prostatectomía radical / Experience in the treatment of rectourethral fistulae after radical prostatectomy

OBJETIVO: Presentar las características clínicas de las fistulas rectouretrales (FRU) tras prostatectomía radical (PR) así como nuestra experiencia en el manejo y tratamiento de las mismas.MÉTODO: Presentamos la experiencia de nuestro centro en el tratamiento de las FRU atendiendo a sus características clínicas y la presencia de factores de complejidad asociada. En todos los casos, tras la historia clínica y el examen físico el estudio se completó con uretrocistografía, enema opaco y uretrocistoscopia. Desde enero de 2000 a julio de 2010 hemos tratado 12 pacientes con FRU. La edad media fue de 64 años (rango 56-74 años). La etiología fue cirugía abierta en dos casos y cirugía laparoscópica en diez. La clínica se presentó en un plazo de 4 a 60 días.RESULTADOS: En nuestra experiencia los hallazgos endoscópicos y radiológicos tuvieron una buena correlación. Dos fístulas fueron pequeñas -menos de 5 mm- y en la vertiente uretral de la anastomosis permitiendo el tratamiento conservador el cierre espontáneo. Diez pacientes presentaron fístulas mayores, en la vertiente vesical de la anastomosis o con complejidad asociada, que requirieron para su resolución de un abordaje transesfinteriano posterior de York-Mason con buena recuperación urinaria y fecal posterior.CONCLUSIÓN: La FRU tras PR es una complicación relevante y de difícil resolución. Proponemos la cirugía reconstructiva precoz en las FRU grandes o con complejidad asociada. El cierre con abordaje transesfinteriano posterior de York-Mason ha permitido la resolución de la FRU en todos los casos(AU)

OBJECTIVES: To report the clinical charac-teristics of recto-urethral fistula (RUF) after radical prosta-tectomy (RP) as well as our experience managing them.METHODS: We present our experience in the treatment of RUF based on their clinical characteristics and the pre-sence of associated complexity factors. After medical history and physical examination, the diagnostic work up was completed in all cases with urethrograms, cystoscopy and barium enema. From January 2000 to July 2010 we treated 12 patients with RUF. Mean age was 64 years (range 56-74 years). The etiology was open sur-gery in two cases and laparoscopic surgery in ten. Clinical presentation varied from 4 to 60 days after surgery.RESULTS: In our experience, endoscopic and radiolo-gical findings were well correlated. Two fistulae were small -less than 5 mm- on the urethral side of the anasto-mosis allowing spontaneous closure after conservative treatment. Ten patients had larger fistulas on the bladder side of the anastomosis and/or were associated with com-plexity factors that required a posterior trans-sphincteric York-Mason approach for resolution, with good reco-very of urinary and fecal continence.CONCLUSION: The RUF is a significant compli-cation after RP and it is difficult to solve. We propose early recons-tructive surgery in large or complex RUF. The posterior trans-sphincteric York-Mason approach has allowed the repair in all cases(AU)

Experience in the treatment of rectourethral fistulae after radical prostatectomy.

OBJECTIVES: To report the clinical characteristics of rectourethral fistula (RUF) after radical prostatectomy (RP) as well as our experience managing them. METHODS: We present our experience in the treatment of RUF based on their clinical characteristics and the presence of associated complexity factors. After medical history and physical examination, the diagnostic work up was completed in all cases with urethrograms, cystoscopy and barium enema. From January 2000 to July 2010 we treated 12 patients with RUF. Mean age was 64 years(range 56-74 years). The etiology was open surgery in two cases and laparoscopic surgery in ten. Clinical presentation varied from 4 to 60 days after surgery. RESULTS: In our experience, endoscopic and radiological findings were well correlated. Two fistulae were small-less than 5 mm- on the urethral side of the anastomosis allowing spontaneous closure after conservative treatment. Ten patients had larger fistulas on the bladder side of the anastomosis and/or were associated with complexity factors that required a posterior transsphincteric York-Mason approach for resolution, with good recovery of urinary and fecal continence. CONCLUSION: The RUF is a significant complication after RP and it is difficult to solve. We propose early reconstructive surgery in large or complex RUF. The posterior transsphincteric York-Mason approach has allowed the repair in all cases.

Influence of comorbid conditions on one-year outcomes in non-ST-segment elevation acute coronary syndrome.

OBJECTIVE: To investigate comorbid conditions with prognostic influence in non-ST-segment elevation acute coronary syndrome (NSTEACS). PATIENTS AND METHODS: The study group consisted of a derivation cohort of 1017 patients (admitted from October 1, 2002, through October 1, 2008) and an external validation cohort of 652 patients (admitted from February 1, 2006, through September 30, 2009). Comorbid conditions, including risk factors and components of the Charlson comorbidity index (ChCI) and coronary artery disease-specific index, were recorded. The main outcome was one-year mortality. RESULTS: During follow-up, 103 patients died. After adjusting for variables associated with NSTEACS characteristics (base model), 5 comorbid conditions predicted mortality: severe or mild renal failure (hazard ratio [HR], 2.9 and HR, 1.6, respectively), dementia (HR, 3.1), peripheral artery disease (HR, 2.0), previous heart failure (HR, 2.6), and previous myocardial infarction (HR, 1.4). A simple comorbidity index (SCI) was developed using these variables, (per point: HR, 1.6; 95% confidence interval, 1.4-1.8; P = .0001). Adding the SCI, Charlson comorbidity index, or coronary artery disease-specific index to the base model resulted in a gain of 6.58%, 5.00%, and 4.04%, respectively, in discriminative ability (P = .001), without significant differences among the 3 indices. In patients with comorbid conditions, the highest risk period was in the first weeks after NSTEACS. The strength of the association between SCI and mortality rate was similar in the external validation cohort (HR, 1.3; 95% confidence interval, 1.1-1.6; P = .001). CONCLUSION: Renal dysfunction, dementia, peripheral artery disease, previous heart failure, and previous myocardial infarction are the comorbid conditions that predict mortality in NSTEACS. A simple index using these variables proved to be as accurate as the more complex comorbidity indices for risk stratification. In-hospital management of patients with comorbid conditions merits further investigation.

Superficial dorsal penile vein thrombosis: a little-known complication of subinguinal varicocelectomy.

OBJECTIVE: To describe the symptomatology, diagnosis and treatment of superficial thrombosis of the dorsal penile vein - the most common complication of subinguinal varicocelectomy - and analyse the possible mechanisms involved in the development of the condition. PATIENTS AND METHODS: The clinical records of 326 patients who underwent varicocele repair during the last 10 years was reviewed. The technique used was subinguinal varicocelectomy with arterial preservation. A mini-Doppler probe was used during surgery for artery identification. We report on the postoperative complications of varicocelectomy, with special attention to superficial dorsal penile vein thrombosis, and provide a detailed description of the anatomy of the superficial venous system of the penis. RESULTS: Complications usually associated with varicocele surgery occurred in less than 1% of patients. However, the most common complication in our series was superficial dorsal penile vein thrombosis, which occurred in 2.1% of patients. The use of the mini-Doppler probe allowed us to identify and preserve the arteries in all 326 patients. CONCLUSION: Subinguinal varicocelectomy with intra-operative use of a mini-Doppler probe is a rapid and safe technique. The outcomes and complications are similar to those reported for subinguinal microscopic varicocelectomy. Superficial dorsal penile vein thrombosis is a benign self-limited condition whose association with subinguinal varicocelectomy has not been previously reported.

Empleo de bandas libres de tensión asociadas a la cirugía reconstructiva del suelo pelviano / The use of tension-free vaginal tape associated with pelvic floor reconstructive surgery

Objetivos: Presentar nuestros resultados a medio-largo plazo en la utilización de la cinta vaginal sin tensión (TVT) en la incontinencia urinaria (IUE) de esfuerzo femenina cuando se asocia a la corrección quirúrgica de los defectos del suelo pelviano para su resolución integral. Material y métodos: Entre enero de 2000 y mayo de 2008 se intervino quirúrgicamente a 171 pacientes con trastornos del suelo pelviano mediante TVT. En 117 se colocó una TVT de forma aislada como tratamiento de su IUE. A las restantes 54 pacientes, que presentaban diversos trastornos del suelo pelviano, la TVT se asoció a tratamiento para estos defectos (cistocele, rectocele, prolapso uterino) con el objetivo de corregirlos. Resultados: La media de seguimiento fue 36 (12-108) meses. La media de edad de las pacientes fue 55 (35-78) años en el grupo de TVT (grupo 1) y 57 (43-76) años en el grupo de TVT y cirugía vaginal (grupo 2). La paridad fue 2,23 (0-6) en el grupo 1 y 3,12 (1-6) en el grupo 2. Hay diferencias en cuanto al motivo de consulta para ambos grupos. La media de estancia fue de 24 h en el grupo 1 y de 4 días en el grupo 2. La complicación más grave fue la perforación vesical durante el acto quirúrgico, que sucedió en siete ocasiones y la más frecuente, la aparición de hiperactividad detrusora sintomática de novo que fue similar para los dos grupos. Conclusiones: La TVT es el estándar para la IUE femenina, con resultados demostrados en la literatura, su asociación a cirugía reconstructiva se presenta como una alternativa segura y satisfactoria para la resolución integral de los defectos del suelo pelviano, sin incrementarse por ello la morbilidad de la técnica (AU)

Objective: We present our medium- to long-term results for the use of TVT for female stress urinary incontinence (SUI) employed concomitantly with surgical correction of pelvic floor prolapse in order to provide an integral solution. Material and methods: Between January 2000 and May 2008, 171 women with pelvic floor disorders underwent a surgical procedure with TVT. 117 of those women received TVT as a sole treatment for SUI; in the 54 remaining patients who suffered from some type of pelvic organ prolapse, TVT was associated with a vaginal procedure to correct the prolapsed (cystocele, rectocele, prolapsed uterus).Results: Mean follow-up time was 36 months (range 12-108). The mean age was 55 years (35-78) in group 1 and 57 years (range 43-76) in the group for which TVT was associated with a pelvic floor correction. The parity was 2.23 (range 0-6) in group 1 and 3.12 (1-6) in group 2. There are some differences in the initial medical complaints among both groups. The mean hospitalisation time was 24 hours in group 1 and 4 days in group 2. The most serious complication was bladder perforation during surgery, which occurred in seven patients. The most frequent complication was the onset of de novo urge symptoms (overactive bladder), which was similar in both groups. Conclusions: TVT remains the gold standard treatment for female SUI with proven results in the literature, and may be safely and effectively associated with pelvic floor reconstructive surgery without increasing the technique’s morbidity rate (AU)

The use of tension-free vaginal tape associated with pelvic floor reconstructive surgery.

OBJECTIVE: To present our medium-to-long term results for the use of TVT in female stress urinary incontinence (SUI) employed concomitantly with surgical correction of pelvic floor prolapse for an integral solution. MATERIAL AND METHODS: Between January 2000 and May 2008, 171 women with pelvic floor disorders underwent a surgical procedure with TVT. 117 of those women received TVT as a sole treatment for SUI. In the remaining 54 patients, who suffered from some type of pelvic organ prolapse, TVT was combined with a vaginal procedure to correct the prolapse (cystocele, rectocele, prolapsed uterus). RESULTS: Mean follow-up time was 36 months (range 12-108). The mean age was 55 years (35-78) in the TVT group (group 1) and 57 years (range 43-76) in the TVT and pelvic floor correction group (group 2). The number of childbirths was 2.23 (range 0-6) in group 1 and 3.12 (1-6) in group 2. There were some differences in the initial medical complaints in both groups. Mean hospitalisation time was 24 hours in group 1 and 4 days in group 2. The most serious complication was bladder perforation during surgery, which occurred in seven patients. The most frequent complication was the onset of de novo detrusor overactivity (overactive bladder), which was similar in both groups. CONCLUSIONS: TVT is the reference standard treatment for female SUI with proven results in the literature. Its association with reconstructive surgery is presented as a safe and satisfactory alternative for comprehensive resolution of pelvic floor defects, without increasing the morbidity of the technique.

[Treatment of a rectourethral fistula after radical prostatectomy by York Mason posterior trans-sphincter exposure]. / Tratamiento de la fístula rectouretral tras prostatectomía radical mediante la exposición transesfinteriana posterior de York Mason.

INTRODUCTION: Recto-urethral fistula is an uncommon complication after radical prostatectomy, occurring in less than 2% of patients. Our aim is to review our experience for repairing these fistulas with the posterior trans-sphincter approach of York Mason. PATIENTS AND METHOD: Retrospective review. All patients who underwent repair of postoperative recto-urethral fistula in our unit were included. The procedure described by York Mason was performed in all cases. RESULTS: During the last 6 years, 5 patients with recto-urethral fistulas after radical prostatectomy were repaired by using this method. Symptoms, including faecaluria and/or passing of urine via the anus, appeared between the postoperative day 4 and 7 weeks after surgery, and confirmation was obtained by cystography. Initial faecal diversion with sigmoid loop colostomy was performed in 3 cases, whereas in the other 2 patients a loop ileostomy was performed at the time of surgical repair. The posterior trans- sphincter approach and fistula repair was performed between 5 and 10 months after diagnosis. Morbidity included wound infection in 2 cases and skin dehiscence in another 2 patients. Successful fistula closure was achieved in all cases with complete faecal continence. No recurrence has been observed after a mean follow-up of 22 (4-40) months. CONCLUSIONS: The posterior trans-sphincter approach of York Mason is effective for the repair of recto-urethral fistulas after radical prostatectomy with minor morbidity and no impairment of continence.

Tratamiento de la fístula rectouretral tras prostatectomía radical mediante la exposición transesfinteriana posterior de York Mason / Treatment of a rectourethral fistula after radical prostatectomy by York Mason posterior trans-sphincter exposure

Introducción. La fístula rectouretral tras prostatectomía radical es una complicación poco frecuente que ocurre en menos de un 2% de los casos. El objetivo es analizar nuestra experiencia en el tratamiento de la fístula rectouretral mediante la exposición (..) (AU)

Introduction. Recto-urethral fistula is an uncommon complication after radical prostatectomy, occurring in less than 2% of patients. Our aim is to review our experience for repairing these fistulas with the posterior trans-sphincter approach of York Mason. Patients and method. Retrospective review. All patients who underwent repair of postoperative (..) (AU)

Hypertension confirmation and blood pressure control rates in epidemiological surveys.

BACKGROUND: Scarce knowledge about hypertension confirmation and control after a single blood pressure (BP) measurement is available. The objective of this study was to evaluate hypertension confirmation and control rates after 6-year follow-up in a population-based cohort. METHODS: A cohort of 1748 participants representative of a Spanish population received standardized BP measurements. Systolic BP>or=140 mmHg or diastolic BP>or=90 mmHg was found in 617 participants. Three hundred and thirty-four of them had no history of hypertension and the remaining 283 had been previously diagnosed or received antihypertensive treatment. All were advised to consult their physicians. We discarded for follow-up 109 participants with already well-controlled hypertension (27.8% of all hypertensive participants). We followed 583 participants (94.5% of the cohort) for 6 years (14 died and 20 were lost to follow-up). RESULTS: The diagnosis of hypertension was confirmed during follow-up in 139 (44.4%) of those with no previously known hypertension, making the overall prevalence for the cohort equal to 30.4% (n=531). The hypertension control rate at the end of follow-up was 50.1%, whereas it was 27.9% at baseline. Diabetes was the only factor to be independently associated with good control of hypertension. CONCLUSION: Six years after a single-occasion blood pressure measurement, hypertension was confirmed in almost half of the participants with systolic BP>or=140 mmHg or diastolic BP>or=90 mmHg and no history of hypertension. Hypertension control achieved with this screening procedure is almost double that observed in the baseline examination, and is highest among diabetic participants.

[Analysis of trends in myocardial infarction case-fatality, incidence and mortality rates in Girona, Spain, 1990-1999]. / Análisis de la tendencia en la letalidad, incidencia y mortalidad por infarto de miocardio en Girona entre 1990 y 1999.

INTRODUCTION AND OBJECTIVES: The incidence of myocardial infarction in Spain is low, and mortality has been decreasing over the last few decades. The objective of this study was to analyze trends in myocardial infarction mortality, incidence, attack rates, and 28-day case-fatality attack rates between 1990 and 1999 in the general population aged 35-74 years in Girona, Spain. METHODS: The study included all myocardial infarction cases in Girona classified according to the MONICA algorithm. Attack, incidence, mortality rates and case-fatality were calculated. In addition, the annual percentage change in each of these indicators during the study period was also calculated. RESULTS: The mean attack rate per 100,000 inhabitants was 258 (95% CI, 249-267) in men and 55 (95% CI, 51-59) in women. The mean mortality rate per 100,000 was 99 (95% CI, 93-104) in men and 25 (95% CI, 22-28) in women. Significant reductions in attack, incidence and recurrence rates were observed in men aged 35-64 years during the period 1990-1999, but not in men aged 65-74 years, nor in women. CONCLUSIONS: Myocardial infarction incidence and mortality rates were low in the general population aged 35-64 years. Rates improved in men aged 35-64 years during the period 1990-1999, but not in those aged 65-74 years, which indicates that a combination of primary and secondary prevention has increased the age at which a myocardial infarction or its recurrence is observed. Rates in woman were lower and did not change during the study period.

Análisis de la tendencia en la letalidad, incidencia y mortalidad por infarto de miocardio en Girona entre 1990 y 1999 / Analysis of trends in myocardial infarction case-fatality, incidence and mortality rates in Girona, Spain, 1990-1999

Introducción y objetivos. La incidencia por infarto de miocardio en España es baja y la mortalidad está disminuyendo en las últimas décadas. Hemos analizado las tendencias en las tasas de mortalidad, incidencia y ataque, y en la letalidad a 28 días por infarto de miocardio entre 1990 y 1999 en la población de 35 a 74 años de Girona. Métodos. Se incluyeron todos los casos de infarto de miocardio de Girona clasificados según el algoritmo MONICA. Se calcularon las tasas de ataque, incidencia y mortalidad, y la letalidad, así como el porcentaje de cambio anual en cada uno de los indicadores durante el período analizado. Resultados. La tasa anual media de ataque fue de 258 (intervalo de confianza [IC] del 95%, 249-267) y 55 (IC del 95%, 51-59) por 100.000 habitantes para varones y mujeres, respectivamente, y la de mortalidad de 99 (IC del 95%, 93-104) por 100.000 en varones y de 25 (IC del 95%, 22-28) por 100.000 en mujeres. Las tasas de ataque, incidencia y recurrencia disminuyeron significativamente en varones de 35 a 64 años durante el período 1990-1999, pero no en los de 65 a 74 años ni en las mujeres. Conclusiones. La incidencia y la mortalidad por IAM fueron bajas en la población de 35 a 64 años, y mejoraron en los varones de 35 a 64 años durante el período 1990-1999, pero no en los de 65 a 74 años, lo que indica que la combinación de prevención primaria y secundaria ha retrasado la edad de aparición del infarto de miocardio o de las recurrencias. Las tasas en mujeres fueron inferiores y no cambiaron durante el período estudiado (AU)

Introduction and objectives. The incidence of myocardial infarction in Spain is low, and mortality has been decreasing over the last few decades. The objective of this study was to analyze trends in myocardial infarction mortality, incidence, attack rates, and 28-day case-fatality attack rates between 1990 and 1999 in the general population aged 35-74 years in Girona, Spain. Methods. The study included all myocardial infarction cases in Girona classified according to the MONICA algorithm. Attack, incidence, mortality rates and case-fatality were calculated. In addition, the annual percentage change in each of these indicators during the study period was also calculated. Results. The mean attack rate per 100,000 inhabitants was 258 (95% CI, 249-267) in men and 55 (95% CI, 51-59) in women. The mean mortality rate per 100,000 was 99 (95% CI, 93-104) in men and 25 (95% CI, 22-28) in women. Significant reductions in attack, incidence and recurrence rates were observed in men aged 35-64 years during the period 1990-1999, but not in men aged 65-74 years, nor in women. Conclusions. Myocardial infarction incidence and mortality rates were low in the general population aged 35-64 years. Rates improved in men aged 35-64 years during the period 1990-1999, but not in those aged 65-74 years, which indicates that a combination of primary and secondary prevention has increased the age at which a myocardial infarction or its recurrence is observed. Rates in woman were lower and did not change during the study period (AU)

Open testicular biopsy without a surgical assistant using a scrotal Rumel tourniquet.

PURPOSE: The main current indication for open testicular biopsy is the extraction of sperm cells for intracytoplasmic sperm injection in patients with azoospermia. Usually the surgical assistant or operator holds the testicle with the nondominant hand throughout the operation. We propose using a scrotal device in the shape of a Rumel tourniquet to maintain the testicle fixed and tight against the scrotal wall all the time with no need to be held by the hand. MATERIALS AND METHODS: The Rumel tourniquet is made of a Penrose-type rubber drain and a piece of plastic tube. It is placed at the base of the scrotum to include the 2 testicles, while tension is adjusted until the skin becomes tense and the scrotal wall is held tightly against the testicles. Placing the eyelid retractor is unnecessary since the various scrotal wall layers become spontaneously separated. RESULTS: We have used this device in 20 consecutive testicular biopsies in patients with obstructive azoospermia and for histopathological diagnosis. It was useful in all cases. No device related complications were observed. CONCLUSIONS: This straightforward scrotal device simplifies the procedure since no surgical assistant is required, the surgeon can use 2 hands during the operation and testicular biopsy is achievable through a small incision.

Insertion (8;11) in a renal oncocytoma with multifocal transformation to chromophobe renal cell carcinoma.

We report the case of a 43-year-old male with multiple tumor foci showing microscopic features of chromophobe renal carcinoma (ChRCC) arising in an oncocytoma. Conventional cytogenetics of fresh tumor cells and fluorescence in situ hybridization (FISH) revealed the following abnormal karyotype: 46,XY,der(8)ins(8;11)(p?;q13),der(11)ins(8;11)inv(11)(q12?p15) with CCND1 (11q13) rearrangement. To our knowledge, chromosome 8 has not been reported as a partner involved in structural rearrangements of 11q13 in oncocytomas. FISH in paraffin tissue sections revealed a rearrangement of CCND1 (11q13) in the oncocytoma cells. The multiple foci of chromophobe carcinoma presented multiple copies of CCND1, suggesting that they represented a transformation from oncocytoma into ChRCC. There was immunohistochemical overexpression of CCND1 in both oncocytoma and chromophobe carcinoma cells. In this case, the correlation of the microscopic findings with changes in CCND1 gene associated to CCND1 overexpression in both components suggest that the ChRCC would have originated from the preexisting oncocytoma. It is not possible to detect, by cytogenetic techniques alone, if the ChRCC component have also the CCND1 rearrangement in addition to the detected polysomy. FISH techniques on paraffin tissue sections may help to identify genetic aberrations such as CCND1 rearrangement in order to establish a diagnosis of oncocytoma.

Hemiscrotectomy with contralateral testicular transposition for scrotal cancer.

PURPOSE: Wide excision of scrotal tumors results in serious defects to such an extent that in some cases the contents of the scrotum cannot be preserved. We describe a hemiscrotectomy technique with transposition of the testis to the contralateral hemiscrotum that facilitates closure of the surgical wound and allows preservation of the testis. MATERIALS AND METHODS: Our procedure was used in 3 patients with scrotal neoplasia, including 2 with squamous cell carcinoma and 1 with extramammary Paget's disease. After excision of the hemiscrotum affected by the tumor, which includes all layers of the scrotal wall, the testis is transposed into the contralateral hemiscrotum through a slit made in the medial scrotal septum. The defect is easily closed by apposing the surgical wound edges. RESULTS: The 3 men were disease-free 8, 7 and 4 years after surgery, respectively. After intervention they remained pain-free. None had hydrocele or epididymitis secondary to placement of the 2 testes in the same hemiscrotum. CONCLUSIONS: In appropriate candidates this technique allows the scrotal defect to be easily reconstructed after tumor excision without any need for skin flaps or free skin grafts. The procedure makes it possible to preserve the scrotal content and perform more radical treatment since the scrotal wall is completely excised.