Undergraduate teaching of urology: Quo vadis?

BACKGROUND: The undergraduate teaching of urology is not uniform in the various European medical schools and even absent in some of them, despite the widespread adoption of the Bologna process, which advocates a standardization and harmonization of medical education. Our aim was to evaluate the perception of junior doctors about the undergraduate teaching of Urology and the exposure to the specialty of Urology in undergraduate education in Portuguese medical schools. METHODS: A questionnaire was emailed to all physicians who first enrolled in the Board of Portuguese Doctors in 2017 and 2018. The questionnaire consisted of several questions about specialty exposure, pathology, and basic urological procedures. A database for statistical analysis was created. RESULTS: One hundred and eighty-six answers were considered valid. Although almost all participant physicians attribute considerable importance to Urology specialty, most find their exposure to urological pathology and basic urological procedures to be inappropriate in medical school. Urinary lithiasis and lower urinary tract symptoms are the subjects on which doctors feel most prepared after graduating. Interestingly, 63.4% of doctors consider that the education they had in college was preponderant in choosing their specialty. CONCLUSIONS: The teaching of Urology in Portuguese Medical Schools is considered by junior doctors as inadequate, not reflecting the importance of this specialty in the clinical practice. These results are like those found in other countries. A reflection and consequent change of the teaching paradigm is necessary, namely at the practical teaching level.

Synchronous bilateral seminoma.

OBJECTIVE: To present a case of synchronous bilateral seminoma and perform a bibliographic review about this rare presentation of testicular neoplasia, with important physical and psychological consequences. METHODS: 25-year old man with bilateral multifocal testicular neoplasias and azoospermia. We performed a bilateral inguinal radical orchiectomy, with the pathologic exam diagnosing bilateral seminoma. Adjuvant lumbar-aortic radiotherapy was initiated. More than a year after the surgery the patient is asymptomatic and without evidence of disease, although dependent of testosterone supplement. RESULTS: Germ cell testicular neoplasias are more frequent in young men between 15 and 35 years old. There is a 2-3% incidence of bilateral neoplasm, either synchronous or metachronous. Bilateral radical orchiectomy remains as standard of treatment, rendering the patient infertile and depending on exogenous androgens, which causes several psychological problems. However, a testis-sparing surgery could be performed in selected cases; our patient, having multiple bilateral neoplasias, was not eligible for this procedure. With a great incidence of carcinoma in situ on spared testicular parenchyma, scrotal radiotherapy is indicated. In spite of infertility, this treatment presents very good oncological results with androgen independence and consequent physical and psychological advantages. CONCLUSION: Bilateral orchiectomy still remains as "gold-standard" treatment for bilateral seminoma. However, there are other possibilities of treatment, such as partial orchiectomy, feasible in selected cases of small volume testicular tumours in solitary testis / bilateral tumour in men without preoperative androgen deficiency and who could be object of close clinical and imaging follow-up. This way you could avoid additional loss of quality of life, without any prejudice on oncological results.

Seminoma bilateral sincrónico. Revisión de la literatura a propósito de un caso / Synchronous bilateral seminoma

OBJETIVO: Presentar un caso de seminoma bilateral sincrónico y realizar una revisión bibliográfica sobre una presentación poco frecuente de neoplasia testicular.MÉTODOS: Presentamos el caso de un hombre de 25 años con neoplasia testicular bilateral multifocal y azoospermia. Realizamos una orquiectomía radical inguinal bilateral, cuyo examen anatomopatológico reveló seminoma bilateral, por lo que se efectuó radioterapia lumbo-aórtica adyuvante. Más de un año después de la cirugía, se encuentra asintomático y sin evidencia de enfermedad, pero dependiente de testosterona exógena.RESULTADOS: Las neoplasias testiculares germinativas presentan una incidencia mayor en hombres entre 15 a 35 años. En el 2-3 % de los casos, se verifica neoplasia bilateral. El tratamiento recomendado es la orquiectomía radical bilateral, que ocasiona infertilidad en el paciente y dependencia de testosterona exógena. En nuestro paciente, por tener múltiples tumores bilateralmente, no existía otra opción, pero en casos seleccionados se puede efectuar orquiectomía parcial. Si es muy elevada la incidencia de carcinoma in situ en el restante parénquima, está indicada la radioterapia escrotal. A pesar de la infertilidad secundaria al tratamiento, esta opción presenta muy buenos resultados oncológicos y de no dependencia de testosterona exógena.CONCLUSIÓN: El tratamiento recomendado del seminoma bilateral sigue siendo la orquiectomía bilateral, aunque existen otras posibilidades, como la orquiectomía parcial, posible en tumores testiculares únicos, de pequeño volumen en hombres con testosterona normal y con posibilidad de vigilancia clínica y radiológica frecuente. De esta manera, se puede disminuir el impacto sobre la calidad de vida, sin alterar el resultado oncológico final(AU)

OBJECTIVE: To present a case of synchronous bilateral seminoma and perform a bibliographic review about this rare presentation of testicular neoplasia, with important physical and psychological consequences.METHODS: 25-year old man with bilateral multifocal testicular neoplasias and azoospermia. We performed a bilateral inguinal radical orchiectomy, with the pathologic exam diagnosing bilateral seminoma. Adjuvant lumbar-aortic radiotherapy was initiated. More than a year after the surgery the patient is asymptomatic and without evidence of disease, although dependent of testosterone supplement.RESULTS: Germ cell testicular neoplasias are more frequent in young men between 15 and 35 years old. There is a 2-3% incidence of bilateral neoplasm, either synchronous or metachronous. Bilateral radical orchiectomy remains as standard of treatment, rendering the patient infertile and depending on exogenous androgens, which causes several psychological problems. However, a testis-sparing surgery could be performed in selected cases; our patient, having multiple bilateral neoplasias, was not eligible for this procedure. With a great incidence of carcinoma in situ on spared testicular parenchyma, scrotal radiotherapy is indicated. In spite of infertility, this treatment presents very good oncological results with androgen independence and consequent physical and psychological advantages.CONCLUSION: Bilateral orchiectomy still remains as “gold-standard” treatment for bilateral seminoma. However, there are other possibilities of treatment, such as partial orchiectomy, feasible in selected cases of small volume testicular tumours in solitary testis / bilateral tumour in men without preoperative androgen deficiency and who could be object of close clinical and imaging follow-up. This way you could avoid additional loss of quality of life, without any prejudice on oncological results(AU)