Primary epithelioid hemangioendothelioma of the penis: a case report and literature review.

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumour with an intermediate behaviour between benign hemangioma and malignant angiosarcoma. There is scarce data on the penile EHE's management and its natural history, as our knowledge is based on few reported cases with a short follow-up period. We present a case report and conducted a literature review, including 17 cases. The relevance of this case report derives from the need for better clinical characterization of patients with penile EHE and the importance of defining the outcomes. We report the case of a 53-year-old male with a 1-year history of sleep-related painful erections. Imaging techniques showed a well-defined hypoechoic and hypervascular solid nodule on the dorsal aspect of the penis. It was surgically removed, and the histopathological study revealed a low-risk EHE of the penis. Follow-up magnetic resonance imaging (MRI) and computed tomography did not demonstrate local recurrence nor metastases. According to the literature review, most of the patients were in their fifth and sixth decades of life at the time of diagnosis and lesions were usually located in the glans. The most common clinical presentation was as a painful mass. Follow-up period ranged from 2 months to 5 years. Three patients showed systemic metastases, two of which died due to cancer. The conclusions from the literature review are limited by the reduced number of cases and the short follow-up. This case report highlights the importance of understanding the diagnosis and treatment of this type of rare non-squamous malignant tumours of the penis. Penile EHE is a malignant vascular tumour that is very rare in this location. The best treatment is local excision, with re-excision or intraoperative margins assessment. Occasionally, systemic chemotherapy and radiation therapy can be useful. There is consensus on the importance of very strict follow-up of these patients.

Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy.

PURPOSE: Prostatic multi-parametric magnetic resonance imaging (mpMRI) has markedly improved the assessment of men with suspected prostate cancer (PCa). Nevertheless, as mpMRI exhibits a high negative predictive value, a negative MRI may represent a diagnostic dilemma. The aim of this study was to evaluate the incidence of positive transperineal saturation biopsy in men who have negative mpMRI and to analyse the factors associated with positive biopsy in this scenario. PATIENTS AND METHODS: A retrospective study of men with normal mpMRI and suspicion of PCa who underwent saturation biopsy (≥20 cores) was carried out. A total of 580 patients underwent transperineal MRI/transrectal ultrasound fusion targeted biopsies or saturation prostate biopsies from January 2017 to September 2020. Of them, 73 had a pre-biopsy negative mpMRI (with Prostate Imaging - Reporting and Data System, PI-RADS, ≤2) and were included in this study. Demographics, clinical characteristics, data regarding biopsy results and potential predictive factors of positive saturation biopsy were collected. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for MRI-invisible PCa. RESULTS: The detection rate of PCa with saturation biopsy in patients with negative MRI was 34/73 (46.58%). Out of 34 MRI-invisible prostate cancers detected, 12 (35.29%) were clinically significant PCa (csPCa) forms. Regarding factors of positive biopsy, in univariate analysis, the use of 5-alpha reductase inhibitors and free:total prostate-specific antigen (PSA) ratio were associated with the result of the saturation biopsy. In multivariate analysis, only an unfavourable free:total PSA ratio remained a risk factor (OR 11.03, CI95% 1.93-63.15, p=0.01). Furthermore, multivariate logistic analysis demonstrated that prostate volume >50mL significantly predicts the absence of csPCa on saturation biopsy (OR 0.11, 95% CI 0.01-0.94, p=0.04). CONCLUSION: A free:total PSA ratio <20% is a risk factor for MRI-invisible PCa. Saturation biopsy could be considered in patients with suspected PCa, despite having a negative MRI.

Reconstrucción del defecto de exenteración pélvico/perineal extendida con colgajo libre compuesto dorsal ancho-escapular-paraescapular y malla. La lógica en la elección / Reconstruction of extended pelvic/perineal exenteration defect with a composite latissimus dorsi-scapular-parascapular free flap and a mesh. The rationale behind the technique

Presentamos los fundamentos funcionales y reconstructivos en un caso de exenteración pélvica extendida. El propósito es analizar el defecto quirúrgico y los requerimientos reconstructivos, aspectos no suficientemente descritos en la literatura. Se trata de un varón de 62 años, con carcinoma epidermoide perineal de origen uretral (82x117x108 mm) que invadía vejiga, pelvis y fosa pararrectal. El defecto escisional fue reconstruido con un colgajo compuesto dorsal ancho-escapular-paraescapular y una malla bicapa (polipropileno y politetrafluoroetileno extendido). Describimos una reconstrucción multiplanar orientada a 3 requerimientos funcionales definidos: 1.- soporte visceral para evitar la herniación perineal; 2.- colapso del espacio muerto para minimizar el riesgo de infección; y 3.- cobertura cutánea estable en una región exigente. Sin complicaciones postoperatorias en el corto o largo plazo, el paciente puede deambular adecuadamente y se encuentra libre de enfermedad 1 año después de la intervención. Hasta donde hemos podido conocer, este caso presenta por primera vez el uso del colgajo compuesto descrito en la reconstrucción del defecto de exenteración pélvica

The article reports the functional, reconstructive rationale behind a case of extended pelvic exenteration. Our aim is to analyze the surgical defect and consequent reconstructive requirements, aspects which have not been adequately addressed in the literature. A case is presented of a 62-year-old man presenting with an 82x117x108 mm perineal squamous cell carcinoma of urethral origin invading bladder, pelvic bone and pararectal fossa. The resection defect was reconstructed with a composite latissimus dorsi-scapular-parascapular flap and a bilayer mesh (polypropylene and extended polytetrafluoroethylene). A multiplanar reconstruction is shown that addresses 3 distinct functional requirements: 1.- visceral support to prevent perineal herniation; 2.- collapse of dead space to minimize the risk of infection; and 3.- a stable skin cover for a demanding area. With no postoperative short or long-term complications, the patient is ambulating and free of disease at one-year follow-up. To the best of the authors' knowledge, this is the first report of the described composite flap in the reconstruction of the pelvic exenteration defect

What Should Be Known by a Urologist About the Medical Management of COVID-19's Patients?

PURPOSE OF REVIEW: The alarming number of confirmed COVID-19 cases put a strain on the healthcare systems, which had to reallocate human and technical resources to respond to the emergency. Many urologists became integrated into multidisciplinary teams, dealing with this respiratory illness and its unknown management. It aims to summarize the epidemiological, clinical, diagnostical, and therapeutical characteristics of COVID-19, from a practical perspective, to ease COVID-19 management to non-physician staff. RECENT FINDINGS: We performed a narrative review of the literature regarding COVID-19, updated to May 8th, 2020, at PubMed and COVID resource platforms of the main scientific editorials. COVID-19, characterized by fever, myalgias, dyspnea, and dry cough, varies widely from asymptomatic infection to death. Arrhythmias and thrombotic events are prevalent. Lymphopenia and inflammatory reactant elevation on laboratory, as well as bilateral and peripheral ground-glass opacities or consolidations on X-Ray, are usually found in its assessment. Little is known about SARS-CoV-2 immunology. To date, no therapy has demonstrated efficacy in COVID-19. Of-level or compassionate-use therapies are prescribed in the context of clinical trials. We should become familiar with specific adverse events and pharmacological interactions. The COVID-19 pandemic has paralyzed the urological activity, and its long-term consequences are unpredictable. Despite not being used to deal with respiratory diseases, the urologists become easily qualified to manage COVID-19 by following protocols and being integrated into multidisciplinary teams, helping to overcome the pandemic.

[Patient with testosterone deficit syndrome and HIV infection]. / Paciente con SDT e infección por VIH.

Testosterone deficit sindrome (TDS) is more frequent in males with HIV infection than in general population, being in fact the most frequent endocrine disorder in these patients. There are multiple physiopathological mechanisms favoring this testosterone deficit but they are only partially known. Identification of these patients and their adequate treatment will have important consequences not only in their sexual health but also in their general health.

Paciente con SDT e infección por VIH / Patient with testosterone deficit syndrome and HIV infection

El síndrome de déficit de testosterona (SDT) es más frecuente en los varones con infección por VIH que en la población general, constituyendo de hecho la alteración endocrina más frecuente en estos enfermos. Los mecanismos fisiopatológicos que favorecen este déficit de testosterona son múltiples y sólo parcialmente conocidos. La identificación de estos pacientes y su correcto tratamiento tendrá importantes consecuencias no sólo en su salud sexual, sino también en su salud general (AU)

Testosterone déficit síndrome (TDS) is more frequent in males with HIVinfection tan in general population, being in fact the most frequent endocrine disorder in these patients. There are multiple physiopathological mechanisms favoring this testosterone deficit but they are only partially known. Identification of these patients and their adequate treatment will have important consequences not only in their sexual health but also in their general health (AU)

[Ultrasound for the diagnosis of female urinary incontinence]. / Ecografía en el diagnóstico de la incontinencia urinaria femenina.

OBJECTIVES: The value of ultrasonography for the study of female urinary incontinence has been redefined over the last years. METHODS: We review the literature about the value of ultrasound in the workup of females with urinary incontinence, mainly transperineal ultrasound for the female stress urinary incontinence (SUI). RESULTS: Many papers have been published over the last few years. Upper urinary tract ultrasound has not a place in the workup of genuine female SUI. Transperineal ultrasound allows to evaluate the mobility of the bladder neck and urethra, the thickness of the bladder wall, the funnel shape of the bladder neck, the presence of SUI or pelvic organ prolapse (POP), to visualize mesh implants, to help with biofeedback, and to evaluate changes after surgical treatment. CONCLUSIONS: Ultrasounds in general, and transperineal or translabial ultrasound in particular, are in the process of becoming the standard diagnostic method in urogynecology. Their wide availability, the standardization of parameters, the possibility of evaluating not only the bladder but also the levator ani muscle or pelvic organ prolapses (POP) contribute to this fact. It allows to obtain data in a non invasive way before and after therapy.

Ecografía en el diagnóstico de la incontiencia urinaria femenina / Ultrasound for the diagnosis of female urinary incontinence

OBJETIVO: El valor de la Ecografía en el estudio de la Incontinencia Urinaria Femenina (IUF) ha sido redefinido en los últimos años MÉTODOS: Se revisa la literatura sobre el valor de la Ecografía en el estudio de las mujeres con Incontinencia urinaria, fundamentalmente en la ecografía transperineal en la Incontinencia Urinaria de esfuerzo femenina RESULTADOS: En los últimos años son numerosos los trabajos publicados. La ecografía del TUS tiene poco lugar en la evaluación de la IUF de esfuerzo pura. La ecografía transperineal permite evaluar movilidad del cuello vesical y uretra, grosor de la pared vesical, embudización del cuello, presencia de IUF de esfuerzo, presencia de prolapso de órganos pelvianos (POP), visualización de mallas, ayudar al biofeedback y valorar cambios tras tratamiento quirúrgico. CONCLUSIONES: Los ultrasonidos y en particular la ECO transperineal o translabial está en proceso de convertirse un método diagnóstico estándar en uroginecología. A ello contribuye su amplia disponibilidad, estandarización de los parámetros y la posibilidad de evaluar no sólo la vejiga, sino también el elevador del ano o los Prolapsos de órganos pelvianos (POP). Permite obtener, de forma no invasiva datos pre y postratamiento

OBJECTIVES: The value of ultrasonography for the study of female urinary incontinence has been redefined over the last years. METHODS: We review the literature about the value of ultrasound in the workup of females with urinary incontinence, mainly transperineal ultrasound for the female stress urinary incontinence (SUI). RESULTS: Many papers have been published over the last few years. Upper urinary tract ultrasound has not a place in the workup of genuine female SUI. Transperineal ultrasound allows to evaluate the mobility of the bladder neck and urethra, the thickness of the bladder wall, the funnel shape of the bladder neck, the presence of SUI or pelvic organ prolapse (POP), to visualize mesh implants, to help with biofeedback, and to evaluate changes after surgical treatment. CONCLUSIONS: Ultrasounds in general, and transperineal or translabial ultrasound in particular, are in the process of becoming the standard diagnostic method in urogynecology. Their wide availability, the standardization of parameters, the possibility of evaluating not only the bladder but also the levator ani muscle or pelvic organ prolapses (POP) contribute to this fact. It allows to obtain data in a non invasive way before and after therapy