Clinicopathologic analysis of upper urinary tract carcinoma with variant histology.

We report on the clinicopathologic features of 115 cases of high-grade urothelial carcinoma of the upper urinary tract with variant histology present in 39 (34%). Variant histology was typically seen in high pathological stage (pT2-pT4) (82%, 32 cases) patients with lower survival rate (70%, 27 cases, median survival 31 months) and consisted in urothelial with one (23%), two (3%), and three or more variants (3%); 4% of cases presented with pure variant histology. Squamous divergent differentiation was the most common variant (7%) followed by sarcomatoid (6%) and glandular (4%), followed by 3% each of micropapillary, diffuse-plasmacytoid, inverted growth, clear cell glycogenic, or lipid-rich. The pseudo-angiosarcomatous variant is seen in 2%, and 1% each of nested, giant-cell, lymphoepithelioma-like, small-cell, trophoblastic, rhabdoid, microcystic, lymphoid-rich stroma, or myxoid stroma/chordoid completed the study series. Loss of mismatch repair protein expression was identified in one case of upper urinary tract carcinoma with inverted growth variant (3.6%). Variant histology was associated to pathological stage (p = 0.007) and survival status (p = 0.039). The univariate survival analysis identified variant histology as a feature of lower recurrence-free survival (p = 0.046). Our findings suggest that variant histology is a feature of aggressiveness in urothelial carcinoma of the upper urinary tract worth it to be reported.

A referenciação para a consulta de andrologia - Quem e como são referenciados? / Andrology - Whom and how are patients being referred?

Introdução: A andrologia é uma área médica que estuda a sexualidade e a fertilidade no sexo masculino. A referenciação de utentes deve ser feita de forma criteriosa e adequada para assegurar o acesso a tratamentos diferenciados sempre que haja indicação. Objetivo: Caracterizar a referenciação específica para a consulta de andrologia no nosso centro hospitalar. Material e métodos: Avaliação retrospectiva da casuística da consulta de andrologia entre janeiro de 2014 e dezembro de 2015. Resultados: Consultaram‐se os registos clínicos de 96 das 102 consultas de primeira vez de andrologia. Cerca de 60% dos doentes foram referenciados por disfunção eréctil, 15% por curvatura peniana e 8% por disfunção ejaculatória. Apenas 27% dos doentes com disfunção eréctil já tinham efetuado prova terapêutica e 40% não tinham perfil metabólico recente. Discussão: A elevada prevalência de comorbilidades sexuais e a elevada prevalência de doentes naïve na população referenciada levam a ponderar se existe dificuldade entre os médicos referenciadores de categorizar e tratar a disfunção sexual masculina de acordo com o modelo tetrafásico da resposta sexual. A ausência de estratificação de doentes segundo os critérios de Princeton III demonstra a dificuldade na seleção de doentes que podem iniciar terapêuticas de primeira linha antes da referenciação. Conclusão: As disfunções sexuais têm uma elevada prevalência na população geral. Os cuidados de saúde necessitam de ter uma maior capacidade de intervenção diagnóstica e terapêutica

Introduction: Andrology focuses in male sexual and fertility diseases. Its referral should be thoughtful and tailored in order to select the correct cases. Objectives: The aim of this work was to evaluate the referral to our department and improvement points. Material and methods: A retrospective analysis was performed of the Andrology consults between January 2014 and December 2015. Results: We evaluated 96 of the 102 consults performed. About 60% of patients were referred with erectile dysfunction complaints, 15% with penile curvature and 8% with ejaculatory dysfunction. About 27% had previously tried phosphodiesterase 5 inhibitor, and 40% lacked recent metabolic workup. Discussion: The high prevalence of sexual complaints coupled with a high number of naïve patients could be due to difficulties by the referral doctors when analyzing and characterizing male sexual dysfunction according to the current sexual response cycle model. The lack of patient categorization accordingly to Princeton criteria (III) shows the difficulties found when selecting patients to start the first line of treatment for erectile dysfunction. Conclusion: Sexual dysfunction are highly prevalent in the general population. Healthcare providers should improve diagnostic and treatment skills in this field of Urology

[Andrology - Whom and how are patients being referred?] / A referenciação para a consulta de andrologia ­ Quem e como são referenciados?

INTRODUCTION: Andrology focuses in male sexual and fertility diseases. Its referral should be thoughtful and tailored in order to select the correct cases. OBJECTIVES: The aim of this work was to evaluate the referral to our department and improvement points. MATERIAL AND METHODS: A retrospective analysis was performed of the Andrology consults between January 2014 and December 2015. RESULTS: We evaluated 96 of the 102 consults performed. About 60% of patients were referred with erectile dysfunction complaints, 15% with penile curvature and 8% with ejaculatory dysfunction. About 27% had previously tried phosphodiesterase 5 inhibitor, and 40% lacked recent metabolic workup. DISCUSSION: The high prevalence of sexual complaints coupled with a high number of naïve patients could be due to difficulties by the referral doctors when analyzing and characterizing male sexual dysfunction according to the current sexual response cycle model. The lack of patient categorization accordingly to Princeton criteria (III) shows the difficulties found when selecting patients to start the first line of treatment for erectile dysfunction. CONCLUSION: Sexual dysfunction are highly prevalent in the general population. Healthcare providers should improve diagnostic and treatment skills in this field of Urology.

Acquired male urethral diverticulum: a rare entity treated in a one-stage procedure.

Acquired male urethral diverticulum is a rare entity with most of the literature revolving around case reports or small case series. Up to two-thirds of cases are acquired, mostly as a result of trauma, stricture or infection. Infrequently, some cases develop as a complication of urological procedures, or even penile clamping. We present the case of an adult male with lower urinary tract symptoms, recurrent urinary infections and a history of multiple surgeries to treat a complicated perineal fistulae disease. With the help of imaging techniques, a bulbar urethral diverticulum was discovered. Owing to the symptomatic nature of the diverticulum, an open procedure was performed with excision and primary urethral anastomosis. No urinary symptoms were reported and follow-up imaging and flowmetry demonstrated very good functional outcome.

The management of bilateral cryptorchidism in the adult man: report of two cases.

OBJECTIVE: Undescended testis or cryptorchidism is a pathology usually presenting in the newborn or during childhood, rarely diagnosed in the adult man. This article pretends to perform a review of its management in the adulthood. METHODS: We present two cases of man with bilateral congenital cryptorchidism diagnosed in the adult. We made a review of the management of this condition in the adult male, based in a research performed in PubMed database. CONCLUSIONS: With the use of laparoscopy in the management of men with cryptorchidism, the diagnostic and therapeutic approach in this pathology doesn't differ from that used in childhood. Surgical management is based in the localization of the testis in physical exploration, the risk of testicular cancer and the viability of the gonad in its exploration. Hormonal replacement therapy and fertility preservation techniques should be offered in selected cases to optimize patient health and desires.

Tratamiento de la criptorquidia bilateral en el adulto: revisión, a propósito de dos casos clínicos / The Management of Bilateral Cryptorchidism in the Adult Man. Report of Two Cases

OBJETIVO: La criptorquidia es una patología característica del recién nacido y la infancia, siendo raramente identificada en el hombre adulto. En el articulo hacemos una revisión del diagnostico y tratamiento de la patología en el hombre adulto. MÉTODOS: Se presentan los casos de dos hombres adultos con criptorquidia bilateral congénita con diagnostico tardío en la consulta de urología. Realizamos una revisión del manejo diagnóstico y terapéutico de esta patología de la diferenciación genital masculina, en la edad adulta, con base en la búsqueda bibliográfica en Pubmed. CONCLUSIONES: Con la cirugía laparoscópica, el riesgo quirúrgico del diagnóstico y tratamiento de la criptorquidia en el adulto no difiere del de la infancia. El manejo quirúrgico es determinado por la localización del testículo en la palpación inguinal, el riesgo de tumor testicular y por la presencia ó no de una gónada atrófica a la exploración. El manejo de los hombres se complementa con la optimización del status hormonal y de la preservación de la fertilidad

OBJECTIVE: Undescended testis or cryptorchidism is a pathology usually presenting in the newborn or during childhood, rarely diagnosed in the adult man. This article pretends to perform a review of its management in the adulthood. METHODS: We present two cases of man with bilateral congenital cryptorchidism diagnosed in the adult. We made a review of the management of this condition in the adult male, based in a research performed in PubMed database. Coclusions: With the use of laparoscopy in the management of men with cryptorchidism, the diagnostic and therapeutic approach in this pathology doesn't differ from that used in childhood. Surgical management is based in the localization of the testis in physical exploration, the risk of testicular cancer and the viability of the gonad in its exploration. Hormonal replacement therapy and fertility preservation techniques should be offered in selected cases to optimize patient health and desires

Intestinal adenocarcinoma in an augmented ileocystoplasty.

We present a case of a 67-year-old patient with a history of augmentation ileocystoplasty 31 years ago following genitourinary tuberculosis. Radiological investigations performed due to asymptomatic microscopic haematuria revealed three contrast-enhancing polyps within the neobladder. The patient had enterocystoprostatectomy and histopathological examination of the neobladder revealed mucinous adenocarcinoma in all three polyps, together with a prostatic adenocarcinoma Gleason 7 (3+4). After adjuvant chemotherapy and 1 year of follow-up, he had no sign of clinical or radiological recurrence. Taking into consideration this rare case, we discuss the development of malignant tumours after the incorporation of intestinal segments in a urinary tract reconstruction, showing what relationship exists between secondary neoplastic growth, the primary disease and the type of urinary diversion utilised.