RESUMO
BACKGROUND: Almost 50% of patients with germ-cell tumors (GCT) are subfertile, and every step of the treatment may further impair fertility. As a result, sperm banking is often advised prior to radical orchiectomy. However, whether affected testes contribute to fertility is unclear. OBJECTIVES: To determine whether maximal tumor diameter (MTD) is correlated with ipsilateral fertility (IF) in patients treated for GCT. METHODS: We reviewed medical charts for demographic and clinical data of patients with GCT who had undergone orchiectomy at our institution between 1999 and 2015. The extent of spermatogenesis was categorized into three groups: full spermatogenesis, hypospermatogenesis, and absence of spermatogenesis. The presence of mature spermatozoa in the epididymis tail was also assessed. We defined IF as the combination of full spermatogenesis in more than 100 tubules and the presence of mature spermatozoa in the epididymis tail. Mann-Whitney was applied to determine the correlation between MTD and IF. RESULTS: Of 57 patients, IF was present in 28 (49%). Mean patient age was 32.8 years in patients with positive IF and 33.4 years those with negative IF. Seminoma was diagnosed in 46.4% of patients with positive IF and in 65.5% of patients with negative IF. Full spermatogenesis was observed in 33 patients (57.8%). In 48 (82.7%), mature epididymal spermatozoa were found. No correlation was found between MTD and IF. CONCLUSIONS: IF is present in almost half of the patients undergoing radical orchiectomy. Because IF cannot be predicted by MTD, routine pre-orchiectomy sperm banking is suggested.
Assuntos
Neoplasias Embrionárias de Células Germinativas/patologia , Seminoma/patologia , Espermatogênese/fisiologia , Neoplasias Testiculares/patologia , Testículo/patologia , Adulto , Epididimo/fisiologia , Fertilidade/fisiologia , Humanos , Infertilidade Masculina/etiologia , Masculino , Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia , Estudos Retrospectivos , Seminoma/epidemiologia , Seminoma/cirurgia , Espermatozoides/metabolismo , Estatísticas não Paramétricas , Neoplasias Testiculares/cirurgia , Testículo/metabolismoRESUMO
We present a case of ureteral obstruction secondary to pelvic actinomycosis. Despite stenting, prolonged antibiotic therapy, and debridement, the patient required ureteral resection and reconstruction. This condition may simulate advanced malignancy, and diagnostic suspicion lessens the need for radical extirpative surgery.
Assuntos
Actinomicose/complicações , Infecção Pélvica/complicações , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Amoxicilina/uso terapêutico , Cistostomia/métodos , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Infecção Pélvica/diagnóstico , Infecção Pélvica/tratamento farmacológico , Neoplasias Pélvicas/diagnóstico , Penicilinas/uso terapêutico , Stents , Ureter/cirurgiaRESUMO
Análisis retrospectivo de 467 expedientes clínicos de pacientes radiadas por padecer cáncer ginecológico. Como resultados se señalan la mayor incidencia de complicaciones en mujeres operadas como parte de su tratamiento, sin establecer en la mayoría de los casos una correlación entre las características del tratamiento aplicado y la aparición de complicaciones.
