Rare Case of Complete Androgen Insensitivity Syndrome.

Androgen insensitivity syndrome is a rare X-linked recessive condition in which patients present a female phenotype. After complete androgen insensitivity syndrome (CAIS) diagnosis, the timing of gonadectomy should be evaluated, considering the risks and benefits of this procedure. This paper reports an uncommon case of complete androgen insensitivity syndrome diagnosed belatedly in an adult patient. Surgical treatment was deemed necessary due to the elevated risk of gonadal malignancy.

Accidental insertion of double-J in the inferior vena cava in a patient with retroperitoneal fibrosis: a case report.

Background: Implantation of the double-J stent is a common procedure in urology. The function of this device is to maintain the flow of urine from the ureteropelvic junction to the urinary bladder when the ureter is blocked or partially blocked for some reason. Once in place, the stent may cause low back pain, hematuria, symptoms of urinary irritation, a reduction in labor capacity, infection and calcification which are side effects that are easy to manage. However, severe complications can occur, such as the insertion of the stent into the circulatory system, such as the vena cava, which, although uncommon, is one of the most severe and difficult to manage. This work reports the case of a patient with the accidental insertion of a double-J stent into the inferior vena cava. Case Description: An 80-year-old female patient with repeated urinary tract infections using a double-J stent due to stenosis of the right distal ureter distal presenting retroperitoneal fibrosis secondary to previous radiotherapy. The patient had Lynch syndrome, ovarian and uterine cancer, colorectal cancer, and nephrolithiasis. She had been submitted to multiple previous surgeries. Due to the possibility of viral infection by coronavirus disease 2019 (COVID-19), chest computed tomography was performed, which suggested the insertion of the double-J stent in the inferior vena cava, confirmed by abdominal computed tomography. As the distal end of the stent was within the bladder, the decision was made to remove the stent by cystoscopy, with the implantation of a new stent using fluoroscopic control for the confirmation of its trajectory. No intraoperative or postoperative complications occurred and the patient is currently in outpatient follow-up. Conclusions: Situations such as this require caution during the implantation of the drainage device, with the occurrence of resistance indicating the need to discontinue the procedure and perform a new assessment with imaging exams. No intraoperative or postoperative complications occurred and the patient is currently in outpatient follow-up.

A Rare Case of Spontaneous Steinstrasse.

Spontaneous steinstrasse ("stone street") is a collection of stones within the ureter and is a rare and understudied event. Factors such as infection, altered kidney function, and degree of obstruction are used to define the most adequate therapeutic option. Treatment can be either conservative or surgical. The decision of which depends on the clinical presentation. This paper reports a rare case of a 59-year-old patient with spontaneous steinstrasse examined at a urology clinic. Surgical intervention was required because of altered kidney function. The patient is currently undergoing follow-up for the metabolic investigation.

Impact of COVID-19 on Outpatient Care for Urological Conditions at a University Hospital.

INTRODUCTION: The 2019 coronavirus (COVID-19) rapidly spread throughout the world, with diverse negative consequences in all fields, including the continuity of treatment for patients with other diseases. The public hospital for high-complexity procedures affiliated with the São José do Rio Preto School of Medicine, São Paulo, Brazil, normally has a high annual quantity of outpatient appointments. However, the consequences of COVID-19 led to a reduction in the number of appointments, exams, and outpatient procedures. The aim of the present study was to evaluate the impact of the pandemic on outpatient care for individuals with urological conditions at a university hospital. PATIENTS AND METHODS: A retrospective, descriptive, cross-sectional study was conducted involving the analysis of all outpatient appointments for individuals with urological conditions at the Urology Clinic of the São José do Rio Preto Hospital, São Paulo, Brazil, between January 2019 (pre-pandemic period) and December 2020 (after the first year of COVID-19). The variables of interest were sex, age, and affected organs of the genitourinary system. RESULTS: Among the 4,972 outpatient appointments involving patients with urological conditions in 2019, 70.7% involved males and the largest portion of patients were in the seventh decade of life (40.02%). Among the 4,584 outpatient appointments in 2020, 69.9% involved males and the largest portion were in the seventh decade of life (47.07%). Significant differences were found in the number of outpatient appointments between 2019 and 2020 in all age groups (p < 0.0001). The most affected organs of the genitourinary system in both 2019 and 2020 were the prostate (46.07% and 56.31%, respectively), bladder (30.56% and 22.48%, respectively), and kidney/ureter (22.85% and 19.68%, respectively), with no significant differences between the two years. CONCLUSION: The COVID-19 pandemic exerted an impact on outpatient care for individuals with urological conditions at a university hospital, leading to a reduction in the number of appointments. No change was found with regard to the sex of the patient. In contrast, an increase was found in the number of patients 60 years of age or older during the year of the pandemic. The most affected organs of the genitourinary system were the prostate, bladder, and kidney/ureter in both years analyzed.

Impact of the COVID-19 Pandemic on Surgical Treatment of Patients With Urological Diseases at a University Hospital.

BACKGROUND: The coronavirus disease 2019 (COVID-19) appeared in China and spread quickly to other regions of the country and around the world, changing the way of life of individuals and the routine of healthcare systems. OBJECTIVE: The aim of the present study was to investigate the impact of the pandemic on the surgical treatment of patients with urological diseases at a university hospital. MATERIALS AND METHODS: A retrospective analysis of the charts of patients with urological diseases submitted to surgical treatment between January 2019 and December 2020 was conducted. The variables of interest were age, sex, and most performed surgical procedures (double-J stent placement, cystoscopy, vasectomy, removal of double-J stent, ureterolithotripsy, endoscopic bladder procedure, kidney transplant, and endoscopic prostate procedure). RESULTS: Around 59.03% of patients with urological diseases who had surgery in 2019 were male; placement of the double-J stent accounted for 35.85% of all surgeries; 3556 surgical procedures were performed. In 2020, 57.22% of the patients were male, placement of the double-J stent accounted for 38.34% of all surgeries, and 3093 surgical procedures took place. Analyzing the types of surgery conducted in 2019 and 2020, a significant reduction occurred in the number of procedures in 2020 (p = 0.000). CONCLUSION: The pandemic exerted an impact on the surgical treatment of patients with urological diseases at a university hospital. No significant changes occurred with regard to the sex and age of the patients, but a significant difference was found in the number of surgical procedures performed.

A Rare Case of Bladder Perineurioma.

Perineuriomas are benign, rare neoplasms of the nerve sheath, basically in two forms: intraneural and extraneural. Extraneural forms are mainly found in the trunk and limbs, while visceral organs are rarely affected. To date, there have been no previous reports in the literature of bladder perineurioma. In this case, we report a young adult with hematuria and bladder tumor which after surgical resection and immunohistochemical study was confirmed to be a perineurioma. Therefore, this should be included in the differential diagnosis during the analysis of resections of bladder tumors.

Clinical and Molecular Profile of Patients With Condyloma Acuminatum Treated in the Brazilian Public Healthcare System.

Condyloma acuminatum is a common clinical outcome of human papillomavirus (HPV) in men. A prospective investigation was performed of the clinical and molecular profile of 122 patients with condyloma acuminatum treated by the Brazilian public healthcare system. The patients were evaluated clinically. The fragments were submitted to molecular analysis for the identification of HPV genotypes. A total of 104 (85.2%) patients presented multiple warts and 18 (14.8%) presented a single wart. The predominant location was the body of the penis (48.4% of cases of multiple warts and 7.4% of cases of single warts), and 49 (40.2%) cases were recurrences and 73 (59.8%) were initial occurrences. Regarding sexual activity, 56 patients (45.9%) had multiple partners and 65 (53.3%) had a single partner. The most frequent genotype was HPV6 (70%). In conclusion, the most frequent anatomic location of condyloma acuminatum was the body of the penis in the present sample. The present findings suggest that the natural history of infection by HPV is not yet completely known and that greater care is needed to ensure clinical safety in the follow-up of these patients due to the oncogenic potential.

Impact of the Pandemic on the Diagnosis and Treatment of Patients With Urological Tumors at a University Hospital.

Background The rapid dissemination of the coronavirus 2019 (COVID-19) had dramatic effects on individuals and healthcare systems in 2020. At our tertiary hospital, surgeries were recommended for patients at high oncological risk, with the prioritization of the maintenance of care and treatment of cancer. We aimed to assess the impact of the pandemic on the diagnosis and treatment of patients with urological tumors under the care of a university hospital. Materials and methods A retrospective analysis was performed of the charts of patients with urological tumors (prostate, kidney, bladder, and testicle) under the care and treated surgically at the Hospital de Base in 2019 and 2020, independently of ethnicity. The results were compared by the chi-square test (with a significance level of 5%). Results A discrete increase occurred in the quantity of appointments in 2020 (n = 5,846) compared to 2019 (n = 5,726). The most frequent types of cancer in 2019 and 2020 were, respectively, prostate (70.97% and 73.37%), bladder (18.07% and 12.52%), kidney (7.96% and 8%), and testicle (29.24% and 70.76%). Analyzing 279 surgeries performed on patients with prostate tumors, a 12.7% increase occurred in the year of the pandemic. Analyzing 271 surgical procedures on patients with bladder cancer, no considerable change occurred. Conclusion The analysis of the impact of the pandemic on the diagnosis and treatment of patients with urological tumors at a university hospital revealed a discrete increase in the number of outpatient appointments and a slight reduction in the number of patients and surgical procedures in the year of the pandemic (2020). More surgical procedures were conducted on patients with prostate cancer in 2020. More patients with bladder cancer sought medical care in the year of the pandemic, and practically the same quantity was submitted for surgical treatment. There was no statistically significant difference among types of cancer.

Sexual Health Teaching in Basic Science Courses Among Medical Students.

INTRODUCTION: Sexuality is a multifaceted and makes up part of the lives of all individuals. AIM: To evaluate the teaching of sexual health to students in the basic cycle of an undergraduate course in medicine. METHODS: A descriptive, cross-sectional study was conducted using primary data on the teaching of sexual health in the first 4 years of the course. The students were contacted personally and given a self-administrated questionnaire on the teaching of sexual health. The questionnaire was based on studies conducted with physicians and medical students regarding their educational background in sexual health. The degree of satisfaction regarding the learning process was determined using a ten-point scale; on which, a score of 1 to 5 indicated dissatisfaction and of 6 to 10 satisfaction. MAIN OUTCOME MEASURES: The main outcome measure was a self-administered questionnaire addressing the teaching of sexual health in the first 4 years and how this knowledge affected relationships with patients. RESULTS: A total of 216 students answered the questionnaire. Only 27.27% and 22% of the students in the first and second years, respectively, reported having classes related to sexual medicine, whereas 38.1% (third year) and 54.40% (fourth year) had such classes. Regarding satisfaction, the weighted mean was 4.55 and the modes were 5 and 6. In the evaluation of their expectations about learning sexual health, 46 (67.6%) reported feeling non-confident, 18 (26.5%) did not answer the question, and 4 (5.9%) reported feeling confident. CONCLUSION: This study revealed a gradual progression in the offer of content related to sexual medicine to students throughout the medicine course, with weighted means of 2.6 (first year), 2.82 (second year), 3.58 (third year), and 4.55 (fourth year). However, the findings indicate that the teaching of this subject remains deficient and students feel unsatisfied and unprepared for their future practice of medicine. Teixeira Santos AU, Fava Spessoto LC, Fácio FN. Sexual Health Teaching in Basic Science Courses Among Medical Students. Sex Med 2021;9:100309.

Testicular Pouch Hibernoma: A Case Report.

Hibernomas are rare lipomatous tumors derived from brown adipose tissue. Only two cases of hibernomas in the scrotum have been reported in the literature so far. Brown adipose tissue is responsible for thermogenesis in hibernating mammals and embryos. In adult humans, reminiscent brown tissue is most frequently located in the axial skeleton, scapular waist, and neck. This case report describes the finding of a testicular pouch hibernoma in a 34-year-old male who presented with a nodule in the scrotum, which was initially suspected to be a lipoma. The diagnosis was confirmed by histopathological analysis, and the patient was treated by surgical excision. Despite its rarity, hibernoma should be part of the differential diagnosis for lipoma, the most frequent benign mesenchymal neoplasm worldwide.

Treatment of male genital lymphedema with non-elastic fabric.

Lymphedema is a specific type of edema stemming from a failure in the formation or drainage of lymph. This condition can be congenital or acquired. The clinical treatment of genital lymphedema involves compression mechanisms of the penis. In acquired cases, the individual is born with the lymphatic system intact, but this system is damaged at some point in life, which can lead to lymphatic insufficiency and the development of edema. The non-elastic material for the penis is grosgrain that enable the adjustment to the proper pressure. This report describes a case series of penile lymphedema treated with compression mechanism. Thirteen consecutive patients with penoscrotal lymphedema aged 22 to 56 years (mean: 42.3 years) were treated. Inclusion criteria were patients with primary and secondary penoscrotal lymphedema. Volume larger than three times the normal size of the scrotum was excluded. Reductions in edema occurred in the penis in all patients. Such reductions varied in accordance with the adherence of the patients to the use and duration of compression. The patients used the compression device at times that best fit their schedules. An interesting aspect was the fact that the patients reported the possibility of leaving the penis the size they wished-neither very small nor very large-for sexual activity. All were able to control the size of the edema within the standards they considered acceptable.

Embolization in Patient with Hypovolemic Shock after Transobturator Sling Procedure.

The placement of a suburethral sling is standard treatment for stress urinary incontinence. The transobturator technique (TOT) emerged as an alternative to minimize the risks of the blind insertion of needles, leading to a lower rate of perforation complications compared with the retropubic approach. We present a case of injury to a branch of the left obturator artery following the placement of a urethral sling using TOT, followed by intense bleeding and hemodynamic instability, which was treated with embolization.

Sling de uretra média é o tratamento padrão para a incontinência urinária de esforço. A abordagem transobturatória (TOT) surgiu como alternativa para minimizar os riscos da inserção às cegas das agulhas com taxa de complicações perfurativas menores quando comparadas à abordagem retropúbica. Apresentamos um caso de lesão em ramo da artéria obturatória esquerda após sling TOT que evoluiu com sangramento intenso e instabilidade hemodinâmica, sendo tratado com embolização.

Sexual health education among undergraduate students of medicine.

BACKGROUND: Sexuality occupies a fundamental position in the lives of individuals and is related to general health. However, undergraduate curricula in medical courses address this topic in an incomplete manner. The aim of this study is to investigate sexual health education among undergraduate medical students. METHODS: A descriptive, cross-sectional study was conducted with students 18 years of age and older in the fifth and sixth years of the undergraduate course in medicine in 2018. Data were collected using a self-administered questionnaire addressing the teaching of sexual health in the first four years of the course and how knowledge on this topic affected their relationships with patients. RESULTS: A total of 125 students answered the questionnaire. Although the majority reported the teaching of sexual medicine during the undergraduate course, the classes were focused on reproduction (70%) and organic diseases (70%). A total of 52% of the respondents reported that the classes did not enhance their knowledge or confidence with regards to discussing the subject with patients. During routine care, the main difficulties the students faced in addressing the sexual health of patients were fear of offending the patient (53.8%) and insufficient knowledge on the subject (33.4%). CONCLUSIONS: The present findings demonstrate that knowledge of students regarding sexual health in undergraduate courses is insufficient, as evidenced by deficiencies in teaching and difficulties in addressing the subject with patients.

Xanthogranulomatous orchitis: case report of a rare condition.

Xanthogranulomatous orchitis is a rare, non-neoplastic inflammatory condition. We present a case of a 55-year-old diabetic male with an increase in volume, pain and edema in right testicle with a one-year history. The examination involved the investigation of inflammatory markers and ultrasound. Exploration of the scrotum revealed important destruction of the tissue architecture. This case underscores the importance of including xanthogranulomatous orchitis in the differential diagnosis of a testicular lump.

Does right-sided varicocele indicate a right-sided kidney tumor?

Varicocele is a dilation of the pampiniform venous plexus, mainly affecting the left side of the scrotum. In rare cases, however, the right side is affected. When this occurs, a retroperitoneal disease should be suspected, such as right-sided renal neoplasm. The present case report highlights the importance of right-sided varicocele in the diagnostic investigation of neoplasm of the right kidney.

Cake kidney drained though a single ureter in a patient with recurring urinary tract infection.

Cake kidney is a rare abnormality of the urinary tract. It is generally asymptomatic but can lead to renal and nonspecific systemic manifestations. This report describes a case of cake kidney drained through a single ureter diagnosed in a female patient with recurring urinary infection.

Incidental finding of retrocaval ureter in a patient without hydronephrosis.

Retrocaval or circuncaval ureters are rare congenital anomaly, in which the ureter is located posterior to the inferior vena cava (IVC). Usually, patients present symptoms in the 3rd or 4th decade of life due to compression of the ureter by the IVC, with obstruction of the urinary flow and consequent hydronephrosis. Herein we report the case of a 62-year-old patient who underwent ultrasonography to investigate abdominal pain. The patient had bilateral renal lithiasis associated with urinary tract dilation with no obvious obstruction. Computed tomography of the abdomen demonstrated a retrocaval ureter without hydronephrosis.