Complete corporeal preservation clitoroplasty: new insights into feminizing genitoplasty

Q2Q2Pacientes sometidos a Genitoplastia feminizanteIntroduction: 46,XX Congenital adrenal hyperplasia (CAH) remains the first cause of genital virilization and current surgical techniques aim to restore female aspect of genitalia while preserving dorsal neurovascular bundle but not at the expense of not preserving erectile tissue. We aim to report our experience with a new surgical technique for clitoroplasty, completely preserving corporeal bodies, neurovascular bundles without dismembering the clitoris, in four patients with over a year follow up. Materials and Methods: After IRB approval four patients with 46,XX CAH and Prader 5 and 3 external genitalia, underwent feminizing genitoplasty. Complete preservation of erectile tissue was accomplished without a need to dissect dorsal neurovascular bundle. Glans size allowed no need for glanular reduction and there was no need to dismember the corporeal bodies. Results: Four patients 12 to 24-months-old underwent complete corporeal preservation clitoroplasty (CCPC), mean age was 18.5 months, mean follow up was 10.25 months. Vaginoplasty was performed in all patients with partial urogenital mobilization (PUM) and Urogenital Sinus flap (UF), only one severely virilized patient required a parasagittal pre-rectal approach to mobilize the vagina. We had no complications until last follow up. Conclusion: To our knowledge, we are introducing the concept of CCPC without the need of disassembling the corporeal bodies, neurovascular bundle and glans. It stands as a new alternative for feminizing genitoplasty with complete preservation of erectile tissue and no dissection of neurovascular bundle. Although there is still lacking long-term follow-up, it represents a new step in conservative reconfiguration of the external virilized female genitalia.https://orcid.org/0000-0002-9675-5963https://orcid.org/0000-0003-0363-5485https://orcid.org/0000-0002-2231-4321Revista Internacional - IndexadaBS

Laser lithotripsy fundamentals: from the physics to optimal fragmentation

Purpose: Laser Lithotripsy has remained the cornerstone for the management of urolithiasis for more than thirty years. Miniaturization of endoscopic equipment, digital vision, improvement of laser lithotripters, laser fibers has made endourology a field of growing interest, immersed in a technologic revolution. The aim of this article is to do an extense review on laser lithotripsy starting from the physics of the lasers, to translational science apply to lithotripsy fundamentals in order to make lithotripsy safer and more efficient. Methods: We performed a review of the literature in four different databases (PubMed, Embase, Ovid® , and Scopus® ) on any information concerning laser lithotripsy in February 2020 independently by three authors, a total of 186 articles were reviewed and 38 of the most influential articles were selected and a detailed reviewed on this topic is presented. Results: We aim to make a reference paper for all urologists and health personal involved in laser lithotripsy, starting from the physics to answer practical questions as how to set the parameters in my laser system, how to improve lithotripsy efficiency, should we dust or bust? and finally discussing new technologies such as the Holmium: YtriumAluminium-Garnet (Ho:YAG) Moses technology, the revolutionary Thulium Laser Fiber (TLF) and discussing the future of laser lithotripsy. Conclusions: Laser lithotripsy must offer. Higher ablative efficiency, wider range of laser parameters and comprehensive combinations, reduce retropulsion and fiber burnback, scope miniaturization capabilities, smaller fiber sizes, increased safety, lower environmental impact, reduced maintenance costs Ho:YAG has remained the unquestioned gold standard for laser lithotripsy, but the recently launched Thulium fiber laser has all the above mentioned features and outruns without no doubt the current gold standard and is set to gradually replace it.https://orcid.org/0000-0002-5895-3029https://orcid.org/0000-0003-0363-5485Revista Internacional - No indexadaN

Segmental testicular infarction mimicking testicular seminoma

Segmental testicular infarction could present as a hypoechoic well-rounded mass, with or without vascular flow and negative tumor markers mimicking testicular seminoma. We aim to present a case of segmental testicular infarction of the upper pole of the testis, the microscopic pathological assessment and a state of the art of the current management and diagnosis of this rare entity.https://orcid.org/0000-0003-0363-5485N/

Squamous cell carcinoma arising from suprapubic cystostomy: report of two cases and a narrative review of literature

Pacientes con Carcinoma de células escamosasSquamous cell carcinoma arising from Marjolin’s ulcer of the suprapubic cystostomy tract is a rare entity that usually occurs in patients with a history of spinal cord injuries and a chronic indwelling catheter. We present 2 cases of this rare entity with the clinical exams needed for diagnosis and treatment according to individual characteristics of each case. Marjolin’s ulcer is a cutaneous malignancy that arises from injured skin. The most frequent type of malignancy identified on histopathologic examination is squamous cell carcinoma (80-90%). It can develop from long-standing scars, chronic wounds, pressure ulcers, osteomyelitis, and burns. Only cases have been reported about Marjolin’s ulcer with squamous cell carcinoma at the cystostomy cite. Treatment regimens have not been standardized; cases have received individualized treatments, usually with excision, radiation, or a combination of both. There is insufficient evidence to aid in the understanding of the etiology. In addition, there is no consensus on its optimal treatment and follow-up schemes.https://orcid.org/0000-0003-1940-741Xhttps://orcid.org/0000-0003-1271-5612https://orcid.org/0000-0003-0158-504Xhttps://orcid.org/0000-0003-1877-4621https://orcid.org/0000-0001-8202-9744https://orcid.org/0000-0003-4853-3618https://orcid.org/0000-0003-0394-9644Revista Internacional - No indexadaN

Limitations of Prostate Biopsy in Detection of Cribriform and Intraductal Prostate Cancer

Funding Information: Acknowledgments: Rui M. Bernardino is supported by Fundacao para a Ciencia e a Tecnologia (2022.13386.BD). Publisher Copyright: © 2023 European Association of UrologyBackground: The presence of cribriform morphology and intraductal carcinoma (IDC) in prostate biopsies and radical prostatectomy specimens is an adverse prognostic feature that can be used to guide treatment decisions. Objective: To assess how accurately biopsies can detect cribriform morphology and IDC cancer by examining matched biopsy and prostatectomy samples. Design, setting, and participants: Patients who underwent radical prostatectomy at The Princess Margaret Cancer Centre between January 2015 and December 2022 and had cribriform morphology and/or IDC in the surgical specimen were included in the study. Outcome measurements and statistical analysis: We used detection sensitivity to evaluate the level of agreement between biopsy and prostatectomy samples regarding the presence of cribriform morphology and IDC. Results and limitations: Of the 287 men who underwent radical prostatectomy, 241 (84%) had cribriform morphology and 161 (56%) had IDC on final pathology. The sensitivity of prostate biopsy, using radical prostatectomy as the reference, was 42.4% (95% confidence interval [CI] 36–49%) for detection of cribriform morphology and 44.1% (95% CI 36–52%) for detection of IDC. The sensitivity of prostate biopsy for detection of either IDC or cribriform morphology was 52.5% (95% CI 47–58%). Among patients who underwent multiparametric magnetic resonance imaging–guided biopsies, the sensitivity was 54% (95% CI 39–68%) for detection of cribriform morphology and 37% (95% CI 19–58%) for detection of IDC. Conclusions: Biopsy has low sensitivity for detecting cribriform morphology and IDC. These limitations should be incorporated into clinical decision-making. Biomarkers for better detection of these histological patterns are needed. Patient summary: Prostate biopsy is not an accurate method for detecting two specific types of prostate cancer cells, called cribriform pattern and intraductal prostate cancer, which are associated with unfavorable prognosis.proofepub_ahead_of_prin

Reliable Predictors of Muscle-Invasive Upper Tract Urothelial Carcinoma before Nephroureterectomy: Why, to Whom, and How Should We Perform Lymph Node Dissection?

(1) Introduction and Objective: Upper tract urothelial carcinoma (UTUC) is an uncommon disease, only accounting for 5–10% of all urothelial carcinomas. Current clinical practice guidelines encourage a risk-adapted approach to UTUC management, including lymph node dissection (LND) in patients with muscle-invasive or high-risk tumors. If pathological characteristics could be more accurately predicted from preoperative data, we could optimize perioperative management strategies and outcomes. The aim of this article is to present a detailed revision of preoperative predictors for muscle-invasive UTUC, locally advanced or advanced UTUC, as well as current indications, technique variations, and the reasons as to why LND should be offered to these patients. (2) Methods: We included any kind of studies related to information concerning UTUC, nephroureterectomy, LND, risk factors for recurrence, prediction tools and models for risk stratification. A literature search was conducted following medical subject headings (MeSh), Emtree language, Decs, and text words related. We searched through MEDLINE (OVID), EMBASE (Scopus), LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to May 2021. Evidence acquisition was presented according to the PRISMA diagram. (3) Results: Preoperative risk factors for either muscle-invasive UTUC (≥pT2), extra urothelial recurrence (EUR), locally advanced disease, or high-risk UTUC can either be derived from ureteroscopic (URS) findings, urine cytology, URS biopsy, or from preoperative radiologic findings. It seems reasonable that LND may provide not only staging and prognostic information but also play a therapeutic role in selected UTUC patients. The patients who benefit the most from LND appear to be those with ≥ pT2 disease, because patients with tumors ≤ pT1 rarely metastasized to LNs. UTUC has characteristic patterns of lymphatic spread that are dependent on tumor laterality and anatomical location. Choosing the right patients for LND, designing and standardizing LND templates based on tumor location and laterality is critical to improve LN yield, survival outcomes, and to avoid under-staging or overtreatment. (4) Conclusions: Patients with muscle-invasive or non-organ-confined UTUC have an extremely high risk for disease recurrence and cancer-specific mortality (CSM). Preoperative factors and prediction models must be included in the UTUC management pathway in our clinical practice to improve the accurate determination of high-risk groups that would benefit from LND. We recommend offering LND to patients with ipsilateral hydronephrosis, cHG, cT1 at URS biopsy and renal sinus fat or periureteric fat invasion. The role of lymphadenectomy in conjunction with radical nephroureterectomy (RNU) is still controversial, given that it may result in overtreatment of patients with pTa-pT1 tumors. However, a clear benefit in terms of recurrence-free survival (RFS) and cancer-specific survival (CSS) has been reported in patients with ≥pT2. We try to avoid LND in patients with cLG, cTa, and no ipsilateral hydronephrosis if the patient is expected to be compliant with the follow up schedule. There is still plenty of work to do in this area, and new molecular and non-invasive tests are necessary to improve risk stratification

MicroRNAs as potential liquid biopsy biomarker for patients with castration-resistant prostate cancer

Q3Q3HombresPurpose: To identify micro-RNAs (miRNAs) expression profiles in peripheral blood plasma that could play a role as potential biomarkers in patients who progressed to castration-resistant prostate cancer (CRPC). Liquid biopsy analysis of miRNAs is a fast-developing field with a considerable likelihood to predict tumor progression and metastasis by targeting genes involved in oncogenesis. Patients and Methods: Differential expression analysis of miRNAs profile in CRPC patients was performed by creating small RNA libraries of circulating miRNAs using HiSeq2500 Illumina platform. A secondary analysis of aligned reads with miRNA identification and quantification was performed using miARmaSeq. Using the Bowtie algorithm, the selected variants were compared to reference nucleotide sequence GRCh38 and miRbase. Novel miRNA sequences were structurally analyzed using mirDeep2®. Results: A total of 16 patients with CRPC were included for analysis. Identified circulating miRNAs were hsa-miR-885-3p, hsa-miR -4467, hsa-miR-4686, hsa-miR-146a-3p, hsa-miR-6514-5p. Genes identified as regulated by these miRNAs were GPR56, BDNF, CTNND1, C17orf62, and DTNA. Conclusion: We explored the miRNA expression profile in patients with CRPC, identifying five miRNAs implicated in the regulation of genes involved in prostate cancer (PCa) oncogenesis and progression. We also found miRNA 855–3p in peripheral blood for the first time, which has a critical role in tumor growth mechanisms and higher expression profile than in healthy individuals.https://orcid.org/0000-0002-9675-5963https://orcid.org/0000-0002-0141-1149https://orcid.org/0000-0001-5685-8354https://orcid.org/0000-0001-8202-9744https://orcid.org/0000-0002-0700-5686https://orcid.org/0000-0002-3772-6177https://orcid.org/0000-0002-0729-6866Revista Internacional - IndexadaA2N

Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The <i>Tetrafecta</i> Achievement

Background: To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. Methods: A purpose-built multicenter, multi-national database was queried for stage I–IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan–Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. Results: A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94–0.99; p = 0.04). Conclusions: Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality