Eduardo P. Miranda

Analysis of Sexual Function in Kidney Transplanted Men

INTRODUCTION Sexual dysfunction among renal failure and kidney transplant patients remains controversial. The aim of this study was to evaluate sexual functions of men on hemodialysis compared with patients undergoing kidney transplantation. MATERIALS AND METHODS Our study was based on 36 end-stage renal disease (ESRD) patients undergoing hemodialysis versus 32 kidney transplanted patients. A control group was composed of 23 healthy patients. The patients underwent an anamnesis, a physical examination, and the International Index of Erectile Function about sexual performance. Statistical analysis was performed by Students t-test or the chi-square test with the level of significance set at P < .05. Data are reported as mean values +/- standard error of the means. RESULTS The mean scores of the control, ESRD, and transplanted group were, respectively: for erectile function, 27.4 +/- 0.5, 22.4 +/- 1.3, 23.4 +/- 1.3; for orgasmic function, 9.5 +/- 0.1, 7.6 +/- 0.5, 8.9 +/- 0.5; for sexual desire function 9.4 +/- 0.1, 7.1 +/- 0.3, 9.0 +/- 0.5; for intercourse satisfaction 12.8 +/- 0.3, 9.4 +/- 0.7, 11.0 +/- 0.7; and for satisfaction related to sexual life 9.2 +/- 0.2, 7.7 +/- 0.3, 8.6 +/- 0.6, proving that there were significant differences regarding orgasmic function, sexual desire, and intercourse satisfaction. CONCLUSION It was possible to conclude from our study that kidney transplants do improve sexual function of patients with ESRD on hemodialysis.

Infrared digital telethermography: a new method for early detection of varicocele

Besides physical examination, various traditional methods of examination are believed to have an important role in diagnosing varicocele. Infrared digital telethermography is presented as a new diagnostic tool for early presentation of varicocele.

Percutaneous injection of fibrin glue resolves persistent nephrocutaneous fistula complicating colonic perforation after percutaneous nephrolithotripsy

Colonic perforation (CP) is an extremely rare complication of percutaneous nephrolithotrypsy (PCNL).¹ Nephrocutaneous fistulas after PCNL are unusual. Typically, they resolve with conservative measures such as observation, ureteral stenting, and, occasionally, percutaneous drainage.² We present a case of nephrocutaneous fistula as a result of a CP after PCNL that was treated with percutaneous injection of fibrin glue.

Recurrent Penile Fracture—Case Report and Alternative Surgical Approach

Introduction Penile refracture is an exceedingly rare event, with very few published studies. To the best of our knowledge, this is the first documented case in the literature of penile fracture with 3 same-site recurrences. Aims To describe the case of a 25-year-old Caucasian man with recurrent penile fracture ultimately treated with resuture and patch reinforcement. Methods Patient history (clinical and surgical) and literature review. Results After the 3rd same-site recurrence, patch reinforcement over the sutured area was performed. The patient had an uneventful recovery and no recurrences to date. Conclusion There is no evidence indicating the superiority of non-absorbable sutures. Bovine pericardium reinforcement over the sutured area was used to minimize the chance of another recurrence. More studies are necessary to investigate its safety and efficacy in this scenario. Nascimento B, Guglielmetti GB, Miranda EP, et al. Recurrent Penile Fracture—Case Report and Alternative Surgical Approach. Sex Med 2018;6:263–266.

Isolated noncompacted myocardium in an elderly patient

Noncompaction of the myocardium (NCM) is a rare disorder that is characterized by prominent myocardial trabecularizations and deep intertrabecular recesses, leading to a spongy appearance of the myocardium. In the first month of normal intrauterine development, the myocardium consists of a mesh of muscle fibers. In this mesh, trabeculae alternate with recesses, which provide the blood supply to the cardiac muscle through communication with the ventricular cavity. During the fifth to the eighth week of development, these recesses are supposed to turn into capillaries as the ventricular myocardium gradually compacts.3,4 Although the exact mechanisms that generate NCM remain unclear, it has been suggested that an arrest of cardiac development during the compaction of myocardial fibers may lead to the persistence of multiple trabeculations within the ventricular myocardium.1,2

Diagnostic accuracy of Onen’s Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of obstructive hydronephrosis in children

Introduction Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic Renal Scintigraphy (DRS) and Ultrasonography (US). Recent studies have suggested that new parameters of conventional and color Doppler ultrasonography (CDUS) may be useful in discriminating which kidneys are obstructed. The present study aims to assess the diagnostic accuracy of such parameters in the diagnosis of obstruction in children with UPJO. Methods We evaluated 44 patients (33 boys) with a mean age of 6.53 ± 4.39 years diagnosed with unilateral high-grade hydronephrosis (SFU grades 3 and 4). All underwent DRS and index tests (conventional US and CDUS to evaluate ureteral jets frequency) within a maximum interval of two weeks. Hydronephrotic units were reclassified according to the alternative grading system (AGS) proposed by Onen et al. Obstruction in the DRS was defined as a differential renal function <40% on the affected side and/or features indicating poor drainage function like T1/2 >20 minutes after the administration of furosemide, and a plateau or ascending pattern of the excretion curve. Results Nineteen hydronephrotic units (43.1%) were obstructed. Some degree of cortical atrophy—grades 3 (segmental) or 4 (diffuse)—was present in those obstructed units. AGS grades had 100% sensitivity, 76% of specificity and 86.4% of accuracy. The absence of ureteral jets had a sensitivity of 73.68%, a specificity of 100% with an accuracy of 88.6%. When we analyzed the two aspects together and considered obstructed the renal units classified as AGS grade 3 or 4 with no jets, sensitivity increased to 78.9%, accuracy to 92%, remaining with a maximum specificity of 100%. These features combined would allow us to avoid performing DRS in 61% of our patients, leaving more invasive tests to inconclusive cases. Conclusions Although DRS remains the mainstay to distinguishing obstructive from non-obstructive kidneys, grade of hydronephrosis and frequency of ureteral jets, independently or in combination may be a reliable alternative in the mostly cases.This alternative approach has high accuracy, it is less invasive, easily reproducible and may play a role in the diagnosis of obstruction in pediatric population.

Impact of the route of clean intermittent catheterization on quality of life in children with lower urinary tract dysfunction

To compare the impact of the different routes for clean intermittent catheterization on the quality of life of children with lower urinary tract dysfunction.

MP91-10 TESTOSTERONE RECOVERY PROFILES AFTER CESSATION OF ANDROGEN DEPRIVATION THERAPY (ADT)

of T-dose). Stepwise multivariate Cox regression models revealed fundamental differences in inter-individual effects: hazard ratios for loss of BMI/WC were significantly higher in those subjects with younger age, lower baseline T and higher ratios of delta testosterone over delta estradiol levels induced by treatment (all p<0.01). Advanced age, higher baseline BMI and higher delta estradiol levels resulted in significantly higher hazard ratios for prostate growth/increase in PSA or hematocrit (all p<0.01). Overall, effects were attenuated, but still significant, in subjects with androgen receptor gene CAG repeat length >24, in those with KS or men with non-classical hypogonadism (using non-KS primary hypogonadism as referent, all p<0.05). CONCLUSIONS: Major new findings regarding effects and safety of T substitution in hypogonadal men are provided. This longterm registry on T substitution in hypogonadal men of a wide age-range demonstrates a decrement of weight, factors influencing cardiovascular health and a low, manageable amount of risk factors. Effects are modulated by diagnosis, age and genetic background.

MP91-09 LOW PSA LEVEL IN MEN DIAGNOSED WITH PROSTATE CANCER PREDICTS TESTOSTERONE DEFICIENCY (TD)

of T-dose). Stepwise multivariate Cox regression models revealed fundamental differences in inter-individual effects: hazard ratios for loss of BMI/WC were significantly higher in those subjects with younger age, lower baseline T and higher ratios of delta testosterone over delta estradiol levels induced by treatment (all p<0.01). Advanced age, higher baseline BMI and higher delta estradiol levels resulted in significantly higher hazard ratios for prostate growth/increase in PSA or hematocrit (all p<0.01). Overall, effects were attenuated, but still significant, in subjects with androgen receptor gene CAG repeat length >24, in those with KS or men with non-classical hypogonadism (using non-KS primary hypogonadism as referent, all p<0.05). CONCLUSIONS: Major new findings regarding effects and safety of T substitution in hypogonadal men are provided. This longterm registry on T substitution in hypogonadal men of a wide age-range demonstrates a decrement of weight, factors influencing cardiovascular health and a low, manageable amount of risk factors. Effects are modulated by diagnosis, age and genetic background.

MP91-08 COMBINATION OF METABOLIC SYNDROME COMPONENTS TO PREDICT TESTOSTERONE DEFICIENCY IN MEN

of T-dose). Stepwise multivariate Cox regression models revealed fundamental differences in inter-individual effects: hazard ratios for loss of BMI/WC were significantly higher in those subjects with younger age, lower baseline T and higher ratios of delta testosterone over delta estradiol levels induced by treatment (all p<0.01). Advanced age, higher baseline BMI and higher delta estradiol levels resulted in significantly higher hazard ratios for prostate growth/increase in PSA or hematocrit (all p<0.01). Overall, effects were attenuated, but still significant, in subjects with androgen receptor gene CAG repeat length >24, in those with KS or men with non-classical hypogonadism (using non-KS primary hypogonadism as referent, all p<0.05). CONCLUSIONS: Major new findings regarding effects and safety of T substitution in hypogonadal men are provided. This longterm registry on T substitution in hypogonadal men of a wide age-range demonstrates a decrement of weight, factors influencing cardiovascular health and a low, manageable amount of risk factors. Effects are modulated by diagnosis, age and genetic background.