Eloísio A. da Silva

Penile anthropometry in Brazilian children and adolescents.

OBJECTIVE Classically, the penis has two functions: to make internal fertilization possible and to direct the urine stream. However, objective abnormalities in penis size can lead to diseases being diagnosed. Furthermore, many medical consultations are the result of patients seeking parameters for normal penis size. Additionally, the penile anthropometry of Brazilian children and adolescents has not yet been properly studied. The objective of this study is to carry out penile anthropometry of Brazilian children and adolescents, establishing references for clinical use. METHODS A cross-sectional study was carried out of 2,010 patients with ages varying from 0 to 18 years. Five penile measurements were taken: diameter of penile shaft; apparent and real length of flaccid penis; apparent and real (RSL(max)) length of flaccid penis fully stretched. Pubertal development was defined according to Tanners criteria. RESULTS Only RSLmax, out of all of the penile measurements, did not exhibit significant interobserver variation at all ages analyzed (p = 0.255). Results were tabulated with mean RSLmax and the values that define micropenis (mean - 2.5 standard deviations) by age and by Tanner sexual maturity stages. A graph was plotted of the distribution of RSLmax results by the 10th, 25th, 50th, 75th and 90th percentiles and by age. CONCLUSIONS Out of all of the penile anthropometric measurements, only RSL(max) is clinically useful. We recommend our results as a reference standard for penile anthropometry of Brazilian children and adolescents.

Avaliação das medidas do comprimento peniano de crianças e adolescentes

OBJECTIVE: Classically, the penis has two functions: to make internal fertilization possible and to direct the urine stream. However, objective abnormalities in penis size can lead to diseases being diagnosed. Furthermore, many medical consultations are the result of patients seeking parameters for normal penis size. Additionally, the penile anthropometry of Brazilian children and adolescents has not yet been properly studied. The objective of this study is to carry out penile anthropometry of Brazilian children and adolescents, establishing references for clinical use. METHODS: A cross-sectional study was carried out of 2,010 patients with ages varying from 0 to 18 years. Five penile measurements were taken: diameter of penile shaft; apparent and real length of flaccid penis; apparent and real (RSLmax) length of flaccid penis fully stretched. Pubertal development was defined according to Tanners criteria. RESULTS: Only RSLmax, out of all of the penile measurements, did not exhibit significant interobserver variation at all ages analyzed (p = 0.255). Results were tabulated with mean RSLmax and the values that define micropenis (mean - 2.5 standard deviations) by age and by Tanner sexual maturity stages. A graph was plotted of the distribution of RSLmax results by the 10th, 25th, 50th, 75th and 90th percentiles and by age. CONCLUSIONS: Out of all of the penile anthropometric measurements, only RSLmax is clinically useful. We recommend our results as a reference standard for penile anthropometry of Brazilian children and adolescents.

The concentration of elastic fibres in the male urethra during human fetal development.

To describe the distribution of elastic fibres in the developing male urethra and to provide stereological data of the concentration of elastic fibres in the human urethra.

Assessment of domestic violence against children and adolescents with enuresis.

OBJECTIVE To describe the frequency of domestic violence against Brazilian children and adolescents due to episodes of enuresis, as well as associated risk factors. METHODS A cross-sectional study was carried out with 149 patients aged between 6 and 18 years who received the diagnosis of primary monosymptomatic nocturnal enuresis. A semi-structured interview was done with the patients and their guardians to collect information about the characteristics of domestic violence and abusers. In addition, a playful activity was performed by the patients. Abuse was characterized as verbal aggression, physical aggression without physical contact, and physical aggression with physical contact. RESULTS Eighty-nine percent (n = 132) of the patients suffered abuse due to episodes of urine leakage. All cases were characterized by verbal punishment associated or not with other types of aggression. Physical punishment without physical contact occurred in 50.8% of the cases, while physical punishment with physical contact accounted for 48.5% of the cases. The main abuser was the mother (87.9%). One patient suffered an intentional severe genital injury, and reconstructive surgery was necessary. There was a significant correlation (p = 0.043, r = -0.768) between the abusers educational level and punishment severity. CONCLUSIONS Punishment rates due to episodes of urine leakage are alarming. Children and adolescents with enuresis who live with low-educated people can be considered a population at risk of suffering domestic violence.

Avaliação da violência intradomiciliar na criança e no adolescente enuréticos

OBJETIVO: Descrever a frequencia da violencia domestica praticada contra criancas e adolescentes brasileiros devido ao episodio enuretico e os fatores de risco associados a ela. METODOS: Foi realizado um estudo transversal envolvendo 149 pacientes com idades de entre 6 e 18 anos, diagnosticados com enurese noturna monossintomatica primaria. Durante uma entrevista semiestruturada com o paciente e seu responsavel legal, foram obtidas informacoes sobre as caracteristicas da violencia domestica e o agressor, sendo adicionada uma atividade ludica para o paciente. A agressao foi classificada em verbal, fisica sem contato, ou fisica com contato. RESULTADOS: Dos pacientes entrevistados, 89% (n = 132) sofreram algum tipo de agressao devido ao episodio enuretico. Todos os casos apresentaram punicao verbal associada ou nao a outro tipo de agressao. Punicao fisica sem contato ocorreu em 50,8% dos casos, e com contato, em 48,5%. O principal agressor foi a mae (87,9%). Em um caso, houve lesao genital grave que necessitou de cirurgia reconstrutora. Houve uma correlacao significativa (p = 0,043, r = -0,768) entre os anos de estudo dos responsaveis e a gravidade da punicao. CONCLUSOES: Os indices de punicao em pacientes com enurese noturna monossintomatica primaria sao alarmantes. Criancas e adolescentes enureticos que convivem no âmbito domestico com pessoas com poucos anos de estudo podem ser considerados populacao de risco em relacao a violencia domestica.

The Management of Erectile Dysfunction with Placebo Only: Does it Work?*

INTRODUCTION Randomized clinical trials (RCT) remain the gold standard in providing scientific evidence in medical practice in spite of the significant placebo effect in the treatment of several disorders. Although the first-line therapy for erectile dysfunction (ED) is oral phosphodiesterase type-5 inhibitor (iPDE5), the placebo effect in RCT of iPDE5 for ED occurs at a rate as high as 50%. AIMS To evaluate the role of therapeutic illusion in the oral treatment for ED. METHODS A prospective, controlled, single-blind, parallel-group study was performed at single-center. One hundred and twenty-three patients with ED were randomly assigned into three groups and received different letters: Group 1 (G1) was informed to be receiving a substance for ED treatment; Group 2 (G2) was informed that they could be receiving an active drug or placebo; Group 3 (G3) was conscious to be using placebo. Starch capsules were dispensed to all patients. Median follow up was 12 weeks. MAIN OUTCOME MEASURES ED improvement was assessed after 8 weeks of the intervention by the erectile function domain of the International Index of Erectile Function (IIEF) and the Quality of Erection Questionnaire. ED severity was classified by the IIEF erectile function (IIEF-EF) domain score into five categories: no ED (score of 26-30), mild (22-25), mild to moderate (17-21), moderate (11-16), and severe (6-10). Improvement in IIEF-EF domain was considered as a change in category of severity. RESULTS ED severity improved in all three groups (G1 = 31.7%, P = 0.039; G2 = 36.8%, P = 0.028; G3 = 36.8%, P = 0.002) and no difference was found among groups (P = 0.857). Improvement of quality of erection score was only significant in G2 (P = 0.005) and G3 (P < 0.001). CONCLUSIONS Written-suggested therapeutic illusion for patients with ED has no major influence in the outcomes. However, treatment of ED with oral placebo capsules demonstrates clinical effects, improving erectile function and quality of erection.

Histological Characterization of the Urethral Edges in Patients Who Underwent Bulbar Anastomotic Urethroplasty

PURPOSE Meticulous excision of the stricture and any associated spongiofibrosis is critical to the success of urethral reconstruction. However, normal urethral limits are determined during surgical reconstruction based on macroscopic appearance only. We evaluated structural changes of the presumed healthy urethral ends. MATERIALS AND METHODS Samples were obtained from 29 patients with a mean age of 40 years who underwent end-to-end anastomotic urethroplasty. Suprapubic catheter drainage was performed for at least 30 days in 15 patients. After the urethral stricture was excised biopsy was performed of the proximal and distal healthy ends. Structural characterization was evaluated by staining histological sections with Massons trichrome, Sirius red and Weigerts resorcin-fuchsin method. The control group consisted of 10 cadaver bulbar urethras. RESULTS All samples of presumed normal urethral ends showed histological changes. Chronic and acute inflammatory reactions were the most common findings. In the proximal urethral end intense cellularity was found in 18 patients (62.1%). Fibroblast and inflammatory cells were most common and related to the lack of suprapubic cystostomy (p = 0.001). Between proximal urethral edges with and without a suprapubic urinary catheter the elastic fiber distribution and the ratio of collagen types III and I showed a significant change (p = 0.045 and <0.001, respectively). CONCLUSIONS The supposedly healthy urethral ends of end-to-end anastomotic urethroplasty show structural changes. Urethral obstruction and its relief by suprapubic urinary drainage can affect extracellular matrix turnover regulation. Therefore, these changes can lead to urethral remodeling in the proximal bulbar urethra.

Expression analysis of thrombospondin 2 in prostate cancer and benign prostatic hyperplasia.

Thrombospondin 2 (TSP2) is a protein with important roles in different tumor types, mainly related to tumor inhibition. However, there are limiting data regarding TSP2 in prostate cancer (PCa) and benign prostatic hyperplasia (BPH). We aimed to investigate TSP2 transcript and protein expression in tumoral and non-tumoral prostate tissues and cell lines, and its implications for PCa diagnosis and progression. TSP2 transcript expression was evaluated by real time PCR in PCa and BPH tissue samples and in tumoral and non-tumoral cell lines. TSP2 protein expression analysis was conducted by immunohistochemistry in a tissue microarray (TMA) containing PCa and BPH tissue samples. TSP2 transcript was down-regulated in PCa tissue samples and cell lines, when compared to BPH and non-tumoral samples (P<0.01). Receiver Operating Curve (ROC) analysis demonstrated that TSP2 transcript levels can better distinguish PCa from BPH tissue samples (P<0.01) than serum PSA levels (P=0.299). TSP2 protein expression has been observed in the cytoplasm of both PCa and BPH epithelial and stromal compartments. TSP2 stromal staining scores were significantly lower in PCa than in BPH tissues (P<0.01), while similar TSP2 epithelial staining patterns were observed in both diseases. Notably, the TSP2 epithelial staining score was significantly correlated to vascular invasion and biochemical recurrence in PCa tissue samples (P<0.05). Our data indicate that TSP2 is down-regulated at PCa tissues and cell lines, especially at stroma compartment, which could be related to PCa progression. TSP2 levels could potentially be applied for differential PCa and BPH diagnosis.

Human Acellular Matrix Graft of Tunica Albuginea for Penile Reconstruction

INTRODUCTION Penile curvature is one of the most common male conditions, affecting nearly 10% of men, and can impair sexual intercourse. Tunica albuginea (hTA) plays a key role in penile curvature, and reconstructive procedures may be necessary for its substitution. Although several grafts have been proposed for hTA repair, the ideal graft is not yet available. AIM The aim of this article is to evaluate a new human tunica albuginea acellular matrix (hTAAM) as potential graft for penile reconstructive procedures. METHODS Twelve penises were obtained during sex reassignment surgeries from male-to-female transsexual patients. After dissection, hTAs were assigned into two groups according to the decellularization methods: polyethylene glycol (PEG) 1000 method following ultraviolet-C radiation, and Triton X-100 modified method. MAIN OUTCOME MEASURES Structural analyses were assessed by hematoxilin and eosin, Massons trichrome, Weigerts, and picrosirius-polarization staining methods. Total protein, total glycosaminoglycan (GAG), and nucleic acid (DNA and RNA) concentrations were assessed by specific biochemical analyses. Uniaxial strength tests were performed to evaluate biomechanical properties. RESULTS All hTAAMs presented no nuclear or cellular remnants. Total protein concentration was significantly higher in PEG 1000 hTAAM. Despite GAG concentration decreased significantly in hTAAM, Triton X-100 hTAAM retained the highest GAG concentration (1.0 ± 0.42 µg HexUr/mg dry tissue, P > 0.05). All decellularization methods were efficacious to remove nucleic acids. The maximal break point presented no difference between hTA and hTAAM groups (P > 0.05). CONCLUSIONS PEG 1000 and Triton X-100 decellularization methods provide equally successful hTAAMs, preserving original structural and biochemical properties.

From Palmistry to Anthropometry: Can 2nd to 4th Digit Length (2D:4D) Predict the Risk of Prostate Cancer?

Objective: The 2nd to 4th digit length (2D:4D) is inversely related to androgen exposure during the fetal period, which may represent a risk factor for several steroid-related diseases. We aimed to evaluate the relationship between 2D:4D ratio and the risk of developing prostate cancer (PCa). Subjects and Methods: We assessed the 2D:4D ratio of 474 men >40 years old, stratified into three groups: group 1 (n = 222) patients with PCa, group 2 (n = 82) subjects with high risk of PCa, and group 3 (n = 170) men with low risk of PCa. Subjects were submitted to a digital picture of the ventral surface of the right hand and 2nd and 4th fingers measurements were determined by the distance from the proximal crease to the tip using computer-assisted analysis. Results: The mean serum prostate-specific antigen level was 7.5 ng/ml in the high-risk group and 0.92 ng/ml in the low-risk group (p < 0.05). The mean 2D:4D ratios were 0.96 ± 0.04, 0.97 ± 0.04 and 0.96 ± 0.04 for the PCa, high-risk and low-risk groups, respectively, and no difference was found among the three groups (p = 0.12). Conclusion: Anthropometry of the hand using the 2D:4D ratio is not a predictor of PCa.