Tiago Elias Rosito

Minimum 2-year follow up of sex reassignment surgery in Brazilian male-to-female transsexuals.

general fatigue were resolved after a switch to blonanserin. Hypoglycemia was not detected on Day 167 following a 75-g OGTT. Her auditory hallucinations and persecutory delusions were improved (BPRS score: 21), therefore she was discharged on Day 180. Because complaints of hypoglycemia are similar to the sedative effect of SGA, clinicians may overlook hypoglycemia in patients with schizophrenia. We previously reported another case of hypoglycemia induced by quetiapine. In that case, replacement of quetiapine with perospirone improved the symptoms of hypoglycemia but asymptomatic hypoglycemia was still present upon repeat OGTT. In the current case, a switch to blonanserin improved not only the symptoms of hypoglycemia but also hypoglycemia itself upon repeat OGTT. Because blonanserin is a new antipsychotic, its effect on glucose metabolism has not been established. However, this report suggests that a switch to blonanserin may be useful when hypoglycemia induced by SGA occurs.

Performance of Massachusetts Male Aging Study (MMAS) and androgen deficiency in the aging male (ADAM) questionnaires in the prediction of free testosterone in patients aged 40 years or older treated in outpatient regimen

Abstract Objective: At present, calculated free testosterone assessment is considered as the gold standard in diagnosing male hypogonadism. However, this assessment is not available for all the individuals diagnosed with decreased testicular function. The investigators of this study were, thus, prompted to evaluate whether the androgen deficiency in the aging male (ADAM) and the Massachusetts Male Ageing Study (MMAS) questionnaires could be used to replace biochemical parameters in the diagnosis for hypogonadism in men aged 40 years and above. Methods: We evaluated 460 men, aged 40 years and above, all volunteers of a screening program for prostate cancer based at the Hospital de Clínicas of Porto Alegre. In this study, we assessed the efficiency of the ADAM and MMAS questionnaires in diagnosing Brazilian men with low levels of total, calculated free and bioavailable testosterone. Results: The sensitivity of the ADAM questionnaire in diagnosing the calculated free testosterone was 73.6%, whereas specificity was 31.9%. ADAM could be used to properly classify our cohort into normal or hypogonadal individuals in 52.75% of the cases. The sensitivity of the MMAS questionnaire was 59.9%, whereas the specificity was 42.9%, resulting in a successful classification of 51.4% of the patients. Conclusion: The ADAM and MMAS questionnaires showed adequate sensitivity in diagnosing male patients with low levels of free testosterone. However, because of the lack of specificity, these tools cannot replace calculated free testosterone assessments in men aged 40 years and above.

WHOQOL-100 Before and After Sex Reassignment Surgery in Brazilian Male-to-Female Transsexual Individuals

INTRODUCTION The 100-item World Health Organization Quality of Life Assessment (WHOQOL-100) evaluates quality of life as a subjective and multidimensional construct. Currently, particularly in Brazil, there are controversies concerning quality of life after sex reassignment surgery (SRS). AIM To assess the impact of surgical interventions on quality of life of 47 Brazilian male-to-female transsexual individuals using the WHOQOL-100. METHODS This was a prospective cohort study using the WHOQOL-100 and sociodemographic questions for individuals diagnosed with gender identity disorder according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The protocol was used when a transsexual person entered the ambulatory clinic and at least 12 months after SRS. MAIN OUTCOME MEASURES Initially, improvement or worsening of quality of life was assessed using 6 domains and 24 facets. Subsequently, quality of life was assessed for individuals who underwent new surgical interventions and those who did not undergo these procedures 1 year after SRS. RESULTS The participants showed significant improvement after SRS in domains II (psychological) and IV (social relationships) of the WHOQOL-100. In contrast, domains I (physical health) and III (level of independence) were significantly worse after SRS. Individuals who underwent additional surgery had a decrease in quality of life reflected in domains II and IV. During statistical analysis, all results were controlled for variations in demographic characteristics, without significant results. CONCLUSION The WHOQOL-100 is an important instrument to evaluate the quality of life of male-to-female transsexuals during different stages of treatment. SRS promotes the improvement of psychological aspects and social relationships. However, even 1 year after SRS, male-to-female transsexuals continue to report problems in physical health and difficulty in recovering their independence.

Vaginoplasty With Full-thickness Mesh Skin Graft for Vaginal Agenesis

OBJECTIVE To present a novel technique in reconstructive urology for congenital vaginal agenesis using a full-thickness mesh skin graft and to evaluate the functional capacity for maintenance of satisfactory intercourse. METHODS From January 2009 to August 2015, seven patients diagnosed with vaginal agenesis underwent vaginoplasty using a full-thickness mesh graft from lower abdominal skin. Herein, the authors describe the technique and initial results in adult patients. RESULTS The mean hospital stay was 8 days. There were no major complications or need for blood transfusions. The most relevant postoperative result was the functionality of the neovagina and satisfactory donor site results. At 6-month follow-up, all patients reported satisfactory sexual intercourse. The average depth of the vagina was 11.3 cm. There were no significant complications at donor site or at neovagina that needed surgical intervention. CONCLUSION We obtained positive functional results with minimal donor site morbidity by performing vaginal reconstruction using a full-thickness mesh skin graft.

Child non-ischemic priapism, a conservative approach: Case report and updated review

Non-ischemic priapism in children is an uncommon entity usually related to blunt trauma in the perineal region and subsequent fistula formation into the corpus cavernosum. In this report we present the case of a 7-year-old boy who had undergone perineal trauma and developed non-ischemic priapism confirmed radiologically. He was treated by conservative measures along with ultrasonographic monitoring. We discuss the diagnostic approach, the radiologic findings and the mainly conservative management of this infrequent pathology.

Cisto de epidídimo gigante versus hidrocele: confusão diagnóstica

Spermatocele a cystic cavity containing fluid and sperm is among the most common determinant conditions of non-acute scrotal masses. They are usually asymptomatic, but, when with great dimensions, can bring physical and/or aesthetical discomfort. With the advent of ultrasonography (USG), this condition is increasingly diagnosed. Nonetheless, this exam can eventually, in the presence of big fluid collections, misdiagnose it. We therefore report the case of a large spermatocele that was initially confused with hydrocele, as well as a summary review of the topic.

Can dynamic ultrasonography replace urodynamics in the follow-up of patients with myelomeningocele? A prospective concurrent study

To evaluate the accuracy of dynamic ultrasonography (DUS), as a feasible alternative diagnostic method to identify detrusor overactivity (DO) in patients with neurogenic bladder.

Female epispadias: Single-stage approach – A technique to achieve continence

This video provides a case report of a 3 year old girl with epispadia and the highlights of the surgery. A cystoscopic guided bladder neck plication was performed to achieve continence. Key points include: (1) Skin incision planning; (2) Cutaneous flap liberation to create a new urethra; (3) Complete bladder neck release to allow a controlled plication; (4) Use of cystoscopy to achieve the ideal bladder neck closure; (5) Bladder neck manipulation to achieve continence.

Macedo procedure: A continent catheterizable ileum-based reservoir. Step-by-step video

This video provides a case report of a 16-year-old male patient who underwent bladder enlargement with a catheterized conduit under Macedos technique. This technique involves the use of a segment of the distal ileum with a flap that is used for confection of the conduit. Key points include: 1) skin incision planning; 2) bladder release to allow a tension-free anastomosis; 3) reservoir and a conduit creation with a distal ileum; and 4) creation of a continence mechanism.

Posterior Urethral Valves Disorder in Non-Twin Siblings: Case Report and Literature Review

Although a rare condition, Posterior Urethral Valves (PUVs) are the most common obstructive cause of chronic renal disease in children. In order to provide an early diagnosis, it is crucial to identify families with a high risk of developing this disorder. Here, we report a rare case of non-twin siblings with PUV. The first sibling was diagnosed at 2 months of age, presenting with renal insufficiency and managed properly. Despite the brother’s history and general prenatal care, the second sibling presented with the same disorder, at 3 months of age, suffering from acute renal insufficiency, urinary tract infection and severe anemia, revealing even more important complications than the first sibling. We have reviewed the 12 cases of non-twin siblings previously reported in the literature, and noticed that in the majority of these families, late diagnosis was observed. Herein, we discuss aspects of management of the disorder, and highlight the importance of specific antenatal evaluation in boys with a positive family history.