Abstract Objective: To assess the diagnostic accuracy of histogram analysis on unenhanced computed tomography (CT) for differentiating between adrenal adenomas and pheochromocytomas (PCCs). Materials and Methods: We retrospectively identified patients with proven PCCs who had undergone CT examinations between January 2009 and July 2019 at one of two institutions. For each PCC, we selected one or two adenomas diagnosed within two weeks of the date of diagnosis of the PCC. For each lesion, two readers scored the size, determined the mean attenuation, and generated a voxel histogram. The 10th percentile (P10) was obtained from the conventional histogram analysis, as well as being calculated with the following formula: P10 = mean attenuation – (1.282 × standard deviation). The mean attenuation threshold, histogram analysis (observed) P10, and calculated P10 (calcP10) were compared in terms of their diagnostic accuracy. Results: We included 52 adenomas and 29 PCCs. The sensitivity, specificity, and accuracy of the mean attenuation threshold were 75.0%, 100.0%, and 82.5%, respectively, for reader 1, whereas they were 71.5%, 100.0%, and 81.5%, respectively, for reader 2. The sensitivity, specificity, and accuracy of the observed P10 and calcP10 were equal for both readers: 90.4%, 96.5%, and 92.6%, respectively, for reader 1; and 92.3%, 93.1%, and 92.6%, respectively, for reader 2. The increase in sensitivity was significant for both readers (p = 0.009 and p = 0.005, respectively). Conclusion: For differentiating between adenomas and PCCs, the histogram analysis (observed P10 and calcP10) appears to outperform the mean attenuation threshold as a diagnostic criterion.

Resumo Objetivo: Avaliar a acurácia diagnóstica da análise por histograma na tomografia computadorizada (TC) sem contraste para a diferenciação entre adenomas adrenais e feocromocitomas (FCCs). Materiais e Métodos: Identificamos, retrospectivamente, pacientes com diagnóstico de FCC confirmado que foram submetidos a exames de TC entre janeiro de 2009 e julho de 2019 em duas instituições distintas. Para cada FCC, selecionamos um ou dois adenomas diagnosticados em até duas semanas da data do diagnóstico do FCC. Para cada lesão, dois leitores pontuaram o tamanho, determinaram a atenuação média e geraram um histograma com os voxels das imagens. O percentil 10 (P10) foi obtido a partir da análise convencional do histograma, além de ser calculado com a seguinte fórmula: P10 = atenuação média - (1,282 × desvio-padrão). O limiar de atenuação média, o P10 da análise por histograma (P10 observado) e o P10 calculado (P10calc) foram comparados em termos de acurácia diagnóstica. Resultados: Foram incluídos 52 adenomas e 29 FCCs. A sensibilidade, especificidade e acurácia do limiar de atenuação média foram de 75,0%, 100,0% e 82,5% para o leitor 1, respectivamente, e de 71,5%, 100,0% e 81,5% para o leitor 2, respectivamente. A sensibilidade, especificidade e acurácia do P10 observado e do P10calc foram idênticas para os dois leitores: 90,4%, 96,5% e 92,6%, respectivamente, para o leitor 1; e 92,3%, 93,1% e 92,6%, respectivamente, para o leitor 2. O aumento da sensibilidade foi significativo para ambos os leitores (p = 0,009 e p = 0,005, respectivamente). Conclusão: Para a diferenciação entre adenomas e FCCs, a análise por histograma (P10 observado ou P10calc) parece superar o limiar de atenuação média como critério diagnóstico.

RESUMO Introdução: O siringomas são tumores anexais benignos com caraterísticas histopatológicas decorrentes dos ductos écrinos, em forma de pápulas amareladas ou cor da pele, de 1-3 mm, comumente na região periorbitária inferior, podendo causar problemas cosméticos importantes. O objetivo do tratamento é melhorar a aparência, através da destruição completa do tumor usando métodos minimamente invasivos e inclusa cirurgia. Existem na literatura múltiplas opções de tratamento com vários graus de sucesso, porém pouco se conhece sobre a eficácia. Em geral, a remoção completa não é bem-sucedida, e têm sido descritos efeitos colaterais, sendo a recorrência o mais frequente. Métodos: Trata-se de uma revisão narrativa de literatura, de publicações científicas no período de 2014-2019. Resultados: Após revisar 45 artigos, e identificar os publicados nos últimos cinco anos que tiveram registro de número de pacientes, descrição de tratamento, escalas de avaliação dos resultados e acompanhamento, foram selecionados seis artigos. Do número total de seis artigos, foram encontrados: uma revisão sistemática, e cinco estudos retrospectivos, sendo um comparativo. Foi designado um número para cada artigo analisado, e coletados o número de pacientes incluídos, tratamento realizado, escalas de avaliação e resultados, complicações e conclusões. Conclusões: Os siringomas periorbitários ainda são um desafio terapêutico, e até agora nenhum tratamento demostrou ser consistentemente eficaz. O laser CO2 continua sendo a primeira escolha de tratamento quando usado fracionado, e a eletrocoagulação intralesional representa uma segunda alternativa com resultados moderados e menor risco de complicações. Novos tratamentos como Laser Erbium Laser Erbium Yttrium Aluminum Garnet, Neodymium-Doped Yttrium Aluminum Garnet e monoterapia com toxina botulínica A poderiam ser boas alternativas. Estudos prospetivos comparativos são necessários.

ABSTRACT Introduction: Syringomas are benign adnexal tumors with histopathological characteristics arising from the eccrine ducts, in yellowish or skin-colored papules, 1-3 mm, commonly in the lower periorbital region, which can cause important cosmetic problems. The goal of treatment is to improve appearance by destroying the tumor using minimally invasive methods and including surgery. There are multiple treatment options in the literature with varying degrees of success, but little is known about their effectiveness. Complete removal is unsuccessful, and side effects have been described, recurrence being the most frequent. Methods: This is a narrative review of the literature of scientific publications in the period 2014-2019. Results: After reviewing 45 articles and identifying those published in the last five years that had a record of the number of patients, treatment description, scales of evaluation of results and follow-up, six articles were selected. Of the total number of six articles, we found: a systematic review and five retrospective studies, one being a comparative one. A number was assigned to each article analyzed, and the number of patients included, treatment performed, assessment scales and results, complications and conclusions were collected. Conclusions: Periorbital syringomas are still a therapeutic challenge, and so far, no treatment is consistently effective. The CO2 laser remains the first choice of treatment when used fractionally, and intralesional electrocoagulation represents a second alternative with moderate results and a lower risk of complications. New treatments such as Laser Erbium Yttrium Aluminum Garnet, Neodymium-Doped Yttrium Aluminum Garnet and botulinum toxin A monotherapy could be good alternatives. Comparative prospective studies are needed.

SUMMARY We present the unique case of an adult Brazilian woman with severe short stature due to growth hormone deficiency with a heterozygous G to T substitution in the donor splice site of intron 3 of the growth hormone 1 (GH1) gene (c.291+1G>T). In this autosomal dominant form of growth hormone deficiency (type II), exon 3 skipping results in expression of the 17.5 kDa isoform of growth hormone, which has a dominant negative effect over the bioactive isoform, is retained in the endoplasmic reticulum, disrupts the Golgi apparatus, and impairs the secretion of other pituitary hormones in addition to growth hormone deficiency. This mechanism led to the progression of central hypothyroidism in the same patient. After 5 years of growth and thyroid hormone replacement, at the age of 33, laboratory evaluation for increased weight gain revealed high serum and urine cortisol concentrations, which could not be suppressed with dexamethasone. Magnetic resonance imaging of the sella turcica detected a pituitary macroadenoma, which was surgically removed. Histological examination confirmed an adrenocorticotropic hormone (ACTH)-secreting pituitary macroadenoma. A ubiquitin-specific peptidase 8 (USP8) somatic pathogenic variant (c.2159C>G/p.Pro720Arg) was found in the tumor. In conclusion, we report progression of isolated growth hormone deficiency due to a germline GH1 variant to combined pituitary hormone deficiency followed by hypercortisolism due to an ACTH-secreting macroadenoma with a somatic variant in USP8 in the same patient. Genetic studies allowed etiologic diagnosis and prognosis of this unique case.

RESUMO O termo “síndrome disfuncional do cristalino” tem sido mais aceito na área e engloba mudanças naturais devido ao envelhecimento do cristalino. A evolução dos dispositivos diagnósticos tem sido fator fundamental para melhor estadiamento, compreensão e caracterização dessas alterações. Mesmo com esses avanços tecnológicos e o uso de classificações subjetivas, como o Lens Opacities Classification System , um estadiamento objetivo da síndrome disfuncional do cristalino precoce ainda não foi estabelecido. A aberrometria ocular total e o índice de superfície ocular, associado à densitometria de Scheimpflug, mostraram-se instrumentais na detecção da síndrome disfuncional do cristalino precoce. Embora estadiamentos precoces de síndrome disfuncional do cristalino tenham sido propostos na literatura, nenhum foi reconhecido mundialmente até o momento. O objetivo desta revisão de literatura é avaliar o estado atual da síndrome disfuncional do cristalino a partir de uma perspectiva tecnológica, e propor um novo sistema de estadiamento para auxiliar os cirurgiões na tomada de decisões cirúrgicas.

ABSTRACT The term dysfunctional lens syndrome has gained acceptance in the field and encompasses natural changes due to aging of crystalline lens. The evolution of diagnostic devices has been a key factor in better staging, understanding and characterizing of these degenerative changes. Even with these technological advances and the use of subjective classifications, such as the classic Lens Opacities Classification System, an objective staging of early dysfunctional lens syndrome has yet to be established. Ocular wavefront aberrometry and objective scatter index, associated with Scheimpflug backscatter densitometry, have proven instrumental in detecting early dysfunctional lens syndrome. Staging of early dysfunctional lens syndrome has been proposed in the literature, but no classification has been recognized worldwide. The purpose of this literature review is to assess the current state of dysfunctional lens syndrome from a technological perspective and propose a new staging system to assist surgeons in making surgical decisions.

OBJECTIVE: To compare the effectiveness of tibial nerve transcutaneous electrical nerve stimulation (TENS) for an overactive bladder, considering the sites of application and frequency of attendance. METHODS: This multi-arm randomized controlled trial enrolled 137 adult women (61.0±9.0 years) with overactive bladder from a university hospital. They underwent 12 sessions of 30-min TENS application and were assigned to five groups: one leg, once a week (n=26); one leg, twice a week (n=27); two legs, once a week (n=26); two legs, twice a week (n=28); and placebo (n=30). Symptoms of overactive bladder and its impact on quality of life were evaluated before and after 6 or 12 weeks of treatment using the Overactive Bladder Questionnaire-V8 and voiding diary. ClinicalTrials.gov: NCT01912885. RESULTS: The use of one leg, once a week TENS application reduced the frequency of urgency episodes compared with the placebo (1.0±1.6 vs. 1.4±1.9; p=0.046) and frequency of incontinence episodes compared with the placebo (0.7±1.4 vs.1.4±2.2; p<0.0001). The one-leg, twice a week protocol decreased the urinary frequency compared with the two legs, once a week protocol (8.2±3.5 vs. 9.0±5.1; p=0.026) and placebo (8.2±3.5 vs. 7.9±2.7; p=0.02). Nocturia improved using the two legs, once a week protocol (1.5±1.8) when compared with the one leg, twice a week protocol (1.9±2.0) and placebo (1.7±1.6) (p=0.005 and p=0.027, respectively). Nocturia also improved using the two legs, twice a week protocol when compared with the one leg, twice a week protocol (1.3±1.2 vs.1.9±2.0; p=0.011). CONCLUSION: One-leg stimulation improved the daily urinary frequency, urgency, and incontinence, and the two-leg stimulation once and twice weekly improved nocturia.

Abstract INTRODUCTION: Most patients with chronic cardiomyopathy of Chagas disease (CCCD) harbor a secondary cause of coronary microvascular dysfunction (CMD), for which there is no evidence-based therapy. We evaluated the impact of verapamil plus aspirin on symptoms and perfusion abnormalities in patients with CCCD and CMD. METHODS: Consecutive patients with angina pectoris, who had neither coronary artery obstructions nor moderate-severe left ventricular dysfunction (left ventricular ejection fraction > 40%) despite showing wall motion abnormalities on ventriculography, were referred for invasive angiography and tested for Chagas disease. Thirty-two patients with confirmed CCCD and ischemia on stress-rest SPECT myocardial perfusion scintigraphy (MPS) were included. Clinical evaluation, quality of life (EQ-5D/ Seattle Angina Questionnaire), and MPS were assessed before and after 3 months of treatment with oral verapamil plus aspirin (n=26) or placebo (n=6). RESULTS: The mean patient age was 64 years, and 18 (56%) were female. The ischemic index summed difference score (SDS) in MPS was significantly reduced by 55.6% after aspirin+verapamil treatment. A decrease in SDS was observed in 20 (77%) participants, and in 10 participants, no more ischemia could be detected. Enhancements in quality of life were also detected. No change in symptoms or MPS was observed in the placebo group. CONCLUSIONS: This low-cost 3-month treatment for patients diagnosed with CCCD and CMD was safe and resulted in a 55.6% reduction in ischemic burden, symptomatic improvement, and better quality of life.

Resumo Introdução: ferimentos causados por peixes são comuns entre pescadores e, se não forem adequadamente assistidos, podem levar a complicações significativas. Objetivo: reportar o caso de um pescador que se acidentou com um camurim/robalo (Centropomus spp.) e apresentou infecção secundária com sequelas graves. Métodos: as informações foram obtidas por meio de revisão de prontuários, entrevista com o paciente e registro fotográfico. Resultados: um pescador de 48 anos se acidentou, com a espícula da base da nadadeira do peixe, na falange do quinto quirodáctilo da mão esquerda, apresentando sinais flogísticos em todo o membro. O serviço de saúde não dispunha de condições para identificar o agente da infecção e diferentes antibióticos foram administrados. Sem resultados expressivos, a terapia antibiótica foi suspensa e foi adotado tratamento sintomático. Após 32 dias de hospitalização, o paciente teve alta. No entanto, dois meses após o acidente, a vítima desenvolveu abscesso do membro com limitação de movimentos dos quirodáctilos, necessitando de procedimento cirúrgico. Após o controle da infecção, apresentou sequelas como atrofia muscular, perda parcial de movimento, redução da capacidade motora, sensibilidade local e aparência da mão em garra. Conclusão: lesões causadas por peixes em pescadores podem resultar em consequências graves e irreversíveis e mais atenção deve ser dada ao tema.

Abstract Introduction: fish injuries are common among fishers and, if not properly assisted, can lead to major complications. Objective: to report the case of a fisherman who had an accident with a snook fish (Centropomus spp.) and presented secondary infection with severe sequelae. Methods: the information was obtained by reviewing medical records, interviewing the patient, and photographic record. Results: a 48-year-old fisherman was injured by the spike on the base of the fish fin. It affected the phalanx of his left hand fifth finger, showing signs of inflammation throughout the limb. The health service was unable to identify the infectious agent and prescribed several antibiotics. Without substancial results, the doctors discontinued the antibiotic therapy and adopted a symptomatic treatment. After 32 days in hospital, the patient was discharged. However, two months after the accident, he presented an abscess in the limb, which limited the fingers movement and required a surgical procedure. After the infection was controlled, he presented some sequelae such as muscle atrophy, partial loss of movement, reduced motor capacity, local sensitivity, and clawed-shaped hand. Conclusion: injuries caused by fish can result in serious and irreversible consequences, and more attention should be paid to the subject-matter.

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RESUMO A melatonina tem propriedades anti-inflamatórias e antioxidantes que podem influenciar o crescimento e a apoptose dos tecidos. Esse aspecto pode influenciar o sucesso do transplante de órgãos. OBJETIVO Avaliar a relação entre a melatonina e o transplante de órgãos. MÉTODO A revisão sistemática foi realizada nas bases de dados do PubMed, usando os termos de pesquisa: “fisiologia da melatonina” ou “terapêutica da melatonina” e “farmacologia do transplante” ou “fisiologia do transplante” ou “terapêutica do transplante” ou “terapia do transplante”. Não foram incluídos os experimentos sobre os órgãos do sistema reprodutivo. Após análise, cinco artigos foram selecionados após a leitura do título e do resumo de 50 manuscritos. Os trabalhos foram divididos em duas vertentes: a) análise da influência do procedimento de transplante de órgão na produção de melatonina; b) ação da melatonina sobre o transplante de órgãos. RESULTADOS O procedimento cirúrgico do transplante cardíaco, a imunossupressão e o enxerto não influenciaram a secreção de melatonina em roedores, mas houve redução significante da melatonina nos casos do procedimento de transplante renal em pacientes com insuficiência renal. A ministração de melatonina em modelos experimentais diminuiu a rejeição e melhorou o sucesso de transplante. CONCLUSÃO Os estudos mostram que a melatonina pode reduzir a dependência da espécie e do órgão e que o emprego da melatonina diminui a rejeição do órgão.

SUMMARY Melatonin has anti-inflammatory and antioxidant properties that can influence tissue growth and apoptosis. This aspect may influence the success of organ transplantation. OBJECTIVE To evaluate the relationship between melatonin and organ transplantation. METHODS A systematic review was performed in PubMed databases using the search terms: “melatonin physiology” or “melatonin therapy” and “transplant pharmacology” or “transplant physiology” or “transplant therapy” or “Transplant therapy”. Experiments on the organs of the reproductive system were not included. After analysis, five articles were selected after reading the title and abstract of 50 manuscripts. The works were divided into two aspects: a) analysis of the influence of the organ transplantation procedure on melatonin production; b) action of melatonin on organ transplantation. RESULTS The cardiac transplantation surgical procedure, immunosuppression, and graft did not influence melatonin secretion in rodents, but there was a significant reduction of melatonin in the renal transplantation procedure in patients with renal insufficiency. Melatonin administration in experimental models decreased rejection and improved transplant success. CONCLUSION Studies show that melatonin can reduce organ and species dependence, and the use of melatonin decreases graft rejection.

Abstract INTRODUCTION: The Portuguese man-of-war (Physalia physalis) is a cosmopolitan species, with a widespread distribution and responsible for a great number of injuries caused by cnidarians worldwide, including Brazil. Geoprocessing technology, however, has never been used to assess the spatial distribution of these animals on beaches. The aim of this study was to carry out a health risk assessment of Portuguese man-of-war (P. physalis) envenomations on the São Marcos and Calhau beaches in São Luís city, in the state of Maranhão, Brazil. METHODS: This is a descriptive and quantitative study concerning primary data on the occurrence of the Portuguese man-of-war (P. physalis) and human envenomations in the studied places, conducted over a two-year period in São Luís, Maranhão, northeastern Brazil. RESULTS: Envenomations mainly occurred on beaches presenting high density of P. physalis during the dry period. Vinegar has been incorporated as a first aid, according to recommendations set by the Brazilian Ministry of Health. CONCLUSIONS: In order to improve prevention and control actions of human envenomation, risk areas for this type of envenomation should be clearly indicated as alert areas. Inclusion of the geographical location of the envenomation in the Notification/Investigation SINAN Form was suggested for allowing the continuity of studies involving this public health issue.

RESUMO Objetivo: Avaliar objetivamente a qualidade da visão óptica antes e depois da capsulotomia com Nd: YAG, obtida por imagem pelo metodo de dupla passagem de luz em pacientes com opacificação capsular posterior. Método: Análise retrospectiva de 26 olhos pseudofácicos com opacificação capsular posterior visualmente significativa, que foram submetidos à capsulotomia de Nd: YAG. O índice de dispersão objetiva, a função de transferência de modulação, a relação de Strehl e a acuidade visual à distância corrigida foram avaliados antes e após a capsulotomia com YAG usando o dupla passagem de luz (OQAS II, Visiometrics, Espanha). Também foi analisado um subgrupo de pacientes com acuidade visual à distância corrigida pré-YAG de 0,10 logMAR (20/25) ou melhor. Resultados: Os índices de qualidade da visão melhoraram em todos os 26 olhos, resultando em uma melhora estatisticamente significativa na acuidade visual à distância corrigida (p=0,007), índice de dispersão objetiva (p=0,001), função de transferência de modulação (p=0,001) e relação de Strehl (p=0,020). A melhora média na acuidade visual à distância corrigida foi de 0,12 ± 0,04 logMAR, no índice de dispersão objetiva foi de 2,84 ± 0,76, no função de transferência de modulação foi de 12,29 ± 2,77 e na razão de Strehl foi de 0,06 ± 0,03 em todos os olhos. Sub-análise de 10 olhos com 0.10 logMAR (20/25) acuidade visual à distância corrigida ou melhor também mostrou uma melhora estatisticamente significativa no índice de dispersão objetiva (p=0,001). A melhora média no OSI foi de 0,76 ± 16, uma diminuição de 35% na dispersão da luz intraocular. Conclusões: A qualidade da visão avaliada pelo dupla passagem de luz mostra uma melhora significativa nas medidas objetivas da qualidade da visão após a capsulotomia do YAG. O índice de dispersão objetiva melhora após a capsulotomia YAG, mesmo em olhos com acuidade visual à distância corrigida pré-YAG de 0,10 logMAR (Snellen 20/25) ou melhor.

ABSTRACT Purpose: The purpose of this study was to objectively assess the optical vision quality of patients before and after Nd:YAG capsulotomy for posterior capsular opacification using a double-pass retinal imaging system. Methods: We retrospectively analyzed the data from 26 pseudophakic eyes with posterior capsular opacification that underwent Nd:YAG capsulotomy. The objective scatter indices, modulation transfer function cutoff frequencies, Strehl ratios, and logMAR corrected distance visual acuities were assessed before and after YAG capsulotomy with a double-pass retinal imaging system (OQAS II, Visiometrics, Spain). We also analyzed data from a subgroup of 10 patients with pre-YAG corrected distance visual acuity of 0.10 logMAR (20/25) or better. Results: Vision quality indices improved in all 26 eyes, resulting in a statistically significant improvement in the corrected distance visual acuity (p=0.007), objective scatter index (p=0.001), modulation transfer function cutoff frequency (p=0.001), and Strehl ratio (p=0.020). The overall mean improvements included 0.12 ± 0.04 logMAR for corrected distance visual acuity, 2.84 ± 0.76 for objective scatter index, 12.29 ± 2.77 for modulation transfer function cutoff frequency, and 0.06 ± 0.03 for Strehl ratio. Our sub-analysis of 10 eyes with 0.10 logMAR (20/25) corrected distance visual acuity or better also showed a statistically significant improvement in the mean objective scatter index (0.76 ± 16; p=0.001), resulting in approximately 35% decrease in intraocular light scatter. Conclusions: The objective vision quality measurements as assessed by the double-pass retinal imaging system showed a significant improvement after YAG capsulotomy. This suggests that the objective scatter index improves after YAG capsulotomy, even in eyes with pre-YAG 0.10 logMAR (Snellen 20/25) corrected distance visual acuity or better.

Abstract Objective: To present our experience in relation to the safety and efficacy of the 180W Greenlight XPS laser for photoselective vaporization of the prostate. Materials and methods: A retrospective, observational, analytic, and descriptive study was conducted within the time frame of July 2014 to November 2017, evaluating technical aspects and preoperative and postoperative variables at 1, 3, and 6 months. Results: Fifty-five patients were included in the study. Their mean age was 69 years. A total of 49.1% presented with comorbidities, 14.5% with heart disease, and 20% with an ASA III. The preoperative parameters were: IPSS 14.5 points (5-35), Qmax 7.19 ml/sec (1.5-12), prostate volume 74 cc (29.2-130), PSA 5.7 ng/ml, and Foley catheter placement (54%). Laser use, time with catheter, previous infections, and previous biopsy were described, as were intraoperative complications (10.8%), postoperative complications (27.3%), Clavien-Dindo (C-D) I (80.2%), C-D II (6.6%), and C-D IIIa (13.2%). Postoperative control at 6 months was: Qmax 17.2 ml/sec (10.2-34.4) (p=0.01) and IPSS 4.2 points (0-19) (p=0.02). Surgical reintervention was performed in 3.6% of the patients, hospital stay was 1.5 days, and the mortality rate was 0%. Conclusions: Photoselective vaporization of the prostate with the GreenLight laser is a safe surgical technique with good results in high-risk surgical patient populations. Complications are similar to those when utilizing the gold standard, but patients taking anticoagulants and antiaggregants can be operated on with the technique and hospital stay is short. Studies with long-term follow-up are needed.

Resumen Objetivo: Presentar experiencia en seguridad y eficacia con el láser GreenLight XPS de 180w para fotovaporización selectiva de la próstata (FVP). Materiales y Métodos: Se realizó un estudio retrospectivo, observacional, analítico y descriptivo (de julio de 2014 a noviembre de 2017). Se evaluaron aspectos técnicos, así como variables pre y posquirúrgicas al primer mes, tercero y sexto. Resultados: 55 pacientes, media de 69 años, 49.1% con comorbilidades, 14.5% cardiopatías, asaiii 20%. Parámetros prequirúrgicos: ipss 14.5(5-35)pts, Qmax 7.19(1.5-12)ml/seg, volumen prostático 74(29.2-130)cc, ape de 5.7ng/ml, 54% portadores de sonda foley. Se describen parámetros de uso de láser, tiempo de sonda, infecciones previas y biopsia previa, complicaciones transoperatorias 10.8% y postoperatorias 27.3%, Clavien-Dindo (CV) I en 80.2%, cvii 6.6% y cviiia 13.2%. Controles postquirúrgicos 6 meses: Qmax 17.2(10.2-34.4)ml/seg (p=0.01) e ipss 4.2(0-19)pts (p=0.02). Reintervención quirúrgica 3.6%, 1.5 días de estancia intrahospitalaria y una mortalidad de 0%. Conclusiones: La cirugía fvp con GreenLight es una técnica quirúrgica segura, con buenos resultados en poblaciones de pacientes con alto riesgo quirúrgico, las complicaciones no son mayores que el estándar de oro, pero los pacientes con anticoagulantes y antiagregantes pueden ser operados con esta técnica, con poco tiempo de hospitalización. Se requiere seguimientos a largo plazo.

Abstract Background: Cancer of the penis accounts for less than 1% of all cancers affecting males. Nevertheless, it has a huge impact on the patients that present with it. Objective: To report on the quality of life, erectile function, and perception of self-esteem in patients that underwent partial phallectomy due to cancer of the penis. Materials and methods: An analytic, cross-sectional study was conducted that included 10 postoperative partial phallectomy patients. They were evaluated through the EORTC-QLQ-30 questionnaire (validated for the Mexican population), the International Index of Erectile Function-Short Form (IIEF-5), and the Rosenberg Self-Esteem Scale (SES). Results: The quality of life results, evaluated through the EORTC-QLQ-30 questionnaire, were lower than those for the general population in all 10 patients. In the IIEF-5 sexual activity evaluations, 5 of the 10 patients were sexually inactive, one patient had no deterioration of sexual activity, one patient had mild deterioration, and 3 patients had mild-to-moderate deterioration. Self-esteem, evaluated by the SES, was above average in 8 of the 10 patients, average in one patient, and below average in one patient. Conclusions: The results of the present study, determined through different scales, indicated that partial phallectomy as treatment for cancer of the penis affected patient quality of life and had repercussions on sexual function. Nevertheless, the self-esteem of the patients, despite their condition, was not affected and was even above average.

Resumen Introducción: El cáncer de pene representa menos del 1% del total de cánceres que afectan al género masculino; sin embargo, implica un gran impacto para el paciente por lo que esto representa. Objetivo: Reportar la calidad de vida, función eréctil y percepción de autoestima de los pacientes sometidos a falectomía parcial por cáncer de pene. Materiales y métodos: Estudio analítico de cohorte transversal. A 10 pacientes posoperados se les aplicó el cuestionario EORTC-QLQ-30 (validado para población mexicana), Índice Internacional de Función Eréctil 5 y SES (Cuestionario de Autoestima de Rosenberg). Resultados: De los 10 pacientes, la calidad de vida, evaluada con el cuestionario EORTC-QLQ-30, fue menor que los resultados de la población general; la actividad sexual, evaluada por la Escala IIEF-5, 5 de 10 pacientes eran sexualmente inactivos, 1 no tuvo deterioro, 1 tuvo un deterioro leve y 3 un deterioro leve-moderado; el autoestima, evaluada por la Escala de Autoestima de Rosenberg, 8 de 10 pacientes presentaron un autoestima arriba del promedio, 1 dentro del promedio y 1 baja autoestima. Conclusiones: Los resultados obtenidos, evaluados según las distintas escalas, indican que la Falectomía Parcial como tratamiento de Cáncer de Pene, afecta la calidad de vida y puede tener repercusiones respecto a la función sexual, sin embargo, la autoestima, pese a la condición de los pacientes, se muestra sin afección, incluso, mejor que el promedio.