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      Infertility highlighted in International Brazilian Journal of Urology

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      International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
      Sociedade Brasileira de Urologia

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          Abstract

          The May-June number of Int Braz J Urol, the 10th under my supervision, presents original contributions with a lot of interesting papers in different fields: Prostate Cancer, Male Infertility, Renal Cell Carcinoma, Urinary Stones, Testicular Cancer, Bladder Cancer, Nocturnal Enuresis, Penile Cancer, Male Health, LUTS, Neurogenic Bladder, Pediatric Urology, Sacral Neuromodulation and Covid-19 in Urology. The papers came from many different countries such as Brazil, USA, Turkey, China, Chile, Portugal, Israel, Canada, Italy and Iran, and as usual the editor´s comment highlights some of them. In the present issue we present four important papers about Male Infertility. Dr. Xavier and colleagues from Brazil performed in page 495 (1) a nice review about the Semen quality from patients affected by seminomatous and non-seminomatous testicular tumor and concluded that more studies will be necessary to clarify the behavior of seminoma and non-seminoma tumors implicating the reproductive health of male patients. Dr. Lorenzini and colleagues from Brazil performed in page 544 (2) a nice study about the vasectomy re-reversal (VRR) effectiveness and whether specific parameters can be associated with its success and concluded that VRR was effective in restoring the obstruction in more than half of the patients. Furthermore, the presence of spermatozoa in the vas deferens fluid was the parameter associated with the VRR success and Dr. Pariz and colleagues from Brazil performed in page 617 (3) a nice report about dysplasia of the fibrous sheath with axonemal and centriolar defects combined with lack of mitochondrial activity as associated factors of ICSI failure in primary ciliary dyskinesia syndrome and concluded that modern andrology, its clinicians and field scientists have the power and the tools to limit these complications by adopting a more rigorous assessment, especially that of the male gamete. In particular, an assessment of the sperm functional aspects, the presence of ROS, LPO and integrity of the nucleus/DNA; not limited to severe infertility, whether due to asthenozoospermia, severe oligozoospermia, teratozoospermia, leukocytospermia or any chronic disease. The editor in chief would like to highlight the following works too: Dr. Fantin and collegues from Brazil presented in page 484 (4) a nice systematic review about the role of salvage lymph node dissection in patients previously treated for prostate cancer and shows that the papers studied do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. Dr. Monteiro and collegues from Brazil presented in page 515 (5) a nice study about a very important disease in Brazil: Penile Cancer and the authors studied the erectile function after partial penectomy for penile cancer and shows that partial penectomy due to penile cancer provides adequate local control of the disease, however, proper counselling is important especially in relation to ED consequences. Preservation of penile length yields to more optimal erectile recovery. Dr. Rangel and collegues from Brazil presented in page 535 (6) a very interesting study about the quality of life in enuretic children and concluded that enuresis has a great impact in quality of life of children and that this impact is not related to the age or sex of the child. Dr. Oliveira and collegues from Brazil presented in page 558 (7) a study about the a single center experience in the public health system in Prostate Cancer Screening in Brazil and concluded that the PSA-screening remains controversial in literature. In front of a huge miscegenated people and considering the big proportion of high-risk PCa, even in young men diagnosed with the disease, it is imperative to inform patients and health providers about these data particularities in Brazil. Dr. Leite and collegues from Brazil presented in page 566 (8) a very interesting study about the influence of treatment access on survival of metastatic renal cell carcinoma in brazilian cancer center and concluded that patients with metastatic renal cell carcinoma treated via the the public health system in a Brazilian Cancer Center. had worse overall survival, possibly due to poorer prognosis at presentation and less drug access. Dr. Lopes and collegues from Brazil presented in page 574 (9) a very important study about patients with encrusted ureteral stents can be treated by a single session combined endourological approach and concluded that the endoscopic combined approach in the supine position is a safe and feasible technique that allows removal of retained and encrusted stents in a single procedure. The Forgotten- Encrusted-Calcified (FECal) classification seems to be useful for surgical planning. Dr. Bolat and collegues from Turkey presented in page 584 (10) a nice prospective randomized study about the Monopolar versus bipolar transurethral resection of lateral wall-located bladder cancer under obturator nerve block and concluded that during the treatment of lateral-wall located non-muscle invasive bladder cancers, either monopolar TUR (M-TURBT) or bipolar TUR (B-TURBT) can be safely and effectively performed by combining spinal anesthesia with obturator nerve block. Even so, it should be taken into consideration that low-grade postoperative hemorrhagic complications may occur in patients who undergo M-TURBT. Dr. Falahatkar and collegues from Iran presented in page 596 (11) a very nice randomized controlled clinical trial about the effects of pregabalin, solifenacin and their combination therapy on ureteral double-J stent-related symptoms and concluded that the combination therapy of pregabalin and solifenacin has a significant effect on stent-related symptoms and is preferred over monotherapy of the respected medications. Drs. Wang and Braga from Canada presented in page 610 (12) a very important surgical technique about the open distal ureteroureterostomy (UU) for ectopic ureters in infants with duplex systems and no vesicoureteral reflux under 6 months of age – This paper is the Cover in this number – and concluded that an open distal UU can be performed safely and effectively through a small incision in the inguinal crease in infants younger than 6 months of age, with minimal morbidity and short hospital stay. Its excellent cosmesis and minimally invasive nature are comparable to any robotic or laparoscopic procedures. Dr. Ferenczi and collegues from USA presented in Expert Opinion secion in page 631 (13) a interesting report about COVID-19 screening and shows that pre-procedural COVID-19 testing is a scalable intervention that will provide a means to safely reimplement care for the Urologic community. Eventually, Urolo- gic surgical volume will need to expand nationwide in the setting of the ongoing COVID-19 pandemic and limited PPE. Universal COVID-19 screening of pre-operative patients represents a viable means to meet the needs of our patients. The Editor-in-chief expects everyone to enjoy reading this very interesting issue of the International Brazilian Journal of Urology.

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          Erectile function after partial penectomy for penile cancer

          ABSTRACT Purpose: To evaluate the erectile function in patients who underwent partial penectomy and identify factors associated with penile functional status. Materials and Methods: We identified patients who underwent partial penectomy due to penile cancer between 2009 and 2014. Clinical and pathological characteristics included patient age at the time of diagnosis, obesity, hypertension, dyslipidemia, diabetes, smoking, metabolic syndrome, Eastern Cooperative Oncology Group (ECOG) status, penile shaft length, tumor size, primary tumor stage (pT), clinical nodal status, and local recurrence. Erectile function was assessed prospectively with the International Index of Erectile Function (IIEF-5) at least 3 months after partial penectomy. Results: A total of 81 patients met analysis criteria. At the diagnosis, the median age was 62 years (range from 30 to 88). Median follow-up was 17 months (IQR 7-36). Of total patients, 37 (45%) had T2 or higher disease. Clinically positive nodes were present in 16 (20%) patients and seven (8.6%) developed local recurrence. Fifty patients (62%) had erectile dysfunction (ED) after partial penectomy, 30% had moderate or severe erectile dysfunction scores. Patients with ED versus without ED were similar in baseline characteristics except for age, penile shaft length, and presence of inguinal adenopathy (p <0.05). Multivariate analysis using logistic regression confirmed that older patients, shorter penile shaft length, and clinically positive lymph node were significantly associated with ED. Conclusion: Partial penectomy due to penile cancer provides adequate local control of the disease, however, proper counselling is important especially in relation to ED consequences. Preservation of penile length yields to more optimal erectile recovery.
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            Pre-operative COVID-19 screening: a model to provide non-discretionary care for urologic patients

            INTRODUCTION COVID-19 in Washington State has led to unprecedented challenges within the Urologic community as physicians work to provide care that is safe for patients and staff. In order to conserve personal protective equipment (PPE) and to ensure hospital capacity for COVID-19 infected patients, Washington State Governor Jay Inslee directed that elective surgical procedures should be suspended on March 19, 2020 (1). However, non-elective Urologic care still needed to be provided. Preventing transmission of COVID-19 has been of paramount concern during the pandemic. Procedural care is at particularly high risk with its associated aerosol-generating procedures: intubation and extubation (2). Patients cannot be screened for infection solely based on symptoms, as a significant number are asymptomatic (3, 4), and many carriers never develop symptoms(5). Providing fit-tested N95 masks to all procedural staff is not currently feasible given the international shortage of PPE (6). Furthermore, pre-test probability of infection is difficult to estimate as our community's COVID-19 burden has not been established, and studies have demonstrated significant geographic variability within the United States (7, 8). Further complicating the picture are the wide variety of available testing modalities with a range of sensitivity, specificity, and negative and positive predictive values. The majority of these have been FDA approved under emergency use authorization (9). The harm in suspending Urologic care to the community is significant. Increased surgical waiting time (SWT) for T3 renal masses has been associated with decreased overall survival (10), and a delay in bladder cancer treatment has been demonstrated to lead to worse prognosis and higher pathologic stage (11). Based on Organ Procurement and Transplantation Network Data as of May 1, 2020 there has been nearly a 50% decrease in the number of kidney transplants performed in mid-March compared to mid-April, impacting a pre-existing shortage in available organs (12). Delayed relief of ureteral obstruction is associated with long-term renal dysfunction (13). Finally, the psychological impact of a delay in surgical care cannot be underestimated, affecting patient anxiety level and general health perceptions (14). In order to safely provide care for those who may be harmed by a treatment delay, on April 1st, 2020 Virginia Mason Medical Center committed to screen all patients prior to any surgical care. This implementation appears to be an effective measure to protect patients and staff, with no known COVID-19 cases in perioperative staff since the advent of screening. The primary objective of this study was to evaluate the impact of pre-operative COVID-19 screening on our ability to provide Urologic care. This was measured using Urologic surgical volume during an interval when discretionary surgery was suspended. MATERIALS AND METHODS Testing: Effective April 1, 2020 all pre-procedural patients were tested for COVID-19. Testing occurred within 48 hours prior to the scheduled intervention or at the time of hospital admission. A nasopharyngeal swab specimen was collected and processed using the Abbott RealTime SARS-CoV-2 assay. Mid-turbinate testing was substituted for nasopharyngeal swabs on May 3, 2020 in accordance with expanded CDC sampling guidelines (15). Patients who screened positive for COVID-19 were rescheduled to a later date. If medically stable, they were discharged home, and rescheduled for surgery following two subsequent negative repeat screening tests. In emergent situations, patients were either screened with a rapid ePLEX SARS-CoV-2 test or their procedure was performed in a specially engineered negative air pressure “COVID pod,” utilizing Powered Air-Purifying Respirators or fitted N95 face masks and eye protection. PPE for patients who tested negative for COVID-19 included standard surgical masks and protective eye shields. Stratification: All cases were triaged into one of five tiers: Emergent, Urgent, Planned Procedure level 1, Planned Procedure level 2, and Discretionary Procedure (Table-1). Proposed procedures were reviewed by an independent multidisciplinary committee to ensure that purely discretionary procedures (defined as a delay in performing the intervention would not result in harm to the patient) were not performed during the March 19 to May 18, 2020 prohibition period. Table 1 Triage levels used to determine case urgency during the COVID-19 pandemic with corresponding urologic procedures (non-exhaustive list). Triage Level Example of Procedures Emergent Fournier's gangrene debridement, decompression for obstructive pyelonephritis Urgent Decompression of symptomatic nephrolithiasis, cystoscopic fulguration for active bleeding Planned Procedure Level 1 Transurethral resection of high-grade bladder tumor Planned Procedure Level 2 Radical prostatectomy for high-risk prostate cancer, deceased donor renal transplant Discretionary Inflatable penile prosthesis insertion, mid-urethral sling Data Collection and Analysis Data regarding Urologic operative volume was collected retrospectively. Only procedural care based in the operating room was included in the analysis. Comparison of surgical volumes was performed between baseline [one year prior to the COVID-19 pandemic (March 19-May 6, 2019)], pre-intervention (March 19-March 31, 2020), and post-intervention (April 1-May 6, 2020) time periods. All statistical analyses were 2-sided, and significance was defined as p T1a renal neoplasms and bladder neoplasms (21). This approach limits unnecessary surgery during the COVID-19 pandemic. Although case volumes did increase in this study, expansion was done with the clear objective of performing procedures to manage acute disease processes, prevent harm to our patients, limit COVID-19 exposure, and conserve PPE. As the PPE shortage is relieved and emphasis changes, this study provides a model for expansion of a Urologic practice at a time when many institutions are resuming elective surgery (22). There are several weaknesses in this study: First, it was performed in a single institution. Second, the COVID-19 pandemic is rapidly evolving. Although screening facilitates appropriate and responsible assessment of patients prior to proceeding with care, it is unclear if the same strategy will be effective as the disease prevalence changes. Finally, our community currently has a relatively low penetrance of COVID-19. Applicability to regions with far greater burden have yet to be proven. CONCLUSIONS We believe that pre-procedural COVID-19 testing is a scalable intervention that will provide a means to safely reimplement care for the Urologic community. Eventually, Urologic surgical volume will need to expand nationwide in the setting of the ongoing COVID-19 pandemic and limited PPE. Universal COVID-19 screening of pre-operative patients represents a viable means to meet the needs of our patients.
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              Quality of life in enuretic children

              ABSTRACT Introduction: Nocturnal enuresis is a highly incident chronic disorder that generates countless problems to the child and their parents. Bed-wetting has significant negative impacts on self-esteem and the performance of children. The aim of the current study is to assess the quality of life of enuretic children, as well as its association to sex and age. Patients and Methods: Thirty-nine enuretic children (23 boys) and 49 healthy children (27 boys) without any history of previous treatment for enuresis or voiding dysfunction were included. Age ranged between 6 and 11 years old. The “AUQEI” questionnaire was applied in a private environment to all children by the same researcher (psychologist) to evaluate quality of life. Results: Enuretic children displayed loss in quality of life when compared to non-enuretic (35.9% of enuretic x 16.3% of non-enuretic, p=0.035). They were mostly affected in their daily activities (p=0.02). No significant differences were found in the association of sex and gender with quality of life. These results suggest that, children with nocturnal enuresis have 2.87 times more chances of having loss in quality of life compared to non-enuretic. Conclusions: Enuresis has a great impact in quality of life of children. This impact is not related to the age or sex of the child.
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                Author and article information

                Journal
                Int Braz J Urol
                Int Braz J Urol
                ibju
                International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
                Sociedade Brasileira de Urologia
                1677-5538
                1677-6119
                25 March 2021
                May-Jun 2021
                : 47
                : 3
                : 479-481
                Affiliations
                [1 ] orgnameUniversidade do Estado de Rio de Janeiro orgdiv1Unidade de Pesquisa Urogenital Rio de Janeiro RJ Brasil originalUnidade de Pesquisa Urogenital - Universidade do Estado de Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
                [2 ] orgnameHospital Federal da Lagoa orgdiv1Serviço de Urologia Rio de Janeiro RJ Brasil originalServiço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
                Author notes
                Luciano A. Favorito, MD, PhD , Unidade de Pesquisa Urogenital da Universidade do Estado de Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil. E-mail: lufavorito@ 123456yahoo.com.br
                Author information
                https://orcid.org/0000-0003-1562-6068
                Article
                S1677-5538.IBJU.2021.03.01
                10.1590/S1677-5538.IBJU.2021.03.01
                7993941
                33620993
                7189a6eb-669a-4a1d-8644-6d10d39fbc87

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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