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Testicular Cancer

By Dr. Octavio Almanzor

The testicles represent the principle male sex glands. They are located under the penis in a pouch of skin called the scrotum and their functions are sperm production and secretion of a sex hormone called testosterone, which has to do with the sexual development of man.
Compared with other types of cancer, testicular cancer is relatively uncommon, and represents approximately 2% of all cancers in men. It appears most frequently in males aged 20–35 and is much less common after age 50. Risk factors for developing testicular cancer include undescended testicles at birth, family history of testicular cancer, viral diseases of childhood, such as mumps and even infertility.

Usually, this cancer does not cause symptoms, only the growth of one or both testicles. On suspicion, the doctor performs a thorough physical examination and scrotal ultrasound – which can show the presence and size of a tumor mass in the testicle-. Besides there are certain laboratory blood tests that measure increased presence of certain substances that function as tumor markers for testicular cancer, such as the alpha fetoprotein, lactate dehydrogenase and the determination of the human chorionic hormone gonadotropoina subunit B.

Cancer Testiculo-Caracteristicas

Diagnosis is based on the clinical examination, histopathological findings of tumor cells within the organ. In such a case, further tests will be needed to see if the cancer has spread from the testicle to other parts of the body. Determining the stage of the disease helps plan the entire treatment.

Treatment should be multidisciplinary, where the urologist, medical oncologist and radiation therapist are involved. In general, it depends on the patient’s age, the type of tumor and how advanced it is found to be, although cure rates are calculated as high as 95%, especially in those cases detected early.

Orquiectomia radicalThe surgery called radical orchiectomy is the removal of the testicle and is often sufficient for the complete cure of the patient. After surgery the patient retains exactly the same potency and the same capacity for parenthood, because he retains the healthy testicle. If the patient wishes, a prosthesis can be inserted in place of the testicle removed by surgery. In cases where the patient has only one testicle, and it is affected by the cancer, surgery will be needed where only the tumor is removed and the remaining healthy testicular tissue is preserved.
If the tumor has spread outside the testicle and depending on the type of tumor it may be necessary to have both chemotherapy and radiotherapy, to be administered by the medical oncologist or radiation oncologist, respectively.

These two treatment modalities can interfere with sperm production, so that the preservation of semen in biobanks is required for these patients.

Chemotherapy is the use of special drugs that destroy cancer remaining in the body after surgery, although it may be the initial treatment if the cancer is in an advanced stage, i.e., where it has spread outside the testicle before the operation. Most drugs have some side effects including nausea, hair loss, fatigue, diarrhea, vomiting, fever and chills.

In the case of radiation, electromagnetic waves of high intensity that kill cancer cells and shrink the size of the residual tumors are employed. Side effects of radiation therapy depend mainly on the treatment dose. These commonly include fatigue, skin changes where the treatment is performed, loss of appetite, nausea and diarrhea.

Because testicular cancer is curable when detected early, experts recommend conducting a monthly testicular self-examination after a hot shower – when the scrotum is more relaxed-, for lumps, enlargement or other abnormalities; also, try to identify if there is pain or discomfort when doing the exploration and also a sense of heaviness. It is always important to consult a doctor to determine the cause of any of these symptoms.

Testicular cancer can recur. Monitoring can vary depending on the type of tumor and, in general, patients are examined by an urologist 2 or 3 times per year with scans and blood tests.

Auto examen testiculo

Translated by Weldon Woodard

Prevention of Sexually Transmissible Infections

By. Dr. Luis Medina

Sexually Transmissible Infections (STI), also known as venereal diseases are a group of infectious medical conditions that are transmitted from person to person through contact that occurs almost exclusively during intercourse, including vaginal sex, anal and oral sex. However, they can be transmitted by using contaminated or blood contact syringes, and some of them can be transmitted during pregnancy or childbirth, from mother to child.

The incidence rates of STD remain high in most of the world, despite diagnostic and therapeutic advances. In many cultures, changing sexual morals and oral contraceptive use have eliminated traditional sexual restraints, especially for women, and both health professionals and patients have difficulty dealing openly and candidly with sexual problems.

In 1996, WHO estimated that over one million people are infected daily venereal disease. About 60% of these infections occur in children under 25 years and 30% of these are under 20 years. An estimated 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occurred throughout the world in 1999.

Over 2 million primoinfecciones currently presented annually HIV and STD 400 million in total, leading to the medical world to direct their efforts towards finding effective prevention of these diseases and reliable methods.

Failure STD treatment can lead to long-term infertility, ectopic pregnancy and chronic pelvic pain in up to 20% of cases, and spontaneous abortions, premature birth and congenital infections in pregnancy more for immunosuppression in patients AIDS, reasons for preventing STDs should be considered a priority for primary care medicine.

To prevent STDs, it is essential to know its existence, the means of transmission, opt for safe sexual behavior, either abstain from sexual contact, or have only couple practice safe sex, if you have symptoms, go early to the healthcare. It is also essential to avoid sharing needles (for substance abuse, for example).

It is vital for the prevention of these infections to identify high-risk individuals. Are considered at high risk for STDs to the following individuals:

• People with new sexual partners.
• multiple sex partners.
• History of previous STDs.
• Use of illicit drugs.
• Contact with sex workers.
• Sexual partners of people infected with HIV (serodiscordant couples) individuals.
• Men who have sex with men.
• High-risk sexual behaviors and condom disuse.

What strategies exist for prevention of STDs?

Different vaccines have been developed for some of these. For example for hepatitis A, which is recommended for men who have sex with men, intravenous drug users and those with chronic liver disease. The Hepatitis B vaccine recommended for all adults, especially those high-risk patients, antibody titers should be measured in the blood of the vaccine at least once a month to the proper value, and efficiency.

HPV vaccine was also developed, there are two classes currently Cervarix protects against types 16 and 18 (which cause 70% of cervical cancers) and the quadrivalent called Gardesil (6, 11, 16 and 18) in addition to providing protection for serotypes that produce the highest rates of genital warts. However, despite intense efforts to find an effective HIV vaccine no studies to support the use of one of the prototypes that have been developed to prevent infection.

Condom use is a preventive strategy that has been associated with significantly reduced risk of transmission of HIV, chlamydia, gonorrhea, herpes and HPV.

Circumcision has proven useful in reducing infections herpes, HPV and HIV.

Prevention of HIV infection

Preventing HIV infection is a topic that has been working hard, two routes have been devised for this virus prophylaxis, postexposure prophylaxis is pre-exposure and over which major advances have been made.

In Gladstones US Institute working group of Dr. Robert Grant has tested a drug, consisting of two antiretrovirals commonly used in the clinic under the tradename Truvada (Tenofovir-Emtricitabine). Reduced risk of HIV between 44-90% by taking one tablet daily plus the awareness of individuals participating in the study to reduce potential risk behaviors and especially the use of condoms was obtained.

The only contraindication that seems to have it in patients with chronic kidney disease or those in their creatinine levels are above normal, to be elucidated their impact on pregnant women well and should be maintained until the risk factors persist. However, it is not yet known exactly the minimum dosage required to maintain the prophylactic effect of the drug to provide the patient a more convenient dosing regimen and not represent an undue hardship to unnecessary patient (currently one month of treatment for a patient would be estimated around $ 1425).

At the beginning of the investigation evaluated the ability of a drug to be as effective for the prevention of infection in patients with HIV were to promote increased sexual risk behavior but found that this is not so.

There are still details to explore in relation to this new way of prophylaxis but you can not deny that is encouraging news for the world that, if passed in its entirety, represent a potential shift in strategy to tackle the global epidemic of HIV.

Recalling the great Oscar Yanes

A year ago the Venezuelan journalism pioneer and great personal friend, known for his famous phrase “Chúpate esta mandarina”(“Suck on this lemon”), is ‘vibrando’(singing) from the sky.

Oscar was a tireless spokesman for the cause of prostate cancer. From his own peculiar perspective he drafted an impeccable prologue for “No le tenga miedo al dedo” (Have no fear of the finger), which suggested an analogy between the finger of God and that of the urologist carefully and preventatively feeling, accompanied by his memorable anecdotes of the characters in Venezuelan contemporary history.

Interviews, lunch, conversations and lots of laughter I shared with Oscar during the task of raising awareness about men’s health.

It was a pleasure to spend the time with you. Thanks for so much teaching. Farewell dear friend. ¡Así son las cosas! (That’s the way it goes.)

OscarYanes

Translated by Weldon Woodard

#HazloEsteNoviembre: The prostate exam saves lives

As an appetizer for what will be the month of awareness of Prostate Cancer, remember how humorist Laureano Márquez and actor Guillermo Canache joined the campaign to encourage people to have the digital rectal examinations.

The DRE is the introduction of the index finger of the urologist through the patient’s rectum to feel the back portion of the prostate. This test may not only provide information to the physician about abnormalities in the position of that gland, but also on the size, consistency and sensitivity. It also helps in the diagnosis of prostatic enlargement, prostatitis or suspected prostate cancer.

See the video and remember #HazloEsteNoviembre:

#Movember in Venezuela: Interview with Cesar Miguel Rondon

As part of what will be the month of awareness of the Prostate Cancer, I talked with Cesar Miguel Rondon about some of the preparations for #Movember in Venezuela.

#Movember (a portmanteau from the Australian-English diminutive word for “moustache”, “mo”, and “November”) is a world movement which consists in growing a moustache during the eleventh month of the year to raise awareness about men’s health, especially prostate and testicular cancer.

There are still men over 45 years who have not had the DRE (digital rectal examination) for fear of the examination, or fear of the diagnostic results. However, I reiterate that an early diagnosis can save lives.

Here you can listen to the full interview:

Penile Cancer: A devastating reality

Although not a common disease in our area, it is important to detect since its evolution can be fatal and devastating, not only for health status and patient survival, but also for the quality of life

By Dr. Oscar Darioa Martín Garzón

Of the urologic tumors, penile cancer represents one of the less frequent, with 1 case per 100,000 men in the United States and Europe, with variations by demographic area: 0.7 3 per 100,000 people in India, Brazil 8.3 per 100,000 men; surpassed by Uganda, where it is the most commonly diagnosed cancer. By race, it is more common in Hispanic whites and less common in blacks and non-Hispanic whites.

Risk factors important for the development of penile cancer can be identified clearly and precisely, among which are social and cultural habits, hygiene, and customs associated with religion.
The presence of cancer is rare in communities that practice circumcision in newborns or before puberty (Jews, Muslims and the Ibo of Nigeria). “Early circumcision reduces the risk of penile cancer between 3-5 times, but it should be clear that adult circumcision does not protect against penile cancer,” says the American and European urology guidelines.

The risk factors most clearly identified for this condition are phimosis (the redundant or large foreskin), chronic inflammatory condition of the foreskin or head of the penis (glans) resulting from conditions such Balanopostitits, lichen sclerosus and atrophicus (xerotica balanitis , common in diabetics); sexual history (multiple partners, early age at first intercourse) and patient report of warts (lesions on the penis with a fluffy appearance). All these are associated with a risk of 3-5 times more of penile cancer, in addition to smoking cigarettes, which increases the risk of the disease from 4 to 5 times.

It is Important to point out that because of modesty or fear, men do not immediately consult a specialist and prior to this start nonmedical local treatment, resulting in the progression of the disease and a terrible unfavorable outcome for both the patient and his urologist.

Once the diagnosis is made, the disease is classified according to its severity in order to offer local treatment or to go immediately to surgery with a penectomy (removal of penis) which can be complete or partial depending on the case. After this, the possibility of involvement of the lymph nodes is classified, which is the site where the cancer spreads, mainly to the ganglia in the groin and the pelvis.
Given the possibility of lymph node involvement, a resection should be done immediately to ensure no spread of the disease and improve the patient’s chance of survival.

Nowadays there are two possibilities for surgical treatment, open and minimally invasive (laparoscopy and robotics). A few months ago, in Caracas, specifically in the La Floresta Clinic, the first robotic inguinal lymphadenectomy in Latin America was performed, and the third in the world, by our group, the most experienced and with the most reported cases worldwide, allowing us to discern clearly the advantages of robotics in such operations, among which are better identification and dissection of the anatomy, less scarring, improving the aesthetic factor, important for many patients; also there is less chance of intraoperative and postoperative complications, resulting in a faster return to daily activities. The day after the procedure the patient said “it’s amazing to know how medicine has improved in the world and in Caracas.”

INFOGRAPHIC LEGEND: The working ports are placed for the robot-assisted laparoscopic approach, taking into account the different anatomical structures surrounding the affected area. Then the arms of the robot are connected to the working ports.

 

Regioninginal-para estudiar la extension del cancer de pene-colocacion del robot para hacer la linfadenectomia
Linfadenectomia-Comparacion-Incisiones el izquierdo con cirugia minimamente invasiva para linfadenectomia

Interview with Doctor René Sotelo

Rectal examination: an urban taboo. Its importance in the detection of prostate cancer.

Man, throughout history, has been subjected to various urban taboos. Among them is the one concerning the medical examination by the urologist, which has been the subject of great controversy. For many patients it is complex and difficult to accept the DRE, as they feel their privacy is violated, as well as their manhood.

A study published last August in the journal Cancer Epidemiology confirms and promotes further awareness of the importance of the digital rectal examination of the prostate, by means of which some tumors can be felt in patients who might, nevertheless, show normal or even low levels of prostate specific antigen (PSA, for its acronym in English).

An even more troubling finding has shown that those patients in whom a prostate tumor is confirmed by rectal examination of the prostate-and despite normal or low levels of PSA- have a higher risk of death from cancer.

Let’s not forget: better a rectal examination in time than a cancer ravaging our lives. Do it, without fail, have your annual urological checkup… Oscar Darío Martín G. Urologist.

CIMI and the USC team received the third prize of the Congress of the American Urological Association AUA

CIMI and the USC team received the third prize of the Congress of the American Urological Association AUA, for the video “Robotic Level 3 Cava Thrombectomy “

This is the first time that a surgical intervention for these injuries with minimally invasive techniques is performed.

The team from the University of Southern California USC, world leaders in robotic kidney surgery headed by Dr. Inderbir Gill, extended the invitation to Dr. René Sotelo and the CIMI team to participate in the study of this novel technique, which involves removing thrombus from the vena cava which reach the heart

This type of tumor, depending on its scope, can be classified as Level 1, which involves the renal vein and part of the vena cava, up to level 3 which involves the heart. In the case study, we have a Level 3, and the video shows the feasibility of performing this highly complex surgery using the minimally invasive technique with the assistance of the robot, removing the renal tumor and the tumor thrombus from vena cava without any complications at all.

This is the first time in the world that this surgery is performed with a minimally invasive approach, demonstrating once again the great scope of this technique, which also translate into benefits for the patient: less bleeding, less post operative pain, faster recovery and very small incisions.

Testosterone: Hormone of power, sex and laughter. Does its progressive loss really represent a risk?

With the passing of time, all men experience natural changes. Among these the progressive loss of the male hormone known as testosterone (T), has been studied in depth, a loss that brings about the presence of symptoms such as sleep disturbance, changes in mood (mainly irritability), loss of strength, decreased libido and erection quality, among others.

In 1950 an important means of treatment appears for men with low testosterone levels, called hypogonadal. This treatment consists mainly in providing synthetic hormone in different forms such as injections, local applications and spray.

Today you can easily walk the fine line between the normal changes of aging and disease. This has led to a better understanding of the conditions of men with hypogonadism, from which has come the interpretation that there is a direct relationship between low levels of the hormone in the blood and the incidence of increased cardiovascular risk (myocardial infarction), high cholesterol and diabetes, among other ailments.

Recently it has been debated whether the replacement of male hormone promotes the improvement of the condition of hypogonadism or if, on the contrary – and as mentioned in two recent studies in the journals PLOS ONE and JAMA, describing an experiment with a group of men over 65 with a history of acute myocardial infarction undergoing hormone replacement therapy with testosterone – they have a higher risk of cardiovascular events and increased mortality.

To this the scientific community has replied. Some have expressed support, while many others have voiced their opposition to the deleterious effects resulting from the use of hormone replacement therapy.

Meanwhile, the regulator of medicines in the United States, the Food and Drug Administration (FDA for its acronym in English), has spoken and has demanded new and more conclusive scientific studies by companies selling this drug, in order to reassess its safety.

In recent conferences held worldwide in the urological world, the American Congress of Urology (AUA) and the European Congress of Urology (EAU), have spoken about the ongoing debate and have declared their support for the appropriate use, and the timely monitoring of hormone replacement in hypogonadal patients.

Aging is not synonymous with disease nor with the need to stop living with a sense of power, active sexuality and overall well being…