IntroductionParacoccidioidomycosis is a systemic mycosis in Latin America that can affect various organs. Few case reports of paracoccidioidomycosis affecting the prostate are found in the literature.Case presentationWe present the case of a 79-year-old Caucasian man with a six-month history of irritative symptoms of the prostate (urgency, frequency and nocturia) and difficulty initiating urination that progressed to urinary retention and the use of a urinary catheter. The anatomopathological analysis of the transurethral resection of the prostate revealed chronic granulomatous prostatitis of fungal etiology (paracoccidioidomycosis) with extensive necrosis. The patient began treatment with itraconazole at a dose of 100mg/day for six months. Radiography of the thorax revealed bilaterally diffuse nodular reticular interstitial lesions. The patient progressed to respiratory failure and was sent to the intensive care unit, but suffered a cardiopulmonary arrest and was pronounced dead.ConclusionsDue to the high incidence of paracoccidioidomycosis in countries like Brazil, urologists should suspect blastomycosis in all patients with symptoms of lower urinary obstruction with chronic abacterial prostatitis. Considering that paracoccidioidomycosis has the potential to affect various organs, following diagnosis, the treatment must be initiated as soon as possible.

INTRODUCTION AND OBJECTIVE: Cystinuria is a rare genetic cause for kidney stones. Mutations have been found in two genes, SLC3A1 and SLC7A9, on chromosome 2 and 19 respectively, which code for the two subunits of the amino acid transport system, RBAT and b 0,þ AT in the renal proximal tubule and the small intestine. In the literature, cystinuria has been previously defined as an autosomal recessive disorder, however, some heterozygous patients present with symptoms of the disease. There is controversy about whether these patients are carriers or true cystinurics.METHODS: We studied the correlation between the genotype and phenotype in our cohort of SLC7A9 heterozygotes in a single center. Phenotype was recorded including: urine cystine levels, calculus analysis, cytology, previous procedures, active and past medications, medical and family history. These were then compared between patients and used to identify which ones were symptomatic.RESULTS: From a database of 184 genotyped cystinuric patients 20(10.9%) were identified as SLC7A9 heterozygote. The most common mutation in SLC7A9 was c.614dupA which was expressed in 5(25%) patients. This was also a common mutation for all 66 patients in the database with a mutation in SLC7A9 (13(19.7%)). 6(30%) patients, had a documented proven cystine stone on analysis; 9(45%) had cystine crystals on cytology; 5(25%) were positive for both. Additionally 13(55%) patients had an elevated urine cystine value above 100 mM/M creatinine. In all, 13(65%) patients were classified as having a clinical diagnosis of cystinuria; of these 13 patients: 12(92.3%) had undergone at least one stone-related procedure with 8(61.5%) having more than one procedure, 2(15.4%) are currently actively taking medication for cystinuria (alkalinisation or chelating agent), and 4(30.7%) have relatives with stone episodes. 1 patient did not have a clinical diagnosis of cystinuria. 6(30%) patients potentially do have a diagnosis of cystinuria however this is difficult to confirm as they do not have high urine cystine levels and have no traceable documented stone analysis. Further analysis of future stones is needed as well as genetic analysis with in-depth exome sequencing to look for other responsible genes, to establish if they have the disease or are true carriers.CONCLUSIONS: We have demonstrated the symptomatic presentation of cystinuria in patients heterozygous for SLC7A9 who previously would have been classified as carriers. This suggests that the inheritance of SLC7A9 is autosomal dominant with incomplete penetrance but further work is needed to fully characterise this phenotype.

Premature ejaculation is the most frequent male sexual dysfunction, estimated to affect 20 to 30% of men at some time in their life. A Pubmed search from the year 2000 to the present was performed to retrieve publications related to management or treatment of premature ejaculation. Behavioral techniques have been the mainstay of premature ejaculation management for many years, although evidence of their short-term efficacy is limited. Topical therapies for premature ejaculation act by desensitizing the penis and do not alter the sensation of ejaculation. Selective serotonin reuptake inhibitors (SSRIs), commonly used in the treatment of depression, are often used to treat premature ejaculation, based on the observation that delayed ejaculation is a frequent side effect of this drug class. Dapoxetine is a short-acting SSRI formulated to treat premature ejaculation, and results seem very promising.Keywords: Ejaculation; Coitus; Erectile dysfunction; Sexual behavior; Sex education; Serotonin reuptake inhibitors RESUMOA ejaculação precoce é a disfunção sexual masculina mais frequente, com uma estimativa de acometimento de 20 a 30% dos homens em algum momento da vida. Foi realizada uma busca no Pubmed, do ano 2000 até os dias atuais, com a finalidade de revisar publicações relacionadas ao manejo e ao tratamento da ejaculação precoce. Terapias comportamentais foram a base do manejo da ejaculação precoce por muitos anos, embora as evidências de sua eficácia a curto prazo sejam limitadas. Terapias de uso tópico agem por meio de dessensibilização do pênis, mas não alteram a sensação da ejaculação. Os inibidores seletivos da recaptação da serotonina são utilizados para depressão e, em geral, também para tratar ejaculação precoce, com base na observação de que o retardo na ejaculação é um efeito colateral frequente dessa classe de drogas. A dapoxetina é um inibidor seletivo da recaptação da serotonina de curta ação, que foi formulado para tratar a ejaculação precoce, e seus resultados parecem muito promissores.