We aimed to evaluate possible associations of circumcision with several sexual dysfunctions and to identify predictors for the development of these outcomes post-operatively. Telephone surveys about sexual habits and dysfunctions before and after intervention were conducted post-operatively to patients that underwent circumcision in Centro Hospitalar Vila Nova de Gaia/Espinho during 2011. McNemar test was used for a matched-pairs analysis of pre- and post-operative data. Odds ratios, adjusted in a multivariate analysis, explored predictors of de novo sexual dysfunctions after circumcision. With intervention, there was an increase in frequency of erectile dysfunction (9.7% versus 25.8%, P = 0.002) and delayed orgasm (11.3% versus 48.4%, P < 0.001), and a significant symptomatic improvement in patients with pain with intercourse (50.0% versus 6.5%, P < 0.001). Significant predictors for de novo erectile dysfunction were diabetes mellitus (OR 9.81, P = 0.048) and lack of sexual desire (OR 8.76, P = 0.028). Less than three sex partners (OR 7.04, P = 0.007) and low sexual desire (OR 7.49, P = 0.029) were significant predictors for de novo delayed orgasm.

IntroductionThe development of new surgical techniques and medical devices, like therapeutical multimodal approaches has allowed for better outcomes on patients with rectal cancer (RCa). Owing to that, an increased awareness and investment towards better outcomes regarding patients’ sexual and urinary function has been recently observed.AimEvaluate and characterize the sexual dysfunction of patients submitted to surgical treatment for RCa.Materials and MethodsAn observational retrospective study including all male patients who underwent a surgical treatment for RCa between January 2011 December 2014 (n=43) was performed, complemented with an inquiry questionnaire to every patient about its sexual habits and level of function before and after surgery.DiscussionAll patients were male, with an average of 64yo. (range 42-83yo.). The surgical procedure was a rectum anterior resection (RAR) in 22 patients (56%) and an abdominoperineal resection (APR) in 19(44%). Sixty three percent described their sexual life as important/very important. Sexual function worsening was observed in 76% (65% with complains on erectile function, and 27% on ejaculation). Fourteen patients (38%) didn't resume sexual activity after surgery. Increased age (p=0.007), surgery performed (APR) (p=0.03) and the presence of a stoma (p=0.03) were predictors of ED after surgery. A secondary analysis found that the type of surgery (APR) (p=0.04), lower third tumor's location (p=0.03) and presence of comorbidities (p=0.013) (namely, smokers and diabetic patients) were predictors of de novo ED after surgery.ConclusionsThis study demonstrated the clear negative impact in sexual function of patients submitted to a surgical treatment for RCa. Since it is a valued feature for patients, it becomes essential to correctly evaluate/identify these cases in order to offer an adequate therapeutical option.

Testicular tuberculosis is rare, occurring in approximately 3% of patients with genital tuberculosis. It is often clinically indistinguishable from lesions such as testicular tumour and infarction and may even mimic testicular torsion. Men aged 20-50 years old are most commonly affected and often present with painful or painless enlargement of the scrotum. Ultrasound (US) is currently the best technique for imaging the scrotum and its contents and for diagnosing testicular lesions. We present the case of a 58 year-old male, followed in pneumology for pulmonary tuberculosis, who complained of pain and right scrotum enlargement in the second month of anti-tuberculosis chemotherapy. First assessment, seconded by US, suggested a neoplasic lesion, and the final diagnosis revealed testicular tuberculosis.

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Prostate adenocarcinoma (PAC) is the second most common malignant tumor in men, and it is usually diagnosed because of its symptoms and/or because of an increase in the value of the prostate-specific antigen (PSA) in asymptomatic patients. The lymph nodes and the bones are the most common sites in which metastases occur, while the brain is a rare site, with metastases occurring in < 2% of the cases, and usually only after the aforementioned sites have been affected. Considering the brain as the only site where a metastasis can occur, the incidence is of 0.15%. We present the case of a 63-year-old male diagnosed with PAC, with a Gleason score of 7 (3þ4), who underwent radiotherapy and anti-hormonal therapy in 2012. After biochemical recurrence early in 2015 (PSA: 8 ng/mL), he was re-staged, and the bone and node metastases were excluded. The patient then resumed the hormone therapy with bicalutamide. He was admitted in August 2015 to the emergency department of our institution with headache and behavioral changes. The imaging study revealed a single right temporo-parieto-occipital lesion, which was then resected. The histological analysis confirmed it to be a PAC brain metastasis. The patient went through a cycle of brain radiotherapy, and evolved favorably after one year of follow-up. ResumoO adenocarcinoma da próstata (ACP) é a segunda neoplasia maligna mais comum em homens, sendo habitualmente diagnosticada por meio de seus sintomas e/ou pelo aumento do valor do antígeno prostático específico (APE) em doentes assintomáticos. As metastizações óssea e ganglionar são as mais frequentes, sendo o cérebro um local raro de disseminação desta neoplasia, ocorrendo em menos de 2% dos casos, e geralmente surgindo apenas após a disseminação nos locais previamente descritos. Considerando o cérebro como único local de metastização, a incidência é de 0,15%. Os