ABSTRACT Purpose: Statins are one of the most prescribed classes of drugs worldwide to treat hypercholesterolemia and dyslipidemia. By lowering the level of cholesterol, the use of statin could cause a reduction in testosterone levels. The objective was to evaluate whether the continued use of statins in patients with hypercholesterolemia causes a deficiency in testosterone and other sex hormones. Materials and Methods: Systematic Review with Meta-analysis, performed in Embase, Medline and Cochrane databases, until May 2023; PROSPERO CRD42021270424protocol. Selection performed by two independent authors with subsequent conference in stages. Methodology based on PRISMA statement. There were selected comparative studies, prospective cohorts (CP), randomized clinical trials (RCT) and cross-sectional studies (CSS) with comparison of testosterone levels before and after statin administration and between groups. Bias analysis were evaluated with Cochrane Tool, The Newcastle-Ottawa Scale (NOS), and using the Assess the Quality of Cross-sectional studies (AXIS) tool. Results: There were found on MedLine, Embase and Cochrane, after selected comparative studies, 10CP and 6RCT and 6CSS for the meta-analysis. In the Forrest plot with 6CSS, a correlation between patients with continuous use of statins and a reduction in total testosterone was evidenced with a statistically significant reduction of 55.02ng/dL (95%CI=[39.40,70.64],I²=91%,p<0.00001). In the analysis with 5RCT, a reduction in the mean total testosterone in patients who started continuous statin use was evidenced, with a statistical significance of 13.12ng/dL (95%CI=[1.16,25.08],I²=0%,p=0.03). Furthermore, the analysis of all prospective studies with 15 articles showed a statistically significant reduction in the mean total testosterone of 9.11 ng/dL (95%CI=[0.16,18.06],I²=37%,p=0.04). A reduction in total testosterone has been shown in most studies and in its accumulated analysis after statin use. However, this decrease was not enough to reach levels below normal. Conclusion: Statins use causes a decrease in total testosterone, not enough to cause a drop below the normal range and also determines increase in FSH levels. No differences were found in LH, Estradiol, SHBG and Free Testosterone analysis. Purpose dyslipidemia cholesterol hormones Methods Metaanalysis, Metaanalysis Meta analysis, Meta-analysis databases 2023 CRD42021270424protocol CRDprotocol CRD protocol stages statement CP, CP , (CP) RCT (RCT crosssectional cross sectional CSS (CSS groups Tool NewcastleOttawa Newcastle Ottawa NOS, NOS (NOS) Crosssectional Cross AXIS (AXIS tool Results MedLine metaanalysis. metaanalysis meta meta-analysis 5502ngdL ngdL 55 02ng dL ng 95%CI=39.40,70.64,I²=91%,p<0.00001. 95CI39407064I²91p000001 CIIp 95%CI= 39.40,70.64 ,I²=91%,p<0.00001 . 95 CI 39 40 70 64 I² 91 p 0 00001 I (95%CI=[39.40,70.64],I²=91%,p<0.00001) 5RCT 1312ngdL 13 12ng 95%CI=1.16,25.08,I²=0%,p=0.03. 95CI1162508I²0p003 1.16,25.08 ,I²=0%,p=0.03 1 16 25 08 03 (95%CI=[1.16,25.08],I²=0%,p=0.03) Furthermore 911 9 11 9.1 95%CI=0.16,18.06,I²=37%,p=0.04. 95CI0161806I²37p004 0.16,18.06 ,I²=37%,p=0.04 18 06 37 04 (95%CI=[0.16,18.06],I²=37%,p=0.04) However Conclusion LH Estradiol 202 (CP (NOS 5 95%CI=39.40,70.64,I²=91%,p<0.00001 95CI39407064I²91p00000 95CI 95%CI 39407064 39.40,70.6 I²91p000001 Ip ,I²=91%,p<0.0000 3 4 7 6 0000 (95%CI=[39.40,70.64],I²=91%,p<0.00001 95%CI=1.16,25.08,I²=0%,p=0.03 95CI1162508I²0p00 1162508 1.16,25.0 I²0p003 ,I²=0%,p=0.0 2 (95%CI=[1.16,25.08],I²=0%,p=0.03 9. 95%CI=0.16,18.06,I²=37%,p=0.04 95CI0161806I²37p00 0161806 0.16,18.0 I²37p004 ,I²=37%,p=0.0 (95%CI=[0.16,18.06],I²=37%,p=0.04 20 95%CI=39.40,70.64,I²=91%,p<0.0000 95CI39407064I²91p0000 3940706 39.40,70. I²91p00000 ,I²=91%,p<0.000 000 (95%CI=[39.40,70.64],I²=91%,p<0.0000 95%CI=1.16,25.08,I²=0%,p=0.0 95CI1162508I²0p0 116250 1.16,25. I²0p00 ,I²=0%,p=0. (95%CI=[1.16,25.08],I²=0%,p=0.0 95%CI=0.16,18.06,I²=37%,p=0.0 95CI0161806I²37p0 016180 0.16,18. I²37p00 ,I²=37%,p=0. (95%CI=[0.16,18.06],I²=37%,p=0.0 95%CI=39.40,70.64,I²=91%,p<0.000 95CI39407064I²91p000 394070 39.40,70 I²91p0000 ,I²=91%,p<0.00 00 (95%CI=[39.40,70.64],I²=91%,p<0.000 95%CI=1.16,25.08,I²=0%,p=0. 95CI1162508I²0p 11625 1.16,25 I²0p0 ,I²=0%,p=0 (95%CI=[1.16,25.08],I²=0%,p=0. 95%CI=0.16,18.06,I²=37%,p=0. 95CI0161806I²37p 01618 0.16,18 I²37p0 ,I²=37%,p=0 (95%CI=[0.16,18.06],I²=37%,p=0. 95%CI=39.40,70.64,I²=91%,p<0.00 95CI39407064I²91p00 39407 39.40,7 I²91p000 ,I²=91%,p<0.0 (95%CI=[39.40,70.64],I²=91%,p<0.00 95%CI=1.16,25.08,I²=0%,p=0 1162 1.16,2 I²0p ,I²=0%,p= (95%CI=[1.16,25.08],I²=0%,p=0 95%CI=0.16,18.06,I²=37%,p=0 0161 0.16,1 I²37p ,I²=37%,p= (95%CI=[0.16,18.06],I²=37%,p=0 95%CI=39.40,70.64,I²=91%,p<0.0 95CI39407064I²91p0 3940 39.40, I²91p00 ,I²=91%,p<0. (95%CI=[39.40,70.64],I²=91%,p<0.0 95%CI=1.16,25.08,I²=0%,p= 116 1.16, ,I²=0%,p (95%CI=[1.16,25.08],I²=0%,p= 95%CI=0.16,18.06,I²=37%,p= 016 0.16, ,I²=37%,p (95%CI=[0.16,18.06],I²=37%,p= 95%CI=39.40,70.64,I²=91%,p<0. 95CI39407064I²91p 394 39.40 I²91p0 ,I²=91%,p<0 (95%CI=[39.40,70.64],I²=91%,p<0. 95%CI=1.16,25.08,I²=0%,p 1.16 (95%CI=[1.16,25.08],I²=0%,p 95%CI=0.16,18.06,I²=37%,p 01 0.16 (95%CI=[0.16,18.06],I²=37%,p 95%CI=39.40,70.64,I²=91%,p<0 39.4 I²91p ,I²=91%,p< (95%CI=[39.40,70.64],I²=91%,p<0 1.1 0.1 95%CI=39.40,70.64,I²=91%,p< 39. ,I²=91%,p (95%CI=[39.40,70.64],I²=91%,p< 1. 0. 95%CI=39.40,70.64,I²=91%,p (95%CI=[39.40,70.64],I²=91%,p

SUMMARY OBJECTIVE: The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. METHODS: This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS: There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. CONCLUSION: Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects. OBJECTIVE gel pills rates METHODS prospective 8 protocol 4 mgday mg 3 45 5 4. group. . th ultrasounds visit p005 p 0 05 p<0.0 Students Student s ttest t chisquare chi square Fishers Fisher RESULTS p>0.05 (p>0.05 rate administration CONCLUSION p00 p<0. p>0.0 (p>0.0 p0 p<0 p>0. (p>0. p< p>0 (p>0 p> (p> (p

ABSTRACT Objective To report the effects of a tunica vagina flap on testicular compartment syndrome. Methods This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. Results Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. Conclusion The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma. syndrome singlearm single arm 202 2021 2 included excluded opened P1 P , (P1) P2 (P2) P3. P3 . (P3) P4. P4 (P4) Pc. (Pc) followup follow up months followup. up. range (range 1 919. 919 9 19 (9-19) 43 60 23 20 14mmHg mmHg respectively 663 66 3 66.3 889 88 88.9% observed Furthermore preservation parenchyma (P1 (P2 (P3 (P4 (Pc 91 (9-19 4 66. 8 88.9 (P (9-1 88. (9- (9 (

ABSTRACT Objective To evaluate the time interval and possible delay in transportation to referral units for the treatment of testicular torsion. Methods We retrospectively analyzed all cases of spermatic cord torsion surgically treated at a university hospital between January 2018 to December 2021. We evaluated the time intervals, including pain onset until the first presentation (D1), interhospital transference time (D2), pain onset until urological evaluation in a tertiary service (D3), urological evaluation until surgery (D4), and time from pain onset to surgical treatment (D5). We analyzed demographic and surgical data, orchiectomy rates, and time intervals (D1–D5). Torsions presented to the first medical presentation within 6h were considered early for testicular preservation. Results Of the 116 medical records evaluated, 87 had complete data for the time interval analysis (D1 to D5) and were considered the total sample. Thirty-three had D1 ≤6h, 53 had D1 ≤24h (includes patients in the D1 ≤6h subgroup), and 34 had D1 >24h. The median time intervals of the total samples and subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were D1 = 16h 42min, 2h 43min, 4h 14min and 72h, D2 = 4h 41min, 3h 39min, 3h 44min and 9h 59min; D3 = 24h, 6h 40min, 7h and 96h; D4 = 2h 20min, 1h 43min, 1h 52min and 3h 44min; D5 = 24h 42min, 8h 03min, 9h 26min and 99h 10min, respectively. Orchiectomy rates of the total sample, subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were 56.32%, 24.24% (p<0.01), 32.08% (p<0.01), and 91.18% (p<0.01), respectively. Conclusion Late arrival at the emergency department or a long interhospital transference time determined a large number of patients who underwent orchiectomy. Thus, public health measures and preventive strategies can be developed based on the data from this study aiming to reduce this avoidable outcome. 201 2021 D1, D , (D1) D2, (D2) D3, (D3) D4, (D4) D5. . (D5) D1–D5. D1D5 DD D1–D5 (D1–D5) h preservation 11 8 (D sample Thirtythree Thirty three 5 includes subgroup, subgroup subgroup) 3 42min min 43min 72h 41min 39min 59min 40min 96h 20min 03min 10min respectively 5632 56 32 56.32% 2424 24 24.24 p<0.01, p001 p p<0.01 0 01 (p<0.01) 3208 08 32.08 9118 91 18 91.18 Thus outcome 20 202 (D2 (D3 (D4 (D5 D1D D1–D (D1–D5 1 563 56.32 242 2 24.2 p00 p<0.0 (p<0.01 320 32.0 911 9 91.1 (D1–D 56.3 24. p0 p<0. (p<0.0 32. 91. 56. p<0 (p<0. p< (p<0 (p< (p

Abstract Objective: To determine the association between the presence of genetic disease in the offspring and the paternal age. Methods: We carried out a systematic review in: Medline (Ovid), EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), from encompassing the full catalogue up until October 2022. We included RCTs, Cohort, case-control and cross-sectional studies. Every study was evaluated according to eligibility criteria. Meta-analysis was not possible given the clinical and methodological heterogeneity. Results: We identified 502 studies through the database search. Forty-five studies were selected for data collection and were included in the qualitative analysis. In this systematic review we did not find associations with anomalies such as Trisomy 18, Obsessive Compulsive Disorder, Tourette syndrome, schizoaffective disorder, adverse perinatal outcomes, hematologic disturbances, microcephaly, hydrocephalus, gastrointestinal disturbances, cleft lip with or without cleft palate, cleft palate, and genitourinary disturbances. In contrast, we found a tendency of association between older fathers and psychiatric disorders (schizophrenia, autism, bipolar disorder syndrome, intellectual disability), nervous system cancer and overall musculoskeletal congenital anomalies. Conclusion: There is a tendency of association among the advanced paternal age and an increased number of birth defects regarding some specific conditions.

Resumen Objetivo: Determinar la asociación entre la presencia de enfermedad genética en la descendencia y la edad paterna. Métodos: Realizamos una revisión sistemática en: Medline (Ovid), EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), desde el inicio hasta octubre de 2022. Incluimos ECA, estudios de cohortes, de casos y controles y transversales. Cada estudio fue evaluado de acuerdo con los criterios de elegibilidad. El metaanálisis no fue posible dada la heterogeneidad clínica y metodológica. Resultados: Identificamos 502 estudios a través de la búsqueda en la base de datos. Se seleccionaron cuarenta y cinco estudios para la recopilación de datos y se incluyeron en el análisis cualitativo. En esta revisión sistemática no encontramos asociaciones con anomalías como trisomía 18, trastorno obsesivo compulsivo, síndrome de Tourette, trastorno esquizoafectivo, resultados perinatales adversos, alteraciones hematológicas, microcefalia, hidrocefalia, alteraciones gastrointestinales, labio hendido con o sin paladar hendido, paladar hendido y trastornos genitourinarios. Por el contrario, encontramos una tendencia de asociación entre padres mayores y trastornos psiquiátricos (esquizofrenia, autismo, síndrome de trastorno bipolar, discapacidad intelectual), cáncer del sistema nervioso y anomalías congénitas musculoesqueléticas en general. Conclusión: Existe una tendencia de asociación entre la edad paterna avanzada y un mayor número de malformaciones congénitas respecto a algunas condiciones específicas.

ABSTRACT Purpose: A systematic review of the literature with available published literature to compare ileal conduit (IC) and cutaneous ureterostomy (CU) urinary diversions (UD) in terms of perioperative, functional, and oncological outcomes of high-risk elderly patients treated with radical cystectomy (RC). Protocol Registration: PROSPERO ID CRD42020168851. Materials and Methods: A systematic review, according to the PRISMA Statement, was performed. Search through the Medline, Embase, Scopus, Scielo, Lilacs, and Cochrane Database until July 2020. Results: The literature search yielded 2,883 citations and were selected eight studies, including 1096 patients. A total of 707 patients underwent IC and 389 CU. Surgical procedures and outcomes, complications, mortality, and quality of life were analyzed. Conclusions: CU seems to be a safe alternative for the elderly and more frail patients. It is associated with faster surgery, less blood loss, lower transfusion rates, a lower necessity of intensive care, and shorter hospital stay. According to most studies, complications are less frequent after CU, even though mortality rates are similar. Studies with long-term follow up are awaited.

ABSTRACT Introduction: It has been more than a year since the first case of Covid-19 was diagnosed in Brazil, and its most problematic feature is the oversaturation of the healthcare system capacity. Urolithiasis is a disease that requires timely and appropriate management. The present study aimed to evaluate the impact of the pandemic in hospital admissions for urolithiasis in the Brazilian public healthcare system. Materials and Methods: In this cross-sectional study, hospital admissions were obtained from the Brazilian Public Health Information system. All hospital admissions associated with urolithiasis diagnosis (ICD-10 N20) between March 2017 and February 2021 were analyzed. Results: During the COVID-19 outbreak, there was a significant decrease in hospital admissions (p<0.0001). More than 20.000 patients probably did not have the opportunity to undergo their surgeries. The impact of the COVID-19 outbreak on women's admissions was significantly more intense than for men, reducing from 48.91% to 48.36% of the total (p=0.0281). The extremes of age seemed to be more affected, with patients younger than 20 years and older than 60 years having a significant reduction in access to hospital services (p=0.033). Conclusions: In conclusion, we have noticed a considerable reduction in overall admissions for the treatment of urolithiasis in the Brazilian public healthcare system during the first year of the Covid-19 pandemic. Women and individuals older than 60 years were especially affected. In contrast, we noted a rise in urgent procedures, comparing with the average of the corresponding period of the three previous years. Recovery plans will be needed while returning to activities to handle the impounded surgical volume.

ABSTRACT Objective To understand the feasibility of FGFR3 tests in the Brazilian public health context, and to sample the mutational burden of this receptor in high-grade muscle invasive bladder cancer. Methods A total of 31 patients with high-grade muscle-invasive bladder cancer were included in the present study. Either transurethral resection of bladder tumor or radical cystectomy specimens were analyzed. Formalin-fixed paraffin-embedded tissue blocks were sectioned, hematoxylin and eosin stained, and histologic sections were reviewed. Total RNA was extracted using the RNeasy DSP formalin-fixed paraffin-embedded kit. Qualitative results were displayed in Rotor-Gene AssayManager software. Results Six patients were excluded. From the samples analyzed, four (16.7%) were considered inadequate and could not have their RNA extracted. Two patients presented FGFR3 mutations, accounting for 9.5% of material available for adequate analysis. The two mutations detected included a Y373C mutation in a male patient and a S249C mutation in a female patient. Conclusion FGFR3 mutations could be analyzed in 84% of our cohort and occurred in 9.5% of patients with high-grade muscle invasive bladder cancer in this Brazilian population. FGFR3 gene mutations are targets for therapeutic drugs in muscle-invasive bladder cancer. For this reason, know the frequency of these mutations can have a significant impact on public health policies and costs provisioning.

RESUMO Objetivo: Avaliar o conhecimento da população da cidade de São Paulo em relação ao câncer de próstata. Métodos: Foram entrevistados randomicamente 392 adultos em espaços públicos da cidade de São Paulo, os quais responderam a um questionário que abordava questões demográficas e de conhecimentos específicos sobre o câncer de próstata. Um escore foi utilizado para avaliar o conhecimento de câncer em geral e do câncer de próstata, considerando um conhecimento satisfatório com escore de 6 pontos. Resultados: A média de idade foi de 36,9 anos (desvio-padrão de ±12,6), e 58,2% dos participantes eram do sexo masculino. Ausência de contato anterior com informações relacionadas ao câncer de próstata foi relatada por 45,5% dos participantes. Nesses casos, maior proporção foi observada entre os homens com mais de 50 anos. Quanto ao escore, a média foi 3,7 (desvio-padrão de ±1,3), com correlação positiva entre maiores escores e maiores renda e escolaridade. Menos de 5% dos participantes acreditavam que só deveriam procurar o rastreamento do câncer de próstata quando sintomáticos. Por fim, entre as respostas menos frequentes aos fatores de risco para câncer de próstata, encontrou-se “etnia” (2,8%). Conclusão: Embora a maioria dos participantes não tenha apresentado escore satisfatório, o nível de conhecimento revelado neste estudo parece superior ao de outros estudos populacionais. Assim, sugere-se que a população avaliada tenha compreendido alguns conceitos essenciais do câncer de próstata, como a importância do rastreamento e do acompanhamento. Os esforços da Sociedade Brasileira de Urologia nas campanhas educacionais explicam parcialmente isso. No entanto, trabalhar em alguns conceitos, como identificar fatores de risco para câncer de próstata, pode otimizar os resultados do rastreamento.

ABSTRACT Objective: To evaluate awareness of prostate cancer in the population of the city of São Paulo. Methods: A total of 392 adults were randomly interviewed on public spaces in the city of São Paulo, and answered a questionnaire that addressed demographic questions and specific knowledge about the prostate cancer. A score was used to assess awareness of cancer in general, and of prostate cancer, considering satisfactory knowledge a score of 6 points. Results: The mean age was 36.9 years (standard deviation of ±12.6) and 58.2% of participants were male. No previous contact with information related to prostate cancer was reported by 45.5% of participants. For these cases, a greater proportion was observed among men aged over 50 years. As to the score, the mean was 3.7 (standard deviation of ±1.3), with a positive correlation among higher scores, higher income and education level. Less than 5% of participants believed they should only search for prostate cancer screening when symptomatic. Finally, among the less frequent responses to risk factors for prostate cancer, is “ethnic origin” (2.8%). Conclusion: Even though most participants did not have a satisfactory score, the level of awareness demonstrated in this study seems superior to that of other populational series. Hence it suggested the assessed population understood some essential concepts in prostate cancer, such as the importance of screening and the follow-up. The efforts made by the Sociedade Brasileira de Urologia on educational campaigns partially explain this. However, working in some concepts, like identifying risk factors for prostate cancer, might optimize screening outcomes.

RESUMO Objetivo: Analisar a associação entre mudanças climáticas nas macrorregiões do estado de São Paulo e os casos tratados com torção testicular registrados. Métodos: Os casos foram selecionados no Banco de Dados do Sistema de Dados de Saúde Pública do Brasil de janeiro de 2008 a novembro de 2016. Todos os registros de procedimentos cirúrgicos foram identificados pelo documento de Autorização de Internação Hospitalar. Dois códigos foram selecionados para processar a busca: torção testicular (código de cura cirúrgica) e escroto agudo (código de escrototomia exploratória). As macrorregiões foram agrupadas em cinco áreas ligadas às características climáticas pela Classificação Internacional de Clima Köppen. Resultados: Foram registrados 2.351 casos de torção testicular no período. Para as áreas B, C e E (torção testicular n=2.130), foram encontradas diferenças estatísticas na associação dos casos de torção testicular e diminuição da temperatura (p=0,019, p=0,001 e p=0,006, respectivamente), mas nas análises das áreas A e D não foram observadas diferenças estatísticas (p=0,066 e p=0,494). Conclusão: A diminuição da temperatura foi associada à torção testicular em três macrorregiões de São Paulo. Os resultados apoiam a teoria do clima frio como um gatilho para ocorrência de torção testicular em uma região de clima tropical.

ABSTRACT Objective: To analyze the association between climate changes in the macroregions in the state of São Paulo and testicular torsion treated cases. Methods: The cases were selected in the Brazilian Public Health Data System Database from January 2008 to November 2016. All surgical procedure records were identified by the Hospital Admission Authorization document. Two codes were selected to process the search: testicular torsion (surgical cure code) and acute scrotum (exploratory scrototomy code). The macroregions were grouped in five areas linked to climate characteristics by International Köppen Climate Classification. Results: A total of 2,351 cases of testicular torsion were registered in the period. For the areas B, C and E (testicular torsion n=2,130) there were statistical differences found in association of testicular torsion cases and decreased temperature (p=0.019, p=0.001 and p=0.006, respectively), however, in analyses for the areas A and D statistical differences were not observed (p=0.066 and p=0.494). Conclusion: Decrease in temperature was associated with testicular torsion in three macroregions of São Paulo. The findings support the theory of cold weather like a trigger in occurrence of testicular torsion in a tropical climate region.

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)