RESUMO
OBJECTIVE: To evaluate total testosterone (TT) kinetics and its predictors 6 months after the discontinuation of clomiphene citrate (CC) in patients with hypogonadism. MATERIALS AND METHODS: Consecutive patients with normal testicles and male hypogonadism defined by TT < 300 ng/dl in the presence of signs or symptoms according to the previous consensus were prospectively evaluated in a urologic outpatient clinic by TT levels at baseline (T0), after a daily dose of 50 mg CC for 40 days (T1), and after the washout period of 6 months of CC discontinuation (T2). RESULTS: Among 75 patients, mean age 56.8 years, testosterone at T1 > 300 ng/dl was achieved by 69 (92%), 450-600 ng/dl by 32 (42.6%), and > 600 ng/dl by 27 (36.0%). 18 subjects (24%) maintained asymptomatic and TT levels over 300 ng/dl at T2. Age negatively related to testosterone response and T1 response > 810 ng/dl predicts a median gain of 166.5 ng/dl at 6 months of CC discontinuation. CONCLUSIONS: CC is a compelling option to treat male hypogonadism, although a chronic treatment is needed in most patients. About one in every four patients respond to a CC short trial to "reboot" the physiology. Further understanding of TT kinetics in these patients in the long term is warranted.
Assuntos
Clomifeno , Hipogonadismo , Clomifeno/uso terapêutico , Humanos , Hipogonadismo/complicações , Hipogonadismo/tratamento farmacológico , Lactente , Cinética , Masculino , Pessoa de Meia-Idade , TestosteronaRESUMO
To assess total testosterone and prostatic-specific antigen (PSA) kinetics among diverse chemical castrations, advanced-stage prostate cancer patients were randomized into three groups of 20: Group 1, Leuprolide 3.75 mg; Group 2, Leuprolide 7.5 mg; and Group 3, Goserelin 3.6 mg. All groups were treated with monthly application of the respective drugs. The patients' levels of serum total testosterone and PSA were evaluated at two time periods: before the treatment and 3 months after the treatment. Spearman's rank correlation coefficient was utilized to verify the hypothesis of linear correlation between total testosterone and PSA levels. At the beginning the patients' age, stage, grade, PSA, and total testosterone were similar within the three groups, with median age 72, 70, and 70 years in Groups 1, 2, and 3, respectively. Three months after the treatment, patients who received Leuprolide 7.5 mg presented significantly lower median total testosterone levels compared with Goserelin 3.6 mg and Leuprolide 3.75 mg (9.5 ng/dL vs. 20.0 ng/dL vs. 30.0 ng/dL, respectively; p = .0072), while those who received Goserelin 3.6 mg presented significantly lower PSA levels compared with Leuprolide 7.5 mg and Leuprolide 3.75 mg (0.67 vs. 1.86 vs. 2.57, respectively; p = .0067). There was no linear correlation between total testosterone and PSA levels. Overall, regarding castration levels of total testosterone, 28.77% of patients did not obtain levels ≤50 ng/dL and 47.80% did not obtain levels ≤20 ng/dL. There was no correlation between total testosterone and PSA kinetics and no equivalence among different pharmacological castrations.
Assuntos
Antineoplásicos Hormonais/administração & dosagem , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/tratamento farmacológico , Testosterona/sangue , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Gosserrelina/administração & dosagem , Humanos , Leuprolida/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologiaRESUMO
Os autores descrevem a técnica e discutem os resultados da abordagem videolaparoscópica do cisto de vesícula seminal em três pacientes sintomáticos, dois adultos jovens e uma criança. O tempo médio de cirurgia foi de 100 minutos (variou de 90 a 120), o sangramento foi mínimo e a alta hospitalar ocorreu no primeiro ou segundo PO. Houve uma complicaçäo em um dos pacientes adultos - lesäo acidental da ampola do ducto deferente contralateral ao cisto. O tempo médio de seguimento dos três pacientes foi superior a seis meses. Todos ficaram clinicamente curados e seus respectivos exames ecográficos pós-operatórios demonstraram o desaparecimento dos cistos