Heterochromatin polymorphism is considered a variant of a normal karyotype but is more frequent in infertile men. The aim of this study was to evaluate the correlation between heterochromatic variants and male infertility and to discuss the possible mechanisms of how heterochromatic polymorphism might affect spermatogenesis.Methods: Cytogenetic analysis was undertaken in a group of 392 infertile men from the Andrology Outpatient Clinic of the Human Reproduction Service of the ABC School of Medicine. Additionally, C-banding was performed in men with heterochromatin polymorphism, and NOR-banding in men with satellites variations.Results: 47 patients of the sample showed chromosomal variants (12% of the sample). Considering these men, 8 presented idiopathic infertility, where 19 presented severe oligozoospermia, 18 had non-obstructive azoospermia, 2 presented recurring pregnancy loss. The most frequent chromosome involved was chromosome 9, observed in 37.5% of the cases. Increased heterochromatin of chromosome 9 isolated was present in 8 men and pericentromeric inversion of chromosome 9 isolated was present in 7 men. Both aberrations were found in one man. Increased heterochromatin of chromosome 16 was found isolated in 6 cases and associated to other variation in 3 cases. For chromosome Y, variation in heterochromatin was found in 6 cases and associated to other variation in two cases and for chromosome 1, increased heterochromatin was found only associated to other variations. Satellites' variation of chromosome 14 was found isolated in one case and associated in other case, of chromosome 21 was found isolated in 3 cases and associated in one case and of chromosome 22 was found isolated in 2 cases and associated in one case. Twenty men presented beyond chromosomal variations factors that couldn't be discharged as cause of infertility as orchites and criptorchidia. Conclusions:The incidence of heterochromatin polymorphism was high in infertile men, as observed in the present work. This increased rate in infertile males seems to be more than an incidental finding, and must be considered an important factor contributing to male infertility.

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Introduction: Surgical training models prepare the resident for a more ethical surgical practice as well as providing a less steep learning curve. In urology, there are well-known models of pyeloplasty simulation, urethro-vesical anastomosis and nephrectomy, which have helped in the training of urology residents ( 1 – 3 ). Learning laparoscopic prostatectomy is a difficult surgery and requires advanced surgical skill from the surgeon ( 4 ), requires operate without a direct view of the surgical field in a two-dimensional space and with longer instruments ( 5 ). Laparoscopic prostatectomy step by step makes the surgeon's learning curve less difficult, lead to less intraoperative complications, such as blood loss, while also enabling shorter operative time and less positive surgical margins ( 6 ). The objective of surgical models is to simulate surgical procedures in a reliable way thus preparing the surgeon for his daily practice, surgical simulations in animal models have been described to compensate for inadequate clinical exposure ( 7 ). The canine model of prostate cancer has many similarities with humans. Despite trying to develop a model that is as credible as possible, there are ethical issues in several countries, such as Brazil, that do not allow the use of live dogs for scientific experimentation and there is a difficulty in not standardizing the animals used ( 8 , 9 ). The swine surgical training model is widely known, accepted and used as a valuable tool in the teaching of new surgeons ( 10 ). The porcine video laparoscopic prostatectomy model allows the urologist in training to exercise the skills required in a real surgical situation, practicing them in a single session ( 10 ). We will present an experimental model in pigs for training urology residents in laparoscopic radical prostatectomy with current techniques ( 11 – 13 ). The limitations found are that the prostate has no limits as well defined as in humans, the urethra is long and coiled, the fat surrounding the pelvic organs is scarce and there is no postoperative follow-up for evaluating functionality after the procedure, as well as the effectiveness of the surgery with surgical margins. However, it is similar in surgical model presented, it is reproducible and can provide a realistic simulation environment to the beginner surgeon. Material and Methods: In this paper, according to the institutional protocol approved by the institutional ethics and research committee FMUSP n° 964/2017 and protocol was in accordance with current international regulations for the use of animals in Re...

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INTRODUCTION AND OBJECTIVE: Patient reported outcome measures (PROM) in penile curvature surgery are poorly documented. Previous studies have developed questionnaires for use in alternative treatments (PDQ, IIEF) that do not account for subjective surgical outcomes. We have previously reported on a prospective study documenting the development of a PROM for use in penile curvature surgery. Here we report the final validation of the examined cohort.METHODS: All men being investigated for penile curvature surgery were eligible for assessment with the developed PROM. The developed PROM utilised a 4-domain structure with novel validated questions on penile appearance (PA), subjective pain and anxiety, erectile function and subjective overall bother. Non-validated questions were also included on general and sexual relationships. Cronbach's alpha was used to verify each domain reliably measured the same latent variable. Wilcoxon Signed Rank test was used to assess consistency between test and retest scores, and responsiveness to change between pre-and post-operative scores. Variability and bias were assessed using a Bland Altman plot.RESULTS: 202 men investigated for penile curvature surgery in a single centre were prospectively assessed using the developed PROM. Pre-operative PROM questionnaires were administered at first appointment and on day of surgery, with post-operative PROM administered at first follow up. All 202 men completed the baseline and retest pre-operative PROM, with 130 men to date completing the post-operative PROM. All questions had response rates >90%. Cronbach's alpha for Penile Appearance was 0.34 rising to 0.65 post operatively. Coefficients for pain subjectivity were 0.35. Cronbach's alpha coefficient for ED and bother scores were 0.87 and 0.77 respectively. Wilcoxon Signed Rank test for penile appearance and bother domains showed significant improvements post operatively (Penile appearance p[<0.00001, bother p[<0.00001) and pain preoperatively (p[0.0006) with pain scores post operatively unaffected (P[>0.06). Variability remained consistent for increasing PA scores.CONCLUSIONS: The developed PROM shows content validity, construct validity and reliability for penile appearance, subjective pain, erectile function and overall subjective bother of penile curvature, with robust responsiveness to treatment. The final validated PROM is an effective adjunct to assessment of patients with penile curvature both before and after treatment.

Introduction The evaluation of penile deformity in PD is a critical step in therapeutic decision making and is generally the main outcome in PD clinical trials. 3D reconstruction is becoming increasingly common in the medical field, with highly accurate and long term accessible images. To date, there is no widely accepted 3D documentation protocol for penile deformity. Objective To evaluate the feasibility of 3D imaging and its accuracy in quantifying penile deformity. Methods Video images captured intraoperatively during saline-induced rigid erection were acquired from 4 PD patients undergoing penile surgery. Penile curvature measurements were obtained by the surgeon with a goniometer. Video images were obtained with an iPhone 11 (Apple Inc, Cupertino, CA) camera in full HD or 4k resolution, traveling in a circular 360o motion around the penile shaft. Video images were analysed by a team with 3D expertise using the open source software Blender (Blender Foundation, Amsterdan, NE) and its addon OrtogonBlender, and 3D reconstructed images were created. The 3D team performed curvature measurements using the software tools. A non-concordance magnitude was defined as a measurement difference (between physician measurement and 3D image) of 20% or 10o, whichever was smaller. Results The 3D reconstruction was possible in all cases and all videos used took &lt;1 minute to be captured. Images of 4 patients, 3 with bi-planar curvature, were obtained and therefore 7 measurements were available for caparison. The 3D images quality was good and volume loss deformities were visible. Measurements generated from those reconstructed images showed excellent concordance (100%, N=7 - Table 1). An example of curvature measurement in a 3D model is presented in Figure 1. Conclusions In this pilot study, deformity analysis and measurement with tolerable error was performed using video images acquired quickly intraoperatively, with a smartphone. With further development, this strategy may contribute to a more objective follow up of complex PD cases, as those with biplanar curvature or volume loss deformities. Disclosure No

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