Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study - GESCAP group. / Diagnóstico y tratamiento del cáncer de prostata clínicamente localizado. Adherencia a las guías clínicas en un estudio poblacional nacional ­ GESCAP.

OBJECTIVE: To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain. PATIENTS AND METHODS: Epidemiological, population-based, study including a national representative sample of 3,918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa -low, intermediate, high and locally-advanced by D'Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal-Wallis tests. RESULTS: Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8-12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA<10ng/mL were biopsied. Staging by Computer Tomography (CT) or Bone Scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients' age; 3,293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1,277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1,082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥75Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n=521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT. CONCLUSIONS: Although EAU guidelines for PCa management are easily available in Europe, the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice. (Controlled-trials.com: ISRCTN19893319).

Involvement of HLA class I molecules in the immune escape of urologic tumors.

CONTEXT AND OBJECTIVE: To analyze the influence of different alterations in human leukocyte antigen class I molecules (HLA I) in renal cell carcinoma, as well as in bladder and prostate cancer. We also study the correlation between HLA I expression and the progression of the disease and the response after immunotherapy protocols. EVIDENCES ACQUISITION: It has been shown, experimentally, that the immune system can recognize and kill neoplastic cells. By analyzing the expression of HLA I molecules on the surface of cancer cells, we were able to study the tumor escape mechanisms against the immune system. EVIDENCES SYNTHESIS: Alteration or irreversible damage in HLA I molecules is used by the neoplastic cells to escape the immune system. The function of these molecules is to recognize endogenous peptides and present them to T cells of the immune system. There is a clear relationship between HLA I reversible alterations and success of therapy. Irreversible lesions also imply a lack of response to treatment. The immune system activation can reverse HLA I molecules expression in tumors with reversible lesions, whereas tumors with irreversible ones do not respond to such activation. Determine the type of altered HLA I molecules in tumors is of paramount importance when choosing the type of treatment to keep looking for therapeutic success. Those tumors with reversible lesions can be treated with traditional immunotherapy; however, tumour with irreversible alterations should follow alternative protocols, such as the use of viral vectors carrying the HLA genes to achieve damaged re-expression of the protein. CONCLUSION: From studies in urologic tumors, we can conclude that the HLA I molecules play a key role in these tumors escape to the immune system.

[Prognostic value of E-cadherina, beta catenin, Ki-67 antigen and p53 protein in the superficial bladder tumors]. / Cadherina E, catenina beta, antígeno Ki-67 y proteína p53 en el pronóstico de la recidiva tumoral en los tumores superficiales de vejiga T1.

INTRODUCTION: The natural history of the superficial carcinoma of bladder is characterized by his high rate of recurrence and by the aptitude to progress to higher stages. We are going to investigate the capacity of prediction for tumor recurrence of protein p53, antigen Ki-67, E Cadherin and Beta Catenin MATERIAL AND METHOD: 88 T1 tumors with a median of free time of disease of 36 months. 58% of the serie has received prophylactic treatment with BCG 81 mg. weekly for six weeks. Cut-oof level for For P53 and Ki-67 is 10 % of stained cells. For E Cadherin and Beta Catenin we have established two groups: one with the values 0-4 (negative), and other one with the values 5-8 (positive). RESULTS: Recurrence rate 31%, stage progression 3%. Ki-67 expression is correlated with grade (p .002) and lymphatic permeation (p .028). Multiplicity is correlated with lack( of Cadherin and Catenin's expression. Only Ki-67 expression (p .049) and lack of Beta Catenin expression (p .039) reach statistical significance. In multivariant study only lack of Beta Catenin's expression shows independent recurrence value (p .049; O.R: 2,4-6,9) CONCLUSIONS: The most useful prognmostic markers are Ki-67 and Catenina Beta Only Beta Catenin Beta shows independent value for tumour recurrence. Tumors wich lack expression for Catenin B or Cadherin E have lower recurrence free time.

Evaluation of the transurethral ethanol ablation of the prostate (TEAP) for symptomatic benign prostatic hyperplasia (BPH): a European multi-center evaluation.

OBJECTIVE: We prospectively conducted a European multi-center study to assess the safety and efficacy of injecting dehydrated ethanol using a specialized injection system for the treatment of BPH. METHODS: Patients with symptomatic BPH were enrolled and evaluated to undergo transurethral ethanol ablation of the prostate for their BPH condition. Procedures were performed using the ProstaJect device. Treatment dosages were based on prostate volume, prostatic urethral length and median lobe involvement. Follow-up evaluations were done at four days and one, three, six and 12 months. RESULTS: One-hundred fifteen symptomatic patients underwent the transurethral ethanol ablation procedure and ninety-four patients have been followed and evaluated for the entire 12-month post-treatment period. The average prostate volume was 45.9 g, and average ethanol injected was 14 ml. Post-operatively, 98% of patients voided spontaneously four days following treatment. Significant reduction in reported lower urinary tract symptoms was evidenced at the one-month follow-up visit and maintained through 12 months follow-up, with International Prostate Symptom (IPSS) and Quality of Life (QoL) scores decreased by more than 50%. Peak flow rates (Q(max)) improved by 35% by the three-month evaluation and these results were sustained through to 12-months follow-up. The average prostate volume reduction was 16%. Adverse events included discomfort or irritative voiding symptoms in 26% of patients, hematuria in 16%, with retrograde ejaculation, and erectile dysfunction reported in less than 3% of patients. The majority of these events required no intervention. Two patients experienced serious adverse events (bladder necrosis) and underwent open surgery that included a urinary diversion and a ureteral implantataion. During the one year follow- up, 7% of patients required a trans-urethral resection of prostate (TURP). CONCLUSIONS: This preliminary multi-center data, representing the largest reported cohort to date, suggests that TEAP may be considered an effective minimally invasive treatment option for lower urinary tract symptoms secondary to BPH. Analyses of safety lead to a procedure modification for needle placement more distal from the bladder neck. Objective reduction in symptoms was not correlated in prostate volume reduction suggesting a non-purely mechanical effect.

Energy evaluation of forest residues originated from shrub species in Galicia.

In this study we present an alternative for the management of the excess of shrub species that nowadays take up around 800000 ha in Galicia (NW Spain). This alternative is based on the exploitation of the energetic resources contained in the excess of shrubs by their combustion in specially designed plants for production of electric energy. The different species were sorted into three groups: Ulex europaeus L. (furze), Sarothamnus scoparius (L.) Link (broom) and Erica sp. (heaths). Their LHV were calculated through measurements of the corresponding HHV and resulted 7600, 7300 and 7200 kJ kg(-1) respectively. Biomass productions (T ha(-1)) were also calculated resulting 20 T ha(-1) (furze), 30 T ha(-1) (broom), and 15 T ha(-1) (heaths). Analyses of all these values make these species very valuable for their energy exploitation. Samples were collected over one year in different zones to study the effect of the environmental conditions on the calorific values.

Energy evaluation of forest residues originated from Eucalyptus globulus Labill in Galicia.

The possibility of retrieving the energy contained in forest residues originating from wood exploitation in Galicia (Spain) is evaluated. This study was made on Eucalyptus globulus Labill occupying a forest surface of 240000 ha. This species plays an important role in the economical development of Galicia, as it is the main forest species for production of pulp. Sampling was made over 1999 in seven different zones, three main stations plus four selected for comparison, situated in Galicia. The residues originating from cutting were sorted into three different groups and their calorific values were measured by static bomb calorimetry. These calorific values, close to 7200 kJ kg(-1), make possible the use of this residual biomass as an energy source. Calorific values were measured by static bomb calorimeter in an oxygen atmosphere. Flammability was determined using a standard epiradiator. Simultaneously, some other parameters, elementary chemical composition, heavy metal contents, moisture, density, ash percentage after combustion in the bomb, and main bioclimatic characteristics, were also determined.

Integration in Spain: national and regional perspectives.

At the present moment Spanish psychopedagogical researchers are evaluating the effectiveness and consequences of integration on both a national and a regional level. As a result of two important pieces of legislation, physically and mentally handicapped people are gradually becoming more integrated in education, social life, and the work place. Consequently, both ordinary pupils and those with permanent or temporary special education needs can achieve the same objectives within the same system. Individual strategies are designed to cope with each pupil's specific needs, and each case is followed closely by a multidisciplinary team. The basic concept behind integration in Spain is a global relationship with the educational environment, which includes school, home, vocational training and ultimately work. It is not so much a case of identifying what a pupil is, but rather deciding what education can do for that particular pupil. There are, however, certain difficulties which require adaptation of the curriculum: access to educational opportunities and experiences may be affected by deficient visual, auditory or motor skills; there may be an absence of specific learning skills in certain areas of the curriculum; pupils with serious mental handicaps may lack basic cognitive skills. Spanish educational reform considers the classroom teacher as the central axis in the quality of education. For this reason, new programmes and diplomas in infant and primary teacher education include training for adaptation and integration.

[Mature cystic teratoma of the testis]. / Teratoma quístico maduro del testículo.

Case report of a mature testicular cystic teratoma in a 25 year-old patient. Emphasis is placed on the rarity and benign nature of the lesion, its therapeutical approach and good prognosis, as compared to other mature, potentially aggressive testicular teratomas where the therapeutical and follow-up strategies are different.

[Ultrasonographic (intra- and extraluminal) pattern of cervico-urethral anastomosis after radical prostatectomy]. / Patrón sonográfico (intra y extraluminal) de la anastomosis cérvico-uretral tras la prostatectomía radical.

Thirteen patients, mean age 61 years (range 54 to 71), diagnosed with prostate adenocarcinoma underwent radical prostatectomy. To achieve a diagnosis they were all performed blood PSA determination, digital rectal examination, transrectal ultrasound and a prostate ultrasound-guided biopsy by automatic gun puncture. Serum PSA quantification, digital rectal examination and transrectal ultrasound were repeated in the immediate post-operative, and three and six months after surgery. Through the information obtained with endocavitary ultrasound, the lumen of the cervicourethral anastomosis and the perianastomotic tissue was assessed. Transrectal ultrasound plays a relevant role in the follow-up of patients undergoing radical prostatectomy. When a patient with prostate radical surgery shows an elevation of serum PSA and/or abnormal digital rectal examination, an ultrasound-guided biopsy (at the node or perianastomotic area) is indicated.

[Ureterosigmoidostomy detubularized with surgical staplers: C.F.C. (Original technique)]. / Ureterosigmoidostomía destubulizada mediante súturas mecánicas: C.F.C. (Técnica original).

Description of our modification of the detubulized ureterosigmoidostomy surgical technique (Castiñeiras-Ferragut-Camacho). In an attempt to shorten the surgery time, we used for these changes absorbable mechanical sutures (Poli Gia and T.A.). This paper analyzes the technical details of interest as well as the anatomicosurgical considerations that should be known prior to carry out this type of by-pass. The anatomicophysiological principles on which our developments are based are those referred by N.G. Kock15 and used by R. Hohenfellner and R. Fisch14, when they described the detubulized ureterosigmoidostomy performed manually. We believe that both surgical procedures, R. Hohenfellner & R. Fisch14 and ours (detubulized ureterosigmoidostomy, C.F.C.), are suitable alternatives to conventional ureterosigmoidostomy.

[Complications of ultrasound-guided transperineal puncture biopsy of the prostate]. / Análisis de las complicaciones de la punción-biópsica transperineal ecodirigida de próstata (P.B.T.E.P.).

Between June 1988 and February 1993, 520 ultrasound-guided transperitoneal prostate biopsy punctures were performed in patients with prostate disease. Of these, 89 (17.1 %) were positive for malignancy. An analysis is made of the highly uncommon complications observed, which corresponded to 17 cases of haematuria (3.26%) and 3 of fever (0.5%). Likewise, reference is made to perineal neoplastic implantation, since such complication was evident in one of the cases contributed (0.19%). Also, a review of the literature relative to the complications is made, concluding by stating the relevance of this diagnostic technique in spite of said complications.

[Acute myocardial infarct and Friedreich's disease]. / Infarto agudo de miocardio y enfermedad de Friedreich.

The association between Friedreich's ataxia and heart disease is well known. Microvascular disease and spasm of coronary arteries have been reported. We report now a patient with the association between this disease and acute myocardial infarction, which raises the hypothesis that it may be related with the already known cardiac abnormalities in this disease.

[Clinical features, diagnosis, and treatment of tumor lesions arising in the adrenal gland]. / Clínica, diagnóstico y tratamiento de los procesos tumorales desarrollados en la glándula suprarrenal.

Between 1981 and 1993, 14 patients with tumoral adrenal disease were diagnosed and treated in the Urology Services of both Hospitals. Nature of the adrenal disease was functional in 8 patients (two carcinomas and six pheochromocytomas) and non-functional in the rest (three carcinomas, two adenomas and one myelolipoma). Reference is made to the clinical manifestations and laboratory tests related to hormonal activity, depending on whether the tumour is functional or non-functional, chromaffin or non-chromaffin. Patients with functional carcinomas had Cushing's syndrome, with very clear virtilization signs. Urine 17-hydroxycorticosteroid, 17-cetosteroides and cortisol were all increased, same as plasma cortisol. Patients with pheochromocytomas had hypertension and headaches (six patients), sweating (five patients), anxiety (four patients) and loss of weight (two patients). All of them had increased urine vainillylmandelic acid and catecholamines. Clinical signs and symptoms of non-functional tumours were related to bulk growth and size (in the three carcinomas), and sometimes was highly anodyne, or even absent (in the two adenomas and the myelolipoma), the cause of discovery being accidental during an ultrasound examination. An analysis is made of the different imaging diagnostic procedures performed, such as IVU (performed in 13 patients) with a 38.4% resolutory power; ultrasound (performed in 11 patients) with an 81.8% resolution; CAT (performed in 6 patients) with a 100% resolution capacity and arteriography (performed in 3 patients) with a 100% resolution power, although patients had previously undergone ultrasound and CAT.(ABSTRACT TRUNCATED AT 250 WORDS)

[Paratesticular neoplasms of mesenchymatous origin. Clinico-pathologic study]. / Neoplasias paratesticulares de origen mesenquimatoso. Estudio clínico-patológico.

There is a group of malignant intrascrotal tumours which represent a very small number when compared to testicular neoplasias and which are known as paratesticular neoplasias. More than 90% belong to the sarcomatous species. From a clinical point of view and based on the patient's age, two groups can be distinguished: sarcomas affecting children and adolescents (primarily rabdomiosarcomas) and those occurring in adulthood, the more frequent histopathological variants being fibrosarcoma, leiomiosarcoma and liposarcoma. This work contributes five paratesticular sarcomas (two rabdomiosarcomas, one liposarcoma, one leiomiosarcoma and one fibrosarcoma). The features related to histogenesis, diagnosis (revealing signs and clinical examination), natural history (dissemination routes based on histopathology) and treatment are reported. With regard to treatment, both the local surgery (total orchiectomy by inguinoscrotal approach with or without hemiscrotectomy), and indications for lymphadenectomy and radiotherapy in relation to staging are discussed though insisting on the chemotherapy approach.

[Retropubic radical prostatectomy. I. Denonvilliers' aponeurosis, prostatic "pseudocapsule" and the external striated urethral sphincter]. / La prostatectomía radical retropúbica. I. La aponeurosis de Denonvilliers, la "pseudocápsula" prostática y el esfínter uretral estriado externo.

The present paper reviews the histological characteristics of the prostatic "pseudocapsule", Denonvilliers' aponeurosis and the external striated urethral sphincter. This morphological study has been conducted on pieces of prostate obtained through necropsies. We believe that the knowledge of the morphological characteristics of these structures as well as their relationships is necessary in order to perform the technique of radical retropubic prostatectomy.

[Retropubic radical prostatectomy. II. Neuroanatomy of the pelvic plexus, impotence and urinary incontinence]. / La prostatectomía radical retropúbica. II-La neuroanatomía del plexo pélvico, la impotencia y la incontinencia urinaria.

The present paper reviews the course of the nerves that comprise the pelvic plexus and intervene in the mechanisms of sexual strength and urinary continence. By means of cross-sectional and sagittal incisions in prostates obtained through necropsies the neurovascular bundle, intimately related to the prostatic gland, is studied. Based on the information obtained in the study we raise a series of suggestions all related with the surgical technique of radical retropubic prostatectomy.