[Antimicrobial susceptibility of Escherichia coli isolated from bacteriurias in Bierzo health area during 2003]. / Sensibilidad microbiana de Escherichia coli en bacteriurias en el área sanitaria del Bierzo en el año 2003.

OBJECTIVE: Sensitivity to antibiotics of Escherichia coli isolated from intrahospital and extrahospital bacteriurias is analyzed. MATERIAL AND METHODS: Sensitivity to nineteen antibiotics used in the clinical practice was determined in strains of Escherichia coli isolated from intrahospital and extrahospital bacteriurias. RESULTS: The prevalence of in-vitro susceptibilities to antibiotics were (hospital, state health service clinic, health center-primary-care): imipenem (100%-100%-100%; p=NS), amikacin (100%-100%-99.7%; p=NS), fosfomicyn (98.6%-98.4%-99.6%; p=NS), cefepime (96%-96.9%-98.3%; p=NS), piperacillin-tazobactam (96%-95.3%-96.6%; p=NS), aztreonam (93.5%-94.7%-97.7%; p<0.001), ceftazidime (93.5%-94.3%-97.8%; p<0.001), cefotaxime (93.1%-95%-97.7%; p<0.001), cefixime (92.7%-94.6%-96.7%; p<0.05), nitrofurantoin (92%-94.7%-94.7%; p=NS), cefuroxime (88.4%-93.1%-95%; p<0.001), amoxicillin-clavulanic (87.7%-88.7%-93.8%; p<0.001), tobramicyn (87%-93.7%-93.8%; p<0.001), gentamcin (85.9%-92.8%-93%; p<0.001), cefazolin (84.4%-88.7%-91.6%; p<0.01), ciprofloxacin (63.8%-71.4%-78.4%; p<0.001), norfloxacin (63%-70.8%-78.2%; p<0.001), cotrimoxazole (65.2%-68.6%-74.9%; p<0.01) and ampicillin (35.5%-42.5%-47.8%; p<0.01). (*NS= No significant differences). CONCLUSIONS: The knowledge of the sensitivity of uropathogens to antimicrobians can allow us to initiate empirical therapy of urinary tract infections.

[Extracorporeal shock wave lithotripsy of urolithiasis in patients with urinary diversion]. / Litotricia extracorpórea en litiasis en pacientes con derivación urinaria.

We evaluate the efficacy of ESWL in the management of calculi in patients with urinary diversion. We treated 5 patients who suffered from urinary lithiasis after urinary diversion post cistectomy. We managed the patients with extracorporeal shock wave lithotripsy in monotherapy with a Siemens Lithostar Modularis device. Mean stone size (long axis) was 1.95 cm (range 1 to 3.5 cm). The mean shockwave number per session was 2.6 per patient. Stone free result was 100%. We conclude that ESWL technique can provide acceptable results in patients with urinary diversion and can be used as first choice treatment in these type of patients due to its minimal morbidity and excellent results, equivalent to those achieved in patients without urinary diversion.

[Microbial sensitivity of Escherichia coli in community-acquired urinary tract infections]. / Sensibilidad microbiana de Escherichia coli en infecciones urinarias extrahospitalarias.

OBJECTIVE: For effective empiric therapy of urinary tract infections in the extra-hospital setting the susceptibility pattern of uropathogens should be considered. Moreover, the evolution in sensitivity can be observed when comparing with susceptibility patterns in the previous years. This paper presents an analysis of our experience with Escherichia coli. MATERIAL AND METHODS: During 2002 and 1998, 895 and 595 strains of Escherichia coli respectively, isolated from extrahospitalary bacteriurias were collected in ten health centers in Bierzo (León, Spain). Sensitivity to nine most commonly antibiotics used in the clinical practise was determined. The existence of significant differences of susceptibility among years (2002-1998) was analyzed by the chi square test. RESULTS: Escherichia coli accounted for 63.4% of all isolates in 2002 and 50.8% in 1998. The prevalence of in-vitro susceptibilities to antibiotics were (2002-1998): fosfomycin (99.2%-99.3%; p = NS*), cefixime (98.3%-92.9%; p < 0.001), cefuroxime (96.5%-94.1%; p < 0.05), nitrofurantoin (94.5%-86.9%; p < 0.001), amoxycillin-clavulanic acid (93.1%-90.1%; p < 0.05), ciprofloxacin (77.1%-81.6%; p < 0.05), norfloxacin (75.8%-80.3%; p < 0.05), cotrimoxazole (71.5%-73.4%; p = NS*) and ampicillin (44%-41.4%; p = NS*). (*NS = No significant differences). CONCLUSION: The knowledge of the sensitivity of uropathogens to antimicrobians in a specific medium can allow us to use antibiotics rationally and initiate empirical therapy.

[Utility of prostate-specific antigen in pleural fluid for the diagnosis of metastatic effusion secondary to prostate cancer]. / Utilidad del antígeno prostático específico en líquido pleural para el diagnóstico del derrame metastático por cáncer de próstata.

Pulmonary or pleural involvement from prostate cancer is an uncommon clinical finding. We report on a patient with prostate cancer and a diagnosis of malignant pleural effusion made by determination of pleural fluid prostate specific antigen.

[Ectopic prostatic tissue in the bladder]. / Tejido prostático ectópico en vejiga urinaria.

We report the case of a 58-year-old man with ectopic prostatic tissue at the bladder trigone. The diagnosis was by chance during study and treatment of benign prostatic hyperplasia. The appearance was pseudocystic. It occupied completely the bladder trigone. On histology, the lesion was formed by prostatic type-glands, which were positive for the presence of prostatic specific antigen by using inmunoperoxidase technique. It was partially covered by normal urothelium. Ten months later, no trace of recurrence has been evidenced.

[Urologic disease emergency. Clinico-epidemiologic analysis at a district hospital]. / Patología urológica urgente. Análisis clínico-epidemiológico en un hospital comarcal.

OBJECTIVE: To present the results of a one-year retrospective study that analyzed the clinical and epidemiological aspects of urological emergencies, which is not a negligible percentage of all hospital emergencies. METHODS: Data on all the urological emergencies of the emergency department of our hospital were collected during a one-year period by filling out a form that included sex, age, whether referred or not, disease, etc. RESULTS: There were 1504 urological emergencies; the urologist was required in 458 of these cases (30.45%). There were more men (837) than women (667). Patient ages ranged from 1-101 years (mean 53 years); a higher incidence was found for those aged 65 years. By age groups, there were more patients aged 61-80 years (575 patients). Most of the patients came to the hospital on their own initiative (1114) and 390 had been referred by their primary care physician. Renal colic (670 cases) was the most common diagnosis in both males and females, followed by cystitis, which was prevalent in the females (67.35%). Other conditions seen were urinary retention, hematuria, etc. CONCLUSIONS: There was a higher prevalence of males that consulted for urological conditions at the emergency department and there was a higher incidence in patients in the 6th and 7th decades of life, which is similar to the findings reported in other studies. Renal colic was the main reason for consultation for both genders and for all age groups, except those younger than 20 who presented more scrotal and penile involvement. Infective conditions involving the lower urinary tract (cystitis) and pyelonephritis were prevalent in the females. The large number of patients that were discharged from the emergency department and who consulted on their own initiative shows their confidence in the emergency services and that they could have been attended to at other health centers and did not have to come and unnecessarily strain the hospital emergency services.

[Reabsorption syndrome. Report of a case]. / Síndrome de reabsorción. Presentación de un caso.

OBJECTIVE: To report a case of TURP syndrome and emphasize the importance of early diagnosis. METHODS: A case of reabsorption syndrome in a patient that underwent transurethral resection under spinal anesthesia is presented. RESULTS: Reabsorption syndrome (TURP syndrome) is manifested by neurological and hemodynamic changes resulting from absorption of irrigating fluid used during transurethral resection of the prostate. This complication presented in a patient undergoing elective surgery and with no additional risk factors. CONCLUSIONS: Since it is impossible to prevent this complication of TUR, spinal anesthesia should be utilized whenever possible because it permits early detection before important complications develop.

[Prevalence and risk factors for erectile dysfunction in the Region of Bierzo]. / Prevalencia y factores de riesgo de disfunción eréctil en la Comarca del Bierzo.

OBJECTIVE: To analyze the prevalence and risk factors for erectile dysfunction in Bierzo (León, Spain). METHODS: A study was conducted based on a self-administered survey in males aged 19 to 90 years that consulted at the urology and family medicine services of 10 health centers in Bierzo (León, Spain). To determine the existence or absence of erectile dysfunction, the male sexual health questionnaire (SHIM) was included, and those with a score of 21 or less were considered to have some degree of erectile dysfunction. Distribution of the questionnaire began in September 1999 and ended in May 2000. Submission of the questionnaires concluded on May 31, 2000. Of 935 questionnaire that were received, 830 were valid. RESULTS: The overall prevalence of erectile dysfunction in this study was 63.9%, which increased with age and was markedly higher after age 50 years (38.6% for age 41-50 years and 72.6% for age 51-60 years). The age-adjusted analysis showed the risk factors for erectile dysfunction were depression and arterial hypertension on treatment with drugs. Diabetes mellitus on treatment with oral glucose lowering agents or insulin, heart disease and hypercholesterolemia were also associated with the more severe forms. CONCLUSIONS: The prevalence of erectile dysfunction in patients consulting at the primary care and general urological services in Bierzo (León, Spain) was outstandingly high. The present study showed erectile dysfunction to be an age-dependent disease that caused concern in slightly more than half of the patients with this condition. Apart from age, depression and vascular disease were found to be risk factors.

[Scrotal leiomyoma]. / Leiomioma de escroto.

A case of a 32-year-old patient with a diagnosis of leiomyoma of the scrotum was studied. Histologic analyses did not yield evidence of malignancy. Full excision of tumor was achieved and the postoperative period was uneventful.

[Clinical prognostic factors in superficial cancer of the urinary bladder]. / Estudio de factores pronósticos clínicos en el cáncer superficial de vejiga urinaria.

OBJECTIVE: To determine the relation of the classical prognostic factors (tumor stage, grade, size and location) to the recurrence rate, disease free interval and overall survival in patients with superficial bladder cancer. METHODS: The study was carried out on 144 patients with superficial transitional cell carcinoma of the bladder (pTa, pT1) over a period of three years. Age, sex, history of exposure to aniline, smoking, histological type, tumor grade, size, stage, localization (single vs multiple) and type of complementary treatment were analyzed. Tumors were staged according to the TNM classification (1997 version) and cell grade was determined according to the Broders classification. RESULTS: Mean age was 70 years +/- 12.55 (range 22-100); 124 (86%) were males and 20 (14%) were females. All tumors were superficial transitional cell carcinoma; 93% were papillary and the remaining 7% were solid tumors. There were 52 recurrences (36%); of these, only 13 (25%) showed tumor progression: 4 became infiltrating (31%), one (8%) advanced in superficial tumor stage and 8 (61%) advanced in grade. Mean follow-up was 31 months (range 3-61). Overall and disease free survival at 5 years were 88.42% and 45%, respectively. No differences were found for disease free survival according to the different prognostic factors analyzed. Tumor grade correlated with stage and size. Thus, grade III tumors are likely to be stage pT1 and greater than 3 cm. in size. CONCLUSIONS: The histological grade is the most important prognostic factor in bladder cancer progression. However, while grade I and III tumors show a rather similar behavior, the moderately differentiated tumors comprise a heterogeneous group with a very disparate behavior. Tumor grade was found to correlate with stage and size.

[Expression of epidermal growth factor receptor and p53 protein in superficial cancer of the urinary bladder]. / Expresión del receptor del factor de crecimiento epidérmico y de la proteína p53 en el cáncer superficial de vejiga urinaria.

OBJECTIVE: To determine the relationship of the immunohistochemical expression of p53 and EGF-r (epidermal growth factor receptor) and the recurrence rate and disease-free interval in superficial bladder cancer. METHODS: 144 patients with superficial transitional cell carcinoma of the bladder were studied over a period of three years. Direct dilution anti-EGF-r monoclonal antibody (Biogenex, San Ramon, CA 94583, USA) was utilized for EGF-r determination. Anti-p53 mouse monoclonal antibody (DO7, Novocastra, Newcastle, 24 Claremont Place, UK) at a concentration of 1:100 was utilized for protein p53 determination and was considered negative if less than 10% of the tumor cells were stained and positive if 10% to 100% of the cells stained. EGF-r was determined only as either positive or negative regardless of percent of expression. RESULTS: 55 patients (38%) showed EGF-r and 14 (9.7%) showed p53 expression. The disease free survival was 54.08 months in the patients that showed EGF-r expression vs 30 months for those that did not, the difference being statistically significant (p = 0.027). However, no differences were found in this regard for p53 expression. Tumors that expressed EGF-r recurred in the same site as that of the primary tumor. By contrast, those that did not express EGF-r recurred in another or in multiple sites. CONCLUSIONS: The risk of recurrence is lower in bladder tumors that express EGF-r than those that do not, and when they recur, this generally occurs in the same site as the primary tumor. However, determination of p53 expression was not useful in determining the risk of recurrence or progression of superficial bladder tumors.

[Renal infarct in the adult: apropos of a case]. / Infarto renal en el adulto: a propósito de un caso.

OBJECTIVE: To report a case of renal infarction in a patient on anticoagulant therapy for aortic and tricuspid valvulopathy, with special reference to the diagnostic difficulty. METHODS: The most common causes of this condition, its forms of presentation, diagnostic methods, and therapeutic approaches are discussed. RESULTS/CONCLUSIONS: Renal infarction should be suspected in the presence of abdominal pain of sudden onset that is refractory to treatment with analgesics, especially in patients with a history of embolism, recent surgery or trauma. It is frequent to find increased levels of SGOT, SGPT, LDH, alkaline phosphatase and micro or gross hematuria and proteinuria. Arteriography or isotopic renogram is utilized to confirm the diagnosis, although IVP or CT is useful if the foregoing are not available. Early treatment is important for achieving recovery of the compromised renal parenchyma. In recent years, surgery has been displaced by the good results obtained with intraarterial infusion of fibrinolytics.

[Solitary pulmonary nodule in a patient with treated carcinoma of the renal pelvis: metastatic disease?]. / Nódulo pulmonar solitario en paciente con carcinoma de pelvis renal tratado: enfermedad metastásica?

OBJECTIVE: To describe a case of a solitary pulmonary nodule in a patient that had been treated for carcinoma of the renal pelvis. METHODS: A solitary pulmonary nodule was detected on the chest film of a patient that had been treated for carcinoma of the renal pelvis. The characteristics of the nodule are described and its diagnosis, with special reference to metastasis and primary pulmonary carcinoma, is discussed. RESULTS: The anatomopathological study demonstrated a chondroid hamartoma. CONCLUSIONS: A metastatic or a primary tumor is suspected when a solitary pulmonary nodule is detected in a patient that has been previously treated for urothelial carcinoma. However, other types of lesions with a more favourable outcome cannot be discarded, such as chondroid hamartoma as in the case described herein.

[Penile primary melanoma; report of a case]. / Melanoma primario de pene; a propósito de un caso.

OBJECTIVE: An uncommon variant of penile tumor associated with chronic lymphoid leukemia is presented. METHODS/RESULTS: A case of primary melanoma of the penis associated with chronic lymphoid leukemia is presented. Diagnosis was based on the anatomopathological findings. Lymph node involvement could not be determined due to the associated leukemia. Conservative management was instituted due to the patient's age. CONCLUSIONS: Primary melanoma of the penis is a very aggressive and uncommon tumor. To our knowledge, less than 140 cases have been reported. Hyperpigmented lesions must be biopsied to rule out melanoma.

[Transvesical repair of non-complicated vesicovaginal fistula]. / Reparación transvesical de fístulas vesicovaginales no complicadas.

OBJECTIVE: The management of vesicovaginal fistula still remains controversial in regard to the timing of repair and type of approach. We review the relevant literature and describe our experience with the transvesical management of uncomplicated vesicovaginal fistulas after gynecological surgery. MATERIAL AND METHODS: We reviewed retrospectively 6 consecutive women who presented with uncomplicated vesicovaginal fistula, repaired at our institution between 1995 and 1998. Four cases underwent early repair after a trial of conservative management. One case underwent intraoperative repair and another case after 19 months because of delayed diagnosis. Postoperative follow up ranges from 4 to 35 months. RESULTS: All patients were cure. The fistula tract was excised totally in all patients. There were no postoperative complications. CONCLUSIONS: Early repair of uncomplicated vesicovaginal fistulas after gynecological surgery offers reliable success, according with literature records and our own experience. On the other hand, transvesical repair offers an easy operative approach, with a high successful rate.

[Epidermoid carcinoma of the penis]. / Carcinoma epidermoide de pene.

OBJECTIVE: To analyze our series and review the prognostic factors in the treatment of epidermoid carcinoma of the penis. METHODS: Age, time to consultation, circumcision, form of presentation, local treatment, tumor stage and grade, lymph node involvement and outcome were analyzed in 27 cases of carcinoma of the penis diagnosed at our hospital from 1981 to 1999. RESULTS: The incidence rate was 1.8 cases/100,000 men/year. No patient had been circumcised, except one who was circumcised in the adult age. The median time to consultation was 24 months (interquartile range: 60-7.75). The median follow-up was 37 months (interquartile range: 84-12). All patients with pT1GI-II and pT2G-II primary tumor (n = 21; 78% of the series) and with no lymphadenopathy were disease-free at 6 months' minimum follow-up [17 of the 21 patients (81%) had more than 32 months' follow-up]. Only one patient with pT1-GII tumor, but with a vertical growth pattern, had positive inguinal lymph nodes (pN2). The remaining patients with lymph node involvement showed infiltration of the erectile tissue and moderately or poorly differentiated tumors. Only two prophylactic lymphadenectomy procedures were performed (pN0). Regardless of treatment, 5 of the 6 patients with lymph node involvement died within one year after diagnosis. CONCLUSIONS: Given the demonstrated relationship between carcinoma of the penis and hygiene, and phimosis which makes hygiene difficult, circumcision should be performed in childhood. Furthermore, circumcision at this age has been demonstrated to have a prophylactic value that disappears in the adult age.

[Lipoma of spermatic cord; report of a case]. / Lipoma de cordón espermático; presentación de un caso.

OBJECTIVE: To report an additional case of lipoma of the spermatic cord, an uncommon, silent tumor. METHODS: A case of lipoma of the spermatic cord is described. The patient had presented with an enlarged scrotum with no symptoms. The literature on lipoma of the spermatic cord is briefly reviewed, with special reference to its diagnosis, forms of presentation and treatment. RESULTS: US evaluation demonstrated a mass adhered to the epididymis. An epididymal tumor was suspected and surgical exploration by the inguinal approach was performed. CONCLUSIONS: Lipoma is the most common tumor of the spermatic cord. Its etiology is unknown. It frequently appears in the fourth and fifth decades of life and usually involves the left hemiscrotum. It is silent and is detected by enlargement of the scrotum. The diagnosis is histological supported by US, which offers a reliability of 80%-100%. Treatment is by surgery in all cases.

[Spermatic cord torsion in the Comarca del Bierzo. Clinico-epidemiological analysis of the 5-year period 1994-1998]. / Torsiones de cordón testicular en la Comarca del Bierzo. Análisis clínicoepidemiológico del quinquenio 1994-1998.

OBJECTIVE: To review the cases of torsion of the spermatic cord diagnosed at the emergency and urology services of our hospital over the last 5 years and analyze the clinical and epidemiological features. METHODS: The cases of torsion of the spermatic cord diagnosed at our hospital from 1994-1998 were reviewed. Age, reason for consultation, time from onset of symptoms to consultation, location of the torsion, final diagnosis, treatment, and other data were analyzed. RESULTS: There were 20 cases of torsion of the spermatic cord in patients aged 1 to 25 years, with the highest incidence at age 14 years. The left testis was more frequently compromised. Six patients had a history of testicular pain and/or inflammation. The mean time from presentation of symptoms to consultation was 13.5 hours (range 1 hour to 7 days). The diagnosis was torsion of the spermatic cord in 14 cases and hydatid torsion in 6. Treatment was fundamentally by surgery (orchidopexy), except in three cases that spontaneously resolved or were detorsioned by manipulation. Two patients underwent excision of the compromised testis. CONCLUSIONS: Torsion of the spermatic cord is a urological emergency due to the high risk of complications that may even require orchidectomy. The epidemiological findings for our area are similar to those reported in other series.

[Conservative surgery for renal carcinoma]. / Cirugía conservadora en el carcinoma renal.

OBJECTIVES: To report on our experience in conservative surgery for renal cell carcinoma, pointing at indications, surgical techniques and results. We also make a review of the literature. MATERIAL AND METHODS: From 1975 until 1997, 231 patients underwent surgical treatment of renal cell carcinoma. In 17 cases conservative surgery was done. 11 patients were male and 6 female, with age range 33-78 years. Polar nephrectomy was done in 4 cases and tumorectomy in 13 cases. The indication was elective in 10 cases, and imperative in 7 due to: 4 bilateral carcinomas, 1 chronic renal failure, 1 von Hippel Lindau disease and 1 tumor associated with surgical lithiasis of the kidney. RESULTS: 58.8% of the patients did not have clinical symptoms and the diagnose was incidental. The average size of the tumors was 3.8 cm. The pathological stage was: 3 cases T1N0M0 and 12 T2N0M0. All the T1 cases had an incidental diagnose. The complications were: 1 urinary fistula, 1 haematoma, and 1 case of postoperative fever. All these complications were solved in a conservative way. We had tumoral recurrence in one patient affected with von Hippel Lindau disease. It appeared 4 years after the surgical procedure and required radical nephrectomy. One patient died 24 months after surgery because of causes not related with renal tumor. The rest of the patients are alive, with no tumoral recurrence, within an average follow-up of 49.6 months. None of the patients needed dialysis. CONCLUSIONS: Our experience, though not great is enough to demonstrate the benefits of conservative surgery for renal cell carcinoma. Partial nephrectomy in selected patients and with the appropriate surgical technique offers short-term results similar to those obtained with radical nephrectomy. It is indispensable to make the resection and intraoperative pathological study of a margin of renal parenchyma surrounding the tumor, and also to examine the whole surface of the kidney to search for satellite tumoral nodules. It is very important to do a close follow up of these patients after the surgery.

[Bladder endometriosis]. / Endometriosis vesical.

OBJECTIVE: To describe an additional case of endometriosis of the bladder and to review the diagnostic and therapeutic aspects. METHODS/RESULTS: A case of endometriosis of the bladder in a 30-year-old female with a long history of dysuria, pollakiuria and suprapubic pain during menstruation is described. The endoscopic findings indicated endometriosis of the bladder. Gn-Rh analogues and anovulatories were administered, but were poorly tolerated. Resection of the bladder endometrioma was performed. The patient is asymptomatic at two years' follow-up. CONCLUSION: Transurethral resection of the endometriotic plaque may be a valid therapeutic option in selected cases of endometriosis of the bladder.