Comparability and reproducibility of adult male anogenital distance measurements for two different methods.

The distance from the genitals to the anus, anogenital distance, reflects androgen concentration during prenatal development in mammals. The use of anogenital distance in human studies is still very limited and the quality and consistency of measurements is an important methodological issue. The aim of this study was to assess the feasibility and reproducibility of adult male anogenital distance measurements by two different methods. All men were attending an outpatient clinic at a university hospital and underwent an andrological examination and completed a brief questionnaire. Two variants of anogenital distance [from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP )] by two methods (lithotomy or frog-legged position) were assessed in 70 men. Within and between coefficient of variations, intra-class correlation coefficients, two-way repeated-measures analysis of variance, and scatter and Bland-Altman plots were calculated. The two methods produced similar values for AGDAP but different estimates for AGDAS . Nonetheless, the overall agreement (ICC ≥ 0.80) was acceptable for both measures. Therefore, both methods are internally consistent and adequate for epidemiological studies, and may be used depending on the available medical resources, clinical setting, and populations.

[Ovarian vein syndrome]. / Síndrome de la vena ovárica.

The Ovarian Vein Syndrome has been the subject of controversy ever since first described as such by Clark in 1964. This is an uncommon entity within urologic sings and symptoms which appears as a recurrent nephritic colic coinciding with menstruation or during the immediately preceding days. The authors review a clinical case from our Urology Service, including some considerations on the case.

[Primary vaginal lithiasis associated with urethrovaginal fistula. Report of a case and review of the literature]. / Litiasis vaginal primaria asociada a fístula uretrovaginal. Presentación de un caso y revisión de la literatura.

Vaginal stones are rare. We can classify them as primary or secondary, depending on the presence or the absencse of a foreign body nidus. Various cases can led to stone formation. Most of them developed in women with a vesicovaginal or urethrovaginal fistula, as well as in patients with congenital anomalies of the genitourinary tract, previous pelvic radiotherapy, neuropathic bladder and other different causes of vaginal outlet obstruction. Secondary vaginal stones, formed around foreign bodies, are not so frequent. Radiological examination and urethro-vaginoscopy make easy the right diagnosis. Sometimes the stone may be fragmented by lithotripsy before the extraction. The associated etiology should be treated concomitantly in order to prevent recurrence. We report a case of primary vaginal stone associated with an urethrovaginal fistula in a 25 years old women and a review of the related literature.

[Nephrogenic bladder adenoma associated with glandular cystitis. Immunohistochemical study and significance]. / Adenoma nefrogénico vesical asociado a cistitis glandular. Estudio inmunohistoquímico y significado.

A histopathological and immunohistochemical study of a case of nephrogenic adenoma of the bladder associated to glandular cystitis is presented with a very similar immunostaining to adenomatoid tumors in other organs and probably of a mesothelial origin. Its pathogenesis seems to correspond to a metaplastic change of the bladder's urothelium through anomalous differentiation of the reserve cells faced with different irritating agents. Because of its benign characteristics, we think that treatment can be confined to endoscopic observation and conservative technique.

[Cranial blind ureter: a new case]. / Uréter ciego craneal: un nuevo caso.

One of the anomalies affecting the ureter is the blind bifid cranial ureter, which is truly an uncommon alteration. Clinical signs and symptoms are very ambiguous, and sometimes the condition is diagnosed accidentally while conducting an urographic examination. The aim of this paper is simply to contribute a new case to the existing literature.

[Bladder carcinoma with osteoclast-type giant cells. A case with a rare presentation. Review of the literature]. / Carcinoma con células gigantes tipo osteoclasto de vejiga. Un caso de rara presentación. Revisión de la literatura.

We report a case of neoplasm of the urinary bladder with pseudosarcomatous stromal differentiation. Heterologous carcinosarcomas are extremely rare malignant neoplasms (seventy-eight cases have been previously described). This is a case of carcinoma containing numerous osteoclast type giant cells that stained for vinmentin and acid phosphatase and were negative for cytokeratin and lysozyme.

[Hemorrhagic cystitis caused by BK and JC polyomavirus in patients treated with bone marrow transplantation: clinical features and urologic management]. / Cistitis hemorrágica por poliomavirus BK y JC en pacientes sometidos a transplante de médula ósea: aspectos clínicos y manejo urológico.

INTRODUCTION: Differential diagnosis of hematuria after bone marrow transplantation (B.M.T.) may include polyomavirus (BK and JC)-associated haemorrhagic cystitis. Many reports have implied BK virus as the major pathogen in the development of hemorrhagic cystitis after BMT. BK viruria is also associated with ureteric stenosis in renal allografts recipients. Viral urinary tract infections are uncommon in healthy individuals, but we can find them frequently in patients under immunosuppressive conditions. MATERIAL AND METHODS: Retrospective study of 123 consecutive B.M.T. recipients in the period from 1995 to 2000, evaluating those with polyomavirus-associated hemorrhagic cystitis. We present patient's characteristics, primary disease, clinical features, diagnosis aspects and treatment of these "hidden hosts of urinary tract". RESULTS: 7 patients (5.7% of B.M.T.) developed BK or JC virus-associated hemorrhagic cystitis; 3 men and 4 women; median patient age was 29 years (range 14 to 45 years). Bacterial, mycobacterial and parasitic urine cultivates had negative results in all of them. The clinical course was characterized by a late onset of haemorrhagic cystitis (days +30 to +132 after BMT). All 7 patients developed macroscopic haematuria (duration 3 to 30 days). In 6 cases Graft Versus Host Disease (G.V.H.D.) criteria were found. Ultrasonographic studies revealed diffuse thickening of bladder wall in 5 patients. Hematuria was managed by hyperhydratation, blood transfusions, transurethral catheter and evacuation of blood clots, continuous bladder irrigation, urine alkalinization and antiviral therapy. No other more aggressive measures were required to stop the bleeding. Only 1 case of transient elevated creatinine. CONCLUSIONS: Polyomavirus-associated haemorrhagic cystitis must be considered in differential diagnosis of hematuria in bone marrow transplantation recipients. Urological management, according with the severity and duration of hematuria, is frequently required.

[Juvenile gangrenous vasculitis of the scrotum. Report of a new case and review of the literature]. / Vasculitis gangrenosa juvenil del escroto. Aportación de un nuevo caso y revisión de la literatura.

Juvenile gangrenous vasculitis of the scrotum is a peculiar form of scrotal gangrene of undetermined etiology, with clinical and pathological features of its own, described in 1973 by Piñol et al. We report a new case, considering this entity as part of the differential diagnosis of scrotal gangrene, and a review of relative literature.

[Eosinophilic cystitis]. / Cistitis eosinófila.

Eosinophilic cystitis (EC) is a clinical-pathological entity characterised by the transmural infiltration of the bladder. It shows as an irritative mictional syndrome, though the most common sign is haematuria. Endoscopically it appears as an intravesical mass and is usually mistaken for a transitional tumour of the bladder. There has been many etiologies involved but not one single factor has been identified as responsible for the condition. Medical approach is the most appropriate initial treatment, but since the condition is so often mistaken with vesical tumoration, the first therapeutical attitude in most cases is Transurethral Resection (TUR) which, though more aggressive, is therapeutic, haemostatic and provides material for the pathoanatomical diagnosis.

[Liver failure caused by flutamide]. / Fracaso hepático por flutamida.

Flutamide is a non-steroidal anti-androgen used in the treatment of prostate cancer, usually in combination with LHRH-analogs. Incidence of hepatotoxicity associated to Flutamide in the literature is very low and does not exceed 0.18%. Between February 1989 and December 1994, the FDA was reported 20 cases of patients who had died and 26 who had been hospitalized due to hepatotoxicity secondary to Flutamide. We contribute two cases of patients diagnosed with prostate adenocarcinoma following treatment with flutamide and LHRH-analogs who presented liver failure; one with signs and symptoms of acute hepatitis that recovered after discontinuation of the drug, and a second one who developed micronodular cirrhosis and later died of icteroascitic decompensation and hepatorenal syndrome. Including a review of the literature, the paper comments on the likely biological mechanisms for liver toxicity caused by Flutamide. The authors conclude that clinical and laboratory monitoring of patients who either will receive or are receiving treatment with Flutamide is necessary, and withdrawal of drug imperative as soon as certain symptoms of hepatic dysfunction become apparent.

[Intratumor and retroperitoneal massive hemorrhage caused by retroperitoneal liposarcoma]. / Hemorragia intratumoral y retroperitoneal masiva por liposarcoma retroperitoneal.

Case report of a giant retroperitoneal liposarcoma which presented with a picture of acute abdomen resulting from a massive tumoral haemorrhage. Diagnosis was achieved by ECO and CT, and was confirmed by Pathological Anatomy. Treatment was surgical, performing tumour removal plus polar nephrectomy of the affected side. The patient evolution was favourable. The standard methods of diagnosis and prognostic factors are commented.

[Wallstent prosthesis of unusual location caused by recurrent urethral stenosis following repeated urethroplasty]. / Prótesis wallstent en localización inusual por estenosis de uretra recidivada tras uretroplastia repetida.

Presentation of one case of relapsed urethral stenosis in a penoscrotal location where after several failed therapeutical approaches, the final decision was to place a Wallstent endoluminal prothesis. The patient underwent several endoscopic internal urethrotomies and urethroplasty in two occasions, developing complications: urethral calculi, hair follicles requiring cauterization, repeat infections and relapse urethral stenosis, which finally lead to the decision of fixing a intraluminal stent even if in an unusual location (penoscrotal). The result, 40 months after implantation, is both subjectively and objectively better, with a good mictional calibre and satisfactory erection which allows the patient to have sexual intercourse. The Wallstent prothesis can be the ultimate alternative in those cases of "ill-treated" urethra where other techniques fail.

[Impact of prostatic benign hyperplasia and prostatic inflammation on the increase of prostate specific antigen levels]. / Influencia de la hiperplasia benigna de próstata y de la inflamación prostática en las elevaciones del antígeno prostático específico.

PSA is currently the best marker in the diagnosis and staging of prostate cancer, although it has a low specificity when trying to distinguish between BPH and prostate cancer. Between January 1994 and December 1995, 243 BPHs were diagnosed after prostate TUR and retropubic adenomectomy. A selection of 131 cases were analyzed based on PSA higher than 4 and normal rectal examination pre-surgery. After surgery PSA was determined again with a time interval from the earlier one ranging between 103-211 days, noting that in about 70% cases PSA levels were normalized and 64% of these also presented focused acute prostatitis, chronic prostatitis, prostate infarction, lithiasis or areas of abscess formation. In spite of a significant number of patients with high PSA levels, this elevation should be interpreted cautiously considering the large percentage of cases where posterior pathological anatomy is a sign of BPH. We believe that among the conditions that could justify such abnormal PSA elevations are those described of areas of chronic or acute prostatitis, prostate infarctions, areas of abscess formation and presence of intraprostate lithiasis.

[Changes in the caudal regression of fused Muller ducts: utriculocele. Three clinical forms of presentation]. / Alteración de la regresión caudal de los conductos de Müller fusionados: utriculocele. Tres formas clínicas de presentaciónón.

Utriculocele is the engrossment of the prostate utricle with occlusion and/or cystic formation, sometimes including the ejaculatory conducts. We report three patients diagnosed with utriculocele with different presentation forms: hypospermia, haematuria and mictional syndrome, and the treatment used. Theories on their formation, clinical presentation forms described in the literature, diagnostic means, most frequent associations, and different therapeutic alternatives are all discussed as well as a revision of the reported cases.

[Trigonocervicoprostatomy. Indications and results from 100 case reports]. / La trigonocervicoprostatotomía. Indicaciones y resultados de 100 casos.

Trigonocervicotomy is a barely invasive technique for the treatment of infravesical obstruction, first introduced in the 60's by Turner-Warkic and Orandi. To achieve good results with this procedure, the selection criteria must take into account a series of parameters such as age, sexual activity, PSA, prostate weight (below 30 grams) and others. In addition to its low morbidity, a larger percentage of patients preserve ejaculation than with the use of other techniques, also the neck sclerosis rate being lower as seen in all our series and expertise. The efficacy of this technique was studied on 100 patients.

[The management of urinary candidiasis in cystectomized patients]. / Manejo de la candidiasis urinaria en pacientes cistectomizados.

Presentation of eight cases of urinary candidiasis in patients who underwent radical cystectomy and were managed using by-pass of the urinary tract, oral antifungal therapy and solutions in the way of intermittent instillation through nephrostomy catheters.

[AIDS and HIV infections in urologic practice]. / SIDA e infecciones por VIH en la práctica urológica.

The infection caused by the Human Immunodeficiency Virus (HIV), a retrovirus, leads to a progressive decline and to the suppression of cell-mediated immunity favouring the development of opportunistic diseases and potentially fatal neoplasias which are practically innocuous in individuals with an intact immunologic system. The number of AIDS cases recorded in Spain until March 1997 was 45,132, with a revised mortality rate of 58%. Cases in Murcia total 713 up to October 1997, of which 217 patients are being monitored in the AIDS Unit in our centre, 414 individuals have died in the region. It is well know that about one third of patients with diagnosed AIDS or who are HIV carriers will develop some type of genitourinary lesion, either as a result of a renal disorder, concurrent or not with HIV, or any other condition directly related to the infection. This is a report on our Service's experience in the treatment of HIV patients with genitourinary symptoms that, in a total of 15 cases, required our intervention. Emphasis is placed on the incidence of nephrolithiasis secondary to therapy with protease inhibitors over the last few months following introduction of this new therapeutic tool, prostatitis due to salmonella, and inlaid cystitis among others.

[Tumors of the upper urinary tract]. / Tumores de tracto urinario superior.

A series of 60 cases of tumours of the Upper Urinary Tract (UUT) diagnosed in our centre between 1987-1996 and affecting 57 patients is presented. Patient's mean age was 63.7 years, males being clearly predominant, 4:1, there was no predominant laterality and the preferential location was the renal pelvis. Fifty-two (52) out of all tumours were transitional, 1 was a fibroepithelial polyp and 2 were metastasis from prostate and colon cancers. Pathoanatomy of the remaining cases is not known since no surgery was performed, although the cytologic diagnosis has identified them as transitional tumours. Our series shows a significant association to other transitional tumours as demonstrated by the existence of 2 cases with a background of UUT tumours and other 31 cases associated to transitional tumour of the bladder. Haematuria was the predominant sign (54%) and UIV the leading examination technique. Nephroureterectomy was the most commonly used therapeutical approach. UUT appear to be highly predominant in our environment, with a clear male predominance and preferential location in the renal pelvis. Haematuria continues to be the most frequent presentation sign and UIV the exploratory technique offering better performance in the diagnosis. Also a high association was found to other types of transitional tumours, the diagnosis and follow up of which allowed us to diagnose a large number of tumours of the upper tract.

[Transitional cell carcinoma and renal cell adenocarcinoma: unusual case of association in the same kidney]. / Carcinoma de células transicionales y adenocarcinoma de células renales: caso inusual de asociación en el mismo riñón.

Presentation of one patient with a highly infrequent association of transitional cells carcinoma and renal cells adenocarcinoma synchronically developed in the same renal unit. There has been very few cases diagnosed up to now, and only around 25 have been described in the literature. There is a clear predominance of males versus females, with haematuria being the most frequent sign present in 90% cases. Elective complementary examination is CT and the choice treatment can be either nephroureterectomy or extended nephrectomy based on early suspicion of transitional cells carcinoma or renal cells adenocarcinoma.

[Inverted papilloma: presentation of 5 cases and review of the Spanish literature]. / Papiloma invertido: presentación de 5 casos y revisión de la literatura española.

Vesical inverted papilloma (IP) is a transitional disease most commonly found in the bladder, representing a small percentage within the group of vesical neoformations. Although of benign behaviour, some authors advise that a relatively strict monitoring should be used considering its high rate of proliferative activity. It mainly affects males in their fifth to seventh decade, and it presents as any other transitional tumour. In about one fourth of the cases a transitional carcinoma becomes associated throughout its evolution, thus supporting the theory of periodic monitoring.