[Tridimensional echography: a new urologic challenge]. / Ecografía tridimensional: nuevo reto urológico.

OBJECTIVE: To describe the urological applications of three-dimensional ultrasonography, a new method that basically transforms the two-dimensional into three-dimensional images through complex data processing for enhanced imaging. METHODS: Since the technology for three-dimensional studies was incorporated into our US equipment a few months ago, we have performed three-dimensional US after the conventional two-dimensional study in 30 renal units, 15 bladders and 15 prostates, using the same well-established procedures for ultrasound assessment. The images obtained by both methods were compared to determine the diagnostic enhancements, if any, afforded by this new technology. RESULTS: Three-dimensional US offers more possibilities for renal cortical volume measurement and determination of the extent of the tumor. It also appears to be promising in regard to its capacity to determine the degree of tumor infiltration in the bladder and permits even more precise measurements of residual volume or bladder content. Transrectal ultrasound of the prostate may benefit more since three-dimensional US permits analysis of focal changes from different perspectives and planes without difficulty. CONCLUSIONS: Three-dimensional US was developed recently. It has been utilized in gynecology and cardiology, but there is limited experience in urology. We have started a clinical study to determine its possibilities and main applications in our field. Its impact on other diagnostic parameters or biopsy selection criteria are other interesting areas of research.

[Natural history of cancer of the kidney: iconographic follow-up]. / Historia natural del cáncer de riñón: seguimiento iconográfico.

OBJECTIVE: To describe the natural history of renal cancer based on the images obtained in a case with more than 11 years' follow-up, from the initial stages of the disease to its outcome. METHODS/RESULTS: The history of a female patient in whom a renal mass had been detected at age 25 years is described. The patient died 11 years later due to metastasis. The images obtained throughout follow-up clearly illustrate the natural course of the disease, which could not be changed because the patient had refused surgery. CONCLUSIONS: The observation of a small renal mass in young patients is an indication for early surgery. The natural course of this disease is predictably fatal, its benign behaviour being highly questionable. Because pregnancy does not appear to accelerate the course of the disease, patient assessment can be completed and treatment can be instituted after delivery.

[Fracture of the penis: two new cases. Review of the literature. Usefulness of echography]. / Fractura de pene: dos nuevos casos. Revisión de la literatura. Utilidad de la ecografía.

OBJECTIVE: To analyze the diagnostic and therapeutic difficulties in rupture of the albuginea penis and review the literature. METHODS/RESULTS: Two additional cases of penile rupture are described. Penile ultrasound evaluation disclosed a hematoma in the corpus cavernosum in one case and hematoma and a probable rupture of the albuginea penis in the other case. Treatment was by immediate surgery which achieved good cosmetic and functional results. CONCLUSIONS: Penile fracture is an uncommon condition which occurs when the penis is in erection. Ultrasound is useful in its diagnosis, but MRI is more precise. Treatment is by immediate surgery to avoid sequelae, which are common in cases treated conservatively.

[Diagnosis of leukemic infiltration of the prostate p6ompted by PSA elevation]. / Diagnóstico de infiltración leucémica de la próstata motivado por elevación del P.S.A.

Presentation of one case-report of leukaemic infiltration of the prostate. Interestingly, the biopsy was only performed after finding distinctly elevated PSA levels and not because of the clinical findings, whether exploratory or echographic.

[Adrenal myelolipoma: apropos a case with urologic symptomatology. A review of the literature]. / Mielolipoma suprarrenal: a propósito de un caso con sintomatología urológica. Revisión bibliográfica.

Presentation of a new case of Suprarenal Myelolipoma, its singularity being the urinary clinical presentation. Brief review of the literature, placing special emphasis on the Spanish references.

[Osteoblastic differentiation in primary renal tumor: a rare histologic finding]. / Diferenciación osteoblástica en tumor renal primario: una rareza histológica.

Presentation of one case of renal carcinoma which interest lies in the osteoblastic differentiation presented by the sarcomatoid component. The rarity of this tumour type in major series of sarcomatoid renal carcinomas published is emphasized. Also, a description of its most relevant singularities is made.

[Ultrasonography diagnosis of ureteral ectopy in prostatic urethra]. / Diagnóstico ecográfico de ectopia ureteral en uretra prostática.

A 54-year-old male who consulted for an episode of right-sided nephric colic is described. A urological ultrasound scan disclosed grade I hydronephrosis in the upper half of the right kidney and an anechoic tubular image ending in the prostate gland. A subsequent urographic evaluation confirmed the diagnosis of ectopic ureter in prostatic urethra.

[Fibrino-necrotic ulcers in endovesical chemoprophylaxis in superficial bladder carcinoma: our case histories]. / Ulceras fibrinonecróticas en la quimioprofilaxis endovesical en el carcinoma superficial de vejiga: nuestra casuística.

Presentation of one study on the incidence of fibrino-necrotic ulcers in patients undergoing endovesical chemoprophylaxis with mitomycin C. A description is made of these lesions evaluating their likely relationship to infectious processes. The paper concludes stating the need of endoscopic monitoring and the absence of proven prognostic factors.

[Blue nevus of the prostate]. / Nevus azul de la próstata.

The presence of melanin in the prostatic gland's stroma is a histopathological finding of extreme rarity. It receives the name of blue nevus as a result of its similitude to the skin's blue nevus. The paper describes the finding of melanin stores in the fibromuscular stroma of a patient's prostate and reviews the theories on its source.

[Simple calculation of prostatic weight with transrectal echography]. / Cálculo sencillo del peso prostático mediante ecografía transrectal.

The appraisal of the prostate weight with transrectal ultrasound scanning is simplified with the use of a simple mathematical formula of an ovoid volume. Such a method does not prolong the examination time but provides an acceptable reliability, and therefore it can be used as a substitute to planimetry, more subject to the observer's error and more time consuming for the physician, even when part of the examination can be made by replaying the video.

[Bladder tumors: false recurrences]. / Tumores vesicales: falsas recidivas.

The use of the new cytostatics for prophylactic therapy of superficial bladder tumor recurrence has been associated with fibrino-necrotic ulcers and eosinophilic cystitis. We underscore the problems in making the differential diagnosis which sometimes present with true tumor necrosis. We describe the characteristic features of both pathological conditions which permit these to be recognized before endoscopic maneuvers are performed. Their presenting features and course are analyzed.

[Echodensitometry: a new echographic diagnostic possibility]. / Ecodensitometría: una nueva posibilidad diagnóstica ecográfica.

The determination and quantification of grey levels in the echography scale, designated by some authors Echodensitometry, is viewed as a new method for diagnosis using ultrasound techniques. This paper advances the results from a study conducted with an echographer equipped with an echographic density measuring device. This model analyzes the number of pixels in the image showing the most frequent level of grey. Normal and pathological parenchymatous urological organs (kidney, prostate and testicle) have been examined. Normal organs show a gaussian distribution of grey with a predominant level of typical grey for each of them. When affected by an acute inflammatory process the organs maintain their gaussian distribution but the predominant grey is lower (darker) due to the edema and the hyperaemia. When the inflammatory process becomes chronic, distribution, although somewhat irregular, is still gaussian but with higher predominance of grey (lighter) probably due to the fibrosis. The tumoral cases of our study also showed a gaussian curve even more irregular and with levels of variable grey. When specific areas of the tumour are analyzed the findings are very distinct depending on whether the areas are hypo or hyperechoic. Hyperechoic areas produce highly irregular maps. Research should be directed to provide more complex, although easy to perform systems of analysis which can correlate adequately with the histological study. It would be desirable that the equipment would be standardized to allow analysis of 'in vitro' images. If and when these objectives can be accomplished we would be able to venture into an echography histological diagnosis, something nowadays yet impossible.

[Incidence and characteristics of multiple neoplasms in urologic patients]. / Estudio de la incidencia y características de las neoplasias múltiples en pacientes urológicos.

The incidence and features of malignant primary multiple (MPM) neoplasias found in clinical urological patients have been analyzed so as to determine the actual magnitude of the problem and to obtain a better knowledge of this disease. For this reason, case histories of patients with MPMN, where at least one of the involved neoplasia was urological, were retrospectively studied. The study included a 9-year follow-up period and followed the Warren and Gates inclusion criteria. The number of MPMN patients was 23, representing an incidence of 6.1% among patients with urological neoplasias. Mean age at the time of discovery of the second tumour was 77.1 years. In the 15 patients with metachronic tumours, the time interval between the first and second tumours ranged between 1 to 25 years (average 5.4 years). The most frequently observed tumour association was bladder transitional carcinoma and prostate adenocarcinoma. The cause of death was always the second neoplasia.

[Is the early diagnosis of prostatic cancer possible using transrectal echography?]. / Es posible el diagnóstico precoz del cáncer de próstata mediante ecografía transrectal?

One of the major challenges of using prostate transrectal ultrasound scanning as a procedure to diagnose through images is the theoretical possibility of reaching an early diagnosis of prostate cancer. This paper compiles the author's experience in this field. Based on 142 established diagnosis of prostate cancer since 1984, the conclusion being reached is that prostate cancer has no pathognomonic signs, and therefore it is impossible to make an early diagnosis just by using the images obtained with transrectal ultrasound scanning. This procedure could be used, however, to select patients with scan abnormalities (Alarm signs) who should have a biopsy performed. The support of ultrasound-led transperineal biopsy of the prostate is currently indispensable to achieve an early diagnosis. This paper suggests that a biopsy should be done at the appearance of just one alarm sign, although this may involve a large number of cancer negative biopsies. The almost null incidence of complications from transperineal biopsies enhances this reasoning.

[Paraneoplastic syndromes in urology]. / Los síndromes paraneoplásicos en urología.

The paraneoplastic syndromes in patients with malignant urological tumors are reviewed herein. Some general aspects of these syndromes are briefly described and discussed. Similarly, the different urological tumors in which paraneoplastic syndromes have been observed are briefly reviewed. These are very common in renal cancer and cancer of the prostate, uncommon in bladder cancer and rare in testicular cancer.

[Fever and leukemoid reaction in bladder cancer: report of a case]. / Fiebre y reacción leucemoide en cáncer vesical: a propósito de un caso.

The authors present a unique case of bladder cancer that presented as paraneoplastic syndrome of fever and leukemoid reaction. Furthermore, the patient had a left renal tumor histologically similar to the bladder tumor. We discuss whether the foregoing was a metastatic or a primary tumor coexisting with a bladder tumor. The neoplastic syndromes affecting patients with bladder neoplasms are briefly discussed.

[Transrectal echography and cancer of the prostate. I. Echographic characteristics]. / Ecografía transrectal y cáncer de próstata. I. Características ecográficas.

Our diagnostic criteria in prostatic cancer using transrectal ultrasonography are described herein. A prospective study was undertaken since 1984 in a total of 1,512 patients. 75 of whom had cancer of the prostate. For the present study, we analyzed a series of ultrasonographic parameters that we have termed "intrinsic parameters" (IP) and "morphologic parameters" (MP). IP refer to the echo characteristic of the area within the prostate (intensity of brightness and size of granules) whereas MP refer to the general aspects of the prostate gland (ratio of transverse to anteroposterior diameter, shape deformity and rupture of capsule). The MP have proved to have a more diagnostics capacity; thus, when present, a diagnosis of prostatic cancer is made. IP changes alert us to suspect this condition. A T/AP ratio less than l, a "bell-shaped" prostate, is almost pathognomonic of prostate cancer since the foregoing has not been observed in benign conditions.

[Transrectal echography and cancer of the prostate. II. Comparison with digital examination of the rectum]. / Ecografía transrectal y cáncer de próstata. II. Comparación con el tacto rectal.

A comparative study was performed to determine the usefulness and diagnostic capacity in cancer of the prostate afforded by two different techniques: digital examination and transrectal ultrasonography. Our experience in 69 cases of prostate cancer show that more information is provided by transrectal ultrasound. Thus, the diagnostic capacity and usefulness of transrectal ultrasonography in the management of prostate cancer is greater than that of digital examination. However, on the sole basis of the number of cancers diagnosed, both techniques have very similar values for specificity, while transrectal ultrasonography is slightly superior with respect to sensitivity. The foregoing findings simply show that although both techniques have a similar diagnostic capacity, transrectal ultrasonography provides further important information (size, bladder involvement, graphic representation, etc.) that make it overall more useful and superior to the other technique in the management of prostate cancer.

[Transrectal echography and cancer of the prostate. III. Monitoring of the treatment response]. / Ecografía transrectal y cáncer de próstata. III. Monitorización de la respuesta al tratamiento.

The role of transrectal ultrasonography in monitoring response of prostate cancer to treatment with ciproterone acetate is described. In our therapeutic protocol for prostate cancer, those included between categories 7 and 9 are submitted to antidrogen therapy, regardless of the type of surgical procedure indicated in each case. Fifty-one patients submitted to this treatment modality were followed using transrectal ultrasound 3 months following diagnosis and every 6 months thereafter. The mean follow-up was 2 years Using the intrinsic and morphologic ultrasound parameters we have developed at our department, we can conclude that the changes in prostate size or volume and the changes in the intensity of brightness are the most reliable parameters in assessing the response to treatment. A good response to treatment is manifested by the reduced size of prostate and reduced intensity of brightness ("dark prostate").

[Transrectal echography of the prostate: current evaluation]. / Ecografía transrectal de próstata: evaluación actual.

Our results with transrectal ultrasonography of the prostate are updated herein. Since the specifically urologic ultrasound (Aloka SSD 520) equipped with a sectorial transrectal probe of 5 MHz, became available in our service in 1984, we have performed over 1,700 transrectal ultrasound procedures. From the outset, we established several lines of investigation whose partial results have been published over these past years. Our main interest has been and continues to be that of describing an unequivocal echo pattern that would define prostate cancer in any stage, particularly in its early stages. To date, no finding has proved to be pathognomonic. However, we believe that we have encountered some aspects that have been poorly described to date that allow us to determine the current role of transrectal US in the urologic setting. We support the concept of integral urologic ultrasonography, one that encompasses all of our activities. The present article is a synthesis of a major part of our investigative effort and includes our statistical data and current points of view. Our own experience has taught us that things may turn out to be different from what they initially appear to be. Thus, we cannot rule out that our views will not change in the future. We have therefore attempted not to be rigid with respect to our claims. We must add, however, that except for numerical changes and variations in the degree of significance of specific findings, no major modifications have had to be made during this period. We have divided the study into various parts. Each one reviews a specific pathology (cancer, prostatitis, adenoma...), some procedures (biopsy, puncture, sonometry), and a comparative study between classical and transrectal US (digital rectal examination and US). In all of the foregoing, we have presented our results and some considerations in the discussion. Finally, our current views regarding transrectal US are presented succinctly in the conclusions.