[Results of a screening program for prostatic cancer]. / Resultado de un programa de screening para el cáncer de próstata.

OBJECTIVE: To set up the epidemiology of prostate cancer in the geographical area of Getafe, Madrid (Spain) and to detect curable prostate cancer. The results of screening 2.576 men are reported. PATIENTS & METHODS: Patients underwent digital rectal examination (DRE) and PSA determination. Patients with suspicious DRE or PSA greater than 4 ng/ml were further evaluated with transrectal ultrasonography (TRUS) and biopsy. The diagnostic performances of the tests or combinations of tests were determined. RESULTS: Mean age was 59.9 years (median 58 years). Ninety-four patients (3.6 per cent) had abnormal DRE while PSA was higher than 4 ng/ml in 169 patients (6.5% of the total). 6.8 biopsies were needed to prove one cancer. The higher sensitivity corresponded to the PSA (93%). The test of greatest specificity was the rectal examination (97%). Positive predictive value raised to 78.9% when both DRE and PSA were abnormal. Advanced tumor stages were more common (39.4%) than in previous experiences. CONCLUSIONS: PSA should be the first diagnostic test when screening for prostate cancer. Neither the DRE nor the TRUS have any place in patients with PSA below 4 ng/ml. In summary we can't encourage screening programs for prostate cancer so far.

[Diabetic neurocystopathy: multivariate study]. / La neurocistopatía diabética: estudio multivariante.

OBJECTIVE: To analyze the prevalence of urodynamic disorders and the factors associated with bladder instability in patients with diabetes mellitus. METHODS: We conducted a clinical and urodynamic study on 138 diabetic patients (71 males, 51%; 67 females, 49%) with a mean age of 64.04 years. Patient evaluation included patient history, neurological physical examination, cystometry, pressure-flow test, filling videocystography and selective EMG of the periurethral sphincter. Data obtained were analyzed by multivariant logistic regression analysis, taking the probability of developing bladder instability as a dependent variable. RESULTS: Bladder instability was the most frequent urodynamic finding (52%), followed by lower urinary tract obstruction (44%), involvement of bladder contractility (41%) and stress urinary incontinence (22%). Lower motor neuron (S2-S4) pudendal nerve lesion was observed in 33% of the cases and 24% had upper motor neuron involvement. Multivariant analysis showed age and stress urinary incontinence (inverse correlation) to be the only independent variables for bladder instability. The other variables that correlated with instability (but dependent on the foregoing variables) were involvement of bladder contractility and type of diabetes (higher probability for diabetes type II). No correlation was found for sex, duration of the diabetes, stroke (CVA), urinary obstruction or pudendal nerve lesion. CONCLUSIONS: Bladder instability was found to be the most frequent urodynamic disorder in diabetic patients. The probability of developing bladder instability increases with age and decreases in patients with stress urinary incontinence.

[Flowmetry analysis in patients undergoing transurethral resection of the prostate for BPH]. / Análisis flujométrico en pacientes sometidos a RTU de próstata por HBP.

Transurethral resection (TUR) is the most frequent surgical treatment for symptomatic benign prostate hyperplasia (BPH). Prostate size is a significant factor for choosing TUR versus prostate adenomectomy. Analysis of flowmetry results obtained with TUR in 203 patients, based on weight of resected prostate tissue. Flowmetry was performed prior to TUR and prostate size was estimated with transabdominal ultrasound. Prostate tissue was weighed after TUR and a new flowmetry was performed 6 months after treatment. Mean weight of resected tissue was 31.34 g. When all flowmetry parameters analyzed pre-and post TURs were compare, there were significant differences (p < 0.001). Increased maximum flow (Qmax) and increased mean flow (Qmed) occurred in 91.7% and 96.31% patients, respectively. Mean increase of post-surgical Qmax was significantly higher (p > 0.01) in patients with Qmax prior to surgery lower than 8 ml/s. No significant correlation was demonstrated between prostate volume measured by ultrasound or resected prostate tissue and increased post-surgical Qmax. TUR improves flowmetry parameters, mainly in patients with pre-surgical Qmax lower than 8 mL/s. Extensive prostate resection does not appear to improve the flowmetry results obtained with a sufficient functional TUR.

[Yield of ultrasonography-guided transrectal biopsy in the diagnosis of carcinoma of the prostate]. / Rendimiento de la biopsia transrectal ecodirigida en el diagnóstico del carcinoma de próstata.

OBJECTIVES: The present study analyzes the combination of digital rectal examination (DRE), prostate specific antigen (PSA), transrectal ultrasound (TRUS) and ultrasound-guided transrectal biopsy in the diagnosis of prostate cancer. METHODS: 115 of 224 patients (51.3%) were biopsied due to a suspicious DRE and/or PSA > 4 ng/ml, and/or DPSA > 0.15, and/or the presence of a hypoechoic lesion on TRUS. RESULTS: Adenocarcinoma of the prostate was diagnosed in 28 (24.3%) of these 115 patients. The positive predictive value (PPV) for carcinoma of the prostate was 4.76% if PSA was < 4 ng/ml, 5.12% if PSA was 4.1 to 10 ng/ml, and 48% if PSA was > 10 ng/ml. If DPSA is considered, the PPV is 7.4% if PSA is 4.1 to 10 ng/ml and 51.02% if PSA is > 10 ng/ml. If DRE is suspicious, the PPV is 43.6%, with a sensitivity of 85.7% and a specificity of 63.9%. The PPV for carcinoma of the prostate was 34% for a hypoechoic lesion on TRUS, 50% if DRE is suspicious, 53.5% is PSA is > 10 ng/ml and 65% if DRE is suspicious and PSA > 10 ng/ml. CONCLUSIONS: The detection rate of carcinoma of the prostate is increased when DRE, PSA, TRUS and US-guided transrectal biopsy are used in combination.

[Conservative treatment of muscle-infiltrating bladder tumors with TUR]. / Tratamiento conservador mediante RTU de los tumores vesicales musculoinfiltrantes.

OBJECTIVES: The absence of tumor in up to 10% of cystectomy specimens of patients with invasive bladder cancer justify the search for non aggressive therapies. The present study attempts to establish the safety and curative capacity of TUR alone for patients with superficial muscle-infiltrating bladder cancer. METHODS: Over a period of 18 months, 12 patients with superficial muscle-infiltrating bladder cancer (T2) were diagnosed at our department, TUR was repeated in 9 of the 12 patients. The extension study was negative in all 9 patients. RESULTS: The mean follow up was 12.8 months (range 7-70 months). Local recurrence was found in 4 patients (44.4%) who were submitted to another TUR; 3 were superficial and 1 invasive (with the same muscle involvement as at the initial diagnosis). The tumor-free survival rate was 9.3 months. No patient showed tumor progression. CONCLUSION: The percentage and nature of local recurrence, tumor-free survival and the progression rate (which was not observed during the short follow up period) indicate that TUR is a treatment option that must be taken into account in selected patients with invasive bladder cancer.

[Expectant treatment of superficial bladder tumors: preliminary results]. / Tratamiento expectante de los tumores vesicales superficiales: resultados preliminares.

A group of patients presenting with superficial bladder tumors (Ta-T1, G1-G3) was entered in a surveillance program following TUR. A standard univariative analysis was used to study tumor and patient prognostic factors to recurrence and progression. To define further the importance of each variable, a multivariative analysis was performed. Regardless of stage, grade and sex, patients with multiple tumors and/or size > or = 2 cm were particularly exposed to frequent recurrences. Early recurrences (before month 9) were associated with high recurrence rates. Considering the results of topical chemotherapy and toxicity of BCG immunotherapy, surveillance could be and option for superficial bladder tumors, reserving adjuvant therapy for large, multiple or early recurrence.

[Transrectal ultrasonography technique in stress urinary incontinence in women]. / Técnica de la ecografía transrectal en la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: This study describes the use of transrectal ultrasound as an alternative to cystography in the assessment of female stress urinary incontinence. The procedure and the different parameters that must be evaluated are also described herein. METHODS: The patients were evaluated in the standing position and saggital sections were obtained with a transrectal transducer. The bladder was filled with saline and the test was done at rest using the Valsalva maneuver with or without a bladder catheter. RESULTS: In these patients with female stress urinary incontinence, bladder neck movement was dorsal and caudad, the most important observation being bladder neck descent. Furthermore, we found an increased posterior urethrovesical angle. CONCLUSIONS: Transrectal US is an alternative imaging technique in the assessment of patients with stress urinary incontinence that is easy to learn and avoids exposure of the patients to radiation.

[The relationship of PSA to age and prostatic volume in patients with benign prostatic hypertrophy]. / Relación del PSA con la edad y el volumen prostático en pacientes con hiperplasia benigna de próstata.

Prostate specific antigen (PSA) is the most useful market for the diagnosis, staging and monitoring of prostate cancer. However, the effect of benign prostate hyperplasia on PSA levels is less well known. It has been reported that 20-45% of all adult males with BPH have PSA values over the normal range. To study this confounding factor we have analyzed the likely relationships between monoclonal PSA, age and prostate size as determined by ultrasound, in our series of 163 patients with BPH undergoing adenomectomy. Within the studied factors, the most conditioning parameter of PSA variability was prostate size. The correlation coefficient (r) was 0.61, with the determination coefficient (r2) being 0.037 (p < 0.001). Age correlation, although less important (r = 0.31), was statistically significant. Both variables were independent and resulted jointly in a correlation coefficient of 0.64. Also included is the mathematical formula used in our series to correlate PSA with age and prostate volume. Its application could mean an increased specificity of this tumoral marker.

[Transrectal echography in tuberculous prostatitis]. / Ecografía transrectal en la prostatitis tuberculosa.

Tuberculous prostatitis is diagnosed incidentally, when the pathologist is studying a specimen of transurethral resection of the prostate or a prostatic biopsy. There is scant literature on the role of transrectal ultrasound in the diagnosis of this pathology. A case of tuberculous prostatitis is presented, with special reference to the transrectal ultrasound pattern. A complete review of the references on the imaging techniques in this pathology is done.

["Supreme" dressing in the prevention of hematoma and edema in scrotal surgery]. / Vendaje "sumo" en la prevención del hematoma y edema en cirugía escrotal.

An efficient compression can reduce the complications of an inadequate hemostasis following scrotal surgery. The main difference between the "sumo" and previously described compressive methods lies in the use of both pelvic brims as main loading points for the dressing. Similar features are provided by standard scrotal supports but the compression they are able to achieve is minimal compared to that of "sumo" dressing.

[Ureteral resection of ureteral inflammatory polyp associated with lithiasis]. / Ureteroresección de un pólipo inflamatorio ureteral asociado a litiasis.

We report on a fibroepithelial polyp case with inflammatory characteristics located in the pelvian ureter, and related with an ureteral calculus, which was treated in a conservative way with ureteroscopic resection, after the pincer extraction of the stone. Our team found two fibroepithelial polyp cases in the bibliography reviewed treated with ureteroscopic resection. We consider that the polyp's reactive inflammatory nature is due to the urothelial chronic irritation caused by the calculus.

[Non-surgical treatment of testicular cancer: guidelines for the urologist]. / Aspectos no quirúrgicos del cáncer testicular: guía práctica para el urólogo.

Near 70% of patients diagnosed with testicular seminoma make their presentation without metastasis. Although spread at the time of diagnosis is the rule, 25% of non-seminomatous germ-cell tumours are found confined to the testicle at presentation. Standardization of diagnostic and follow-up methods -within reach of most urology services- should allow a closer relationship between urologists and testicular tumours. Observation of "aggressive" surveillance schedules for stage I non-seminomatosous tumours confined with no risk factors, and use of radiotherapy to treat low degree (I,IIa and IIb) seminomas should allow urologists an initial control of up to 50% of patients. Occurrence of relapse or presentation in advanced stages force the use of chemotherapy. The present paper outlines the most basic aspects of non-surgical treatment of patients with testicular tumours.