[A reliability analysis of transrectal echographic estimation of prostatic volume]. / Análisis de la fiabilidad de la estimación ecográfica transrectal del volumen prostático.

OBJECTIVE: To establish the reliability of transrectal ultrasound to estimate prostatic volume. MATERIAL AND METHODS: Study of 27 patients diagnosed with prostate cancer who were managed with radical prostatectomy. Transrectal ultrasound assessment of prostatic volume was performed using the revolution ellipsoid equation V = (pi/6) x L x T x AP. The values obtained were compared to those from radical prostatectomy specimens calculated by the same method and with the weights of the specimens. RESULTS: Mean prostatic volume estimated through transrectal ultrasound was 38.77 cc vs. 38.46 cc in the pathoanatomical specimens. Mean difference between both was 0.31 cc (not significant). The coefficient of correlation that related both values was 0.80 and the coefficient of correlation between transrectal ultrasound volume and weight was 0.86. CONCLUSIONS: Prostatic transrectal ultrasound is an accurate tool to calculate total prostatic volume.

[A diagnostic algorithm based on transrectal echography in failure of surgery correcting stress urinary incontinence]. / Algoritmo diagnóstico basado en la ecografía transrectal en los fracasos de la cirugía correctora de la incontinencia urinaria de stress.

Transrectal ultrasound is a dynamic imaging diagnostic technique for the study of stress urinary incontinence (SUI). The highest efficiency is obtained in the study of failed corrective surgery of SUI. Our group studied 23 patients reporting clinical SUI after undergoing corrective surgery, 23.3% patients with transrectal ultrasound showed no condition that could justify it (bladder neck hypermobility, intrinsic sphincteral incompetence, calcification of suspension threads, urethra diverticulum...); 34.8% showed bladder neck hypermobility, indicative of failed corrective surgery; 34.8% showed presence of open urethra at rest, an echographic sign of intrinsic sphincteral incompetence; and in 4.3% cases the existence of intravesical calcifications of the suspension threads was diagnosed. Transrectal ultrasound can become the choice test to perform in this group of patients, leading to the performance of other diagnostic tests and offering an adequate customized solution for each patient's problem.

[A bladder nephrogenic adenoma. A case report]. / Adenoma nefrogénico vesical. Descripción de un caso.

OBJECTIVE: To report an additional case of nephrogenic adenoma of the bladder. METHODS/RESULTS: A case of nephrogenic adenoma of the urinary bladder in a 28-year-old female is described. Patient clinical history and diagnostic imaging findings are presented. CONCLUSIONS: Nephrogenic adenoma of the bladder is a rare benign tumor with specific histological features that has been associated with previous surgery, trauma, infections and lithiasis. Although it is currently not considered to be a premalignant lesion, its rate of recurrence is high (37%-49%). The treatment of choice is by transurethral resection and yearly cytological, ultrasound and cystoscopic follow-up evaluation to detect recurrence.

[Echographic diagnosis of female urethral diverticulum]. / Diagnóstico ecográfico del divertículo uretral femenino.

OBJECTIVE: To describe the utility of transrectal ultrasound as an alternative imaging technique in the diagnosis of diverticulum of the female urethra. METHODS/RESULTS: A 35-year-old female that had been initially diagnosed as having a benign tumor of the vagina is described. The voiding cystogram, positive pressure urethrography with a double balloon catheter and urethroscopy were falsely negative for urethral diverticulum of the female urethra. Subsequent evaluation by transrectal ultrasound disclosed on oval-shaped, anechoic lesion located posteriorly to base of the bladder. CONCLUSIONS: Transrectal ultrasound could be the diagnostic imaging technique of choice in patients suspected as having diverticulum of the female urethra.

[Inguinal hernia containing the urinary bladder. Description of a case]. / Hernia inguinal que contiene vejiga urinaria. Descripción de un caso.

OBJECTIVE: Hernial pathology has a high incidence in the adult population. However, involvement of the urinary tract system in a hernial process constitutes an uncommon finding. This rare condition is analyzed in the present article. METHODS/RESULTS: A case of an inguinal hernia containing urinary bladder is described. No complications were found and surgical treatment was not required. CONCLUSIONS: Inguinal bladder hernia is rare and usually has no associated complications and the symptoms are scanty. Diagnosis is established by ultrasound and cystography. Treatment is by surgery, although in many cases this condition requires no treatment.

[Value of transrectal ultrasonography in the assessment of failures of stress urinary incontinence surgery in women]. / Valor de la ecografía transrectal en la evaluación de los fracasos de la cirugía de la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: To describe the role of transrectal ultrasonography as an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. METHODS: The means of independent samples of transrectal ultrasound parameters of two groups of patients (group I, patients who were continent after surgery; group II, patients who remained incontinent after surgery) were compared. RESULTS: Patients who were continent after surgery showed scanty caudal and dorsal mobility of the bladder neck and proximal urethra during the periods of increased intraabdominal pressure. The US finding in this group of patients is characterized by a funnel surrounding the bladder neck and the proximal urethra. The existence of an intrinsically incompetent sphincter can also be determined with this technique. CONCLUSIONS: Transrectal ultrasonography constitutes an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. It permitis determining whether incontinence is due to a failed procedure, the existence of an intrinsically incompetent sphincter, or whether other causes of incontinence should be investigated.

[Erectile dysfunction: clinical course with intracavernous PGE1]. / Disfunción eréctil: aspectos evolutivos con la PGE1 intracavernosa.

OBJECTIVES: The results achieved with PGE1 therapy in 66 patients with erectile dysfunction in our self-injection program are presented. METHODS: Patients with severe conditions (cancer, infectious disease, renal and hepatic failure, etc.), psychological or hormonal disorders were discarded from the study. All patients were tested with PGE1, the dose was adjusted according to individual response, the patient was instructed how to inject the vasoactive drug and included in the self-injection program. Statistical analysis of the data was performed using the chi-square and the Student 't' test. RESULTS: The mean follow-up was 9.8 months (range 1-39). Twenty-five patients (37%) withdrew from the program. Six patients (9%) received another treatment due to pain or poor response. A penile prosthesis was implanted in five patients and one patient was treated with a vacuum erection device. Although not statistically significant, local pain was associated with a shorter follow-up. Prolonged erection was also observed but did not influence the length of follow-up. CONCLUSIONS: Local pain has been associated with a shorter follow-up. A small number of non-responders warranted another therapy.

[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.

[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.

[Diagnostic and therapeutic retrograde ureterorenoscopy (URS)]. / Ureterorrenoscopia retrograda (URS) diagnostica y terapeutica.

Presentation of results obtained in 50 procedures of retrograde ureterorenoscopy (URS), and discussion based on the literature and our results, on the current indications for URS with regard to extracorporeal lithofragmentation (ECL) for the treatment of pelvic ureteral lithiasis and the diagnosis and/or treatment of other conditions. Fifty URS were performed in 47 patients between February 1992 and March 1994: 35 were conducted to treat ureteral lithiasis, achieving a 97% success rate and a mean post-surgery hospital stay of 48 hours; and for diagnostic and/or therapeutic reasons. There were no major complications, and a description is made of minors cases. We prefer to use URS in those cases of distal ureteral lithiasis, as compared to ECL, because of its level of efficacy (higher than or equal to ECL), low cost/benefit ratio, low morbidity and shorter hospital stay involved. The paper emphasizes the major diagnostic and therapeutical indications for URS, and finally, it is noted that URS can avoid undertaking other more aggressive urinary by-passes, since it allows to catheterize the ureters where a false intramural route is conducted.

The value of transrectal ultrasonography in the diagnosis and treatment of partial obstruction of the seminal duct system.

We report a case of male subfertility with ejaculate volume less than 1 cc and moderate oligoasthenozoospermia. Partial obstruction of the seminal duct system was suspected and transrectal ultrasonography revealed a müllerian duct cyst. We confirmed the diagnosis with transperineal puncture and contrast filling of the cyst and seminal vesicles. This procedure allowed us to avoid scrotal vasostomy and perform conventional vasography as well as to measure the distance between the ceiling of the cyst and the urethra, which facilitated subsequent transurethral surgery.

[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.

[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.

[Eosinophilic cystitis]. / Cistitis eosinofílica.

We report two cases of eosinophilic cystitis that had been diagnosed anatomo-pathologically after TUR. These patients had a previous history of low grade and stage superficial bladder tumor that had been treated by intravesical interferon after surgery. The literature is reviewed highlighting the etiopathogenic aspects, the possible relationship with immune allergic factors, clinical aspects, diagnosis and treatment.

[Cystic pyeloureteritis. Our approach]. / Pieloureteritis quística: nuestra actitud.

We report a case of massive cystic pyeloureteritis that had been diagnosed by ureterorenoscopy in a patient with recurrent urinary infection and episodes of nephritic colic. The reports published in the literature indicate there is no specific treatment for this disease whose etiology is unknown. Its pathogenesis has not been well-established and it is difficult to distinguish from other urothelial filling defects. Although it has also been reported that it may progress to malignancy, we believe that the therapeutic approach should be conservative.

[Eosinophilic cystitis associated with transitional cell carcinoma: apropos a case]. / Cistitis esosinófila asociada a carcinoma de células transicionales: a propósito de un caso.

An additional case of eosinophilic cystitis coexisting with transitional cell carcinoma of the bladder is presented. The patient was treated with antihistamine but posteriorly presented with an infiltrating tumor that warranted a cystectomy procedure and ureteroileostomy. The patient is currently symptom-free.

[Inverted papilloma of the ureter]. / Papiloma invertido de uréter.

We report a case of inverted urothelial papilloma localized to the ureter in a patient with solitary kidney. Treatment was by segmental resection and end-to-end anastomosis. In spite of the benign nature of this tumor type and because treatment is conservative, patients should be closely followed owing to the possibility of recurrence and because progression to malignancy has been reported in the literature.

[Monoclonal gammopathy and osteolytic lesions as the initial manifestation of a metastatic hypernephroma]. / Gammapatía monoclonal y lesiones osteolíticas como primera manifestación de un hipernefroma metastásico.

We report on a patient with metastatic renal adenocarcinoma that had been detected following evaluation for monoclonal gammopathy associated with osteolytic lesions. When the foregoing associated conditions present, we must discard the presence of a myeloma. No objective data relating gammopathy with tumor behaviour are currently available.