Testosterone/estradiol ratio, is it useful in the diagnosis of erectile dysfunction and low sexual desire?

Erectile dysfunction and low sexual desire are multifactorial diseases. The decrease in testosterone levels is one of the causes, but the effect of estradiol is not well known. Moreover, study has shown that the testosterone/estradiol ratio has more influence over sexuality than does estradiol alone. The aim of the study was to determine whether the balance between testosterone and estradiol has any relation to some aspects of sexual function. It was an ambispective study of 230 patients with urological problems unrelated to sexuality. They underwent a detailed history and hormone study including total, free, bioavailable testosterone and estradiol. They completed the Sexual Health Inventory for Men and questions 11 and 12 of the IIEF15 were used to assess impairment in sexual desire. The T/E ratio was calculated, and the relationship between the different parameters and erectile function and sexual desire were studied by univariate and multivariate analysis. The mean age was 66.32 ± 8.17 years. The percentage of patients with erectile dysfunction was 60.9% (7% severe, 14.3% moderate, 12.6% mild to moderate and 27% mild) and decreased sexual desire was 46.5%. Age, free and biodisponible testosteron were the only variables with a positive linear association with erectile dysfunction and decreased sexual desire. Age was the only independent variable for both, erectile dysfunction and sexual desire, in the multiple linear regression. There was no association between a testosterone/estradiol imbalance and an alteration in erectile function and sexual desire. Consequently, in the clinical study of these patients, it is not necessary to request estradiol in the laboratory analyses.

Quality of life in patients with non-muscle invasive bladder tumor undergoing adjuvant intravesical treatment.

INTRODUCTION: The objective of the study was to establish a possible relationship between mitomycin-C (MMC) and bacillus Calmette-Guérin (BCG) treatments and quality of life impairment. MATERIAL AND METHODS: Quasi-experimental, prospective, and longitudinal study including patients undergoing adjuvant treatment in NMIBC. The Short form-12 (SF-12) and Urogenital Distress Inventory-6 (UDI-6) questionnaires were used to measure quality of life. Questionnaire scores were compared between cases with MMC and BCG before induction (M1), at 4 weeks (M2) and at 2 months (M3). RESULTS: Of the 90 patients enrolled, 54 were in the BCG group and 36 in the MMC group. It was found that BCG patients had worse perceived physical quality of life compared to MMC patients in M2 (OR:2.59, p=0.046). In addition, significant changes were found in the urinary quality of life of patients on MMC treatment between the different time points (UDI-6 score: 33.33 in M1, 27.78 in M2 and 16.67 in M3, p=0.001). CONCLUSIONS: There are no differences in urinary quality of life between patients treated with MMC and BCG. Patients with MMC show a significant recovery of urinary quality of life from the completion of the induction course, which becomes even more significant after 2 months. In addition, BCG-treated patients have worse physical quality of life after 4 weeks of treatment than those treated with MMC.

Genetic profile and immunohistochemical study of clear cell renal carcinoma: Pathological-anatomical correlation and prognosis.

INTRODUCTION: Renal cell carcinoma (RCC) accounts for 2-3% of all tumors being the most frequent solid lesion in the kidney. OBJECTIVE: To determine what genetic alterations and immunohistochemical (IHC) of clear cell renal carcinoma (ccRCC) are associated with prognosis and tumor aggressiveness. PATIENTS AND METHODS: Experimental analytical study with 57 patients who underwent radical and partial nephrectomy between 2005 and 2011, all with diagnosis of ccRCC and minimum post-operative follow-up of 36 months. The pathological study included IHC determination of biomarkers associated (CAIX, CAM 5.2, CD10, c-erbB-2, EGFR, HIF-1a, Ki67, MDM2, PAX-2 y 8, p53, survivin and VEGFR 1 and 2). Genetic analysis was carried out using multiplex ligation-dependent probe amplification (MLPA). Clinical data were collected and summarized using an access-type database, adding genetic analysis and IHC data of each patient's tumor sample. IHC statistical analysis included Chi-square, Kruskal-Wallis and multivariate analysis. The genetic analysis was performed using multivariate logistic regression (normal/deletion-duplication). Significance level p<0.05. RESULTS: Pathologic stage was: pT1 (61.8%), pT2 (32.7%); pT3-T4 (5.4%); 16.3% were pN+ and 19.3% M1. 23.6% recurred being predominantly to distance in 83.3%. 27.3% of patients died (73.3% ccCCR). CAIX (Carbonic anhydrase IX) and tumor size were associated with worse Fuhrman grade (p = 0.035; p = 0.001 respectively). Deletion-duplication of genes increased the likelihood: of death (APC, Bcl-2 and CDKN2A by 11, 7 and 4 respectively and SMAD4 reduced the probability by 88%); tumor recurrence (CDKN2A by fifteen fold and VHL reduced the probability by 87%); pT greater than 2 (CCND2, MDM2 and WT1 multiplied by 6, 7 and 9); risk of N+ (CDK4 and EBF1 by 13); distant metastases (BRCA2 and DLEU1 by 5); Fuhrman grade ≥3 (BRCA1, BRCA2 and p53 by 40, 75 and 34 respectively, while that FHIT reduced by 96%). Deletion-duplication of CDK4 and DCC increased survival by a factor of 13 and 16, while that DLEU1 and RUNX1 decreased survival time by 80%. CONCLUSION: CAIX and tumor size are associated with increased aggressiveness. The mutations to level 5q, 9p, 11p, 12, 13q, 17, 18q and 21q are associated with more aggressive tumors and with worse survival rate.

Factors related to early castration resistance in metastatic prostate cancer. Results from the National Prostate Cancer Registry in Spain. / Factores relacionados con la resistencia a la castración precoz en el cáncer de próstata metastásico. Resultados del Registro nacional de cáncer de próstata en España.

INTRODUCTION: The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. MATERIAL AND METHODS: 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). RESULTS: Mean follow-up 26,2±13,4 months. 47.1% developed early CR, with mean time until onset of 12,2±8,7 months. Univariate analysis the mean PSA was correlated with CR (290±905,1 ng/mL in non CR, 519,1±1437,2 ng/mL in CR, P<.001), mean age (73,3±8,3 years in non CR, 69,1±9,3 in CR P=.01), mean PSA nadir (15,5±57,3ng/mL in non CR, 15,9±23,7 ng/mL in CR, p<0,001), Gleason (in ≥8, HR:2,11. 95% CI: 1.22-3.65, p=0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P<.001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P=.01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P<.001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P=.02). CONCLUSIONS: PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term.

[Changes in sexual hormones in a male population over 50 years of age. Frequency of low testosterone levels and risk factors]. / Cambios en las hormonas sexuales en varones mayores de 50 años. Prevalencia de niveles bajos de testosterona y factores de riesgo.

OBJECTIVES: To investigate the changes in sexual hormones in a selected male population older than 50 years of age. To assess the frequency of biochemical hypogonadism and which factors are related to testosterone levels. PATIENTS AND METHODS: A Cross-sectional study was carried out on 230 Spanish men older than 50 years of age. Blood tests were performed including: total testosterone, SHBG, calculated free testosterone, dehidroepiandrosterone sulfate, androstendione, estradiol, bioavailable estradiol, FSH, LH, and prolactin. Clinical and socio-demographic backgrounds were investigated. The frequency of biochemical hypogonadism was established using total and free testosterone levels as diagnostic criteria. Factors that may influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression model was used to determine which factors can predict biochemical hypogonadism according to free testosterone levels. RESULTS: Age was associated with a significant decrease (p < 0.05) in total testosterone (0.6% per year), free testosterone (1.3% per year), dehydroepiandrosterone sulfate (1.8% per year) and bioavailable estradiol (0.69% per year). Moreover, an increase in SHBG, LH, and FSH was observed (p < 0.05). According to total testosterone levels, 4.8% of the men were hypogonadal, whereas 24.8% were hypogonadal when free testosterone was considered. In the univariate analysis, obesity, diabetes mellitus and hyperlipemia were related to lower total testosterone levels, while free testosterone levels were lower in men with sedentary life, lower levels of education, obesity or diabetes mellitus. In the multivariate analysis age, diabetes mellitus and obesity were inversely related to total and free testosterone levels. Free testosterone was also inversely related to hyperlipemia. For biochemical hypogonadism, simple logistic regression analysis selected age, sedentary life, obesity and diabetes mellitus. In the multivariate analysis age, obesity and diabetes mellitus had significant independent prognostic value. CONCLUSIONS: Starting from 50 years of age, a significant age-related decrease in total testosterone, free testosterone, dehydroepiandrosterone sulfate and bioavailable estradiol is observed. The frequency of biochemical hypogonadism is higher when free testosterone levels are used for diagnosis. Total testosterone levels were related to age, diabetes mellitus and obesity. Free testosterone was related to age. diabetes mellitus, obesity and hyperlipemia. The probability of suffering low free testosterone levels increases with age, diabetes mellitus and/or obesity.

[Radical cystectomy as a muscle-invasive bladder cancer treatment in elderly patients]. / Cistectomía radical como tratamiento del cáncer vesical infiltrante en el paciente de edad avanzada.

INTRODUCTION: Radical cystectomy in elderly is a controversial issue that increases importance overtime because average life span is growing. OBJECTIVE: The purpose of our work was to analize the differences about perioperative and later outcomes between ages of patients with muscle-invasive bladder neoplasm treated with radical cystectomy. MATERIAL AND METHODS: We retrospectively reviewed the records of patients who underwent radical cystectomy for muscle-invasive bladder cancer. Two age groups were compared: < 70-years-old at time of cystectomy (n = 55) and > or = 70 years (n = 57). RESULTS: There was no difference between both age groups about: time of surgery, intraoperative complications (< 70 = 21,8%, > or = 70 = 31,6%), postoperative mortality (< 70 = 3,6%, > or = 70 = 8,8%), minor (< 70 = 18,2%, > or = 70 = 26,3%) and major medical postoperative complications (< 70 = 7,3%, > or = 70 = 8,8%), late outcomes as cancer-specific morby-mortality and actuarial overall survival stratified by patient age. The rate of major postoperative complications (< 70 = 23,6%, > or = 70 = 43,9%) as well as the mean length of hospital stay (< 70 = 10,2, > or = 70 = 15,2 days) differed significantly between the two age groups. Age and cardiovascular risk factors were independient predictive factors of mayor postoperative complications. CONCLUSIONS: Radical cystectomy could be performed in carefully selected elderly patients.

hTERT mRNA expression in urine as a useful diagnostic tool in bladder cancer. Comparison with cytology and NMP22 BladderCheck Test®. / Expresión de ARNm de hTERT en orina como herramienta diagnóstica útil en cáncer de vejiga. Comparación con citología y NMP22 BladderCheck Test®.

INTRODUCTION: To study the relationship between quantitative mRNA determination (hTERT) in patients with bladder tumor, history of bladder tumor, and in subjects without a history of this neoplasia. MATERIAL AND METHODS: A prospective randomized controlled study with 91 subjects included. The value of mRNA-hTERTN was determined in 63 patients with a history or suspicion of bladder tumor and in 28 controls. Urine samples were sent for evaluation of the mRNA level (hTERT), the cytological study and the NMP22 result. RESULTS: Differences were observed in mean hTERTN levels in each of the groups: tumor presence 21.33+/- 40.66, tumor history 2.16+/- 2.67, controls 0.9+/- 1, 75 (p<0.001). In patients with tumor, there was no difference in mean hTERTN levels between the different grades and stages, although there was a tendency: low grade tumor 9.04+/- 16.95, high grade 28.95+/- 48.36 (p=.069), stage Ta 10.33+/- 19.39, T1 17.88+/- 27.14, T2 54.8+/- 74.05 (p=.056). In addition, the sensitivity of hTERTN was superior to that of other test (76%), although specificity and positive and negative predictive values were better for cytology (94%, 88.4% and 72.3% respectively) and NMP22 (88%, 80.6% and 73.3% respectively). CONCLUSIONS: hTERTN mRNA levels in urine were higher in patients with bladder tumors compared to patients with a history of bladder tumor and with negative cystoscopy, as well as in the control group. This determination showed a higher diagnostic yield compared with the detection of NMP22 and urinary cytology.

[Use of prostatic specific antigen in primary care (PSA)]. / Uso del antígeno prostático específico en atención primaria (PSA).

INTRODUCTION: In the literature it is shown that the use of PSA is occasionally wrong, by requesting this marker in very young or very old men, and repeated measurements in short periods of time. The main objective of this study was to describe the use of PSA in daily practice by primary care physicians in our area, dealing with aspects such as the importance of patient age, the value in the screening for prostate cancer, or the subjective beliefs about its usefulness. A secondary objective was the comparison of use, and beliefs among doctors who claim to know PSA well, and those who do not. PATIENTS AND METHODS: A descriptive and comparative study was conducted using questionnaires that were handed to primary care doctors in all health centres in our area. A descriptive analysis was performed and response rates among doctors who thought they had enough information about PSA, and those who did not, were compared using the Chi-squared test. RESULTS: A total of 103 questionnaires were received from the physicians, with 83.5% claiming to have sufficient knowledge about the PSA. The professionals in this latter group request PSA at an earlier age (P=.029), with a higher frequency (P=.011) and have more doubts about its usefulness (P=.009) than those with less knowledge. Almost half (49.5%) said they request less than 50 determinations per year, and 33% between 50 and 100. More than half (53.4%) of doctors would not request the first PSA on a patient until their 50s, and up to 49% request it up to 80 years. The true value of PSA has been established many times by 64.1% of requesters, and 29.1% believe it is unhelpful in the diagnosis of cancer. CONCLUSIONS: In our study, 64% of primary care physicians have considered the true value of the PSA several times, and 29% believe it to be of little use in the diagnosis of prostate cancer. In addition, some data suggest it has limited use due to the fact that 50% made less than 50 PSA requests per years, and 28% of the professionals would never request it on a male without urinary symptoms. In this study, it has been observed that those professionals who claim not to have enough information about the PSA make more requests in patients of an older age, and consider that it is of limited use as a marker.

Satisfaction and treatment adherence in erectile dysfunction in the medium and long term. / Satisfacción y adherencia al tratamiento en disfunción eréctil a medio y largo plazo.

INTRODUCTION: The aim of this study was to show the satisfaction and treatment adherence in erectile dysfunction (ED) in the medium and long term. MATERIAL AND METHODS: A descriptive, comparative study was conducted in 2 centres through telephone interviews with patients who came for an initial visit between 2012 and 2014 for ED. A complete case history review was conducted on the use of and withdrawal from treatment. For current use, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Global Assessment Questionnaire (GAQ) were filled out; for past use, only the GAQ was filled out. For the statistical analysis, we employed Fisher's exact test for comparisons of percentages and the Kruskal-Wallis test to compare means. RESULTS: The study included 250 patients; 20.8% were prescribed intraurethral alprostadil (ALP-IU), 17.2% were prescribed intracavernous alprostadil (ALP-IC), 92.8% were prescribed a first IPD5, and 24.8% were prescribed at least a second IPD5. The treatment withdrawal rate was 62.07% for the first IPD5, 41.94% for the last IPD5, 69.23% for the ALP-IU and 65.11% for the ALP-IC (P=.007). The main reason for withdrawal for the IPD5 was a lack of response (32.76% of those who took IPD5). In addition to withdrawal, there were adverse reactions for ALP-IU and ALP-IC (28.85% and 11.63%, respectively). The mean duration of use until withdrawal was 4.3 months for IPD5, 2.2 months for ALP-IU and 5.5 months for ALP-IC (P=.064). The most favourable GAQ and EDITS scores were observed for IPD5 (EDITS score of 74). Sildenafil and tadalafil had the longest usage times (mean >5 months). CONCLUSIONS: The withdrawal rate for treating ED is high, with short usage times of a few months. A lack of response and adverse reactions were the main causes for withdrawal. The drugs that provide greater satisfaction are the IPD5, although there are no significant differences in the mean usage time between the different types and in aspects such as the mean usage time to withdrawal or the withdrawal rates.

[Evaluation of an immunoassay kit to measure free testosterone]. / Evaluación de una técnica de inmunoanálisis para la determinación de testosterona libre.

INTRODUCTION AND OBJECTIVES: The best indicators to the diagnosis of hypogonadism are free and bioavailable testosterone circulating levels. Free and bioavailable testosterone measurements are complex. However, simple kits for direct measurement of free testosterone by analog immunoassay are available. We examined the utility of an enzymoimmunoassay kit for free testosterone measurement. MATERIAL AND METHOD: One hundred thirty-three healthy males were included. Total testosterone, SHBG, albumin and free testosterone was measured. We used two different methods to free testosterone estimation: direct measurement by enzymoimmunoassay and mathematical calculation with Vermeulen's formula, which uses albumin concentration, total testosterone and SHBG to calculate free testosterone (method recommended by the International Society for the Study of the Aging Male). We compared the two methods means values and a linear regression study was performed. RESULTS: Mean age was 37 +/- 11 years. Mean serum concentration for total testosterone was 21.43 +/- 6.8 nm ol/L. The mean value for free testosterone measured by direct and mathematical method was 0.0508 +/- 0.0118 nmol/L and 0.474 +/- 0.123 nmol/L respectively. In linear regression study exists a positive correlation between both methods (p< 0.05), although correlation coefficient is very low (r = 0.25). CONCLUSIONS: There are significant statistical differences between the measurements of free testosterone by direct and mathematical methods. Although certain correlation is observed, this is very low. In conclusion, free testosterone measurement by enzymoimmunoassay is not reliable.

Use of individual containers for prostate biopsy samples: Do we gain diagnostic performance? / Uso de contenedores individuales para las muestras obtenidas en biopsia prostática: ¿ganamos en rendimiento diagnóstico?

OBJECTIVE: Prostate cores from transrectal biopsies are usually sent in separate vials for pathological processing. Although this is a common practice, there are controversial studies on its usefulness. We wanted to compare the rate of prostate cancer diagnosis between processing samples in 2 containers and processing them in individual containers to see if there are differences. Our secondary objective was to check the rate of diagnosis of various tumour subtypes in each of the 2 groups. MATERIAL AND METHODS: A retrospective observational study was conducted of 2,601 cases of prostate biopsies. Ten cores were extracted in each biopsy. We divided the sample into 2 groups: biopsies sent in 2 containers to the department of pathology (left and right lobes) or sent in 10 (one for each cylinder), according to the different criteria used in our centre in the past. We then classified the cases according to the absence of neoplasia, insignificant tumour (involvement of just 1 cylinder, <5%, Gleason score<7), Gleason 6 or Gleason≥7. A bivariate statistical analysis was performed using the chi-squared test. RESULTS: A total of 1,777 participants were included in the 2-container group, and 824 were included in the 10-container group. We diagnosed a rate of 32.4% of cancers in the 2-container group and 40% in the 10-container group, a difference that was statistically significant (P<.001). The insignificant carcinomas were diagnosed more often in the 2-container group than in the 10-container group (6.4% vs. 4.3%, respectively; P=.03). Samples with a Gleason score of 6 were diagnosed more often in the 10-container group than in the 2-container group (11.9% vs. 8.1%, respectively; P=.002). The same occurred with the Gleason score≥7 (23.8% in the 10-container group vs. 17.9% in the 2-container group; P<.001). CONCLUSIONS: We diagnosed more prostate cancers when sending biopsied cores in individual containers. Once the procedure was conducted, we also observed in our series a reduction in the diagnoses of insignificant carcinoma to the detriment of an increased diagnosis of not insignificant carcinomas.

Influence of demographic and tumour variables on prostate cancer treatment with curative intent in Spain. Results of the 2010 national prostate cancer registry. / Influencia de las variables demográficas y tumorales en el tratamiento del cáncer de próstata con fines curativos en España. Resultados del Registro nacional de cáncer de próstata 2010.

OBJECTIVE: The aim of this study is to determine which cancer and demographic criteria influence the indication for surgery (radical prostatectomy) or radiation therapy (external or brachytherapy) in the treatment of prostate cancer. MATERIAL AND METHODS: An analysis of the 2714 patients of the 2010 National Prostate Cancer Registry treated with curative intent. The analysed variables were age, prostate-specific antigen (PSA), prostate volume, the number of biopsy cores, the percentage of positive cores, the stage, Gleason score, the type of pathologist, the presence of perineural invasion and the study centre. We analysed the association among these variables and the type of treatment (surgery vs. radiation therapy/brachytherapy), using a univariate analysis (Student's t test and chi-squared) and a binary multiple logistic regression. RESULTS: The 48.12% of the patients (1306/2714) were treated with surgery, and 51.88% (1,408/2,714) underwent radiation therapy/brachytherapy. Differences were observed between the patients treated with prostatectomy and those treated with radiation therapy/brachytherapy (p<.05) in age (63.50±6.5 vs. 69.0±6.7), PSA (8.76±16.97 vs. 13.21±15.88), biopsied cores, percentage of positives cores (30.0±22 vs. 38.7±29), Gleason score (G6: 53.9% vs. 46.1%; G7: 45% vs. 55% G8-10: 26.6%, 73.4%), stage (localised: 50% vs. 50%; locally advanced: 14.6% vs. 85.4%), perineural invasion and hospital centre. In the multivariate analysis, the selected independent variables were age, PSA, percentage of positives cores, stage, Gleason score and hospital centre. CONCLUSION: According to our study, age, tumour aggressiveness and stage and the centre where the patient will be treated affect the selection of curative treatment for prostate cancer.

When to biopsy seminal vesicles.

OBJECTIVES: The involvement of seminal vesicles in prostate cancer can affect the prognosis and determine the treatment. The objective of this study was to determine whether we could predict its infiltration at the time of the prostate biopsy to know when to indicate the biopsy of the seminal vesicles. MATERIAL AND METHODS: observational retrospective study of 466 patients who underwent seminal vesicle biopsy. The indication for this biopsy was a prostate-specific antigen (PSA) level greater than 10 ng/ml or an asymmetric or obliterated prostatoseminal angle. The following variables were included in the analysis: PSA level, PSA density, prostate volume, number of cores biopsied, suspicious rectal examination, and preservation of the prostatoseminal angle, studying its relationship with the involvement of the seminal vesicles. RESULTS: Forty-one patients (8.8%) had infiltrated seminal vesicles and 425 (91.2%) had no involvement. In the univariate analysis, the cases with infiltration had a higher mean PSA level (P < .01) and PSA density (P < .01), as well as a lower mean prostate volume (P < .01). A suspicious rectal examination (20.7% of the infiltrated vesicles) and the obliteration or asymmetry of the prostatoseminal angle (33.3% of the infiltrated vesicles) were significantly related to the involvement (P < .01). In the multivariate analysis, we concluded that the probability of having infiltrated seminal vesicles is 5.19 times higher if the prostatoseminal angle is not preserved (P < .01), 4.65 times higher for PSA levels >19.60 ng/dL (P < .01) and 2.95 times higher if there is a suspicious rectal examination (P = .014). Furthermore, this probability increases by 1.04 times for each unit of prostate volume lower (P < .01). The ROC curves showed maximum sensitivity and specificity at 19.6 ng/mL for PSA and 0.39 for PSA density. CONCLUSIONS: In this series, greater involvement of seminal vesicles was associated with a PSA level ≥20 ng/ml, a suspicious rectal examination and a lack of prostatoseminal angle preservation.

[Percutaneous treatment of renal cysts with iodinated povidone injection. Long-term clinical course]. / Tratamiento percutáneo de quistes renales con inyección de povidona yodada. Evolución a largo plazo.

At present there are several minimally invasive options for the treatment of symptomatic simple renal cysts. One of them, the percutaneous puncture with injection of sclerosant substances, has offered good results. Our study has been conducted in 15 patients with symptomatic simple renal cyst treated by evacuant percutaneous puncture and povidone-iodine injection as sclerosant agent, and makes a short- and long-term evaluation of the results obtained using this procedure. Complete cyst recession with no ultrasound relapse during follow-up was seen in 13 cases (86.5%). Only two patients showed a persistent residual cyst that caused no symptomatology. The easiness of performance, absence of complications and good results obtained make this technique a valid option for the treatment of symptomatic renal cysts.

[Extragonadal germinal tumors of retroperitoneal localization]. / Tumores germinales extragonadales de localización retroperitoneal.

Extragonadal germ cells tumors can arise primarily in the retroperitoneum. It has been suggested that these neoplasms might be metastasis from an occult testicular lesion which would have regressed later. We report our experience with seven retroperitoneal germ cell tumors without testicular involvement. The most frequent symptoms were lumbar or abdominal pain and paraneoplastic syndrome. Abdominal palpable mass was noticeable in 85% of patients. We point out the computerized tomography and echography as the most sensitive exploration for diagnosis. The confirmation of retroperitoneal tumor was achieved preoperatively in all cases. Surgical and chemotherapy treatment was performed. Radiotherapy was employed in two cases. The mean survival was 9.5 months (6-24 m.). Retroperitoneal lymphadenectomy after chemotherapy has not improved the survival. Relapses of the diseases were noticed after and apparently partial or complete response to chemotherapy.

[Vesicoprostatic echography versus transrectal planimetry in the determination of prostatic volume]. / Ecografía vesicoprostática versus planimetría transrectal en la determinación del volumen prostático.

The intention of this paper is to analyze the correlation between two techniques used to measure prostatic volume: transrectal ultrasound with planimetry and transabdominal vesicoprostatic ultrasound. A total of 44 patients have been subjected to transrectal ultrasound, where prostatic volume was determined by planimetry. With this simultaneous technique, patients were performed a vesico-prostatic ultrasound with estimation of volume, achieved by measuring the prostatic diameters and then applying the ellipsoid formula. There were no statistically significant differences between mean values of prostatic volumes as calculated by either technique, both showing a strong correlation (r = 0.817). During transrectal planimetry, the three prostatic diameters were measured and, using a multiple regression study, the influence they have on the changes of prostate's volume was noted. It was observed that it is the transverse, but essentially the longitudinal diameter, the ones which explain those changes (Sig T = 0.0012 and 0.0000, respectively).

[Antimicrobial prophylaxis in urologic endoscopic surgery: pefloxacin versus ceftriaxone]. / Profilaxis antimicrobiana en cirugía endoscópica urológica: pefloxacino versus ceftriaxona.

Prospective, randomized study in 96 patients undergoing urologic endoscopic surgery to assess the efficacy of two antimicrobials, pefloxacin and ceftriaxone, in the prevention of urinary tract infections. The disease most frequently prompting surgery was vesical tumour and prostate adenoma. All patients had sterile pre-operative urine. Drugs were given endovenously two hours prior surgery in one single dose. Prophylactic efficacy was measured through urine culture before removal of the catheters. Incidence of bacteriuria greater than 100,000 colonies/ml was 20% for the pefloxacin group compared to 15.2% for ceftriaxone. These differences were not statistically significant (Squared-chi test). These results show that pefloxacin is as effective as ceftriaxone in the prophylaxis of endoscopic urological surgery. A single dose schedule was not entirely suitable to reduce post-operative bacteriuria.

[Factors influencing variability of PSA blood concentration in patients with prostate benign hyperplasia]. / Factores que influyen en la variabilidad de la concentración sérica de PSA en pacientes con hiperplasia benigna de próstata.

Study conducted in 107 patients with prostate benign hyperplasia to establish the influence that prostate volume, age, sexual activity, extent of obstruction and presence of urethral catheter have on PSA serum levels, using a linear regression model. In simple linear regression studies, a good correlation was seen between PSA serum concentration and prostate volume calculated by transrectal ultrasound (r = 0.57), which decreases when age in used as an independent variable (r = 0.40). In multiple linear regression studies where all the variables are included, correlation increases slightly (r = 0.60), and only prostate volume and sexual activity are significant. Prostate volume in the single most influential factor on PSA levels in prostate benign hypertrophy although it is not the only parameter to be taken into account in serum level variations of this marker. Age influence can be secondary to other factors such as sexual activity.

[Neo-adjuvant M-VAC in the treatment of infiltrating bladder tumors]. / M-VAC neo-adyuvante en el tratamiento de los tumores vesicales infiltrantes.

Between June 1987 and December 1990, systemic chemotherapy following an M-VAC protocol was applied to 38 patients with infiltrant vesical carcinoma (T2-T4). Eight of them (21.05%) were excluded for treatment response evaluation (four due to withdrawal and four to severe toxicity, one of whom died). Of the 30 evaluable patients, 63.3% (19 patients) showed complete response (pT0) after three complete courses of chemotherapy. Of this group, 11 have relapsed within an average interval of 21 +/- 18 months, 5 cases infiltrant (three with cystectomy) and 6 superficial. Mean survival of these 11 patients was 32.9 +/- 16.3 months. Of those showing complete response, 4 (13.3%) developed systemic tumoral progression in an average time of 12.5 +/- 4.2 months, to the point of being impossible to perform any kind of rescue surgery, with a mean survival of 13 +/- 4.5 months. In five patients, 16.6% of sample, stage at post-MVAC biopsy was lower than the initial one, requiring a new TUR (survival, 25.2 +/- -- months). Of these, 4 relapsed with 3 requiring rescue surgery. The remaining 6 patients in the sample (20%) showed no response to chemotherapy, and radical surgery was indicated which was only possible in three of them (survival, 14 +/- 6.8 months). The poor results of this series question the effectiveness of the MVAC protocol for chemotherapy in infiltrant vesical tumours. Only in low stages (T2) good results are observed, while in other cases it delays radical surgery, presumably curative if performed timely.

[Non-specific granulomatous prostatitis. Relationship and differential diagnosis with prostatic cancer]. / Prostatitis granulomatosa inespecifica. Relacion y diagnóstico diferencial con el cáncer de próstata.

The unspecific granulomatous prostatitis (GP) is a rare prostate disease. Its relevance lies on the common confusion with prostate carcinoma. Review of 21 cases of unspecific GP, two of which had previously undergone transurethral resection of the prostate. Forty-eight percent of patients developed urinary tract infection prior to GP diagnosis. In 13 patients (62%), prostate carcinoma was suspected after rectal examination of the prostate and transrectal ultrasound. Diagnosis was achieved by histopathology after prostate biopsy and transurethral resection (100%). Prostate Specific Antigen (PSA) was within the normal ranges in all cases that it was performed (six), with the exception of one patient who developed prostate cancer. During follow-up, four patients developed prostate cancer (19%) with an average presentation time of 5.5 years after GP diagnosis.