[Urological and psychological approach of secondary complications to penile aesthetic modifications]. / Abordaje urológico y psicológico de las complicaciones secundarias a las modificaciones estéticas peneanas.

OBJECTIVES: Due to the scarcity of scientific articles that review the technical alternatives available for aesthetic modifications in the penis that are the cause of subsequent uro-andrological problems, the existing literature is reviewed after the assistance of a penile infection by injection of subcutaneous hyaluronic acid with aesthetic purposes. MATERIAL AND METHODS: A 38-year-old male patient with no medical or psychiatric remarkable reports who came to the emergency room due to inflammation and abscess in penile skin after injection of hyaluronic acid. Surgical treatment was required and degloving and excision of affected skin was performed, with subsequent satisfactory evolution. The psychological analysis showed a narcissistic personality possibly secondary to traumas in childhood. We have reviewed the literature present in medical databases as well as information available on-line. RESULTS: Enlargement of the penis is an important cultural and social concern, so that there are different devices in the market to meet this demand, among them: herbal medicine, stretching exercises, weights, vacuum pumps or extensor devices. Among the surgical techniques, there have been described the pubic liposuction, the section of the suspensory ligament of the penis or the injection of autologous material or synthetic substances among others. As for the aesthetic modifications of the penis, there is a wide variety of genital piercings, tattoos and subcutaneous implants also called "pocketing" or "3D implants". All of these techniques or modifications are described in this article along with their possible associated more frequent urological complications. CONCLUSIONS: Aesthetic manipulations in the penis are becoming increasingly popular, and both its terminology and its medical implications should be known by urologists and andrologists. community.

[Video endoscopic inguinal lymphadenectomy in penile cancer: Systematic review.] / Linfadenectomía inguinal videoendoscópica en cáncer de pene: revisión sistemática.

OBJECTIVES: Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes in video-endoscopic inguinal lymphadenectomy (VEIL). METHODS: A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles. RESULTS: Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach. CONCLUSION: Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower- rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results.

OBJETIVO: El cáncer de pene es una entidad poco frecuente. Para realizar un buen control oncológico, se recomienda la realización de linfadenectomía inguinal en casos de factores de riesgo de mal pronóstico, grado histológico alto o ganglios palpables o positivos. La linfadenectomía inguinal abierta presenta una alta tasa de morbilidad, por lo que en esta revisión se pretende resumir la literatura publicada en cuanto a los resultados oncológicos y postquirúrgicos en la linfadenectomía inguinal videoendoscópica (VEIL).MATERIAL Y MÉTODOS: Se realiza revisión sistemática de la literatura obtenida en "Pubmed", "EMBASE" y Cochrane library para artículos en inglés y español. RESULTADOS: Se han analizado un total de 12 artículos, que globalmente incluyen a 161 pacientes con 226 VEIL y una edad media de 55,66 años y 90 pacientes a los que se les ha realizado 106 linfadenectomías abiertas. En el caso del VEIL se han presentado 6% de complicaciones cutáneas y del 55,6% en el caso de la vía abierta. En cuanto a las complicaciones linfáticas, no hay diferencias significativas. La media de ganglios extraídos en el caso de VEIL de 9,12 ganglios y de 7,09 ganglios en abordaje abierto. CCONCLUSIONES: La linfadenectomía inguinal videoendoscópica aporta una menor morbilidad, con una menor tasa de complicaciones cutáneas, y de menor gravedad. Asimismo, aporta menor estancia hospitalaria, sin afectación de los resultados oncológicos iniciales. Aunque se necesitan series con mayor tiempo de seguimiento para valoración de resultados oncológicos a largo plazo.

[Preventive management of bone disease in advanced prostate cancer.] / Manejo preventivo de la enfermedad ósea en cáncer de proacute;stata avanzado.

OBJECTIVES: Prostate cancer is linked to bone disease by two different entities. On one hand, androgen deprivation therapy (ADT) usually causes osteoporosis, on the other a great number of patients with advanced prostate cancer will present bone that condition not only their vital prognosis but also an important quality of life deterioration. METHODS: We performed a bibliographic review on both the physiology and therapy of osteoporosis secondary to ADT and bone metastasis in prostatic neoplasias. RESULTS: Osteoporosis: Long term ADT is associated with osteopenia/osteoporosis in 80% of the patients, with a 5-20% incidence of osteoporotic fractures. We should monitor bone mineral density before starting ADT therapy and during treatment. Treatment is based on risk factors reduction, regular physical exercise, calcium and vitamin D supplements, and drugs such as biphosphonates or denosumab. Bone metastasis: Currently, both zolendronic acid and denosumab have approval for the prevention of skeletal events in patients with castration resistant prostate cancer (CPRC). Although the last one seems to be more effective, it is associated with a higher risk of hypocalcemia and jaw osteonecrosis so that the choice of drug must be individualized in every patient. The duration of treatment is not clear. Currently, the indication for the use of this drugs in earlier phases of advanced disease is not approved. CONCLUSIONS: Comprehensive management of the patient with advanced prostate cancer should include the study and treatment of osteoporosis and bone metastases. Currently, very effective therapies are available for both entities.

[Evaluation of a seminal vesicle biopsy protocol simultaneous to diagnostic prostate biopsy. Analysis of indication criteria.] / Evaluación de un protocolo de biopsias de vesículas seminales simultáneo a biopsias prostáticas diagnósticas. Análisis de criterios de indicación.

OBJECTIVES: To analyze the indication criteria used for conducting seminal vesicles biopsies as well as the diagnostic capacity of other variables involved. METHODS: We present the results of an observational and retrospective study (May 2006 - December 2012) using a sample of 140 patients to whom seminal vesicles biopsies was performed in a first set of prostate biopsy. They were patients eligible for curative treatment and presented any of the following criteria: PSA ≥15 ng/ml, suspicion of neoplastic seminal vesicle invasion on transrectal US, and/or suspicious node in the prostate base on DRE or transrectal US. RESULTS: Seminal vesicle invasion due to prostate cancer was detected in 22.2%. Patients with 3 criteria had T3b in 66.7% of cases. The criterion most associated with T3b was the presence of a suspicious node in the prostate base, with an association of 29.3% of cases. Variables analyzed that had shown a greater association with stage T3b were PSA density, the presence of suspicious DRE, the Gleason sum. CONCLUSIONS: Our seminal vesicle biopsy protocol has detected 22.2% of seminal vesicle invasion. The detection of a suspicious node at the prostate base has shown the greatest association with T3b.

Seminal vesicle biopsies: an useful staging procedure-exposure of seminal vesicle biopsies protocol and review of the literature.

BACKGROUND AND OBJECTIVES: Although new MRI techniques have a high sensitivity but varying specificity with regard to diagnosing the seminal vesicle invasion (SVI) of prostate cancer, the low availability and high cost involved demands incorporating an inexpensive and accessible technique that might support adequate staging. Currently, uniformity does not exist with regard to the indication criteria of seminal vesicle biopsies (SVBs). Our objective is to analyse the protocol of SVBs at Morales Meseguer Hospital and conduct an exhaustive review of the literature in this field. METHODS AND MATERIALS: SVBs were performed in patients who were amenable to a curative treatment and who showed at least one of the following indication criteria: prostate-specific antigen greater than or equal to 15 ng/ml, a prostate cancer nodule in the base of the prostate, or ultrasound abnormalities suggestive of vesicular involvement. SVBs were performed in 70 patients. RESULTS: These results revealed a rate of SVI of 15.7 and 25.58 % among all patients and patients diagnosed with prostate cancer, respectively. All biopsied patients who tested positive for the three indication criteria had T3b prostate cancer. Patients with a prostate cancer that altered the base of the prostate according to either digital rectal examination or ultrasound showed a T3b rate of 53.8 %. CONCLUSIONS: SVBs should be considered a complementary procedure for prostate cancer staging because provide important information and it is easy, inexpensive and has few complications.

Abordaje urológico y psicológico de las complicaciones secundarias a las modificaciones estéticas peneanas / Urological and psychological approach of secondary complications to penile aesthetic modifications

Objetivos: Dada la escasez de artículos científicos que revisen las distintas técnicas disponibles para modificaciones estéticas en el pene y que son causa de problemas uro-andrológicos posteriores, se revisa la literatura existente tras la asistencia de una infección peneana tras inyección de ácido hialurónico subcutáneo con fines estéticos. Material y métodos: Se expone un caso de un varón de 38 años de edad sin antecedentes médicos o psiquiátricos de interés, que acude a la urgencia por presentar inflamación y abscesificación en la piel peneana tras la inyección de ácido hialurónico. Fue preciso tratamiento quirúrgico mediante denudamiento y exéresis de la piel afecta, siendo la posterior evolución satisfactoria. El análisis psicológico realizado mostró una personalidad narcisista, posiblemente secundaria a traumas en la infancia. Se ha revisado la literatura presente en bases de datos médicas, así como información disponible on-line. Resultados. El aumento del tamaño del pene es una importante preocupación cultural y social, por lo que existen en el mercado distintos dispositivos para satisfacer esta demanda, entre los que destacan la fitoterapia, los ejercicios de estiramiento, pesas, bombas de vacío o dispositivos extensores. Entre las técnicas quirúrgicas descritas están la liposucción púbica, la sección del ligamento suspensorio del pene o la inyección de material autólogo o sustancias sintéticas, entre otras. Existen otras modificaciones estéticas peneanas entre las que destacan una amplia variedad de piercings genitales, tatuajes e implantes subcutáneos también denominados pocketing o "implantes 3D". Todas estas técnicas o modificaciones se describen en este artículo junto con sus posibles complicaciones urológicas asociadas más frecuentes. Conclusiones: Cada vez son más frecuentes las manipulaciones estéticas en el pene, y tanto la terminología popular como sus implicaciones médico-quirúrgicas deben ser conocidas por los urólogos y andrólogos

Objectives: Due to the scarcity of scientific articles that review the technical alternatives available for aesthetic modifications in the penis that are the cause of subsequent uro-andrological problems, the existing literature is reviewed after the assistance of a penile infection by injection of subcutaneous hyaluronic acid with aesthetic purposes. Material and methods: A 38-year-old male patient with no medical or psychiatric remarkable reports who came to the emergency room due to inflammation and abscess in penile skin after injection of hyaluronic acid. Surgical treatment was required and degloving and excision of affected skin was performed, with subsequent satisfactory evolution. The psychological analysis showed a narcissistic personality possibly secondary to traumas in childhood. We have reviewed the literature present in medical databases as well as information available on-line. Results: Enlargement of the penis is an important cultural and social concern, so that there are different devices in the market to meet this demand, among them: herbal medicine, stretching exercises, weights, vacuum pumps or extensor devices. Among the surgical techniques, there have been described the pubic liposuction, the section of the suspensory ligament of the penis or the injection of autologous material or synthetic substances among others. As for the aesthetic modifications of the penis, there is a wide variety of genital piercings, tattoos and subcutaneous implants also called "pocketing" or "3D implants". All of these techniques or modifications are described in this article along with their possible associated more frequent urological complications. Conclusions: Aesthetic manipulations in the penis are becoming increasingly popular, and both its terminology and its medical implications should be known by urologists and andrologists. Community

[Frontal mass simulating lipoma as a clinical presentation of prostatic adenocarcinoma]. / Bultoma frontal simulando lipoma como manifestación de adenocarcinoma de próstata.

OBJECTIVE: To report one case of metastatic prostatic carcinoma with a gaudy presentation as a lump which resulted to be a cutaneous metastasis. METHODS: We describe the debut in a patient, who thanks to the pathologic analysis of a lesion mimicking a lipoma, which was reported as adenocarcinoma, was worked up for prostatic adenocarcinoma and diagnosis was reached. We performed a bibliographic review using an electronic bibliographic search in PubMed (MEDLINE) using the terms "Prostatic Neoplasm" (MesH) AND "Neoplasm Metastasis" (MesH) AND "cutaneous" (free text). Most publications are case reports reviewing the probable dissemination way and localization. RESULTS: Positive immunohistochemical staining for PSA confirmed the origin of the metastasis, although PSA value did not offer doubts due to its value over 1100 ng/ml. Regarding the bibliographic search we obtained more than 26 papers, and selected only 8 that were adjusted to the objectives of our work. Cutaneous metastasis of prostatic origin appear in less than 0.3% of the cases, because bone, lymph node, and visceral disease are more frequent. Cases appearing during the evolution of the disease and metastasis after laparoscopic procedures are described. CONCLUSIONS: Cutaneous metastases of prostatic adenocarcinoma are very rare, but even rarer is it being the debut of the disease.

[Diagnostic and therapeutic management of renal hydatidosis]. / Manejo diagnóstico y terapéutico de la hidatidosis renal.

OBJECTIVE: Renal hydatidosis is caused by Echinococcus granulosus and is extremely rare, accounting for 3-4% of the cases of hydatidosis, being the third site after liver and lungs. It generally remains asymptomatic for years and the most frequent symptoms are pain, feeling of flank heaviness, and dysuria. In front of a compatible clinical picture, we studied the diagnostic, therapeutic, and follow-up schemes reviewing the literature. METHODS: We performed an electronic bibliographic search in PubMed (MEDLINE) which MESH terms "Echinococcosis" [MeSH] AND "urinary tract" [MeSH] and bibliographic citations. We perform a review on epidemiology, vital cycle of the parasite and management of patients with hydatidosis. Most published papers correspond to case reports from different localisations, although we found some reviews. RESULTS: We found a total of 137 papers, we selected 23 of them because they were related; five were reviews, but we only include 10 of them in our references. Although most were case reports, the reviews analyse the cycle of the Echinococcus and its various host sites (organs) in the human host. The human being may become an intermediary host through contact with the definitive host (dogs) or by taking contaminated water or vegetables. CONCLUSIONS: Thanks to the combination of history, imaging tests and serology we get close to the diagnosis in up to 80%. In many cases conservative surgery is possible, but after suspicion we should always sterilise with albendazole before surgical treatment, and monitor serum titles of anti-Echinococcus antibodies.

Linfadenectomía inguinal videoendoscópica en cáncer de pene: revisión sistemática / Video endoscopic inguinal lymphadenectomy in penile cancer: Systematic review

OBJETIVO: El cáncer de pene es una entidad poco frecuente. Para realizar un buen control oncológico, se recomienda la realización de linfadenectomía inguinal en casos de factores de riesgo de mal pronóstico, grado histológico alto o ganglios palpables o positivos. La linfadenectomía inguinal abierta presenta una alta tasa de morbilidad, por lo que en esta revisión se pretende resumir la literatura publicada en cuanto a los resultados oncológicos y postquirúrgicos en la linfadenectomía inguinal videoendoscópica (VEIL). MATERIAL Y MÉTODOS: Se realiza revisión sistemática de la literatura obtenida en "Pubmed", "EMBASE" y Cochrane library para artículos en inglés y español. RESULTADOS: Se han analizado un total de 12 artículos, que globalmente incluyen a 161 pacientes con 226 VEIL y una edad media de 55,66 años y 90 pacientes a los que se les ha realizado 106 linfadenectomías abiertas. En el caso del VEIL se han presentado 6% de complicaciones cutáneas y del 55,6% en el caso de la vía abierta. En cuanto a las complicaciones linfáticas, no hay diferencias significativas. La media de ganglios extraídos en el caso de VEIL de 9,12 ganglios y de 7,09 ganglios en abordaje abierto. CONCLUSIONES: La linfadenectomía inguinal videoendoscópica aporta una menor morbilidad, con una menor tasa de complicaciones cutáneas, y de menor gravedad. Asimismo, aporta menor estancia hospitalaria, sin afectación de los resultados oncológicos iniciales. Aunque se necesitan series con mayor tiempo de seguimiento para valoración de resultados oncológicos a largo plazo

OBJECTIVES: Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes METHODS: A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles. RESULTS: Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach. CONCLUSION: Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower-rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results

Manejo preventivo de la enfermedad ósea en cáncer de próstata avanzado / Preventive management of bone disease in advanced prostate cancer

OBJETIVO: El cáncer de próstata está ligado a la enfermedad ósea por dos entidades diferentes. Por un lado la terapia de deprivación androgénica (TDA) provoca frecuentemente osteoporosis y por otro lado, un gran número de pacientes con cáncer de próstata avanzado van a presentar metástasis óseas, que condicionan no sólo su pronóstico vital sino un deterioro importante en su calidad de vida. MÉTODOS: Se ha realizado una revisión en la literatura de la fisiología y el tratamiento tanto de la osteoporosis ligada a la TDA como de las metástasis óseas en neoplasias prostáticas. RESULTADOS: Osteoporosis: La TDA de larga duración se asocia a osteopenia/osteoporosis en un 80% de los pacientes, con una incidencia de fractura osteoporótica del 5-20%. Se debe monitorizar la densidad mineral ósea previa al inicio de la TDA y durante el seguimiento. El tratamiento se basa en reducir factores de riesgo, ejercicio físico de forma regular, suplementos de calcio y vitamina D, y fármacos como los bifosfonatos o el denosumab. Metástasis óseas: Actualmente están aprobados para la prevención de eventos óseos en pacientes en fase CPRC con metástasis óseas tanto el ácido zoledrónico como el denosumab. Aunque éste último parece más efectivo, se asocia a mayor riesgo de hipocalcemia y osteonecrosis mandibular por lo que la elección del fármaco a usar debe ser personalizada en cada paciente. No está clara cuál debe ser la duración del tratamiento. Actualmente no está aprobada la indicación del uso de estos fármacos en fases más precoces de la enfermedad avanzada. CONCLUSIONES: El manejo integral del paciente con cáncer de próstata avanzado debe incluir el estudio y tratamiento de la osteoporosis y de las metástasis óseas. Actualmente disponemos de tratamientos muy efectivos para ambas entidades

OBJECTIVES: Prostate cancer is linked to bone disease by two different entities. On one hand, androgen deprivation therapy (ADT) usually causes osteoporosis, on the other a great number of patients with advanced prostate cancer will present bone bicametastases, that condition not only their vital prognosis but also an important quality of life deterioration. METHODS: We performed a bibliographic review on both the physiology and therapy of osteoporosis secondary to ADT and bone metastasis in prostatic neoplasias. RESULTS: Osteoporosis: Long term ADT is associated with osteopenia/osteoporosis in 80% of the patients, with a 5-20% incidence of osteoporotic fractures. We should monitor bone mineral density before starting ADT therapy and during treatment. Treatment is based on risk factors reduction, regular physical exercise, calcium and vitamin D supplements, and drugs such as biphosphonates or denosumab. Bone metastasis: Currently, both zolendronic acid and denosumab have approval for the prevention of skeletal events in patients with castration resistant prostate cancer (CPRC). Although the last one seems to be more effective, it is associated with a higher risk of hypocalcemia and jaw osteonecrosis so that the choice of drug must be individualized in every patient. The duration of treatment is not clear. Currently, the indication for the use of this drugs in earlier phases of advanced disease is not approved. CONCLUSIONS: Comprehensive management of the patient with advanced prostate cancer should include the study and treatment of osteoporosis and bone metastases. Currently, very effective therapies are available for both entities

[Voiding symptoms as presentation of an intravesical foreign body]. / Clínica miccional como síntoma por cuerpo extraño intravesical.

OBJECTIVES: The presence of intravesical foreign bodies is exceptional; it is not a common emergency. Most foreign bodies have a sexual-erotic origin, although we cannot forget others such as elements left by the surgeon in the surgical field. We performed a bibliographic review on the topic. METHODS: We performed a PubMed (MEDLINE) electronic bibliographic search with the mesh terms "foreign-body migration" [MESH] AND "Urinary Bladder" [MESH] and bibliographic citations. We performed a bibliographic review establishing a classification depending on the origin and diagnosis, as well as treatment. Most publications are case reports. We described the most frequent presentation which was the same than we have in our Center. RESULTS: We found a total of 122 works, nine of which were reviews; we selected 20 works. Although most are case reports, the reviews establish a classification depending on the origin: so, they refer to those foreign bodies directly introduced into the bladder: 1. By the patient: hairpins, safety pins, pencils, copper wires, hairs; 2. Accidentally: bullets; 3. Iatrogenic: fragments of bladder or ureteral catheters, staples, sutures. Foreign bodies migrated from other places: urological, gynecological, gastrointestinal, or vascular origin. We established a diagnostic and therapeutic algorithm. CONCLUSIONS: Bladder foreign bodies are not as frequent as it is believed. Most are found incidentally. Lower urinary tract symptoms are the most frequent, as the antecedent of manipulation by the patient or others in the genital-urologic sphere. The treatment of choice is extraction using the least invasive and most simple method for the patient.

Evaluación de un protocolo de biopsias de vesículas seminales simultáneo a biopsias prostáticas diagnósticas. Análisis de criterios de indicación / Evaluation of a seminal vesicle biopsy protocol simultaneous to diagnostic prostate biopsy. Analysis of indication criteria

OBJETIVOS: Analizar los criterios de indicación empleados para la realización de biopsias de vesículas seminales, así como la relación de la invasión de vesículas seminales por cáncer de próstata con otras variables implicadas. MÉTODOS: Presentamos los resultados de un estudio observacional y retrospectivo (mayo 2006 - diciembre 2012) con una muestra de 140 pacientes sobre los que se realizó un protocolo de biopsias de vesículas seminales realizadas simultáneamente con las biopsias prostáticas diagnósticas, basado en 3 criterios de indicación: PSA mayor o igual de 15 ng/ml, presentar sospechosa de infiltración de vesículas seminales o presentar sospechosa de infiltración de bases prostáticas. RESULTADOS: Se ha detectado un 22,2% de invasión seminal en los pacientes con cáncer de próstata. Los pacientes que presentaban todos los criterios de indicación asociaron una invasión seminal del 66,7%. La presencia de alteraciones en bases prostáticas resultó ser el criterio de indicación más sensible, asociando un 29,3% de invasión seminal. Otras variables asociadas a una mayor infiltración prostática fueron: densidad de PSA, tacto rectal sospechoso y sumatorio Gleason entre otros. CONCLUSIONES: El protocolo de biopsias seminales empleado ha mostrado una capacidad de detección de invasión seminal del 22,2%, siendo el criterio de sospecha de infiltración basal el que ha supuesto la mayor asociación con dicha invasión

OBJECTIVES: To analyze the indication criteria used for conducting seminal vesicles biopsies as well as the diagnostic capacity of other variables involved. METHODS: We present the results of an observational and retrospective study (May 2006 - December 2012) using a sample of 140 patients to whom seminal vesicles biopsies was performed in a first set of prostate biopsy. They were patients eligible for curative treatment and presented any of the following criteria: PSA ≥15 ng/ml, suspicion of neoplastic seminal vesicle invasion on transrectal US, and/or suspicious node in the prostate base on DRE or transrectal US. RESULTS: Seminal vesicle invasion due to prostate cancer was detected in 22.2%. Patients with 3 criteria had T3b in 66.7% of cases. The criterion most associated with T3b was the presence of a suspicious node in the prostate base, with an association of 29.3% of cases. Variables analyzed that had shown a greater association with stage T3b were PSA density, the presence of suspicious DRE, the Gleason sum. CONCLUSIONS: Our seminal vesicle biopsy protocol has detected 22.2% of seminal vesicle invasion. The detection of a suspicious node at the prostate base has shown the greatest association with T3b

Cáncer de próstata de bajo riesgo e intermedio: opciones de tratamiento / Low and intermediate risk prostate cancer: Treatment options

Los pacientes con cáncer de próstata de bajo riesgo e intermedio constituyen el grupo más frecuentemente diagnosticado en la actualidad. En aquellos con una esperanza de vida inferior a 10 años es muy probable que cualquier tratamiento sea innecesario por lo que la observación debe ser la aproximación más apropiada. En los pacientes en los que esté indicada alguna forma de terapia activa es necesario llevar a cabo un balance entre los riesgos de morir o desarrollar metástasis por la enfermedad y los efectos adversos de los tratamientos radicales comúnmente aceptados, como la prostatectomía radical y la radioterapia externa o intersticial. La significativa incidencia de morbilidad asociada, fundamentalmente disfunción eréctil e incontinencia urinaria, de alto impacto en la calidad de vida, exige esta aproximación en el ámbito de decisiones compartidas con los pacientes. El riesgo de sobretratamiento en este grupo de pacientes ha dado lugar a la introducción de abordajes más conservadores como el seguimiento activo y la terapia focal. El primero, trata de demorar los tratamientos radicales en tanto no existan criterios de agresividad suficiente por parte del tumor o el paciente los solicite. El segundo, que está llamado a ocupar un lugar entre el seguimiento activo y los tratamientos radicales, consiste en llevar a cabo una ablación parcial de la próstata para evitar los efectos adversos de los tratamientos radicales, tratando de lograr un control oncológico lo más similar posible al obtenido con estos

Patients with low and intermediate risk prostate cancer are the most frequently diagnosed group currently. In those with a life expectancy inferior to 10 years it is highly likely that treatment is not necessary so that observation must be the most appropriate approach. In patients in whom active therapy, in any of its forms, is indicated, it is necessary to balance between risk of dying or developing metastases from the disease and adverse effects of commonly accepted radical treatments, such as radical prostatectomy and external beam or interstitial radiotherapy. The significant incidence of associated morbidity, mainly erectile dysfunction and urinary incontinence, with high impact on quality of life, demands this approach in the field of decisions shared with patients. The risk of overtreatment in this group of patients has generated the introduction of more conservative approaches such as active surveillance and focal therapy. The first one tries to differ radical treatments as far as there are not enough aggressiveness criteria on the tumor or the patient requests them. The second, called to have a place between active surveillance and radical treatments, involves the performance of a partial ablation of the prostate to avoid the adverse effects of radical treatments, trying to achieve the closest oncological control to the radical options. We perform a review of the therapeutic options and their results in this type of patients

La importancia de exploración física en la incontinencia urinaria: Urocolpos / The importance of physical examination in urinary incontinence: Urocolpos

No disponible

Pionefrosis secundaria a sonda vesical ubicada en ureter pélvico / Pyonephrosis secondary to bladder catheter misplaced in the pelvic ureter

No disponible

[Renal colic in a patient with crossed renal ectopia]. / Crisis reno-ureteral en paciente con ectopia renal cruzada.

OBJECTIVES: To report a new case of renal colic in a patient with crossed renal ectopia and L-shaped kidney, and to perform a bibliographic review. METHODS AND RESULTS: A 33-year-old male patient consulted for abdominal right pain. Ultrasound and CT showed a L-Shaped Kidney with left renal and ureteral stones. These stones produced obstructive left collecting system. This patient was managed with left pyelolithotomy and ureterolithotomy. The transabdominal approach was recommended to resolve this stones. CONCLUSIONS: The crossed renal ectopia with fusion is a rare condition. The abnormal kidney position and the anomalous kidney supply may impede drainage from the collecting system, creating a predisposition to urinary tract infection and calculus formation. The colic in this patient sometimes is misdiagnosed how abdominal disease. The usual method of detection was excretory urography but now ultrasonography and CT have showed more cases. The indications for open surgery in treatment the stones, are generally failure of extracorporeal shock wave lithotripsy, this is common in these cases for the anatomic abnormality, and the transabdominal approach is recommended to resolve its complications in this kidneys.

[PCNA and Ki-67 expression in locally confined renal adenocarcinoma. Relationship with various histopathologic variables and prognostic significance]. / Expresión de PCNA y Ki-67 en el adenocarcinoma renal localmente confinado. Relación con diferentes variables histopatológicas y significación pronóstica.

OBJECTIVE: PCNA and Ki-67 expression are used as markers of cellular proliferation and different studies have investigated their value as prognostic indicators for renal adenocarcinoma. The aim of this study was to determine PCNA and Ki-67 expression in locally confined renal adenocarcinoma, their relationship with other histopathological variables and prognostic significance. METHODS: 58 cases of renal adenocarcinoma stages pT1-T3a N0 M0 (TNM 1997), treated by curative radical or partial nephrectomy were reviewed. The clinical and histopathological variables were analyzed. PCNA and Ki-67 expression in tissue embedded in paraffin were studied by immunohistochemical techniques. RESULTS: The mean percentage of nuclei that stained for PCNA was 7.03% (range 0-50%). Analysis of the correlation between PCNA and histopathological variables (size, grade and stage), showed a statistically significant correlation of PCNA only for the nuclear grade (p = 0.009). The mean percentage of nuclei that stained for Ki-67 expression was 2.96% (range 0-30%) and a relationship was found for size (p < 0.001), nuclear grade (p < 0.001) and stage (p < 0.001). The incidental clinical presentation, tumor size, stage, nuclear grade, PCNA and Ki-67 expression showed a relationship with survival. However, only perirenal fat infiltration, tumor size, nuclear grade and PCNA expression were found to be independent factors by multivariate analysis. CONCLUSIONS: PCNA expression correlated with nuclear grade, while Ki-67 demonstrated a significant correlation with tumor size, grade and stage. Survival analysis showed a relationship of both markers with prognosis. However, only PCNA was found to be an independent factor by multivariate analysis.

[[Primary psoas abscess. Presentation of 3 cases]. / Absceso primario de psoas. Presentación de 3 casos.

OBJECTIVE: To present 3 cases of primary abscess of the psoas muscle. The clinical features, diagnostic tests, treatment and outcome are discussed. METHODS/RESULTS: Three patients that presented with fever and pain referred to the renal and/or iliac fossa are described. Physical examination showed psoas involvement in only one patient. Among the complementary tests performed, ultrasound demonstrated the abscess in one of the cases; the definitive diagnosis was made by contrast-enhanced CT. One of the cases was treated only with antibiotics while the other two cases were treated with CT-guided percutaneous drainage and appropriate antibiotic therapy. CONCLUSIONS: Psoas abscess is an uncommon pathology whose presenting features are usually unspecific. CT with contrast enhancement is considered to be the technique of choice for the diagnosis and to corroborate the resolution of the condition. Recently, the use of CT or US-guided percutaneous drainage has replaced surgery as the initial therapeutic approach for this condition.

[Encrusted pyelitis in patients with urinary diversion]. / Pielitis incrustante en pacientes con derivación urinaria.

OBJECTIVE: This is a case of Encrusted Pyelitis (EP) caused by Corynebacterium urealyticum (CU) in a patient who had undergone a cystectomy and Bricker type urinary diversion 28 months beforehand. METHODS/RESULTS: After the immediate post-operative period no urinary catheterisation or any other urological procedure was performed on the patient. Before surgery, the patient presented non functional of the right kidney, secondary to a lithiasic obstructive uropathy. Clinical symptoms were deteriorated renal function, anuria, haematuria, pyrexia and left lumbar pain. It was suspected that the patient had this pathology and this was fundamental in diagnosis. Helicoid CT was the principal method used to show calcification plaques on the wall of the left renal pelvis, and selective culture of CU confirmed the diagnosis. Early commencement of treatment with vancomycin at an initial dosage of 500 mg/12 hours, and subsequent adjustment of dosage according to blood drug levels, achieved negative urine culture within a fortnight. Oral acidification was effected using acetohidroxamic acid 125 mg/12 hours, and it was continued until CT confirmed the disappearance or considerable reduction of the pyelic calcification plaques. CONCLUSION: The presence of EP in patients with urinary diversion is a matter worthy of consideration, even in patients who have not undergone recent urological procedures. Awareness of risk factors and early commencement of effective treatment may improve the prognosis of these patients.