Epigenetic insights to pediatric uropathology: Celebrating the fundamental biology vision of Tony Khoury.

INTRODUCTION: Many pediatric urology conditions affect putatively normal tissues or appear too commonly to be based solely on specific DNA mutations. Understanding epigenetic mechanisms in pediatric urology, therefore, has many implications that can impact cell and tissue responses to settings, such as environmental and hormonal influences on urethral development, uropathogenic infections, obstructive stimuli, all of which originate externally or extracellularly. Indeed, the cell's response to external stimuli is often mediated epigenetically. In this commentary, we highlight work on the critical role that epigenetic machinery, such as DNA methyltransferases (DNMTs), Enhancer of Zeste Polycomb Repressive Complex 2 Subunit (EZH2), and others play in regulating gene expression and cellular functions in three urological contexts. DESIGN: Animal and cellular constructs were used to model clinical pediatric uropathology. The hypertrophy, trabeculation, and fibrosis of the chronically obstructed bladder was explored using smooth muscle cell models employing disorganised vs. normal extracellular matrix (ECM), as well as a new animal model of chronic obstructive bladder disease (COBD) which retains its pathologic features even after bladder de-obstruction. Cell models from human and murine hypospadias or genital tubercles (GT) were used to illustrate developmental responses and epigenetic dependency of key developmental genes. Finally, using bladder urothelial and organoid culture systems, we examined activity of epigenetic machinery in response to non uropathogenic vs. uropathogenic E.coli (UPEC). DNMT and EZH2 expression and function were interrogated in these model systems. RESULTS: Disordered ECM exerted a principal mitogenic and epigenetic role for on bladder smooth muscle both in vitro and in CODB in vivo. Key genes, e.g., BDNF and KCNB2 were under epigenetic regulation in actively evolving obstruction and COBD, though each condition showed distinct epigenetic responses. In models of hypospadias, estrogen strongly dysregulated WNT and Hox expression, which was normalized by epigenetic inhibition. Finally, DNA methylation machinery in the urothelium showed specific activation when challenged by uropathogenic E.coli. Similarly, UPEC induces hypermethylation and downregulation of the growth suppressor p16INK4A. Moreover, host cells exposed to UPEC produced secreted factors inducing epigenetic responses transmissible from one affected cell to another without ongoing bacterial presence. DISCUSSION: Microenvironmental influences altered epigenetic activity in the three described urologic contexts. Considering that many obstructed bladders continue to display abnormal architecture and dysfunction despite relief of obstruction similar to after resection of posterior valves or BPH, the epigenetic mechanisms described highlight novel approaches for understanding the underlying smooth muscle myopathy of this crucial clinical problem. Similarly, there is evidence for an epigenetic basis of xenoestrogen on development of hypospadias, and UTI-induced pan-urothelial alteration of epigenetic marks and propensity for subsequent (recurrent) UTI. The impact of mechanical, hormonal, infectious triggers on genitourinary epigenetic machinery activity invite novel avenues for targeting epigenetic modifications associated with these non-cancer diseases in urology. This includes the use of deactivated CRISPR-based technologies for precise epigenome targeting and editing. Overall, we underscore the importance of understanding epigenetic regulation in pediatric urology for the development of innovative therapeutic and management strategies.

Adenoma nefrogénico de vejiga. Un simulador de neoplasia urotelial vesical / Nephrogenic adenoma of the bladder. A simulator of urothelial bladder neoplasia

No disponible

Patologias urologicas asociadas a paralisis cerebral. El rol de la enfermera / Cerebral palsy associated urological pathologies. Nurse's role

Objetivos: Los objetivos de este estudio fueron: analizar las causas de consulta urológica del niño con Parálisis Cerebral (PC), analizar el rol de enfermería en el cuidado urológico de niños con PC referidos a Urología, y conocer la relación entre la infección urinaria del niño con PC y su grado de independencia. Material y método: Estudio observacional analítico retrospectivo en base a la revisión del expediente clínico de pacientes con diagnóstico de parálisis cerebral. Se incluyeron en el estudio a 47 pacientes seleccionados mediante aleatorización simple en un rango de edad de 2 a 16 años en una clínica de atención ambulatoria para pacientes con PC, ubicada en una población del norte de México. Resultados: Las causas de consulta urológica del niño con PC, referidos por enfermería fueron: infección urinaria, fimosis, testículo retráctil, criptorquidia, hipogonadismo, vejiga hiperactiva, e hipospadias. La relación entre la infección urinaria del niño con PC y su grado de independencia se estableció con el nivel de control de esfínter urinario. Conclusiones: El personal de enfermería es factor clave y decisivo en el diagnóstico, referencia temprana para tratamiento y vigilancia de la evolución de los trastornos urinarios en niños con PC. No está indicado iniciar un programa de control de esfínteres en niños con PC, sin haber descartado antes una infección urinaria

Objectives: The objectives of this study were: To analyze the causes of urological consultation of the child with CP, to analyze the role of nursing in the urological care of children with CP referred to Urology, and to know the relationship between the child’s urinary tract infection and CP and its degree of independence. Method: Retrospective analytical observational study based on the review of the clinical records of patients diagnosed with cerebral palsy. Forty-seven patients selected by simple randomization in an age range of 2 to 16 years were included in the study in an outpatient clinic for CP patients located in a town in northern Mexico. Results: The causes of urological consultation of the child with CP, referred by nursing were: urinary infection, phimosis, retractable testicle, cryptorchidism, hypogonadism, overactive bladder, and hypospadias. The relationship between the urinary infection of the child with CP and its degree of independence was established with the level of urinary sphincter control. Conclusions: The nursing staff is a key and decisive factor in the diagnosis, early reference for treatment and monitoring of the evolution of urinary disorders in children with CP. It is not indicated to start a toilet training program in children with CP, without having previously ruled out a urinary tract infection

Valoración integral enfermera al paciente geriátrico con patología quirúrgica urológica / No disponible

Los tumores urológicos son los más habituales entre la población de mayores de 70 años. En el paciente geriátrico, la evaluación preoperatoria es fundamental, pero la clasificación de riesgo ASA no ha sido específicamente diseñada para evaluar pacientes de edad avanzada. La reserva funcional y los síndromes geriátricos son aspectos a valorar en el paciente que va a ser intervenido quirúrgicamente

Urological tumours are the most frequent among population over 70 years of age. Preoperative evaluation is of pivotal importance for elderly people, but ASA has not been specifically designed to evaluate elderly patients

Magnetic resonance imaging and clinical findings in seminal vesicle pathologies

ABSTRACT Purpose Congenital and acquired pathologies of the seminal vesicles (SV) are rare diseases. The diagnosis of SV anomalies is frequently delayed or wrong due to the rarity of these diseases and the lack of adequate evaluation of SV pathology. For this reason, we aimed to comprehensively evaluate SV pathologies and accompanying genitourinary system abnormalities. Materials and Methods Between March 2012 and December 2015, 1455 male patients with different provisional diagnosis underwent MRI. Congenital and acquired pathology of the SV was identified in 42 of these patients. The patients were categorized according to their SV pathologies. The patients were analyzed in terms of genitourinary system findings associated with SV pathologies. Results SV pathologies were accompanied by other genitourinary system findings. Congenital SV pathologies were bilateral or predominantly in the left SV. Patients with bilateral SV hypoplasia were diagnosed at an earlier age compared to patients with unilateral SV agenesis. There was a significant association between abnormal signal intensity in the SV and benign prostate hypertrophy (BPH) and patient age. Conclusion SV pathologies are rare diseases of the genitourinary system. The association between seminal vesicle pathology and other genitourinary system diseases requires complete genitourinary system evaluation that includes the seminal vesicles.

Implantación de un protocolo de actuación en patología prostática en atención primaria e impacto en las derivaciones a urología / Implementing an action protocol on prostatic disease in primary care and impact on referrals to urology

OBJETIVO: Determinar el impacto sobre las derivaciones a Urología desde Atención Primaria, de un protocolo de actuación conjunta en patología prostática en un área sanitaria. MÉTODOS: Se elaboró un protocolo para el manejo del paciente que consulta por clínica relacionada con hiperplasia prostática y para la realización de PSA en varón asintomático. Al mismo tiempo, se abrieron tres direcciones de correo electrónico para consultas generadas desde Atención Primaria y se realizaron sesiones conjuntas en los Centros de Salud. Medimos el impacto del protocolo valorando la adecuación de las derivaciones a Urología por patología prostática, así como determinando la evolución del número total de derivaciones en tres centros de especialidades periféricas. RESULTADOS: Desde enero de 2011, se ha producido una mejor adecuación de las derivaciones a Urología por patología prostática, que han pasado de un 47% de adecuación (valoración previa a la implantación del protocolo) a un 64%. Estos resultados son especialmente buenos cuando consideramos las derivaciones relacionadas con el PSA, que han pasado de un 33% a un 84% de adecuación. En cuanto a la evolución de las derivaciones a Urología, la tasa de derivación (derivaciones por 1000 habitantes) ha descendido en un 15% (de 13,8 a 11,7). CONCLUSIONES: La colaboración entre Urología y Atención Primaria, mediante la implantación de protocolos conjuntos, así como estableciendo nuevos medios de comunicación (correo electrónico, sesiones conjuntas), consigue una mejor adecuación de los pacientes derivados por patología prostática, así como una disminución en el número total de derivaciones (AU)

OBJECTIVES: To determine the impact of implementing a joint action protocol on prostatic disease on the referrals to Urology from Primary Care in a health care area. METHODS: We drafted a protocol for managing patients consulting for clinical signs and symptoms associated to benign prostatic hyperplasia (BPH) and to test PSA in asymptomatic males. At the same time, three e-mail addresses were opened for consultations generated from Primary Care, and joint sessions were carried out in the primary health care centers. We measured the impact of the protocol by assessing the adequacy of prostatic disease referrals to Urology, as well as by determining the course of the total number of referrals in three peripheral specialized health care centers (PSHCC). RESULTS: From January 2011, a better compliance to the referrals to Urology protocol for prostatic disease has been produced, going from 47% (assessment prior to implementing the protocol) to 64%. These results are especially good when we consider referrals associated to PSA, which went from a compliance of 33% to 84%.Regarding the course of the referrals to Urology, the referral rate (referrals per 1000 inhabitants) has decreased by 15% (from 13,8 to 11,7). CONCLUSIONS: The collaboration between Urology and Primary health care, by means of implementing joint protocols, and also by establishing new communication channels (e-mail, joint sessions), achieves a better adequacy of patients referred for prostatic disease, as well as a reduction in the total number of referrals (AU)

Ocorrência de infecção do trato urinário em cobradoras de ônibus / Occurrence of urinary tract infection in a bus servicer

JUSTIFICATIVA E OBJETIVOS: As infecções do trato urinário (ITU) são diversas manifestações clínicas que variam desde a presença assintomática de bactérias na urina até infecção renal grave, resultando em sepse, situação que poderá levar o paciente ao óbito. A principal estratégia de defesa do hospedeiro é um fluxo urinário desobstruído, que dificulta o percurso da bactéria ascendente. O objetivo deste estudo foi verificar a ocorrência de sintomas sugestivos de ITU, descrevendo as atividades diárias que levam à sua maior suscetibilidade, bem como identificar os fatores predisponentes presentes e verificar os principais sintomas clínicos obtidos. MÉTODO: Realizou-se estudo exploratório, descritivo e prospectivo. A população constituiu-se de 100 mulheres selecionadas de acordo com a faixa etária (30 a 40 anos) e função empregatícia como cobradora de ônibus. RESULTADOS: Os resultados demonstram que 50% das entrevistadas apresentaram ocorrência de ITU, 55% alegaram recidivas; o sintoma mais frequente foi dor pélvica (80%), associada ou não ao ato de urinar e que 95% das mulheres relataram estase urinária. CONCLUSÃO: É possível que orientações mais adequadas referentes a hábitos alimentares saudáveis possam melhorar a qualidade de vida e prevenir doenças específicas deste grupo.

BACKGROUND AND OBJECTIVES: Urinary tract infections (UTI) are different clinical manifestations ranging from asymptomatic presence of bacteria in the urine up to serious kidney infection, resulting in sepsis, which could lead the patient to death. The main host defense is a clear urine flow, which makes the route of the bacterium ascendant. This study aimed to verify the occurrence of UTI, describing the daily activities that lead to increased susceptibility to UTI, identify predisposing factors present among the participants and further important clinical symptoms mentioned. METHOD: Carried out an exploratory, descriptive and transversal. The study population consisted of 100 women selected according to age (30 to 40 years) and employment-function. RESULTS: The results show that 50% of respondents reported the occurrence of UTI, 55% reported recurrence; the most frequent symptom was pelvic pain 80%, with or without the act of urinating and that 95% of women report urinary stasis. It was concluded that due to his professional activity, the collectors had a favor to bacterial growth. CONCLUSION: It is possible that appropriate policies relating to healthy habits can improve the quality of life and prevent specific diseases of this group.

Patología nefrourológica en niñas con síndrome de Turner / Nephrourologic pathology in girls with Turner syndrome

Las malformaciones nefrourológicas en el síndrome de Turner son frecuentes, por lo que su diagnóstico y seguimiento son importantes para disminuir la morbilidad de esta entidad. El objetivo de este trabajo retrospectivo fue analizar la patología nefrourológica en 72 niñas con síndrome de Turner atendidas entre 1989 y 2008 en el Hospital Garrahan. La prevalencia de patología nefrourológica fue del 33% (24 pacientes). Predominaron las anomalías del sistema urinario aisladas (10 pacientes, 42%) o asociadas a malformaciones renales (9 pacientes, 37%); 5 pacientes (21%) tuvieron anomalías estructurales renales aisladas. El 50% presentó complicaciones (8 infección urinaria, 2 proteinuria y 2 hipertensión arterial).

Nephrourologic malformations in Turner syndrome are frequent, its diagnosis and follow-up is important in order todiminish the morbidity of this disease. The aim of this retrospective study was to analyze the nephrourologic pathologyin 72 girls with Turner syndrome followed between 1989 and 2008 at Garrahan Hospital. The prevalence of nephrourologic involvement was 33% (24 patients). The most frequent findings were urinary system malformations, isolated (10 pacientes,42%) or associated with renal malformations (9 patients, 37%); 5 patients (21%) had only renal malformations. Fifty percent of patients developed complications (8 urinary tractinfection, 2 proteinuria and 2 arterial hypertension); however, none progressed to chronic renal failure. The prevalence of nephrourologic involvement was 33% and a half of these girls developed complications, our findings show the need of routine nephrological follow-up of girls with Turner syndrome and nephrourologic malformations.

Patología nefrourológica en niñas con síndrome de Turner / Nephrourologic pathology in girls with Turner syndrome

Las malformaciones nefrourológicas en el síndrome de Turner son frecuentes, por lo que su diagnóstico y seguimiento son importantes para disminuir la morbilidad de esta entidad. El objetivo de este trabajo retrospectivo fue analizar la patología nefrourológica en 72 niñas con síndrome de Turner atendidas entre 1989 y 2008 en el Hospital Garrahan. La prevalencia de patología nefrourológica fue del 33% (24 pacientes). Predominaron las anomalías del sistema urinario aisladas (10 pacientes, 42%) o asociadas a malformaciones renales (9 pacientes, 37%); 5 pacientes (21%) tuvieron anomalías estructurales renales aisladas. El 50% presentó complicaciones (8 infección urinaria, 2 proteinuria y 2 hipertensión arterial).(AU)

Nephrourologic malformations in Turner syndrome are frequent, its diagnosis and follow-up is important in order todiminish the morbidity of this disease. The aim of this retrospective study was to analyze the nephrourologic pathologyin 72 girls with Turner syndrome followed between 1989 and 2008 at Garrahan Hospital. The prevalence of nephrourologic involvement was 33% (24 patients). The most frequent findings were urinary system malformations, isolated (10 pacientes,42%) or associated with renal malformations (9 patients, 37%); 5 patients (21%) had only renal malformations. Fifty percent of patients developed complications (8 urinary tractinfection, 2 proteinuria and 2 arterial hypertension); however, none progressed to chronic renal failure. The prevalence of nephrourologic involvement was 33% and a half of these girls developed complications, our findings show the need of routine nephrological follow-up of girls with Turner syndrome and nephrourologic malformations.(AU)

Luis Cifuentes Delatte (1907-2005). Semblanza biográfica / Dr. Luis Cifuentes Delatte (1907-2005). Biographical sketch

Objetivo: Con ocasión de cumplirse el centenario del nacimiento del Dr. D. Luis Cifuentes Delatte, y al considerarlo como una de las personalidades de mayor trascendencia de la Urología española de la segunda mitad del siglo XX, repasamos su vida, su entorno y sus relaciones y resaltamos sus vivencias, además de su obra y su faceta investigadora. Métodos: Lectura de sus libros y artículos varios, de las publicaciones periódicas urológicas españolas desde1930, de las que entresacamos las referencias que sobre él encontramos y también de nuestra relación y conocimiento personal. Resultado/Conclusiones: Con una importante preparación clínica e investigadora, una amplia capacidad de trabajo, observador juicioso y agudo, además de objetivo y riguroso en la comprobación de sus resultados, el análisis del sedimento urinario, la infección de orina junto con la formación de los cálculos y el estudio de la patología vesical, neurogénica, tumoral y cistopatías, fueron los temas fundamentales a los que se dedicó a la par que destacó sobremanera en la práctica de la cirugía transuretral. Publicista de valía, destaca por la trascendencia de sus escritos, y especialmente por ser maestro de una amplia generación de urólogos españoles e hispanoamericanos y por su entrega al estudioy a la Urología (AU)

Objectives: With the centenary of the birth of Dr. Luis Cifuentes Delatte, considering he in as one of the most transcendental personalities in the Spanish urology of the second half of the 20th-century, we review his life, his environment , and his relationships, and emphasize his life experiences, in addition to his works and research. Methods: We read his books and articles from Spanish urological journals from 1930, from which we selected the references we found about him. We also used as a source our personal relationship with him. Results/Conclusions: He had an important clinical and research education, a great working capacity; he was a judicious and acute observer, also objective and rigorous checking results; the analysis of urine sediment, urinary tract infection with stone formation, and the study of bladder, neurogenic and tumoral pathologies, as well as a cystopathies, were the main topics he dedicated to; he also was outstanding in transurethral surgery. Valuable publicist, he is outstanding due to the transcendence of his written works, and especially for being the Master of an ample generation of Spanish and South American urologists, and for his love for study and urology (AU)

La terapia fotodinámica en urología. Mecanismos de acción biológicos y patológicos / Photodynamic therapy in urology. Biologic and pathologic mechanisms of action

La Terapia Fotodinámica (TFD) es una modalidad terapéutica mínimamente invasiva y de extraordinaria utilidad. En Urología, la TFD, es muy útil y puede ser aplicada mediante endoscopia o directamente, habiéndose obtenido excelentes resultados en el diagnóstico y tratamiento de lesiones tumorales de vejiga, en el tratamiento de carcinoma de próstata y de sus recidivas y en el tratamiento de lesiones dermatológicas precancerosas y tumorales del pene. La TFD se fundamenta en el uso de compuestos fotosensibilizadores (FSs) que se acumulan selectivamente en los tejidos tumorales. La irradiación posterior de éstos tejidos con luz de longitud de onda apropiada (generalmente de la región del rojo del espectro visible λ > 600nm) produce la formación de especies reactivas de oxígeno (ROS) con efectos citotóxicos, que conducen a la muerte selectiva de las células neoplásicas y en consecuencia a la regresión del tumor. La principal ventaja de la TFD es que el daño celular queda restringido a la zona irradiada, con la consiguiente disminución de efectos secundarios sobre los tejidos sanos próximos al tumor, al contrario de lo que ocurre con otras terapias convencionales de algunos tumores del tracto urinario. Además, la TFD puede utilizarse en combinación con radioterapia y quimioterapia (AU)

Photodynamic Therapy (FDT) is a minimally invasive therapeutic modality extraordinarily useful. In urology, FDT is very useful and may be applied through endoscopes or directly, with excellent results obtained for the diagnosis and treatment of bladder tumors, in the treatment of prostate cancer and its recurrences, and in the treatment of dermatological premalignant lesions and carcinomas of the penis. FDT is founded on the use of photosensitizing products which selectively accumulate in tumor tissues. The irradiation of these tissues with a proper wavelength light (generally in the red region of the visible spectrum λ > 600nm) produces the formation of oxygen reactive species with cytotoxic effects leading to selective death of neoplastic cells, and tumor regression. The main advantage of FDT is the restriction of cellular damage to the irradiation area, with the associated decrease of secondary effects on healthy tissues near the tumor, on the contrary to what happen with other conventional therapies for some tumors of the urinary tract. Moreover, FDT may be used in combination with radiotherapy and chemotherapy (AU)

Nuevas perspectivas de la laserterapia / New perspectives for laser therapy

Hacemos en este trabajo una revisión de las tendencias actuales y de las nuevas perspectivas del uso del láser en urología, analizando los diferentes campos en los que se ha utilizado esta energía. En litotricia, el láser ha modificando los algoritmos terapéuticos de la litiasis ureteral. Además, su posibilidad de empleo en ureteroscopia flexible está permitiendo realizar la litotricia intracorpórea «in situ» a nivel renal. Nuevos láseres como el Erbium: YAG, más eficaces y más inocuos que el holmium están actualmente en desarrollo. La investigación en nuevas fibras, más flexibles, económicas y duraderas es el próximo reto en este campo. En HBP, si bien el láser KTP ha conseguido una difusión extraordinaria para un determinado tipo de volumen prostático, nuevos láseres como el Thulium y el Diodo, dada la precisión de su corte, compiten con el Holmium en el terreno enucleación prostática. La aplicación del láser en la terapia fotodinámica del cáncer urológico y en la soldadura de tejidos constituyen en la actualidad nuevos objetivos de investigación prometedores (AU)

We review the current trends and new perspectives of the use of laser in urology, analyzing different fields in which this energy has been used. In lithotripsy, the laser has modified the therapeutic algorithms for ureteral lithiasis. Moreover, the possibility of using laser with flexible ureteroscopes is enabling the performance of intracorporeal in situ renal lithotripsy. New lasers such as Erbium:yag, more effective and more innocuous than holmium are currently under development. The research in new fibers, more flexible, economic and long-lasting is the next challenge in this field. In BPH, although the KTP laser has obtained and extraordinary diffusion for a certain type of prostate volume, new lasers such as thulium and diode, are in competition with holmium laser in the field of prostatic enucleation due to their precise cut. The application of laser in photodynamic therapy for urological cancers and tissue welding are currently new promising objectives of research (AU)

La biopsia intraoperatoria en patología oncológica urológica / Frozen section in urological oncology

Las indicaciones de la biopsia intraoperatoria (BI) en las cirugías por neoplasias urológicas son muy concretas, esto explica que sólo representen un 7´3% de las BI en los hospitales generales y motiva que se conozca de una forma precisa su utilidad, siendo éste el motivo la revisión que presentamos. En términos generales no está justificada la BI para identificar la naturaleza de una masa tumoral, a excepción de: 1) Las masas renales con dudas sobre el origen parenquimatoso o en vías urinarias. 2) En las neoplasias testiculares cuando se plantea la posibilidad de un tratamiento conservador. 3) La determinación de la presencia de un adenocarcinoma de próstata en un donante de órganos con PSA sérico elevado, pero incluso en estas circunstancias hay amplia discusión sobre su necesidad. La determinación intraoperatoria de los márgenes quirúrgicos es especialmente útil en: 1) Las nefrectomías parciales (puede limitarse a la inspección habiendo pintado con tinta china el margen y sólo muy ocasionalmente se precisa congelación del lecho). 2) El uretral en mujeres con cistectomías totales y sustitución ortotópica. 3) En las penectomías parciales (estudiando siempre el margen uretral y el de los cuerpos cavernosos y esponjoso). El estudio de los ganglios es un tema ampliamente debatido y salvo en casos del hallazgo de un inesperado aumento del tamaño ganglionar no está indicada la BI sistemática ni en vejiga ni en próstata. Otra es la situación en el carcinoma de pene ya que en los grupos de riesgo intermedio y alto de metástasis ganglionar, aunque haya de un 16% a un 18% de falsos negativos se recomienda BI, especialmente de los ganglios centinelas marcados con radioisótopos

The indications of Frozen section diagnosis (FS) in surgery due to urologic neoplasia are quite specific, and this explains the fact that they amount to a mere 7.3% of the FSs performed in general hospitals. This also makes the precise knowledge of their usefulness necessary, and thus we are submitting the present review. Generally speaking, FS is not warranted to identify the nature of a tumoral mass, with the following exceptions: 1) Renal masses of a doubtful parenchymal origin, or in the urinary tract: 2) In testicular neoplasias, when the possibility of a conservative treatment arises; 3) Determination of the presence of a prostate adenocarcinoma in an organ donor with high serum PSA; but even in these circumstances its need is widely controversial. Intraoperative determination of surgical margins is particularly useful in: 1) Partial nephrectomies (it may be limited to inspection after dyeing the margin with Indian ink - bed freezing is very seldom needed); 2) Urethral margins in women with total cystectomies and orthotopic substitution; 3) In partial penectomies (always studying the urethral margin and the cavernosal and spongiosal corpora margins). The study of the nodes is a widely debated issue, and except for those cases in which unexpectedly increased node size is found, systematic FS is indicated neither of the bladder nor of the prostate. The situation regarding penis carcinoma is different, as in the groups with intermediate and high risk of node metastasis, even though there is around 16% - 18% of false negatives FS is recommended, particularly of radioisotope-marked sentinel nodes

Estudio flujo-presión de la micción en el hombre / Fluid pressure study of the micturition in men

Pressure-flow study of voiding is, at present, the best method of analysing voiding function quantitatively. It is an invasive second line study by which the relationship between pressure in the bladder and urine flow is measured during bladder emptying. The main use of it is the evaluation of older men with lower urinary tract symptoms. It allows to differentiate between patients with low urinary flow resulting from poor bladder contractility (low detrusor pressure) and those whose low urinary flow is secondary to true bladder outlet obstruction (high detrusor pressure),as well as combined alterations. In this article we describe the International Continence Society (ICS) nomenclature, the bladder detrusor and urethral functions during voiding, as well as some principles of voiding mechanics. We also discuss the analysis of the results in men with bladder outlet obstruction using the Abrams-Griffiths nomogram, the Schãfer nomogram and the ICS nomogram, including the evaluation of bladder contractility.