[Yield of ultrasound-guided transrectal biopsy in the diagnosis of prostatic cancer in symptomatic patients]. / Rendimiento de la biopsia transrectal ecodirigida en el diagnóstico del cáncer de próstata en los pacientes sintomáticos.

OBJECTIVE: The aim of this retrospective study was to evaluate the utility of US-guided transrectal biopsy of the prostate in the diagnosis of prostatic cancer in symptomatic patients and its correlation with the digital rectal examination (DRE), PSA levels and ultrasound findings. METHODS: From 1994 to 1995, 427 patients with prostatic symptomatology underwent prostatic biopsy. The mean age was 69.1 +/- 8.3 years (range 44 - 89). The criteria for biopsy were abnormal DRE, PSA > 10 ng/ml, abnormal US findings and/or PSA density > 0.15. RESULTS: Prostate cancer was confirmed in 42% of the patients. The incidence of cancer when DRE was abnormal was 73%, 46% when PSA was > 10 ng/ml and 55% when the US findings were abnormal; 82% for abnormal DRE and PSA > 10 ng/ml, and 84% when the criterion of abnormal US was included. The incidence of cancer when DRE was normal was 16%, 18% when combined with PSA > 10 ng/ml and remained unchanged when combined with the US findings. In patients with normal DRE and PSA between 10 - 30 ng/ml, the incidence of cancer was 14% and 41% for those with PSA > 30 ng/ml. CONCLUSION: DRE was the best independent predictor of prostate cancer and the combination of abnormal DRE, PSA > 10 ng/ml and abnormal US findings gave the highest detection rate. The incidence of prostate cancer was very low in patients with normal DRE and PSA between 10 - 30 ng/ml, which may be due to the fact that the PSA levels are raised by the non neoplastic changes in the transitional zone in symptomatic patients.

[Variability of rectal examination of the prostate among various groups of observers]. / Variabilidad del tacto rectal de la próstata entre distintos groupos de observadores.

Rectal examination (RE) of the prostate gland is compulsory to rule out the presence of prostate cancer (PC). Empirically, it is defined as an examination burdened with a high degree of subjectivity and difficult to reproduce. The objective of this retrospective study is to evaluate RE concordance between different groups of researchers. In 133 patients referred to our Centre with suspected PC, RE was performed by three groups of experimented urologists (2 in-hospital and 1 out-hospital). Concordance between the different groups was evaluated using Kappa's index (K). Kappa's index between out- and in-hospital urologists was 70%, 71% and 78%. Concordance of RE findings between the different groups of urologists can be considered good, since no significant differences were found relative to ER positive predictive value.

[Performance+ of transrectal ultrasonography in the diagnosis of prostatic cancer in patients with abnormal digital examination]. / Rendimiento de la ecografía transrectal en el diagnóstico del cáncer de próstata en los pacientes con tacto rectal anormal.

OBJECTIVES: To determine the incidence of prostatic cancer in patients with abnormal digital rectal examination (DRE) and its correlation with PSA levels and US findings. METHODS: A retrospective study was conducted on 167 patients with abnormal DRE that had been evaluated by PSA, US and prostate biopsy from January, 1994 to September, 1995. The 95% confidence interval was estimated (C195) for the differences observed. RESULTS: Biopsy demonstrated cancer in 73% of the patients; 67.7% of the patients with DRE classification of T2 versus 88.4% of those with T3 (C195 = 8%-33.3%); 81.4% of patients with PSA > 10 ng/ml had cancer versus 60.5% of patients with PSA > 4 and < 10 ng/ml (CI95 = 3%-37.9%); 79.5% of the cases with ultrasound nodes had cancer vs 43.3% of those without (CI95 = 17.3%-55.2%). In patients with PSA > 4 and < or = 10 ng/ml, 71% of the cases with ultrasound nodes had cancer versus 14.3% with no nodal involvement (CI95 = 26.2%-87.1%). In patients with PSA > 10 ng/ml, 83.2% of the patients with ultrasound evidence of node involvement had cancer versus 70.6% of the patients with no node involvement (CI95 = -10.3%-35.4%). CONCLUSIONS: The incidence of prostatic cancer in patients with abnormal DRE was 73%; 81.4% of patients with PSA > 10 ng/ml and 79.5% of patients with ultrasound evidence of node involvement and 83.2% of those with both of the foregoing characteristics. Biopsy of both prostatic lobes should be performed routinely in all patients with abnormal DRE.

[Subcapsular renal hematoma following shock wave lithotripsy]. / Hematomas renales subcapsulares tras litofragmentación por ondas de choque.

OBJECTIVES: The present study analyzed the incidence of subcapsular hematoma of the kidney (SH) following extracorporeal shock wave lithotripsy (ESWL), its management and the possible risk factors that influence the development of this condition. METHODS: We received the records of 1600 patients submitted to 2250 ESWL sessions. SH was evaluated according to the following parameters: clinical features, diagnostic methods, management, follow up and the patient -and ESWL- related factors that influence the development of this condition. RESULTS: Five cases of SH were found (0.22% incidence), which had been diagnosed by ultrasound (US). Eighty per cent had sustained lumbar pain and a fall in hemoglobin values. The patients were managed conservatively and US follow up evaluation was done. At six months, resolution was almost complete with no sequelae. No patient had any of the risk factors described in the literature (hypertension, concomitant urinary tract infection or coagulation disorders) or changes in the ESWL unit standards. CONCLUSIONS: Although SH following ESWL is uncommon, sustained lumbar pain and a fall in hemoglobin values are risk factors that should be taken into account and corroboration and follow up by US should be done. Unless complications present, the patients should be managed conservatively.

[Gangrenous cystitis induced by giant bladder calculus]. / Cistitis gangrenosa inducida por un cálculo vesical gigante.

Presentation of one case of gangrenous cystitis or vesical gangrene induced by the presence of a large vesical calculus in a patient with neurogenic bladder. Remarks on the patho-etiology, symptoms and treatment of this rare entity entailing a truly surgical emergence.

[Genito-urinary tuberculosis in acquired immunodeficiency syndrome]. / Tuberculosis genitourinaria en el síndrome de immunodeficiencia adquirida.

Tuberculosis is being described as a highly associated entity with the acquired immunodeficiency syndrome (AIDS) in countries or geographical areas where this entity is endemic, even becoming its first clinical manifestation. Two cases of prostatic abscess are presented in patients with anti-HIV antibodies, who are parenteral drug users. In one of them, his genitourinary tuberculous infection was the first sign of AIDS. In the other, a previous association with tuberculous meningitis was found. The evolution and pathogenicity of tuberculous genitourinary in AIDS patients is discussed.