Comparative study between 1.5 and 3 Tesla multiparametric MRI systems using the PIRADS version 2 classification in the diagnosis of prostate cancer

Introduction: The 3-Tesla multiparametric MRI (mpMRI) system represents a diagnostic advance for prostate cancer. Our aim is to demonstrate that the results in 1.5-Tesla mpMRI are not inferior compared to the 3-Tesla for the correct diagnosis of prostate cancer. Material and methods: Non-inferiority comparative cross-sectional study between fusion-guided prostate biopsy results. 344 patients with clinical suspicion of prostate cancer (elevated PSA and/or suspicious DRE) and mpMRI interpreted and verified by the same radiologists in all cases, 270 in 1.5-Tesla and 74 in 3-Tesla, with at least one lesion PIRADSv2≥ 3. Exclusion criteria were positive biopsy or previous prostate treatment. We consider malignancy as ISUP≥ 1 and significant tumor as ISUP≥ 2. We used Wilcoxon and t-student test (central tendency measures), diagnostic test (gold standard: ISUP of targeted biopsy), Chi2 test and Z-test (comparison of prevalences and 95%CI malignancy and significant tumor according to mpMRI). Results: Median prostate volume 50cc(IQR:33.5) and PSA 6.11ng/ml(IQR:3.39). Mean age 67.4±8.1years. Number of suspi-cious lesions/patient: mpMRI 1.3 (1.5-Tesla) and 1.5 (3-Tesla). No differences were found between mpMRI (homogeneous and comparable samples). 57% (1.5-Tesla) vs 66% (3-Tesla) of targeted biopsies were malignant, and 34%vs38% were significant tumor, with no significant differences. Se, Sp, PPV and NPV for malignancy (1.5-Tesla vs 3-Tesla) were 96%vs90%, 38%vs44%, 67%vs76%, and 86%vs69%, with no significant differences. Conclusions: There are no significant differences between 1.5-Tesla vs 3-Tesla mpMRI regarding targeted biopsy results. Not to have 3-Tesla mpMRI may not be a limitation to use 1.5-Tesla as a diagnostic test for the better diagnosis of prostate cancer (AU)

Introducción: Los equipos de RM multiparamétrica(RMmp) 3-Tesla suponen un avance diagnóstico en cáncerde próstata. El objetivo es demostrar que los resultados enequipos de 1,5-Tesla no son inferiores a los equipos de 3-Tesla para el correcto diagnóstico de cáncer de próstata.Material y métodos: Estudio transversal comparativo de no inferioridad entre resultados de biopsia fusión.344 pacientes con sospecha de cáncer de próstata (PSA elevado y/o tacto rectal sospechoso) y RMmp interpretada ycomprobada por los mismos radiólogos en todos los casos,270 con 1,5-Tesla y 74 con 3-Tesla, con al menos una imagen PIRADSv2≥ 3. Criterios de exclusión: biopsia positiva o tratamiento prostático previo. Consideramos malignidad como ISUP≥ 1 y tumor significativo como ISUP≥ 2.Comparamos medidas de tendencia central (test Wilcoxony t-student), prevalencias e IC95% (Chi2 y prueba-Z) y testde prueba diagnóstica (gold estándar: ISUP de biopsia dirigida) según RMmp empleado.Resultados: Medianas de volumen prostático50cc(IQR:33,5) y PSA 6,11ng/ml(IQR:3,39). La mediade edad fue 67,4±8,1años. El número de lesiones sospechosas/paciente fue 1,3 (1,5-Tesla) y 1,5 (3-Tesla). No encontramos diferencias entre RMmp (muestras homogéneasy comparables). 57%(1,5-Tesla) vs 66%(3-Tesla) biopsiasdirigidas presentaron malignidad, y 34%vs38% tumorsignificativo, sin diferencias significativas. Se, Sp, VPP yVPN para malignidad (1,5-Tesla vs 3-Tesla) de 96%vs90%,38%vs44%, 67%vs76%, y 86%vs69%, sin diferenciassignificativas.Conclusiones: No encontramos diferencias significativas entre RMmp de 1,5-Tesla y 3-Tesla respecto a los resultados de biopsia. No disponer de RMmp de 3-Tesla...(AU)

Fístulas urinarias: puesta al día / Urinary fistulas: an update

Las fístulas urinarias constituyen una patología poco frecuente en nuestra práctica diaria, si excluimos las vésico-vaginales. Se necesita, sin embargo, conocerlas para diagnosticarlas y tratarlas adecuadamente. De una forma bastante resumida ponemos al día el manejo de las fístulas uro-vasculares, urocutáneas, urodigestivas y uro-ginecológicas, repasando igualmente su etiología (AU)

[Urinary fistula: update]. / Fístulas urinarias: puesta al día.

The urinary fistulas are not a frequent problem in our urological rutinary work, being the vesicovaginal ones the most common. However, it will be necessary to know them to be able to diagnose and treat them in the best way. In this article we classificate the different urinary fistulas (uro-gynecologicals, uro-vasculars, uro-cutaneous and entero-urinarys), explaining the possible etiologies and the correct management.

[Treatment of female stress urinary incontinence with the TVT (tension-free vaginal tape) system: our experience]. / Tratamiento de la incontinencia urinaria de esfuerzo femenina con el sistema TVT (Tensión free Vaginal Tape): nuestra experiencia.

INTRODUCTION: The TVT system is a new surgical procedure for female stress urinary incontinence. The object of this study is to report our initial experience with this technique. We report our results and complications too. MATERIAL AND METHODS: From April 1999 to July 2000, 23 systems TVT was implanted in our hospital. The patients were followed for a 6 to 21 month period. All the patients had stress incontinence. The mean age was 59 years. Gynaecological surgery was associated in 4 patients. One of them was excluded because a diagnosis mistake. TVT implies the implantation of a prolene tape around mid-urethra via a minimal vaginal incision. RESULTS: 17 patients (77.27%) had a significantly improved in the post-operative evaluation. The mean post-surgical stay in the hospital was 1.7 days. A bladder base was damaged during the surgery. No urinary retention, erosion or urethral lesion were found. CONCLUSIONS: We consider the TVT operation to be a safe and effective surgical procedure for the treatment of female urinary stress incontinence. This surgery is easy to lean, fast, cheap and with a low rate of complications.

[Urethro-vesical foreign bodies]. / Cuerpos extraños uretro-vesicales.

We report the case of a squizoid 45 year old man who presented an acute urinary retention and had several foreign bodies in the urethra and bladder.

Tratamiento de la incontinencia urinaria de esfuerzo femenina con el sistema TVT (Tensión free Vaginal Tape): nuestra experiencia / TVT system for treatment of females stress urinary incontinence: our experience

INTRODUCCIÓN: El sistema TVT (tensión-free vaginal tape), es una nueva técnica quirúrgica para el tratamiento de la incontinencia de esfuerzo femenina. El objetivo de este trabajo es presentar nuestra experiencia inicial con la técnica, dando nuestros resultados y complicaciones. MATERIAL Y MÉTODOS: Desde Abril de 1999 hasta Julio de 2000 se implantaron en nuestro servicio 23 sistemas TVT, con un tiempo de seguimiento de entre 6 y 21 meses. Todas las pacientes presentaban incontinencia urinaria de esfuerzo. La edad media era de 59 años. Se asoció cirugía ginecológica concomitante en 4 pacientes. Una se excluye del estudio por error diagnóstico. El sistema TVT supone el implante de una fina banda de prolene sobre la uretra media mediante la realización de una mínima incisión. RESULTADOS: De las 22 pacientes, 17 (77,27 por ciento) tuvieron una clara mejoría entre 6 y 21 meses tras la cirugía. La estancia media post-operatoria fue de 1,7 días. Se produjo una lesión intraoperatoria de la base vesical. No tenemos casos de retención de orina post-quirúrgica, erosión o fístula uretral. CONCLUSIONES: Consideramos al sistema TVT una técnica quirúrgica eficaz para el tratamiento de la incontinencia urinaria femenina de esfuerzo. Es una técnica fácil de aprender, de rápida ejecución, económica y con pocas complicaciones (AU)

[Solitary renal metastasis of primary esophageal cancer]. / Metástasis renal solitaria de un cáncer primario esofágico.

We present an unusual case of single kidney metastasis from an primary esophageal neoplasm. Its main clinical and diagnostic topics are described. They made us consider him as a good candidate for surgery. The pathological study of the nephrectomy specimen was surprising. The postoperative period was unfortunate, however.

[Pyelocalicial diverticula]. / Divertículos pielocaliciales.

OBJECTIVE: To review the embryological and clinical aspects of the different types of pyelocaliceal diverticula, with special reference to the differential diagnosis and treatment. METHODS: Images of type I and II pyelocaliceal diverticula are shown. The conditions that cause difficulty in making the differential diagnosis are discussed. RESULTS: Urography continues to be the diagnostic method preferred and is sometimes aided by retrograde ureteropyelography. CONCLUSIONS: Pyelocaliceal diverticula are cystic eventrations of the upper urinary tract lying within the renal parenchyma that communicate through a narrow channel into the main collecting system. They occur in 0.2 to 0.5% of the population and are congenital in origin. Calyceal diverticula are frequently found incidentally on routine excretory urograms, but patients may complain of flank pain, hematuria or recurrent urinary infections. In the past, treatment required open renal surgery. Endourologic procedures are widely utilized today.

Metástasis renal solitaria de un cáncer primario esofágico / Single renal metastasis from a primary esophageal cancer

Presentamos el infrecuente caso de una metástasis renal única procedente de una neoplasia esofágica primaria. Describimos los principales aspectos clínicos y diagnósticos. Estos nos hicieron considerar al paciente como un buen candidato para cirugía. El estudio anatomopatológico de la pieza de nefrectomía fue sorprendente. El periodo postoperatorio fue, sin embargo, desafortunado (AU)

[Partial nephrectomy in lithiasis]. / Nefrectomía parcial en la patología litiásica.

OBJECTIVE: To analyze our series of patients with renal lithiasis who underwent partial nephrectomy from 1980-1999. METHODS: 28 patients who underwent partial nephrectomy were analyzed (22 females; mean age 48.09 years, and 6 males; mean age 60 years). Surgery for lithiasis had been previously performed in 5 renal units. Nine patients had previously undergone ESWL (more than 3 sessions), all of whom subsequently developed multiple residual calculi. Twelve patients had a microbiologically confirmed positive urine culture. The renal lithiasis amenable to treatment by partial nephrectomy was frequently localized in the lower calyces (17 cases). RESULTS: Histopathological analysis of the nephrectomy specimen showed a prevalence of signs of chronic parenchymal atrophy (25 cases). Three cases showed segmental renal dysplasia (those in whom a superior heminephrectomy was performed for duplex excretory system). Fifty percent of the stone fragments analyzed showed calcium phosphocarbonate. Eight patients had postoperative complications; the most important were two cases of renal cutaneous fistula and one subphrenic abscess. At 9 1/2 years' mean follow-up, renal function is normal in 25 patients. Lithiasis developed in the contralateral unit in 6 cases and in the same renal unit in one case. CONCLUSIONS: Partial nephrectomy continues to be a therapeutic option for lithiasis. Its indication depends on the morphological and functional characteristics of the compromised renal unit, especially in those cases in whom renal preservation can be obviated due to its scanty significance.

[Saint Liborius, patron of European urology. Iconography found in Croatia and Spain]. / San Liborio, patrón de la Urología Europea. La iconografía hallada en Croacia y España.

The discovery made by the group of Dr. Stella Fatovic-Ferencic in Varazdin (Croatia) of a painting of St. Liborius, patron saint invoked for calculi, and the painting of the Sevillian school (circa 1700) discovered by another group in Spain have led to the retrieval of part of the history of European Urology forgotten 250 years ago. Saint Liborius, bishop of Le Mans (France), died in 397, at the time the barbarian hordes were ravaging the Roman Empire, which had been divided into a Western and an Eastern Empire on the death of Theodosius I. Learning more about St. Liborius is of interest. Here is an example of the Graeco-Roman culture of antiguity that is passed on to the present time. The significance of both paintings and their differences are described. The article concludes that on the basis of his biography, St. Liborius should be considered the patron saint of Urology.