[Molecular forms of PSA and differentiating between benign hypertrophy,carcinoma, and disseminated prostatic carcinoma. Correlation between two determination technics]. / Formas moleculares de PSA en la discriminación entre hipertrofia benigna, carcinoma y carcinoma diseminado de próstata. Correlación entre dos diferentes técnicas de determinación.

OBJECTIVE: To determine the correlation between two methods of measurement of total PSA (PSA-T) and free PSA (PSA-F) and the utility of the PSA-F/PSA-T ratio in patients with PSA-T between 4 and 10 ng/ml suspected as having prostate cancer. METHODS: Determinations of both PSA-T and PSA-F were performed using two different techniques in 91 patients suspected as having prostate cancer. Diagnosis was made on the findings of biopsy and the complementary tests. RESULTS: The following correlation was found for the two techniques: R = 0.99 and p < 0.05 for PSA-T, and R = 0.85 and p < 0.05 for PSA-F. For PSA-T values of 4-10 ng/ml and PSA-F greater than 25%, we found two patients with prostate cancer. For a PSA-F/PSA-T ratio less than 9%, all cases had prostate cancer. Three cases with bone metastasis had PSA-T values less than 10 ng/ml. CONCLUSIONS: A PSA-F/PSA-T ratio greater than 25% does not exclude malignancy in patients with a total PSA of 4-10 ng/ml; values less than 9% correspond to prostate cancer. Bone metastasis was found with both methods in patients with total PSA values less than 10 ng/ml.

[The early diagnosis of prostate cancer in a selected population. The usefulness of PSAD, PSAD ad. and age-adjusted PSA in patients with a PSA between 4-10 ngr./ml]. / Diagnóstico precoz del cáncer de próstata en población seleccionada. Utilidad del PSAD, PSAD ad. Y PSA ajustado a la edad en pacientes con PSA entre 4-10 ngr./ml.

RATIONALE: Exposition of our experience in the early diagnosis of prostate cancer, based on the initial selection of patients. METHODS: Evaluation of patients from within the area covered by our hospital and seen for signs and symptoms of prostatism. Those with suspicion rectal examination (RE) or PSA greater than 4 ng/ml were further evaluated with transrectal ultrasound and prostate biopsy. RESULTS: Based on the biopsies of 700 patients, prostate carcinoma was diagnosed in 294/700 (42%). 55.72% patients with suspicion RE, and 47.5% with PSA > 4 had cancer. In patients with PSA > 4 and non-suspicion RE, cancer was detected in 16.44%. The percentage of neoplasia in patients with PSA 4-10 ng/ml and non-suspicion RE was 10%. As a result of these findings, 88 radical prostatectomies were performed. PASD and PASD ad. showed significant differences between patients with and without cancer, whether with (+)RE (p = 0.0001) or (-)RE (p < 0.0004), unlike PSA that showed no differences. The diagnostic value shown by PSAD ad. in ROC curves was similar to that of PSAD. Value of age-adjusted PSA was not higher than PSAD. CONCLUSION: Performance of prostate biopsy with a suspicion RE is recommended. If RE shows no suspicion, biopsy should be performed when PSA is > 10 ng/ml, and with PSA 4-10 ng/ml a biopsy is advocated with PSAD > 0.15.

Seminal vesicle biopsy in prostate cancer staging.

PURPOSE: Prostate cancer patients were differentiated using seminal vesicle biopsies related to clinical staging, prostate specific antigen (PSA), Gleason scores and PSA density values. MATERIALS AND METHODS: A total of 75 patients underwent seminal vesicle biopsies. Patients with no seminal vesicle invasion and negative lymphadenectomy results underwent radical prostatectomy. RESULTS: Efficacy of seminal vesicle biopsy was 90.9%. Infiltration rates were 69% for disease stage T2b or greater, 68% for PSA greater than 10 ng./ml., 78% for PSA greater than 20 ng./ml. and 73% for type 4 and/or 5 Gleason scores. For the prognosis of seminal vesicle invasion, 0.40 was the best PSA density cutoff point. CONCLUSIONS: We recommend seminal vesicle biopsy in patients with stage T2b or greater disease, and with a lower clinical stage when the PSA level is 20 ng./ml. or greater and/or the Gleason score is 7 or greater.

[Endoscopic internal urethrotomy guided with transrectal echography]. / Uretrotomía interna endoscópica dirigida por ecografía transrectal.

Internal urethrotomy is the endoscopic technique most commonly performed in order to resolve urethral stenosis. This paper describes a new technique which associates transrectal ultrasound to internal endoscopic urethrotomy for the resolution of unsurmountable stenosis of the urethra. Presentation of 6 cases, with a 100% success rate. The authors believe that the association of transrectal ultrasound with internal endoscopic urethrotomy is a simple technique, and very useful for the resolution of unsurmountable stenosis of the urethra.

[Ureteral iatrogenic injury of gynecologic cause. Our experience]. / Yatrogenia ureteral de causa ginecológica. Nuestra experiencia.

In recent years technical and technological advancements in the field of urology have led to the enhancement of iatrogenic lesions of gynecological origin. Herein we describe our experience of 15 years during which 76 renal units were treated with a mean follow-up of 29.3 months. In 46 renal units diversion was performed previously. The surgical technique was a therapeutic success in 89.28% of the cases. Ureterovesical reinsertion with vesical lateralization was the most commonly used technique. We underscore the importance of microsurgical transureteroureterostomy as a useful alternative as well as the use of effective less invasive endourological procedures.

[Diagnostic and therapeutic aspects in Klinefelter's syndrome. Our experience]. / Aspectos diagnósticos y terapéuticos en el síndrome de Klinefelter. Nuestra experiencia.

We present a retrospective study of 30 new cases of Klinefelter's syndrome and set forth our customary diagnostic and therapeutic schedule. We analyse the results obtained and single out the fact that 100% of the patients displayed high gonadotropins and 45% apparent plasmatic testosterone normality at the time of diagnosis. There is a relationship between lower semen fructose concentration, smaller volume of semen and higher degree of hypoandrogenism in Klinefelter's syndrome. Long duration hormonal treatment with testosterone esters is effective in improving the physical psychic and sexual state of patients. The interval between the last administration and the control hormone determination should be uniform for correct result evaluation.

[Emphysematous cystitis]. / Cistitis enfisematosa.

We present a new case of emphysematous cystitis, commenting on some of the more interesting aspects of the etiopatogeny diagnosis and treatment of this entity. We underline the importance of early diagnosis and effective treatment of the disease as well as of the coadjuvant factors.

[Wilms' tumor in the adult. A new case and review of the literature]. / Tumor de Wilms en el adulto. Un nuevo caso y revisión de la literatura.

The nephroblastoma is a rare tumour in the adult and there are 240 cases reported in the world literature. We offer a new case and then review the literature, analysing the major features of diagnosis, treatment and evolution of this tumour.