Extrauterine Retroperitoneal Leiomyomas: 3 Case Reports and Review of the Literature.

Leiomyomas are benign mesenchymal tumors which originate from smooth muscle cells. Extrauterine leiomyomas are rare and they may arise where smooth muscle cells are found. Their diagnosis is challenging due to their heterogeneous ways of presentation. Histological analysis may reveal areas of sarcomatous differentiation; therefore, complete resection of the entire tumor is the only curative treatment. There is no adjuvant therapy proved to increase overall survival. It is essential to develop a standardized protocol, detailing how to follow up these patients since it is not reported in the literature to date; however, it is advisable to follow them because the local recurrence rate is high if small implants remain. In this review, we present 3 cases of extrauterine leiomyomas diagnosed and treated in our hospital. The management was different in each case, highlighting the heterogeneity of this condition. According to the literature, there are no solid guidelines on their management. We compare our experience with the data available to date in order to support the existing knowledge and provide our expertise for future studies.

Ureteral Stenosis and Fistula after Kidney Transplantation.

INTRODUCTION: Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center. METHODS: Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas. RESULTS: Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948). CONCLUSION: Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival.

[Late kidney transplant complications treatment.] / Tratamiento de las complicaciones tardías del trasplante renal.

OBJECTIVES: Late kidney transplant complication might compromise graft durability, thus the need for early detection and treatment. MATERIAL AND METHODS: A PubMed review including the following MeSH terms was included: kidney transplant¨, ¨complications¨, ¨vascular complications¨,¨transplant renal artery stenosis¨, ¨ureteral obstruction¨,¨urologic complications¨, ¨forgotten stent¨, ¨vesicoureteralreflux¨, ¨urinary lithiasis¨ e ¨incisional hernia¨. Metanalysis and systematic review in spanish and English were included from January 2015 till February 2021, as well as relevant selected manuscripts. RESULTS: We defined as late complications those appearing at 3 months from kidney transplant. Those include vascular complications (renal artery stricture), urinary tract (ureteral stricture, permanent double Js, pyelonephritis due to reflux, urinary stones) and abdominal wall (incisional hernia). CONCLUSIONS: Late kidney transplant complications remain high still with advancement on surgical technique and immunotherapy. Those complication might compromise the graft durability and so early detection is or primary importance.

OBJETIVO: Las complicaciones tardías del trasplante renal pueden comprometer de manera importante la viabilidad del injerto, por lo que debemos detectarlas y tratarlas de manera precoz.MATERIAL Y MÉTODOS: Realizamos una revisión bibliográfica en PubMed utilizando los términos MeSH ¨kidney transplant¨, ¨complications¨, ¨vascular complications¨, ¨transplant renal artery stenosis¨, ¨ureteralobstruction¨, ¨urologic complications¨, ¨forgotten stent¨,¨vesicoureteral reflux¨, ¨urinary lithiasis¨ e ¨incisionalhernia¨. Se incluyeron metaanálisis, revisiones y revisiones sistemáticas en inglés y español, desde enero de2015 hasta febrero de 2021, así como las referencias más relevantes incluidas en los artículos seleccionados. RESULTADOS: Definimos como complicaciones tardías aquellas que suelen aparecer a partir del tercer mes trasla realización del trasplante. Dentro de ellas se incluyen complicaciones vasculares (estenosis de la arteria renal), de la vía urinaria (estenosis ureteral, catéteres ureterales no retirados, pielonefritis secundarias a reflujovesico-ureteral y litiasis urinaria) y de pared (hernia incisional). CONCLUSIONES: A pesar de los avances, tanto médicos (inmunosupresión) como en la técnica quirúrgica, en el trasplante renal, todavía son frecuentes las complicaciones a largo plazo. Estas complicaciones pueden comprometer la viabilidad del injerto renal, lo que hace necesario que sean detectadas lo antes posible, y no demorar su tratamiento.

Tratamiento de las complicaciones tardías del trasplante renal / Treatment of late complications of renal transplantation

Objetivo: Las complicaciones tardíasdel trasplante renal pueden comprometer de maneraimportante la viabilidad del injerto, por lo que debemosdetectarlas y tratarlas de manera precoz.Materiales y métodos: Realizamos una revisión bibliográfica en PubMed utilizando los términos MeSH ̈kidney transplant ̈, ̈complications ̈, ̈vascular complications ̈, ̈transplant renal artery stenosis ̈, ̈ureteralobstruction ̈, ̈urologic complications ̈, ̈forgotten stent ̈, ̈vesicoureteral reflux ̈, ̈urinary lithiasis ̈ e ̈incisionalhernia ̈. Se incluyeron metaanálisis, revisiones y revisiones sistemáticas en inglés y español, desde enero de2015 hasta febrero de 2021, así como las referenciasmás relevantes incluidas en los artículos seleccionados. Resultados: Definimos como complicaciones tardíasaquellas que suelen aparecer a partir del tercer mes trasla realización del trasplante. Dentro de ellas se incluyen complicaciones vasculares (estenosis de la arteriarenal), de la vía urinaria (estenosis ureteral, catéteresureterales no retirados, pielonefritis secundarias a reflujo vesico-ureteral y litiasis urinaria) y de pared (herniaincisional).Conclusiones: A pesar de los avances, tanto médicos (inmunosupresión) como en la técnica quirúrgica,en el trasplante renal, todavía son frecuentes las complicaciones a largo plazo. Estas complicaciones puedencomprometer la viabilidad del injerto renal, lo que hacenecesario que sean detectadas lo antes posible, y nodemorar su tratamiento.(AU)

Objetives: Late kidney transplant complication might compromise graft durability, thus theneed for early detection and treatment.Material and methods: A PubMed review including the following MeSH terms was included: kidneytransplant ̈, ̈complications ̈, ̈vascular complications ̈, ̈transplant renal artery stenosis ̈, ̈ureteral obstruction ̈, ̈urologic complications ̈, ̈forgotten stent ̈, ̈vesicoureteral reflux ̈, ̈urinary lithiasis ̈ e ̈incisional hernia ̈. Metanalysis and systematic review in spanish and Englishwere included from January 2015 till February 2021,as well as relevant selected manuscripts. Results: We defined as late complications those ap-pearing at 3 months from kidney transplant. Those include vascular complications (renal artery stricture),urinary tract (ureteral stricture, permanent double Js, pyelonephritis due to reflux, urinary stones) and abdominalwall (incisional hernia).Conclusions: Late kidney transplant complicationsremain high still with advancement on surgical techniqueand immunotherapy. Those complication might compromise the graft durability and so early detection is or primary importance.(AU)

Iterative renal transplantation: our experience on third transplants.

PURPOSE: To report our experience on third kidney transplantation, analyzing the complications and graft survival rates as compared to previous transplants. METHODS: Retrospective study of third renal transplants performed at our center. Outcomes were compared with a cohort of first and second transplants. RESULTS: Of a total of 4143, we performed 72 third transplants in 46 men and 26 women with an average age of 46 years and mean time on dialysis of 70 months. Thirty-seven patients were hypersensitized [panel-reactive antibody (PRA) > 50%]. They were all from deceased donors, with a mean cold ischemia time of 19.2 h. The extraperitoneal heterotopic approach was used in 88.8%, transplantectomy was performed in 80.6% and vascular anastomoses were realized mostly to external iliac vessels, using the common iliac artery in 15 cases, and the inferior vena cava in 16. The main ureteral reimplantation technique was the Politano-Leadbetter (76.4%). Third transplantation reported a significantly higher incidence of lymphocele (13.9% vs. 3.2% in first and 4.5% in second transplants; p < 0.001), rejection (34.7% vs. 14.9% and 20.5%, p < 0.001) and urinary obstruction (11.1% vs. 3.6% and 6.3%, p 0.002). Graft survival rates for first, second and third transplants were 87%, 86% and 78% at 1 year, 83%, 82% and 74% at 3 years and 80%, 79% and 65% at 5 years, respectively. CONCLUSION: Iterative transplantation constitutes a valid therapeutic option with adequate surgical and survival results compared to previous transplants. It is a challenging procedure which must be performed by experienced surgeons.

Seizures and Neuropsychiatric Toxicity in Patients with Non-Metastatic CRPC Treated with New Antiandrogens: Systematic Review and Meta-Analysis.

INTRODUCTION: Recently, enzalutamide, apalutamide, and darolutamide have shown benefits in metastasis-free survival in non-metastatic castration-resistant prostate cancer (nmCRPC) patients compared to placebo. Previous evidence about the safety profile of these new androgens is limited. This meta-analysis studies seizure and neuropsychiatric effects of new anti-androgens compared to placebo in nmCRPC patients. METHODS: PubMed and Cochrane databases were systematically reviewed until 1 March 2020 by 2 independent researchers using a pre-specified search strategy. Placebo-compared randomized controlled trials (RCTs) of nmCRPC patients treated with new anti-androgens providing data on neuropsychiatric events and seizures were included. Variables were seizure, headache, mental impairment, and dizziness. Pooled risk ratios (RR) were calculated using the Mantel-Hansel random effects model and Review Manager v5.3 software. RESULTS: After systematic review, 3 eligible RCTs were selected that included 4,104 patients; 2,687 comprised the treatment group and 1,417 the control group. No significant increase in RR for seizures was registered with the new anti-androgens compared to placebo (RR 1.96; 95% confidence interval [CI] 0.40-9.61). However, 2 trials excluded patients with risk factors or a history of seizures. There was also no significant increase RR for grade ≥3 seizures (RR 2.50; 95% CI 0.12-52.02). RR for suffering dizziness (any grade) was 1.57 (95% CI 1.07-2.32) with the new anti-androgens, but no significant differences were found in the other study regarding neuropsychiatric events or grade ≥3 events. CONCLUSIONS: New anti-androgens (i.e., enzalutamide, apalutamide, and darolutamide) are acceptably safe in terms of seizures and neuropsychiatric toxicity compared to placebo in patients with nmCRPC.

Factors Influencing Intraoperative Blood Loss in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Large Multicenter Analysis.

OBJECTIVE: To assess blood loss during holmium laser enucleation of the prostate (HoLEP) and investigate the factors influencing it. PATIENTS AND METHODS: Analysis of patients with benign prostatic hyperplasia (BPH) treated with HoLEP at 3 centers. Hemoglobin and hematocrit were measured before surgery and hospital discharge. All blood transfusions performed during and after HoLEP were recorded. Blood loss outcomes were analyzed regarding antithrombotic (antiplatelet/anticoagulant) therapies and drug treatments for BPH and other conditions. RESULTS: The analysis included 963 patients with a mean age of 72 years. Mean (range) prostate size was 102 (40-316) g; 28% of patients were receiving antiplatelets and 11% anticoagulants. Mean (range) prostate-specific antigen was 6.0 (0.3-43.5) ng/dL. Mean (range) operation time was 77 (28-178) minutes. Bladder calculi were found in 54 (5.6%) patients; all of them were successfully treated with cystolitholapaxy. Forty-eight (5%) patients required blood transfusion during or immediately after the HoLEP procedure. Overall, mean (SD) hemoglobin decreased from 14.6 (1.5) g/dL to 12.3 (2.1) g/dL (P <.001), and mean (SD) hematocrit decreased from 44.3% (4.7) to 37.7% (6.5) (P <.001). Neither hemoglobin nor hematocrit decreases were significantly different between patients receiving and not receiving antithrombotic therapy or BPH therapy. CONCLUSION: HoLEP is safe and has no remarkable impact on blood loss. Patients at high risk, such as those receiving antithrombotic therapy, had the same outcome than the rest regarding blood loss, although showed a higher transfusion rate. Operating time may influence hemoglobin decrease; therefore, it should be considered in patients with higher risk of bleeding.

Analysis of Holmium Laser Enucleation of the Prostate in a High-Volume Center: The Impact of Concomitant Holmium Laser Cystolitholapaxy.

Purpose: To assess the influence of holmium laser cystolitholapaxy (HLC) concomitantly with holmium laser prostate enucleation (HoLEP) on patients with benign prostatic hyperplasia (BPH) presenting bladder calculi. Materials and Methods: We present a retrospective analysis of patients with BPH (with or without concomitant HLC) at three Spanish centers. Intraoperative variables (e.g., time and resected tissue), changes in functional parameters of the prostate, and frequency of complications (intraoperative, early postoperative, and at 12 months) in patients with and without HLC were compared. Results: The analysis included 963 patients aged 48 to 91 years, of which 54 (5.6%) underwent HLC to treat vesical lithiasis. Mean (range) prostate size (measured by transrectal ultrasound) was 79 (43-173) g and 91 (35-247) g for patients with and without concomitant HLC, respectively (p = 0.080). All bladder calculi were effectively removed. No significant differences were found regarding enucleation and morcellation times, but total operation time was significantly higher in patients with HLC: mean (standard deviation [SD]) of 78 (27) minutes vs 95 (41) minutes (p < 0.001). Three patients underwent conversion to open surgery because of bladder perforation, all of them from the group without HLC. Rates of intraoperative, early, and 12-month complications were similar in both groups. No significant differences in International Prostate Symptom Scale, maximum flow rate (Qmax), and mean flow were observed between groups 12 months after surgery. Conclusions: Simultaneous HoLEP and HLC increases the total operation time, but does not influence the risk of clinically relevant perioperative and postoperative complications.

Correlación entre síntomas y resultado del estudio urodinámico tras la prostatectomía radical / Correlation between symptoms and urodynamic results in patients with urinary incontinence after radical prostatectomy

OBJETIVOS: La incontinencia urinaria (IU) es una importante complicación tras la prostatectomía radical (PR). Aunque la incompetencia esfinteriana es la causa predominante; la disfunción vesical puede contribuir considerablemente. Nuestro objetivo fue evaluar los resultados del estudio urodinámico (EUD) en hombres con IU tras PR y analizar su relación con la clínica. MÉTODOS: Evaluamos retrospectivamente aquellos pacientes remitidos a nuestra unidad con IU tras PR entre 2004 y 2014. Describimos sintomatología, hallazgos urodinámicos y analizamos la correlación entre ambos. RESULTADOS: Incluimos 74 pacientes con una mediana de pañales al día de 3. El 61% referían urgencia, 63% IU esfuerzo (IUE), 11% IU urgencia (IUU) y 26% IU mixta (IUM).El EUD mostró IUE urodinámica en el 53%, hiperactividad del detrusor en el 53% y una acomodación vesical disminuida en el 43%. Del total con acomodación vesical disminuida, referían IUU el 56%. El EUD no demostró IU en el 16%, de los cuales el 80% referían clínicamente IUU. Se observa obstrucción del tracto de salida vesical en el 17% e hipoactividad del detrusor o detrusor acontráctil en el 36%. De los pacientes con obstrucción, en el 46% se objetivó incontinencia por hiperactividad del detrusor. Al correlacionar la clínica y resultados urodinámicos observamos que pacientes con IUE, un 31% sólo presentaban incontinencia por hiperactividad del detrusor. En aquellos con IUM, en un 42% sólo se observó IUE urodinámica y en el 33% sólo incontinencia por hiperactividad del detrusor. Sólo en el 27% de los que referían urgencia se objetivó incontinencia por hiperactividad del detrusor. CONCLUSIONES: En pacientes con IU tras PR existe un elevado porcentaje de obstrucción del tracto urinario, hiperactividad del detrusor y disminución de la acomodación vesical, que podría contribuir a la IU. Además, la correlación entre la clínica y EUD es baja

OBJECTIVES: Urinary incontinence (UI) is a significant complication after radical prostatectomy (RP). Although sphincter incompetence is considered the main cause; bladder dysfunction can contribute substantially. Our objective was to evaluate the results of the urodynamic study (UDS) in men with UI after radical prostatectomy and analyze the correlation between symptoms and urodynamic parameters. METHODS: We carried out a retrospective study reviewing the symptoms and urodynamics in patients with urinary incontinence after RP. We describe the symptoms, urodynamic findings and we analyze the correlation between both. RESULTS: Our study included 74 patients. The median number of pads used per day was 3. 61% reported urgency, 63% stress urinary incontinence, 11% urgency urinary incontinence and 26% mixed urinary incontinence. The UDS showed stress urinary incontinence in 53% of patients, detrusor overactivity in 53% and, reduced bladder compliance in 43%. Urgency urinary incontinence was reported in 56% of patients with reduced bladder compliance. Urodynamics showed no incontinence in 16% of patients, of whom 80% showed urgency urinary incontinence. Urodynamics data showing obstruction of the urinary tract was reported in 17% and detrusor hypo or acontractility in 36%. Among patients with obstruction, 46% showed incontinence due to detrusor overactivity. The correlation of symptoms and urodynamics showed that only 31% of patients with stress urinary incontinence had incontinence due to detrusor overactivity in urodynamics. Among those with mixed urinary incontinence, urodynamic stress urinary incontinence only was found in 42% and 33% incontinence due to detrusor overactivity only. Finally, among those with symptoms of urgency urinary incontinence, the urodynamics showed detrusor overactivity in 27%. CONCLUSIONS: In patients with urinary incontinence after radical prostatectomy, there is a high percentage of patients with urinary tract obstruction, detrusor overactivity and decreased compliance. Moreover, the correlation between symptoms and urodynamics is low

[Correlation between symptoms and urodynamic results in patients with urinary incontinence after radical prostatectomy.] / Correlación entre síntomas y resultado del estudio urodinámico tras la prostatectomía radical.

OBJECTIVES: Urinary incontinence (UI) is a significant complication after radical prostatectomy (RP). Although sphincter incompetence is considered the main cause; bladder dysfunction can contribute substantially. Our objective was to evaluate the results of the urodynamic study (UDS) in men with UI after radical prostatectomy and analyze the correlation between symptoms and urodynamic parameters. METHODS: We carried out a retrospective study reviewing the symptoms and urodynamics in patients with urinary incontinence after RP. We describe the symptoms, urodynamic findings and we analyze the correlation between both. RESULTS: Our study included 74 patients. The median number of pads used per day was 3. 61% reported urgency, 63% stress urinary incontinence, 11% urgency urinary incontinence and 26% mixed urinary incontinence. The UDS showed stress urinary incontinence in 53% of patients, detrusor overactivity in 53% and, reduced bladder compliance in 43%. Urgency urinary incontinence was reported in 56% of patients with reduced bladder compliance. Urodynamics showed no incontinence in 16% of patients, of whom 80% showed urgency urinary incontinence. Urodynamics data showing obstruction of the urinary tract was reported in 17% and detrusor hypo or acontractility in 36%. Among patients with obstruction, 46% showed incontinence due to detrusor overactivity. The correlation of symptoms and urodynamics showed that only 31% of patients with stress urinary incontinence had incontinence due to detrusor overactivity in urodynamics. Among those with mixed urinary incontinence, urodynamic stress urinary incontinence only was found in 42% and 33% incontinence due to detrusor overactivity only. Finally, among those with symptoms of urgency urinary incontinence, the urodynamics showed detrusor overactivity in 27%. CONCLUSIONS: In patients with urinary incontinence after radical prostatectomy, there is a high percentage of patients with urinary tract obstruction, detrusor overactivity and decreased compliance. Moreover, the correlation between symptoms and urodynamics is low.

[Mitomycin C HIVEC. Update and results in high risk patients.] / HIVEC con mitomicina C. Actualización y resultados en pacientes de alto riesgo.

Adjuvant endovesical treatment is a research field in constant exploration with the aim to minimize the risk of recurrence and progression of non muscle invasive bladder tumors. Over the last years, the administration of chemotherapy in a chemo hyperthermia regimen has been added to the existing regimens. There are various systems for its administration, but this article focus on HIVEC (Hyperthermic IntraVEsical Chemotherapy) and its current status. In this review article we update the results of this system in the case-scenarios it has been used (preoperative with ablative intention and as adjuvant therapy with prophylactic purposes), tolerance and security issues, on-going clinical trials and future perspectives.

HIVEC con mitomicina C. Actualización y resultados en pacientes de alto riesgo / Mitomycin C HIVEC. Update and results in high risk patients

Los tratamientos endovesicales adyuvantes son un campo de investigación en constante exploración con el objeto de minimizar el riesgo de recurrencia y progresión de los tumores de vejiga no músculo invasivos. En los últimos años, a los ya existentes se ha añadido la administración de quimioterapia en régimen de quimiohipertermia. Hay diversos sistemas de administración de ésta, centrándonos en este artículo en HIVEC (Hyperthermic IntraVEsical Chemotherapy) y su situación actual. En esta revisión, ponemos al día los resultados de este sistema en los escenarios en que ha sido empleado (tanto de forma preoperatoria con intención ablativa como de forma adyuvante con intención profiláctica), las cuestiones relativas a tolerancia y seguridad, los ensayos que hay en marcha y las perspectivas de futuro

Adjuvant endovesical treatment is a research field in constant exploration with the aim to minimize the risk of recurrence and progression of non muscle invasive bladder tumors. Over the last years, the administration of chemotherapy in a chemo hyperthermia regimen has been added to the existing regimens.There are various systems for its administration, but this article focus on HIVEC (Hyperthermic IntraVEsical Chemotherapy) and its current status. In this review article we update the results of this system in the case-scenarios it has been used (preoperative with ablative intention and as adjuvant therapy with prophylactic purposes), tolerance and security issues, on-going clinical trials and future perspectives

Semen Quality Assessment in Fertile Men in Madrid During the Last 3 Decades.

OBJECTIVE: To evaluate semen quality of men with proven fertility in Spain over the last 3 decades. METHODS: We conduct a retrospective analysis of ejaculate samples of 992 men between 1985 and 2009. All patients had proven fertility as demonstrated by fathering at least 2 children and a semen analysis performed before they underwent vasectomy. A standardized procedure was used for the semen analysis. Semen volume, total sperm count, sperm concentration, motility, and percentage of morphologically normal spermatozoa were assessed. Mean values were calculated by examining microscopic fields of 100 spermatozoa. RESULTS: Statistically significant differences were found in all semen parameters analyzed. For the periods 1985-1990, 1990-2000, and 2000-2009, the mean (standard deviation [SD]) sperm concentration was 27.7 (22.97), 20.73 (14.79), and 20.18 (20.79) × 10(6) (P <.0001). The mean (SD) progressive motility for each period was 53.19 (20.35), 47.22 (15.84), and 40.57 (15.15; P <.0001). The mean (SD) normal-shaped spermatozoa for each period was 67.69 (10.24), 58.87 (14.67), and 51.02 (15.76; P <.0001). Multivariate analysis using a logistic regression model showed that age had no significant effect in the variation of semen parameters at the cut-points analyzed, except for normal forms at percentile 25 (P = .001). Multivariate analysis revealed a trend for decline of semen in sperm concentration, progressive and nonprogressive motility, and the percentage of morphologically normal spermatozoa (P = .001-.002). CONCLUSION: Over the last 3 decades, a decline in semen quality was found in all the parameters analyzed in Spanish men with proven fertility.

Tratamiento hormonal en la recidiva bioquimica tras prostatectomía radical / Hormonal treatment in biochemical recurrence after radical prostatectomy

Hasta la fecha el papel de la HT en la recidiva bioquímica, su inicio, esquema y duración permanecen en controversia dada la ausencia de ensayos randomizados que analicen la supervivencia del paciente sometido a esta terapia tras fracaso bioquímico. La hormonoterapia mediante el empleo de análogos LH-RH resulta en este escenario la medida más frecuentemente empleada en la práctica clínica. Sin embargo el sustento científico de la misma es bastante endeble. Implica extrapolar los beneficios de la HT precoz vs diferida, vista en otros estadios de la enfermedad (generalmente avanzada), a un paciente asintomático con exclusivo aumento del PSA, que tendría en muchos casos una larga historia natural hasta el desarrollo de metástasis y con el impuesto añadido de los efectos secundarios bien conocidos actualmente. Probablemente los pacientes con Gleason >8 y TDPSA < 12 meses sí pudieran beneficiarse de un tratamiento hormonal precoz, sobre todo si son jóvenes (grado 2c). En muchos otros casos donde no se contemple un tratamiento local como RT, la decisión de HT precoz o tardía debe ser cuidadosamente valorada y comentada con el paciente. Las alternativas de tratamiento hormonal con preservación de función sexual, como el bloqueo intermitente, monoterapia con antiandrógenos o la suma de un 5- ARI con antiandrógeno, deben ser valoradas con cautela ante la escasez de información a largo plazo aunque éste parece un atractivo escenario para su empleo(AU)

To date, the role of hormonal therapy (HT) after biochemical failure, when to initiate it, the therapeutic scheme and duration remains controversial due to the absence of well designed randomized trials analyzing the overall survival of patients. In clinical practice, the most widely spread treatment in this scenario is hormonal therapy with LH-RH analogues. However, the scientific support for this issue is very weak. We are extrapolating the benefits proven for early vs delayed HT in advanced prostate cancer, to asymptomatic patients presenting just an increase in PSA. These patients usually have a long time disease-history until development of metastasis. It should also be noticed the harmful secondary effects acquired with the time of employment of hormotherapy. Probably patients suffering a Gleason score >8 and PSA doubling time <12 months could obtain a benefit from an early castration treatment, even more if they are young (grade 2c). Except in selected cases of local treatment as radiotherapy, the decision for early or delayed hormonal therapy should be taken carefully with patient consensus. The alternatives for hormonal treatment to preserve sexual function, as intermittent treatment, antiandrogen monotherapy, or antiandrogen plus 5 alpha reductase inhibitors, are very attractive in this scenario. However due to the short time experience with these modalities of treatment should be evaluated with caution(AU)

[Penile tunica albuginea plication for the treatment of penile curvature secondary Peyronie's disease]. / Plicatura de la albugínea como tratamiento de la incurvación de pene causada por la enfermedad de Peyronie.

OBJECTIVE: To evaluate, in a retrospective analysis, our long-term results of patients undergoing the Essed plication procedure for the correction of penile curvature due to Peyronie's disease. METHODS: Between January 1998 and June 2003, 83 patients with acquired penile deviation were treated with the Essed technique in our hospital. We analyse the following data: age, main complaint, type of deviation, erection before and after the surgery, physical exploration, ecographic data, complications and results. RESULTS: Mean follow-up was 36 months. Main complaint was penile curvature in 96.3% of patients. The most frequent types of deviation were dorsal (55.4%) and left lateral (48.1%). Erection before surgery was sufficient for sexual intercourse in 74.7%. Physical exploration revealed a plaque in 79.5% of the patients. 93% of the cases reported complete penile curvature correction or residual deviation < 10 degrees. 65.1% of the patients were satisfied or very satisfied with the result of the operation and 64% were able to perform sexual intercourse. CONCLUSIONS: The Essed plication is a simple and minimally invasive method for correcting acquired penile deviation. Although functional results seem to be satisfactory, in our experience the degree of satisfaction with the outcome is not as good, among the patients, as it could be expected.

Plicatura de la albugínea como tratamiento de la incurvación de pene causada por la enfermedad de Peyronie / Penile tunica albuginea plication for the treatment of penile curvature secondary Peyronie´s disease

OBJETIVO: Evaluar nuestros resultados enel tratamiento de la incurvación peneana causada porla enfermedad de Peyronie mediante la plicatura albugíneadescrita por Essed.MÉTODOS:Revisión retrospectiva de los 83 pacientestratados quirúrgicamente de incurvación peneanaadquirida en nuestro centro mediante la técnica de plicaturaentre enero de 1998 y junio de 2003, analizandolas siguientes variables: edad, motivo de consulta,antecedentes personales, exploración física,datos ecográficos, tipo de incurvación, erección pre ypostcirugía, complicaciones y resultados de la técnicaquirúrgica.RESULTADOS:El seguimiento medio fue de 36 meses.El motivo de consulta principal fue la desviación peneanaen erección (96,3%). El tipo de incurvación másfrecuente fue dorsal (55,4%) y lateral izquierda(48,1%). La erección previa a la cirugía era suficientepara mantener una relación sexual en el 74,7% de lospacientes. La exploración física reveló la existencia deplaca en el 79,5% de los casos. En cuanto a los resultadosde la cirugía, el 93% refieren una correccióncompleta de la incurvación o una desviación residualmenor de 10º. El 65,1% manifestaron encontrarse satisfechoso muy satisfechos con la operación, mientrasque el 64% eran capaces de llevar a cabo una relaciónsexual.CONCLUSIONES: La plicatura de Essed es un procedimientosencillo y mínimamente invasivo para corregirla desviación adquirida de pene. En nuestra experiencia,aunque los resultados funcionales parecen ser buenos,el grado de satisfacción entre los pacientes tras lacirugía no es tan alto como cabría esperar

OBJETIVE: To evaluate, in a retrospective analysis, our long term results of patients undergoing the Essed plication procedure for the correction of penile curvature due to Peyronie´s disease. METHODS: Between January 1998 and June 2003, 83 patients with acquired penile deviation were treated with the Essed technique in our hospital. We analyse the following data: age, main complaint, type of deviation, erection before and after the surgery, physical exploration, ecographic data, complications and results. RESULTS: Mean follow-up was 36 months. Main complaint was penile curvature in 96.3% of patients. The most frequent types of deviation were dorsal (55.4%) and left lateral (48.1%). Erection before surgery was sufficient for sexual intercourse in 74.7%. Physical exploration revealed a plaque in 79.5% of the patients. 93% of the cases reported complete penile curvature correction or residual deviation < 10º. 65.1% of the patients were satisfied or very satisfied with the result of the operation and 64% were able to perform sexual intercourse. CONCLUSIONS: The Essed plication is a simple and minimally invasive method for correcting acquired penile deviation. Although functional results seem to be satisfactory, in our experience the degree of satisfaction with the outcome is not as good, among the patients, as it could be expected

[The effect of seminal leukocytes on semen quality in subfertile males with and without varicocele]. / Efectos de la leucocitospermia sobre la calidad seminal en varones subfértiles con y sin varicocele.

OBJECTIVES: To compare the concentration of leukocytes and round cells in semen samples of subfertile males (SM), men with varicocele (VM), and fertile males (FM) to establish a possible relationship between leukocyte concentration, semen parameters (pH, concentration, mobility, spermatic morphology) and lipidic peroxidation of the spermatozoid. METHODS: We evaluated 298 semen samples from: 42 fertile males, 170 subfertile males, and 86 men with varicocele. Sperm tests were performed following WHO criteria. All samples with leukocyte counts higher than 1 million/ml were submitted for oxidative stress study (malonyldialdehyde in seminal plasma). RESULTS: Leukocyte concentration was higher in subfertile males and men with varicocele (2.5 +/- 2.1 x 10(6)/ml and 2.3 +/- 2.1 x 10(6)/ml) than in fertile males (1.1 +/- 0.1 x 10(6)/ml) (p 0.0001). In the same way concentration of round cells was higher in the SM group (6.5 +/- 0.3 x 10(6)/ml) and VM group (6.1 +/- 0.4 x 10(6)/ml) than in FM (4.5 +/- 0.4 x 10(6)/ml) (p 0.05). Spermatozoid concentration was lower in SM (42.1 +/- 2.4 x 10(6)/ml) and VM (9.9 +/- 3.5 x 10(6)/ml) than in FM (82.4 +/- 5.7 x 10(6)/ml) (p 0.0001). The percentage of spermatozoa with type "a" mobility was lower in the SM (14.1 +/- 0.9) and VM (19.9 +/- 1.4) groups than in the FM group (50.0 +/- 1.3) (p 0.0001). In the same way, "a + b" mobility was lower in the SF group (26.7 +/- 1.4) and VM group (34.1 +/- 1.9) than in the FM group (50.0 +/- 1.3) (p 0.0001). The SM group showed a lower percentage of normal forms (43.3 +/- 1.5) than the VM (50.0 +/- 1.6) and FM (60.6 +/- 1.3) groups (p 0.0001). When grouping by concentration of peroxidase positive cells, there were not statistical differences in the spermatic variables in SM, with the exception of progeny cells. Type "a" mobility in the VM group was lower in the peroxidase positive group than in the peroxidase negative group (p 0.005); "a + b" mobility was also lower in the peroxidase positive men than in peroxidase negative (p 0.01); in the progeny cells they were higher in the peroxidase positive males (4.2 +/- 0.4 x 10(6)/ml) than in peroxidase negative males (3.0 +/- 0.3 x 10(6)/ml). Malonyldialdehyde concentrations were significantly higher in seminal plasma of subfertile and varicocele males than in fertile males (p 0.006, and p 0.03). CONCLUSIONS: Increased number of semen lymphocytes is more frequent in subfertile and varicocele males than in fertile males. The increase of semen leukocytes is associated with deterioration of seminal parameters. Oxidative stress has a negative influence on seminal parameters in subfertile males of unknown etiology.

[The treatment of varicocele in the infertile male I: results on semen quality]. / Tratamiento del varicocele en el varón infértil I: resultados sobre la calidad seminal.

OBJECTIVES: To evaluate the effect of interventionist treatment of varicocele, either open surgery or endovascular radiological occlusion, on seminal parameters, and to identify which factors are associated with their normalization. METHODS: Between 1975 and 2000, 631 patients with the diagnosis of idiopathic varicocele were evaluated in our hospital; 238 of them were part of an infertile couple. Among them, finally, 183 underwent studies; they complied with the following criteria: 1) Infertility for more than one year; 2) seminal parameters below normality following WHO criteria (1992); 3) absence of other pathologies or diseases which could explain male infertility; and 4) absence of evident causes of male infertility. 131 patients were treated by radiological occlusion and 26 by conventional surgery. The remaining 26 patients did not undergo the treatment indicated. Two parameters were evaluated on follow-up: 1) achievement of pregnancy (these results will be analyzed in a next article), and 2) normalization of seminal parameters. RESULTS: 48% and 39% of the patients respectively achieved normalization of the number of spermatozoids per ml (=20 million spermatozoids per ml) and spermatic morbidity (=50%). The association between normalization of seminal parameters and age, clinical grade, or type of treatment was not demonstrated. Only baseline degree of severity in the alteration of seminal parameters showed statistically significant differences in the evaluation of semen quality after treatment of varicocele (p = 0.001 and p = 0.002). CONCLUSIONS: The degree of previous seminal alteration--oligospermia and asthenospermia--was the factor with greatest prognostic value in relation with normalization of seminal parameters.

[The treatment of varicocele in the infertile male II: results on fertility]. / Tratamiento del varicocele en el varón infértil II: resultados sobre la fertilidad.

OBJECTIVES: To analyze the efficacy of varicocele treatment, either surgical or endovoscular radiological occlusion, on pregnancy rates of infertile couples in which the male had clinically. patent left varicocele, and to identify which factors are associated with the probability of obtaining pregnancy in such cases. METHODS: This study is part of a more ample one described in previous article: "The treatment of varicocele in the infertile male I: Results on semen quality". Overall, 183 couples were included. 157 males received treatment (131 radiological occlusion and 26 open surgery), the remaining 26 did not received the treatment indicated. Couples underwent periodic follow-up during the first year, evaluating two parameters: 1) normalization of semen analysis parameters, and 2) pregnancy during the following 12 months after indication of treatment. RESULTS: Overall, 41 couples (22.4%) achieved pregnancy during first year, 35/157 (22%) in the group of treated patients, and 6/26 (23%) in the non treatment group. In the treatment group, surgical ligature achieved higher pregnancy rates than radiological occlusion (35% vs. 20%), but the difference was not statistically significant (p = 0.255). No association was demonstrated between male age, female age, varicocele clinical grade, degree of semen quality abnormalities, or duration of infertility and pregnancy rates. The FSH value was significantly lower (p 0.0006) in patients who achieved pregnancy. CONCLUSIONS: The degree of semen quality abnormality, which so closely correlated to normalization of seminal parameters, locked of prognostic significance in terms of achievement of pregnancy. The FSH value was the only factor with certain prognostic value, although it did not reach significance in logistic regression analysis.