Tratamiento mínimamente invasivo de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata. Nuestra experiencia inicial con Urolift(R) bajo anestesia local y sedación / Minimally invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia. Our initial experience with Urolift(R) under local anaesthesia and sedation

Introducción: El tratamiento de los síntomas del tracto urinario inferior secundarios a hiperplasia benigna de próstata con la utilización del sistema Urolift(R) se lleva realizando desde 2005 con buenos resultados a medio plazo. En este trabajo presentamos nuestra experiencia realizando esta técnica bajo anestesia local y sedación en 2 centros españoles. Material y métodos: Se llevó a cabo un estudio prospectivo con 20 pacientes tratados con Urolift(R) bajo anestesia local y sedación entre abril de 2017 y abril de 2018. El protocolo anestésico consistía en la colocación de 2 lubricantes con lidocaína fríos (el primero 10 min antes de la intervención y el segundo momentos antes de iniciar la endoscopia). A un tercio de los pacientes se les añadió un bloqueo prostático similar al que se realiza en las biopsias de próstata y, según la tolerancia, durante el procedimiento, se les añadió 1 mg de midazolam intravenoso. El objetivo primario es evaluar la tolerabilidad de este procedimiento bajo anestesia local usando la escala visual analógica. Resultados: El procedimiento ha sido realizado en 20 pacientes en 2 centros diferentes usando el mismo protocolo anestésico. La puntuación media en la escala escala visual analógica de dolor fue de 1,37 para la introducción del cistoscopio y de 1,19 para la colocación de los implantes. A la pregunta de si el dolor había sido mayor, menor o igual al de la cistoscopia diagnóstica, solo el 20% de los pacientes respondieron que había sido mayor. En todos los casos hubo una buena tolerancia al procedimiento, no precisándose en ninguno de ellos el cambio del tipo de anestesia. Conclusiones: Consideramos que la utilización del Urolift(R) bajo anestesia local y sedación es un método bien tolerado, seguro y eficaz para el tratamiento de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata

Introduction: The treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia with the Urolift(R) system has been carried out since 2005 with good results in the medium term. In this work, we present our experience performing this technique under local anaesthesia and sedation in 2 Spanish centres. Material and methods: A prospective study was conducted with 20 patients treated with Urolift(R) under local anaesthesia and sedation between April 2017 and April 2018. The anaesthesia protocol consisted in the placement of 2 lubricants with cold lidocaine (the first one, 10 min before the intervention, and the second one, just before introducing the cystoscopy). A prostate block (similar to the one employed in prostate biopsies) was administered to one third of the patients and 1mg of intravenous midazolam was added if required during the procedure. Our primary objective is to evaluate the tolerability of this procedure under local anaesthesia using the validated Visual Analogue Scale measurement instrument. Results: The procedure has been performed under the same anaesthetic protocol to 20 patients from 2 different centres. The average pain scores on the Visual Analogue Scale were 1.37 for the cystoscopy procedure and 1.19 for the placement of the implants. When asked whether the pain sensations had been higher, lower or the same during the procedure or at the preoperative cystoscopy, only 18% of the patients responded it was higher. In all cases there was a good tolerance to the procedure, and changes to the anaesthesia protocols were never required. Conclusions: We consider that the Urolift(R) system under local anaesthesia and sedation is a well-tolerated, safe and effective method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

Minimally invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia. Our initial experience with Urolift® under local anaesthesia and sedation. / Tratamiento mínimamente invasivo de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata. Nuestra experiencia inicial con Urolift® bajo anestesia local y sedación.

INTRODUCTION: The treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia with the Urolift® system has been carried out since 2005 with good results in the medium term. In this work, we present our experience performing this technique under local anaesthesia and sedation in 2 Spanish centres. MATERIAL AND METHODS: A prospective study was conducted with 20 patients treated with Urolift® under local anaesthesia and sedation between April 2017 and April 2018. The anaesthesia protocol consisted in the placement of 2 lubricants with cold lidocaine (the first one, 10min before the intervention, and the second one, just before introducing the cystoscopy). A prostate block (similar to the one employed in prostate biopsies) was administered to one third of the patients and 1mg of intravenous midazolam was added if required during the procedure. Our primary objective is to evaluate the tolerability of this procedure under local anaesthesia using the validated Visual Analogue Scale measurement instrument. RESULTS: The procedure has been performed under the same anaesthetic protocol to 20 patients from 2 different centres. The average pain scores on the Visual Analogue Scale were 1.37 for the cystoscopy procedure and 1.19 for the placement of the implants. When asked whether the pain sensations had been higher, lower or the same during the procedure or at the preoperative cystoscopy, only 18% of the patients responded it was higher. In all cases there was a good tolerance to the procedure, and changes to the anaesthesia protocols were never required. CONCLUSIONS: We consider that the Urolift® system under local anaesthesia and sedation is a well-tolerated, safe and effective method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Terapia ultrasonido focalizado de alta intensidad (HIFU) para el tratamiento del cáncer de próstata: Experiencia a medio plazo / High-intensity focused ultrasound therapy for the treatment of prostate cancer: Medium-term experience

Introducción: Hoy en día, el tratamiento del cáncer de próstata localizado busca minimizar el impacto en la función sexual y la continencia urinaria. En este sentido, la terapia con ultrasonido de alta intensidad ofrece resultados interesantes. Presentamos nuestra experiencia con esta técnica en 2 centros españoles. Material y métodos: Revisión retrospectiva de 75 pacientes con cáncer de próstata localizado tratados con terapia con ultrasonido de alta intensidad entre marzo de 2007 y julio de 2016. Se evaluaron los resultados oncológicos y las complicaciones perioperatorias, así como el impacto en la función sexual y la continencia. Resultados: Sesenta y siete pacientes fueron analizados. El seguimiento medio fue de 7,2 años. El PSA nadir fue de 0,2 ng/ml (0-3); 24 pacientes (35,5%) presentaron recidiva bioquímica y en 18 se realizó una nueva biopsia, evidenciando 10 casos (55,5%) con recidiva anatomopatológica. La supervivencia libre de recidiva bioquímica global a 5 y 8 años fue de 93,2 y 80,5%, respectivamente. La supervivencia específica para cáncer a 5 y 8 años fue en ambos casos de un 96%. En el postoperatorio, 50 pacientes (74,6%) eran continentes, 16 (23,9%) reportaban incontinencia leve y uno (1,5%), moderada. La mediana del International Index of Erectile Function-5 previa y postratamiento fue de 17 (5-25) y 16 (2-23) puntos, respectivamente. Reportaron disfunción eréctil de novo 9 pacientes (13,5%). Conclusión: La terapia con ultrasonido de alta intensidad parece ser una alternativa segura para el tratamiento del cáncer de próstata localizado, especialmente de bajo riesgo. En nuestra experiencia, esta técnica ofrece ventajas en la conservación de la continencia urinaria, y los resultados oncológicos parecen ser alentadores a medio plazo. Dada la evolución natural del cáncer de próstata, se requieren estudios a largo plazo y con mayor casuística que corroboren estos resultados

Introduction: The treatment of localised prostate cancer seeks to minimise the impact on sexual function and urinary continence. In this respect, therapy with high-intensity focused ultrasound offers important results. We present our experience with this technique in 2 Spanish centres. Material and methods: We conducted a retrospective review of 75 patients with localised prostate cancer treated with high-intensity focused ultrasound between March 2007 and July 2016. The oncological results and perioperative complications were assessed, as well as the impact on sexual function and continence. Results: A total of 67 patients were analysed. The mean follow-up was 7.2 years. The PSA nadir was 0.2 ng/mL (0-3), 24 patients (35.5%) presented biochemical recurrence, and 18 underwent a further biopsy, with 10 cases (55.5%) presenting disease recurrence. The overall biochemical relapse-free survival at 5 and 8 years was 93.2 and 80.5%, respectively. The cancer-specific survival at 5 and 8 years was 96% in both cases. In the postoperative period, 50 patients (74.6%) were continent, 16 (23.9%) reported mild incontinence, and one (1.5%) reported moderate incontinence. The median International Index of Erectile Function-5 before and after the surgery was 17 (5-25) and 16 (2-23) points, respectively. Nine patients reported de novo erectile dysfunction (13.5%). Conclusion: High-intensity focused ultrasound appears to be a safe alternative for the treatment of localised prostate cancer, especially for low-risk localised prostate cancer. In our experience, this technique offers advantages in preserving urinary continence, and the medium-term oncological results are encouraging. Given the natural progression of prostate cancer, long-term studies with a larger number of cases are needed to corroborate these results

High-intensity focused ultrasound therapy for the treatment of prostate cancer: Medium-term experience. / Terapia ultrasonido focalizado de alta intensidad (HIFU) para el tratamiento del cáncer de próstata: Experiencia a medio plazo.

INTRODUCTION: The treatment of localised prostate cancer seeks to minimise the impact on sexual function and urinary continence. In this respect, therapy with high-intensity focused ultrasound offers important results. We present our experience with this technique in 2 Spanish centres. MATERIAL AND METHODS: We conducted a retrospective review of 75 patients with localised prostate cancer treated with high-intensity focused ultrasound between March 2007 and July 2016. The oncological results and perioperative complications were assessed, as well as the impact on sexual function and continence. RESULTS: A total of 67 patients were analysed. The mean follow-up was 7.2 years. The PSA nadir was 0.2ng/mL (0-3), 24 patients (35.5%) presented biochemical recurrence, and 18 underwent a further biopsy, with 10 cases (55.5%) presenting disease recurrence. The overall biochemical relapse-free survival at 5 and 8 years was 93.2 and 80.5%, respectively. The cancer-specific survival at 5 and 8 years was 96% in both cases. In the postoperative period, 50 patients (74.6%) were continent, 16 (23.9%) reported mild incontinence, and one (1.5%) reported moderate incontinence. The median International Index of Erectile Function-5 before and after the surgery was 17 (5-25) and 16 (2-23) points, respectively. Nine patients reported de novo erectile dysfunction (13.5%). CONCLUSION: High-intensity focused ultrasound appears to be a safe alternative for the treatment of localised prostate cancer, especially for low-risk localised prostate cancer. In our experience, this technique offers advantages in preserving urinary continence, and the medium-term oncological results are encouraging. Given the natural progression of prostate cancer, long-term studies with a larger number of cases are needed to corroborate these results.

Eficacia y seguridad del alprostadil intrauretral en pacientes con disfunción eréctil refractarios al tratamiento mediante inhibidores de la 5-fosfodiesterasa / Safety and efficacy of intraurethral alprostadil in patients with erectile dysfunction refractory to treatment using phosphodiesterase-5 inhibitors

Introducción: Los inhibidores de la 5-fosfodiesterasa (IPDE5) son de primera elección para el tratamiento de la disfunción eréctil (DE), pero no siempre son efectivos. El objetivo es presentar nuestra experiencia en el tratamiento de pacientes con DE, refractaria al tratamiento con IPDE5, mediante alprostadil intrauretral. Material y métodos: Revisión de 82 pacientes con DE, sin respuesta a IPDE5, desde marzo de 2013 hasta octubre de 2014. De ellos, 47 (57%) presentaban hipertensión (HTA), 24 (29%) diabetes (DM), y 20 (24%) HTA y DM. Además, 19 (23%) habían sido tratados mediante cirugía radical prostática (PR). Fueron evaluados en la consulta tras la aplicación del tratamiento y a las 4 semanas mediante los cuestionarios validados: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) y Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). Resultados: La edad media fue de 60,5 años (40-80), con seguimiento medio de 11,3 meses (1-20). El 68% de los pacientes tratados respondieron a MUSE® (74% en el grupo de HTA, 65% en el de HTA + DM, 62,5% en el de DM y 58% en el de PR). La media del IIEF-5 era de 11,7 ± 4,7, y ascendió hasta 18,6 ± 4,9 tras MUSE®(p = 0,027). La media de la puntuación del EDITS a las 4 semanas fue de 61,6 (6-81,9). El efecto adverso más frecuente fue el escozor uretral, que ocurrió en 24 pacientes (29%). No se observó ningún caso de infección del tracto urinario, síncope ni priapismo. Conclusiones: El alprostadil intrauretral es un tratamiento efectivo y con un amplio perfil de seguridad para tratar a aquellos pacientes con disfunción eréctil refractaria al tratamiento oral con IPDE5

Introduction: Phosphodiesterase-5 inhibitors (PDE5i) are the first choice for treating erectile dysfunction (ED) but are not always effective. The aim of this study was to present our experience in treating patients with ED, refractory to treatment with PDE5i, using intraurethral alprostadil (MUSE). Material and methods: We conducted a review of 82 patients with ED and no response to PDE5i, from March 2013 to October 2014. Forty-seven patients (57%) had hypertension (AHT), 24 (29%) had diabetes (DM) and 20 (24%) had AHT and DM. Additionally, 19 (23%) had undergone radical prostatic (RP) surgery. The patients were evaluated after the treatment was applied and at 4 weeks using the following validated questionnaires: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). Results: The mean patient age was 60.5 years (40-80), and the mean follow-up was 11.3 months (1-20). Sixty-eight percent of the treated patients responded to MUSE® (74% in the AHT group, 65% in the AHT + DM group, 62.5% in the DM group and 58% in the RP group). The mean IIEF-5 score was 11.7 ± 4.7, which increased to 18.6 ± 4.9 after MUSE was administered (P=.027). The mean EDITS score at 4 weeks was 61.6 (6-81.9). The most common adverse effect was urethral burning, which occurred in 24 patients (29%). There were no cases of urinary tract infection, syncope or priapism. Conclusions: Intraurethral alprostadil is an effective treatment and has a broad safety profile for treating patients with erectile dysfunction refractory to oral treatment with PDE5i

Safety and efficacy of intraurethral alprostadil in patients with erectile dysfunction refractory to treatment using phosphodiesterase-5 inhibitors.

INTRODUCTION: Phosphodiesterase-5 inhibitors (PDE5i) are the first choice for treating erectile dysfunction (ED) but are not always effective. The aim of this study was to present our experience in treating patients with ED, refractory to treatment with PDE5i, using intraurethral alprostadil (MUSE). MATERIAL AND METHODS: We conducted a review of 82 patients with ED and no response to PDE5i, from March 2013 to October 2014. Forty-seven patients (57%) had hypertension (AHT), 24 (29%) had diabetes (DM) and 20 (24%) had AHT and DM. Additionally, 19 (23%) had undergone radical prostatic (RP) surgery. The patients were evaluated after the treatment was applied and at 4 weeks using the following validated questionnaires: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). RESULTS: The mean patient age was 60.5 years (40-80), and the mean follow-up was 11.3 months (1-20). Sixty-eight percent of the treated patients responded to MUSE(®) (74% in the AHT group, 65% in the AHT+DM group, 62.5% in the DM group and 58% in the RP group). The mean IIEF-5 score was 11.7±4.7, which increased to 18.6±4.9 after MUSE was administered (P=.027). The mean EDITS score at 4 weeks was 61.6 (6-81.9). The most common adverse effect was urethral burning, which occurred in 24 patients (29%). There were no cases of urinary tract infection, syncope or priapism. CONCLUSIONS: Intraurethral alprostadil is an effective treatment and has a broad safety profile for treating patients with erectile dysfunction refractory to oral treatment with PDE5i.

Hematoma renal en paciente con esclerosis tuberosa y angiomiolipomas renales múltiples / Renal hematoma in Tuberous Sclerosis patient with several renal angiomyolipomas

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Validación en España del cuestionario de calidad de vida PROSQOLI en pacientes con cáncer de próstata avanzado / Validation in Spain of the Quality of Life Questionnaire PROSQOLI in Patients with Advanced Prostate Cancer

Objetivos: Validación del cuestionario PROSQOLI adaptado al castellano, persiguiendo la obtención de un instrumento para evaluar, en la práctica clínica habitual, la calidad de vida en pacientes con cáncer de próstata localmente avanzado o diseminado en nuestro país. Material y métodos: Se diseñó un estudio transversal prospectivo en 750 pacientes (150 centros) con cáncer de próstata diseminado o localmente avanzado (criterio TNM) que acudían a revisión programada. Se recogieron datos socio-demográficos y clínicos de los participantes. Éstos cumplimentaron los cuestionarios PROSQOLI y EQ-5D. El análisis incluyó 561 casos que cumplieron criterios de selección. Se estudiaron las características psicométricas (factibilidad, validez y fiabilidad) del cuestionario PROSQOLI adaptado. Resultados: La edad media fue de 73,63 (7,59) años. El 72,01% de los participantes sufría enfermedad localmente avanzada; en el 28,16% el tratamiento primario fue radioterapia y en el 12,30% prostatectomía. El 83,48% recibía tratamiento hormonal. La media para cada escala del cuestionario PROSQOLI varió entre 68,86 y 74,51. El porcentaje de no respuesta fue inferior al 3% para cada escala. El porcentaje de sujetos con puntuación mínima en alguna escala fue despreciable, y el de puntuación máxima no sobrepasó el 5%. El tiempo medio de cumplimentación fue 109,42 (101,00) segundos. El coeficiente alfa-Cronbach fue 0,937 y la correlación ítem-total superior a 0,7 para todos los ítems. Las correlaciones con el cuestionario EQ-5Dfueron moderadas. Las puntuaciones en el cuestionario se asociaron con todos los parámetros estudiados relacionados con la enfermedad. Conclusiones: el cuestionario adaptado presentó adecuadas propiedades psicométricas para su uso tanto en investigación como en la práctica clínica (AU)

Objectives: Validation of the PROSQOLI questionnaire adapted to Spanish, pursing an instrument to evaluate, in the common clinical practice, the quality of life in patients with locally advanced or disseminated prostate cancer in our country. Material and Methods: A cross-sectional prospective study was designed in 750 patients (150 centers) with disseminated or locally advanced prostate cancer (TNM criterion) who came to the scheduled check-up. Socio-demographic and clinical data of the participants were collected. The subjects filled out the PROSQOLI and EQ-5D questionnaires. The analysis included 561 cases that met the selection criteria. The psychometric characteristics (feasibility, validity and reliability) of the adapted PROSQOLI questionnaire were studied. Results: Mean age was 73.63 (7.59) years. A total of 72.01% of the participants had locally advanced disease. In 28.16%, the primary treatment was radiotherapy, in 12.30% it was prostatectomy. A total of 83.48% received hormone treatment. The mean for each scale of the PROSQOLI questionnaire varied from 68.86 to 74.51. The percentage of no response was less than 3% for each scale. The percentage of subjects with minimum score in any scale was negligible, and the maximum score did not surpass 5%. Mean time to fill out the questionnaire was 109.42 (101.00) seconds. Cronbach’s -alpha coefficient was 0.937 and the total item correlation was superior o 0.7 for all the items. Correlations with the EQ-5D questionnaire were moderate. Scores on the questionnaire were associated to all the parameters studied related to the disease. Conclusions: The adapted questionnaire has adequate psychometric properties for its use in research and in the clinical practice (AU)

Giant adrenal carcinoma associated with renal vein and inferior vena cava thrombus. Case report and literature review.

OBJECTIVE: To present a case of giant adrenal carcinoma associated with renal vein and inferior vena cava (IVC) thrombus. Up to now, there is no similar case reported in the national literature. METHODS: 75 year old woman with signs of virilization. CT-scan showed an 18 cm adrenal mass with venous thrombus and possible pulmonary metastases. The working diagnosis was primary suprarenal carcinoma. RESULT: Due to elderly age and advanced stage, including metastasis, we decided to not perform surgery, and initiate chemotherapy. CONCLUSIONS: Adrenal Cancer is an infrequent and very aggressive tumor. Surgery is the only curative treatment. In advanced stages chemotherapy is recommended, but with poor results.

Carcinoma suprarrenal gigante con trombo en vena renal y vena cava inferior. Presentación de un caso y revisión de la literatura / Giant adrenal carcinoma associated with renal vein and inferior vena cava thrombus. Case report and literature review

OBJETIVO: El objetivo del presente artículo es presentar un nuevo caso de carcinoma suprarrenal de grandes dimensiones, con la particularidad de la presencia de trombo en vena renal y cava inferior, hasta la fecha no descrito en la literatura nacional. MÉTODOS: Mujer de 75 años que presenta signos de virilización. En el TAC solicitado se observa masa suprarrenal izquierda de 18 cms con afectación trombótica venosa y metástasis pulmonares. La sospecha diagnóstica principal es la de un carcinoma suprarrenal primario. RESULTADO: Debido a la avanzada edad de la paciente y al estadio de su enfermedad, se decide la no realización de tratamiento quirúrgico, y se inicia quimioterapia. CONCLUSIONES: El cáncer suprarrenal es un tumor infrecuente con una agresividad muy elevada. Su único tratamiento curativo es la exéresis quirúrgica. En estadíos avanzados se puede aplicar tratamiento quimioterápico, pero con pobres tasas de respuesta y baja supervivencia(AU)

OBJECTIVE: To present a case of giant adrenal carcinoma associated with renal vein and inferior vena cava (IVC) thrombus. Up to now, there is no similar case reported in the national literature. METHODS: 75 year old woman with signs of virilization. CT-scan showed an 18 cm adrenal mass with venous thrombus and possible pulmonary metastases. The working diagnosis was primary suprarenal carcinoma. RESULT: Due to elderly age and advanced stage, including metastasis, we decided to not perform surgery, and initiate chemotherapy. CONCLUSIONS: Adrenal Cancer is an infrequent and very aggressive tumor. Surgery is the only curative treatment. In advanced stages chemotherapy is recommended, but with poor results(AU)

[Validation in Spain of the quality of life questionnaire PROSQOLI in patients with advanced prostate cancer]. / Validación en España del cuestionario de calidad de vida PROSQOLI en pacientes con cáncer de próstata avanzado.

OBJECTIVES: Validation of the PROSQOLI questionnaire adapted to Spanish, pursing an instrument to evaluate, in the common clinical practice, the quality of life in patients with locally advanced or disseminated prostate cancer in our country. MATERIAL AND METHODS: A cross-sectional prospective study was designed in 750 patients (150 centers) with disseminated or locally advanced prostate cancer (TNM criterion) who came to the scheduled check-up. Socio-demographic and clinical data of the participants were collected. The subjects filled out the PROSQOLI and EQ-5D questionnaires. The analysis included 561 cases that met the selection criteria. The psychometric characteristics (feasibility, validity and reliability) of the adapted PROSQOLI questionnaire were studied. RESULTS: Mean age was 73.63 (7.59) years. A total of 72.01% of the participants had locally advanced disease. In 28.16%, the primary treatment was radiotherapy, in 12.30% it was prostatectomy. A total of 83.48% received hormone treatment. The mean for each scale of the PROSQOLI questionnaire varied from 68.86 to 74.51. The percentage of no response was less than 3% for each scale. The percentage of subjects with minimum score in any scale was negligible, and the maximum score did not surpass 5%. Mean time to fill out the questionnaire was 109.42 (101.00) seconds. Cronbach's α coefficient was 0.937 and the total item correlation was superior to 0.7 for all the items. Correlations with the EQ-5D questionnaire were moderate. Scores on the questionnaire were associated to all the parameters studied related to the disease. CONCLUSIONS: The adapted questionnaire has adequate psychometric properties for its use in research and in the clinical practice.

[Mature cystic teratoma of the testis (dermoid cyst). Case report and literature review]. / Teratoma quístico maduro testicular (quiste dermoide). Aportación de un caso y revisión de la literatura.

SUMMARY OBJECTIVES: Case report of a mature cystic teratoma (dermoid cyst), pseudopilomatrixoma like variant. METHOD: 53-year old patient with a left testicular mass, diagnosed as mature cystic teratoma of the testis(dermoid cyst), the pilomatrixoma-like variant, after radical orchiectomy. Tumoral markers were negative and no extension was observed. The patient is disease-free after 6 months follow-up. RESULTS: Testicular teratoma is a tumour composed of cells derived from the three embryonic layers (ectoderm, endoderm and mesoderm). They can appear at any age, but they are much more prevalent in childhood. They appear at any age, but are much more common in childhood, where they comprise up to 30% of all tumours. They are much less prevalent in adults,representing only 7% of all testicular germ cell tumours CONCLUSIONS: Prepubertal cases are invariably benign in nature, regardless of their histology. However, cases which appear after puberty are potentially malignant, even if histologically pure. Mature cystic teratoma (dermoid cyst) is the only exception to this rule, as no malignant degeneration of these types of tumours has been published.

Teratoma quístico maduro testicular (quiste dermoide). Aportación de un caso y revisión de la literatura) / Mature cystic teratoma of the testis (dermoid cyst). Case report and literature review

OBJETIVOS: Aportamos un caso de un teratoma quístico maduro testicular (quiste dermoide) en su variante pseudopilomatrixoma.MÉTODOS: Paciente de 53 años con una masa testicular izquierda no dolorosa al que, tras la realización de orquiectomía radical, se diagnostica de teratoma quístico maduro testicular (quiste dermoide) en su variante pseudopilomatrixoma. Estudio de extensión y marcadores tumorales negativos. El paciente se encuentra libre de enfermedad tras 6 meses de seguimiento.INTRODUCCIÓNLos teratomas testiculares son un tipo de tumor compuesto típicamente por varios tejidos que representan las diferentes capas germinales (endodermo, mesodermo y ectodermo).RESULTADOS: El teratoma testicular es un tumor compuesto por células derivadas de las tres hojas embrionarias (ectodermo, endodermo y mesodermo). Aparecen a cualquier edad, siendo mucho más incidentes en la infancia, donde llegan a representar hasta un 30% de todos los tumores. En la edad adulta es mucho menos prevalente, llegando sólo a representar un 7% de todos los tumores germinales del testículo.CONCLUSIONES: Los casos prepuberales son casi invariablemente de carácter benigno, independientemente de su histología. Sin embargo, los casos que aparecen tras la pubertad presentan potencial maligno, incluso si es histológicamente puro. El teratoma quístico maduro (quiste dermoide) representa la única excepción a esta regla, ya que no se ha publicado ninguna degeneración maligna de este tipo de tumores(AU)

OBJECTIVES: Case report of a mature cystic teratoma (dermoid cyst), pseudopilomatrixoma like variant.METHOD: 53-year old patient with a left testicular mass, diagnosed as mature cystic teratoma of the testis (dermoid cyst), the pilomatrixoma-like variant, after radical orchiectomy. Tumoral markers were negative and no extension was observed. The patient is disease-free after 6 months follow-up.RESULTS: Testicular teratoma is a tumour composed of cells derived from the three embryonic layers (ectoderm, endoderm and mesoderm). They can appear at any age, but they are much more prevalent in childhood. They appear at any age, but are much more common in childhood, where they comprise up to 30% of all tumours. They are much less prevalent in adults, representing only 7% of all testicular germ cell tumoursCONCLUSIONS: Prepubertal cases are invariably benign in nature, regardless of their histology. However, cases which appear after puberty are potentially malignant, even if histologically pure. Mature cystic teratoma (dermoid cyst) is the only exception to this rule, as no malignant degeneration of these types of tumours has been published(AU)

Migración proximal de catéter doble J. Presentación de un nuevo caso y revisión de la literatura / Proximal migration of a Double J catheter: case report and bibliographic review

Objetivo: Presentación de un caso clínico de migración proximal de catéter doble J. Revisión de la literatura que lo provocan y las maniobras para evitar dicha complicación. Método/Resultados: Mujer de 48 años sometida a cirugía ginecológica que presenta uropatía obstructiva derecha durante el postoperatorio. Después de colocación de catéter doble J se objetiva una migración proximal del mismo que se resuelve mediante nefrostomía percutánea y colocación anterógrada de catéter ureteral. Conclusiones: La elección adecuada de la longitud del catéter y la colocación distal del mismo son elementos claves para evitar esta complicación (AU)

Objective: To report one case of proximal migration of ureteral stent. To perform a bibliographic review about other cases and management to avoid this complication. Methods/Results: 48-year-old woman who presents right obstructive uropathy after gynecologic surgery. After the introduction of the right ureteral stent we observed a proximal stent migration. We put on a right nephrostomy tube and antergrade ureteral stent. Conclusions: The right stent length and proper location of the distal tip are important factors to avoid this complication (AU)

[Influence of climate, according to Koppën classification and Lang's index, on gross rate mortality associated with prostate cancer in the geographical area of Spain]. / Influencia de la climatología, según la clasificación de Koppën e índice de Lang, sobre la tasa bruta de mortalidad asociada al cancer de próstata en el área geográfica de España.

OBJECTIVE: To evaluate if the climatic factors of temperature and rainfall influence mortality associated with prostate cancer for a period of five years. MATERIAL AND METHODS: The mortality trends associated with prostate cancer will be evaluated in the period ranging from 1st january 1998 to 31st december 2002, in the geographical area of Spain. The demographic and mortality data were obtained from the National Institute of Statistics and the climatologically data on temperature and rainfall were obtained from the National Meteorology Institute applying the values registered in 2002. Based on the meteorological data, the different provinces are classified in accordance with Koppën climate classification and climatic index of Lang that defines them from the mean annual and monthly temperature and rainfall data. Mortality rates will be expressed by 100.000 men year, applying for their study the Kruskall-Wallis test for "n" independent samples through the SPSS v12.0 Windows software. RESULTS: Three main climatic areas are obtained, one area with type B climate, which accounts for 13% of the total population, a Csa climate, and a Csb, accounting for 67 and 20% respectively. The mortality found is higher in the Csb type for prostate cancer (p= 0.007), as compared to the other two climatic areas. CONCLUSION: Mortality associated with prostate cancer is significantly higher in the regions with a lower sun exposure. However, randomized prospective studies confirming these findings are warranted.

Influencia de la climatología, según la clasificación de Koppën e índice de Lang, sobre la tasa bruta de mortalidad asociada al cáncer de próstata en el área geográfica de España / Influence of climate, according to Koppën classification and Lang´s index, on gross rate mortality associated with prostate cancer in the geographical area of Spain

Objetivo: Evaluar si los factores climatológicos de temperaturas y precipitaciones influyen sobre la mortalidad asociada al cáncer de próstata a lo largo de un periodo de cinco años. Material y Métodos: Se evalúan las tendencias de mortalidad asociada al cáncer de próstata en el periodo comprendido entre el 1 de enero de 1998 y el 31 de diciembre de 2002, en el área geográfica de España. Los datos demográficos y de mortalidad se obtuvieron del Instituto Nacional de Estadística y los datos climatológicos de temperaturas y precipitaciones se obtuvieron del Instituto Nacional de Meteorología aplicándose los valores registrados en el año 2002. A partir de los datos meteorológicos se clasifican las diferentes provincias de acuerdo a la clasificación climática de Koppën, que los define a partir de los valores medios anuales y mensuales de temperatura y precipitación. Las tasas de mortalidad serán expresadas por 100.000 habitantes y año (100.000 varones año en el caso del cáncer de próstata) aplicándose para su estudio el test de Kruskall-Wallis para “n” muestras independientes mediante el software SPSS v12.0 para Windows. Resultados: Se obtienen tres áreas climáticas fundamentales, un área con clima tipo B que representa el 13 % de la población total, un clima Csa y otro Csb que representan el 67 y el 20 % respectivamente. La mortalidad hallada para el cáncer de próstata es mayor de forma estadísticamente significativa en el área climática Csb (p= 0,007), cuando se compara con las otras dos áreas climáticas. Conclusión: La mortalidad asociada al cáncer de próstata es significativamente superior en las regiones con menor exposición solar. No obstante se requieren estudios prospectivos randomizados que confirmen estos hallazgos (AU)

Objective: To evaluate if the climatic factors of temperature and rainfall influence mortality associated with prostate cancer for a period of five years. Material and methods: The mortality trends associated with prostate cancer will be evaluated in the period ranging from 1st january 1998 to 31st december 2002, in the geographical area of Spain. The demographic and mortality data were obtained from the National Institute of Statistics and the climatologically data on temperature and rainfall were obtained from the National Meteorology Institute applying the values registered in 2002. Based on the meteorological data, the different provinces are classified in accordance with Koppën climate classification and climatic index of Lang that defines them from the mean annual and monthly temperature and rainfall data. Mortality rates will be expressed by 100.000 men year, applying for their study the Kruskall-Wallis test for “n” independent samples through the SPSS v12.0 Windows software. Results: Three main climatic areas are obtained, one area with type B climate, which accounts for 13% of the total population, a Csa climate, and a Csb, accounting for 67 and 20% respectively. The mortality found is higher in the Csb type for prostate cancer (p= 0.007), as compared to the other two climatic areas. Conclusion: Mortality associated with prostate cancer is significantly higher in the regions with a lower sun exposure. However, randomized prospective studies confirming these findings are warranted (AU)

Relationship between gonadotrophin secretion, inhibin B and spermatogenesis in oligozoospermic men treated with highly purified urinary follicle-stimulating hormone (uFSH-HP): a preliminary report.

PURPOSE: To study the potential relationship between circulating follicle-stimulating hormone (FSH) gonadotrophin, inhibin B, spermatogenesis and the benefit of highly purified urinary FSH (uFSH-HP) treatment in men with oligozoospermia. METHODS: Twenty-nine normogonadotropic, normogonadal men with oligozoospermia were evaluated. Serum hormonal concentration and spermiogram were analyzed before and after 3-month treatment with uFSH-HP. RESULTS: Our results support the hypothesis that inhibin B is involved in the physiological regulation of FSH secretion and reflects the FSH-stimulated Sertoli cell function. After treating with uFSH-HP for 3 months a significant increase in all semen parameters was observed in most of the patients. CONCLUSIONS: Although the benefit of inhibin B as a prognosis factor in oligozoospermic patients treated with FSH is not defined, it can be considered as an important serum marker in reproductive and testicular functions. Treatment of oligozoospermic patients with uFSH-HP has shown to be an effective and safe therapy.

TVT (Tension-free Vaginal Tape) nuevo procedimiento quirúrgico para el tratamiento de la incontinencia urinaria de esfuerzo en la mujer / TVT (Tension-free Vaginal Tape) a new surgical procedure for treatment of female urinary incontinence

Múltiples son las técnicas quirúrgicas existentes para el tratamiento de la incontinencia urinaria de esfuerzo, aunque hasta ahora ninguna ha resultado plenamente eficaz. En nuestro hospital, las técnicas más utilizadas son las de Ramírez y la de Burch por laparoscopia, técnicas que están siendo sustituidas por la TVT, por su comodidad, sus buenos resultados y su eficiencia. Presentamos los resultados de 34 casos de TVT con un período de observación de 8 meses, claramente corto pero que por sus magníficos resultados creemos importante su comunicación (AU)

[Antioxidative state and lipid peroxidation in erectile dysfunction: preliminary study]. / Estado antioxidante y peroxidación lipídica en la disfunción eréctil: estudio preliminar.

OBJECTIVE: The aims of this study were to analyze the cavernosal tissue metabolic status of patients with vascular and psychogenic impotence and attempt to establish metabolic differences between these types of erectile dysfunction. METHODS: 103 patients were classified according to the type of erectile dysfunction into group A (vascular) and group B (psychogenic). Diagnosis was based on clinical history, physical examination, intracavernosal injection test, penile echo-doppler assessment, cavernosography-cavernosometry and nocturnal penile test. Cavernosal and peripheral venous blood samples were obtained from each patient and the lipoperoxide (LPO) levels and total antioxidant status (TAS) were determined. SPSS V9.0 was used for the statistical analysis. RESULTS: The mean age was 62 years (range 32-73). Cavernosal blood lipoperoxide levels were statistically higher (p < 0.05) in patients with vascular impotence (2.45 mumol/L) than in those with psychogenic impotence (1.47 mumol/L). Cavernosal blood total antioxidant status was statistically higher (p < 0.05) in patients with psychogenic (1.40 mmol/L) than those with vascular impotence (1.10 mmol/L). The lipoperoxide levels and total antioxidant status for peripheral blood were 1.68 mumol/L vs 1.60 mumol/L and 1.29 mmol/L vs 1.35 mmol/L, respectively, with no statistically significant differences between both groups. CONCLUSIONS: Cavernosal blood lipoperoxide levels and total antioxidant status can be an indicator of cavernosal tissue metabolic status and function.

Percutaneous embolization for erectile dysfunction due to venous leakage: prognostic factors for a good therapeutic result.

OBJECTIVES: To identify prognostic parameters for patient outcome after embolization for erectile dysfunction (ED) due to venous leakage (VL). METHODS: 23 patients presenting with ED due to pure venous leakage were selected. Intracavernous pharmacological testing, Doppler ultrasound, dynamic cavernosography-cavernosometry and cavernous oxygen tension were done. All patients underwent embolization of the leakage areas visualized. The results were assessed in terms of the response: good, partial or absent. Mean values were calculated for diastolic flow, oxygen tension, maintenance flow and pressure decay, and were compared between the group of patients who responded and the group which did not respond using Student's t test. RESULTS: 26% had a good response, with a mean follow-up of 22 months, if we include partial response and adjuvant therapy this rate rises to 44%. A statistically significant relationship was found between the intracavernous oxygen tension and maintenance flow with a good response to treatment; patients with cavernosography types I and II showed a better response to treatment than those with cavernosography type III. CONCLUSIONS: Maintenance flow, intracavernous oxygen tension, and cavernosography types can be prognostic factors of success in the treatment of ED due to pure VL with embolization.