Comentario editorial a «Estudio prospectivo comparativo entre adenomectomía laparoscópica y abierta: resultados operatorios y funcionales» / Comment to «Prospective study comparing laparoscopic and open adenomectomy: Surgical and functional»

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Biopsia prostática transperineal con fusión de imagen ecografía- resonancia magnética. Sistema Biopsee. Experiencia inicial / Transperineal prostate biopsy with ECHO-MRI fusion. Biopsee system. Initial experience

Objetivo: El objetivo del estudio es presentar nuestra experiencia inicial con el sistema estereotáctico de fusión de imagen ECO-RM para el diagnóstico de cáncer de próstata. Material y métodos: Entre septiembre de 2014 y enero de 2015 se realizaron 50 biopsias de próstata mediante el sistema estereotáctico de fusión de imagen ECO-RM. Las imágenes de RM multiparaméticas 3 Tesla (RM3T) se superpusieron mediante este sistema de fusión de imagen sobre las imágenes de ECO3D obtenidas con el sistema Biopsee para la localización exacta de las zonas de sospecha de cáncer de próstata. Las lesiones se clasificaron mediante el sistema Prostate Imaging Report and Data System. Resultados: Se valoraron un total de 50 pacientes, edad media de 63 años (rango 45-79), PSA medio 8 ng/ml (rango 1,9-20) y un volumen prostático medio de 52 ml (rango 12-118). Se diagnosticó cáncer de próstata en el 69% de los pacientes, neoplasia intraepitelial (PIN) en el 6% y la biopsia resultó negativa en el 24%. Un 62% de los pacientes tenía coincidencia entre la biopsia y la RM, pero un 46% presentó tumor también fuera de la lesión sospechosa. Se diagnosticaron un 46% de tumores anteriores y un 33% de tumores apicales. Un paciente presentó hematuria, otro un hematoma y un tercero retención aguda de orina. Conclusiones: La RM prostática multiparamétrica permite identificar lesiones de próstata sugestivas de cáncer. El sistema Biopsee de fusión de imagen ECO-RM permite su biopsia dirigida y aumenta el rendimiento diagnóstico, reduce los falsos negativos de las biopsias tradicionales y aumenta el diagnóstico de tumores anteriores. El acceso transperineal minimiza el riesgo de infección prostática o sepsis

Objective: The aim of this study is to present our initial experience with the stereotactic echo-MRI fusion system for diagnosing prostate cancer. Material and methods: Between September 2014 and January 2015, we performed 50 prostate biopsies using the stereotactic echo-MRI fusion system. The 3-Tesla multiparameter MR images were superimposed using this image fusion system on 3 D echo images obtained with the Biopsee system for the exact locating of areas suspected of prostate cancer. The lesions were classified using the Prostate Imaging Report and Date System. Results: We assessed a total of 50 patients, with a mean age of 63 years (range, 45−79), a mean prostate-specific antigen level of 8 ng/mL (range, 1.9−20) and a mean prostate volume of 52 mL (range, 12-118). Prostate cancer was diagnosed in 69% of the patients and intraepithelial neoplasia in 6%. The results of the biopsy were negative for 24% of the patients. The results of the biopsy and MRI were in agreement for 62% of the patients; however, 46% also had a tumour outside of the suspicious lesion. We diagnosed 46% anterior tumours and 33% apical tumours. One patient had a haematuria, another had a haematoma and a third had acute urine retention. Conclusions: Multiparametric prostatic MRI helps identify prostate lesions suggestive of cancer. The Biopsee echo-MRI fusion system provides for guided biopsy and increases the diagnostic performance, reducing the false negatives of classical biopsies and increasing the diagnosis of anterior tumours. Transperineal access minimises the risk of prostatic infection and sepsis

Transperineal prostate biopsy with ECHO-MRI fusion. Biopsee system. Initial experience. / Biopsia prostática transperineal con fusión de imagen ecografía-resonancia magnética. Sistema Biopsee. Experiencia inicial.

OBJECTIVE: The aim of this study is to present our initial experience with the stereotactic echo-MRI fusion system for diagnosing prostate cancer. MATERIAL AND METHODS: Between September 2014 and January 2015, we performed 50 prostate biopsies using the stereotactic echo-MRI fusion system. The 3-Tesla multiparameter MR images were superimposed using this image fusion system on 3D echo images obtained with the Biopsee system for the exact locating of areas suspected of prostate cancer. The lesions were classified using the Prostate Imaging Report and Date System. RESULTS: We assessed a total of 50 patients, with a mean age of 63 years (range, 45-79), a mean prostate-specific antigen level of 8 ng/mL (range, 1.9-20) and a mean prostate volume of 52mL (range, 12-118). Prostate cancer was diagnosed in 69% of the patients and intraepithelial neoplasia in 6%. The results of the biopsy were negative for 24% of the patients. The results of the biopsy and MRI were in agreement for 62% of the patients; however, 46% also had a tumour outside of the suspicious lesion. We diagnosed 46% anterior tumours and 33% apical tumours. One patient had a haematuria, another had a haematoma and a third had acute urine retention. CONCLUSIONS: Multiparametric prostatic MRI helps identify prostate lesions suggestive of cancer. The Biopsee echo-MRI fusion system provides for guided biopsy and increases the diagnostic performance, reducing the false negatives of classical biopsies and increasing the diagnosis of anterior tumours. Transperineal access minimises the risk of prostatic infection and sepsis.

Efectividad y seguridad del sistema Urolift(R) para el tratamiento de los síntomas de la hiperplasia benigna de próstata: revisión sistemática / Efficacy and Safety of the Urolift(R) System for the Treatment of Benign Prostate Hyperplasia Symptoms: Systematic Review

Contexto: Interés por disponer de alternativas en el tratamiento de la hiperplasia benigna de próstata. Objetivo: Evaluar la efectividad y seguridad del sistema Urolift(R) para el tratamiento de los síntomas de la hiperplasia benigna de próstata. Adquisición de evidencia: Revisión sistemática de la literatura con búsqueda en PubMed, Cochrane Library, CRD, Clinical Trials y EuroScan, recogiéndose indicadores de efectividad y seguridad. Síntesis de evidencia: Se incluyeron 5 series de casos y un ensayo clínico. La edad media de los pacientes osciló entre 65-74,3 años, y el volumen prostático medio entre 41-55 cm3. El número medio de implantes Urolif(R) fue de 3,7-5,5. El seguimiento máximo en meses fue de 24, 12 (3 estudios) y uno (2 estudios). Se encontraron mejoras en: síntomas del tracto urinario inferior medidos con International Prostate Symptom Score, Benign Prostatic Hyperplasia Impact Index (BPHII), flujo urinario máximo (Qmax) y volumen residual postmiccional (PVR); síntomas de función sexual medidos con Sexual Health Inventory for Men (SHIM) y Male Sexual Health Questionnaire or Ejaculatory Dysfunction (MHSQ-EjD); y calidad de vida (QoL). En el ensayo clínico, las diferencias fueron significativas para International Prostate Symptom Score, BPHII, Qmax y QoL (p < 0,05). Los efectos adversos fueron leves. Conclusiones: Aunque la calidad de la evidencia es baja, Urolift(R) constituye una buena alternativa terapéutica para pacientes con hiperplasia benigna de próstata. Los resultados a corto/medio plazo muestran que la técnica contribuye a mejorar los síntomas del tracto urinario inferior, sin efectos secundarios relevantes, sin afectar la función sexual y mejorando la calidad de vida. Sería preciso continuar la investigación especialmente sobre resultados a largo plazo

Context: Interest in having alternatives in the treatment of benign prostate hyperplasia. Objectives: To assess the efficacy and safety of the Urolift(R) system for treating the symptoms of benign prostate hyperplasia. Acquisition of evidence: Systematic review of the literature through searches on PubMed, Cochrane Library, CRD, Clinical Trials and EuroScan, collecting indicators of efficacy and safety. Summary of the evidence: We included 5 case series and one clinical trial. The patients' mean age ranged from 65-74.3 years, and the mean prostate volume was 41-55 cm3. The mean number of Urolif(R) implants was 3.7-5.5. The maximum follow-up in months was 24, 12 (3 studies) and one (2 studies). Improvements were found in lower urinary tract symptoms, as measured with the International Prostate Symptom Score, Benign Prostatic Hyperplasia Impact Index (BPHII), maximum urinary flow (Qmax) and postvoid residual (PVR) volume. Improvements were in found sexual dysfunction symptoms, as measured with the Sexual Health Inventory for Men (SHIM) and the Male Sexual Health Questionnaire or Ejaculatory Dysfunction (MHSQ-EjD), and in quality of life (QoL). In the clinical trial, the differences were significant for International Prostate Symptom Score, BPHII, Qmax and QoL (p<.05). The adverse effects were mild. Conclusions: Although the quality of evidence is low, Urolift® constitutes a good therapeutic alternative for patients with benign prostate hyperplasia. The short to medium-term results show that the technique contributes to improving lower urinary tract symptoms, with no relevant side effects, does not affect sexual function and improves quality of life. Further research is required, especially on long-term results

Efficacy and safety of the urolift® system for the treatment of benign prostate hyperplasia symptoms: systematic review.

CONTEXT: Interest in having alternatives in the treatment of benign prostate hyperplasia. OBJECTIVES: To assess the efficacy and safety of the Urolift® system for treating the symptoms of benign prostate hyperplasia. ACQUISITION OF EVIDENCE: Systematic review of the literature through searches on PubMed, Cochrane Library, CRD, Clinical Trials and EuroScan, collecting indicators of efficacy and safety. SUMMARY OF THE EVIDENCE: We included 5 case series and one clinical trial. The patients' mean age ranged from 65-74.3 years, and the mean prostate volume was 41-55cm3. The mean number of Urolif® implants was 3.7-5.5. The maximum follow-up in months was 24, 12 (3 studies) and one (2 studies). Improvements were found in lower urinary tract symptoms, as measured with the International Prostate Symptom Score, Benign Prostatic Hyperplasia Impact Index (BPHII), maximum urinary flow (Qmax) and postvoid residual (PVR) volume. Improvements were in found sexual dysfunction symptoms, as measured with the Sexual Health Inventory for Men (SHIM) and the Male Sexual Health Questionnaire or Ejaculatory Dysfunction (MHSQ-EjD), and in quality of life (QoL). In the clinical trial, the differences were significant for International Prostate Symptom Score, BPHII, Qmax and QoL (p<.05). The adverse effects were mild. CONCLUSIONS: Although the quality of evidence is low, Urolift® constitutes a good therapeutic alternative for patients with benign prostate hyperplasia. The short to medium-term results show that the technique contributes to improving lower urinary tract symptoms, with no relevant side effects, does not affect sexual function and improves quality of life. Further research is required, especially on long-term results.

Comentario a: «Análisis de factores predictivos de éxito para la fotovaporización próstatica en HBP mediante láser verde» / Comment to «Analysis of Predictive Factors of Success for Prostate Photovaporization in BPH by Greenlight Laser»

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Puesta al día en el diagnóstico y tratamiento de la vulvodinia / Update on the Diagnosis and Treatment of Vulvodynia

Contexto: La vulvodinia es una entidad clínica compleja y multifactorial. Se define como un malestar vulvar crónico caracterizado por quemazón, escozor o irritación. Es sabida su dificultad diagnóstica y su manejo. Objetivos: Revisar la literatura médica de los últimos 10 años desde un punto de vista crítico. Adquisición de evidencia: Se realizó una búsqueda en Medline/Pubmed y librería Cochrane usando los términos vulvodynia y vestibulodynia, a los que se añadieron etiology, epidemiology, diagnosis, neurophysiological test and treatment or management. Síntesis de evidencia: A pesar de los avances conseguidos en todos los aspectos de la vulvodinia, hoy la metodología utilizada en buen número de casos no tiene la solidez estadística deseable: pocos grupos controles o placebo y estudios a doble ciego, falta de uniformidad en las escalas, índices y cuestionarios para la correcta evaluación del dolor antes y después del tratamiento y una utilización de criterios diagnósticos discutible. Se ha visto en los estudios analizados la poca utilización de medios diagnósticos neurofisiológicos que validen los hallazgos clínicos. Los tratamientos médicos se muestran en la mayoría de los trabajos examinados poco efectivos. La fisioterapia y la terapia cognitiva-conductual parecen ser herramientas terapéuticas prometedoras. La cirugía (vestibulectomía) destaca por la eficacia demostrada en las publicaciones estudiadas. Conclusiones: El abordaje multidisciplinar es siempre necesario. El tratamiento médico tópico, el psicológico y la fisioterapia pueden tener efectos sumatorios y convertirse en una alternativa a la cirugía. Se precisan nuevas vías de investigación y estudios más reglados (AU)

Context: Vulvodynia is a complex and multifactorial clinical condition. It is defined as chronic vulvar discomfort characterized by burning, stinging or irritation. Its diagnostic difficulty and treatment is known. Objectives: To review the medical literature of the last 10 years from a critical point of view. Evidence Acquisition: A search was made in Medline/Pubmed and the Cochrane Library using the terms vulvodynia and vestibulodynia to which etiology, epidemiology, diagnosis, neurophysiological test and treatment or management, were added. Evidence Synthesis: In spite of the advances achieved in all of the aspects of vulvodynia, the methodology used at present in many cases does not have the desirable statistical soundness: there are few control or placebo-controlled groups and double-blind studies. Uniformity is lacking in the scales, indexes and questionnaires for the correct evaluation of pain before and after the treatment and debatable diagnostic criteria are use. The limited use of neurophysiological diagnostic resources that validate the clinical findings has been observed in the studies analyzed. In most of the works, the medical treatments have been shown to be ineffective. Physiotherapy and cognitive-behavioral therapy seem to be promising therapeutic tools. Surgery (vestibulectomy) stands out by its demonstrated efficacy in the publications studied. Conclusions: A multidisciplinary approach is always necessary. Topical medical, psychological and physical therapy treatments may have sum effects and become an alternative to surgery. New pathways of research and more regulated studies are required (AU)

[Update on the diagnosis and treatment of vulvodynia]. / Puesta al día en el diagnóstico y tratamiento de la vulvodinia.

CONTEXT: Vulvodynia is a complex and multifactorial clinical condition. It is defined as chronic vulvar discomfort characterized by burning, stinging or irritation. Its diagnostic difficulty and treatment is known. OBJECTIVES: To review the medical literature of the last 10 years from a critical point of view. EVIDENCE ACQUISITION: A search was made in Medline/Pubmed and the Cochrane Library using the terms vulvodynia and vestibulodynia to which etiology, epidemiology, diagnosis, neurophysiological test and treatment or management, were added. EVIDENCE SYNTHESIS: In spite of the advances achieved in all of the aspects of vulvodynia, the methodology used at present in many cases does not have the desirable statistical soundness: there are few control or placebo-controlled groups and double-blind studies. Uniformity is lacking in the scales, indexes and questionnaires for the correct evaluation of pain before and after the treatment and debatable diagnostic criteria are use. The limited use of neurophysiological diagnostic resources that validate the clinical findings has been observed in the studies analyzed. In most of the works, the medical treatments have been shown to be ineffective. Physiotherapy and cognitive-behavioral therapy seem to be promising therapeutic tools. Surgery (vestibulectomy) stands out by its demonstrated efficacy in the publications studied. CONCLUSIONS: A multidisciplinary approach is always necessary. Topical medical, psychological and physical therapy treatments may have sum effects and become an alternative to surgery. New pathways of research and more regulated studies are required.

[Update in pudendal nerve entrapment syndrome: an approach anatomic-surgical, diagnostic and therapeutic]. / Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico.

INTRODUCTION: The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area. OBJECTIVES: To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment. MATERIAL AND METHODS: We performed a literature search through the database Pubmed using the terms Pudendal nerve, Pudendal nerve entrapment syndrome, Pelvic floor neuropathic pain, Pelvic floor myofascial syndrome, Pudendal nerve decompression. Also, selected works in English, Spanish and French, also reviewing the articles relate this work. RESULTS: We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery. CONCLUSION: It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Actualización del síndrome de atrapamiento del nervio pudendo: enfoque anatómico-quirúrgico, diagnóstico y terapéutico / Update in pudendal nerve entrapment syndrome: an approach anatomic-surgical, diagnostic and therapeutic

Introducción: El síndrome de atrapamiento del nervio pudendo (SANP) es un gran desconocido y suele ser mal diagnosticado o confundido con otras patologías. Fue descrito por primera vez por Amarenco en 1987. La manifestación clínica clásica es la neuralgia del pudendo, un dolor neuropático del área genital. Objetivos: Dar a conocer su existencia a los profesionales de la urología a través de una revisión sistemática de la bibliografía existente y sus posibilidades de diagnostico y tratamiento. Material y método: Realizamos una búsqueda bibliográfica a través de la base de datos «Pubmed» utilizando los términos «Pudendal nerve», «Pudendal nerve entrapment síndrome», «Pelvic floor neuropathic pain», «Pelvic floor myofascial síndrome», «Pudendal nerve decompression». Asimismo, seleccionamos los trabajos en lengua inglesa, española y francesa, revisando también los artículos que dichos trabajos refieren. Resultados: Se desarrollan los aspectos más destacados del síndrome: anatomía, etiología, fisiopatología, diagnostico clínico, ecodoppler de la arteria pudenda interna, estudios electrofisiológicos, criterios diagnósticos, terapéutica médica, tratamiento con fisioterapia y tratamiento quirúrgico. Conclusión: Es una causa poco frecuente de dolor en el suelo pélvico y afecta en gran medida la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnósticas y terapéuticas que nos permiten tratar este síndrome invalidante con buenos resultados (AU)

Introduction: The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area. Objectives: To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment. Materials and methods: We performed a literature search through the database “Pubmed” using the terms “Pudendal nerve”, “Pudendal nerve entrapment syndrome,” “Pelvic floor neuropathic pain”, “Pelvic floor myofascial syndrome,” “Pudendal nerve decompression”. Also, selected works in English, Spanish and French, also reviewing the articles relate this work. Results: We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery. Conclusion: It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results (AU)

[Myofascial pain syndrome in the pelvic floor: a common urological condition]. / Síndrome de dolor miofascial del suelo pélvico: una patología urológica muy frecuente.

INTRODUCTION: Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed. OBJECTIVES: To present the prevalence of this syndrome to professionals of urology through a systematic review of existing literature and its potentials for diagnosis and treatment. MATERIALS AND METHODS: We performed a literature search through the database "Pubmed" using the terms "Trigger points", "myofascial pain", "referred pain", "infiltrations" and "physical therapy", to which we add the term "pelvic floor". Then, we select the works in English, Spanish and French that we might like. RESULTS: We develop the highlights of the syndrome: anatomy, etiology, anatomical-clinical correlation, epidemiology, perpetuating factors, diagnosis, medical therapy and physiotherapy treatment. CONCLUSION: It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Síndrome de dolor miofascial del suelo pélvico: una patología urológica muy frecuente / Myofascial pain syndrome in the pelvic floor: A common urological condition

Introducción: El síndrome de dolor miofascial de suelo pélvico es una entidad nosológica muy frecuente en el campo urológico y suele ser ignorada o mal diagnosticada. Objetivos: Dar a conocer la prevalencia de este síndrome a los profesionales de la urología a través de una revisión sistemática de la bibliografía existente y sus posibilidades de diagnóstico y tratamiento. Materiales y métodos: Realizamos una búsqueda bibliográfica a través de la base de datos «Pubmed» utilizando los términos «trigger points», «myofascial pain», «referred pain», «infiltrations» y «physical therapy», a los que añadimos el término «pelvic floor». Entonces, seleccionamos los trabajos en lengua inglesa, española y francesa que nos podrían interesar. Resultados: Se desarrollan los aspectos más destacados del síndrome: anatomía, etiología, correlación anatomoclínica, epidemiología, factores de perpetuación, diagnóstico, terapéutica médica y tratamiento con fisioterapia. Conclusión: Es la causa más frecuente de dolor en el suelo pélvico y afecta, en gran medida, la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnósticas y terapéuticas que nos permiten tratar este síndrome invalidante con buenos resultados (AU)

Introduction: Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed. Objectives: To present the prevalence of this syndrome to professionals of urology through a systematic review of existing literature and its potentials for diagnosis and treatment. Materials and methods: We performed a literature search through the database "Pubmed" using the terms "Trigger points", "myofascial pain", "referred pain", "infiltrations" and "physical therapy", to which we add the term "pelvic floor". Then, we select the works in English, Spanish and French that we might like. Results: We develop the highlights of the syndrome: anatomy, etiology, anatomical-clinical correlation, epidemiology, perpetuating factors, diagnosis, medical therapy and physiotherapy treatment. Conclusion: It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results (AU)

Photoselective vaporization of the prostate (GreenLight PV): lessons learnt after 3500 procedures.

The technical recommendations of an international group of experts on photoselective vaporization of the prostate (PVP; GreenLight PV) for benign prostatic hyperplasia are described. Their experience stems from the treatment of over 3500 patients at five centres in Europe and the United States. The objectives of this physician-based initiative are to optimize the results achieved with PVP by standardizing the procedure, as well as to recommend training requirements.

[Artificial urinary sphincter]. / El esfínter urinario artificial.

OBJECTIVE: To review the literature on artificial urinary sphincters, to describe their function, technique of implantation, indications, results and complications, and to analyze the possible utility of the prosthesis in the treatment of stress incontinence. METHODS: Medline (Index Medicus Online) and Embase (Excerpta Medica Online) were accessed to review the literature on artificial urinary sphincters published from 1974 (when the first artificial urinary sphincter was described by Foley) to October 1999. Of 322 articles identified, only those that described the patient selection criteria, type of prosthesis utilized, results and complications, and mean follow-up were considered. Articles describing historical aspects and new prototypes were also reviewed. Papers by the authors of the present article were excluded to avoid the bias of author preference. The bias of the language barrier, which occurs when articles published in Spanish, English and French are reviewed, was minimum. RESULTS: The AMS-800 is the only model available today. The results achieved are excellent if the indication is correct and perioperative management is careful and exact. The ideal candidate is one with genuine stress urinary incontinence and normal bladder function, although hyper or hyporeflexia is not an absolute contraindication if corrected before, during or after insertion of the prosthesis. The surgical technique is relatively simple and the only difficulty consists in the choice of the appropriate cuff and reservoir. The complications include urethral atrophy, erosion, infection and bladder instability, and are less frequent in women with stress urinary incontinence type III and in men incontinent after prostate surgery, and more frequent in patients with incontinence following pelvic trauma, incontinence due to congenital malformation and those with a neurogenic bladder. The mechanical failures of the prosthesis have diminished with its improved design. New hydraulic and non-hydraulic prototypes have been designed to reduce the complications, but the results are as yet unavailable. CONCLUSIONS: Today, patients with stress urinary incontinence have more possibilities to recover continence. If incontinence persists after all the available medical and surgical options have been attempted, one possibility still remains: the artificial urinary sphincter.

[Early diagnosis of prostate cancer in patients with prostate symptoms by DRE, PSA, TRU and DPSA]. / Diagnóstico precoz del cáncer de próstata en pacientes con sintomatología prostática mediante TR, PSA, ECOTR y DPSA.

Presentation of our experience in the early diagnosis of prostate cancer in patients with signs and symptoms of prostatism. Over a one year period (96-97), 316 patients underwent biopsy based on clearly defined criteria according to the diagnostic algorithm used in our centre: suspicious DRE and/or PSA > or = 10 ng/mL, and in patients with PSA between 4 and 10 ng/mL in the presence of suspicious TRU or when DPSA was > or = 0.15. The ratio of the 136 (43%) prostate cancer diagnosed relative to biopsy +/- was 1:1.32. It is concluded that early diagnosis in a selected population is useful and shows good diagnostic yield. The diagnostic algorithm used is more than acceptable with 43% positive biopsies and a good ratio between biopsy +/-. With a cutoff of 0.15 DPSA is a good method to improve PSA significance in patients in the difficult PSA range of 4 to 10 ng/mL.

[Left supraclavicular adenopathy with a neuroendocrine pattern of unknown cause: prostatic carcinoma metastasis]. / Adenopatía supraclavicular izquierda con patrón neuroendocrino de causa desconocida: metástasis por carcinoma de próstata.

Contribution of a case report of a male patient presenting with single left supraclavicular adenopathy of initially unknown origin and histologic pattern of neuroendocrine nature, finally traced to the prostate. It is believed that in any male over 45 diagnosed with carcinoma of unknown origin in the supradiaphragm lymph nodes, prostate carcinoma metastasis should also be ruled out using PSA immunostaining and by measuring serum PSA, serum alkaline phosphatase and DRE.

[Bladder tumor in pregnancy]. / Tumor vesical durante el embarazo.

Diagnosis of tumours during pregnancy is quite unusual, considering the low frequency of neoplasias in this period (1/1000 pregnancies) as well as the low incidence of bladder cancer in patients under 30, which makes the coincidence of both phenomena quite uncommon. The paper contributes the case of a 28-year old female diagnosed with bladder cancer during her pregnancy.

[Report of a new case of small-cell carcinoma of the bladder and review of the literature]. / Aportación de un nuevo caso de carcinoma de células pequeñas de localización vesical y revisión de la literatura.

We report a case of small cell carcinoma of the urinary bladder in 71-year-old male patient. Oat cell of the urinary bladder is extremely uncommon, and up to date only 135 cases have been reported in word literature. Histologic, microscopic, and immunohistochemical characteristics are similar to oat cell carcinoma of the lung and other extrapulmonary oat cell carcinomas. We conclude this report with immunohistochemical study with PGP 9.5, neuron-specific enolase a synaptophisine.