Relación entre los niveles de hormonas sexuales en varones por encima de los 50 años y composición corporal, calidad ósea y calidad de vida / Relationships between Sex Hormone Levels in Men over 50 Years of Age and Body Composition, Bone Quality, and Quality of Life

Objetivo: Determinar la relación existente entre los niveles de hormonas sexuales y la composición corporal, la salud ósea y la calidad de vida en hombres por encima de los 50 años. Material y métodos: Estudio transversal en el que se incluyen 230 pacientes. Se determina la composición corporal utilizando parámetros antropométricos directos como el peso, la talla, la circunferencia de la cintura, la circunferencia del brazo dominante, el pliegue cutáneo tricipital, el pliegue en brazo dominante y el pliegue subcapsular. Se calculan parámetros antropométricos indirectos. Se realizan medidas cuantitativas de densidad ósea mediante ecografía del calcáneo, así como marcadores de recambio óseo (N-telopéptidos de excreción urinaria y relación calcio/ creatina). La calidad de vida se evalúa mediante el cuestionario abreviado de calidad de vida SF-36. Los análisis sanguíneos incluyen la determinación de testosterona total, globulina transportadora de hormonas sexuales (SHBG), testosterona libre calculada (TLc), sulfato de dehidroepiandrosterona (S-DHEA), androsteriona, 17-β-estradiol y gonadotropinas. Resultados: La TLc se asocia con un incremento muscular y una disminución del contenido graso, aun ajustándolo por edad (p<0,05). La densidad ósea sólo se relaciona con los niveles de estradiol y su fracción biodisponible (p<0,05). El S-DHEA y la TLc están asociadas a algunas subescalas del SF-36 (p<0,05). Conclusiones: La TLc es la hormona que mejor se relaciona con los cambios corporales asociados a la edad; sin embargo, los niveles de andrógenos no están asociados a la densidad ósea. Un descenso en la TLc y el S-DHEA podría estar relacionado con un descenso en la calidad de vida (AU)

Objetive: To determine whether there was a relationship between sex hormone levels and body composition, bone health, and health-related quality of life in men over 50 years of age. Material and methods: Transversal study carried out in 230 Spanish male outpatients. Body composition was studied using direct anthropometric measures: height, weight, waistline circumference, dominant arm circumference, tricipital skinfold, dominant arm skinfold, subscapular skinfold. Calculated anthropometric parameters were obtained. Quantitative ultrasound measurements of the calcaneus were performed and bone turnover markers were determined (N-telopeptides urinary excretion and calcium/creatinine urinary rate). Quality of life was studied using the short form 36 questionnaire (SF-36). Blood tests included total testosterone, sex hormone binding-globulin, calculated free testosterone (cFT), dehydroepiandrosterone sulphate (DHEA-S), androstenedione, 17-β-estradiol and gonadotrophins. Results: cFT was associated with increased muscle and to decreased in fat content, even after adjusting for age (p<0.05). Bone density was only related to estradiol and its bioavailable fraction (p<0.05). DHEA-S and cFT were related (p<0.05) to some SF-36 subscales. Conclusions: cFT level is most associated with body changes that accompany aging. Androgen levels are not related to bone density. Decline in cFT and DHEA-s levels might be related to decreased quality of life (AU)

[Relationships between sex hormone levels in men over 50 years of age and body composition, bone quality, and quality of life]. / Relación entre los niveles de hormonas sexuales en varones por encima de los 50 años y composición corporal, calidad ósea y calidad de vida.

OBJECTIVE: To determine whether there was a relationship between sex hormone levels and body composition, bone health, and health-related quality of life in men over 50 years of age. MATERIAL AND METHODS: Transversal study carried out in 230 Spanish male outpatients. Body composition was studied using direct anthropometric measures: height, weight, waistline circumference, dominant arm circumference, tricipital skinfold, dominant arm skinfold, subscapular skinfold. Calculated anthropometric parameters were obtained. Quantitative ultrasound measurements of the calcaneus were performed and bone turnover markers were determined (N-telopeptides urinary excretion and calcium/creatinine urinary rate). Quality of life was studied using the short form 36 questionnaire (SF-36). Blood tests included total testosterone, sex hormone binding-globulin, calculated free testosterone (cFT), dehydroepiandrosterone sulphate (DHEA-S), androstenedione, 17-ß-estradiol and gonadotrophins. RESULTS: cFT was associated with increased muscle and to decreased in fat content, even after adjusting for age (p<0.05). Bone density was only related to estradiol and its bioavailable fraction (p<0.05). DHEA-S and cFT were related (p<0.05) to some SF-36 subscales. CONCLUSIONS: cFT level is most associated with body changes that accompany aging. Androgen levels are not related to bone density. Decline in cFT and DHEA-s levels might be related to decreased quality of life.

Células madre y medicina regenerativa en urología, 2ª parte: urotelio, vejiga, uretra y próstata / Stem cells and regenerative medicine in urology, part 2: urothelium, urinary bladder, urethra and prostate

Introducción: La investigación en terapia celular y medicina regenerativa, desarrollada en su mayor parte en torno al estudio de las células madre, está obteniendo resultados prometedores en todas las especialidades médicas. En urología están llevándose a cabo grandes avances en este campo, si bien existen ciertas dificultades, pues, por ejemplo, a fecha de hoy aún no ha sido posible la completa identificación y aislamiento de las células madre uroteliales ni prostáticas humanas, aunque muchos grupos se están acercando cada vez más a ello. Material y métodos: Realizamos una búsqueda electrónica mediante la base de datos Pubmed, tanto de artículos originales como de revisiones, utilizando los criterios de búsqueda stem cells urology, urothelial stem cells, bladder stem cells, prostate stem cells, urethra stem cells, cell therapy urology, tissue engeneering urology y regenerative medicine urology. Resultados: Hemos hecho una revisión de 30 trabajos publicados hasta noviembre de 2009, tratando con ello de hacer una recopilación lo más completa posible, para poder conocer un poco mejor los avances realizados en este campo, desde los inicios hasta nuestros días. Conclusión: Aunque existen aún importantes numerosas incógnitas, la mayor de ellas conseguir la identificación, aislamiento y cultivo de las células madre renales, uroteliales y prostáticas humanas, esto no debe impedir a los investigadores el poder trasladar los resultados obtenidos en el laboratorio a la clínica (AU)

Introduction: Investigation in cell therapy and regenerative medicine, mainly developed around stem cell research, is reaching promising results in every medical specialities. There are also being great advances in Urology, despite the difficulties researchers are facing, as complete identification and isolation of human urothelial and prostatic stem cells has not been possible yet, although many groups are close to achieve it. Material and methods: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: "stem cells urology", "urothelial stem cells", "bladder stem cells", "prostate stem cells", "urethra stem cells", "cell therapy urology", "tissue engeneering urology" y "regenerative medicine urology". Results: We reviewed 30 articles published up to November 2009, trying to summarize thoroughly the most relevant findings and the last advances in this fild, from the first steps to this day. Conclusion: Despite the great lack of knowledge existing, especially the need for achieving the identification of kidney, urothelium and prostate stem cells, this shouldn’t prevent researchers from translating the laboratory results to the clinical work (AU)

[Stem cells and regenerative medicine in urology, part 2: urothelium, urinary bladder, urethra and prostate]. / Células madre y medicina regenerativa en urología, 2.a parte: urotelio, vejiga, uretra y próstata.

INTRODUCTION: Investigation in cell therapy and regenerative medicine, mainly developed around stem cell research, is reaching promising results in every medical specialities. There are also being great advances in Urology, despite the difficulties researchers are facing, as complete identification and isolation of human urothelial and prostatic stem cells has not been possible yet, although many groups are close to achieve it. MATERIAL AND METHODS: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: "stem cells urology", "urothelial stem cells", "bladder stem cells", "prostate stem cells", "urethra stem cells", "cell therapy urology", "tissue engineering urology" y "regenerative medicine urology". RESULTS: We reviewed 30 articles published up to November 2009, trying to summarize thoroughly the most relevant findings and the last advances in this field, from the first steps to this day. CONCLUSION: Despite the great lack of knowledge existing, especially the need for achieving the identification of kidney, urothelium and prostate stem cells, this shouldn't prevent researchers from translating the laboratory results to the clinical work.

[Stem cells and regenerative medicine in urology, part 1: General concepts, kidney, testis and urinary incontinence]. / Células madre y medicina regenerativa en urología, 1.a parte: generalidades, riñón, teste e incontinencia.

INTRODUCTION: Progress in stem cell study and tissue engineering reached during the last times proves that this may be one of the most promising research fields in the future. Most urological diseases could profit from the development of disciplines such as regenerative medicine as, up to now, there have been encouraging results in this subject. MATERIAL AND METHODS: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: stem cells urology, kidney stem cells, testis stem cells, urinary sphincter, cell therapy urology, tissue engineering urology y regenerative medicine urology. RESULTS: We reviewed 33 articles published up to January 2010, trying to summarize the most relevant findings within the last years, the clinical applications and the point we have come to this day. CONCLUSION: Cell therapy and regenerative medicine are showing themselves to be one of the most promising fields within urological basic investigation in the last years. However, there is much work to be done yet, to make the advances reached in basic research be applicable to the clinic.

Células madre y medicina regenerativa en urología, 1. a parte: generalidades, riñón, teste e incontinencia / Stem cells and regenerative medicine in urology, part 1: General concepts, kidney, testis and urinary incontinence

Introducción: Los progresos alcanzados en los últimos años en el estudio de las células madre y la ingeniería tisular demuestran que probablemente se trate de unos de los campos de la investigación más prometedores para el futuro. Gran parte de las enfermedades urológicas podrían beneficiarse del desarrollo de disciplinas como la medicina regenerativa, pues en la actualidad ya se han conseguido resultados esperanzadores en esta materia. Material y métodos: Realizamos una búsqueda electrónica mediante la base de datos Pubmed, tanto de artículos originales como de revisiones, utilizando los criterios de búsqueda «stem cells urology», «kidney stem cells», «testis stem cells», «urinary sphincter», «cell therapy urology», «tissue engeneering urology» y «regenerative medicine urology». Resultados: Hemos revisado un total de 33 trabajos publicados hasta enero de 2010, intentando resumir los hallazgos más relevantes de los últimos años y su aplicación clínica, así como el punto en el que nos encontramos hoy en día. Conclusión: La terapia celular y la medicina regenerativa se están imponiendo como uno de los campos de investigación urológica más en auge en los últimos años. Sin embargo, queda aún mucho por investigar para que todos los rápidos avances de la investigación básica puedan ser trasladados a la clínica (AU)

Introduction: Progress in stem cell study and tissue engineering reached during the last times proves that this may be one of the most promising research fields in the future. Most urological diseases could profit from the development of disciplines such as regenerative medicine as, up to now, there have been encouraging results in this subject. Material and methods: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: “stem cells urology”, “kidney stem cells”, “testis stem cells”, “urinary sphincter”, “cell therapy urology”, “tissue engeneering urology” y “regenerative medicine urology”. Results: We reviewed 33 articles published up to January 2010, trying to summarize the most relevant findings within the last years, the clinical applications and the point we have come to this day. Conclusion: Cell therapy and regenerative medicine are showing themselves to be one of the most promising fields within urological basic investigation in the last years. However, there is much work to be done yet, to make the advances reached in basic research be applicable to the clinic (AU)

Comparative analysis of the germ cell markers c-KIT, SSEA-1 and VASA in testicular biopsies from secretory and obstructive azoospermias.

Testicular biopsy is needed to confirm diagnosis in azoospermic patients and to recover spermatozoa, if possible. This report aims to quantitatively analyse the germline markers stage-specific embryonic antigen (SSEA-1), c-KIT and VASA in testicular biopsies with distinct azoospermic aetiologies. Twenty-three testicular biopsies were analysed by flow cytometry and RT-qPCR for c-KIT, SSEA-1 and VASA. In all the Sertoli cell-only (SCO) samples, significantly lower VASA mRNA expression and fewer VASA+ cells were found compared with obstructive controls. Maturation arrest (MA) cases showed significant differences only with the non-mosaic SCO samples when compared for VASA mRNA expression and percentage of VASA+ cells, but not with the mosaics. However, the normalized VASA-KIT parameter obtained by subtracting the percentage of c-KIT+ cells from the percentage of VASA+ cells showed significant differences between the MA and all the SCO samples. RT-qPCR consistently found differences for the VASA expression between SCO mosaic and non-mosaic samples. However, by flow cytometry, only VASA-KIT showed significant differences between them. Conversely, the percentage of SSEA-1+ cells revealed no inter-group differences. In conclusion, testicular biopsies display different expression profiles for c-KIT and VASA depending on the azoospermic aetiology. These results can be used as a complementary tool to create new molecular categories for diagnoses in azoospermic patients, particularly useful to discriminate between mosaic and non-mosaic SCO patients.

Masa abdominal indolora / No disponible

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[Value of transrectal FNA in the diagnosis of prostate cancer in elderly patients]. / Valor de la PAAF transrectal en el diagnóstico del cáncer de próstata en pacientes de edad avanzada.

OBJECTIVES: To identify if there is a group elderly patients with clinical suspicion of prostate cancer in which pathological confirmation may be unnecessary, and if prostatic transrectal fine needle aspiration (FNA) may be a useful diagnostic tool for old patients. MATERIAL AND METHODS: A total of 72 patients aged 75-93 years were evaluated by means of prostatic transrectal FNA. Antibiotic prophylaxis, analgesia or cessation of anticoagulant therapy were not necessary. RESULTS: In 35 patients (48.6%) cytological diagnosis was positive for prostatic adenocarcinoma, whereas in 37 cytology was negative for cancer. In 100% of patients with PSA > 30 ng/ml or with PSA > 20 ng/ml and suspicious digital rectal examination FNA results were positive for cancer. 4.1% minor and 1.3% major (acute prostatitis) complications after FNA were observed. CONCLUSIONS: In male patients older than 75 years with PSA > 30 ng/ml or with PSA > 20 ng/ml and suspicious digital rectal examination, histological confirmation of carcinoma by prostatic biopsy may be not necessary, because of the high probability of a positive result. When histological confirmation of prostatic carcinoma is required in elderly patients, transrectal prostatic FNA is a valid alternative to transrectal biopsy, due to its excellent tolerance and low complication rate.

[Changes in sexual hormones in a male population over 50 years of age. Frequency of low testosterone levels and risk factors]. / Cambios en las hormonas sexuales en varones mayores de 50 años. Prevalencia de niveles bajos de testosterona y factores de riesgo.

OBJECTIVES: To investigate the changes in sexual hormones in a selected male population older than 50 years of age. To assess the frequency of biochemical hypogonadism and which factors are related to testosterone levels. PATIENTS AND METHODS: A Cross-sectional study was carried out on 230 Spanish men older than 50 years of age. Blood tests were performed including: total testosterone, SHBG, calculated free testosterone, dehidroepiandrosterone sulfate, androstendione, estradiol, bioavailable estradiol, FSH, LH, and prolactin. Clinical and socio-demographic backgrounds were investigated. The frequency of biochemical hypogonadism was established using total and free testosterone levels as diagnostic criteria. Factors that may influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression model was used to determine which factors can predict biochemical hypogonadism according to free testosterone levels. RESULTS: Age was associated with a significant decrease (p < 0.05) in total testosterone (0.6% per year), free testosterone (1.3% per year), dehydroepiandrosterone sulfate (1.8% per year) and bioavailable estradiol (0.69% per year). Moreover, an increase in SHBG, LH, and FSH was observed (p < 0.05). According to total testosterone levels, 4.8% of the men were hypogonadal, whereas 24.8% were hypogonadal when free testosterone was considered. In the univariate analysis, obesity, diabetes mellitus and hyperlipemia were related to lower total testosterone levels, while free testosterone levels were lower in men with sedentary life, lower levels of education, obesity or diabetes mellitus. In the multivariate analysis age, diabetes mellitus and obesity were inversely related to total and free testosterone levels. Free testosterone was also inversely related to hyperlipemia. For biochemical hypogonadism, simple logistic regression analysis selected age, sedentary life, obesity and diabetes mellitus. In the multivariate analysis age, obesity and diabetes mellitus had significant independent prognostic value. CONCLUSIONS: Starting from 50 years of age, a significant age-related decrease in total testosterone, free testosterone, dehydroepiandrosterone sulfate and bioavailable estradiol is observed. The frequency of biochemical hypogonadism is higher when free testosterone levels are used for diagnosis. Total testosterone levels were related to age, diabetes mellitus and obesity. Free testosterone was related to age. diabetes mellitus, obesity and hyperlipemia. The probability of suffering low free testosterone levels increases with age, diabetes mellitus and/or obesity.

Cambios en las hormonas sexuales en varones mayores de 50 años. Prevalencia de niveles bajos de testosterona y factores de riesgo / Changes in sexual hormones in a male population over 50 years of age. Frequency of low testosterone levels and risk factors

Objetivos: Evaluar los cambios en las hormonas sexuales en una población masculina mayor de 50 años, conocer la frecuencia de hipogonadismo bioquímico y qué factores se relacionan con los niveles de testosterona. Pacientes y método: Estudio transversal en 230 varones sanos mayores de 50 años. Se realizaron determinaciones de testosterona total, testosterona libre, testosterona biodisponible, sulfato de de hidroepiandrosterona, estradiol total y biodisponible, LH, FSH y prolactina y se averiguaron los antecedentes clínicos y sociodemográficos. Determinamos la frecuencia de hipogonadismo bioquímico. Analizamos los factores que podían influir en los niveles de testosterona total y libre mediante análisis uni y multivariante y realizamos un análisis de regresión logística para conocer los factores que pueden predecir el hipogonadismo bioquímico en base a la testosterona libre. Resultados: A medida que incrementa la edad de los sujetos evaluados, se observan niveles significativamente más bajos (p<0,05) de los niveles de testosterona total (0,6% anual), testosterona libre (1,3% anual), sulfato de de hidroepiandrosterona (1,8% anual) y estradiol biodisponible (0,69% anual), mientras que se observó un incremento de la SHBG, la LH y la FSH (p>0,05).La prevalencia de niveles bajos de testosterona total fue del 4,8%, alcanzando el 24,8% cuando utilizamos como referencia la testosterona libre. La media de los niveles plasmáticos de testosterona total fue significativamente inferior en los varones con obesidad, diabetes mellitus o dislipemia, mientras que la de los niveles de testosterona libre fue menor en aquellos con estilo de vida sedentario, bajo nivel de estudios, obesos o con diabetes mellitus. En el análisis multivariante, la edad, la diabetes y la obesidad se relacionaron inversamente con los niveles de testosterona total. Con la testosterona libre se relacionan los mismos factores además de la dislipemia. En el análisis de regresión logística multivariante para el hipogonadismo bioquímico, la edad, la obesidad y la diabetes fueron las variables con valor predictivo independiente. Conclusión: A partir de los 50 años se produce un descenso significativo de testosterona total, testosterona libre, sulfato de de hidroepiandrosterona y estradiol biodisponible relacionado con la edad. La prevalencia de hipogonadismo bioquímico es mayor si utilizamos la testosterona libre. Los niveles de testosterona total se relacionan además de con la edad, con la diabetes y la obesidad, añadiéndose la dislipemia para la testosterona libre. La probabilidad presentar niveles bajos de testosterona libre aumenta con la edad y es mayor cuando existen antecedentes de diabetes mellitus y/u obesidad (AU)

Objectives: To investigate the changes in sexual hormones in a selected male population older than 50 years of age. To assess the frequency of biochemical hypogonadism and which factors are related to testosterone levels. Patients and methods: A Cross-sectional study was carried out on 230 Spanish men older than 50 years of age. Blood tests were performed including: total testosterone, SHBG, calculated free testosterone, dehidroepiandrosterone sulfate, androstendione, estradiol, bioavailable estradiol, FSH, LH, and prolactin. Clinical and socio-demographic backgrounds were investigated. The frequency of biochemical hypogonadism was established using total and free testosterone levels as diagnostic criteria. Factors that may influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression model was used to determine which factors can predict biochemical hypogonadism according to free testosterone levels. Results: Age was associated with a significant decrease (p<0.05) in total testosterone (0.6% per year), free testosterone (1.3% per year),dehidroepiandrosterone sulfate (1.8% per year) and bioavailable estradiol (0.69% per year). Moreover, an increase in SHBG, LH, and FSH was observed (p<0.05). According to total testosterone levels, 4.8% of the men were hypogonadal, whereas 24.8% were hypogonadal when free testosterone was considered. In the univariate analysis, obesity, diabetes mellitus and hyperlipemia were related to lower total testosterone levels, while free testosterone levels were lower in men with sedentary life, lower levels of education, obesity or diabetes mellitus. In the multivariate analysis age, diabetes mellitus and obesity were inversely related to total and free testosterone levels. Free testosterone was also inversely related to hyperlipemia. For biochemical hypogonadism, simple logistic regression analysis selected age, sedentary life, obesity and diabetes mellitus. In the multivariate analysis age, obesity and diabetes mellitus had significant independent prognostic value. Conclusions: Starting from 50 years of age, a significant age-related decrease in total testosterone, free testosterone, dehidroepiandrosterone sulfate and bioavailable estradiol is observed. The frequency of biochemical hypogonadism is higher when free testosterone levels are used for diagnosis. Total testosterone levels were related to age, diabetes mellitus and obesity. Free testosterone was related to age, diabetes mellitus, obesity and hyperlipemia. The probability of suffering low free testosterone levels increases with age, diabetes mellitus and/or obesity (AU)

Valor de la PAAF transrectal en el diagnóstico del cáncer de próstata en pacientes de edad avanzada / Value of transrectal FNA in the diagnosis of prostate cancer in elderly patients

Objetivos: Identificar si existe algún grupo de varones ancianos con sospecha clínica de cáncer de próstata, en el cual la confirmación anatomopatológica del diagnóstico puede no ser necesaria, y valorar si la punción aspiración con aguja fina (PAAF) transrectal de próstata puede ser adecuada para el diagnóstico en la población anciana. Material y método: Se evaluaron mediante PAAF transrectal a 72 pacientes de edades comprendidas entre 75 y 93 años. No fue necesaria la administración de ningún tipo de profilaxis antibiótica, analgesia, ni el abandono o sustitución de medicación anticoagulante. Resultados: En 35 de estos pacientes (48,6%) el resultado de la citología fue positivo para adenocarcinoma de próstata, mientras que en 37 fue negativo para tumor. En el 100% de los pacientes con PSA > 30 ng/ml o con PSA> 20 ng/ml y tacto rectal sospechoso de cáncer, la PAAF fue positiva. Se detectó un 4,1% de complicaciones menores y un 1,3% de complicaciones mayores (prostatitis aguda). Conclusiones: En varones mayores de 75 años con PSA > 30 ng/ml o con PSA > 20 ng/ml y tacto rectal sospechoso puede no ser necesaria la confirmación histológica de cáncer de próstata mediante biopsia dada la elevada probabilidad de que ésta sea positiva. Cuando se considere necesaria la confirmación anatomopatológica del diagnóstico de cáncer de próstata en pacientes de edad avanzada, la PAAF constituye una buena alternativa a la biopsia transrectal, dada su excelente tolerancia y baja tasa de complicaciones (AU)

Objectives: To identify if there is a group elderly patients with clinical suspicion of prostate cancer in which pathological confirmation may be unnecessary, and if prostatic transrectal fine needle aspiration (FNA) may be auseful diagnostic tool for old patients. Material and methods: A total of 72 patients aged 75 - 93 years were evaluated by means of prostatic transrectal FNA. Antibiotic prophylaxis, analgesia or cessation of anticoagulant therapy were not necessary. Results: In 35 patients (48.6%) cytological diagnosis was positive for prostatic adenocarcinoma, whereas in 37cytology was negative for cancer. In 100% of patients with PSA > 30 ng/ml or with PSA > 20 ng/ml and suspicious digital rectal examination FNA results were positive for cancer. 4.1% minor and 1.3% major (acute prostatitis) complications after FNA were observed. Conclusions: In male patients older than 75 years with PSA > 30 ng/ml or with PSA > 20 ng/ml and suspicious digital rectal examination, histological confirmation of carcinoma by prostatic biopsy may be not necessary, because of the high probability of a positive result. When histological confirmation of prostatic carcinoma is required in elderly patients, transrectal prostatic FNA is a valid alternative to transrectal biopsy, due to its excellent tolerance and low complication rate (AU)

Cancer testicular bilateral: presentación de cuatro casos / Bilateral testicular cancer: a report of four cases

El cáncer testicular bilateral suponen el 2-5 % de todos los tumores de testículo, aunque actualmente esa prevalencia va aumentando. La edad media de aparición es de los 15-35 años y el 75 % de ellos se presenta metacrónicamente. Suele haber hallazgos histológicos similares en ambos testículos, siendo el tipo histológico más frecuente el seminoma. El factor de riesgo más importante en el desarrollo del cancer testicular es la presencia de neoplasia intratubular de células germinales. El tratamiento de elección es la orquiectomía radical , aunque en algunos casos seleccionados se puede realizar una cirugía conservadora del testículo Presentamos 4 casos atendidos en nuestro servicio, analizamos los factores de riesgo, manejo de los tumores y realizamos una revisión de la literatura médica

Bilateral testicular cancer represents from 2 to 5 % of all testicle tumors, even though this prevalence nowadays is increasing. The median age of presentation was from 15 to years and in approximately 75 % of them occurred metachronously. There used to be concordance in histological findings between both testicles, being seminoma the most common histological type. The most important risk factor in the development of testicular cancer is the presence of intratubular germ cell neoplasia. Radical orquiectomy is the treatment to choose, although in some carefully selected patients testis-sparing surgery may be considered. We present four cases attended in our medical service, we analize the risk factors, management of tumors and a medical literature review is done

[Bilateral testicular cancer: a report of four cases]. / Cancer testicular bilateral: presentación de cuatro casos.

Bilateral testicular cancer represents from 2 to 5% of all testicle tumors, even though this prevalence nowadays is increasing. The median age of presentation was from 15 to years and in approximately 75% of them occurred metachronously. There used to be concordance in histological findings between both testicles, being seminoma the most common histological type. The most important risk factor in the development of testicular cancer is the presence of intratubular germ cell neoplasia. Radical orquiectomy is the treatment to choose, although in some carefully selected patients testis-sparing surgery may be considered. We present four cases attended in our medical service, we analize the risk factors, management of tumors and a medical literature review is done.

[Evaluation of an immunoassay kit to measure free testosterone]. / Evaluación de una técnica de inmunoanálisis para la determinación de testosterona libre.

INTRODUCTION AND OBJECTIVES: The best indicators to the diagnosis of hypogonadism are free and bioavailable testosterone circulating levels. Free and bioavailable testosterone measurements are complex. However, simple kits for direct measurement of free testosterone by analog immunoassay are available. We examined the utility of an enzymoimmunoassay kit for free testosterone measurement. MATERIAL AND METHOD: One hundred thirty-three healthy males were included. Total testosterone, SHBG, albumin and free testosterone was measured. We used two different methods to free testosterone estimation: direct measurement by enzymoimmunoassay and mathematical calculation with Vermeulen's formula, which uses albumin concentration, total testosterone and SHBG to calculate free testosterone (method recommended by the International Society for the Study of the Aging Male). We compared the two methods means values and a linear regression study was performed. RESULTS: Mean age was 37 +/- 11 years. Mean serum concentration for total testosterone was 21.43 +/- 6.8 nm ol/L. The mean value for free testosterone measured by direct and mathematical method was 0.0508 +/- 0.0118 nmol/L and 0.474 +/- 0.123 nmol/L respectively. In linear regression study exists a positive correlation between both methods (p< 0.05), although correlation coefficient is very low (r = 0.25). CONCLUSIONS: There are significant statistical differences between the measurements of free testosterone by direct and mathematical methods. Although certain correlation is observed, this is very low. In conclusion, free testosterone measurement by enzymoimmunoassay is not reliable.

Evaluación de una técnica de inmunoanálisis para la determinación de testosterona libre / Evaluation of an immunoassay kit to measure free testosterone

Introducción y objetivos: Los mejores indicadores bioquímicos para el diagnóstico del hipogonadismo son la testosterona libre y la biodisponible. La determinación de ambas fracciones de testosterona es compleja, aunque se han desarrollado técnicas de inmunoanálisis que permiten la determinación de la testosterona libre de manera directa y sencilla. Valoramos la utilidad de una técnica no evaluada de enzimoinmunoanálisis para la determinación de testosterona libre. Material y métodos: En el estudio se incluyeron 133 varones sanos en los que se determinó la testosterona total, la SHBG, la albúmina y la testosterona libre. La testosterona libre fue determinada mediante 2 métodos diferentes: determinación directa mediante enzimoinmunoanálisis (DSL 10-49100 ACTIVE(R) Free Testosterone EIA, Diagnostics System Laboratories) y mediante cálculo matemático utilizando la fórmula desarrollada por Vermeulen, que utiliza la concentración de albúmina, testosterona total y SHBG para calcular la testosterona libre (método recomendado por la 'International Society for the Study of the Aging Male'). Comparamos los valores obtenidos mediante un test de comparación de medias y realizamos un análisis de regresión para observar el grado de correlación existente entre ambos tipos de determinaciones. Resultados: La edad media fue de 37 ± 11 años. Los niveles medios de testosterona total fue de 21,43 ± 6,8 nmol/L y los de testosterona libre de 0,0508 ± 0,0118 nmol/L para el método directo y de 0,474 ± 0,123 nmol/L para el método matemático (p<0,05). En el estudio de regresión lineal se observa que aunque existe una correlación positiva entre ambos métodos (p<0,05) el coeficiente de correlación es bajo (r = 0,25). Conclusiones: Existen diferencias significativas entre los valores de testosterona libre determinados por el método directo de enzimoinmunoanálisis y la testosterona libre calculada. Aunque se observa una cierta correlación, esta es tan baja que hace poco fiable la utilización del enzimoinmunoanálisis para la determinación de la testosterona libre

Introduction and objetives: The best indicators to the diagnosis of hypogonadism are free and bioavailable testosterone circulating levels. Free and bioavailable testosterone measurements are complex. However, simple kits for direct measurement of free testosterone by analog immunoassay are available. We examined the utility of an enzymoimmunoassay kit for free testosterone measurement. Material and method: One hundred thirty-three healthy males were included. Total testosterone, SHBG, albumin and free testosterone was measured. We used two different methods to free testosterone estimation: direct measurement by enzymoimmunoassay and mathematical calculation with Vermeulen’s formula, which uses albumin concentration, total testosterone and SHBG to calculate free testosterone (method recommended by the International Society for the Study of the Aging Male). We compared the two methods means values and a linear regression study was performed. Results: Mean age was 37 ± 11 years. Mean serum concentration for total testosterone was 21.43 ± 6.8 nm ol/L. The mean value for free testosterone measured by direct and mathematical method was 0.0508 ± 0.0118 nmol/L and 0.474±0.123 nmol/L respectively. In linear regression study exists a positive correlation between both methods (p< 0.05), although correlation coefficient is very low (r = 0.25). Conclusions: There are significant statistical differences between the measurements of free testosterone by direct and mathematical methods. Although certain correlation is observed, this is very low. In conclusion, free testosterone measurement by enzymoimmunoassay is not reliable

Analysis of chromosomal abnormalities in testicular and epididymal spermatozoa from azoospermic ICSI patients by fluorescence in-situ hybridization.

BACKGROUND: An increased incidence of numerical chromosomal abnormalities has been reported in the ejaculated spermatozoa of infertile patients. However, there are few cytogenetic studies of testicular and epididymal spermatozoa, and their results are still controversial. METHODS: Fluorescence in-situ hybridization (FISH) analysis of chromosomes 13, 18, 21, X and Y was performed on seven testicular samples and two epididymal samples from patients with obstructive azoospermia (OA), and on 13 testicular samples from patients with non-obstructive azoospermia (NOA). Five ejaculated sperm samples from normozoospermic fertile donors were evaluated as a control group. RESULTS: Both epididymal sperm samples showed normal FISH results for the parameters analysed when compared with those of the control group. FISH results were abnormal in 29% (two of seven) of testicular samples from OA patients and in 54% (seven of 13) of those from NOA patients, although this difference was not statistically significant. Testicular samples from OA patients showed a significant increase of disomy for sex chromosomes (P<0.01), whereas NOA patients displayed significantly higher rates of diploidy (P<0.0001) and disomy for chromosomes 13 (P<0.0001), 21 (P<0.001) and sex chromosomes (P<0.0001) than the control group. CONCLUSIONS: Testicular spermatozoa from azoospermic patients present increased rates of chromosomal abnormalities, mainly of the sex chromosomes, which are particularly high in NOA patients.

[Value of prostate-specific antigen density and transitional-zone prostate-specific antigen density in the diagnosis of prostate cancer]. / Valor de la densidad del antígeno prostático específico y de la densidad del antígeno prostático específico de la zona transicional en el diagnóstico del cáncer de próstata.

INTRODUCTION: With serum prostate specific antigen (PSA) levels of 4.1 to 10 ng/ml a significant number of patients are unnecessary subjected to biopsy. We try to determine if the calculation of prostate specific antigen density (PSAD) and prostate specific antigen density of the transition zone (PSADTZ) improve the capacity to discriminate between non-malignant disease and prostate cancer. METHODS: A prospective study including 314 males with PSA levels between 4.1 and 10 ng/ml is reported. Transrectal ultrasonography and prostatic biopsy were performed in all of them and total prostate and transition-zone volumes were calculated. PSA density and PSA density of the transition zone were calculated for each patient. Receiver operating characteristics (ROC) curves for PSA, PSAD and PSADTZ were constructed for all the patients and for those patients with digital rectal examination unsuspicous of malignancy, determining the sensitivity and specificity for several cutoff values. RESULTS: The area under the curve for both, PSAD and PSADTZ, were greater than for PSA (p < 0.05), without any significant differences between PSADTZ and PSAD. The cutoff value of greatest diagnostic efficiency for PSAD was 0.17 ng/ml/cc (71.4% sensitivity and 55.7% specificity), while it was 0.41 ng/ml/cc for DPSATZ (70% sensitivity and 61.5% specificity). For those cases of normal digital rectal examination, no differences were observed between PSA and PSAD but they were between PSA and PSADTZ. In any event, the area under ROC curves was always less than 0.7, and, in order to avoid a large number of biopsies (high specificity), a large number of cancers are left without diagnosis (low sensitivity). CONCLUSIONS: We conclude that PSAD and PSADTZ are not excessively useful for adequately discriminating between patients with prostate cancer and those with non-malignant disease, particularly when digital rectal examination is normal.

Valor de la densidad del antígeno prostático específico y de la densidad del antígeno prostático específico dela zona transicional en el diagnóstico del cáncer de próstata / Value of prostate specific antigen density and prostate specific antigen density of the transition zone for the diagnosis of prostate cancer

INTRODUCCIÓN: Cuando el antígeno prostático específico (PSA) sérico se encuentra entre 4,1 y 10 ng/ml un número importante de pacientes son sometidos a biopsia de forma innecesaria. Intentamos determinar si el cálculo de la densidad de PSA (DPSA) y la densidad de PSA de la zona de transición (DPSAZT) mejoran la capacidad del PSA para discriminar entre enfermedad benigna y cáncer. MÉTODOS: Estudio prospectivo en el que se incluyeron 314 varones con cifras de PSA entre 4,1 y 10 ng/ml. En todos ellos se realizó ecografía transrectal y biopsia prostática, calculando el volumen prostático y de la zona de transición. Se calculó la DPSA y la DPSAZT para cada paciente. Se realizaron curvas de rendimiento diagnóstico (ROC curves) para PSA, DPSA y DPSAZT para la totalidad de los pacientes y seleccionando aquellos con tacto rectal no sospechoso de malignidad. Se calculó sensibilidad y especificidad para diferentes puntos de corte para el DPSA y DPSAZT. RESULTADOS: Para la totalidad de la muestra, tanto DPSA como DPSAZT mostraron un área bajo la curva mayor que PSA (p<0,05), sin que se apreciasen diferencias entre DPSAZT y DPSA. El punto de corte con mayor eficiencia diagnóstica para DPSA fue de 0,17 ng/ml/cc (sensibilidad de 71,4 por ciento y especificidad de 55,7 por ciento) y para DPSAZT de 0,41 ng/ml/cc (sensibilidad 70 por ciento y especificidad de 61,5 por ciento). Cuando el tacto rectal era normal no se observaron diferencias entre PSA y DPSA y sí entre PSA y DPSAZT. En cualquier modo el área bajo la curva o exactitud fue siempre inferior al 70 por ciento y para evitar un número considerable de biopsias (alta especificidad) se dejan por diagnosticar un número considerable de cánceres (baja sensibilidad). CONCLUSIONES: Consideramos que la DPSA y DPSAZT no son métodos excesivamente útiles para discriminar adecuadamente entre pacientes con cáncer prostático y enfermedad benigna, especialmente cuando el tacto rectal es negativo (AU)