Complications of transrectal prostate biopsy in our context. International multicenter study of 3350 patients. / Complicaciones de la biopsia transrectal de próstata en nuestro medio. Estudio multicéntrico internacional de 3.350 pacientes.

INTRODUCTION: Prostate cancer is the most common visceral neoplasm in men and the second one in the United States with the highest mortality behind lung cancer and ahead of colorectal cancer. While prostate cancer mortality rates have been reduced in the United States, Austria, United Kingdom and France, 5-year survival rates have been incremented in Sweden, probably due to a higher diagnostic activity and non-lethal tumor detection. TRPB usually has low rates of serious complications, with a not negligible number of minor complications. Mortality directly associated with this procedure is low and usually related to septic shock. The main complications derived from prostate biopsy can be infectious (mild or severe) and non-infectious (hematuria consistent with hemorrhage, urethral bleeding, rectal bleeding or hemospermia, acute urinary retention, pain or vasovagal reactions). MATERIAL AND METHOD: The objective of the study is to compare three usual TRPB protocols and their relationship with the incidence of complications. Retrospective multicenter observational study conducted in three countries (Spain, Italy and Portugal). We have reviewed the medical records of 3350 men who underwent TRPB to evaluate the existence of prostate cancer, with a minimum evolutionary control of 6months. RESULTS: The mean age was 65,50years, median 66, range 43-79. The subgroup analysis showed that younger patients had higher rates of acute urine retention (AUR) (P=.0000001). Likewise, our results revealed that younger patients presented more procedural pain (P=.0000001) than older patients. Regarding PSA, the mean value was 10.44, SD 7.73, median 8.15, range 0.98-68.09. A higher body mass index (BMI) was not associated with further infection (P=.000004). When performing the multivariate analysis, it was found that the significant variables in the general group were: age (P=.0013), PSA (P=.0402), local infiltration anesthesia (P=.0001) and prophylaxis with metronidazole +tobramycin +amoxicillin/clavulanic acid +gentamicin (P=.0001), presenting a normal distribution with high confidence interval (95%) and significant correlation. Prophylaxis is the most significant variable for no complications and pain (P=.0001), age (P=.0013) and prophylaxis (P=.0001) are for bleeding, age (P=.0013), prophylaxis and PSA (P=.0001) are for infection, and finally, age (P=.0013), anesthesia with local infiltration and prophylaxis (P=.0001) and PSA (P=.0402) are for AUR. CONCLUSIONS: Sedation has fewer side effects and complications related to the transrectal prostate biopsy procedure with respect to transrectal local anesthesia. The choice of the antibiotic prophylaxis scheme is decisive in the onset of complications arising from the performance of a transrectal prostate biopsy.

[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.

[Subcutaneous metastasis as the first manifestation of kidney cancer dissemination]. / Metástasis subcutáneas como primera manifestación de la diseminación del cáncer renal.

Presentation of an uncommon form of distant primary dissemination of renal adenocarcinoma (RA) 5 years after radical surgery, the subcutaneous metastasis. The patient underwent surgical resection of metastasis, and later developed early pulmonary, mediastinal and new skin metastasis. A review is made of the incidence, therapeutical approach and prognostic value of skin metastasis due to RA.

[An in-vitro study of the sources of intracellular calcium in Ach-induced contractions and electrical depolarization and of the capacity of calcium antagonists to influence them in the canine detrusor]. / Estudio "in vitro" de las fuentes del calcio intracelular en las contracciones inducidas por Ach y despolarización eléctrica y de la capacidad de los calcionantagonistas para influir sobre éstas, en detrusor canino.

An "in vitro" experimental line was designed to study the dependence of the canine detrussor's contractile activity on extracellular calcium, or whether on the contrary there are intracellular sources of this element. If dependence from extracellular calcium could be demonstrated, the capacity of calcium channel blockers to block the input the this ion would be studied. The conclusions arrived at were: 1. Ach- and KCl-induced activity is dependent from extracellular calcium. 2. This activity is also sensitive to the action of calcium channel blockers. 3. Calcium channel blockers block Ach-activated calcium channels completely, but only partially dose activated by KCl. 4. While the activity induced by Ach and resistant to action from calcium channel blockers is probably due to calcium released from the intracellular reservoirs, the activity induced by KCl and resistant to the calcium channel blockers action can be better explained by the activation of the transmembrane channels which cannot be blocked by this agents.

[Extracorporeal shockwave lithotripsy in patients with urinary diversion]. / Litotricia extracorpórea con ondas de choque en pacientes con derivación urinaria.

Presentation of a review on nine patients (10 renal units) with urinary by-pass and renoureteral lithiasis who underwent shock wave extracorporeal lithotrity in our hospital. The justification for the by-pass was an infiltrant vesical tumour in 6 patients, myelomeningocele in 2, and vesicourethral trauma in the remaining one. All cases were being treated for a Bricker-type by-pass except the last one (bilateral ureterosigmoidostomy). Outcome of treatment was: absence of residual lithiasis in 6, minimal residues in 1 (2 renal units), failure in 1. The remaining patient suffered anaphylactic shock induced by the latex in the ureteral catheter placed prior to lithotrity which caused the patient's death.

[Urologic manifestations in patients with acquired immunodeficiency syndrome]. / Manifestaciones urológicas en pacientes con el síndrome de inmunodeficiencia adquirido.

In order to know the incidence and nature of urological conditions in the Acquired Immunodeficiency Syndrome, a revision was made of 223 clinical histories from patients admitted to our hospital between 1998 and 1992. Some 24.6% developed urological conditions with prevalence of unspecific urinary infections, though several types of specific infections, immunological, neoplastic, neurourological and nephrological changes were also found as well as other conditions not caused by the disease, such as renal lithiasis. We noted that, although involvement of urinary tract in AIDS is not well defined, its frequency is high, since up to one fourth of patients are affected by different disorders.

[Adrenal gland carcinoma. Clinical, pathologic, and therapeutic study]. / Carcinoma suprarrenal. Estudio clínico, patológico y terapéutico.

From 1973 to 1991, 13 patients [4 females (30%) and 9 males (70%)] were diagnosed with adrenal carcinoma at our hospital. The mean age at the time of diagnosis was 47.4 years (range 29 to 72 yrs). Eleven patients (85%) presented with abdominal symptoms and 8 (61%) with paraneoplastic syndrome. At the time of diagnosis, 3 (23%) had clinical or radiological signs of metastasis. Five patients (38.5%) had regional involvement and 5 (38.5%) had localized disease. The preoperative imaging studies disclosed an abnormal IVP in 8 of 13 patients (61%); 7 of 10 (70%) had an abnormal ultrasound scan and the CT scan was abnormal in 9 out of 9 patients (100%). Seventy-three percent of the tumors were classified as anaplastic or poorly differentiated carcinoma and 27% as differentiated carcinoma. Complete surgical excision was performed in 8 cases and op'DDD was administered in 4 cases. The five-year survival rate was 30%. We can conclude that early diagnosis, staging and histopathology have a significant effect on survival and surgical excision is the only treatment associated with medium or long-term survival.

[Risk of suffering from a second primary neoplasm in patients with bladder tumor]. / Riesgo de padecer una segunda neoplasia primaria en pacientes con tumor vesical.

An evaluation was made on the risk of having a second primary neoplasia following vesical tumor diagnosis. All patients attended the 'Hospital La Fe' and had been diagnosed between 1984 and 1993. A total of 238 vesical tumours were studied, 45 (15.9%) with associated second neoplasia; in 34 cases the vesical tumour was the first one to be diagnosed. The number of tumors seen was compared to expected figures, according to the appropriate incidence rates by age, sex and tumour type, taken out from the Spanish section of the 1987 edition of "Cancer Incidence in Five Continents". An increase over the expected values of second neoplasias for lung, prostate, kidney and bone cancer was found. Sixty percent developed concurrently (within 6 months from initial diagnosis). Most vesical tumours were infiltrant, thus conditioning both the prognosis and the second neoplasia. The likely factors implied in this phenomenon are discussed.

[Non-specific granulomatous prostatitis. Relationship and differential diagnosis with prostatic cancer]. / Prostatitis granulomatosa inespecifica. Relacion y diagnóstico diferencial con el cáncer de próstata.

The unspecific granulomatous prostatitis (GP) is a rare prostate disease. Its relevance lies on the common confusion with prostate carcinoma. Review of 21 cases of unspecific GP, two of which had previously undergone transurethral resection of the prostate. Forty-eight percent of patients developed urinary tract infection prior to GP diagnosis. In 13 patients (62%), prostate carcinoma was suspected after rectal examination of the prostate and transrectal ultrasound. Diagnosis was achieved by histopathology after prostate biopsy and transurethral resection (100%). Prostate Specific Antigen (PSA) was within the normal ranges in all cases that it was performed (six), with the exception of one patient who developed prostate cancer. During follow-up, four patients developed prostate cancer (19%) with an average presentation time of 5.5 years after GP diagnosis.

[Leiomyosarcoma of the prostate]. / Leiomiosarcoma de próstata.

Leiomyosarcoma of the prostate is a very uncommon malignant tumor arising from the smooth muscle cells of the prostate gland. We report on a 72-year-old patient who underwent surgery for benign prostatic hyperplasia. The pathological analysis following retropubic resection, however, revealed a leiomyosarcoma and an extended cystectomy and pelvic tumorectomy were performed after preoperative radiotherapy. The patient is alive with local recurrence at four years follow up.

[Prognostic factors in tumors of the upper urinary tract]. / Factores pronósticos de los tumores del tracto urinario superior.

Review of patients treated for tumours of the upper urinary tract (UUTT) in our hospital during the 1969-1992 period. The characteristics studied were: stage (TNM 1987), grade (OMS), associated vesical tumour, location of primitive tumour, size, number, surgery performed and presence of tumoral relapse. Cox's regression model was used for the analysis of prognostic factors with survival time as the response variable. The sample has 92 patients (78% men and 22% women), average age 64 years. The tumours were: 46 pyelitic, 36 ureteral and 10 mixed. Stage distribution was: 13 pTa (14%), 41 pT1 (45%), 16 pT2 (17%), 15 pT3 (17%), 3 pT4 (7%); grade distribution: 22 grade I (24%), 54 grade II (59%) and 16 grade III (17%) 48% cases presented associated vesical tumour and 15% relapsed. The sample's median survival was 81 months and survival probability at 5 and 10 years was 52% and 45%. A significant association with survival time was shown by: stage, grade, sex and renal annulment. The multivariant analysis selected: 1) stage; 2) renal annulment and 3) sex. The predictive power of staging is indisputable, thus becoming the first selected variable. Renal annulment and sex factors add independent information on evolution. The information provided by the tumour's grade highly correlates to that of the stage, and therefore it was not selected in the multivariant analysis.

[The risk of second primary neoplasm in prostatic cancer patients]. / Riesgo de padecer una segunda neoplasia primaria en pacientes con cáncer de próstata.

The risk of suffering a second primary neoplasia after bearing a prostate cancer has been evaluated. The study patients attended the Hospital La Fe and were diagnosed between 1984 and 1992. There was a total of 223 prostate neoplasias, 22 of which had associated a second neoplasia and in 12 cases, corresponding to seven tumoral locations, prostate cancer was the first pathology to be diagnosed. Tumours observed were compared to those expected, according to the incidence rates appropriate for each age group and tumoral type, taken from the Spanish section of "Cancer Incidence in Five Continents", 1987. An excess of second neoplasias for vesical, kidney, CNS, bone and lymphoma tumours was found. In most cases, the second tumour was diagnosed between 6 to 12 months after diagnosis of prostate cancer. The patient's prognosis is dependent of the second neoplasia. The possible mechanisms of these associations are discussed in the light of state-of-the-art knowledge.

[The ability of extracellular calcium and calcium channel blockers to modify the spontaneous activity of the detrusor muscle. An in-vitro study]. / Capacidad del calcio extracelular y los farmacos bloqueadores de la entrada de calcio para modificar la actividad espontaneo del musculo detrusor. Estudio "in vitro".

The ultimate mechanism of action for all substances with the ability of modifying the activity of smooth muscle is an increased or decreased intracellular concentration of Ca2+. This report presents an "in vitro" study where the dependency on extracellular Ca2+ for the spontaneous activity of the detrusor muscle was investigated, and also the changes that calcium channel blockers can exert on it. The study concludes that the tonic component of the spontaneous activity depends on the Ca2+ intracellular deposits while the physical activity depends on Ca2+ entry from extracellular space. This entry of Ca2+ from the outside is not inhibited by the action of Ca2+ channel blocking agents.

[Antimicrobial prophylaxis in urologic endoscopic surgery: pefloxacin versus ceftriaxone]. / Profilaxis antimicrobiana en cirugía endoscópica urológica: pefloxacino versus ceftriaxona.

Prospective, randomized study in 96 patients undergoing urologic endoscopic surgery to assess the efficacy of two antimicrobials, pefloxacin and ceftriaxone, in the prevention of urinary tract infections. The disease most frequently prompting surgery was vesical tumour and prostate adenoma. All patients had sterile pre-operative urine. Drugs were given endovenously two hours prior surgery in one single dose. Prophylactic efficacy was measured through urine culture before removal of the catheters. Incidence of bacteriuria greater than 100,000 colonies/ml was 20% for the pefloxacin group compared to 15.2% for ceftriaxone. These differences were not statistically significant (Squared-chi test). These results show that pefloxacin is as effective as ceftriaxone in the prophylaxis of endoscopic urological surgery. A single dose schedule was not entirely suitable to reduce post-operative bacteriuria.

[Renal involvement in Burkitt's lymphoma]. / Afectación renal por linfoma de Burkitt.

Review of one case of Burkitt's lymphoma in a 60 year-old male diagnosed with a renal tumour based on the symptomatology, intravenous urography (IVU), ultrasound and CT. In spite of the chemotherapy applied, the patient died 31 days after hospitalization. Burkitt's lymphoma is an infrequent tumour in our setting and renal invasion is rarely observed. The tumour's nature is neither revealed by IVU or ultrasound, CT being the most appropriate imaging technique showing a mass of decreased density that surrounds and infiltrates the tumour. The therapeutical approach for renal tumours is the same as for Burkitt's lymphoma. Besides the rarity of Burkitt's lymphoma, our patient was an atypical case for the age of presentation, early stage of renal invasion and fulminant evolution.

[Vesicoprostatic echography versus transrectal planimetry in the determination of prostatic volume]. / Ecografía vesicoprostática versus planimetría transrectal en la determinación del volumen prostático.

The intention of this paper is to analyze the correlation between two techniques used to measure prostatic volume: transrectal ultrasound with planimetry and transabdominal vesicoprostatic ultrasound. A total of 44 patients have been subjected to transrectal ultrasound, where prostatic volume was determined by planimetry. With this simultaneous technique, patients were performed a vesico-prostatic ultrasound with estimation of volume, achieved by measuring the prostatic diameters and then applying the ellipsoid formula. There were no statistically significant differences between mean values of prostatic volumes as calculated by either technique, both showing a strong correlation (r = 0.817). During transrectal planimetry, the three prostatic diameters were measured and, using a multiple regression study, the influence they have on the changes of prostate's volume was noted. It was observed that it is the transverse, but essentially the longitudinal diameter, the ones which explain those changes (Sig T = 0.0012 and 0.0000, respectively).

[Primary Kaposi's sarcoma of the penis in a patient with acquired immunodeficiency syndrome]. / Sarcoma de Kaposi primario de pene en un paciente con síndrome de inmunodeficiencia adquirida.

Presentation of one case of a 40 year-old, homosexual, AIDS diagnosed male with extrapulmonary tuberculosis (lymphatic nodes) and prior history of gonococcal urethritis, brain toxoplasmosis, molluscum contagiosum and pneumonia by Pneumocystis carinii. A purpura-type lesion with inflammatory features appeared in the foreskin which was diagnosed as primary Kaposi's sarcoma of the penis. The article explains the clinical signs and symptoms, laboratory data, histological findings, and it reviews the literature.

[Surgical wound infection in renal transplant recipients]. / Infección de herida operatoria en trasplantados renales.

Between 1980 and 1991, 504 transplantations were performed in our hospital. All patients received pre-surgical therapy with antibiotics. The total incidence of surgical wound infection was 15 cases (3%). After reviewing all parameters that could have been involved in the development of these infections, it become apparent that diabetes mellitus, more than one transplant in the same patient, development of haematoma in the wound and presence of urinary fistulae were statistically significant (p < 0.05). On the other hand, the use of the different immunosuppressive regimes (azathioprin and cyclosporin) and acute tubular necrosis showed no statistical significance (p > 0.05); also, no relationship was found between infection and acute graft rejection.