[Preliminary data of the Spanish contribution to the European Randomized Study on Screening of Prostate Cancer (ERSPC)]. / Datos preliminares de la contribución española al estudio randomizado europeo de screening del cancer de próstata (ERSPC).

OBJECTIVES: Data from the participation of our department in the ERSPC study in terms of detection and PSA diagnostic yield, staging, therapeutic management and mortality in the context of a multicentric randomized screening study for prostate cancer. METHODS: Patients were recruited between February 1996 and June 1999, randomized in screening and control arms, with several rounds for screening patients with four-year intervals, with PSA analysis and sextant prostate biopsy (t PSA > 4 ng/ml before May 1998, tPSA > 2.99 ng/ml after May 1998). These tests were not done in the control group. All deaths were studied (date and cause) RESULTS: A total of 4278 patients were included, 24 16 in the screening arm (56.4%) and 1862 in the control arm (43.5%), with an age between 45 and 70 years (mean age 57.8 years, 95 CI 57.6-58.0). Median follow-up was 8.77 years. 142 prostate cancers were found, 113 in the screening arm (accumulated detection rate 4.7%) and 29 in the control arm (1.6%). Detection rates were 1.7%, 2.2% and 0% in the first, second and third round respectively. Organ confined cancers (T1 and T2) were 102 in the screening arm (90.3%) and 24 in the control arm (82.8%), p = 0.254 . Metastatic disease was found in six patients (4.2% out of 142), 3 in the screening arm ( 2.7%) and three in the control arm (10.3%), p = 0.187. Radical prostatectomy was the most frequently performed treatment: 47 cases in the screening arm (41.6%), 10 in the control arm (34.5%). 151 patients have died, 82 in the screening arm and 69 in the control arm. Only 3 of this deaths were secondary to prostate cancer, all of them in the screening arm (p = 0.308). CONCLUSIONS: We observed a non significant tendency to lower clinical stages in patients undergoing screening. Radical surgery was the treatment of choice in patients with prostate cancer. Even with the current follow-up in the series (close to 9 years), no differences have been observed in terms of prostate cancer mortality between both study arms.

Datos preliminares de la contribución española al estudio randomizado europeo de screening del cáncer de próstata (ERSPC) / Preliminary data of the Spanish contribution to the European RAndomized Study on Screening of Prostate Cancer (ERSPC)

OBJETIVO: Datos de la participación de nuestro Centro en el ERSPC en términos de detección y rendimiento diagnóstico del PSA, estadiaje, manejo terapéutico y mortalidad, en el contexto de un estudio multicéntrico randomizado de screening del cáncer de próstata (CaP). MÉTODOS: Se reclutaron pacientes entre febrero de 1996 y junio de 1999, randomizando en brazos screening y control, realizado varias rondas a los pacientes del brazo screening con intervalo de 4 años, con determinación de PSA y biopsia prostática sextante (PSAt >4ng/mL hasta mayo de 1998, posteriormente PSAt >2.99ng/mL), sin realizar dichos tests en los varones del grupo control. Se investigaron los fallecimientos (fecha de defunción y causa de la misma). RESULTADOS: Se incluyeron un total de 4.278 pacientes, 2.416 del brazo screening (56,4%) y 1.862 del brazo control (43,5%), con edad entre 45 a 70 años y media de 57,8 años (IC95 57,6-58,0). La mediana del tiempo de seguimiento fue de 8,77 años. Se encontraron 142 cánceres, 113 del brazo screening (tasa de detección acumulada 4,7%) y 29 del brazo control (1,6%). Las tasas de detección fueron de 1,7%, 2,2% y 0% en la primera, segunda y tercera ronda respectivamente. Los cánceres órgano confinados (T1 y T2) fueron 102 en el brazo screening (90,3%) y 24 en el control (82,8%), p=0,254. Se detectaron 6 pacientes con enfermedad metastásica (4,2% de 142), 3 del brazo screening (2,7%) y 3 del control (10,3%), p=0,187. El tratamiento más realizado fue la prostatectomía radical: 47 del brazo screening (41,6%) y 10 del control (34,5%). Se han producido 151 fallecimientos, 82 en el brazo screening y 69 en el control, de estos sólo 3 fallecimientos por CaP, todos del brazo screening (p=0,308). CONCLUSIONES: Se observa tendencia no significativa hacia estadíos clínicos más precoces en los pacientes sometidos a screening. El tratamiento de elección en los pacientes con CaP fue la cirugía radical. Aún con el seguimiento actual de esta serie (cercano a los 9 años), no se han observado en nuestro Centro diferencias en cuanto a la mortalidad por CaP entre los dos brazos del estudio

OBJECTIVES: Data from the participation of our department in the ERSPC study in terms of detection and PSA diagnostic yield, staging, therapeutic management and mortality in the context of a multicentric randomized screening study for prostate cancer. METHODS: Patients were recruited between February 1996 and June 1999, randomized in screening and control arms, with several rounds for screening patients with four-year intervals, with PSA analysis and sextant prostate biopsy (t PSA > 4 ng/ml before May 1998, tPSA > 2.99 ng/ml after May 1998). These tests were not done in the control group. All deaths were studied (date and cause) RESULTS: A total of 4278 patients were included, 2416 in the screening arm (56.4%) and 1862 in the control arm (43.5%), with an age between 45 and 70 years (mean age 57.8 years, 95 CI 57.6-58.0). Median follow-up was 8.77 years. 142 prostate cancers were found, 113 in the screening arm (accumulated detection rate 4.7%) and 29 in the control arm (1.6%). Detection rates were 1.7%, 2.2% and 0% in the first, second and third round respectively. Organ confined cancers (T1 and T2) were 102 in the screening arm (90.3% ) and 24 in the control arm ( 82.8% ) , p = 0.254 . Metastatic disease was found in six patients ( 4.2% out of 142 ) , 3 in the screening arm ( 2.7% ) and three in the control arm ( 10.3% ) , p = 0 . 187 . Radical prostatectomy was the most frequently performed treatment: 47 cases in the screening arm (41. 6 %), 10 in the control arm (34. 5 %). 151 patients have died, 82 in the screening arm and 69 in the control arm. Only 3 of this deaths were secondary to prostate cancer, all of them in the screening arm (p = 0.308). CONCLUSIONS: We observed a non significant tendency to lower clinical stages in patients undergoing screening. Radical surgery was the treatment of choice in patients with prostate cancer. Even with the current follow-up in the series (close to 9 years), no differences have been observed in terms of prostate cancer mortality between both study arms

[Post chemotherapy laparoscopic retroperitoneal lymph node dissection]. / Linfadenectomía retroperitoneal vía laparoscópica postquimioterapia.

OBJECTIVES: To describe the laparoscopic excision of a postchemotherapy retroperitoneal residual mass in a patient with mixed germ cell testicular tumor. METHODS/RESULTS: We report the operative technique of laparoscopic excision of a retroperitoneal mass in a 33 year old patient with mixed germ cell testicular tumor. The patient is placed in a lateral decubitus right lumbotomy position and trocars are introduced into the abdominal cavity. Once the retroperitoneum is approached, and after a Kocher manoeuvre of the duodenum, the interaortocaval mass is identified and excised. The operation is completed with lympadenectomy down to the common iliac artery bifurcation bilaterally. CONCLUSION: The laparoscopic approach is another option for the surgical treatment of residual masses after chemotherapy in testicular tumors. Nevertheless, previous laparoscopic experience is necessary due to its difficulty.

[Right transperitoneal laparoscopic nephroureterectomy]. / Nefroureterectomía derecha laparoscópica vía transperitoneal.

OBJECTIVES: To describe the surgical technique of the right laparoscopic nephroureterectomy. METHODS/RESULTS: With the patient in the lithotomy position we performed an endoscopic section of the ureteral meatus. Once the patient is placed in the lumbotomy position and trocars are placed, the retroperitoneal space is accessed. The gonadal vein, and the ureter medial to it, are identified. We proceed to dissect and clip it. Posteriorly, the Kocher maneuver on the duodenum is performed, identifying the inferior vena cava. We dissect the renal artery and vein placing Hemolock clips on both. Once the vascular control is achieved, we free the upper pole with the help of the Ligasure Atlas instrument. When the kidney is free we continue with the ureter down. CONCLUSIONS: Laparoscopic nephroureterectomy is a feasible technique for groups with experience in laparoscopic surgery.

Nefrourectomiía derecha laparoscópica vía transperitoneal / right transperitoneal laparoscopic nephroureterectomy

OBJETIVO: Describir la técnica quirúrgica para la realización de una nefroureterectomía por vía laparoscópica. MÉTODOS/RESULTADOS: Con el paciente en posición de litotomía se realiza desinserción endoscópica del meato ureteral. Una vez colocado el paciente en posición de lumbotomía e introducidos los trócares, se accede al espacio retroperitoneal. Se identifica la vena gonadal y más medial el uréter. Procedemos a su disección y clipado precoz. Posteriormente se realiza la maniobra de Kocher sobre el duodeno, identificándose la vena cava. Disecamos la vena y arteria renal colocando clips Hemolock® en ambas. Con el control vascular realizado, liberamos el polo superior de riñón, ayudándonos de la pinza Atlas de Ligasure®. Una vez liberado todo el riñón, realizamos la misma operación sobre el uréter hasta desinsertarlo completamente. CONCLUSIÓN: La nefroureterectomía por vía laparoscópica es una técnica realizable en grupos con experiencia en cirugía laparoscópica

OBJECTIVES: To describe the surgical technique of the right laparoscopic nephroureterectomy. METHODS/RESULTS: With the patient in the lithotomy position we performed an endoscopic section of the ureteral meatus. Once the patient is placed in the lumbotomy position and trocars are placed, the retroperitoneal space is accessed. The gonadal vein, and the ureter medial to it, are identified. We proceed to dissect and clip it. Posteriorly, the Kocher maneuver on the duodenum is performed, identifying the inferior vena cava. We dissect the renal artery and vein placing Hemolock clips on both. Once the vascular control is achieved, we free the upper pole with the help of the Ligasure Atlas instrument. When the kidney is free we continue with the ureter down. CONCLUSIONS: Laparoscopic nephroureterectomy is a feasible technique for groups with experience in laparoscopic surgery

Linfadenectomía retroperitoneal vía laparoscópica postquimioterapia / Post chemotherapy laparoscopic retroperitoneal lymph node dissection

OBJETIVO: Describir la realización de la exéresis de una masa residual retroperitoneal post-quimioterapia, de un tumor germinal mixto por vía laparoscópica. MÉTODO/RESULTADOS: Presentamos la descripción técnica, por vía laparoscópica, de la exéresis de una masa residual post-quimioterapia de un tumor germinal mixto, en un paciente de 33 años. Se coloca al paciente en posición de lumbotomía derecha y se introducen los trócares. Una vez que se accede al retroperitoneo y realizada la maniobra de Kocher sobre el duodeno identificamos la masa residual interaorto-cava, procediendose a su exéresis. Por último se completa la disección, realizándose una linfadenectomía hasta la bifurcación de las arterias ilíacas primitivas. CONCLUSIÓN: La vía laparoscópica es una alternativa más para el tratamiento quirúrgico de las masas residuales post-quimioterapia en los tumores de testículo. No obstante precisa de experiencia en técnicas laparoscópicas debido a su dificultad

OBJECTIVES: To describe the laparoscopic excision of a postchemotherapy retroperitoneal residual mass in a patient with mixed germ cell testicular tumor. METHODS/RESULTS: We report the operative technique of laparoscopic excision of a retroperitoneal mass in a 33 year old patient with mixed germ cell testicular tumor. The patient is placed in a lateral decubitus right lumbotomy position and trocars are introduced into the abdominal cavity. Once the retroperitoneum is approached, and after a Kocher manoeuvre of the duodenum, the interaortocaval mass is identified and excised. The operation is completed with lympadenectomy down to the common iliac artery bifurcation bilaterally. CONCLUSION: The laparoscopic approach is another option for the surgical treatment of residual masses after chemotherapy in testicular tumors. Nevertheless, previous laparoscopic experience is necessary due to its difficulty

[Tobacco consumption and bladder cancer mortality in Spain]. / Consumo de tabaco y mortalidad por cáncer vesical en España.

OBJECTIVES: To establish the trend of the bladder cancer adjusted mortality and its correlation with tobacco consumption in different Spanish Autonomic Communities over a 15 year period. METHODS: We evaluate the trends of mortality rates associated with bladder cancer between January 1st 1989 and December 31st 2002 in the geographic area of Spain, as well as the tendency of tobacco consumption. Demographic and mortality data were obtained from the National Institute of Statistics, and consumption data were obtained from the Commissioner for the Tobacco Market in the Spanish Economics and Finances Ministry. We calculate the average number of cigarettes (1 package = 20 cigarettes) consumed per person; we also calculate bladder cancer adjusted mortality rates, presented as number of deaths for that cause per 100.000 persons year, and the ratio between number of packages of cigarettes consumed and adjusted mortality rate. We determine the yearly percentage increase over the whole period of study for both the mortality rate and tobacco consumption, and evaluate their correlation by the Spearman's coefficient. RESULTS: Mean adjusted bladder cancer mortality rate over the period of study was 9.4 deaths per 100.000 habitants year, and mean tobacco consumption was 109.7 packages per person year. There has been a 2.05% yearly increase of bladder cancer associated mortality, mean cigarette consumption has diminished 1.3% per year. The Spearman's test did not show any correlation between both factors (p = 0.722). CONCLUSIONS: Despite preventive measures for tobacco addiction in our country, there is an important continuous consumption. The increase in the incidence of bladder cancer does not seem to be related with higher tobacco consumption currently, therefore it may be related with other genetic or environmental factors.

[Laparoscopic pyelolithotomy]. / Pielolitotomía laparoscópica.

The application of laparoscopy as a surgical technique in Urology has enabled to expand the therapeutic options for various pathologies. The treatment of urinary lithiasis localized in the renal pelvis is one of them. We report a laparoscopic pyelolithotomy, describing the operation step-by-step, from patient positioning and trochar insertion to drainage tube insertion and closure. The objective of this article is to show the technique, presenting it as an alternative option.

[Impact of the weather on the serum levels of prostatic specific antigen (PSA)]. / Impacto de la climatología sobre el nivel sérico de antígeno especifico prostático (PSA).

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). EXCLUSION CRITERIA: prostate cancer diagnosis, PSA > = 10 ng/ml, or PSA > = 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value > = 3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p < 0.001), minimum temperature (p = 0.001) and age (p < 0.001) as independent predictors of a PSA value > = 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of < = 15 degrees C, 16-20 degrees C, 21-25 degrees C and > =26 degrees C were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters.

Impacto de la climatología sobre el nivel sérico de antígeno específico prostático (PSA) / Impact of the weather on the serum levels of prostatic specific antigen (PSA)

OBJETIVO: Analizar el impacto de la estación climática y de ciertos parámetros meteorológicos sobre el nivel de PSA sérico en varones sin cáncer de próstata. MÉTODOS: Estudio retrospectivo que incluye registros de la rama Española del European Randomized Study of Screening for Prostate Cancer (ERSPC). Los criterios de exclusión fueron el diagnóstico de cáncer de próstata, presentar PSA >= 10 ng/ml, o bien PSA >= 3 ng/ml y/o anomalías en el tacto rectal a menos que se disponga de una biopsia prostática negativa para malignidad. Se investigó la relación univariante entre nivel de PSA y estación climática, así como varios parámetros meteorológicos. Se empleó un modelo multivariante de regresión logística para identificar predictores independientes de la obtención de un nivel de PSA >=3 ng/ml. RESULTADOS: Un total de 2.147 varones fueron incluidos en el estudio. Las medianas de edad y PSA fueron 57 años y 0,9 ng/ml respectivamente. Se observó una tendencia no significativa hacia niveles de PSA más elevados durante las estaciones de otoño e invierno. El modelo multivariante de regresión logística identificó únicamente las temperaturas máxima (p= 3 ng/ml. Los niveles medios de PSA ajustado a la edad en los rangos de temperatura máxima =26ºC fueron 1,25, 1,20, 1,17 y 1,09 ng/ml respectivamente. CONCLUSIONES: Los niveles de PSA sérico son ligeramente más elevados durante condiciones de frío climático. Debido a la pequeña magnitud de esta elevación, no recomendamos cambiar la indicación de biopsia prostática basándonos únicamente en factores climáticos

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Exclusion criteria: prostate cancer diagnosis, PSA >= 10 ng/ml, or PSA >= 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value >=3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p= 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of =26ºC were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters

[Cystic ectasia of the rete testis]. / Ectasia quística de la rete testis.

OBJECTIVES: The cystic ectasia of the rete testis is a benign entity with a typical ultrasound appearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component. METHODS: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period. RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all the indication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up. CONCLUSIONS: The knowledge of the ultrasound characteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy.

[Testicular microlithiasis]. / Microlitiasis testicular.

OBJECTIVES: Testicular microlithiasis, characterized by the existence of microscopic calcifications within the seminiferous tubules, is rare, generally an incidental finding during a scrotal ultrasound. METHODS: We report the case of a 45-year-old male without risk factors for the development of a germ cell testicular tumor with the diagnosis of bilateral testicular microlithiasis. RESULTS: The patient was followed yearly with testicular ultrasound, without evidence of germ cell tumor over a four-year follow-up period. CONCLUSIONS: Although the clinical significance of testicular microlithiasis is under debate due to the various controversies found in the literature about its association or not with testicular tumors, as well as the various protocols for initial management and adequate intervals for follow-up, it seems reasonable to perform an ultrasound yearly independently of the existence or not of associated risk factors.

Consumo de tabaco y mortalidad por cáncer vesical en España / Tobacco consumption and bladder cancer mortality

OBJETIVO: Determinar la tendencia de la mortalidad ajustada por cáncer vesical y establecer una correlación con el consumo de tabaco en las diferentes Comunidades españolas a lo largo de un periodo de quince años.MÉTODOS: Se evaluarán las tendencias de mortalidad asociada al cáncer vesical en el periodo comprendido entre el 1 de Enero de 1989 y el 31 de Diciembre de 2002, en el área geográfica de España, así como las tendencias en el consumo de tabaco durante el mismo periodo. Los datos demográficos y de mortalidad se obtuvierondel Instituto Nacional de Estadística y los datos de consumo de tabaco se obtuvieron del Comisionado para el Mercado de Tabacos del Ministerio de Economiay Hacienda.Se calcularán el número medio de cajetillasde cigarrillos (1 cajetilla equivale a 20 cigarrillos) consumidas por persona; así como las tasas de mortalidadajustadas por cáncer de vejiga expresada como fallecimientos por dicha causa por 100.000 personas y año, y el ratio entre las cajetillas de cigarrillos consumidosy la tasa de mortalidad ajustada.Se determinará el incremento porcentual anual durante todo el periodo, tanto para la tasa de mortalidad como para el consumo de tabaco, y se evaluará la correlación entre ambas tendencias mediante el coeficiente de Spearman.RESULTADOS: Durante todo el periodo a estudio, la tasa media de mortalidad ajustada por cáncer vesical fue de 9,4 fallecidos por cada 100,000 habitantes y año, y el consumo medio de tabaco fue de 109,7 cajetillas por persona y año. Se ha producido un incremento de la mortalidad asociada a cáncer vesical de un 2,05 % anual, mientras que el consumo de cigarrillos ha disminuidoun 1,3 % al año. El test de Spearman no muestra correlación entre ambos factores (p=0,722).CONCLUSIONES: A pesar de las medidas de prevencióndel tabaquismo en nuetro medio, continúa produciéndoseun importante consumo del mismo. El incrementoen la incidencia de cáncer vesical no parece estar en relación con un mayor consumo de tabaco en la actualidad, por lo que puede estar en relación con otros factores genéticos o ambientales

OBJECTIVES: To establish the trend of the bladder cancer adjusted mortality and its correlation with tobacco consumption in different Spanish Autonomic Communities over a 15 year period. METHODS: We evaluate the trends of mortality rates associated with bladder cancer between January 1st 1989 and December 31st 2002 in the geographic area of Spain, as well as the tendency of tobacco consumption. Demographic and mortality data were obtained from the National Institute of Statistics, and consumption data were obtained from the Commissioner for the Tobacco Market in the Spanish Economics and Finances Ministry. We calculate the average number of cigarettes (1 package = 20 cigarettes) consumed per person; we also calculate bladder cancer adjusted mortality rates, presented as number of deaths for that cause per 100.000 persons year, and the ratio between number of packages of cigarettes consumed and adjusted mortality rate. We determine the yearly percentage increase over the whole period of study for both the mortality rate and tobacco consumption, and evaluate their correlation by the Spearman’s coefficient. RESULTS: Mean adjusted bladder cancer mortality rate over the period of study was 9.4 deaths per 100.000 habitants year, and mean tobacco consumption was 109.7 packages per person year. There has been a 2.05% yearly increase of bladder cancer associated mortality, mean cigarette consumption has diminished 1.3% per year. The Spearman’s test did not show any correlation between both factors (p = 0.722). CONCLUSIONS: Despite preventive measures for tobacco addiction in our country, there is an important continuous consumption. The increase in the incidence of bladder cancer does not seem to be related with higher tobacco consumption currently, therefore it may be related with other genetic or environmental factors

Pielotitotomía laparoscópica / Laparoscopic pyelolithotomy

La aplicación de la laparoscopia como técnica quirúrgica en Urología ha permitido ampliar el abanico de opciones terapéuticas para diferentes patologías.Esto incluye también el tratamiento de la litiasis localizada en pelvis renal.Presentamos una Pielolitotomía laparoscópica como técnicaquirúrgica, describiendo paso a paso todo el procesodesde la colocación del paciente e introducción de trócares, hasta la colocación del drenaje y cierre.El objetivo del trabajo es mostrar la realización de dichatécnica y presentarla como alternativa a otras ya existentes

The application of laparoscopy as a ;;surgical technique in Urology has enabled to expand the therapeutic options for various pathologies. The ;;treatment of urinary lithiasis localized in the renal pelvis is one of them. ;;We report a laparoscopic pyelolithotomy, describing the operation step-by-step, from patient positioning and trochar insertion to drainage tube insertion and closure. ;;The objective of this article is to show the technique, presenting it as an alternative option

Ectasia quística de la rete testis / Cystic ectasia of the rete testis

OBJETIVO: La ectasia quística de la rete testis es una entidad benigna y típicamente en la ecografíaaparece como una colección de pequeñas estructurasanecoicas en la confluencia del mediastinum testis. La importancia clínica de esta entidad radica en hacer un adecuado diagnóstico diferencial con la neoplasiatesticular con componente quísticoMÉTODO: De forma retrospectiva, se revisa en la base de datos de la Unidad de Ecografía del Servicio de Urología el número de pacientes diagnosticados de ectasiaquística de la rete testis durante un periodo de 6 años.RESULTADOS: Durante los 6 años revisados se han diagnosticado 3 casos de ectasia quística de la rete testis y la ecografía fue realizada por dolor testicular. La edad media de los pacientes fue de 62 años. Ningún paciente ha desarrollado durante el tiempo de seguimientoun tumor testicularCONCLUSIONES: El conocimiento de las característicasecográficas encontradas en la ectasia quística de la rete testis permite hacer un adecuado diagnóstico de esta entidad benigna sin necesidad de recurrir a la biopsia testicular

OBJECTIVES: The cystic ectasia of the rete testis is a benign entity with a typical ultrasoundappearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component.METHODS: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period.RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all theindication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up.CONCLUSIONS: The knowledge of the ultrasoundcharacteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy

Microlitiasis testicular / Testicular microlithiasis

OBJETIVO: La microlitiasis testicular (MT), que se caracteriza por la existencia de microcalcificacionesdentro de los túbulos seminíferos, es poco frecuente y generalmente constituye un hallazgo incidental durante la realización de la ecografía escrotal.MÉTODO: Presentamos un caso de un varón de 45 años de edad, sin factores de riesgo para el desarrollo de un tumor testicular de células germinales, diagnosticado de una microlitiasis testicular bilateral.RESULTADOS: El paciente ha sido sometido a control evolutivoanual con ecografía testicular, sin desarrollar un tumorgerminal durante un seguimiento de 4 años.CONCLUSIONES: Aunque el significado clínico de la MT está en debate debido a las diferentes controversias halladasen la literatura sobre su asociación o no con el tumor testicular, así como los diferentes protocolos de manejo inicial y de los intervalos adecuados para su vigilancia y seguimiento, parece razonable realizar un control ecográficoanual, independientemente de la existencia o no de factores de riesgo asociados

OBJECTIVES: Testicular microlithiasis,characterized by the existence of microscopic calcifications within the seminiferous tubules, is rare, generally anincidental finding during a scrotal ultrasound.METHODS: We report the case of a 45-year-old male without risk factors for the development of a germ celltesticular tumor with the diagnosis of bilateral testicularmicrolithiasis.RESULTS: The patient was followed yearly with testicular ultrasound, without evidence of germ cell tumor over a four-year follow-up period.CONCLUSIONS: Although the clinical significance oftesticular microlithiasis is under debate due to the various controversies found in the literature about its association or not with testicular tumors, as well as the various protocols for initial management and adequate intervals for follow-up, it seems reasonable to perform an ultrasound yearly independently of the existence or not of associated risk factors

Prostatectomía radical laparoscópica transperitoneal / Transperitoneal laparoscopic radical prostatectomy

Las técnicas quirúrgicas laparoscópicas cada vez están más extendidas dentro de la práctica urológica y es preciso realizar un entrenamiento exhaustivopara llegar a un nivel óptimo de habilidad para realizarlas. Presentamos la técnica quirúrgica paso a paso de la prostatectomía radical laparoscópica transperitoneal

Laparoscopic surgical techniques are ;;reaching widespread diffusion in the urological ;;community but intensive training is necessary to achieve an optimal level of skill to perform them. We report the transperitoneal laparoscopic radical prostatectomy surgical technique step-by-step

Hematospermia y quiste del conducto mülleriano / Hemospermia and mullerian duct cyst

OBJETIVO: presentación de un caso de quistede utrículo tratado endoscópicamente.MÉTODO: describimos el caso de un varón de mediana edad que consulta por hematospermia monosintomática de larga evolución. Al tacto rectal presentaba una próstata adenomatosa no sospechosa. Se practicó ecografía transrectalque revela quiste de utrículo complicado.RESULTADOS: Se realizó marsupialización endoscópica del quiste, consiguiendo remisión total de la hematospermia.CONCLUSIONES: Se debe realizar ecografía transrectal a todos los pacientes que consultan por hematospermia de larga evolución, indicando la marsupialización endoscópicadel quiste del conducto mülleriano en aquellos pacientessintomáticos y con quistes complejos observados en la exploración ecográfica, obteniendo un importante porcentaje de cura o mejoría en este grupo de pacientes sin inducir ningún efecto colateral secundario

OBJECTIVES: To report one case of utriculum cyst treated endoscopically. ;;METHODS: We describe the case of a mid-age male patient consulting for long-term monosymptomatic hemospermia. Rectal digital examination revealed a non suspicious ;;adenomatous prostate. Transrectal ultrasound showed a complicated utriculum cyst. ;;RESULTS: Endoscopical marsupialization of the cyst was performed with complete remission of hemospermia. ;;CONCLUSIONS: Transrectal ultrasound should be performed in all patients presenting with long-term hemospermia. ;;Endoscopical marsupialization of the mullerian duct cyst is indicated in symptomatic patients or those with complex cysts on ultrasound, offering a high cure/improvement rate in this group of patients without secondary effects

Prótesis de pene. Resultados de calidad y morbilidad / Penile prosthesis. Quality outcomes and morbidity

OBJETIVO: Conocer la satisfacción ycomplicaciones presentadas en una serie de pacientescon disfunción eréctil sometidos a la implantación deuna prótesis peneana.MÉTODOS: Estudio retrospectivo de los pacientes intervenidosquirúrgicamente por D.E. mediante la colocaciónde una prótesis de pene en el periodo comprendidoentre 1993 y 2003. Se recogieron datos comola edad del paciente en el momento de la intervención,el tratamiento previo y los diferentes antecedentes patológicos.Se revisaron los distintos modelos de prótesis, el tipo de incisión empleada y las distintas complicacionesque surgieron. Por último se elaboró un cuestionariopara determinar el nivel de satisfacción delpaciente.RESULTADOS: En el periodo comprendido entre losaños 1993 y 2003 se implantaron 24 prótesis. Laedad media de los pacientes fue 56,6 +/- 7,56 (36-63) años mediana de 59,5. La incisión peno-escrotalse empleó en 13 (54,16%) pacientes, suprapúbica en6 (25%) y subcoronal en 1 (4,16%). En cuanto a losmodelos empleados, en 9 (37,5%) se utilizó la prótesissemirrígida AMS 600, y en 10 (41,66%) el modeloAMS 650, también semirrígida. Unicamente en unaocasión se empleó una prótesis hidráulica de dos componentesAMS Ambicor. Se presentaron complicacionesen 6 (25%) pacientes, de las cuales el 12,5% fueronmenores como cavernositis, dolor o hematoma. En3 (12,5%) ocasiones fue necesaria la retirada de lamisma. Respondieron a la encuesta telefónica 13(54,16%) pacientes, de los cuales un 85 % emplea laprótesis. Un 54% presentan una satisfacción propia yen la pareja adecuada (buena o mucha), un 23 %regular y el resto, otro 23 % mala o muy mala.CONCLUSIÓN: A pesar de la elevada tasa de complicacionespostoperatorias, la prótesis de pene esaceptada adecuadamente, incluso en los modelosmaleables, por los enfermos con disfunción eréctil. Lasatisfacción por parte del paciente es alta, siendomayor en la pareja. La mayor parte de los enfermosdesearía volver a ser intervenido en el caso de encontrarse en una situación similar anterior al implante

OBJECTIVES: To study patient satisfaction and complications appeared in a series of patients with erectile dysfunction undergoing implant of penile prosthesis. METHODS: Retrospective study of all patients undergoing surgical treatment for erectile dysfunction by penile prosthesis implant between 1993 and 2003. Collected data included patient age at the time of surgery, previous treatment, and significant medical history. We reviewed the models of prosthesis employed, incisions, and complications appeared. Finally, a questionnaire was elaborated to establish the level of patient satisfaction. RESULTS: 24 prostheses were implanted between 1993 and 2003. Mean patient age was 56.6 ± 7.56 years (36-63), median 59.5 yr. Penile-scrotal incision was employed in 13 (54.16%) patients, suprapubic incision in 6 (25%) and subcoronal incision in 1 (4.16%). Type of prosthesis: semirrigid AMS 600 9 (37.5%), semirrigid AMS 650 10 (41.66%); the two component hydraulic prosthesis AMS Ambicor was used only in one case. Six (25%) patients presented complications. 16.66% were minor, cavernositis, pain, hematoma or prosthesis extrusion. Prosthesis extraction was necessary in 2 (8.33%) cases. 13 (54.16%) patients responded to the telephone survey. 85% of them use their prosthesis. 54% percent refer adequate self-satisfaction and partner satisfaction (well satisfied/much satisfaction).23% not too bad, and the remainder 23% bad or very bad. CONCLUSIONS: Despite the highest rate of postoperative complications, penile prosthesis is adequately accepted by patients with erectile dysfunction, even malleable models. Patient satisfaction is high, being higher in partners. Most patients would desire to undergo surgery again if they were in the same situation

Rabdomiosarcoma de cordon espermático en el adulto / Spermatic cord rabdomyosarcoma in an adult

OBJETIVOS: Presentar un caso de rabdomiosarcomade cordón espermático en el adulto.MÉTODO: Describimos el caso de un varón de 36 añosque presenta una masa inguinoescrotal izquierda muydolorosa.RESULTADO: Se realizó orquiectomía radical izquierda yexéresis de la masa. El estudio anatomopatológico evidencióun rabdomiosarcoma de cordón espermático.Posteriormente el paciente recibió varios ciclos de quimioterapiasistémica.CONCLUSIÓN: El rabdomiosarcoma de cordón es untumor poco frecuente que deriva del mesodermo indiferenciado.Aparece raramente después de la segundadécada. Es muy frecuente la recidiva locorregional tras lacirugía. Se disponen de tratamientos adyuvantes cuya indicacióny empleo no ha podido prootocolizarse debido ala incidencia anecdótica de este tumor en el adulto

OBJECTIVES: To report one case of ;;spermatic cord rabdomyosarcoma in an adult patient. ;;METHODS: We report the case of a 36-year-old male ;;presenting with a painful left inguinal scrotal mass. ;;RESULTS: Left radical orchiectomy was performed with ;;excision of the mass. Pathology showed a spermatic ;;cord rabdomyosarcoma. The patient received several ;;cycles of systemic chemotherapy. ;;CONCLUSIONS: Spermatic cord rabdomyosarcoma is ;;a rare tumor derived from the undifferentiated mesoderm. ;;It rarely appears after the second decade of life. Localregional ;;recurrence after surgery is very frequent. There ;;are adjuvant treatments, the indication and use of which ;;couldn’t be included in proper protocols due to the low ;;incidence of this tumour in adults