Comparative study between 1.5 and 3 Tesla multiparametric MRI systems using the PIRADS version 2 classification in the diagnosis of prostate cancer

Introduction: The 3-Tesla multiparametric MRI (mpMRI) system represents a diagnostic advance for prostate cancer. Our aim is to demonstrate that the results in 1.5-Tesla mpMRI are not inferior compared to the 3-Tesla for the correct diagnosis of prostate cancer. Material and methods: Non-inferiority comparative cross-sectional study between fusion-guided prostate biopsy results. 344 patients with clinical suspicion of prostate cancer (elevated PSA and/or suspicious DRE) and mpMRI interpreted and verified by the same radiologists in all cases, 270 in 1.5-Tesla and 74 in 3-Tesla, with at least one lesion PIRADSv2≥ 3. Exclusion criteria were positive biopsy or previous prostate treatment. We consider malignancy as ISUP≥ 1 and significant tumor as ISUP≥ 2. We used Wilcoxon and t-student test (central tendency measures), diagnostic test (gold standard: ISUP of targeted biopsy), Chi2 test and Z-test (comparison of prevalences and 95%CI malignancy and significant tumor according to mpMRI). Results: Median prostate volume 50cc(IQR:33.5) and PSA 6.11ng/ml(IQR:3.39). Mean age 67.4±8.1years. Number of suspi-cious lesions/patient: mpMRI 1.3 (1.5-Tesla) and 1.5 (3-Tesla). No differences were found between mpMRI (homogeneous and comparable samples). 57% (1.5-Tesla) vs 66% (3-Tesla) of targeted biopsies were malignant, and 34%vs38% were significant tumor, with no significant differences. Se, Sp, PPV and NPV for malignancy (1.5-Tesla vs 3-Tesla) were 96%vs90%, 38%vs44%, 67%vs76%, and 86%vs69%, with no significant differences. Conclusions: There are no significant differences between 1.5-Tesla vs 3-Tesla mpMRI regarding targeted biopsy results. Not to have 3-Tesla mpMRI may not be a limitation to use 1.5-Tesla as a diagnostic test for the better diagnosis of prostate cancer (AU)

Introducción: Los equipos de RM multiparamétrica(RMmp) 3-Tesla suponen un avance diagnóstico en cáncerde próstata. El objetivo es demostrar que los resultados enequipos de 1,5-Tesla no son inferiores a los equipos de 3-Tesla para el correcto diagnóstico de cáncer de próstata.Material y métodos: Estudio transversal comparativo de no inferioridad entre resultados de biopsia fusión.344 pacientes con sospecha de cáncer de próstata (PSA elevado y/o tacto rectal sospechoso) y RMmp interpretada ycomprobada por los mismos radiólogos en todos los casos,270 con 1,5-Tesla y 74 con 3-Tesla, con al menos una imagen PIRADSv2≥ 3. Criterios de exclusión: biopsia positiva o tratamiento prostático previo. Consideramos malignidad como ISUP≥ 1 y tumor significativo como ISUP≥ 2.Comparamos medidas de tendencia central (test Wilcoxony t-student), prevalencias e IC95% (Chi2 y prueba-Z) y testde prueba diagnóstica (gold estándar: ISUP de biopsia dirigida) según RMmp empleado.Resultados: Medianas de volumen prostático50cc(IQR:33,5) y PSA 6,11ng/ml(IQR:3,39). La mediade edad fue 67,4±8,1años. El número de lesiones sospechosas/paciente fue 1,3 (1,5-Tesla) y 1,5 (3-Tesla). No encontramos diferencias entre RMmp (muestras homogéneasy comparables). 57%(1,5-Tesla) vs 66%(3-Tesla) biopsiasdirigidas presentaron malignidad, y 34%vs38% tumorsignificativo, sin diferencias significativas. Se, Sp, VPP yVPN para malignidad (1,5-Tesla vs 3-Tesla) de 96%vs90%,38%vs44%, 67%vs76%, y 86%vs69%, sin diferenciassignificativas.Conclusiones: No encontramos diferencias significativas entre RMmp de 1,5-Tesla y 3-Tesla respecto a los resultados de biopsia. No disponer de RMmp de 3-Tesla...(AU)

[Reabsorption syndrome after transurethral resection (TUR) of the prostate: review of physiologic, diagnostic, and therapeutic features]. / Síndrome de reabsorción post-resección transuretral (R.T.U.) de próstata: revisión de aspectos fisiopatológicos, diagnósticos y terapéuticos.

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as "Transurethral prostatic resection syndrome" or "TURP syndrome". The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

Síndrome de reabsorción post-resección transuretral (R.T.U.) de próstata: revisión de aspectos fisiopatológicos, diagnósticos y terapéuticos / Transurethral prostatic ressection syndrome. A review of its physiopathology, diagnosis and treatment

A pesar del desarrollo de técnicas no invasivas para el tratamiento de la hiperplasia benigna prostática (HBP), el tratamiento quirúrgico que, en muchas ocasiones es la resección transuretral (R.T.U.), constituye la opción terapéutica más eficaz para aquellos pacientes que no responden favorablemente a la farmacoterapia. La absorción de líquidos hipotónicos utilizados para la irrigación vesical duran-te el procedimiento pueden causar alteraciones hemodinámicas y del sistema nervioso central (S.N.C.) que, en su conjunto o por separado, se conocen como "Síndrome de reabsorción o de resección transuretral" (Síndrome R.T.U.).A pesar de que la descripción de este síndrome se produjo hace más de medio siglo, permanecen aún en debate a múltiples aspectos, tanto de su fisiopatología como de su tratamiento. Hemos llevado a cabo una revisión bibliográfica de este tema, actualizando aspectos diagnósticos y terapéuticos (AU)

[Assessment of double-J ureteral catheters at a lithotripsy unit: our experience]. / Evaluación de los catéteres ureterales tipo doble J en una unidad de litotricia: nuestra experiencia.

The present study evaluated a total of 350 patients who underwent placement of double-J catheters as a result of their lithiasic condition. The work includes a review of the patients' urological background, indication for the double-J placement, tolerance to catheter, time of permanence, reason for withdrawal, presence of encrustations in the catheter and relationship between all these parameters. A significant increase of adverse symptoms was observed when permanence of the double-J catheter lasted longer than 6 weeks. Likewise, there was a significant increase in the number of encrustations in catheters retained longer than 6 weeks, as well as when the lithiasic mass was meaningful and urine cultures were positive. The authors consider that double-J catheters effectively prevent the complications of the lithiasic condition but an excessively long permanence, more than 6 weeks, increases occurrence of side-effects significantly.

[Comparative analysis of lithiasic fragmentation induced by extracorporeal and direct contact sources]. / Análisis comparativo de la fragmentación litiásica inducida por las fuentes extracorpóreas y de contacto directo.

An in vitro experimental study on stone fragmentation was conducted on 114 calculi analyzed by infrared spectrophotometry. Four energy sources were utilized: electrohydraulic, piezoelectric, ultrasound and pulsed laser. We analyzed stone susceptibility to fragmentation (particles < 3 mm), pulverization (particles < 1 mm) and stone fragility (amount of energy/mg of calculus fragmented into particles < 3 mm) for each type of energy source of each of the following 6 stone compositions: calcium oxalate monohydrate, calcium oxalate dihydrate, magnesium ammonium phosphate, phosphate carbonate, uric acid and phosphate oxalate. The calcium oxalate dihydrate calculi were the most susceptible to fragmentation and the infective calculi (magnesium ammonium phosphate and phosphate carbonate) were the most susceptible to pulverization. The piezoelectric energy showed the highest capacity for fragmentation and pulverization of calculi. Stone fragility depended on each stone type and the energy source utilized.

[Adrenal myelolipoma: a new case. Review]. / Mielolipoma adrenal: un nuevo caso. Revisión.

We report a case of symptomatic myelolipoma with a good evolution at three and a half years' follow up. The clinical features and the diagnosis of this tumor type are discussed. In this case, as in most cases, CT proved to be the most useful in making the diagnosis. Like most of the cases, the patient was middle aged, obese and hypertensive. The etiology, pathogenesis, clinical features and diagnosis of this disease entity are reviewed. The treatment modalities utilized according to the specific features of each case are discussed.

[Rupture of simple renal cyst after minimal renal injury]. / Rotura de quiste renal simple tras traumatismo renal mínimo.

A case is presented of minimum renal trauma, leading to a retroperitoneal hematoma as a consequence of a simple renal cyst rupture as well as an artery contained therein. The etiopathogenicity of this phenomenon is commented. The different clinical manifestations of renal trauma are highlighted, as well as the suspicion of previous renal pathology when a large renal lesion is found secondary to minimum renal trauma. The approach of the renal pediculum must be the first step in the surgical treatment of renal trauma.

[Is the bladder localization of urothelial transitional carcinoma a nosologic entity different from tumors appearing in the upper urinary tract?]. / Es la localización vesical de carcinoma transicional de urotelio una entidad nosológica diferente a los brotes que surgen en el tracto urinario superior?

This study was undertaken in 69 patients with transitional cell carcinoma of the upper urinary tract. In 31, bladder tumor was diagnosed prior to (35.5%), concomitant with (38.5%), and after treatment of the upper urothelial tumor. Localization in the bladder more commonly involved the ipsilateral left or right lateral aspect and less frequently involved the trigone. It is difficult to predict the nature of the bladder tumor from the upper urinary tract tumor. However, we have observed that excision of the upper tract tumor favourably affects the evolution of the bladder tumor diagnosed prior to or concomitant with treatment of the upper tract tumor.