Schwannoma of the seminal vesicle: Case report and review of the literature.

Seminal vesicles can be affected by tumours originating in other locations. However, primary tumours of the seminal vesicle are extremely rare, with less than 100 cases reported in literature. Seminal vesicle adenocarcinoma is the most common type, but there are also other malign lesions. Diagnosis is challenging due to the lack of early symptoms and well-defined criteria. These tumours are usually asymptomatic and discovered incidentally during imaging tests or pelvic surgery. Definitive diagnosis requires anatomopathological analysis. Case report of 58-years-old man with schwannoma of the seminal vesicle. We describe the main characteristics of these tumours as well as their therapeutic approach.

Prospective long-term experience in the treatment of renal tumors with cryotherapy: follow-up with computed tomography scan and contrast-enhanced ultrasound.

Introduction: The aim of this article was to evaluate the oncological results and safety of cryotherapy for the treatment of renal tumors. Material and methods: This study was a prospective review and follow-up of patients who underwent cryotherapy from January 2008 to May 2021. Cryotherapy was offered to patients with bilateral tumors, tumors in solitary kidneys, or comorbid patients. Follow-up consisted of a computed tomography (CT) scan and contrast-enhanced ultrasound (CEUS), with analysis of concordance (kappa index). Overall survival and kidney survival were analyzed (Kaplan-Meier). Results: Cryotherapy was performed 71 times in 67 patients. A total of 74.6% of patients were men. The mean age of patients was 69.7 years (standard deviation (SD) 11.3]. Mean follow-up was 52.7 months (SD 36.2). Mean tumor size was 26.2 mm (SD 7.6). 90% were cT1a, 10% cT1b stage. Type of access was open in 1 patient, laparoscopic in 8, percutaneous US-guided in 8 and percutaneous CT-guided in 54 patients. Biopsy was taken in 60 patients (84.5%) and consisted of renal cell carcinoma (22), oncocytoma (9), papillary carcinoma (4), angiomyolipoma (1), sarcoma (1), and non-conclusive (23).There were 22 complications such as pain in 2 patients, hematoma in 8 and 2 cases of bleeding, all resolved conservatively except for one case of bleeding which required embolization.Recurrences occurred in 16 cases (22.5%). Management was cryotherapy in 25%, radical nephrectomy in 31.3% and surveillance in 43.8%. Concordance between contrast-enhanced ultrasound and CT was 0.8 (excellent).Mean glomerular filtration did not change. One patient developed metastasis.No cancer-specific mortality was found. Overall survival at 12, 24 and 48 months was 98.5%, 96.8% and 76.9% respectively. Kidney survival at 12, 24 and 48 months was 97%, 93.5% and 93.5% respectively. Conclusions: Cryotherapy for renal tumors is a safe treatment for comorbid or solitary kidney patients, with rare major complications and good oncological outcome.

How has the COVID-19 pandemic influenced prostate cancer?-a tertiary single-centre analysis of oncological results, diagnosis and treatment times.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected care for diseases like cancer. The aim was to evaluate the impact of COVID-19 on waiting times for diagnosis and treatment of prostate cancer (PC), as well as the possible effect on the treatment results in PC patients undergoing radical prostatectomy. Methods: We compared the results of 497 patients who underwent biopsy prior to the COVID-19 pandemic (1 January-31 December 2019) with those of 290 patients biopsied during the COVID-19 pandemic (1 January-31 December 2020). Demographic data, tumour characteristics, type of treatment and diagnosis times were comparable. Prostate specific antigen (PSA) levels were recorded at consultation prior to biopsy and after treatment. Mann-Whitney and chi-square tests were used to compare continuous variables and percentages, respectively. Results: In 2020, there were fewer urology consultations (35,160 vs. 40,225 in 2019). The median PSA in 2020 was significantly higher (14.3 vs. 9.9 ng/dL in 2019). In 2019, 53.1% (N=264) of the biopsies were positive for cancer vs. 47.2% (N=137) in 2020 (P=0.104). In 2020, more patients presented with metastatic disease (7.3% vs. 1.9%, P=0.009). Also, in 2020 there was a longer waiting time for prostate biopsy (42.1 vs. 35.3 days in 2019, P=0.019). A total of 132 patients underwent laparoscopic radical prostatectomy (LARP). The median time until surgery was similar in both years (71.9 vs. 58.29 days). During 2020, a higher percentage of patients had ISUP grade 4 in the surgical specimen (34.3% vs. 17.5%, P=0.07). Furthermore, a higher percentage of aggressive (pT3) tumours were diagnosed (37.2% vs. 27.2%, P=0.08), and the percentage of patients with involvement of surgical margins was also higher (48.6% vs. 29.3%, P=0.027). There were no differences between the groups in terms of biochemical recurrence or persistent PSA at one year (P=0.711). Conclusions: Delayed biopsy during the COVID-19 period did not appear to adversely impact biopsy results. Patients biopsied in 2020 had higher PSA, possibly due to proper triaging. A higher rate of adverse pathology outcomes was observed in patients undergoing radical prostatectomy during the pandemic, probably due to understaging of the biopsy. This study serves to raise awareness of the risk of deterioration of care of PC patients due to possible underdiagnosis.

Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy.

PURPOSE: Prostatic multi-parametric magnetic resonance imaging (mpMRI) has markedly improved the assessment of men with suspected prostate cancer (PCa). Nevertheless, as mpMRI exhibits a high negative predictive value, a negative MRI may represent a diagnostic dilemma. The aim of this study was to evaluate the incidence of positive transperineal saturation biopsy in men who have negative mpMRI and to analyse the factors associated with positive biopsy in this scenario. PATIENTS AND METHODS: A retrospective study of men with normal mpMRI and suspicion of PCa who underwent saturation biopsy (≥20 cores) was carried out. A total of 580 patients underwent transperineal MRI/transrectal ultrasound fusion targeted biopsies or saturation prostate biopsies from January 2017 to September 2020. Of them, 73 had a pre-biopsy negative mpMRI (with Prostate Imaging - Reporting and Data System, PI-RADS, ≤2) and were included in this study. Demographics, clinical characteristics, data regarding biopsy results and potential predictive factors of positive saturation biopsy were collected. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for MRI-invisible PCa. RESULTS: The detection rate of PCa with saturation biopsy in patients with negative MRI was 34/73 (46.58%). Out of 34 MRI-invisible prostate cancers detected, 12 (35.29%) were clinically significant PCa (csPCa) forms. Regarding factors of positive biopsy, in univariate analysis, the use of 5-alpha reductase inhibitors and free:total prostate-specific antigen (PSA) ratio were associated with the result of the saturation biopsy. In multivariate analysis, only an unfavourable free:total PSA ratio remained a risk factor (OR 11.03, CI95% 1.93-63.15, p=0.01). Furthermore, multivariate logistic analysis demonstrated that prostate volume >50mL significantly predicts the absence of csPCa on saturation biopsy (OR 0.11, 95% CI 0.01-0.94, p=0.04). CONCLUSION: A free:total PSA ratio <20% is a risk factor for MRI-invisible PCa. Saturation biopsy could be considered in patients with suspected PCa, despite having a negative MRI.

What Should Be Known by a Urologist About the Medical Management of COVID-19's Patients?

PURPOSE OF REVIEW: The alarming number of confirmed COVID-19 cases put a strain on the healthcare systems, which had to reallocate human and technical resources to respond to the emergency. Many urologists became integrated into multidisciplinary teams, dealing with this respiratory illness and its unknown management. It aims to summarize the epidemiological, clinical, diagnostical, and therapeutical characteristics of COVID-19, from a practical perspective, to ease COVID-19 management to non-physician staff. RECENT FINDINGS: We performed a narrative review of the literature regarding COVID-19, updated to May 8th, 2020, at PubMed and COVID resource platforms of the main scientific editorials. COVID-19, characterized by fever, myalgias, dyspnea, and dry cough, varies widely from asymptomatic infection to death. Arrhythmias and thrombotic events are prevalent. Lymphopenia and inflammatory reactant elevation on laboratory, as well as bilateral and peripheral ground-glass opacities or consolidations on X-Ray, are usually found in its assessment. Little is known about SARS-CoV-2 immunology. To date, no therapy has demonstrated efficacy in COVID-19. Of-level or compassionate-use therapies are prescribed in the context of clinical trials. We should become familiar with specific adverse events and pharmacological interactions. The COVID-19 pandemic has paralyzed the urological activity, and its long-term consequences are unpredictable. Despite not being used to deal with respiratory diseases, the urologists become easily qualified to manage COVID-19 by following protocols and being integrated into multidisciplinary teams, helping to overcome the pandemic.

The Usefulness of Contrast-Enhanced Ultrasound in the Assessment of Early Kidney Transplant Function and Complications.

OBJECTIVES: The routine diagnostic method for assessment of renal graft dysfunction is Doppler ultrasound. However, contrast-enhanced ultrasound (CEUS) may provide more information about parenchymal flow and vascular status of kidney allografts. The aim of the study was to assess the effectiveness of CEUS in the immediate post-transplant period, focusing on acute vascular complications. A brief review of available literature and a report of our initial experience is made. MATERIAL AND METHODS: 15 kidney transplant (KT) cases with clinical suspicion of acute surgical complication were assessed with CEUS and conventional Doppler ultrasound (US). In addition, bibliographic review was conducted through PubMed, Embase, and ClinicalKey databases. RESULTS: 10% of KT underwent CEUS, useful for detecting vascular complication or cortical necrosis in 4 (26%) and exclude them in 74%. Grafts with acute vascular complications have a delayed contrast-enhancement with peak intensity lower than normal kidneys. Perfusion defects can be clearly observed and the imaging of cortical necrosis is pathognomonic. CONCLUSIONS: CEUS is a useful tool in the characterization of renal graft dysfunction with special interest on acute vascular complications after renal transplant. It is a feasible technique for quantitative analysis of kidney perfusion, which provides information on renal tissue microcirculation and regional parenchymal flow. Exploration could be done by a urologist at the patient's bedside while avoiding iodinated contrast.

[Prostatic biopsy: From organ biopsy to lesion biopsy. The role of MRI and MRI based biopsy systems]. / Biopsia prostática: de la biopsia del órgano a la biopsia de la lesión. Papel de la resonancia magnética y sistemas de biopsia basados en ella.

OBJECTIVES: Ultrasound guided prostatic biopsy is still the reference method for the diagnosis of prostate cancer. Nevertheless, multiparametric magnetic resonance imaging (mpMRI) has become the best imaging method to identify clinically significant tumors. Form this new situation derives the search of the best method to enable the biopsy of the lesions identified by mpMRI and are not visible on ultrasound. The objective of this work is to review the current role of MRI and the various modalities of MRI based biopsies. METHODS: Non-structured literature review about the current status of prostatic mpMRI and the various methods of biopsy of the lesions identified with it: in bore, cognitive and different commercial fusion software biopsy methods available for directed biopsies. RESULTS: Although results in the literature are very heterogeneous, all three bore biopsy, cognitive biopsy in experienced hands and the various fusion/biopsy software platforms enable a precise biopsy of mpMRI/identified lesions, increasing the yield of each sample obtained. Fusion systems do not imply a clear advantage in global detection over systematic biopsy, except in the subgroup of patients with previous negative biopsy. Nevertheless, they do demonstrate a higher detection rate for clinically significant tumors that increases in patients with a first negative biopsy. Its role in the new therapeutic approaches for prostate cancer is yet to be defined, but it will be growing and essential in a near future. CONCLUSIONS: Multiparametric MRI is already an essential test in diagnostic algorithms for prostate cancer and the systems that enable to biopsy the lesion identified are day by day a more integrated tool in the urological daily practice, and urological procedures that will enable a more precise diagnosis leading to a personalized treatment for each patient.

Biopsia prostática: de la biopsia del órgano a la biopsia de la lesión. Papel de la resonancia magnética y sistemas de biopsia basados en ella / Prostatic biopsy: From organ biopsy to lesion biopsy. The role of MRI and MRI based biopsy systems

OBJETIVO: La biopsia prostática ecodirigida continúa siendo el método de referencia para el diagnóstico del cáncer de próstata. Sin embargo la Resonancia Magnética multiparamétrica (RMmp) se ha situado como el mejor método de imagen en la identificación de los tumores clínicamente significativos. De esta nueva situación deriva la búsqueda del mejor método para poder biopsiar las lesiones que la RMmp identifica y que no resultan visibles en ecografía. El objetivo de este trabajo es revisar el papel actual de la RM y las distintas modalidades de biopsia basadas en ella. MÉTODO: Revisión no estructurada de la literatura sobre el estado actual de la RMmp prostática y los diversos métodos de biopsiar las lesiones identificadas por ella: biopsia "in bore", biopsia cognitiva y los diversos software de fusión comerciales disponibles para la biopsia dirigida. RESULTADOS: Aunque los resultados en la literatura son muy heterogéneos, tanto la biopsia "in bore", la biopsia cognitiva en manos experimentadas, y los distintos software de "biopsia/fusión" permiten biopsiar de forma certera las lesiones identificadas en la RMmp, aumentando el rendimiento de cada muestra obtenida. Los sistemas de fusión no suponen una clara ventaja frente a la Biopsia Sistemática en la detección global de cáncer salvo en el subgrupo de pacientes con biopsia previa negativa. Sin embargo sí demuestran una mayor tasa de detección de tumores clínicamente significativos que se acentúa en pacientes con primera biopsia negativa. Su papel en los nuevos enfoques terapéuticos del cáncer de próstata, vigilancia activa y tratamientos focales, está todavía por definir pero será creciente y fundamental en un futuro próximo. CONCLUSIONES: La Resonancia Magnética multiparamétrica es ya una prueba imprescindible en los algoritmos diagnósticos del cáncer de próstata y los sistemas que permiten biopsiar las lesiones identificadas cada vez una herramienta más integrada en la rutina y procedimientos urológicos que nos permitirá un diagnóstico más exacto encaminado a un tratamiento personalizado de cada paciente

OBJECTIVES: Ultrasound guided prostatic biopsy is still the reference method for the diagnosis of prostate cancer. Nevertheless, multiparametric magnetic resonance imaging (mpMRI) has become the best imaging method to identify clinically significant tumors. Form this new situation derives the search of the best method to enable the biopsy of the lesions identified by mpMRI and are not visible on ultrasound. The objective of this work is to review the current role of MRI and the various modalities of MRI based biopsies. METHODS: Non-structured literature review about the current status of prostatic mpMRI and the various methods of biopsy of the lesions identified with it: in bore, cognitive and different commercial fusion software biopsy methods available for directed biopsies. RESULTS: Although results in the literature are very heterogeneous, all three bore biopsy, cognitive biopsy in experienced hands and the various fusion/biopsy software platforms enable a precise biopsy of mpMRI identified lesions, increasing the yield of each sample obtained. Fusion systems do not imply a clear advantage in global detection over systematic biopsy, except in the subgroup of patients with previous negative biopsy. Nevertheless, they do demonstrate a higher detection rate for clinically significant tumors that increases in patients with a first negative biopsy. Its role in the new therapeutic approaches for prostate cancer is yet to be defined, but it will be growing and essential in a near future. CONCLUSIONS: Multiparametric MRI is already an essential test in diagnostic algorithms for prostate cancer and the systems that enable to biopsy the lesion identified are day by day a more integrated tool in the urological daily practice, and urological procedures that will enable a more precise diagnosis leading to a personalized treatment for each patient

Bibliographic review about the usefulness of ultrasound contrast media in the study of renal masses.

OBJECTIVES: The microbubbles enhanced ultrasound contrast is a novel technique that informs us in real time of renal perfusion and microcirculation. METHOD: We reviewed the literature about its use in the study of renal masses in order to show their actual clinical performance in this condition. RESULT: This technique is useful in the differential diagnosis of pseudotumors, characterization and monitoring of small renal masses, the study of complex renal cysts and controlling the progression of renal masses that underwent ablative treatments. Like any diagnostic technique has some limitations on usage;its rapid contrast wash, being operator-dependent, require some experience and need special software to be correctly interpreted. CONCLUSIONS: The microbubbles enhanced ultrasound contrast is a useful and economic technique for the study and differential diagnosis of the renal masses.

Revisión bibliográfica sobre la utilidad de los contrastes ecográficos en el estudio de las masas renales / Bibliographic review about the usefulness of ultrasound contrast media in the study of renal masses

OBJETIVO: La ecografía realzada con contraste de microburbujas es una técnica novedosa que nos informa en tiempo real de la perfusión renal y su microcirculación. MÉTODOS: Hemos revisado la literatura sobre su uso en el estudio de las masas renales con el fin de mostrar su rentabilidad clínica real en esta patología. RESULTADOS: Esta técnica resulta útil en el diagnóstico diferencial de pseudotumores, en la caracterización y seguimiento de masas renales de pequeño tamaño, en el estudio de quistes renales complejos y en el control evolutivo de masas renales sometidas a tratamientos ablativos. CONCLUSIONES: Como toda técnica diagnóstica, no está exenta de limitaciones de uso, siendo sus principales inconvenientes la rapidez del lavado del contraste, el ser operador-dependiente, requerir de cierta experiencia y la necesidad de un software especial para su correcta interpretación(AU)

OBJECTIVES: The microbubbles enhanced ultrasound contrast is a novel technique that informs us in real time of renal perfusion and microcirculation. METHOD: We reviewed the literature about its use in the study of renal masses in order to show their actual clinical performance in this condition. RESULT: This technique is useful in the differential diagnosis of pseudotumors, characterization and monitoring of small renal masses, the study of complex renal cysts and controlling the progression of renal masses that underwent ablative treatments. Like any diagnostic technique has some limitations on usage; its rapid contrast wash, being operator-dependent, require some experience and need special software to be correctly interpreted. CONCLUSSIONS: The microbubbles enhanced ultrasound contrast is a useful and economic technique for the study and differential diagnosis of the renal masses(AU)

[Ultrasonography for the study of small renal masses]. / Estudio ultrasonográfico de las masas renales de pequeño tamaño.

OBJECTIVES: To perform an update on the usefulness of ultrasound in the study of small size renal tumors and its current possibilities. METHODS: We review the results of ultrasound in this pathology with the addition of the most recent technological advances such as a harmonic digital converters and power color Doppler. We analyze its contribution to the differential diagnosis of the cystic pathology, to the definition of solid masses, to the detection and characterization of small size masses, and to the definition of the vascular patterns of various tumors. RESULTS: Ultrasonography offers a diagnostic safety of 98% in cystic masses, being able to detect them from 0.5 cm diameter in favourable conditions. The differential diagnosis of multiloculated masses, multivesicular hydatid cyst, multiloculated cystic nephroma, and multiloculated cystic carcinoma still poses great difficulty, the same way it happens with other radiological tests. For solid masses, the greater image resolution has lead to a progressive increase in the incidental detection of tumors and the percentage of patients candidates to conservative surgery due to the decrease in size. It is easy to differentiate between adenocarcinoma and angiomyolipoma, up to 85% of the cases, but the rest of the tumors do not have specific characteristics. For small size masses, smaller than 3 cm, ultrasound sensitivity is clearly inferior to CT scan. Power color Doppler helps to confirm the existence of solid masses and helps a better differential diagnosis with pseudo tumors. CONCLUSIONS: The modern ultrasound techniques provide a high cost-effectiveness both in detection and definition of the nature of small size renal masses.

[Diagnosis and follow-up of benign prostatic hyperplasia by ultrasound]. / Diagnóstico y seguimiento de la hipertrofia prostática benigna mediante ecografía.

OBJECTIVES: The aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH). METHODS: A total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound. RESULTS: The first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected. CONCLUSIONS: Ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH.

[Transrectal ultrasound-guided prostatic biopsy: contribution of an ultrasound diagnostic unit after ten years of experience]. / Biopsia transrectal ecodirigida de próstata: aportación de una unidad urológica de diagnóstico ecográfico tras 10 años de experiencia.

OBJECTIVES: Although transrectal ultrasound-guided (TRUS) prostatic biopsy is the procedure of choice for the diagnosis of prostate cancer (PC), neither the ideal number of cores nor the number of repeated biopsies, nor the required diagnostic yield have been established. After our experience of ten years with TRUS biopsy we perform a review of the technique and its indications. METHODS: PSA, ultrasound features, and pathologic data of 6000 patients undergoing modified sextant TRUS biopsy between 1994 to December 2002 were collected. 222 patients undergoing ten-core TRUS biopsy were included in an experimental group to study the role of the extended biopsy. The contribution of the extra cores to the diagnostic yield in the experimental group was studied to determine the effectiveness of the extended biopsy, using as a control group 552 patients undergoing sextant TRUS biopsy during 2002. Both groups were comparable for the study variables at the start of the study. RESULTS: The incidence of PC in the first biopsy in the group of 6000 patients was 39.1% (2345/6000). Patients with PSA between 4 and 10 ng/ml have an incidence of PC greater than 50% among prostates smaller than 20 cc, diminishing down to 8.9% in those greater than 50 cc. The percentage of PC among patients with negative digital rectal examination (DRE), normal TRUS, and PSA below 4 ng/ml was 16.7%. The diagnostic yield for PSA density lower than 0.11 ng/ml/cc was lower than 8%. The free/total PSA ratio shows a 13.7% incidence of PC with values higher than 0.24. Multivariate logistic regression analysis showed that the only non-significant parameter was free/total PSA. Sixty (27.15%) patients of the extended TRUS biopsy group had PC. Only 2.25% of the 221 patients benefited from the augmented number of biopsies. There were no significant differences in the figures of prostate cancer between groups. Only PSA and volume where significant in the multivariate logistic regression analysis; number of samples, PSA density and age lacked of influence in the detection of PC. CONCLUSIONS: The sextant biopsy model obtaining cores from the lateral horns of the prostate continues to be the reference for TRUS biopsy, and the extended biopsy is not applicable to all patients from the beginning do to the small increase in the diagnostic yield. Isolated PSA may not be the unique reference to indicate TRUS biopsy, being volume, in our experience, a definitive factor for the adjustment of high risk levels.

[Testicular ultrasonography]. / Ecografía testicular.

OBJECTIVES: To review the contribution of ultrasound to the differential diagnosis of scrotal pathology, both testicular and adnexal. METHODS: We performed a bibliographic review on the topic, adding the experience of our Unit over the years; we classified the pathology in testicular and extratesticular, separating liquid and solid lesions, and a miscellaneous group of unclassifiable cases. RESULTS: Currently, ultrasonography with high frequency equipment allows not only to differentiate between intra and extratesticular lesions, but also to identify specific lesions, the manage of which may include follow-up without need of unavoidable surgery. CONCLUSIONS: Ultrasonography is a painless simple test that may be repeated without inconvenience so that it is the first test to be indicated for any problem of the scrotal content.

Estudio ultrasonográfico de las masas renales de pequeño tamaño / Ultrasonography for the study of small renal masses

OBJETIVO: Efectuar una puesta al día de la utilidad de la ecografía en el estudio de los tumores renales de pequeño tamaño y de las posibilidades que esta técnica ofrece en el momento actual. MÉTODO: Revisión de los resultados obtenidos en esta patología con las aportaciones ofrecidas por los desarrollos tecnológicos más recientes como los convertidores digitales con modo armónico y el Doppler color energía. Análisis de su contribución al diagnóstico diferencial con la patología quística, a la definición de las masas sólidas, a la detección y caracterización de las masas de pequeño tamaño y a la definición de los patrones vasculares de los diferentes tumores. RESULTADOS: La ecografía ofrece una seguridad diagnóstica del 98% en las masas quísticas pudiéndose objetivar en condiciones favorables a partir de un diámetro de 0,5 cm. El diagnóstico diferencial de las masas multitabicadas, quiste hidatídico multivesicular, nefroma quístico multilocular y carcinoma quístico multilocular, sigue planteando graves dificultades, al igual que ocurre con el resto de las técnicas de imagen. En las masas sólidas la mayor resolución de las imágenes ha conducido a un incremento progresivo en la detección de tumores incidentales y en el porcentaje de pacientes candidatos a cirugía conservadora dada la continua disminución en su tamaño. La diferenciación entre el adenocarcinoma y el angiomiolipoma es fácil y posible en el 85% de los casos no presentando el resto de tumores características específicas. En las masas de pequeño tamaño, menores de 3 cm., la sensibilidad de esta técnica es claramente inferior a la de la TAC. El Doppler color energía ayuda a confirmar la existencia de las masas sólidas y permite un mejor diagnóstico diferencial con los seudotumores. CONCLUSIONES: Las modernas técnicas ecográficas ofrecen una elevada rentabilidad tanto en la detección como en la definición de la naturaleza de las masas renales de pequeño tamaño

OBJECTIVES: To perform an update on the usefulness of ultrasound in the study of small size renal tumors and its current possibilities. METHODS: We review the results of ultrasound in this pathology with the addition of the most recent technological advances such as a harmonic digital converters and power color Doppler. We analyze its contribution to the differential diagnosis of the cystic pathology, to the definition of solid masses, to the detection and characterization of small size masses, and to the definition of the vascular patterns of various tumors. RESULTS: Ultrasonography offers a diagnostic safety of 98% in cystic masses, being able to detect them from 0.5 cm diameter in favourable conditions. The differential diagnosis of multiloculated masses, multivesicular hydatid cyst, multiloculated cystic nephroma, and multiloculated cystic carcinoma still poses great difficulty, the same way it happens with other radiological tests. For solid masses, the greater image resolution has lead to a progressive increase in the incidental detection of tumors and the percentage of patients candidates to conservative surgery due to the decrease in size. It is easy to differentiate between adenocarcinoma and angiomyolipoma, up to 85% of the cases, but the rest of the tumors do not have specific characteristics. For small size masses, smaller than 3 cm, ultrasound sensitivity is clearly inferior to CT scan. Power color Doppler helps to confirm the existence of solid masses and helps a better differential diagnosis with pseudo tumors. CONCLUSIONS: The modern ultrasound techniques provide a high cost-effectiveness both in detection and definition of the nature of small size renal masses

Diagnóstico y seguimiento de la hipertrofia prostática benigna mediante ecografía / Diagnosis and follow-up of benign prostatic hyperplasia by ultrasound

OBJETIVO: La finalidad del estudio es analizar la utilidad de la ecografía en la evaluación, elección del tratamiento y seguimiento del paciente con una hiperplasia prostática benigna (HPB). MÉTODOS: Se estudiaron 5.000 pacientes de edad > 50 años con clínica de prostatismo mediante ecografía abdominal y en casos seleccionados transrectal. RESULTADOS: El signo ecográfico más precoz de la HPB es el incremento de los diámetros anteroposterior y longitudinal de la próstata. La ecografía tiene una seguridad del 80% en la evaluación del volumen prostático y permite medir el residuo postmiccional, así corno datos indirectos de obstrucción del músculo detrusor vesical. Finalmente, posibilita la detección de patología asociada en el tracto urinario superior. CONCLUSIONES: la ecografía en colaboración con el PSA y la flujometría permite evaluar y seleccionar el tratamiento en el paciente con HPB

OBJECTIVES: the aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH). METHODS: a total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound. RESULTS: the first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected. CONCLUSIONS: ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH

Biopsia transrectal ecodirigida de próstata: aportación de una unidad urológica de diagnóstico exográfico tras 10 años de experiencia / Transrectal ultrasound-guided prostatic biopsy: contribution of an ultrasound diagnostic unit after ten years of experience

OBJETIVO: A pesar de que la Biopsia Transrectal Ecodirigida (BTE) prostática es el método fundamental de diagnóstico del cáncer prostático (CP) no se ha establecido el número ideal de muestras, de repeticiones o la rentabilidad que se le debe exigir. A través de la experiencia de 10 años en BTE pretendemos revisar que puede aportarse a la realización de la prueba y a sus indicaciones. MÉTODO: Se han recogido los datos de PSA, características ecográficas y anatomía patológica de 6000 pacientes a los que se realizó BTE sextante modificada desde 1994 a diciembre de 2002.Para estudiar el papel de la biopsia ampliada se realizo un grupo experimental de 222 pacientes en los que se intentó la obtención de 10 muestras prostáticas mediante BTE. Para determinar la rentabilidad de la biopsia ampliada se estudiará la aportación de las muestras “extras” al rendimiento diagnóstico del grupo experimental (BTE ampliada) y se empleará como grupo control (BTE sextante) y de comparación un conjunto más amplio de 552 pacientes biopsiados en el año 2002. Se estudió la comparabilidad del grupo experimental y control, respecto a las variables recogidas al inicio del estudio. RESULTADOS: La incidencia de CP en el grupo de 6000 pacientes en la primera biopsia es del 39,1% (2345/6000). Los pacientes con PSA entre 4 y 10 ng/ml presentan una incidencia mayor del 50% de cánceres entre las próstatas de menos de 20 cc que disminuye hasta un 8,9% en la mayores de 50 cc. El porcentaje de CP entre los pacientes con PSA menor de 4ng/ml con tacto y ETR normales fue del 16,7%. La rentabilidad con Densidad de PSA menor de 0,11 ng/ml/c.c. fue inferior al 8%. El PSA L/T muestra una incidencia de CP del 13,7% con cifras superiores a 0,24. En las regresiones logísticas multivariantes únicamente el PSA L/T no resultó significativo. Entre los pacientes a los que se realizó BTE ampliada 60 (27,15%) presentaron CP. Tan sólo el 2,25% del total de 221 pacientes se beneficiaron del mayor número de muestras. No se han encontrado diferencias significativas en las cifras de CP entre los grupos de biopsia sextante y ampliada. En el análisis de regresión logística multivariante únicamente el PSA y el volumen han resultado significativos, careciendo de influencia en la detección de cáncer el número de muestras, la DPSA y la edad. CONCLUSIONES: El modelo sextante con obtención de muestras de los cuernos laterales de la próstata sigue siendo la referencia de la BTE mientras que la BTE ampliada no es aplicable de inicio a todos los pacientes por el escaso incremento en la capacidad diagnóstica. El PSA aislado no puede ser más el referente único para indicar la BTE, siendo, en nuestra experiencia, el volumen un factor decisivo para el ajuste de los niveles de mayor riesgo

OBJECTIVES: Although transrectal ultrasound- guided (TRUS) prostatic biopsy is the procedure of choice for the diagnosis of prostate cancer (PC), neither the ideal number of cores nor the number of repeated biopsies, nor the required diagnostic yield have been established. After our experience of ten years with TRUS biopsy we perform a review of the technique and its indications. METHODS: PSA, ultrasound features, and pathologic data of 6000 patients undergoing modified sextant TRUS biopsy between 1994 to December 2002 were collected. 222 patients undergoing ten-core TRUS biopsy were included in an experimental group to study the role of the extended biopsy. The contribution of the extra cores to the diagnostic yield in the experimental group was studied to determine the effectiveness of the extended biopsy, using as a control group 552 patients undergoing sextant TRUS biopsy during 2002. Both groups were comparable for the study variables at the start of the study. RESULTS: The incidence of PC in the first biopsy in the group of 6000 patients was 39.1% (2345/6000). Patients with PSA between 4 and 10 ng/ml have an incidence of PC greater than 50% among prostates smaller than 20 cc, diminishing down to 8.9% in those greater than 50 cc. The percentage of PC among patients with negative digital rectal examination (DRE), normal TRUS, and PSA below 4 ng/ml was 16.7%. The diagnostic yield for PSA density lower than 0.11 ng/ml/cc was lower than 8%. The free/total PSA ratio shows a 13.7% incidence of PC with values higher than 0.24. Multivariate logistic regression analysis showed that the only non-significant parameter was free/total PSA. Sixty (27.15%) patients of the extended TRUS biopsy group had PC. Only 2.25% of the 221 patients benefited from the augmented number of biopsies. There were no significant differences in the figures of prostate cancer between groups. Only PSA and volume where significant in the multivariate logistic regression analysis; number of samples, PSA density and age lacked of influence in the detection of PC. CONCLUSIONS: The sextant biopsy model obtaining cores from the lateral horns of the prostate continues to be the reference for TRUS biopsy, and the extended biopsy is not applicable to all patients from the beginning do to the small increase in the diagnostic yield. Isolated PSA may not be the unique reference to indicate TRUS biopsy, being volume, in our experience, a definitive factor for the adjustment of high risk levels

Ecografía testicular / No disponible

OBJETIVO: Se pretende revisar la aportación de la ecografía al diagnóstico diferencial de la patología escrotal tanto testicular como anexial. MÉTODO: se ha realizado una revisión bibliográfica sobre el tema incorporando la experiencia de nuestra Unidad a lo largo de los años, clasificando la patología en testicular y extratesticular y dentro de estas separando aquellas lesiones líquidas de las sólidas, además de un grupo de miscelánea no clasificable. RESULTADOS: actualmente la ecografía con equipos de alta frecuencia permite no sólo diferenciar entre patología intra y extraescrotal sino identificar lesiones específicas cuyo manejo puede incluir el seguimiento sin tener que recurrir a la exploración quirúrgica inevitable. CONCLUSIONES: la ecografía es una prueba sencilla, no dolorosa y puede repetirse sin mayor inconveniente por lo que es la primera prueba que debe solicitarse ante cualquier problema del contenido escrotal

OBJECTIVES: To review the contribution of ultrasound to the differential diagnosis of scrotal pathology, both testicular and adnexal. METHODS: We performed a bibliographic review on the topic, adding the experience of our Unit over the years; we classified the pathology in testicular and extratesticular, separating liquid and solid lesions, and a miscellaneous group of unclassifiable cases. RESULTS: Currently, ultrasonography with high frequency equipment allows not only to differentiate between intra and extratesticular lesions, but also to identify specific lesions, the manage of which may include follow-up without need of unavoidable surgery. CONCLUSIONS: Ultrasonography is a painless simple test that may be repeated without inconvenience so that it is the first test to be indicated for any problem of the scrotal content

[Infertility and varicocele through history]. / La infertilidad y el varicocele a través de la historia.

OBJECTIVES: To perform a historical review of varicocele and male infertility with the aim to find descriptions that first related them. In parallel, we review the evolution of treatment for varicocele up to date. METHODS/RESULTS: We refer to multiple authors and their treaties on Medicine, from first to 20th Century, in which descriptions of these pathologies are found, focusing on descriptions of the surgical technique for treatment of varicocele and their application in Spain. CONCLUSIONS: Varicocele was already described in treaties from the first century having bee of n its treatment predominantly surgical from the first description to our days. Not identified as a cause of infertility until late, by the end of the 19th century, it is the main indication for treatment nowadays. The surgical technique has suffered many modifications over time, both in the approach as in the "radicality" of a vascular ligature applied.

[Penile metastasis of a prostatic adenocarcinoma]. / Metástasis peneana de adenocarcinoma prostático.

OBJECTIVES: To report one case of prostate carcinoma with metastasis to the corpora cavernosum. METHODS: We report the case of a 79-year-old patient with the diagnosis of Gleason 9 prostatic adenocarcinoma who presented a hard lesion on the glans penis one year after starting androgen blockade. The patient underwent palliative TURP and biopsy of the lesion. RESULTS: Pathology reported a penile metastasis of prostatic adenocarcinoma. CONCLUSIONS: Penile metastasis are rare, usually appearing in advanced stages of the primary disease; their treatment is palliative and should only be carried out in symptomatic patients.