[Usefulness of abdominal leak point pressure determination in the diagnosis of female urinary incontinence in the TVT era]. / Utilidad de la determinación de la presión abdominal de fuga en el diagnóstico de la incontinencia de orina femenina en la epoca del TVT.

OBJECTIVE: To analyse our results about continence in the treatment of female urinary incontinence with the tension-free vaginal tape (TVT) procedure based on abdominal leak point pressure(ALPP). PATIENTS AND METHODS: Retrospective study of the fifty two patients who had urodynamic study and abdominal leak point pressure determination and were operated on between 1999 and 2002 for stress urinary incontinence. We reviewed the data of clinical history, physical examination and urodynamic report, surgery, complications, and objective and subjective results. Those patients having ALPP > 100 are included in group 1, between 61 and 100 in group 2 and less than 60 in group 3. RESULTS: There were 19 patients in group 1, 17 in group 2 and 16 in group 3. We found no difference between the three groups regarding age, delivery, menopause, hysterectomy, evolution, previous surgery, grade of cystocele, association of anterior colporraphy to TVT and type of anaesthesia. The Obrink clinical grade increased as the ALPP decreased (grade 3 in 26.32% of group 1, 31.58% in group 2 and 68.71% in group 3). 100% of patients in groups 1 and 2 were continent with effort and 93.75% in group 3. Complications, especially de novo instability or urgency-frequency episodes or persistence of instability in patients having mixed incontinence, caused a decrease in the satisfaction degree to 79% in group 1, 76.5% in 2 and 62.5% in 3. CONCLUSIONS: Abdominal leak point pressure determination does not change our decision of perform a TVT procedure but permits us to differentiate one group in which results could be worse.

[Upper urinary tract tumours]. / Tumores de urotelio superior.

OBJECTIVE: To evaluate diagnostic techniques, treatment and follow-up in 94 patients affected of upper urinary tract tumor. PATIENTS AND METHOD: From 1978 to december 2002 we operated 105 patients due to upper urinary tract tumor, although only 94 are valid for analysis. Mean age was 65 years and 85% were man. Haematuria was the most frequent symptom. RESULTS: Urography (93%), ecography (77%) and CT (67%) were the most used diagnostic techniques. Pelvic tumor was the most frequent (71%) and total nephroureterectomy including bladder cuff the chosen treatment (76.4%). Previous or simultaneous bladder tumor was observed in 23% cases and delayed in 30%. With a mean follow-up of 76 months the patient survival is 53%. CONCLUSIONS: Due to the high frequence of previous, simultaneous or delayed bladder tumors, the upper urinary tract tumor should be considered as a panurothelial disease, worsening the outcome of this kind of tumors.

[Corrective surgery of penile inward curvature]. / Cirugía correctora de la incurvación peneana.

OBJECTIVE: To evaluate the corporoplasty techniques performed on 59 patients to correct congenital penile curvature and Peyronie's disease. PATIENTS AND METHOD: From april 1991 to december 2001, 39 Nesbit technique, 12 Ruiz-Castañé method and 8 Essed-Schröeder procedure were performed on forty-four congenital curvatures and fifteen Peyronie's diseases. The mean age was 24 years old. Trying to hide the knots, in all patients except five a nonabsorbable inverting sutures were placed. RESULTS: The mean follow-up was 12 months. Postoperatively, 53 patients (86%) had satisfactory cosmetic and functional results. Four patients of five with absorbable sutures had residual curvature which needed another successful surgical correction. One patient complained of penile shortening, one of glans hypoaesthesia, one of foreskin oedema and five of palpable plication sutures. No differences were found depending on the applied surgical technique. CONCLUSIONS: The results reported are in accordance with the literature showing a higher recurrence rate with the absorbable sutures. The outcome is very similar with the three described techniques.

[Complications in a consecutive series of 133 cases of radical prostatectomy]. / Complicaciones de una serie consecutiva de 133 casos de prostatectomía radical.

OBJECTIVE: To evaluate the surgical complications of radical prostatectomy in our hospital. PATIENTS AND METHOD: From august 1991 to december 1999, 138 patients with clinically localized prostate cancer underwent Walsh technique radical prostatectomy. The follow-up is known from 133 patients with a mean age of 64.8% and a mean PSA of 17.6 ng/ml. RESULTS: The mean follow-up is 43 months. Urinary fistula (9%), lymphatic leakage (5.22%) and rectal injury (2.2%) are the most common early complications. Urinary incontinence (27%), erectile dysfunction (98%) and urethrovesical junction stenosis (12%) are the delay complications. Only three patients have died due to prostate cancer. Our results are compared with another series. CONCLUSIONS: The morbidity of radical prostatectomy is very similar to the compared series. Urinary incontinence and erectile dysfunction are the most worrying complications which the patient must know to have the opportunity to choose another therapeutic option.

[Leydig cell tumor. Report of 2 cases and review of the literature]. / Tumor de células de Leydig. Aportación de dos casos y revisión de la literatura.

The Leydig cell tumor is the most frequent of non-germ cell tumors of the testis. Clinical findings depend on the age of presentation. We present two cases of Leydig Cell tumors of the testis, diagnosed in a 8 years old child with isosexual precocity, and a 42 years old adult with Gynaecomastia. After reviewing the existing literature on this uncommon pathology we consider that the iconography presented is very interesting for furthering the knowledge on this subject.

[Correlation between imaging findings and anatomopathologic results in radical prostatectomy. Data from our series]. / Correlación de los hallazgos por imagen y resultados anatomopatológicos en la prostatectomía radical. Datos de nuestra serie.

OBJECTIVE: To analyze the diagnostic methods utilized in prostate cancer and the preoperative information on the extent of the tumor, and compare these results with those obtained from anatomopathological analyses of the radical prostatectomy specimen. METHODS: Data on the radical prostatectomies performed during the study period were obtained from the Admissions and Clinical Records services and were analyzed using the SPSS statistical analysis software for Windows. RESULTS: From 1991 to 1998, 109 radical prostatectomies were performed. Evaluation by transrectal US was carried out in 89 patients (81.6%) and detected a tumor (unilateral or bilateral) in 77, for a sensitivity of 86% (CI 78.8-93.2). A CT study was performed in 94 patients and was positive in 25, for a sensitivity of 26.5% (CI 17.6-35.4). The sensitivity for transrectal US and CT were 4.17% and 3.33% for capsular involvement, 5.88% and 5.26% for seminal vesicle involvement, and 0% and 0% for node involvement, respectively. CONCLUSIONS: Transrectal ultrasound is a reliable diagnostic imaging method, although it has a low sensitivity when used to determine the extent of the tumor. In our series, the radiological methods showed a low sensitivity when they were utilized to determine the extent of the prostate cancer. Routine preoperative assessment by CT can be obviated in prostate cancer.

[Incidence of priapism at the Marqués de Valdecilla University Hospital in Santander]. / Incidencia de priapismo en el Hospital Universitario Marqués de Valdecilla de Santander.

OBJECTIVE: Our experience in the management of priapism, its etiology, blood gas changes, treatment and outcome are presented. METHODS: The records of patients that had been treated at the Urology services of our hospital over the last 8 years were reviewed. During this period, patients with erectile dysfunction were treated according to a protocol. RESULTS: There were 9 episodes of priapism in 8 patients; all cases were low flow and the patients were aged 37-71 years. The duration of the prolonged erection ranged from 4 to 72 hours. Of these 9 cases, the etiology was intracavernosal PGE in 7, after trazodone administration in one case, and unknown in one case. Intracavernosal metoxamine was administered in all cases with excellent results, except one case that required a saphenous-cavernosal shunt and another case that was initially treated with adrenalin also with good results. CONCLUSIONS: Since intracavernosal agents have been utilized in the treatment of erectile dysfunction, priapism has become a more frequent urological emergency. Although a lower incidence has been reported for PGE, the dose should be well adjusted to avoid a higher incidence.

[Mucinous adenocarcinoma of the prostate. Report of a new case]. / Adenocarcinoma mucinoso de próstata. Aportación de un nuevo caso.

OBJECTIVE: To describe a case of mucinous adenocarcinoma of the prostate, an uncommon variant of prostatic carcinoma of which few cases have been reported in the literature. This tumor type is briefly reviewed with special reference to the controversial issues that remain unresolved due to the small number of cases. METHODS/RESULTS: A case of mucinous adenocarcinoma of the prostate is presented. An extraprostatic origin had been discarded. The diagnosis was made by DRE, transrectal US and histological confirmation by transrectal biopsy. PSA values were normal. Studies to determine the extent of the lesion showed advanced locoregional dissemination. Surgery was therefore not indicated and hormonal therapy was administered. Patient outcome was poor with no apparent clinical response to hormone blockade. Radiotherapy was attempted. The patient rapidly became worse and died. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is characterized by the presence of significant amounts of extra and intracellular mucin. Its clinical features are not unlike those of classical adenocarcinoma and in general terms, it is considered to carry a worse prognosis and refractory to hormone therapy.

[Synchronous renal oncocytoma and asymptomatic pheochromocytoma. Report of a case]. / Oncocitoma renal y feocromocitoma asintomático sincrónicos. A propósito de un caso.

OBJECTIVE: To report a rare case of coexisting renal oncocytoma and pheochromocytoma. To our knowledge, only one such case has been reported in the literature. METHODS: The findings of the imaging studies of this rare case and the unsuspected anatomopathological findings are presented. RESULTS/CONCLUSIONS: Despite its very low frequency, coexisting renal ocnocytoma and pheochromocytoma should be taken into account in patients with synchronous renal and adrenal masses. Unfortunately, there are no radiological patterns that allow us to suspect this rare condition.

[Retroperitoneal benign schwannoma. Report of a new case]. / Schwannoma benigno retroperitoneal. Aportación de un nuevo caso.

The schwannoma is a tumor resulting from the Schwann cells of neural shwath, being its retroperitoneal localization quite unusual. This tumor is clinically unspecified and in most of the cases it originates symptoms coming from the compression of the close structures when its localization is retroperitoneal. Its diagnosis is quite often fortuitous being confirmed by anatomopathological study afterwards. The treatment is surgical radical exeresis with subsequent followup. We report a new case of this uncommon retroperitoneal pathology in a female patient showing a nonspecific clinic. Two years after the surgery she remains asymptomatic without any radiological evidence of recidive.

[Bellini's carcinoma. Our experience]. / Carcinoma de Bellini. Nuestra experiencia.

OBJECTIVE: To present our experience with Bellini duct carcinoma, a rare form of renal adenocarcinoma with well-defined histological, cytogenetic and immunohistochemical characteristics. The literature is reviewed. METHODS/RESULTS: We reviewed the records of 430 patients with renal tumor that had been treated over a 10-year period. Only 6 cases with Bellini duct carcinoma were found. The mean age was 60 years, all patients were male and hematuria and lumbar pain were the most common clinical manifestations. Diagnosis was made by imaging techniques (US, urography, CT). The definitive diagnosis was based on the histological and immunohistochemical findings following nephrectomy. The one-year and three-year survival rates were 50% and 0%, respectively, indicating the aggressive nature of this variant of renal adenocarcinoma. CONCLUSIONS: Bellini duct carcinoma is an uncommon variant of renal carcinoma with nonspecific clinical features. It is a very aggressive tumor type whose treatment is only by nephrectomy and the outcome is poor.

[Fournier's gangrene after vasectomy]. / Gangrena de Fournier postvasectomía.

OBJECTIVE: An uncommon case of Fournier's gangrene following vasectomy is described. METHODS/RESULTS: A 35-year-old male with no remarkable previous history, who underwent vasectomy in another hospital, developed a clinical picture compatible with Fournier's gangrene 7-8 days later. The patient required wide, aggressive surgical debridement on several occasions with broad spectrum antibiotic coverage. After a long stay at the hospital, the patient was finally discharged and referred to another hospital for plastic surgery. CONCLUSIONS: Fournier's gangrene is a polymicrobial infection of the perineoscrotal region that manifests as a rapidly progressive necrotizing fasciitis. Most of the cases have a predisposing and/or triggering factor. Fournier's gangrene following vasectomy is uncommon. The morbidity and mortality in this severe complication depend on early diagnosis and aggressive surgical management.

[Comparative study of BTA stat test, NMP-22, and cytology in the diagnosis of bladder cancer]. / Estudio comparativo entre el BTA stat test, NMP-22 y citología en el diagnóstico del cáncer vesical.

OBJECTIVE: To compare the sensitivity and specificity of the BTA stat test, NMP-22 and voided urine cytology in the diagnosis of bladder cancer. METHODS: The study comprised 100 patients or follow-up or with a suspicion of bladder cancer. A voided urine sample was obtained and alliquoted in three samples for the BTA stat test, NMP-22 and cytology. The patients were subsequently evaluated by cystoscopy and TUR was performed when cancer was suspected. The bladder cancer was classified according to TNM stage and WHO grade. The McNemar test was utilized to compare the results. The cut-off level used for NMP-22 was 10 U/ml. ROC curves were plotted to determine the NMP-22 values for optimal sensitivity and specificity in our seires. RESULTS: Two patients were excluded from the study. The overall sensitivity was 76.47% for cytology, 78.43% for the BTA stat test and 84.31% for NMP-22 (p = n.s.). The specificity was 91.49%, 87.23% and 87.23% respectively (p = n.s.). By grade and stage, NMP-22 showed the best results followed by the BTA stat test and lastly cytology, although the differences were not significant. The ideal cut-off for NMP-22 in our series was 6 U/ml and not the generally recognized 10 U/ml. CONCLUSIONS: NMP-22 is superior to the BTA stat test and cytology in the diagnosis of bladder cancer, although the differences were not significant. The ideal cut-off in our series was 6 U/ml. The BTA stat test has the advantage of being easy to perform and provides the results in 5 minutes. In our view, NMP-22 and BTA stat test can replace cytology in the diagnosis of bladder cancer.

[NMP-22 in the diagnosis of bladder cancer]. / El NMP-22 en el diagnóstico del cáncer vesical.

OBJECTIVE: To evaluate the usefulness of the NMP-22 test in the diagnosis of bladder cancer; to calculate the ideal cutoff and to compare the results among NMP-22, voided urine cytology and cystoscopy. MATERIAL AND METHODS: 166 patients having clinical suspicious of bladder cancer or in follow-up due to a previous one. The exclusions criteria were: other urological conditions, radiotherapy in the last three months, systemic chemotherapy in the last month, recent vesical trauma or indwelling catheter. Prior cystoscopy a recent voided urinary sample was sent to the pathology and biochemistry laboratory to perform cytology and NMP-22. A TUR was performed in patients with bladder tumour. The cutoff was calculated with ROC curves. For each test we calculate sensitivity, specificity, positive and negative predictive value. We use the McNemar test to compare the results, all of which are expressed with a confidence interval of 95%. RESULTS: The ideal cutoff was 6 U/ml. We have a global sensitivity of 82.75% for NMP-22 and 67.9 for cytology (p = 0.0118); the specificity was 80% and 94.12% respectively (p = 0.0018). By grade the sensitivity was 72.22% G1, 70.97% G2 and 100% G3 for NMP-22 and 44.44%, 58.06% and 90.62% for cytology. By stage it was 68.42% Ta, 83.33% T1 and 100 T2 or more for NMP-22 and 36.84%, 75% and 85.71% for cytology. With the cystoscopy we obtained a 100% sensitivity and 89.41% specificity. CONCLUSIONS: The NMP-22 is a useful test for the diagnosis of bladder cancer; is more sensitive and less specific than cytology. We think it can replace the cytology in the diagnosis and follow-up of bladder cancer. The ideal cutoff is 6 U/ml.

[Trazodone-induced priapism]. / Priapismo por trazodona.

We present a 41 years old male, treated with trazodone because of depression. He was seen at our Andrology unit for a 72 hours evolutioned priapism. We review the literature and submit this paper for publication because it is an uncommon pathology.

[Massive lymphatic involvement secondary to prostatic adenocarcinoma]. / Macroafectación linfática secundaria a adenocarcinoma de próstata.

Prostatic carcinoma may be diagnosed by the clinic manifestations or by the symptoms for locoregional disemination and distance metastasis. The lymphatic system is the first metastatic station, which is affected in a high percentage of cases. Event it may simulate lymphoproliferatives process and it si uncommon the lymphatic macroaffectation at first. In theses cases, the histologic and immunohistochemical study by the determination of prostatic specific antigen in lymph nodes can provice the diagnosis. Treatment of these tumors is palliative with hormonotherapy. Prognosis is bad with a low survival at five years.

[The BTA stat test in the follow-up for bladder cancer]. / El BTA stat test en el seguimiento del cáncer vesical.

OBJECTIVE: To evaluate the utility of the BTA stat test in the follow-up of asymptomatic patients with superficial carcinoma of the bladder. METHODS: In 122 asymptomatic patients on follow-up for superficial bladder carcinoma, a sample of recently voided urine was obtained prior to cystoscopy and BTA stat test and cytology were performed. Thereafter we performed cystoscopy and TUR in those patients suspected of having recurrent bladder carcinoma. RESULTS: 51 patients had bladder cancer and 71 were tumor free. The sensitivity was 60.78% for the BTA stat test, 45% for cytology and 98% for cystoscopy. The specificity was 87.32%, 94.36% and 90.14%, respectively. The positive predictive value and negative predictive value were 77.5 and 75.6, 85.16 and 70.5, and 87.7 and 98.46, respectively for each test. The sensitivity by grade was 23% for G1, 71.4% for G2 and 92.8% for G3 for the BTA test versus 15.3%, 37.5% and 85.7% for cytology. The sensitivity by stage was 46.6% for Ta, 52% T1 and 100% for T2-4 and Tis for the BTA test versus 26.6%, 40% and 80% for cytology. CONCLUSIONS: The BTA stat test is superior to cytology in the follow-up of patients with bladder cancer. However, it has a low sensitivity in G1 and Ta and T1 tumors, therefore cystoscopy cannot be avoided.

[Retroperitoneal mass secondary to Bellini carcinoma]. / Masa retroperitoneal secundaria a carcinoma de Bellini.

Bellini Collecting Duct carcinoma is a rare and aggresive histological variety of renal adenocarcinoma which originates from the epithelium of the collecting tubule, with a well established histological, cytogenetic and inmunohistochemic characterization. It allows us to differenciate this tumor type from the rest of renal adenocarcinomas. There are 7 cases already published in the national literature. We introduce a new case with a particularity that is to show an unusual presentation form. It appears clinically without a specific urological symptomatology and radiologically it present a retroperitoneal mass shape with explains the patient's clinical manifestations.

[Iatrogenic ureteral lesions in open surgery: review of 10 years]. / Lesiones ureterales yatrógenas en cirugía abierta: revisión de 10 años.

OBJECTIVE: To carry out a revision of iatrogenic ureteral damage during open surgery occurred in our hospital over a 10-year period, to review the literature and to contrast the results. MATERIAL AND METHOD: Between January 1987 and December 1996, 19 cases of iatrogenic ureteral damage were reported in 18 patients. Ureteral damage was the result of gynaecological surgery in 8 cases (42%), general surgery in 5 cases (26.5%), vascular surgery in 4 cases (21.1%) and urological surgery in 2 cases (10.5%). Four patients had been given radiotherapy. In 15 of the ureteral units involved, reconstructive open surgery was performed while the remaining 4 units received conservative therapy. RESULTS: In 11 cases of open surgery the results were good, 2 cases are nephrostomy carriers and 2 underwent nephrectomy. Conservative treatment was resolutive in all instances. CONCLUSIONS: Gynaecological and general surgery are the major causes of ureteral iatrogeny in our media. In more than half the cases, diagnosis is late. Radiotherapy was associated to late diagnosis in all cases. When diagnosed early, both surgical and conservative therapy achieve good results.