[Use of statistical analysis in original articles in "Actas Urológicas Españolas." Accessibility for the reader]. / Uso de los análisis estadísticos en los artículos originales de Actas Urológicas Españolas. Accesibilidad para el lector.

OBJECTIVES: To describe the use of statistical methods employed in original articles published in Actas Urológicas Españolas as the first step to quantify the accessability for the readers. METHODS: Observational, retrospective, descriptive and transversal study to analize all the original articles published in Actas Urológicas Españolas during the year 2000. Once the anectotic cases were excluded, 55 original studies were selected. In each article it was minuciously reviewed the methods and results sections, tables and figures included, to identify the statistical analysis used and to classify them into 18 categories with three accessability levels as Emerson and Colditz and Mora y cols, previously reported: descriptive statistics, bivariables analysis and complex analysis. A randomized sample of the originals were reviewed again by the same investigator three months later to evaluate the criteria liability. The accessability was defined as a) article dependent (rate of originals that readers with different statistical knowledge are able to understand) and b) analysis dependent (rate of statistical methods respect to the total performed overall the articles that readers are able to understand). RESULTS: Our major findings are that the more frequently used technics are descriptive analysis (39.3%), bivariable tables (12.1%), survival analysis (10%), t Student and z tests (6%), and nonparametric tests (8.6%). The accessability for a reader which statistical konowledge includes bivariable methods is 63.6% (IC 95% 49%-76%) and 79% (IC 95% 71%-85), article and analysis dependent respectively, rates that are similar to the reported for biomedical journals in our country. CONCLUSIONS: A great percentage of original articles in Actas Urológicas Españolas includes complex analysis. It could be good that readers were able to increase our statistical and methodological knowledge to perform a critical approach to our publication.

Uso de los análisis estadísticos en los artículos originales de Actas Urológicas Españolas.Accesibilidad para el lector / Use of statistical analysis in original articles published in Actas Urológicas Españolas: accessibility for the reader

OBJETIVOS: Descripción de los tipos de análisis estadísticos realizados en los trabajos de la Sección "Originales" de Actas Urológicas Españolas, cuantificando la accesibilidad estadística para el lector. MATERIAL Y MÉTODO: Estudio observacional, retrospectivo, descriptivo y transversal, analizando todos los Originales de Actas Urológicas Españolas publicados consecutivamente durante el año 2000 (muestreo aleatorio de conveniencia). Se excluyeron revisiones de casos anecdóticos, recogiéndose 55 originales. Fueron estudiadas detalladamente las secciones de Material y Método y Resultados, identificando los análisis efectuados para clasificarlos en 18 categorías jerárquicas con tres niveles de accesibilidad (Emerson-Colditz): estadística descriptiva, análisis bivariables y análisis complejos incluidos los multivariables. La concordancia intraobservador (fiabilidad de los criterios) fue evaluada mediante una nueva revisión de una muestra aleatoria de los originales seleccionados. La accesibilidad se definió: a) artículo dependiente (proporción de artículos accesibles para lectores con diferentes niveles de conocimiento estadístico) y b) análisis dependiente (proporción del total de técnicas estadísticas realizadas en todos los originales y que son accesibles a dichos lectores). RESULTADOS: Categorías más frecuentes: estadística descriptiva (39,3 por ciento), tablas bivariables (12,1 por ciento), análisis de supervivencia (10 por ciento), test t de Student y pruebas z (8,6 por ciento) y tests no paramétricos (8,6 por ciento). Globalmente, el 78,6 por ciento de los análisis estadísticos y el 63,6 por ciento de los artículos fueron accesibles para un lector con conocimientos básicos (análisis bivariables), cifras similares a las de otras revistas biomédicas. CONCLUSIONES: Un porcentaje considerable de los artículos originales de Actas Urológicas Españolas incorpora actualmente análisis complejos en su desarrollo. Parece así aconsejable que los lectores profundicemos en nuestros conocimientos estadísticos (AU)

OBJETIVES: To describe the use of statistical methods employed in original articles published in Actas Urológicas Españolas as the first step to cuantify the accesibility for the readers. METHODS: Observational, retrospective, descriptive and transversal study to analize all the original articles published in Actas Urológicas Españolas during the year 2000. Once the anectotic cases were excluded, 55 original studies were selected. In each article it was minuciously reviewed the methods and results sections, tables and figures included, to identify the statistical analisys used and to clasify them into 18 cathegories with three accesibilty levels as Emerson and Colditz and Mora y cols. previosly reported: descriptive statistics, bivariables analysis and complex analysis. A randomized sample of the originals were reviewed again by the same investigator three months later to evaluate the criteria fiability. The accesibility was defined as a) article dependent (rate of originals that readers with different statistical knowledge are able to understand) and b) analisys dependent (rate of statistical methods respect to the total performed overall the articles that readers are able to understand). RESULTS: Our major findings are that the more frecuently used technics are descriptive analysis (39.3%), bivariable tables (12.1%), survival analysis (10%), t Student and z tests (6%), and nonparametric tests (8.6%). The accesibility for a reader which statistical konowledge includes bivariable methods is 63.6% (IC 95% 49%-76%) and 79% (IC 95% 71%-85), article and analysis dependent respectively, rates that are similar to the reported for biomedical journals in our country. CONCLUSIONS: A great percentaje of original articles in Actas Urológicas Españolas includes complex analysis. It could be good that readers were able to increase our statistical and methodological konwledge to perform a critical approach to our publication (AU)

Tratamiento conservador del tumor testicular de células germinales / Conservative treatment of malignant germ cell tumors of the testis

El tumor de células germinales de testículo es la lesión neoplásica más frecuente en los varones de entre 15 y 35 años. Los resultados terapéuticos obtenidos gracias a la orquiectomía radical y, especialmente, a la poliquimioterapia neoadyuvante permiten obtener supervivencias libres de enfermedad en torno al 90 por ciento en el momento actual. Esta gran quimiosensibilidad está abriendo nuevas puertas a opciones terapéuticas alternativas, encaminadas a conservar la cantidad suficiente de parénquima que permita evitar los problemas derivados de la insuficiencia testicular. Tales alternativas quedan plenamente justificadas en los casos de tumores germinales bilaterales o de asiento en órgano único. En este artículo aportamos un caso de seminoma puro desarrollado en testículo único funcionante tratado mediante cirugía conservadora de parénquima. Asimismo, analizamos las indicaciones y resultados del manejo conservador del tumor primario basándonos en criterios de revisión bibliográfica metodológicamente estrictos, encaminados a ofrecer las mejores evidencias disponibles al respecto (AU)

[Metastasis priapism. Report of 4 new cases and review of the literature]. / Priapismo metastásico. Presentación de cuatro nuevos casos y revisión de la literatura.

OBJECTIVE: Four additional cases of malignant priapism or priapism secondary to penile metastasis from urogenital tumors are presented and the literature is reviewed. METHODS: Chest and abdominal radiological evaluation, cavernosal and abdominal US, abdominal and pelvic CT and MRI, and cavernosal biopsy were performed for the localization and staging of the primary tumor. RESULTS: Conservative palliative management achieved a survival of only a few months in three of the patients with tumor dissemination to adjacent vital organs. Radical surgery was performed in one patient with tumor localized to the genital area. Currently, this patient has no clinical symptoms, although the follow-up is only 4 months. CONCLUSIONS: Malignant priapism is rare and usually secondary to GU tumors. The prognosis is poor since it generally indicates the presence of multiorgan metastasis. However, the prognosis is better for single metastasis, which is an indication for radical surgery.

[Cystic pyeloureteritis and infection. Presentation forms and review of the literature]. / Pieloureteritis quística e infección. Formas de presentación y revisión de la literatura.

OBJECTIVE: To present three illustrative cases of pyeloureteritis cystica and review the literature. METHODS: Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed. RESULTS: Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter. CONCLUSIONS: Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.

[Conservative treatment of germ cell tumor of the testis]. / Tratamiento conservador del tumor testicular de células germinales.

Testis germ cell tumor is the most frequent cancer in men between 15 and 35 years old. The therapeutic results of radical orchiectomy and chemotherapy reaches 90% free disease survival al the present time. This great chemosensibility is opening new doors to alternative therapeutic options, directed to preserve the sufficient amount of tissue to avoid the problems derived from testicular insufficiency. Such alternatives are clearly beneficial in bilateral germinal tumors or in solitary testis. In this article we describe a case of seminoma developed in a solitary functional testis managed in a conservative approach: organ preserving surgery and surveillance. We analyzed the indications and international results of such approach based on the best evidences now available.

[Trigonocervicoprostatomy. Indications and results from 100 case reports]. / La trigonocervicoprostatotomía. Indicaciones y resultados de 100 casos.

Trigonocervicotomy is a barely invasive technique for the treatment of infravesical obstruction, first introduced in the 60's by Turner-Warkic and Orandi. To achieve good results with this procedure, the selection criteria must take into account a series of parameters such as age, sexual activity, PSA, prostate weight (below 30 grams) and others. In addition to its low morbidity, a larger percentage of patients preserve ejaculation than with the use of other techniques, also the neck sclerosis rate being lower as seen in all our series and expertise. The efficacy of this technique was studied on 100 patients.

[The management of urinary candidiasis in cystectomized patients]. / Manejo de la candidiasis urinaria en pacientes cistectomizados.

Presentation of eight cases of urinary candidiasis in patients who underwent radical cystectomy and were managed using by-pass of the urinary tract, oral antifungal therapy and solutions in the way of intermittent instillation through nephrostomy catheters.

[AIDS and HIV infections in urologic practice]. / SIDA e infecciones por VIH en la práctica urológica.

The infection caused by the Human Immunodeficiency Virus (HIV), a retrovirus, leads to a progressive decline and to the suppression of cell-mediated immunity favouring the development of opportunistic diseases and potentially fatal neoplasias which are practically innocuous in individuals with an intact immunologic system. The number of AIDS cases recorded in Spain until March 1997 was 45,132, with a revised mortality rate of 58%. Cases in Murcia total 713 up to October 1997, of which 217 patients are being monitored in the AIDS Unit in our centre, 414 individuals have died in the region. It is well know that about one third of patients with diagnosed AIDS or who are HIV carriers will develop some type of genitourinary lesion, either as a result of a renal disorder, concurrent or not with HIV, or any other condition directly related to the infection. This is a report on our Service's experience in the treatment of HIV patients with genitourinary symptoms that, in a total of 15 cases, required our intervention. Emphasis is placed on the incidence of nephrolithiasis secondary to therapy with protease inhibitors over the last few months following introduction of this new therapeutic tool, prostatitis due to salmonella, and inlaid cystitis among others.

[Tumors of the upper urinary tract]. / Tumores de tracto urinario superior.

A series of 60 cases of tumours of the Upper Urinary Tract (UUT) diagnosed in our centre between 1987-1996 and affecting 57 patients is presented. Patient's mean age was 63.7 years, males being clearly predominant, 4:1, there was no predominant laterality and the preferential location was the renal pelvis. Fifty-two (52) out of all tumours were transitional, 1 was a fibroepithelial polyp and 2 were metastasis from prostate and colon cancers. Pathoanatomy of the remaining cases is not known since no surgery was performed, although the cytologic diagnosis has identified them as transitional tumours. Our series shows a significant association to other transitional tumours as demonstrated by the existence of 2 cases with a background of UUT tumours and other 31 cases associated to transitional tumour of the bladder. Haematuria was the predominant sign (54%) and UIV the leading examination technique. Nephroureterectomy was the most commonly used therapeutical approach. UUT appear to be highly predominant in our environment, with a clear male predominance and preferential location in the renal pelvis. Haematuria continues to be the most frequent presentation sign and UIV the exploratory technique offering better performance in the diagnosis. Also a high association was found to other types of transitional tumours, the diagnosis and follow up of which allowed us to diagnose a large number of tumours of the upper tract.

[Transitional cell carcinoma and renal cell adenocarcinoma: unusual case of association in the same kidney]. / Carcinoma de células transicionales y adenocarcinoma de células renales: caso inusual de asociación en el mismo riñón.

Presentation of one patient with a highly infrequent association of transitional cells carcinoma and renal cells adenocarcinoma synchronically developed in the same renal unit. There has been very few cases diagnosed up to now, and only around 25 have been described in the literature. There is a clear predominance of males versus females, with haematuria being the most frequent sign present in 90% cases. Elective complementary examination is CT and the choice treatment can be either nephroureterectomy or extended nephrectomy based on early suspicion of transitional cells carcinoma or renal cells adenocarcinoma.

[Congenital bilateral agenesis of the vas deferens associated with cystic fibrosis. A molecular genetic study]. / Agenesia congénita bilateral de vasos deferentes asociada a fibrosis quística. Estudio genético molecular.

OBJECTIVE: To analyze the association of congenital bilateral agenesis of the vas deferens and cystic fibrosis. METHODS: Three azoospermic patients with surgically confirmed congenital agenesis of the vas deferens in whom a molecular genetics study had been performed to discard the more common mutations of cystic fibrosis are described and the literature reviewed. RESULTS: All patients showed azoospermia. The molecular genetics study showed one of the patients to be a heterozygotic carrier of G542X and no other mutations like the remaining patients. CONCLUSIONS: 15% of patients with azoospermia have chromosomal anomalies. Recently, it has been reported that 50%-65% of patients with congenital bilateral agenesis of the vas deferens have mutations for the CFTR gene, with more than 400 reported. Patients with bilateral agenesis and their partners should be screened for cystic fibrosis prior to any in vitro fertilization techniques.

[Management of priapism induced by PGE1]. / Manejo del priapismo inducido por PGE1.

OBJECTIVE: To review the literature on priapism following intracavernous injection of PGE1, its management and the physiopathological mechanisms involved. METHODS/RESULTS: The literature on PGE1-induced priapism available on Medline is reviewed and two cases treated at our hospital are described. The diagnostic and therapeutic algorithms are presented. The relationship between drug use and priapism is difficult to establish since patients with the same history who received the same dose of Alprostatil did not develop priapism. CONCLUSIONS: Although infrequent, treatment must be instituted urgently since there is generally low flow.

[Non-urothelial neoplasm in patients with infiltrating bladder carcinoma]. / Neoplasia asociada de estirpe no urotelial en pacientes con carcinoma vesical infiltrante.

OBJECTIVE: To analyze the incidence of non-urothelial neoplasms in patients with infiltrating bladder tumor submitted to radical surgery. METHODS: A retrospective study was conducted in patients who underwent radical cystoprostatectomy for an infiltrating bladder tumor from 1987-1996. The pathological and follow-up data were analyzed. RESULTS: Of 120 patients submitted to radical cystoprostatectomy for an infiltrating bladder tumor, 23 (19%) had an associated non-urothelial neoplasm: 14 (61%) were metachronous and 9 (39%) were synchronous. Two patients had two secondary tumors (9%). CONCLUSION: We have found a high incidence of non-urothelial tumor in patients with infiltrating bladder tumor. By order of frequency, these were prostate cancer, gastrointestinal cancer, pulmonary cancer, etc. Studies have ascribed the association of prostate and bladder cancer to the deletion of suppressor genes.

[Inverted papilloma: presentation of 5 cases and review of the Spanish literature]. / Papiloma invertido: presentación de 5 casos y revisión de la literatura española.

Vesical inverted papilloma (IP) is a transitional disease most commonly found in the bladder, representing a small percentage within the group of vesical neoformations. Although of benign behaviour, some authors advise that a relatively strict monitoring should be used considering its high rate of proliferative activity. It mainly affects males in their fifth to seventh decade, and it presents as any other transitional tumour. In about one fourth of the cases a transitional carcinoma becomes associated throughout its evolution, thus supporting the theory of periodic monitoring.

[Infiltrating bladder tumors associated with upper urinary tract tumors]. / Asociación de tumores vesicales infiltrantes a tumores del tracto urinario superior.

Analysis of the infiltrant tumours of the bladder diagnosed in our service between 1986-1996 both inclusive, with associated tumour of the upper tract during its evolution. From a total of 262 infiltrant transitional tumours of the bladder and 52 transitional tumours of the upper urinary tract, 8 patients were found to have both types of tumours in association, which accounted for 3.05% of all infiltrant vesical tumours. Mean age of our patients, all male, was 65. The pathological anatomy of the upper tract tumours was: 4 pT1 and 4 pT3. 75% presented relapsing tumours of the bladder, 50% had a background of bladder Cys, 87.5% were multifocal vesical tumours and 100% were larger than 3 cm. In addition, 62% cases were ipsilateral to the tumours of the upper urinary tract. It can therefore be concluded that for tumours of the bladder, multifocality, relapse, presence of vesical Cys and tumour size, are all concurring features when association of these two types of tumours occurs.

[Recurrent hydrocele in a patient with familial mediterranean fever]. / Hidrocele recidivante en un paciente con fiebre mediterránea familiar.

OBJECTIVE: To report an uncommon case of familial Mediterranean fever with urological manifestations. METHODS/RESULTS: A case of recurrent hydrocele in a patient with familial Mediterranean fever is described. CONCLUSIONS: Although familial Mediterranean fever is characterized by an acute febrile stage and involvement of the serosa, it may manifest as recurrent hydrocele due to involvement of the urological serosa, as in the case described herein.

[Retroperitoneal liposarcoma. Apropos of 3 cases]. / Liposarcoma retroperitoneal. A propósito de tres casos.

OBJECTIVE: Three additional cases of retroperitoneal liposarcoma are described, with special reference to the diagnostic utility of CT, although the definitive diagnosis can only be established anatomopathologically. METHODS/RESULTS: Three cases of retroperitonel liposarcoma are described. Two patients had complained of the presence of an abdominal mass and discomfort and one patient had referred colic pain. CONCLUSION: The prognosis of retroperitoneal liposarcoma is closely related to the histological type and involvement of the adjacent structures. The most common clinical feature is the sensation of an abdominal mass and discomfort.

[Changes in the caudal regression of fused Muller ducts: utriculocele. Three clinical forms of presentation]. / Alteración de la regresión caudal de los conductos de Müller fusionados: utriculocele. Tres formas clínicas de presentaciónón.

Utriculocele is the engrossment of the prostate utricle with occlusion and/or cystic formation, sometimes including the ejaculatory conducts. We report three patients diagnosed with utriculocele with different presentation forms: hypospermia, haematuria and mictional syndrome, and the treatment used. Theories on their formation, clinical presentation forms described in the literature, diagnostic means, most frequent associations, and different therapeutic alternatives are all discussed as well as a revision of the reported cases.

[Eosinophilic cystitis]. / Cistitis eosinófila.

Eosinophilic cystitis (EC) is a clinical-pathological entity characterised by the transmural infiltration of the bladder. It shows as an irritative mictional syndrome, though the most common sign is haematuria. Endoscopically it appears as an intravesical mass and is usually mistaken for a transitional tumour of the bladder. There has been many etiologies involved but not one single factor has been identified as responsible for the condition. Medical approach is the most appropriate initial treatment, but since the condition is so often mistaken with vesical tumoration, the first therapeutical attitude in most cases is Transurethral Resection (TUR) which, though more aggressive, is therapeutic, haemostatic and provides material for the pathoanatomical diagnosis.