[Diagnostic yield of the extended prostatic biopsy with 10 cores. Prospective study on 222 patients]. / Rentabilidad de la biopsia ampliada con 10 muestras prostáticas. estudio prospectivo sobre 222 pacientes.

OBJECTIVES: The number of biopsy samples for a proper prostate cancer diagnosis has not yet been established. We report our experience with the 10-sample extended biopsy. METHODS: We collected the results of a group of 222 patients undergoing extended ultrasound guided prostate biopsy with 10 samples. In addition to the sextant biopsies 2 extra samples were obtained from the dorsal-apex area on each lobe. Results of this group were compared with a control group of 552 patients undergoing sextant biopsy in 2002 with the same inclusion in criteria. RESULTS: 60 patients had cancer (27.15%). The extra samples gave the diagnosis in 5 out of 60 patients, 8.33% of the tumors and 2.25% of all patients. Control group showed cancer in 24.5%, not having the difference statistical significance. The incidence in prostates smaller than 20 cc was 69.2%, 11.6% in prostates bigger than 50 cc. 80% of the patients with prostate cancer only in the extra samples have a volume smaller than 35 cc. Multivariate logistic regression study for the probability of prostate cancer only showed association with serum PSA and prostate volume but not with the number of samples. CONCLUSIONS: The extended biopsy is not indicated as an initial diagnostic technique, being reserved for specific cases such as repeated biopsies in patients with high risk pathology reports. Neither it is indicated in the bigger volume prostates.

Rentabilidad de la biopsia ampliada con 10 muestras prostáticas. Estudio prospectivo sobre 222 pacientes / Diagnostic yield of the extended prostatic biopsy with 10 cores. Prospective study on 222 patients

OBJETIVO: Actualmente no está establecidoni el número de muestras ni de biopsias para el correcto diagnóstico del cáncer prostático. Presentamos nuestra experiencia en biopsia ampliada con 10 muestras.MÉTODO: se recogieron los resultados de un grupo de 222 pacientes en los que se realizó biopsia transrectal ecodirigida prostática ampliada con 10 muestras. Ademásde las muestras de una biopsia sextante se obtuvieron2 muestras “extras” de la región apical-dorsal de cada lóbulo, estudiando los resultados en este grupo y comparándolo con un grupo control de 552 pacientes sometidos en 2002 a biopsia sextante con los mismos criterios de inclusión.RESULTADOS: Presentaron cáncer 60 pacientes (27,15%). Las muestras “extras” supusieron el diagnósticoen 5 de los 60 pacientes, el 8,33% de los tumores y el 2,25% del total de pacientes. El grupo de control presentabacáncer en un 24,5% no resultando significativa la diferencia. Mientras que la incidencia en próstatas menores de 20 cc fue del 69,2% en las mayores de 50cc fue del 11,6%. De los pacientes diagnosticados únicamente por las muestras “extras” el 80% tenía un volumen menor de 35cc. En el estudio de regresión logísticamultivariante sólo se asoció con la posibilidad de cáncer el PSA sérico y el volumen prostático pero no el número de muestras.CONCLUSIÓN: la biopsia ampliada no está indicada como técnica diagnóstica de inicio debiendo reservarsepara casos concretos como rebiopsias en pacientes con anatomías patológicas de alto riesgo. Tampoco parece indicada en la biopsia de próstatas de mayor tamaño

OBJECTIVES: The number of biopsy samples for a proper prostate cancer diagnosis has not yet been established. We report our experience with the10-sample extended biopsy.METHODS: We collected the results of a group of 222 patients undergoing extended ultrasound guided prostate biopsy with 10 samples. In addition to the sextant biopsies 2 extra samples were obtained from the dorsal-apex area on each lobe. Results of this group were compared with a control group of 552 patients undergoing sextant biopsy in 2002 with the same inclusion in criteria.RESULTS: 60 patients had cancer (27.15%). The extra samples gave the diagnosis in 5 out of 60 patients, 8.33% of the tumors and 2.25% of all patients. Control group showed cancer in 24.5%, not having the difference statistical significance. The incidence in prostates smaller than 20 cc was 69.2%, 11.6% in prostates bigger than 50 cc. 80% of the patients with prostate cancer only in the extra samples have a volume smaller than 35 cc. Multivariate logistic regression study for the probability of prostate cancer only showed association with serum PSA and prostate volume but not with the number of samples.CONCLUSIONS: The extended biopsy is not indicated as an initial diagnostic technique, being reserved for specific cases such as repeated biopsies in patients with high risk pathology reports. Neither it is indicated in the bigger volume prostates

Tolerancia y complicaciones de la biopsia transrectal ecodirigida prostática ampliada a diez cilindros. Papel del bloqueo de haces neurovasculares con lidocaína / Tolerability and complications of the ultrasound guided transrectal biopsy of the prostate extended to 10 cores. The role of neurovascular bundle blockage with lidocaine

OBJETIVO: El creciente interés por ampliar el número de muestras obtenidas durante la biopsia transrectal ecodirigida prostática nos ha hecho evaluar la tolerancia y complicaciones de la biopsia ampliada con y sin bloqueo de los haces neurovasculares de esta modalidad diagnóstica.MÉTODO: Un grupo de 222 pacientes se sometieron a biopsia prostática con intención de obtener 10 cilindrosde tejido. Tras la evaluación de los primeros 50 pacientes realizados sin anestesia se decidió continuar practicando bloqueo de los haces neurovasculares con lidocaina al 2%, evaluando comparativamente los resultadosde tolerancia en ambos grupos y la incidencia de complicaciones y efectos secundarios en su conjunto.RESULTADOS: No se pudo completar el número de muestras previsto en el 16% de pacientes sin anestesia frente al 2,33% con anestesia (p<0,002), la prueba resultó dolorosa o muy dolorosa en el 10,9 y 1,9% respectivamente(p<0,0002). La puntuación en la escala analógica visual de dolor fue de 2,46± 1,67 y 4,5± 2,11 según se hubiera usado anestésico o no con reaccionesvagales leves-moderadas en el 28% de estos últimos frente al 7,7% si se administró lidocaina. La rectorragiafue la complicación más preocupante siendo moderada-importante en el 4,7% precisando de ingreso en un 2% de pacientes.CONCLUSIONES: El incremento del número de muestrasen la biopsia transrectal ecodirigida se puede asociara una mayor frecuencia de complicaciones sobre todo hemorrágicas y precisa de la aplicación de anestesialocal por su peor tolerancia, si bien el bloqueo de haces neurovasculares con lidocaina es muy efectivo parra disminuir el dolor asociado a las punciones

OBJECTIVES: The growing interest on increasing the number of biopsy samples during ultrasound guided prostatic biopsies moved us to evaluate the tolerability and complications of the extensive biopsy with/without blockage of neurovascular bundles. METHODS: A group of 222 patients underwent prostatic biopsy with the aim to obtain 10 cores on each. After evaluation of the first 50 cases performed without anesthesia, decision was taken to proceed with neurovascular blockage with 2% lidocaine, comparatively evaluating both groups for results on tolerability, complications and global adverse events. RESULTS: The aimed number of cores could not be completed in 16% of the patients without anesthesia in comparison with 2.33% with anesthesia (p < 0.002); the biopsy was qualified as painful or very painful by 10.9% and 1.9% respectively (p < 0. 0002). The results of the visual analogical scale for pain were 2.46 ± 1.67 and 4.5 ± 2.11 for the anesthesia / without anesthesia groups respectively, with mild-moderate vagal reactions in 28% of these latter in comparison with 7.7% in patients receiving lidocaine. Rectal bleeding was the most worrying complication, being moderate-severe in 4.7% of the patients, with 2% hospital admission. CONCLUSIONS: The increase in the number of ultrasound guided prostatic biopsy samples may be associated with a higher frequency of complications, mainly bleeding, and requires the application of local anesthesia due to worse tolerance. Neurovascular bundle blockage with lidocaine is very effective to diminish biopsy associated pain

[Results of a series of transrectal ultrasound guided biopsy of the prostate in 6000 patients. Part I: pathology, digital rectal examination, transrectal ultrasound, and PSA]. / Resultados de una serie de 6000 pacientes con biopsia transrectal ecodirigida de próstata. Parte I: anatomía patológica, tacto rectal, ecografía transrectal y psa.

OBJECTIVES: To analyze the results of transrectal ultrasound (TRUS) guided biopsy of the prostate in 6000 patients, and their relation to common-use clinical parameters. METHODS: We collected PSA, digital rectal examination, TRUS characteristics, and pathology report in a data- base including 6000 patients who underwent sextant TRUS biopsy from 1994 to December 2002. 861 of them underwent more than one biopsy, accounting for a total of 7127 biopsies. Sextant biopsy with samples from the most lateral portions of the prostate was the standard procedure so that they included peripheral zone only. We analyze pathological results and their relation with clinical variables. RESULTS: Total percentage of cancer in biopsy samples was 42.6%, with 39.1% in the first biopsy. Overall, repeated biopsies resulted in a 3.5% diagnostic yield increase. PIN or focal glandular atypia were detected in 2.0% and 2.1% of the cases respectively. The percentage of patients with Gleason score =<6 increased from 41.8% in the first biopsy to 70% in the third. Similarly, single core involvement increased from 21.% to 65%. Digital rectal examination and presence of hypoechogenic nodules specificity were 82.6 and 78.2% respectively. The incidence of prostate cancer with PSA between 4 and 10 ng/ml was 29.6%, 16.7% in those with PSA lower than 4 ng/ml. CONCLUSIONS: TRUS biopsy of the lateral prostatic areas offers a good diagnostic yield in comparison with most series of extensive biopsies. The sensitivity of TRUS has decreased but it maintains a high specificity which should not be forgotten when planning the TRUS strategy

[Results of a series of transrectal ultrasound guided biopsy of the prostate in 6000 patients. Part II: PSA derived parameters]. / Resultados de una serie de 6000 pacientes con biopsia transrectal ecodirigida de prostata. Parte II: parámetros derivados del PSA.

OBJECTIVES: We review the results of 6000 patients with the clinical suspect of prostate cancer who underwent one or more prostate, biopsies, analyzing the role of PSA derived parameters in the probability of having prostate cancer in the TRUS biopsy. METHODS: We selected 6000 patients who under- went TRUS biopsy between 1994 and 2002. 861 of them underwent more than one is biopsy, adding up to a total of 7127 biopsies. For the study of PSA derived indexes we established ranges based on the 10th percentile for the first biopsy for all patients and also for those with PSA between 4 and 10 ng/ml. Several predictive models were determined by logistic regression of the variables related with presence/no presence of cancer. RESULTS: For first biopsies the ranges of PSAD established showed a diagnostic effectiveness below 8% with PSA densities lower than 0.11 ng/ml/cc. The free/total PSA ratio is less discriminant in the ranges obtained with a 13.7% incidence of prostate cancer for values above 0.24. In the case of second biopsies the group of patients with PSAD below 0.12 had only a 5.3% incidence, and only one patient with F/T PSA ratio higher than 0.24 had a prostate cancer (2.9%). All studied parameters but F/T PSA ratio showed statistical significance in the multivariant analysis. CONCLUSIONS: Although the establishment of a cut point for PSAD diminishes sensitivity, prostate biopsy habits should be modified assuming the loss of tumors in patients with low PSAD and increasing the number of biopsies in patients with total PSA values below 4 ng/ml with higher densities.

Papel del volumen prostático en la biopsia transrectal ecodirigida de próstata: ¿es un marcador tan importante como el PSA? / The role of prostate volume in ultrasound guided transrectal prostate biopsy: is it as important as a marker as PSA?

OBJETIVO: La limitación del PSA paraidentificar a los pacientes con cáncer prostático hahecho que se definan diferentes parámetros que aumentensu especificidad sin reducir su sensibilidad de formaimportante. En este trabajo se estudia la relación delvolumen con la presencia de cáncer de próstata enbiopsia sextante.MÉTODO: se han recogido los resultados de las biopsiasprostáticas realizadas a 6000 pacientes entre1994 y 2002. De ellos 861 se han biopsiado en másde una ocasión, sumando un total de 7127 biopsias.Se realizaron diferentes modelos predictivos para identificarlos factores relacionados con la positividad de labiopsia. RESULTADOS: La media de volumen prostático es de40,6± 66,2 c.c. en la primera biopsia aumentando enlas sucesivas biopsias hasta los 85,17 c.c. Se observauna alta incidencia de CP en las próstatas pequeñasque alcanza el 67,2% en las de tamaño normal (menoresde 20 c.c.) que disminuye a medida que aumentael volumen encontrando únicamente un 19,7% en aquellasmayores de 50 c.c. (p<0,0001). En pacientes conPSA entre 4 y 10 ng/ml y segundas biopsias el porcentajede cáncer con glándulas mayores de 50cc fueinferior al 10%. En la regresión logística multivariantemostraron relación con la positividad el PSA, el volumeny la Densidad de PSA pero no la relación PSALibre/PSA total.CONCLUSIONES: Los puntos de corte estándar dePSA no son adecuados para un correcto diagnósticode CP mediante BTE. El volumen (HPB) influye de maneradeterminante en sus cifras y en la rentabilidad de laprueba por lo que es preciso tenerlo en consideraciónal indicar la biopsia

OBJECTIVES: The limitations of PSA to identify patients with prostate cancer prompted the definition of different parameters trying to increase specificity without reducing sensitivity. This paper studies the relationship of volume and presence of prostate cancer in sextant biopsies. METHODS: We collected the results of prostate biopsies performed to 6000 patients between 1994 and 2002. 861 of them underwent more than one biopsy, adding up for a total of 7127 biopsies. Various predictive models to identify factors related to positive biopsy were constructed. RESULTS: Mean prostate volume is 14.6 ± 66.2 cc for the first biopsy, increasing in successive biopsies to 85.17 cc. A high incidence of prostate cancer was observed in small prostates, reaching 67.2% of those with normal size (< 20 cc) and diminishing with the increase of volume down to only 19.7% in those larger than 50 cc (p < 0.0001). In second biopsies of patients with PSA between 4 and 10 ng/ml and gland volume higher than 50 cc percentage of biopsies positive for cancer was below 10%. Multivariant logistic regression showed that PSA, volume and PSA density were related with positive biopsies, but not free/total PSA ratio. CONCLUSIONS: Standard PSA cutoffs are not adequate for a proper diagnosis of prostate cancer by ultrasound guided transrectal biopsy. Volume (BPH) has a significant influence in PSA values and results of the biopsy, so that it should be taken into consideration when indicating biopsies

Resultados de una serie de 6000 pacientes con biopsia transrectal ecodirigida del próstata. Parte I. Anatomía patológica, tacto rectal, ecografía tramsrectal y PSA / Results of a serieees of transrectal ultrasound guided biopsy of the prostate in 6000 patients. Part I: pathology, digital rectal examination, transrectal ultrasound, and PSA

OBJETIVOSAnalizar los resultados de la Biopsia Transrectal Ecodirigida (BTE) prostática realizadas en 6000 pacientes así como su relación con los diferentes parámetros clínicos empleados habitualmente. METODOSSe han recogido los datos de PSA, tacto rectal, características ecográficas y anatomía patológica de 6000 pacientes a los que se realizó BTE sextante desde 1994 a diciembre de 2002. De ellos 861 se han biopsiado en más de una ocasión sumando un total de 7127 biopsias. De forma general se realizó biopsia sextante obteniendo las muestras de la región más lateral de forma que incluyeran únicamente zona periférica. Se analizan los resultados patológicos y su relación con los parámetros estudiados. RESULTADOSEl porcentaje total de cáncer en las biopsias fue del 42,6% con un 39,1% en la primera biopsia. El conjunto de rebiopsias supone un incremento diagnóstico del 3,5%. Se detectó PIN o Atipia Glandular Focal en un 2 y 2,1% respectivamente. El porcentaje de pacientes con Gleason de 6 o menor aumentó del 41,8% en la primera biopsia al 70% en la tercera. Igualmente la afectación de un único cilindro pasó del 21,8 al 65%. La especificidad del tanto rectal y la presencia de nódulos hipoecogénicos fue del 82,6 y 78,2% respectivamente. La incidencia de cáncer con PSA entre 4 y 10 ng/ml fue del 29,6% y del 16,7% en aquellos con PSA inferior a 4 ng/ml . CONCLUSIONESLa BTE de los cuernos laterales prostáticos mantiene una buena rentabilidad diagnóstica comparada con la mayoría de series de biopsias ampliadas. La sensibilidad de la ETR ha descendido pero mantiene una especificidad elevada por lo que no debe olvidarse al plantear la estrategia de la BTE

OBJECTIVES: To analyze the results oftransrectal ultrasound (TRUS) guided biopsy of the prostatein 6000 patients, and their relation to common-useclinical parameters.METHODS: We collected PSA, digital rectal examination,TRUS characteristics, and pathology report in a database including 6000 patients who underwent sextant TRUS biopsy from 1994 to December 2002. 861 of them underwent more than one biopsy, accounting for a total of 7127 biopsies. Sextant biopsy with samples from the most lateral portions of the prostate was the standard procedure so that they included peripheral zone only. We analyze pathological results and their relation with clinical variables. RESULTS: Total percentage of cancer in biopsy samples was 42.6%, with 39.1% in the first biopsy. Overall, repeated biopsies resulted in a 3.5% diagnostic yield increase. PIN or focal glandular atypia were detected in 2.0% and 2.1% of the cases respectively. The percentage of patients with Gleason score =<6 increased from 41.8% in the first biopsy to 70% in the third. Similarly, single core involvement increased from 21.% to 65%. Digital rectal examination and presence of hypoechogenic nodules specificity were 82.6 and 78.2% respectively. The incidence of prostate cancer with PSA between 4 and 10 ng/ml was 29.6%, 16.7% in those with PSA lower than 4 ng/ml. CONCLUSIONS: TRUS biopsy of the lateral prostatic areas offers a good diagnostic yield in comparison with most series of extensive biopsies. The sensitivity of TRUS has decreased but it maintains a high specificity which should not be forgotten when planning the TRUS strategy

Resultados de una serie de 6000 pacientes con biopsia transrectal ecodirigida del próstata. Parte II. Parámetros derivados de PSA / Results of a serieees of transrectal ultrasound guided biopsy of the prostate in 6000 patients. Part II: PSA derived parameters

OBJETIVO: En esta serie se revisan losresultados de 6000 pacientes biopsiados en una omás ocasiones por sospecha de CP, analizando elpapel que puedan jugar los parámetros derivados delPSA en la posibilidad de presentar un tumor de próstataen la BTE.MÉTODO: se han seleccionado 6000 pacientes sometidosa biopsia transrectal ecodirigida prostática entre1994 y 2002. De ellos 861 se han biopsiado en másde una ocasión, sumando un total de 7127 biopsias.Para el estudio de la utilidad de los índices derivadosdel PSA se han establecido rangos basados en el percentil10 para la primera biopsia tanto en el grupo totalcomo en aquellos con un PSA entre 4 y 10 ng/ml Sedeterminaron varios modelos predictivos medianteregresión logística de las variables relacionadas con lapresencia o no de cáncer.RESULTADOS: Para el total de primeras biopsias losrangos establecidos de DPSA muestran una rentabilidadpor debajo del 8% con densidades menores de0,11 ng/ml/c.c. El PSA L/T es menos discriminativocon los rangos obtenidos encontrando una incidenciade CP del 13,7% con cifras superiores a 0,24. En elcaso de las segundas biopsias el grupo de pacientescon DPSA menor de 0,12 sólo tiene una incidencia del5,3% y sólo un paciente presenta CP con PSA L/Tmayor de 0,24 (2,9%). A excepción del PSA L/T elresto de parámetros estudiados fueron significativos enel análisis multivariante.CONCLUSIONES: Aunque el establecimiento de puntosde corte para la DPSA suponga el descenso de lasensibilidad, deben modificarse los hábitos de biopsiaprostática asumiendo la pérdida de tumores en pacientescon DPSA bajas e incrementando las biopsias enpacientes con cifras totales de PSA inferiores a 4 ng/mly densidades mayores

OBJECTIVES: We review the results of 6000 patients with the clinical suspect of prostate cancer who underwent one or more prostate biopsies, analyzing the role of PSA derived parameters in the probability of having prostate cancer in the TRUS biopsy. METHODS: We selected 6000 patients who underwent TRUS biopsy between 1994 and 2002. 861 of them underwent more than one is biopsy, adding up to a total of 7127 biopsies. For the study of PSA derived indexes we established ranges based on the 10th percentile for the first biopsy for all patients and also for those with PSA between 4 and 10 ng/ml. Several predictive models were determined by logistic regression of the variables related with presence/no presence of cancer. RESULTS: For first biopsies the ranges of PSAD established showed a diagnostic effectiveness below 8% with PSA densities lower than 0.11 ng/ml/cc. The free/total PSA ratio is less discriminant in the ranges obtained with a 13.7% incidence of prostate cancer for values above 0.24. In the case of second biopsies the group of patients with PSAD below 0.12 had only a 5.3% incidence, and only one patient with F/T PSA ratio higher than 0.24 had a prostate cancer (2.9%). All studied parameters but F/T PSA ratio showed statistical significance in the multivariant analysis. CONCLUSIONS: Although the establishment of a cut point for PSAD diminishes sensitivity, prostate biopsy habits should be modified assuming the loss of tumors in patients with low PSAD and increasing the number of biopsies in patients with total PSA values below 4 ng/ml with higher densities

[Tolerability and complications of the ultrasound guided transrectal biopsy of the prostate extended to 10 cores. The role of neurovascular bundle blockage with lidocaine]. / Tolerancia y complicaciones de la biopsia transrectal ecodirigida prostática ampliada a diez cilindros. papel del bloqueo de haces neurovasculares con lidocaína.

OBJECTIVES: The growing interest on increasing the number of biopsy samples during ultrasound guided prostatic biopsies moved us to evaluate the tolerability and complications of the extensive biopsy with/without blockage of neurovascular bundles. METHODS: A group of 222 patients underwent prostatic biopsy with the aim to obtain 10 cores on each. After evaluation of the first 50 cases performed without anesthesia, decision was taken to proceed with neurovascular blockage with 2% lidocaine, comparatively evaluating both groups for results on tolerability, complications and global adverse events. RESULTS: The aimed number of cores could not be completed in 16% of the patients without anesthesia in comparison with 2.33% with anesthesia (p < 0.002); the biopsy was qualified as painful or very painful by 10.9% and 1.9% respectively (p < 0.0002). The results of the visual analogical scale for pain were 2.46 +/- 1.67 and 4.5 +/- 2.11 for the anesthesia/without anesthesia groups respectively, with mild-moderate vagal reactions in 28% of these latter in comparison with 7.7% in patients receiving lidocaine. Rectal bleeding was the most worrying complication, being moderate-severe in 4.7% of the patients, with 2% hospital admission. CONCLUSIONS: The increase in the number of ultrasound guided prostatic biopsy samples may be associated with a higher frequency of complications, mainly bleeding, and requires the application of local anesthesia due to worse tolerance. Neurovascular bundle blockage with lidocaine is very effective to diminish biopsy associated pain.

[The role of prostate volume in ultrasound guided transrectal prostate biopsy: is it as important as a marker as PSA?]. / Papel del volumen prostático en la biopsia transrectal ecodirigida de próstata: es un marcador tan importante como el psa?

OBJECTIVES: The limitations of PSA to identify patients with prostate cancer prompted the definition of different parameters trying to increase specificity without reducing sensitivity. This paper studies the relationship of volume and presence of prostate cancer in sextant biopsies. METHODS: We collected the results of prostate biopsies performed to 6000 patients between 1994 and 2002. 861 of them underwent more than one biopsy, adding up for a total of 7127 biopsies. Various predictive models to identify factors related to positive biopsy were constructed. RESULTS: Mean prostate volume is 14.6 +/- 66.2 cc for the first biopsy, increasing in successive biopsies to 85.17 cc. A high incidence of prostate cancer was observed in small prostates, reaching 67.2% of those with normal size (< 20 cc) and diminishing with the increase of volume down to only 19.7% in those larger than 50 cc (p < 0.0001). In second biopsies of patients with PSA between 4 and 10 ng/ml and gland volume higher than 50 cc percentage of biopsies positive for cancer was below 10%. Multivariant logistic regression showed that PSA, volume and PSA density were related with positive biopsies, but not free/total PSA ratio. CONCLUSIONS: Standard PSA cutoffs are not adequate for a proper diagnosis of prostate cancer by ultrasound guided transrectal biopsy Volume (BPH) has a significant influence in PSA values and results of the biopsy, so that it should be taken into consideration when indicating biopsies.

[Current status of high-resolution scrotal echography]. / Estado actual de la ecografia escrotal de alta resolución.

OBJECTIVES: To review the main images that can be observed by ultrasound, trying to highlight what decision to take after their finding: exploratory surgery, orchyectomy, or follow-up. METHODS: We performed a bibliographic review about the topic and incorporated our personal experience with scrotal ultrasound. Given that there is an extensive variety of anomalies that can be observed we divide them in liquid and solid lesions, and these in intra or extratesticular, plus a group of lesions that do not qualify in the previous groups. RESULTS: The development of high frequencies transducers (8-10 Mhz) and a greater experience today allows to diagnose not only testicular tumors but also a number of benign clinical entities, with enough specificity in some of them as to avoid surgery. CONCLUSIONS: Ultrasound is a simple test, painless, and can be repeated without trouble, so that it is the first test that should be ordered when managing any intra scrotal problem.

Estado actual de la ecografia escrotal de alta resolución / Update on high-resolution scrotal ultrasound

OBJETIVOS: Se pretende hacer un repaso a las principales imágenes que pueden observarse en ecografía intentando señalar que actitud tomar con posterioridad a su hallazgo: cirugía exploradora, orquiectomía o seguimiento. MÉTODO: Se ha revisado la bibliografía sobre el tema a lo que hemos incorporado nuestra experiencia personal en ecografía escrotal. Dado lo extenso de las anomalías que pueden observarse se han dividido en lesiones líquidas y sólidas y estas en intra o extratesticulares, además de un grupo no clasificable en los anteriores. RESULTADOS: El desarrollo de transductores de alta frecuencia (8-10 Mhz) y una mayor experiencia permiten hoy día el diagnóstico no sólo de los tumores testiculares sino de una serie de entidades clínicas benignas con suficiente especificidad en algunas de ellas como para evitar la cirugía. 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 (AU)

[Comparison of prostate volume measured by transrectal and abdominal echography and its implication for the measurement of the PSA density for the diagnosis of prostate cancer]. / Comparación del volumen prostático medido por ecografía transrectal y abdominal y su implicación en la determinación de la densidad de PSA para el diagnóstico del cáncer prostático.

OBJECTIVE: To compare PSA density (PSAD) results based on prostate volume measurements obtained by either transrectal or abdominal ultrasound (US) in the diagnosis of prostate cancer. METHODS: We prospectively selected 420 consecutive subjects whom at the time of a transrectal US (TRUS) guided biopsy or an abdominal US had the other US evaluation done within the previous 6 months and who did not undergo hormonal, surgical o radiotherapeutic therapy. For both abdominal and transrectal US PSAD (PSA/volume) were obtained from this data and compared, with volumes calculated using the formula: V = antero-posterior diameter2 x transverse diameter/2. RESULTS: 140 patients had prostate cancer (33.8%). Using Student's t test mean differences were 0.27 cm for anteroposterior diameter, 0.39 cm for transverse diameter, 3.36 cc for volume and 0.014 for PSAD, being the differences significative in all cases (p < 0.001). When ROC curves were calculated for TRUS PSAD and abdominal PSAD areas obtained were 0.66 and 0.67 respectively. For a PSAD cut off point of 0.15, in patients with PSA values between 4-10 ng/ml Sensitivity was 0.77 for TRUS and 0.75 for abdominal US, and specificity was 0.40 and 0.49 respectively. CONCLUSIONS: Although statistically significative differences were found in all measurements between TRUS and abdominal US, most probably due to the high number of patients, these differences have little clinical relevance as the other results show. In our experience PSAD calculation by abdominal US has the same utility than by transrectal US and avoids its mayor inconvenience which is to perform TRUS.

Comparación del volumen prostático medido por ecografía transrectal y abdominal y su implicación en la determinación de la densidad de PSA para el diagnóstico del cáncer prostático / Comparison of prostate volume measurements by transrectal or abdominal ultrasound and its involvement in PSA density assessment for prostate cancer diagnosis

OBJETIVO: En este trabajo se pretende comparar la densidad de PSA empleando el volumen obtenido por vía transrectal y por vía abdominal para el diagnóstico de cáncer prostático. MÉTODOS: De forma prospectiva se seleccionaron 420 pacientes consecutivos que en el momento de realizarse una biopsia prostática o una ecografía urológica tuvieran realizada la otra prueba en un plazo no superior a 6 meses y no hubieran sido sometidos a tratamiento quirúrgico, hormonal o de radioterapia. A partir de estos datos se ha obtenido la DPSA (PSA/volumen) con el volumen calculado según la fórmula V = diámetro anteroposterior²x diámetro transversal/2, empleando las medidas por vía abdominal y transrectal y se han comparado estos datos entre sí. RESULTADOS: Presentaban cáncer 140 pacientes (33,8 por ciento). Empleando la prueba t para comparación de medias se ha encontrado que la media de la diferencia para el diámetro anteroposterior es de 0,27 cm, 0,39 cm para el diámetro transversal, 3,36 cc para el volumen y 0,014 para la DPSA, siendo en todos los casos significativa (p<0,0001). Al calcular las curvas ROC para la DPSA transrectal y DPSA abdominal se han obtenido áreas de 0,66 para la primera y 0,67 para la abdominal. Para puntos de corte de DPSA de 0,15 la sensibilidad es de, 0,77 para la obtenida por vía transrectal y 0,75 por vía abdominal y la especificidad de 0,40 y 0,49 respectivamente en pacientes con PSA entre 4 y 10 ng/ml. CONCLUSIONES: A pesar de encontrar diferencias significativas en todas las medidas entre la vía transrectal y abdominal, atribuible al elevado número de pacientes, estas diferencias tienen poca relevancia como apuntan el resto de resultados. En nuestra experiencia el cálculo de la densidad de PSA por vía abdominal tiene la misma utilidad que por vía transrectal y evita el mayor inconveniente atribuido a esta que es la realización de la ecografía transrectal (AU)

[Complications of prostatic echo-guided transrectal biopsy and tolerance depending on the patient and the operator. Study of 205 patients]. / Complicaciones de la biopsia transrectal ecodirigida prostática y tolerancia según el paciente y el realizador. Estudio de 305 pacientes.

OBJECTIVE: Ultrasound-guided transrectal biopsy of the prostate is generally considered to be well-tolerated and with few complications. The results of a prospective study that evaluated patient and biopsy performer's perception of the foregoing aspects are presented. METHODS: The records of 305 consecutive patients submitted to ultrasound-guided transrectal biopsy were analyzed. Aspects of the physical examination and biopsy performer's assessment of patient tolerance were recorded in 290 cases. 264 patients filled out a questionnaire on different aspects of the test. A telephone interview was carried out to obtain data on side-effects and complications of the biopsy procedure. Patient and biopsy performer's perception of tolerance and complications of ultrasound-guided transrectal biopsy were analyzed. RESULTS: Biopsy could not be performed in 1% of the cases due to pain. Before biopsy 34.5% of the patients thought the procedure would be painful, while only 6.8% sustained this view after biopsy. Insertion of the transducer and punction were considered to be painful by 8% and 12.9% of the patients, respectively, and 2.9% considered anesthesia should be used for the procedure. Tolerance of biopsy punction remained unchanged throughout the procedure in 53.2% and became worse as the test proceeded in the remaining patients. Anxiety and increased anal tone were found to be the only factors that had an impact on tolerance. The complications were: fever > 38 degrees C (0.7%), rectal bleeding that required admission to the observation ward (1%), hematuria (51.1%), hemospermia (21.3%), difficulty in voiding (2.5%) and urinary retention (0.3%). Moderate vagal reactions were the most common immediate complications (2.4%). CONCLUSIONS: Ultrasound-guided transrectal biopsy is generally well-tolerated and with few complications. Rectal bleeding is the complication that most frequently requires management and causes more anxiety to patients, but infection is the most severe.

Complicaciones de la biopsia transrectal ecodirigida prostática y tolerancia según el paciente y el realizador. Estudio de 305 pacientes / Patient and biopsy performer's perception of complications and tolerance of ultrasound-guided transrectal biopsy. Experience with 305 patients

Objetivo: La biopsia transrectal ecodirigida de próstata (BTE) es una prueba generalmente considerada como bien tolerada y de escasas complicaciones. Este estudio prospectivo evalúa estos aspectos así como la percepción que el realizador tiene de la tolerancia del paciente. Método: Se recogen datos de 305 pacientes consecutivos, remitidos para BTE. En 290 se registraron aspectos de la exploración física y de la valoración que el realizador hizo de la tolerancia del paciente. 264 pacientes contestaron un cuestionario sobre distintos aspectos de la prueba. Se contactó con los pacientes telefónicamente para recoger los efectos secundarios y complicaciones de la biopsia. Se analizan las complicaciones y la tolerancia según los realizadores y los pacientes. Resultados: En un 1 por ciento no fue posible realizar la biopsia por dolor. El 34,5 por ciento pensaba a priori que sería dolorosa mientras que esta opinión sólo la mantenían el 6,8 por ciento después de la biopsia. El 8 por ciento consideró dolorosa la introducción del transductor y el 12,9 por ciento las punciones. 2,9 por ciento de los pacientes consideran que sería necesario el empleo de la anestesia. Un 53,2 por ciento toleró igual todas las punciones, el resto refieren peor tolerancia a medida que la prueba progresa. La ansiedad y el tono anal aumentado son los únicos factores que influyen en la tolerancia. En cuanto a las complicaciones, apareció fiebre mayor de 38o en el 0,7 por ciento y rectorragia que obligó a ingreso en observación en el 1 por ciento. Hematuria en el 51,1 por ciento, hemospermia en el 21,3 por ciento, dificultad miccional en el 2,5 por ciento y en el 0,3 por ciento retención urinaria. Las reacciones vagales moderadas fueron la complicación inmediata más frecuente apareciendo en el 2,4 por ciento. Conclusiones: la tolerancia a la BTE es generalmente buena y con escasas complicaciones. La rectorragia es la que requiere atención médica con más frecuencia y más ansiedad genera en los pacientes pero son las complicaciones sépticas las que pueden revestir mayor gravedad (AU)