[Clinical and analytical parameters that might indicate a second biopsy in patient with high PSA and previously negative biopsy]. / Parámetros clínicos y analíticos que indicarían la realización de una segunda biopsia en pacientes con PSAelevado y biopsia previa negativa.

OBJECTIVES: To determine what clinical, analytic and ultrasound parameters, are more effective to predict the result of a second biopsy in patient with high PSA and a first prostate biopsy negative. MATERIAL AND METHODS: It was carried out a longitudinal study in a series of 435 cases with negative prostate biopsy. In 59 of these cases it was practiced a second biopsy due to a permanent or sudden high PSA levels with or without a suspicious digital rectal examination. Of the 31 cases with a negative second biopsy, in 4 cases it was carried out a third biopsy. The biopsy was made in all the occasions by transrectal ultrasound guided sextant biopsy. It were also valued the ultrasound characteristic of the prostate, the prostate volume and the proportion of free PSA. RESULTS: It was demonstrated statistically significant differences among the patients with a second biopsy negative and positive regarding: the age, proportion of free PSA, abnormal digital rectal examination and presence of hipoechogenic areas in the prostate. The multivariate analysis demonstrated that the only significant parameters were the proportion of free PSA and the existence of an abnormal digital rectal examination. Based on the data of multivariate analysis, we settled down for the patients with normal digital rectal examination a cut-off point of 0.23 of proportion of free PSA as indication for the realization of a second biopsy, and of 0.59 for the patients with abnormal digital rectal examination. This protocol applied to our series would avoid the realization of a second biopsy in 8 patients, and a third biopsy in 1 patient, diagnosing all the cases of prostate cancer. CONCLUSIONS: The digital rectal examination associated with the proportion of free PSA constitutes a reliable parameter to indicate the realization of a second prostate biopsy in patient with high PSA and previous negative biopsy.

Parametros clínicos y analíticos que indicarían la realización de una segunda biopsia en pacientes con PSA elevado y biopsia previa negativa / Clinical and analytical parameters indicating the need of a second biopsy in patients with high PSA and earlier negative biopsy

OBJETIVOS: Determinar que parámetros clínicos, analíticos y ecográfícos resultan más eficaces para predecir el resultado de una segunda biopsia en pacientes con PSA elevado, y una primera biopsia prostática negativa.MATERIAL Y MÉTODOS: Se realizó un estudio longitudinal en una serie de 435 casos con biopsia negativa. En 59 de estos casos se practicó una SEGUNDA biopsia por mantenerse o aparecer un PSA elevado con o sin tacto rectal sospechoso. De los 31 casos en que esta segunda biopsia fue negativa, en 4 casos se realizó una tercera biopsia. La biopsia se efectuó en todas las ocasiones mediante control ecográfico, se valoraron además las características ecográficas de la próstata, el volumen prostático y la proporción de PSA libre.RESULTADOS: Se demostraron diferencias estadísticamente significativas entre los pacientes con una segunda biopsia negativa y positiva respecto a: la edad, proporción de PSA libre, tacto rectal anormal y presencia de áreas hipoecogénicas en la próstata. El análisis multivariante demostró que los únicos parámetros significativos fueron la proporción de PSA libre y la existencia de un tacto rectal anormal. Basándose en los datos del análisis multivariante se estableció para los pacientes con tacto rectal normal un punto de corte de 0,23 de proporción de PSA libre como indicación para la realización de una segunda biopsia, y de 0,59 para los pacientes con tacto rectal anormal. Este protocolo aplicado a nuestra serie evitaría la realización de una segunda biopsia en 8 pacientes, y de la tercera biopsia en 1 paciente, diagnosticando todos los casos de cáncer prostático.CONCLUSIONES: El tacto rectal combinado con la proporción de PSA libre constituye un parámetro fiable para indicar la realización de una segunda biopsia prostática en pacientes con PSA elevado y biopsia previa negativa (AU)

[Ureteral endometriosis]. / Endometriosis ureteral.

OBJECTIVE: To report a case of ureteral endometriosis, an uncommon disease in the urological practice that is diagnosed late and may cause irreversible damage to the upper urinary tract. METHODS/RESULTS: A case of unilateral ureteral endometriosis is presented. After attempting hormonal therapy and endourological management, the patient eventually underwent aggressive surgical treatment. CONCLUSIONS: The diagnosis of ureteral endometriosis should be considered in women presenting with noncalculous renal obstruction, particularly premenopausal women of low parity or those who have had previous pelvic surgery. Only a high index of suspicion and the radiological supports may help to reduce the number of alarming nephrectomies associated to this condition.

[Verrucous carcinoma of the penis or Buschke-Löwenstein tumor. A rare tumor. Apropos of a case]. / "Carcinoma verrucoso de pene o tumor de Buschke-Löwenstein". Una tumoración poco frecuente. A propósito de un caso.

An additional case of verrucous carcinoma of the penis is described. This tumor type accounts for approximately 5% of squamous carcinomas of the penis. Today penile verrucous carcinoma is widely considered to be the same tumor as that described by Buschke and Löwenstein in 1925. The histological and clinical features as well as the therapeutical aspects of this tumor type are briefly reviewed herein.

[Papillary necrosis and formation of fungal balls in a patient with AIDS: a clinical case and brief review]. / Necrosis papilar y formación de pelotones de hongos en paciente afecto de SIDA: caso clínico y breve revisión.

An AIDS case, with a Candida urinary infection causing papillary necrosis and accompanied by occurrence of fungal lumps is reported. The paper remarks on the incidence and peculiarities of urinary affectation in these patients, emphasizing the usefulness of percutaneous nephrostomy as a diagnostic, and above all as a therapeutic procedure, in cases of expanded urinary tract.

[Multilocular cyst of the kidney: clinico-pathologic considerations]. / Quiste multilocular renal: consideraciones clínico-patológicas.

Multilocular Renal Cyst is a variety contained within the Spectrum of Renal Embryonic Tumors, presenting much confusion relating to its terminology, histology, clinical aspects, etc. We have carried out a review of this subject through bibliographical compilation of the cases published between 1976-86, and close analysis of the series thus far published. The diagnostic criteria described by Boggs and Kimmeslstiels in 1956, which classify this entity separate from other varieties of R.E.T. and similar ones. This pathological state can be seen in both children and adults, and it is characterized by its unusual appearance, clinical silent in the adults and in the child it appears as an abdominal mass. This pathology lacks specific diagnostic tests as well as the assistance rendered by clinical, radiological or ultrasound studies, it will depend on a correct preoperative diagnosis, an extremely difficult task to achieve, or on a diagnostic approximation geared to avoid in the child population the implementation of coadjuvant measures to surgery that will no doubt give rise to unwanted situations in the long run. The treatment of this pathology is strictly surgical and must be preceded by an extremely conservative approach. Tumorectomy or Partial Nephrectomy is curative and sufficient. From the anatomopathological study of the surgical sample, the correct diagnosis may be inferred.

[Iatrogenic urethral pathology in paraplegic patients]. / Patología uretral yatrógena en pacientes parapléjicos.

A review is made of the urethral pathology of iatrogenic origin in 127 paraplegic patients in which the etiopathogenic mechanisms and the treatment applied are annalysed as well as the results obtained and the most suitable prophylaxis of the said pathology.