[Influence of the delay in urinary NMP22 preanalytical processing]. / Influencia del retraso en el procesamiento preanalítico de la orina en la determinacin del NMP22.

OBJECTIVES: To evaluate the influence of the delay in urinary NMP22 preanalytical processing. MATERIAL AND METHODS: Twenty-eight voided urine samples were taken: bladder cancer (14), urine tract infections (4), lithiasis (4), healthy volunteers (1), and with other no malignant bladder diseases (5). All samples, were maintained at environment temperature, and were processed according to the stabilization of parts of urine collected at 0, 30, 90 and 150 minutes. Samples were stored at 4 degrees C until its determination. NMP22 was determined with the IMMULITE One analyzer. RESULTS: There were no significant differences for NMP22 levels between each different point of time studied. CONCLUSIONS: Delay up to 2 hours and a half when we add stabilization solution to urine samples no affects NMP22 results. That thing, might provide more confidence and flexibility on quantitative immunoassays that required urine stabilization.

Influencia del retraso en el procesamiento preanalítico de la orina en la determinación del NMP22 / Influence of the delay in urinary NMP22 preanalytical processing

Objetivo: Evaluar la influencia del retraso en el procesamiento preanalítico de orinas en las que se realiza la determinación del marcador tumoral NMP22. Material y métodos: Se recogieron 28 muestras de orina: tumores vesicales (14), infecciones urinarias (4), litiasis (4), voluntarios sanos (1), y otras patologías vesicales benignas (5). De cada muestra, mantenida a temperatura ambiente, se fueron estabilizando alícuotas con el conservante suministrado por el fabricante a los 0, 30, 90 y 150 minutos, guardándose a 4ºC hasta su procesamiento. El análisis del NMP22 se realizó en autoanalizador IMMULITE One. Resultados: No se apreciaron diferencias significativas en los niveles del NMP22 entre los diferentes puntos de demora estudiados. Conclusiones: La demora de hasta dos horas y media en la adición de la solución conservante a la orina para determinación de NMP22 no afecta significativamente a los resultados obtenidos. Este hecho permite una mayor confianza y flexibilidad en los inmunoensayos cuantitativos que requieren estabilización de la muestra

Objectives: To evaluate the influence of the delay in urinary NMP22 preanalytical processing. Material and methods: Twenty-eight voided urine samples were taken: bladder cancer (14), urine tract infections (4), lithiasis (4), healthy volunteers (1), and with other no malignant bladder diseases (5). All samples, were maintained at environment temperature, and were processed according to the stabilization of parts of urine collected at 0, 30, 90 and 150 minutes. Samples were stored at 4 ºC until its determination. NMP22 was determined with the IMMULITE One analyzer. Results: There were no significant differences for NMP22 levels between each different point of time studied. Conclusions: Delay up to 2 hours and a half when we add stabilization solution to urine samples no affects NMP22 results. That thing, might provide more confidence and flexibility on quantitative immunoassays that required urine stabilization

[Female paraurethral cysts. Experience of 4 cases]. / Quistes parauretrales femeninos. Experiencia de 4 casos.

Parauthreal cysts are an uncommon pathology. We present 4 cases diagnosed and treated in our hospital during the last 10 years.

Quistes parauretrales femeninos. Experiencia de 4 casos / Female paraurethral cysts. Experience of 4 cases

Los quistes parauretrales son una patología poco frecuente. Presentamos 4 casos que fueron diagnosticados y tratados en nuestro hospital durante los últimos 10 años

Parauthreal cysts are an uncommon pathology. We present 4 cases diagnosed and treated in our hospital during the last 10 years

[Urinary bacteriologic study prior to endoscopic urologic surgery]. / Estudio bacteriológico de la orina previa a la cirugía urológica endoscópica.

OBJECTIVE: The objectives of this study are to know the incidence of preoperative bacteriuria in patients undergoing endoscopic urologic surgery, to analyze the most frequent microorganisms appearing in the cultures and their resistance to antibiotics in order to select the most appropriate prophylactic one for our population, and to determine the risk factors related to postoperative bacteriuria or sepsis of urologic origin. MATERIAL AND METHODS: 449 patients undergoing endoscopic urologic surgery were included in the study. Urinary samples were collected for culture prior to prophylactic antibiotic administration and again a week after bladder catheter removal once the antibiotic treatment was finished. Variables related to an increase in infectious complications were analyzed. Special attention was paid to postoperatory incidences, mainly those of infectious nature. RESULTS: Preoperative bacteriuria was found in 66 out of 428 patients (15.4%). It was found to be related to age, sex, previous infection episodes, diabetes mellitus, indwelling catheter and to the pathology for which operation was indicated. The most frequently found microorganism was Escherichia Coli. Resistance to prophylactic antibiotic was found in 37.9% of patients with preoperatory bacteriuria. Postoperatory bacteriuria, observed in 22.0% of the patients was exclusively related to preoperatory bacteriuria. 2.9% of patients showed sepsis of urinary origin criteria during hospital staying, and it was found to be exclusively related to length of surgery and neither to preoperatory bacteriuria nor to indwelling catheter time or the "inappropriate" prophylactic antibiotic use in these cases. CONCLUSIONS: A good part of patients who underwent endoscopic surgery showed preoperatory bacteriuria, responsible for postoperative bacteriuria in less than 25% of the cases. The length of surgery seemed to be the only related cause whit sepsis of urinary origin.

Estudio bacteriológico de la orina previa a la cirugía urológica endoscópica / Urinary bacteriologic study prior to endoscopic urologic surgery

Objetivo: Los objetivos de este estudio son conocer la incidencia de bacteriuria preoperatoria en pacientes que van a ser sometidos a intervenciones urológicas por vía endoscópica, analizar los microorganismos más frecuentes que aparecen en los cultivos y sus resistencias a los antibióticos, para así seleccionar el antibiótico profiláctico más apropiado para nuestra población y determinar qué factores de riesgo están relacionados con la aparición de bacteriuria o sepsis urinaria en el postoperatorio. Material y Método: Se incluyeron en el estudio a 449 pacientes a los que se les iba a someter a cirugía urológica endoscópica. Se recogieron muestras de orina para su cultivo antes de la administración del antibiótico profiláctico y se volvieron a tomara la semana de retirar la sonda vesical, ya sin tratamiento antibiótico. Se analizaron las variables que podían estar relacionadas con la mayor incidencia de complicaciones infecciosas. Se prestó especial atención a las incidencias del postoperatorio, y sobre todo, a las de naturaleza infecciosa. Resultados: Se detectó bacteriuria preoperatoria en 66 de 428 pacientes (15,4%). Esta se asoció a la edad, el sexo, la historia de infecciones previas, la existencia de diabetes mellitus, la presencia de sonda vesical y a la patología que indicaba la intervención quirúrgica. El tipo de microorganismo más frecuente fue Escherichia coli (43,1%). En el 37,9% de los pacientes con bacteriuria preoperatoria el microorganismo fue resistente al antibiótico utilizado profilácticamente para la intervención quirúrgica. Apareció bacteriuria postoperatoria en el 22% de los pacientes, lo que se asoció únicamente a la presencia de bacteriuria preoperatoria. El 2,9% de los pacientes tuvieron criterios de sepsis de origen urinario durante la estancia hospitalaria. La sepsis se asoció únicamente a la duración de la cirugía y no a la presencia de bacteriuria preoperatoria, ni con los días de permanencia de la sonda, y ni a la utilización, en estos casos, de un antibiótico profiláctico “no apropiado”. Conclusión: Una parte importante de los pacientes sometidos a cirugía endoscópica presentan bacteriuria preoperatoria, aunque fue responsable de la bacteriuria posoperatoria en menos del 25% de los casos. La duración de la cirugía parece ser la única causa relacionada con la sepsis de origen urinario (AU)

Objective: The objectives of this study are to know the incidence of preoperative bacteriuria in patients undergoing endoscopic urologic surgery, to analyze the most frequent microorganisms appearing in the cultures and their resistance to antibiotics in order to select the most appropriate prophylactic one for our population, and to determine the risk factors related to postoperative bacteriuria or sepsis of urologic origin. Material and Methods: 449 patients undergoing endoscopic urologic surgery were included in the study. Urinary samples were collected for culture prior to prophylactic antibiotic administration and again a week after bladder catheter removal once the antibiotic treatment was finished. Variables related to an increase in infectious complications were analyzed. Special attention was paid to postoperatory incidences, mainly those of infectious nature. Results: Preoperative bacteriuria was found in 66 out of 428 patients (15.4%). It was found to be related to age, sex, previous infection episodes, diabetes mellitus, indwelling catheter and to the pathology for which operation was indicated. The most frequently found microorganism was Escherichia Coli. Resistance to prophylactic antibiotic was found in 37.9% of patients with preoperatory bacteriuria. Postoperatory bacteriuria, observed in 22.0% of the patients was exclusively related to preoperatory bacteriuria. 2.9% of patients showed sepsis of urinary origin criteria during hospital staying, and it was found to be exclusively related to length of surgery and neither to preoperatory bacteriuria nor to indwelling catheter time or the “inappropriate” prophylactic antibiotic use in these cases. Conclusions: A good part of patients who underwent endoscopic surgery showed preoperatory bacteriuria, responsible for postoperative bacteriuria in less than 25% of the cases. The length of surgery seemed to be the only related cause whit sepsis of urinary origin (AU)

Sobre la necesidad del rasurado de la región púbica en los pacientes que van a ser sometidos a cirugía urológica endoscópica / On the need of pubic region shaving in patients undergoing endoscopic urologic surgery

OBJETIVO: El objetivo del estudio es determinar, mediante un ensayo clínico aleatorio controlado, si se produce algún aumento en el número de bacteriurias postoperatorias de un grupo de pacientes sometidos a cirugía urológica endoscópica, a los que no se rasura la región púbica (práctica inhabitual en la preparación quirúrgica actual). MATERIAL Y MÉTODO: El estudio se realizó distribuyendo a los pacientes que iban a ser intervenidos mediante cirugía urológica endoscópica de forma aleatoria en dos grupos. A un grupo se le rasuró la región púbica, según las técnicas habituales, mientras que al otro grupo no se le rasuró dicha región; el resto de la preparación fue igual para ambos grupos. Se recogieron muestras de orina para su cultivo antes de la administración del antibiótico profiláctico y se volvieron a tomar a la semana de retirar la sonda vesical, ya sin tratamiento antibiótico. Se prestó especial atención a las incidencias del postoperatorio, sobre todo, a las de naturaleza infecciosa. RESULTADOS: Se incluyeron un total de 449 pacientes, de los cuales 149 fueron retirados del estudio por diferentes causas. De estos, 149 fueron rasurados y 151 no lo fueron. En el grupo de pacientes no rasurados se observó una tasa de bacteriuria postoperatoria del 19,5%, mientras que en el otro grupo fue del 16,6%, no observándose diferencias estadísticamente significativas. CONCLUSIÓN: La conclusión a la que se llegó es que no se produce un aumento de bacteriurias postoperatorias en los pacientes sometidos a cirugía urológica endoscópica, a los que no se les rasura la región púbica, en comparación con el grupo de pacientes que son rasurados con cuchillas desechables

OBJECTIVE: The objective of this study is to assess the effects of preoperative shaving of the pubic region on postoperative bacteriuria after endoscopic urological surgery. MATERIALS AND METHOD: The study was carried out distributing the patients undergoing endoscopic urological surgery in a controlled randomized way in two groups. In a group the pubic region was shaved, according to the habitual techniques, while the other group was not shaved; the rest of the preparation was the same for both groups. Urine samples were collected for their culture before the administration of the prophylactic antibiotic and a week after the removal of the Foley catheter, yet without antibiotic treatment. Special attention was paid to the postoperative incidences, mainly, those of infectious nature. RESULTS: They were included a total of 449 patients, of which 149 were removed from the study by different causes. Of these, 149 were shaved and 151 were not it. In the group of unshaved patients a 19,5% of postoperative bacteriurias was observed, while in the other group it was of 16,6%. Differences in both groups were not statistically significant. CONCLUSIONS: We conclude that there is no an increase of postoperative bacteriurias in the unshaved patients undergoing endoscopic urological surgery, compared with the group of patients shaved with disposable bladders

[On the need of pubic region shaving in patients undergoing endoscopic urologic surgery]. / Sobre la necesidad del rasurado de la región púbica en los pacientes que van a ser sometidos a cirugía urológica endoscópica.

OBJECTIVE: The objective of this study is to assess the effects of preoperative shaving of the pubic region on post-operative bacteriuria after endoscopic urological surgery. MATERIALS AND METHOD: The study was carried out distributing the patients undergoing endoscopic urological surgery in a controlled randomized way in two groups. In a group the pubic region was shaved, according to the habitual techniques, while the other group was not shaved; the rest of the preparation was the same for both groups. Urine samples were collected for their culture before the administration of the prophylactic antibiotic and a week after the removal of the Foley catheter, yet without antibiotic treatment. Special attention was paid to the postoperative incidences, mainly, those of infectious nature. RESULTS: They were included a total of 449 patients, of which 149 were removed from the study by different causes. Of these, 149 were shaved and 151 were not it. In the group of unshaved patients a 19.5% of postoperative bacteriurias was observed, while in the other group it was of 16.6%. Differences in both groups were not statistically significant. CONCLUSIONS: We conclude that there is no an increase of postoperative bacteriurias in the unshaved patients undergoing endoscopic urological surgery, compared with the group of patients shaved with disposable bladders.

[Unusual localization of granulosa cell tumor]. / Localización poco habitual de un tumor de células granulosas.

OBJECTIVE: To present a case of granular cell tumor with an uncommon localization. METHODS: A 38-year-old patient presented with a painless nodule 10 mm in diameter on the scrotum that he had noted two years earlier. RESULTS: The tumor was surgically excised. Pathological analysis demonstrated a granular cell tumor that was strongly positive for protein S-100 and negative for cytokeratin AE1-AE3 and CEA. CONCLUSIONS: Granular cell tumors are very frequent in the head and neck, but rare in the genitourinary region and are asymptomatic. Histological diagnosis is simple but should be confirmed by protein S-100 staining, which is positive in all cases. Treatment is by simple excision of the lesion. Tumor recurrence and metastasis have been reported, therefore follow-up is necessary.

[Relationship between tumor recurrence and the expression of the p53 gene in primary superficial transitional carcinoma of the bladder]. / Relación entre las recidivas tumorales y la expresión del gen p53 en los carcinomas transicionales superficiales primarios de vejiga.

Contribution of 60 patients with primary surface transitional cell tumours of the bladder where nuclear expression of p53 protein was prospectively studied and compared to known prognostic factors in an attempt to find out its role in the development of relapses. An statistically significant relationship was found between the protein expression and cytology, tumoral multifocality, stage, relapse development and tumoral progression. It can be concluded that expression of this protein can be of use as relapse predictor.

[Long course metastasis in renal adenocarcinoma. Adrenal gland involvement]. / Enfermedad mestastásica de larga evolución en el adenocarcinoma renal. Afectación suprarrenal.

OBJECTIVES: To report two cases of metachronic adrenal metastasis (one contralateral and the other bilateral) from renal cell carcinoma with long survival. METHODS: Two patients with clear cell renal carcinoma that developed metastasis to the adrenals are described. Each patient had undergone three operations for solitary metastasis during the 8-years follow-up. The indications for the surgical management of solitary metastasis, morbidity, prognosis and recent investigational treatment possibilities reported in the literature are analyzed. RESULTS: Resection of the renal cell carcinoma achieved a survival of more than 8 years with a good quality of life and no significant surgical complications. The outcome, however, is poor. CONCLUSIONS: Although there was no lymph node involvement and the tumor was localized to the renal parenchyma, one patient developed solitary lung metastasis and contralateral adrenal metastasis 4 and 8 years after the initial diagnosis, respectively. In the other case, contralateral adrenal metastasis appeared three years later. The possibility of long-term metastasis to the adrenal gland should be taken into account due to renal vein involvement. Preservation of the adrenal gland at the initial surgery (lower pole tumor) led to adrenal metastasis 8 years after the initial diagnosis. The prognosis is poor in both cases and the situation is discouraging for the urologist.

Relación entre las recidivas tumorales y la expresión del gen p53 en los carcinomas transicionales superficiales primarios de vejiga / Relationship between tumoral relapses and p53 gen expresssion in primary surface transitional cell carcinoma of the bladder

Presentamos 60 casos de pacientes con tumores vesicales superficiales primarios de células transicionales, en los cuales hemos estudiado de forma prospectiva la expresión nuclear de la proteína p53, y la hemos comparado con factores pronósticos conocidos, intentando averiguar asimismo su papel en la aparición de recidivas. Se ha observado la existencia de una relación estadísticamente significativa entre dicha expresión y la citología, la multifocalidad tumoral, el estadio, la aparición de recidivas y la progresión tumoral. Podemos concluir que la expresión de esta proteína puede ser útil como factor predictor de las recidivas. (AU)

[Painful erections related to sleeping]. / Erecciones dolorosas relacionadas con el sueño.

Case report of sleep-related painful erections in a 34 year-old male with grade C3 HIV infection. Due to severe impairment of the patient's general condition, no proper diagnostic studies were performed to gain deeper knowledge of the symptom's pathological etiology. Empirical therapy was started based on evidence from the literature consulted, and the results seen were optimal. This paper contributes a brief review of a condition infrequently seen by the vast majority of urologists.

[Disjunction patterns: the morphological and ultrastructural bases of bladder instability in the male]. / Patrones de disyunción: bases morfológicas y ultraestructurales de la inestabilidad vesical del varón.

OBJECTIVE: To apply the new protocols and recent contributions on detrusor ultrastructural morphology in order to standardize criteria and evaluate our findings relative to the ultrastructural morphology, the presence of a dysfunction pattern, changes in nerve supply and formation of a chained cellular syncytium in hyperactive detrusor bladder instability in the male. METHODS: We studied 480 ultrastructural preparations of detrusor muscle from 32 male patients with bladder outlet obstruction with and without urodynamically demonstrated bladder hyperactivity. Bladder biopsies were obtained from the anterior aspect of the bladder and prepared according to the standard procedures for ultrastructural study. Semiquantitative nerve supply ultrastructural patterns, syncytial composition, and complete and incomplete disjunction were analyzed. RESULTS: Lower urinary tract obstruction was demonstrated in all patients; 6 of these patients had involuntary phasic detrusor contractions during filling. No significant decrease in nerve supply was found in isolated obstruction or in bladder hyperactivity. No axonal degeneration was observed in any of the patients and the myelin sheath structure was normal. Nerve effector endings were also normal. Four patients with hyperactive detrusor showed complete and two incomplete disjunction pattern. Incomplete disjunction pattern was also demonstrated in two patients with isolated obstruction. CONCLUSIONS: The change in the properties of the detrusor muscle in the unstable bladder is due to a complete reduction in excitatory nerve relation to smooth muscle. Having established the concept of common final myogenic pathway that explains involuntary detrusor contraction, complete dysfunction ultrastructural patterns have been defined with univocal relation to hyperactive detrusor. These patterns indicate the existence of a syncytium of chained muscle cells with changes in the excitation threshold that are absent in the normal stable detrusor. Two ultrastructural components sustain this hypothesis: 1) the major loss observed in intermediate cellular unions that are thought to mediate in the mechanical coupling of cellular contraction and 2) the presence in all the microscopic fields of abutments in the narrow cellular unions like gap-junctions, which mediate the electrical coupling. In the present study we have found this pattern in 4 out of 6 patients with hyperactive detrusor, and congruent with other studies, the incomplete disjunction pattern could be the prelude of bladder hyperactivity.

[Treatment of pelvis fungus ball with ureteral catheterization, fluconazole, and urine alkalinization]. / Tratamiento del fungus ball piélico con cateterismo ureteral, fluconazol y alcalinización de la orina.

Fungal concretions known as "fungus ball" may be the cause of ureteral obstruction, normally presenting as pain in the renal cavity. This paper presents one case treated with ureteral catheterism, fluconazol and urine alkalinization.

[Expression of the tumor suppressor gene p53 in superficial transitional carcinoma of the bladder]. / Expresión del gen supresor tumoral p53 en los carcinomas transicionales superficiales de vejiga.

Presentation of 113 cases of transitional cells surface tumours of the bladder where p53 protein expression has been used and compared to known prognostic factors. The existence of a statistically significant relationship between this expression and the tumoral grade and stage in all studied groups has been noticed. It can be concluded that the expression of this protein can be useful as a new prognostic factor, even though it is still necessary to conduct more studies, basically prospective.

[Valsalva minimal leak point pressure: a useful approximation to type III female urinary incontinence]. / Presión mínima de escape con Valsalva: una útil aproximación a la incontinencia urinaria femenina tipo III.

OBJECTIVE: It has been reported that anatomic female urinary incontinence with complex sphincteric malposition can coexist with intrinsic damage of the sphincter itself. In this study we analyzed the utility of measuring minimum abdominal pressure at standardized bladder capacities that causes urinary incontinence in order to quantify intrinsic sphincteric damage in female urinary incontinence. METHODS: The study comprised 50 women with urinary incontinence aged 36-78 years (mean 59.4), ICS standardized complete urodynamic study was performed. Minimum leak point pressure with Valsalva maneuver in decumbent and standing positions was determined during the filling phase of cystomanometry and it was defined as a measure of the abdominal pressure expressed as total baldder pressure without involuntary detrusor activity and exercised at standardized bladder capacities that originates objective urinary incontinence. Minimum leak point pressure for each bladder capacity was evaluated. Leak point pressures below 60 cm H2O indicate intrinsic sphincteric damage; pressures between 60 and 90 cm H2O indicate intrinsic damage and malposition or urethral hypermobility may coexist, and leak pressures over 90 cm H2O are related to complex sphincteric malposition. RESULTS: 5 women showed severe sphincteric deficiency (type III) and urinary incontinence was demonstrated with 50 ml bladder capacity and 30 cm H2O of abdominal pressure without detrusor activity. Thirty-five women (70%) had type II urinary incontinence. Of these, 10 (28.5%) showed intrinsic sphincteric damage in addition to malpositioning of the sphincteric complex at leak point pressures between 60 and 90 cm H2O. The rest of the women showed Blaivas' type 0 and I urinary incontinence. CONCLUSIONS: Valsalva minimum leak point pressure is a reproducible, reliable, useful and easily measured parameter in diagnosing female stress urinary incontinence. It allows approximation of the abdominal pressure to the level at which urinary leakage is produced during the filling phase of cystomanometry and gives us an idea of the extent of the intrinsic sphincteric damage, if any. Not only is sphincter damage demonstrated in type III urinary incontinence, but that it may also coexist to a varying degree with complex sphincteric malposition.