[Altered urinary calcium excretion in prostate cancer patients subjected to androgen deprivation. Preliminary pilot study results.] / Alteración de la excreción urinaria de calcio en pacientes sometidos a deprivación androgénica por cáncer de próstata. Resultados preliminares de un estudio piloto.

OBJECTIVES: Androgen deprivation therapy (ADT) in prostate cancer is associated with the appearance of different adverse effects. Among these effects, notable ones that may affect metabolism are osteoporosis and metabolic syndrome. The aim of this study is to analyse lithogenic risk markers three months after initiating treatment with LHRH analogue. METHODS: Pilot study encompassing 15 prostate cancer patients who were candidates for ADT, which they received in the form of quarterly doses of goserelin 10.8 mg. A blood and urine analyses for lithogenic risk, bone and metabolic markers were carried out, as was a study of metabolic syndrome criteria. Statistical analysis was performed with SPSS 17.0, taking P≤.05 to be statistically significant. RESULTS: Patients included in the study had a mean age of 72.46 ± 6.61 years. We observed a significant increase in the percentage of metabolic syndrome (20% versus 46.7%; P<.05) and insulin resistance index (1.87 versus 2.96; P=.01) at 3 months treatment. There was a notable increase in bone remodelling markers and significant increases in 24 h urinary calcium values (9.46 versus 14.57 mg/dl; P=.008), 24 h urinary calcium excretion index (0.10 versus 0.13 mg/dl GF [glomerular filtration]; P=.01) and the fasting calcium/ creatinine ratio (0.107 versus 0.195; P=.007), without any changes to other lithogenous risk markers. CONCLUSIONS: Androgen deprivation therapy can lead to the short-term appearance, primarily when fasting, of hypercalciuria in prostate cancer patients, possibly in association with bone metabolism.

Alteración de la excreción urinaria de calcio en pacientes sometidos a deprivación androgénica por cáncer de próstata. Resultados preliminares de un estudio piloto / Altered urinary calcium excretion in prostate cancer patients subjected to androgen deprivation. Preliminary pilot study results

OBJETIVOS: La terapia de deprivación androgénica en el cáncer de próstata se relaciona con la aparición de diferentes efectos adversos. En el ámbito metabólico destacan la aparición de osteoporosis y síndrome metabólico. El objetivo de este estudio es analizar los marcadores de riesgo litógeno a los 3 meses de haber iniciado tratamiento con análogo LHRH. MÉTODOS: Estudio piloto que incluye a 15 pacientes con cáncer de próstata subsidiarios de tratamiento con deprivación androgénica que se realiza con goserelina 10,8 mg trimestral. Se realiza estudio en sangre y orina de marcadores de riesgo litógeno, marcadores óseos y metabólicos, así como estudio de criterios de síndrome metabólico. Análisis estadístico con programa SPSS 17.0, considerando p≤0,05 como significación estadística. RESULTADOS: La edad media de los pacientes incluidos fue de 72,46 ± 6,61 años. Se observó un aumento significativo del porcentaje de síndrome metabólico a los 3 meses de tratamiento (20% versus 46,7%; p < 0,05), así como del índice de resistencia a la insulina (1,87 versus 2,96; p = 0,01). Destaca un aumento de los marcadores de remodelado óseo, así como un aumento significativo de la calciuria (9,46 versus 14,57 mg/dl; p = 0,008), del índice de excreción urinario de calcio (0,10 versus 0,13 mg/dl FG; p = 0,01) y del cociente calcio/creatinina de ayunas (0,107 versus 0,195; p = 0,007), sin modificaciones en otros marcadores de riesgo litógeno. CONCLUSIÓN: La terapia de deprivación androgénica puede inducir a corto plazo incremento de la calciuria, fundamentalmente de ayunas, en este tipo de pacientes en posible relación con alteración del metabolismo óseo

OBJECTIVES: Androgen deprivation therapy (ADT) in prostate cancer is associated with the appearance of different adverse effects. Among these effects, notable ones that may affect metabolism are osteoporosis and metabolic syndrome. The aim of this study is to analyse lithogenic risk markers three months after initiating treatment with LHRH analogue. METHODS: Pilot study encompassing 15 prostate cancer patients who were candidates for ADT, which they received in the form of quarterly doses of goserelin 10.8 mg. A blood and urine analyses for lithogenic risk, bone and metabolic markers were carried out, as was a study of metabolic syndrome criteria. Statistical analysis was performed with SPSS 17.0, taking P≤.05 to be statistically significant. RESULTS: Patients included in the study had a mean age of 72.46 ± 6.61 years. We observed a significant increase in the percentage of metabolic syndrome (20% versus 46.7%; P<.05) and insulin resistance index (1.87 versus 2.96; P=.01) at 3 months treatment. There was a notable increase in bone remodelling markers and significant increases in 24 h urinary calcium values (9.46 versus 14.57 mg/dl; P=.008), 24 h urinary calcium excretion index (0.10 versus 0.13 mg/dl GF [glomerular filtration]; P=.01) and the fasting calcium/ creatinine ratio (0.107 versus 0.195; P=.007), without any changes to other lithogenous risk markers. CONCLUSIONS: Androgen deprivation therapy can lead to the short-term appearance, primarily when fasting, of hypercalciuria in prostate cancer patients, possibly in association with bone metabolism

Deprivación androgénica en cáncer de próstata y riesgo de aparición de litiasis renal. Resultados de un estudio de casos y controles / Androgen deprivation therapy in prostate cancer and risk of developing renal calculi: Results of a case-control study

Antecedentes y objetivo: El tratamiento de privación androgénica en el cáncer de próstata se asocia a la aparición de diferentes efectos adversos, entre los que se encuentran la osteoporosis y el síndrome metabólico. Ambos están relacionados con la aparición de nefrolitiasis. El objetivo de este estudio es analizar la aparición de nefrolitiasis en pacientes sometidos a este tratamiento con análogos LHRH. Pacientes y métodos: Estudio de casos y controles en el que se incluyeron un total de 85 pacientes divididos en 2 grupos: el grupo 1 estaba formado por 41 pacientes con tratamiento de privación androgénica y el grupo 2 por 44 pacientes sin tratamiento de privación androgénica. Resultados: En el grupo 1 se produjo litiasis de nueva aparición en 12 casos (29,3%) frente a 2 casos en el grupo 2 (4,5%) (p = 0,0001), a los 4,4 años de comenzar el tratamiento de privación androgénica. La odds ratio estimada fue de 8,69 (IC al 95% 1,81-41,76). Conclusión: Parece existir relación entre el tratamiento con análogos LHRH y la litiasis; no obstante, son precisos estudios prospectivos a largo plazo con control metabólico para poder establecer las causas que expliquen la aparición de este fenómeno (AU)

Background and objective: Androgenic deprivation therapy in prostate cancer is associated with the onset of different adverse effects, including osteoporosis and metabolic syndrome. Both are related to the onset of nephrolithiasis. The objective of this article is to study the incidence of renal stones in patients undergoing androgen deprivation therapy with LHRH analogue. Patients and methods: Case-control study including a total of 85 patients divided into 2 groups: group 1, with 41 patients on androgen deprivation therapy, and group 2, with 44 patients not receiving androgen deprivation therapy. Results: New-onset lithiasis was observed in 12 cases (29.3%) in group 1 compared to 2 cases (4.5%) in group 2 (P = .0001), 4.4 years after starting the androgen deprivation therapy. The estimated odds ratio was 8.69 (95% CI 1.81-41.76). Conclusion: The incidence of renal stones could be increased in patients receiving treatment with analogue LHRH. However, long-term prospective studies with a metabolic control are required to be able to establish the causes explaining the development of this phenomenon in patients undergoing treatment with androgen deprivation therapy (AU)

Androgen deprivation therapy in prostate cancer and risk of developing renal calculi: Results of a case-control study. / Deprivación androgénica en cáncer de próstata y riesgo de aparición de litiasis renal. Resultados de un estudio de casos y controles.

BACKGROUND AND OBJECTIVE: Androgenic deprivation therapy in prostate cancer is associated with the onset of different adverse effects, including osteoporosis and metabolic syndrome. Both are related to the onset of nephrolithiasis. The objective of this article is to study the incidence of renal stones in patients undergoing androgen deprivation therapy with LHRH analogue. PATIENTS AND METHODS: Case-control study including a total of 85 patients divided into 2 groups: group 1, with 41 patients on androgen deprivation therapy, and group 2, with 44 patients not receiving androgen deprivation therapy. RESULTS: New-onset lithiasis was observed in 12 cases (29.3%) in group 1 compared to 2 cases (4.5%) in group 2 (P=.0001), 4.4 years after starting the androgen deprivation therapy. The estimated odds ratio was 8.69 (95% CI 1.81-41.76). CONCLUSION: The incidence of renal stones could be increased in patients receiving treatment with analogue LHRH. However, long-term prospective studies with a metabolic control are required to be able to establish the causes explaining the development of this phenomenon in patients undergoing treatment with androgen deprivation therapy.

Value of focal applied energy quotient in treatment of ureteral lithiasis with shock waves.

The treatment of ureteral lithiasis by extracorporeal shock wave lithotripsy (ESWL) is progressively being abandoned owing to advances in endoscopic lithotripsy. The purpose of this paper is to analyze the causes as to why ESWL is less effective-with a measurable parameter: focal applied energy quotient (FAEQ) that allows us to apply an improvement project in ESWL results for ureteral lithiasis. A prospective observational cohort study with 3-year follow-up and enrollment period was done with three groups of cases. In Group A, 83 cases of ureteral lithiasis were treated by endoscopic lithotripsy using Holmiun:YAG laser. In Group B, 81 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP). In Group C, 65 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP) (FAEQ >10). Statistical study and calculation of RR, NNT, Chi-square test, Fisher's exact test, and Student's t test were done. Efficiency quotient (EQ) and focal applied energy quotient [FAEQ = (radioscopy seconds/number of shock waves) × ESWL session J] were analyzed. From the results, the success rate of the treatment using Holmium:YAG laser lithotripsy and ESWL is found to be 94 and 48%, respectively, with a statistically significant difference (p < 0.001). Success rate of endoscopic laser lithotripsy for lumbar ureteral stones was 82% versus 57% of ESWL (p = 0.611). In Group B, FAEQ was 8.12. In Group C, success rate was 93.84% with FAEQ of 10.64%. When we compare results from endoscopic lithotripsy with Holmium:YAG laser in Group B with results from ESWL with FAEQ >10, we do not observe absolute benefit choosing one or the other. In conclusion, the application of ESWL with FAEQ >10, that is, improving radiologic focalization of the calculus and increasing the number of Joules/SW, makes possible a treatment as safe and equally efficient as Holmium:YAG laser lithotripsy in ureteral lithiasis less than 13 mm.

Gross calcification on distal end of ureteral stent.

OBJECTIVE: The commonest indications for ureteral stent placement are: obstructive nephrolithiasis, renoureteral surgery, urologic oncology, endourology and extrinsic ureteral compression. METHODS: We report the case of a 77-year-old male patient with a DJ ureteral catheter placed for an 8-month period and history of nephrolithiasis; the stent showed a 60 mm x 30 mm calcification on its distal end. RESULTS: Open cystolithotomy and removal of stent resolved the clinic symptomatology. CONCLUSION: A prolonged indwell time of stents, as well as a history of nephrolithiasis and urinary infections may on many occasions result in calcification and encrustation of ureteral stents, and will lead to the use of endourology techniques, extracorporeal lithotripsy or open surgery to resolve these conditions.

Calcificación gigante en extremo distal de stent ureteral / Gross calcification on distal end of ureteral stent

OBJETIVO: Las indicaciones más habituales para la colocación de un stent ureteral son nefrolitiasis obstructivas, cirugía nefroureteral, oncología urológica, endourología, compresión ureteral extrínseca y como apoyo previo al tratamiento con LEOC.MÉTODOS: Presentamos un caso de un varón de 77 años de edad con catéter ureteral DJ colocado durante 8 meses y con antecedentes personales de nefrolitiasis que presenta calcificación de 60 mm x 30 mm de extremo distal del mismo.RESULTADOS: Se realizó cistolitotomía abierta y extracción del stent que solventó el cuadro. La composición del cálculo fue fosfato amónico magnésico con trazas de urato amónico y fosfato cálcico.CONCLUSIÓN: En muchas ocasiones la persistencia prolongada de dicho stent, junto con antecedentes de nefrolitiasis e infección urinaria predispone a la calcificación y encrustamiento de dicho catéter ureteral, siendo necesarias técnicas de endourología, litotricia extracorpórea o cirugía abierta para la resolución de dichos cuadros (AU)

OBJECTIVE: The commonest indications for ureteral stent placement are: obstructive nephrolithiasis, renoureteral surgery, urologic oncology, endourology and extrinsic ureteral compression.METHODS: We report the case of a 77-year-old male patient with a DJ ureteral catheter placed for an 8-month period and history of nephrolithiasis; the stent showed a 60 mm x 30 mm calcification, on its distal end.RESULTS: Open cystolithotomy and removal of stent resolved the clinic symptomatology.CONCLUSION: A prolonged indwell time of stents, as well as a history of nephrolithiasis and urinary infections may on many occasions result in calcification and encrustation of ureteral stents, and will lead to the use of endourology techniques, extracorporeal lithotripsy or open surgery to resolve these conditions (AU)

Relationship between biopsy Gleason score and radical prostatectomy specimen Gleason score in patients undergoing sextant vs 12 core biopsies.

OBJECTIVES: Our goal is to analyze the degree of concordance between the Gleason score (GS) obtained in prostate biopsies and the one after radical prostatectomy. The intention is to know whether 12-core biopsy, instead of 6 (sextant biopsy), improves, or not, this correlation. METHODS: A Cohort/prevalence study was conducted on 128 patients who underwent prostate biopsy and subsequent radical prostatectomy. Patients showing biopsy Gleason values greater or equal to 6 were selected as candidates for radical prostatectomy. RESULTS: Mean age of the group of 128 patients was 62.9 years, with a mean PSA value of 8.53ng/ml. There was concordance between biopsy Gleason score and that obtained after radical prostatectomy in 63.28% of cases, while discordance was found in 36.72% of cases. There were not significant statistical differences after comparing results obtained between Gleason score concordance after 6 or 12-core biopsies and that obtained after radical prostatectomy. CONCLUSIONS: We have noticed a low correlation between Gleason score after biopsy when it was compared with that obtained after radical prostatectomy, while these results are similar to those found in the literature. We did not find better results regarding Gleason score correlation after biopsies performed with 12 cores instead of 6.

Relación entre score gleason biópsico y score gleason tras prostatectomía radical en pacientes sometidos a biopsia sextante vs 12 cilindros / Relationship between biopsy gleason score and radical prostatectomy specimen gleason score in patients undergoing sextant vs 12 core biopsies

OBJETIVO: El cáncer de próstata es una patología cada vez más prevalente por la longevidad de la población. Es por ello que cada vez con más frecuencia se somete a los pacientes a realización de biopsia prostática para realizar su diagnóstico de certeza.Nuestro objetivo fue analizar la relación del score gleason obtenido en la biopsia de próstata con el obtenido tras prostatectomía radical. Se pretendió analizar si la obtención de 12 cilindros en lugar de 6 (biopsia sextante) mejora o no esta relación.MÉTODOS: Se realizó un estudio de casos y controles con 128 pacientes (98 casos en los que se obtuvó 6 cilindros y 30 controles en los que se obtuvieron 12 cilindros) que fueron sometidos a biopsia de próstata y posterior prostatectomía radical. Para ello se seleccionaron a pacientes con Gleason biópsico mayor o igual de 6 y candidatos a prostatectomía radical.RESULTADOS: La media de edad de los 128 pacientes incluidos en el estudio fue de 62,9 años, con una media de PSA de 8,53 ng/ml. Se observó igualdad de Score Gleason biopsia/prostatectomía en el 63,28 % de los pacientes y desigualdad en el 36,72 %. Tras comparar los resultados obtenidos entre la relación del score gleason tras extracción de 6 o 12 cilindros y tras prostatectomía radical no se apreciaron diferencias estadísticamente significativasCONCLUSIONES: La correlación gleason biopsia-prostatectomía radical es baja. No apreciamos mejoría significativa para esta correlación el obtener 12 cilindros en lugar de 6(AU)

OBJECTIVES: Our goal is to analyze the degree of concordance between the Gleason score (GS) obtained in prostate biopsies and the one after radical prostatectomy. The intention is to know whether 12-core biopsy, ins-tead of 6 (sextant biopsy), improves, or not, this correla-tion.METHODS: A Cohort/prevalence study was conducted on 128 patients who underwent prostate biopsy and subsequent radical prostatectomy. Patients showing biop-sy Gleason values greater or equal to 6 were selected as candidates for radical prostatectomy.RESULTS: Mean age of the group of 128 patients was 62.9 years, with a mean PSA value of 8.53ng/ml. There was concordance between biopsy Gleason score and that obtained after radical prostatectomy in 63.28% of cases, while discordance was found in 36.72% of cases. There were not significant statistical differences after comparing results obtained between Gleason sco-re concordance after 6 or 12-core biopsies and that obtained after radical prostatectomy.CONCLUSIONS: We have noticed a low correlation between Gleason score after biopsy when it was com-pared with that obtained after radical prostatectomy, while these results are similar to those found in the lite-rature. We did not find better results regarding Gleason score correlation after biopsies performed with 12 cores instead of 6(AU)

Spontaneous retroperitoneal abscess as the first clinical manifestation of a non-functioning retroperitoneal paraganglioma.

We demonstrate a novel clinical presentation of paraganglioma not described in the literature. The paraganglioma is a catecholamine secretory, or non-secretory, neuroendocrine tumour that derives from chromaffin cells. Its frequency, with regard to pheochromocytoma, is low, and the abdominal region is the most frequent localisation site, followed in importance by the cervical region. We report the case of a 54-year-old woman diagnosed with a retroperitoneal abscess; after drainage of the lesion, samples indicated necrotic paraganglioma cells, so it was decided to conduct a survey to determine catecholamine levels in urine, and carry out a MIBG gammagraphy, which described a non-functioning retroperitoneal paraganglioma that underwent surgical removal. There was no residual disease after 3-month follow-up.

Treatment of ureteral lithiasis with tamsulosin: literature review and meta-analysis.

OBJECTIVE: Ninety percent of ureteral calculi <4 mm are expelled over a period of 3 months; if they are >6 mm the elimination possibilities are reduced to 30%. Presently, investigations in the treatment of ureteral lithiasis have the objective of modifying ureter contractibility with the aid of calcium antagonist and alpha-blocking drugs. The objective of this study is to analyze the effect of tamsulosin in the treatment of the distal ureter lithiasis and to make a systematic analysis of the literature. PATIENTS AND METHODS: In a prospective study 70 cases of distal ureter lithiasis were divided into 2 groups: group 1 = 35 cases treated with ibuprofen (600 mg/12 h) and 2,000 ml water/24 h with tramadol on demand, and group 2 = 35 cases with the same treatment as described before plus tamsulosin 0.4 mg/day over 3 weeks. The number of stone-free patients, time to expulsion and the necessity for analgesia were evaluated. A literature review (2002-2007) and meta-analysis of 11 studies was performed. Statistical analysis included relative risk (RR), number needed to treat (NNT) and chi(2) test. RESULTS: Group 1 reported 19 stone expulsions (54.3%) and group 2 30 expulsions [85.7%, chi(2) = 8.23 (p < 0.01), RR = 1.58, NNT = 3 (95% CI 2-9)]. The mean time to expulsion was 14 days in group 1 and 8 days in group 2. No side effects were detected. Meta-analysis included 792 patients: 392 patients in group 1 and 400 patients in group 2. Group 1 reported 211 stone expulsions (53.8%) and group 2 reported 332 expulsions [83%, chi(2) = 78.17 (p < 0.01), RR = 1.54, absolute benefit = 29.2% (95% CI 23-35.3%), NNT = 3 (95% CI 3-4)]. The mean time to expulsion was 9.45 days in group 1 and 6.07 days in group 2 treated with tamsulosin; a significant difference was observed in all studies. CONCLUSIONS: Tamsulosin increases the elimination of distal ureter lithiasis of <10 mm.

[Secondary hyperparathyroidism in advanced prostate cancer]. / Hiperparatiroidismo secundario en el cáncer de próstata avanzado.

BACKGROUND AND OBJECTIVE: High parathyroid hormone (PTH) concentrations are associated with increased bone resorption and bone matrix degradation. Some studies show elevated PTH concentrations and hypocalcemia in patients with advanced prostate carcinoma, although the pathophysiological significance of these findings is not well defined. MATERIALS AND METHODS: We performed a retrospective study of 60 patients diagnosed with advanced prostate cancer (44 nonmetastatic and 16 metastatic) treated with androgen deprivation. In all patients, PTH, calcium, phosphorus, 25 (OH) vitamin D and prostate-specific antigen (PSA) were determined. Bone scintigraphy had previously been performed. RESULTS: In patients with bone metastases, mean concentrations were as follows: calcium 9.19 mg/dl, phosphorus 3.47 mg/dl, 25 (OH) vitamin D 13.85 ng/ml, PTH 66.8 pg/ml and total PSA 101.27 ng/ml. For those without bone metastases, the results were calcium 9.39 mg/dl, phosphorus 3.38 mg/dl, 25 (OH) vitamin D 20.50 ng/ml, PTH 52.23 pg/ml and total PSA 2.52 ng/ml. PTH levels were significantly higher in patients with prostate cancer and bone metastases than in those without metastases (p=0.03). Vitamin D levels were also significantly lower in this group (p=0.03). There were no differences in other values. CONCLUSIONS: The present study found increased PTH concentrations in patients with advanced prostate cancer. This finding could be useful to predict disease progression.

Bladder lithiasis on tension-free polypropylene tape after TVT technique.

We describe a case of a 74-year-old woman with a history of hysterectomy and subsequent placement of tension-free tape, according to TVT procedure, who presented with bladder lithiasis secondary to bladder perforation after placement of the aforementioned tape. The treatment included endoscopic lithotripsy for lithiasis removal and resection of distal and proximal ends of intra-bladder tape with the aid of endoscopic scissors, and photocoagulation of the resulting carved lesions with Holmium:Yag laser. The composition of lithiasis was magnesium ammonium phosphate with some calcium phosphate 1 month later, the patient feels asymptomatic; cystoscopy reveals complete restitution of bladder mucosa and absence of intra-bladder protrusion of the aforementioned material.

Hiperparatiroidismo secundario en el cáncer de próstata avanzado / Secondary hyperparathyroidism in advanced prostate cancer

Antecedentes y objetivo Se conoce que concentraciones altas de PTH se asocian con aumento de reabsorción y degradación de la matriz ósea. Algunos estudios evidencian concentraciones elevadas de PTH e hipocalcemia en pacientes con carcinoma de próstata avanzado; sin embargo, su importancia fisiopatológica aún no está bien definida. Material y método Estudio descriptivo retrospectivo de 60 pacientes diagnosticados de cáncer de próstata avanzado (44 no metastásicos y 16 metastásicos) en tratamiento actual con bloqueo hormonal. En todos los casos se hicieron determinaciones de PTH, calcio, fósforo, 25 (OH) vitamina D y antígeno específico de la próstata (PSA). Se les realizó previamente gammagrafía ósea. Resultados Los pacientes con metástasis óseas presentaban unas concentraciones medias de: calcio 9,19mg/dl, fósforo 3,47mg/dl, 25 (OH) vitamina D 13,85ng/ml, PTH 66,8pg/ml y de antígeno prostático total de 101,27ng/ml. Para aquellos que no tenían metástasis óseas las medias fueron: calcio 9,39mg/dl, fósforo 3,38mg/dl, 25 (OH) vitamina D 20,50ng/ml, PTH 52,23pg/ml y antígeno prostático total de 2,52ng/ml. Los pacientes con cáncer de próstata y metástasis óseas presentaron concentraciones de PTH superiores a los no metastásicos de forma estadísticamente significativa (p=0,03). Las concentraciones de vitamina D también fueron significativamente menores en este grupo (p=0,03). No se apreciaron diferencias en el resto de los valores. Conclusiones En este estudio se ha observado un aumento de las concentraciones de PTH en los pacientes con cáncer de próstata avanzado lo que podría implicar valores pronósticos en cuanto a la evolución de la enfermedad (AU)

Background and Objective High parathyroid hormone (PTH) concentrations are associated with increased bone resorption and bone matrix degradation. Some studies show elevated PTH concentrations and hypocalcemia in patients with advanced prostate carcinoma, although the pathophysiological significance of these findings is not well defined. Materials and methods We performed a retrospective study of 60 patients diagnosed with advanced prostate cancer (44 non metastatic and 16 metastatic) treated with androgen deprivation. In all patients, PTH, calcium, phosphorus, 25 (OH) vitamin D and prostate-specific antigen (PSA) were determined. Bone scintigraphy had previously been performed. Results In patients with bone metastases, mean concentrations were as follows: calcium 9.19mg/dl, phosphorus 3.47mg/dl, 25 (OH) vitamin D 13.85ng/ml, PTH 66.8pg/ml and total PSA 101.27ng/ml. For those without bone metastases, the results were calcium 9.39mg/dl, phosphorus 3.38mg/dl, 25 (OH) vitamin D 20.50ng/ml, PTH 52.23pg/ml and total PSA 2.52ng/ml. PTH levels were significantly higher in patients with prostate cancer and bone metastases than in those without metastases (p=0.03). Vitamin D levels were also significantly lower in this group (p=0.03). There were no differences in other values. Conclusions The present study found increased PTH concentrations in patients with advanced prostate cancer. This finding could be useful to predict disease progression (AU)

Renal lithiasis in patients with primary hyperparathyroidism. Evolution and treatment.

OBJECTIVES: The relationship between hyperparathyroidism and lithiasis is quite known, so the study of parathyroid glands is especially mandatory in the face of relapses. Our objective is to analyze both primary hyperparathyroidism (PHPT) associated with renal lithiasis and the evolution of this condition after parathyroidectomy, as well as to study factors associated with the presence of lithiasis or bone pathology, and carry out a review on bibliography. METHODS: We describe a retrospective study of a series comprising 287 cases of hyperparathyroidism: 237 of them were primary and the remaining 50, secondary. We have included: sex, age, evolution time and symptoms, diagnostic tests (biochemical, radiological and histological). Factors such as number of episodes prior to diagnosis and treatments were analyzed in patients with symptomatic lithiasis to know whether patients exhibited residual lithiasis after the management of calculi or whether patients underwent episodes after parathyroidectomy, or whether or not they were treated. Statistical analysis was carried out through SPSS 15.0 for Windows. RESULTS: Forty five percent of the patients had suffered lithiasis episodes; 50%, osteopenia/osteoporosis; 23%, musculoskeletal pain; 23%, asthenia and/or depressive syndrome. In 13.5% of cases, diagnosis was supported by the presence of hypercalcemia; no other symptoms were detected. We have analyzed factors that favor or inhibit renal lithiasis formation and compared biochemical parameters from the group of primary hyperthyroidism that exhibited lithiasis (41 patients) with those patients who did not (49). We noted that lithiasis patients showed higher values of calcium, alkaline phosphatase, intact PTH, mean PTH, osteocalcin, and chlorine/phosphate, calciuria and phosphaturia indexes. Student's t test on two independent samples revealed significant statistical differences in calcium levels (p<0.05), intact PTH (<.05) and osteocalcin. CONCLUSIONS: Primary hyperparathyroidism patients with lithiasis presented higher values of parathormone, alkaline phosphatase, osteocalcin, and Cl/P and calciuria indexes than lithiasis-free PHPT patients. These patients exhibit objective improvement of symptoms after parathyroidectomy, and rarely a recurrence of lithiasis, a factor that generally coincides with persistence of residual lithiasis.

Litiasis renal en pacientes con hiperparatiroidismo primario. Evolución y tratamiento / Renal lithiasis in patients with primary hyperparathyroidism. Evolution and treatment

OBJETIVO: La relación hiperparatiroidismo-litiasis renal es bien conocida y el estudio de paratiroideses obligado en paciente con litiasis, sobre todo si hay recidivas. Nuestro objetivo es analizar los casos de HPTP con litiasis renal y su evolución tras paratiroidectomía;estudiar los factores que se asocian a la presencia de litiasis o patología ósea y revisión bibliográfica.MÉTODOS: Estudio descriptivo retrospectivo de una serie de 287 casos de hiperparatiroidismo: 237 primarios,50 hiperparatiroidismos secundarios. Hemos analizado: sexo, edad, tiempo de evolución, clínica, pruebas diagnósticas (bioquímicas, radiológicas e histológicas).En pacientes con clínica de litiasis se ha analizado el número de episodios previos al diagnóstico y su tratamiento,si presentaban litiasis residual tras el tratamiento del cálculo, si sufrieron episodios posteriores a la paratiroidectomíay si fueron tratados o no. Análisis estadísticocon SPSS 15.0 para Windows.RESULTADOS: El 45% de pacientes había presentado episodios de litiasis, 50% osteopenia/osteoporosis, 23% algias osteomusculares, astenia y/o síndrome depresivoel 23%; en el 13,5% de los casos el diagnóstico se realiza tras el hallazgo de hipercalcemia sin otros síntomas.Analizamos factores favorecedores o inhibidores de formaciónde litiasis renal, hemos comparado parámetros bioquímicos del grupo de hiperparatiroidismos primarioscon litiasis (41 pacientes) con grupo sin litiasis (49). Observamos que enfermos con litiasis presentan cifras más elevadas de calcio, fosfatasa alcalina, PTHi, PTHm, osteocalcina, índice cloro/fosfato, calciuria y fosfaturia. Al aplicar el test “t” Student para dos muestras independientesse encontraron diferencias estadísticamente significativasen niveles de calcio (p<0,05), PTHi (p<0,05) y osteocalcina...(AU)

OBJECTIVES: The relationship between hyperparathyroidism and lithiasis is quite known, so the study of parathyroid glands is especially mandatory in the face of relapses. Our objective is to analyze both primary hyperparathyroidism (PHPT) associated with renallithiasis and the evolution of this condition after parathyroidectomy,as well as to study factors associated with the presence of lithiasis or bone pathology, and carry out a review on bibliography.METHODS: We describe a retrospective study of a series comprising 287 cases of hyperparathyroidism: 237 of them were primary and the remaining 50, secondary.We have included: sex, age, evolution time and symptoms, diagnostic tests (biochemical, radiologicaland histological). Factors such as number of episodesprior to diagnosis and treatments were analyzed in patients with symptomatic lithiasis to know whether patients exhibited residual lithiasis after the management of calculi or whether patients underwent episodes after parathyroidectomy, or whether or not they were treated. Statistical analysis was carried out through SPSS 15.0 for Windows.RESULTS: Forty five percent of the patients had suffered lithiasis episodes; 50%, osteopenia/osteoporosis; 23%, musculoskeletal pain; 23%, asthenia and/or depressive syndrome. In 13.5% of cases, diagnosis was supported by the presence of hypercalcemia; no other symptoms were detected.We have analyzed factors that favor or inhibit renal lithiasisformation and compared biochemical parameters from the group of primary hyperthyroidism that exhibited lithiasis (41 patients) with those patients who did not (49). We noted that lithiasis patients showed higher valuesof calcium, alkaline phosphatase, intact PTH, mean PTH, osteocalcin, and chlorine/phosphate, calciuria and phosphaturia indexes. Student’s t test on two independentsamples revealed significant statistical differencesin calcium levels (p<0.05), intact PTH (<0.05) and osteocalcin...(AU)

[Current indications of open surgery for the treatment of renal lithiasis. Ureterocalycostomy as definitive treatment for lithiasis in a female with recurrent disease]. / Indicación actual de la cirugía abierta en el tratamiento de la litiasis renal. Ureterocalicostomía como tratamiento definitivo de litiasis en mujer con patología recidivante.

OBJECTIVE: We describe one case of recurrent lithiasis associated with anatomical alteration of the renal pelvis related to previous surgery. METHODS/RESULTS: The patient presented a urinary tract infection episode, complicated with pyonephrosis and septicemia. In the intravenous urography, infectious radiopaque pyelocaliceal multiple and complex lithiasis can be seen, as well as kidney hydronephrosis grade III-IV. Important pyelic sclerosis secondary to previous surgery on the renal unit was seen. Nephrectomy was performed with lower pole nephro-lithotomy and reconstruction of the upper urinary tract through ureterocalicostomy. Two and a half years after surgery, control urogram shows absence of urolithiasis and a slight delay of renal function. CONCLUSIONS: Ureterocalicostomy is indicated in cases of ureteropelvic junction obstruction associated with intrarenal pelvis caused by alterations of fusion, rotation or location of kidney. It is also indicated in cases of severe peripyelic fibrosis secondary to previous pyeloplasty failure or renal surgery. In our case, in addition to the infectious component of lithiasis, an anatomical alteration, probably secondary to previous surgery, caused the chronification of lithiasis. Facing such suspicion a surgical management was undertaken to eliminate the lithiasis and get a correct derivation of the working area of the kidney, in order to prevent further recurrences.

Indicación actual de la cirugía abierta en el tratamiento de la litiasis renal. Ureterocalicostomía como tratamiento definitivo de litiasis en mujer con patología renal / Current indications of open surgery for the treatment of renal lithiasis. Ureterocalycostomy as definitive treatment for lithiasis in a female with recurrent dis

OBJETIVO: Presentamos un caso de litiasis recidivante asociado a alteración anatómica de la pelvis renal secundaria a cirugía.MÉTODOS/RESULTADOS: La paciente presenta un episodio de infección urinaria complicada con pionefrosis y septicemia. En la urografía intravenosa se observa litiasis radiodensa infecciosa, pielolocalicial múltiple compleja, sobre riñón con hidronefrosis grado III-IV por importante esclerosis piélica secundaria a cirugía previa sobre dicha unidad renal. Se realiza nefrectomía polar inferior con nefrolitotomía y reconstrucción de la vía urinaria superior mediante uréterocalicostomía. Dos años y medio después de la cirugía la urografía de control refleja ausencia de litiasis y leve retraso de la función renal.CONCLUSIONES: La ureterocalicostomía está indicada en casos de obstrucción de la unión ureteropiélica asociada a una pelvis intrarrenal por alteraciones de la fusión, rotación o localización renal, y en casos de fibrosis peripiélica severa secundaria a una pieloplastía fallida o cirugía renal previa. En el caso presentado además del componente infeccioso de las litiasis, una alteración anatómica, probablemente secundaria a la cirugía previa, provocaba una perpetuación de la clínica litiásica. Ante tal sospecha se impuso una solución de tipo quirúrgico que solucionara en un tiempo tanto la eliminación de la litiasis como una correcta derivación de la zona funcionante del riñón para evitar recidivas posteriores(AU)

OBJECTIVE: We describe one case of recurrent lithiasis associated with anatomical alteration of the renal pelvis related to previous surgery.METHODS/RESULTS: The patient presented a urinary tract infection episode, complicated with pyonephrosis and septi-cemia. In the intravenous urography, infectious radiopaque pyelocaliceal multiple and complex lithiasis can be seen, as well as kidney hydronephrosis grade III-IV. Important pyelic sclerosis secondary to previous surgery on the renal unit was seen. Nephrectomy was performed with lower pole nephro-lithotomy and reconstruction of the upper urinary tract through ureterocalicostomy. Two and a half years after surgery, control urogram shows absence of urolithiasis and a slight delay of renal function.CONCLUSIONS: Ureterocalicostomy is indicated in cases of ureteropelvic junction obstruction associated with intrare-nal pelvis caused by alterations of fusion, rotation or location of kidney. It is also indicated in cases of severe peripyelic fibrosis secondary to previous pyeloplasty failure or renal sur-gery. In our case, in addition to the infectious component of lithiasis, an anatomical alteration, probably secondary to previous surgery, caused the chronification of lithiasis. Fa-cing such suspicion a surgical management was undertaken to eliminate the lithiasis and get a correct derivation of the working area of the kidney, in order to prevent further recu-rrences(AU)

Tratamiento de la litiasis vesical con láser / The treatment of bladder lithiasis with laser

OBJETIVO: El uso del láser para litotricia endoscópica, comienza en 1968 al utilizar Mulvaney un láser de rubí sin éxito, posteriormente se probaron láser de CO2 y Neodymio-YAG. Con el láser pulsado de colorante y el láser de alexandrita se obtienen unos rendimientos energéticos que oscilan de 30 a 200 mJ, su capacidad de fragmentación no es universal y esta limitada a pequeños cálculos, generalmente ureterales, por lo que no han sido alternativa terapéutica en la litiasis vesical. El láser de Holmio genera pulsos de energía de 400-2500 mJ, capaz de fragmentar todo tipo de cálculos. El Objetivo de este trabajo es analizar los resultados de la litotricia vesical endoscópica con láser de holmio YAG. MÉTODOS: En el periodo de 2006-2008 hemos tratado 21 casos de litiasis vesical, con tamaños de 1 a 4 cm. en pacientes de 8-76 años, 6 mujeres y 15 hombres, que corresponden a: Cuatro casos de litiasis infantil, 3 de ácido úrico, 1 caso de cistina, litiasis de oxalato y/o fosfato cálcico en 7 casos, 5 casos de litiasis vesical sobre extremo inferior de doble jota, 1 caso de litiasis en ureterocele intravesical. El tratamiento se ha realizado con un equipo Dornier Medilas de 20 watios de Holmio-YAG como fuente de energía, que se ha aplicado a través de cistoscopios infantil-adulto o ureteroscopios de 7-8.5 Ch. semirrígido y flexible. El control post-operatorio se ha realizado con radiografía simple de aparato urinario y ecografía. Realizamos estudio de factores de riesgo litógeno y análisis de los fragmentos del cálculo. RESULTADOS: Los 21 casos descritos corresponden a litiasis vesical secundaria o tipo II. En todos los casos se ha comprobadola ausencia de litiasis residual con estudios de imagen y se han corregido los factores de riesgo litógeno con procedimientos médicos o quirúrgicos. CONCLUSIONES: Consideramos que hoy, la litotricia vesical endoscópica con láser de holmio si es alternativa terapéutica. A pesar de que existen múltiples opciones de tratamiento endoscópico,la litotricia transuretral con láser de holmio ofrece buenos resultados con un bajo porcentaje de complicaciones (AU)

OBJECTIVES: The use of laser for endoscopic lithotripsy started in 1968 when Mulvaney tried a ruby laser without success; Later on, the CO2 laser and the Nd: YAG were tried. With the pulsed dye and alexandrite lasers energetic performances between 30 and 200 mJ are obtained, their capacity of fragmentation is not universal and is limited to small stones, generally ureteral stones, so that it has not been a therapeutic alternative for bladder lithiasis. The holmium laser generates energy pulses of 400-2500mJ, it is able to fragment every type of stone. The objective of this work is to analyze the results of endoscopic bladder lithotripsy with holmium-YAG laser. METHODS: In the period between 2006-2008 we treated 21 cases of bladder lithiasis, with a stone size between 1 and 4 cm in patients from 8-76 years, six women and 15 men, which correspond to: four cases of infantile lithiasis, 3 of uric acid, one case of cystine, seven cases of calcium oxalate and/or phosphate, five cases of bladder lithiasis growing around a double J catheter, and one case of lithiasis within an intravesical ureterocele. Treatment was performed with a 20W Dornier Medilas holmium-YAG equipment, applied using children/adult cystoscopes or 7-8.5 Ch ureteroscopes, both semirigid and flexible. Post operative control included KUB x-ray and ultrasound. We performed a study of lithogenic risk factors and stone fragments analysis. RESULTS: The 21 cases described are all secondary or type II bladder lithiasis. In all cases the absence of residual lithiasis was checked with imaging studies and the lithogenic risk factors were corrected with medical or surgical procedures. CONCLUSIONS: We consider that today bladder endoscopic lithotripsy with holmium laser is a therapeutic alternative. Despite there are multiple options for endoscopic treatment, transurethral lithotripsy with holmium laser offers good results with a low complication rate (AU)