[Prognostic value of DNA ploidy and nuclear morphometry in metastatic prostate cancer]. / Valor pronóstico de la ploidía del ADN y la morfometría nuclear en el cáncer de próstata metastásico.

PURPOSE: To assess the prognostic value of DNA ploidy and nuclear morphometry in metastatic prostate cancer after androgenic deprivation treatment. METHODS: Fifty four patients with prostate cancer and bone metastases who had undergone androgenic suppression treatment were retrospectively studied. The deoxyribonucleic acid (DNA) content was analysed by flow cytometry. Nuclear morphometry characterized 14 nuclear descriptors. The study also included age, Gleason score, T classification, haematocrite, serum albumin, serum alkaline phosphatase, serum prostatic acid phosphatase and the amount of metastatic foci detected during radioisotope bone scan. Univariate survival analyses were performed and Cox's proportional hazards model was used to identify significant prognostic factors. To assess how the experimental factors improve the capacity of the classical factors for predicting the patients who reach median survival, logistic regression multivariate analysis was performed for the classical prognostic factors only and after added experimental variables (DNA content and Nuclear Area). RESULTS: The univariate survival analyses assigned a prognostic value to T category, level of albumin, alkaline phosphatase, Gleason score, bone scan, DNA ploidy and mean nuclear area. In the case of the Cox regression model only Gleason score, bone scan, mean nuclear area and DNA ploidy provided independent prognostic information. In logistic regression for classic prognostic factors only Gleason score is significant (sensibility 89.3%, specificity 64%). However, when the experimental factors are added, in addition to Gleason score, radioisotope bone scan and DNA ploidy are of prognostic value (sensibility 90% and specificity 72%). CONCLUSIONS: The study of DNA content and nuclear morphometry in the primitive tumor provides independent prognostic information in survival analysis for patients with metastatic prostate cancer. However, there is limited improvement with respect to the classical factors in predicting survival. This questions its utility in the daily clinical usage.

Valor pronóstico de la ploidía del ADN y la morfometría nuclear en el cáncer de próstata metastásico / Prognostic value of DNA ploidy and nuclear mophometry in metastatic prostate cancer

FUNDAMENTO: Conocer el valor pronóstico de la ploidía del ADN y la morfometría nuclear determinadas en el foco tumoral primario en pacientes afectos de cáncer de próstata con metástasis óseas. MÉTODOS: Estudio retrospectivo sobre 54 pacientes con adenocarcinoma de próstata y metástasis óseas tratados con supresión androgénica. En todos ellos se realizó análisis de ADN (citometría de flujo) sobre tejido tumoral desparafinado y estudio de morfometría nuclear. También se analizó la edad, la puntuación de Gleason, la categoría T, el hematocrito, el nivel de albúmina sanguínea, las fosfatasas alcalinas, fosfatasas ácidas prostáticas, y el número de focos metastásicos que aparecían en el rastreo. Se realizaron estudios univariantes y multivariantes de supervivencia mediante el método de Kaplan-Meier y de riesgos proporcionales de Cox, respectivamente. Finalmente, realizamos un análisis de regresión logística multivariante para los factores pronósticos clásicos y otro en el que se añadieron los experimentales (ploidía de ADN y morfometría nuclear), con la intención de conocer qué factores pueden predecir el que un paciente alcance la mediana de supervivencia y en qué medida los factores experimentales mejoran dicha predicción. RESULTADOS: En el análisis univariante de supervivencia tuvieron carácter pronóstico la categoría T, el nivel de albúmina, las fosfatasas alcalinas, la puntuación de Gleason, el rastreo óseo, la ploidía del ADN y el área nuclear media. En el multivariante únicamente aportaron información pronóstica independiente la puntuación de Gleason, el rastreo óseo, el área nuclear media y la ploidía del ADN. En el estudio de regresión logística para factores pronósticos clásicos únicamente el Gleason tiene capacidad predictiva (sensibilidad 89,3%, especificidad 64%), mientras que al introducir los factores experimentales también el rastreo óseo y la ploidía del ADN son significativos (sensibilidad 90% y especificidad 72%) (AU)

CONCLUSIONES: El estudio de contenido de ADN y de morfometría nuclear del foco tumoral primitivo aporta información pronóstica independiente en el análisis de supervivencia para el cáncer de próstata metastásico. Sin embargo, la escasa mejora en la capacidad predictiva sobre los factores pronósticos clásicos cuestionan su utilidad en la práctica clínica (AU)

PURPOSE: To assess the prognostic value of DNA ploidy and nuclear morphometry in metastatic prostate cancer after androgenic deprivation treatment. METHODS: Fifty four patients with prostate cancer and bone metastases who had undergone androgenic suppression treatment were retrospectively studied. The deoxyribonucleic acid (DNA) content was analysed by flow cytometry. Nuclear morphometry characterized 14 nuclear descriptors. The study also included age, Gleason score, T classification, haematocrite, serum albumin, serum alkaline phosphatase, serum prostatic acid phosphatase and the amount of metastatic foci detected during radioisotope bone scan. Univariate survival analyses were performed and Cox’s proportional hazards model was used to identify significant prognostic factors. To assess how the experimental factors improve the capacity of the classical factors for predicting the patients who reach median survival, logistic regression multivariate analysis was performed for the classical prognostic factors only and after added experimental variables (DNA content and Nuclear Area). RESULTS: The univariate survival analyses assigned a prognostic value to T category, level of albumin, alkaline phosphatase, Gleason score, bone scan, DNA ploidy and mean nuclear area. In the case of the Cox regression model only Gleason score, bone scan, mean nuclear area and DNA ploidy provided independent prognostic information. In logistic regression for classic prognostic factors only Gleason score is significant (sensibility 89,3%, specificity 64%). However, when the experimental factors are added, in addition to Gleason score, radioisotope bone scan and DNA ploidy are of prognostic value (sensibility 90% and specificity 72%) (AU)

CONCLUSIONS: The study of DNA content and nuclear morphometry in the primitive tumor provides independent prognostic information in survival analysis for patients with metastatic prostate cancer. However, there is limited improvement with respect to the classical factors in predicting survival. This questions its utility in the daily clinical usage (AU)

[Prognostic value of DNA ploidy in prostatic cancer]. / Valor pronóstico de la ploidía del ADN en el cáncer de próstata.

OBJECTIVE: To asses the prognostic value of deoxyribonucleic acid (DNA) ploidy in a group of patients with prostate cancer treated with adrogenic blockade. MATERIALS AND METHODS: A retrospective study on 136 patients with prostatic cancer having undergone androgenic blockade was carried out. The prognostic influence of age, T and M categories, Gleason score and flow cytometry-determined DNA ploidy from survival analyses. Univariate survival analysis was carried out following Kaplan-Meier's method, while for multivariate survival analysis Cox's proportional hazard model was used. RESULTS: The univariante analysis showed that T and M categories, Gleason score and DNA ploidy have prognostic value. The Cox's regression analysis identified DNA ploidy, metastasis and Gleason score as independent variables having prognostic potential. CONCLUSIONS: DNA ploidy has independent prognostic value in prostate cancer treated with androgenic blockade and improves the predictive potential of classical prognostic factors.

Valor pronóstico de la ploidía del ADN en el cáncer de próstata / Prognostic value of DNA ploidy in prostatic cancer

OBJETIVO: Conocer la capacidad pronóstica de la ploidía del ácido desoxirribonucleico (ADN) en un grupo de pacientes afectos de cáncer de próstata, tratados con bloqueo androgénico. MATERIAL Y MÉTODO: Realizamos un estudio retrospectivo en el que se incluyeron 136 pacientes diagnosticados de adenocarcinoma prostático, y que fueron sometidos a tratamiento de supresión androgénica. Se evaluó la influencia que tenían en el pronóstico la edad, la categoría T y M, la puntuación de Gleason y la ploidía del ADN determinada mediante citometría de flujo, para lo que se realizarón análisis de supervivencia univariantes mediante el método de Kaplan-Meier y multivariante, utilizando el modelo de riesgos proporcionales de Cox. RESULTADOS: En el análisis univariante, la categoría T y M, la puntuación de Gleason, y la ploidía del ADN mostraron valor pronóstico. El análisis de regresión de Cox seleccionó como variables con capacidad pronóstica la ploidía del ADN, la presencia de metástasis y la puntuación de Gleason. CONCLUSIONES: La ploidía del ADN tiene valor pronóstico independiente en el cáncer de próstata tratado mediante bloqueo androgénico, y mejora la capacidad predictiva de los factores pronósticos clásicos. (AU)

[Urinary and sexual alterations in multiple sclerosis]. / Alteraciones urinarias y sexuales en la esclerosis múltiple.

Urinary and sexual symptoms in patients with multiple sclerosis (MS) are frequent, although this question has scarcely been addressed in our country. The aim of this study is to prospectively evaluate the presence of such symptoms in 77 MS patients. We have valued the neurological involvement and the degree of functional disability through the Minimum Dossier of Disability for Multiple Sclerosis. The urinary and sexual symptoms were collected through a directed survey. We have performed an urodynamic study in order to evaluate the bladder function. Urinary symptoms wire observed in 81.8% of patients, with predominance of the mixed syndrome (52%). Males show greater neurological affectation and functional disability, as well as greater urinary symptoms frequency (91%). The most frequent symptoms have been urgency (66.6%), frequency (60.3%) and dysuria (53.8%). The complications have been scarce, of infectious type (14.28%) and with female predominance. The most frequent urodynamic finding has been the detrusor hyperreflexia (60%). The minimum dossier of Disability for Multiple Sclerosis is useful to establish comparative parameters with other studies and with more specific urologic data. The presence of urinary symptoms in multiple sclerosis correlated with the degree of neurological (pyramidal and cerebellar) involvement and of functional disability in the Dysfunction Status Escale.

[Percutaneous treatment of renal cysts with iodinated povidone injection. Long-term clinical course]. / Tratamiento percutáneo de quistes renales con inyección de povidona yodada. Evolución a largo plazo.

At present there are several minimally invasive options for the treatment of symptomatic simple renal cysts. One of them, the percutaneous puncture with injection of sclerosant substances, has offered good results. Our study has been conducted in 15 patients with symptomatic simple renal cyst treated by evacuant percutaneous puncture and povidone-iodine injection as sclerosant agent, and makes a short- and long-term evaluation of the results obtained using this procedure. Complete cyst recession with no ultrasound relapse during follow-up was seen in 13 cases (86.5%). Only two patients showed a persistent residual cyst that caused no symptomatology. The easiness of performance, absence of complications and good results obtained make this technique a valid option for the treatment of symptomatic renal cysts.

[Cost-effectiveness comparative study of ceftriaxone verus cefotaxime in the treatment of complicated urinary infections]. / Estudio comparativo coste eficacia ceftriaxona versus cefotaxima en el tratamiento de las infecciones urinarias complicadas.

Prospective, randomized, multicenter study in 267 patients with complicated urinary infection from 9 hospitals nationwide. Drug treatment was either Ceftriaxone 1 g once daily parenterally or Cefotaxime parenteral 1 g 8 hourly for a minimum of 7 days. Patients were clinically, analytically and microbiologically evaluated before and after treatment to assess the efficacy and tolerance of both drug products. To evaluate treatment cost, we used the price of both drugs and the material required for their administration (syringe and disposable needle). 119 patients were excluded from the cost-efficacy evaluation and 148 remained in the study (75 assigned to treatment with Ceftriaxone and 73 to Cefotaxime). Clinical efficacy of treatment was 93% and 87.6% for Ceftriaxone and Cefotaxime respectively (p > 0.05). Cost per patient was 27,347 pesetas for Ceftriaxone and 34,490 for Cefotaxime (p < 0.05).

[Neurologic changes in patients with multiple sclerosis]. / Alteraciones neurourológicas en pacientes afectos de esclerosis múltiple.

OBJECTIVE: To evaluate the presence of urinary symptoms in 77 patients with multiple sclerosis. METHODS: The neurological compromise and the degree of functional disability were evaluated through the Minimum Dossier of Disability for Multiple Sclerosis. The pertinent data for the urinary symptoms were collected through a directed survey. A urodynamic study was performed to evaluate bladder function. RESULTS: 81.8% of the patients had urinary symptoms, the most prevalent being the mixed syndrome (52%). Neurological involvement and functional disability were greater in the male patients and there was a higher incidence of urinary symptoms (91%). Urgency (66.6%), frequency (60.3%) and dysuria (53.8%) were the most common urinary symptoms. The complication rate was low; infection was the most common complication (14.28%) and was more prevalent in the females. Detrusor hyperreflexia (60%) was the most frequent urodynamic finding. CONCLUSIONS: Urinary symptoms are frequent in multiple sclerosis (81.8%), the most prevalent being the mixed syndrome. Neurological involvement and functional disability are greater in the male patients and there is a higher incidence of urinary symptoms. There is a significant correlation between the severity of neurological compromise (pyramidal and cerebellar) and the degree of functional disability and the presence of urinary symptoms.

[Treatment of benign prostatic hyperplasia with finasteride. Results after 7 years of follow-up]. / Tratamiento de la hiperplasia benigna de próstata con Finasteride. Resultados a los siete años de seguimiento.

Our centre took part in an international, multicentre, Phase III trial with Finasteride (MK-906) in the treatment of BPH. In the first year, this was a double-blind, randomised, placebo-controlled study which included 25 patients who were randomly assigned: 9 to treatment with placebo, 8 to finasteride 1 mg and 8 to finasteride 5 mg. After the first year, all patients were assigned to finasteride 5 mg as a single daily dose taken before breakfast. Of the 25 patients who started the trial, 7 have completed 7 years treatment (28%): 1 from the placebo group. 1 from finasteride 1 mg, and 5 who took finasteride 5 mg throughout the study. Total symptoms score, assessed by the modified Boyarsky questionnaire, improved during the first year 4.97 points (51%) and remained unchanged up to year 7 with a final reduction of 6.2 points (64%). Percentual increase in peak urinary flow during follow-up ranged between 21 and 45.9% with an absolute increase at 7 years of 4.2 mL/seg (47.5%) and a reduction in prostate volume of 26%. Finasteride tolerance was excellent at all times, and no serious clinical reaction was seen in laboratory parameters. Two patients reported decreased libido and sexual potency and 1 decreased libido. In summary, since after 7 years of treatment efficacy is maintained in at least 30% of patients with an excellent safety profile, finasteride can be considered an alternative in the medical treatment of BPH.

[Factors influencing variability of PSA blood concentration in patients with prostate benign hyperplasia]. / Factores que influyen en la variabilidad de la concentración sérica de PSA en pacientes con hiperplasia benigna de próstata.

Study conducted in 107 patients with prostate benign hyperplasia to establish the influence that prostate volume, age, sexual activity, extent of obstruction and presence of urethral catheter have on PSA serum levels, using a linear regression model. In simple linear regression studies, a good correlation was seen between PSA serum concentration and prostate volume calculated by transrectal ultrasound (r = 0.57), which decreases when age in used as an independent variable (r = 0.40). In multiple linear regression studies where all the variables are included, correlation increases slightly (r = 0.60), and only prostate volume and sexual activity are significant. Prostate volume in the single most influential factor on PSA levels in prostate benign hypertrophy although it is not the only parameter to be taken into account in serum level variations of this marker. Age influence can be secondary to other factors such as sexual activity.

[Sarcomatoid renal carcinoma]. / Carcinoma renal sarcomatoide.

Study of 250 pieces from nephrectomies performed in our service due to renal carcinoma, 10 (4%) of which where of the sarcomatoid histological variant. In 2 of the 10 cases, tumour was confined within the renal capsule at the time of surgery. These were the only cases where no disease progression was seen after treatment. A survival study using the Kaplan-Meter method was conducted. Median survival of patients with sarcomatoid pattern was 6 months, showing a significant difference with that obtained in other histological patterns. DNA content of tumoral cells was assessed by flow cytometry, which displayed a diploid pattern in 7 patients and aneuploid in 3. The 2 cases with no disease progression were diploid. We conducted nuclear cytomorphometry studies which showed significant differences in the mean nuclear perimeter between progressive and non-progressive tumours.

[Bladder bilharziosis]. / Bilharziosis vesical.

OBJECTIVES: We report two cases of urinary schistosomiasis that had been diagnosed and treated during the early stages of the disease. These cases are presented to provide further insight into this disease, which is uncommon in our setting. METHODS/RESULTS: The presenting features, diagnostic methods and the treatment currently available are discussed. CONCLUSIONS: Urinary bilharziasis is a parasitic disease caused by Schistosoma haematobium that may involve the entire urogenital tract. Schistosomiasis causes important lesions in the early stages and complications in the long term if treatment is not instituted early. Although it is uncommon in our area, it must be suspected in patients with GU dysfunction, particularly in those presenting with hematuria and/or have traveled to countries where this disease is endemic.

[Burned-out testicular tumor]. / Tumor testicular fundido.

Burned-out testicular tumour is an uncommon entity defined by the spontaneous regression of the testicular tumoral site after spread to metastasis, leaving behind a scarring lesion with typical histological changes. This paper reports one case of burned-out testicular tumour diagnosed and treated initially as an embryonic carcinoma with areas of extragonadal malignant immature teratoma that after nine years of follow-up reveals the primary testicular site. Physical examination and detailed ultrasound study of the testes is of the greatest significance in stem cells tumours with extragonadal location, given the prospect of identifying the primary testicular lesion as a burned-out tumoral site and performing radical treatment of these tumours.

[Treatment of prostatic benign hyperplasia with endoscopically controlled laser fiber]. / Tratamiento de la hiperplasia benigna de próstata con fibra de láser bajo control endoscópico.

Between October 1992 and February 1993, 12 patients with benign prostate hyperplasia (BPH) were treated with Neodymium-YAG laser through an endoscopically-guided right angle fibre, and follow-up is now over 1 year. Follow-up consisted in the symptomatic assessment using I-PSS questionnaires, vesicoprostate ultrasound with flowmetry and residue measurement and urethrocystometry at least every 3 months. Mean time for suprapubic catheter withdrawal was 23.4 days (range 9-34), and one patient did not resumed micturition spontaneously. Symptomatology improved after the first month. remaining stable after 6 months, with a mean score decrease at one year of 11,2 (p < 0,001). All flowmetry parameters improved although only peak and mid-stream flow showed statistical differences, peak flow increasing at one year by an average of 5,9 ml/sec (P < 0,001). In 4 of the 12 patients surgery was performed; 1 underwent early surgery due to absence of spontaneous micturition and was excluded from the results assessment, and 3 due to persistence of symptomatology at 16, 18 and 21 months post-laser. In spite of the advantages presented by the laser when compared to conventional surgical approaches, such as short time application, absence of haemorrhage and likely used in an ambulatory setting, the major initial irritative symptomatology and the need for a suprapubic catheter during at least three weeks, are in general poorly tolerated and limit its use. The apparent improvement in symptomatology after one month is not accompanied by objective changes in flowmetry, since in our series only 1 patient presented Qmax greater than 15 ml/sec with no residues. Therefore, we consider that treatment with endoscopically-guided laser fibre in BPH has, with the technology currently available. a very limited use.

[Extracorporeal shockwave lithotripsy in single kidneys. Our experience]. / Litotricia extracorpórea por ondas de choque en monorrenos. Nuestra experiencia.

Forty patients with renal lithiasis in single kidney were treated with extracorporeal shock wave lithotrity in our unit. Nine patients required emergency urinary by-pass, because of original picture of obstructive anuria, and in another 21 cases a double-J catheterism was conducted as prophylaxis prior to lithotrity. Treatment was carried out with analgesia and ambulatory, except for 10 patients with calculi of less than 10 mm where by-pass was not performed, and who were kept in preventive hospitalization for 24 hours. Average of sessions per patients was 1.59 (range 1-7). After 6 months follow-up there are 24 free renal units (60%), 12 (30%) with debris that can be expelled, failure in 4 (10%): 2 with debris that can be expelled and 2 which were not fragmented. Renal function has not deteriorated during follow-up, except for 2 patients with obstructive uropathy, that subsequently normalized following resolution of the condition. No significant differences were found in the treatment of calculi of less than 10 mm with or without double-J. ESWL is considered to be the choice approach for lithiasis in patients with one single kidney, due to is efficacy and low morbidity, safety in the ambulatory environment, even for calculi of less than 10 mm with no urinary by-pass.

[Extracorporeal shockwave lithotripsy in patients with urinary diversion]. / Litotricia extracorpórea con ondas de choque en pacientes con derivación urinaria.

Presentation of a review on nine patients (10 renal units) with urinary by-pass and renoureteral lithiasis who underwent shock wave extracorporeal lithotrity in our hospital. The justification for the by-pass was an infiltrant vesical tumour in 6 patients, myelomeningocele in 2, and vesicourethral trauma in the remaining one. All cases were being treated for a Bricker-type by-pass except the last one (bilateral ureterosigmoidostomy). Outcome of treatment was: absence of residual lithiasis in 6, minimal residues in 1 (2 renal units), failure in 1. The remaining patient suffered anaphylactic shock induced by the latex in the ureteral catheter placed prior to lithotrity which caused the patient's death.

[Perirenal abscess following lithotripsy]. / Absceso perirrenal post-litotricia.

Presentation of one case of perirenal abscess secondary to lithotrity on a calcified cyst simulating a pyelic lithiasis. A pathogenic hypothesis and the importance of urography in the confirmation diagnosis of the lithiasic disease is raised.

[Is radical surgery indicated in patients with infiltrating bladder carcinoma and involved regional lymph nodes?]. / Está indicada la cirugía radical en los pacientes con carcinoma vesical infiltrante y ganglios regionales afectos?

To evaluate the efficacy of radical vesical surgery in Infiltrant Vesical Carcinoma affecting the regional nodes, a retrospective study of a group of 75 patients who underwent radical cystectomy and lymphadenectomy was conducted. Based on the degree of node affectation patients were classified as follows: 49 pN(-) (65.3); 22 pN(+) (29.3); and 4 pN(x) (5.3) in which the pathological anatomy was inconclusive. In the pN(-) group, 8 (8.16%) died during the immediate postoperative due to surgical complications. Of the remaining 45, 5 cases were lost to follow-up; 31 (63.26%) died (all of them as a result of the tumour (M+)); whereas 9 (18.36%) are still alive and disease-free. Overall mean survival is 35.91% 10.3 months (4-65 months). Of them, 3 (13.6%) were lost while in poor performance status; 13 (59.09%) died for neoplasia-related causes (M+), and only one (4.5%) is alive and disease free. In this group, neoadjuvant chemotherapy was used in 10 cases, neoadjuvant radiotherapy in 4 and adjuvant radiotherapy in 5. Local relapse was seen in 8 (36.6%) cases. In our experience, a clear improvement in quality of live and mean survival at one year (up to 65 months) was noted in patients with Vesical Infiltrant Carcinoma and regional node affectation. Such situation encourages the use of radical surgery when faced, during surgical examination, with node infiltration by neoplastic cells.