PSA levels in patients on hemodialysis treatment.

OBJECTIVES: Standardized prostate-specific antigen (PSA) levels are based upon the general population levels and, although a higher incidence of prostate cancer in patients on hemodialysis (HD)has not been demonstrated, some studies point at the possibility of observing higher PSA levels in this type of patients than in males with preserved renal function. The objective of the present study is to compare PSA levels in males on hemodialysis with those of the population with normal renal function. METHODS: Comparative, transversal study of the variables age, total PSA, free PSA and PSA index in 190 patients with chronic renal disease on hemodialysis treatment (group 1) and 237 subjects without renal disease ( group 2). We carried out a descriptive analysis and a comparative study of the above mentioned variables using the SPSS software. RESULTS: Median age of patients on HD was 55 in cases (47-61)and 59 in controls (54-63.5). Mean total PSA was 1.49 ng/mL [1.24-1.73] in cases and 1.62 ng/mL [1.29-1.95] in controls; mean free PSA was 1.40 ng/mL [0.89-1.91] in group 1 and 2.31 ng/mL [-0.83-5.45] in group 2; mean PSA index was 27.67% [19.91-35.63] in cases and 14.82%[12.79-16.85]] in controls. The comparative study showed differences between the two groups in free PSA (p ≤ 0.007), PSA index (p ≤ 0.000) and total PSA (p ≤ 0.000) in patients under 50 after an age-specific analysis. CONCLUSIONS: Total PSA is higher in patients on HD within the subgroup of patients under 50 with statistically significant but not clinically relevant difference. PSA index is remarkably higher in the group of patients on HD. These data could have clinical implications as far as indications for biopsy is concerned.

Low-dose-rate brachytherapy for prostate cancer in renal transplant recipients.

PURPOSE: Prostate cancer (PCa) is the most common malignancy among men and one of the most common neoplasms affecting renal transplant recipients (RTRs). The available treatments for localized PCa among the general population (GP), surgery and external beam radiotherapy, carry a risk of damage to the transplanted kidney, the ureters, and the bladder and therefore tend to be avoided by most groups. The objective of this study was to assess the efficacy and feasibility of low-dose-rate brachytherapy (LDR-BT) for PCa in RTRs. METHODS AND MATERIALS: We carried out a retrospective review on all RTRs diagnosed of PCa who had undergone LDR-BT at our institution between 2000 and 2015. Nine patients met these criteria, but 1 did not fulfill the followup. Hence, we analyzed 8 patients. We reviewed all clinical data for PCa and graft function in these patients and compared the results with the GP. RESULTS: Mean baseline prostate-specific antigen was 6.8 ± 1.9 ng/mL. All PCa had a Gleason score of 6 and were classified as low risk according the Europe Association of Urology guidelines. Mean followup after seed implantation was 48 ± 12.8 months. All 8 patients remain free of prostate-specific antigen failure. Five-year progression-free survival, cancer-specific survival, and overall survival rates were 100%, 100%, and 62.5%. There was no specific toxicity associated with LDR-BT, and there were no acute adverse events affecting the graft. CONCLUSIONS: LDR-BT is a feasible and acceptable treatment for localized PCa in RTRs. Oncological outcomes are similar to the GP, and there is minimal toxicity to the renal graft.

Learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer. / Curva de aprendizaje en el manejo de los inhibidores de tirosina quinasa como primera línea de tratamiento en pacientes con cáncer renal metastásico.

OBJECTIVES: To analyse the learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer. MATERIAL AND METHODS: We evaluated 32 consecutive patients treated in our department for metastatic renal cancer with tyrosine kinase inhibitors (pazopanib or sunitinib) as first-line treatment between September 2012 and November 2015. We retrospectively analysed this sample. We measured the time to the withdrawal of the first-line treatment, the time to progression and overall survival using Kaplan-Meier curves. The learning curve was analysed with the cumulative sum (CUSUM) methodology. RESULTS: In our series, the median time to the withdrawal of the first-line treatment was 11 months (95% CI 4.9-17.1). The mean time to progression was 30.4 months (95% CI 22.7-38.1), and the mean overall survival was 34.9 months (95% CI 27.8-42). By applying the CUSUM methodology, we obtained a graph for the CUSUM value of the time to withdrawal of the first-line treatment (CUSUM TW), observing 3 well-differentiated phases: phase 1 or initial learning phase (1-15), phase 2 (16-26) in which the management of the drug progressively improved and phase 3 (27-32) of maximum experience or mastery of the management of these drugs. The number of treated patients needed to achieve the proper management of these patients was estimated at 15. CONCLUSIONS: Despite the limitations of the sample size and follow-up time, we estimated (in 15 patients) the number needed to reach the necessary experience in the management of these patients with tyrosine kinase inhibitors. We observed no relationship between the time to the withdrawal of the first-line treatment for any cause and progression.

[Cystine calculi. Prevention with captopril. Clinical case]. / Cálculo de cistina. Profilaxis con captopril. Caso clínico.

Contribution of a case report of multiple cystine lithiasis with underlying homozygous cystinuria in a 5-year old male child. Following surgical management of the lithiasic episode the patient was followed-up with super-hydration, urine alkalinization and captopril prophylaxis. After three and a half years evolution, the patient has not developed new lithiasic episodes and maintains normal dibasic amino acids values in 24 h urine.

[Absorptive hypercalciuria type III or caused by renal loss of phosphates]. / Hipercalciuria absortiva tipo III o por pérdida renal de fosfatos.

Contribution of a retrospective series of 16 patients with type II absorptive hypercalciuria over a total of 1.041 patients undergoing metabolic study due to relapsing renal lithiasis. Clinical history of lithiasis, biochemistry prior to treatment and instituted therapy were examined in all cases. Stones composition, radiologic appearance of lithiasis and evolution of biochemical parameters after medical treatment with a mixture of phosphates were also studied.

[Penile cutaneous horn. A clinical case]. / Cuerno cutáneo peneano. Caso clínico.

Contribution of a case report of cutaneous horn of penis surgically treated with extensive resection of the implantation base. A well differentiated, microinvasive epidermoid carcinoma was histopathologically demonstrated on a hyperkeratosis squamous papilloma. Although underlying lesions to cutaneous horn are usually benign, malignant changes have been reported in up to one third of cases; surgical treatment should therefore include extensive resection of the implantation base.

[Giant inguino-scrotal hernia of the bladder. Clinical case and review of the literature]. / Hernia vesical inguinoescrotal gigante. Caso clínico y revisión de la literatura.

Bladder hernia is an uncommon condition with a frequency between 0.5 and 3%, reaching the 10% between patients older than 50 years. It's more predominant in males aged between 50 and 70. The diagnosis usually happens in the course of surgical repair of inguinal hernias, because the bladder hernia has no specific clinical findings. Management includes the resection or reduction of the bladder hernia, with de-obstruction of the lower urinary tract, if present, and repairmen of inguinal path. We report a new case and review the literature.

[Benign presacral schwannoma producing obstructive uropathy. Clinical case and review of the literature]. / Schwannoma presacro benigno que provoca uropatía obstructiva. Caso clínico y revisión de la literatura.

We report a case of a presacral benign schwannoma which causes right hydroureteronephrosis without other clinical findings. After a fine-needle aspiration (FNA) biopsy under computed tomography (CT) guidance, a fusocellular tumour without athypia was demonstrated. With the initial diagnosis of benign schwannoma the patient was operated on, removing the tumour, and with the immunohistochemical examination (reactivity for S-100) this diagnosis was confirmed.

[Squamous cell carcinoma of the renal pelvis. A clinical case]. / Carcinoma de células escamosas de la pelvis renal. Caso clínico.

Squamous cell carcinoma of the renal pelvis is uncommon, accounting for approximately 10% of all renal pelvic tumours. It's often associated with chronic renal calculi or infection and it usually presents at an advanced stage with pain or a palpable mass. We report an incidental case of squamous cell carcinoma of the renal pelvis, associated with chronic renal calculi and infection, and weight loss. The prognosis of patients with advanced squamous cell carcinoma of genitourinary origin is poor. In patients with chronic stones or infection squamous cell carcinoma of renal pelvis must be suspected if survival is to be affected.

[Paratesticular adenomatoid tumor: a report of nine cases]. / Tumor adenomatoide paratesticular: una serie de nueve casos.

INTRODUCTION: Paratesticular tumors are rare. Most of them are benign, and adenomatoid tumors are most common. These tumors sometimes infiltrate the testicular parenchyma and require differential diagnosis with malignant tumors. In such cases, intraoperative biopsy allows for performing conservative surgery. MATERIALS AND METHODS: A retrospective study of nine patients with paratesticular adenomatoid tumors seen during a nine-year period (2000-2008) is reported. RESULTS AND CONCLUSIONS: Patient age (mean, 49.6 years) and most common initial signs (tender nodule) are reported. The tumor most commonly occurred as a small, usually oval, nodule in the tail of epididymis. Our series included a case each of intraparenchymal tumor of the testis and tumor of the tunica vaginalis. Diagnosis was initially made based on a ultrasound scan and subsequently confirmed by histology. Differential diagnosis and surgical treatment, performed in all patients, are reported, and also the pathological features of surgical specimens.

Tumor adenomatoide paratesticular: una serie de nueve casos / Paratesticular adenomatoid tumor: a report of nine cases

Introducción: los tumores paratesticulares son raros. La mayoría son benignos, siendo el más frecuente el tumor adenomatoide. En ocasiones estos tumores infiltran el parénquima testicular y es necesario plantear un diagnóstico diferencial con tumores malignos, por lo que la biopsia intraoperatoria, en estos casos, permite realizar una cirugía conservadora. Material y métodos: presentamos de forma retrospectiva nuestra extraordinaria serie de 9 casos de tumores adenomatoides paratesticulares durante un periodo de 9 años (2000- 2008). Resultados y conclusiones: describimos la edad de los pacientes (media de 49,6 años) y la clínica de inicio (nódulo palpable doloroso). La localización de la lesión más frecuente fue en el epidídimo, que habitualmente se manifiesta como un nódulo de pequeño tamaño, generalmente oval en la cola del epidídimo. En nuestra serie tenemos un caso de lesión testicular intraparenquimatosa y otro en túnica vaginal; el resto se localizan en el epidídimo. El diagnóstico de sospecha fue por ecografía, con confirmación histológica posterior. Describimos el diagnóstico diferencial y el tratamiento quirúrgico, que se aplicó en el 100% de los casos, así como sus características anatomopatológicas(AU)

Introduction: Paratesticular tumors are rare. Most of them are benign, and adenomatoid tumors are most common. These tumors sometimes infiltrate the testicular parenchyma and require differential diagnosis with malignant tumors. In such cases, intraoperative biopsy allows for performing conservative surgery. Materials and methods: A retrospective study of nine patients with paratesticular adenomatoid tumors seen during a nine-year period (2000-2008) is reported. Results and conclusions: Patient age (mean, 49.6 years) and most common initial signs (tender nodule) are reported. The tumor most commonly occurred as a small, usually oval, nodule in the tail of epididymis. Our series included a case each of intraparenchymal tumor of the testis and tumor of the tunica vaginalis. Diagnosis was initially made based on a ultrasound scan and subsequently confirmed by histology. Differential diagnosis and surgical treatment, performed in all patients, are reported, and also the pathological features of surgical specimens(AU)

[Role of phosphate in recurrent calcium lithiasis. A current view]. / Papel del fosfato en la litiasis cálcica recidivante. Una visión actual.

OBJECTIVE: To analyze the biochemical impact of treatment with phosphates in patients with recurrent calcium lithiasis and hypercalciuria. METHODS: 20 patients were selected according to the following criteria: normal renal function, recurrent calcium nephrolithiasis, hypercalciuria, hypophosphatemia, normal calcium and low tubular phosphate reabsorption (TPR). The mean duration of treatment was 7.5 +/- 3.8 months. The pre and post-treatment phosphatemia, calciuria, phosphaturia and TPR were analyzed. The results were analyzed by the Wilcoxon statistical method. RESULTS: We found a moderate but significant decrease of calciuria (326.5 +/- 52-4 to 266.4 +/- 31.7 mg/24 h), while phosphatemia (2.21 +/- 0.09 to 2.52 +/- 0.30 mg/24 h) and TPR (65.7 +/- 6.3 to 71.3 +/- 4.1) increased significantly. Overall treatment was well-tolerated and no patient abandoned treatment. CONCLUSIONS: The short-term biochemical results obtained are similar to those reported in the literature. However, definitive conclusions cannot be made since treatment application is not standardized and studies that demonstrate its clinical efficacy are scanty.

Cuerno cutáneo peneano. Caso clínico / Cutaneous horn of penis. Case report

Aportamos a la literatura un caso de un cuerno cutáneo peneano, tratado quirúrgicamente con resección amplia de la base de implantación. El estudio histopatológico demostró un carcinoma epidermoide microinvasor bien diferenciado, sobre un papiloma escamoso hiperqueratósico. Aunque las lesiones subyacentes al cuerno cutáneo suelen ser benignas, se han descrito cambios malignos hasta en un tercio de los casos, por lo que el tratamiento quirúrgico debe incluir la resección amplia de la base de implantación (AU)

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Cálculo de cistina. Profilaxis con captopril. Caso clínico / Cystine calculi. Captopril prophylaxis. Case report

Presentamos un caso clínico de litiasis de cistina múltiple en el contexto de una Cistinuria homocigota, en un varón de 5 años de edad. Tras el tratamiento quirúrgico del episodio litiásico, el enfermo ha seguido tratamiento profiláctico con sobrehidratación, alcalinización de la orina y captopril. Durante una evolución de tres años y medio el enfermo no ha vuelto a presentar nue-vos episodios litiásicos, manteniendo cifras normales de aminoácidos dibásicos en orina de 24 horas (AU)

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Hipercalciuria absortiva tipo iii o por pérdida renal de fosfatos / Type III absortive hypercalciuria due to renal loss of phosphates

Presentamos una serie retrospectiva de 16 pacientes con criterios de hipercalciuria absortiva tipo III sobre 1.041 pacientes, a los que se realizó estudio metabólico por litiasis renal recidivante. En todos ellos se estudiaron sus antecedentes clínicos de litiasis, valores bioquímicos previos al tratamiento y terapia que realizaron. Así mismo se realizó estudio de la composición del cálculo, apariencia radiológica de la litiasis y evolución de los parámetros bioquímicos tras el tratamiento médico con mezcla de fosfatos (AU)

Schwannoma presacro benigno que provoca uropatía obstructiva. Caso clínico y revisión de la literatura / Presacral bening schawannoma with obstructive uropathy. Case report and review of the literature

Presentamos un caso clínico de schwannoma benigno de localización presacra, que provoca ureterohidronefrosis derecha sin sintomatología. Tras un diagnóstico inicial mediante punción aspiración con aguja fina dirigida por TC, de tumor fusocelular sin atipia citológica compatible con schwannoma, se realiza exéresis quirúrgica, cuyo estudio anatomopatológico (con técnicas inmunohistoquímicas sobre la proteína S-100) confirma el diagnóstico de schwannoma benigno (AU)

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Hernia vesical inguinoescrotal gigante. Caso clínico y revisión de la literatura / Giant inguinoscrotal bladder hernia. Case report and review of the literature

La hernia vesical es una patología infrecuente con una incidencia que oscila entre el 0,5 por ciento y el 3 por ciento, alcanzando el 10 por ciento en pacientes mayores de 50 años. Presenta un predominio en varones con edades comprendidas entre los 50 y 70 años. La hernia vesical carece de clínica específica, esto hace que su diagnóstico sea con frecuencia intraoperatorio durante la reparación quirúrgica de las hernias inguinales. El tratamiento consiste en la resección o reducción de la hernia vesical, con desobstrucción del tracto urinario inferior, si existe, y reparación del trayecto inguinal. Aportamos un nuevo caso clínico y revisamos la literatura (AU)

Carcinoma de células escamosas de la pelvis renal. Caso clínico / Squamous cell carcinoma of the renal pelvis. Case report

El carcinoma escamoso de pelvis renal es infrecuente, representando aproximadamente el 10 por ciento de todos los tumores piélicos. Frecuentemente se asocia con litiasis o infección renal crónica. Se suele diagnosticar en estadios avanzados de la enfermedad por dolor o masa palpable. Presentamos un caso clínico de carcinoma de células escamosas de pelvis renal de diagnóstico incidental, asociado a uropatía obstructiva litiásica de larga evolución, pielonefritis de repetición y pérdida de peso. El pronóstico de los pacientes con carcinoma escamoso genitourinario en estadio avanzado es pobre. Debemos descartar la existencia de carcinoma de células escamosas de la pelvis renal en pacientes con historia de litiasis o infección renal crónica, ya que ello afecta la supervivencia (AU)

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