RESUMO
INTRODUCTION: Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD: Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS: Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥50% of cylinders and a DPSA ≥0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS: The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU.
Assuntos
Próstata/patologia , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Prospectivos , Prostatectomia/métodos , Estudos Retrospectivos , Fatores de Tempo , Tempo para o TratamentoRESUMO
A case of labial adhesions in an elderly woman is reported. The patient was admitted in the urology department since she related urinary symptoms. The diagnosis was been made by simple inspection of the genital region. Under anaesthesia, surgical procedure was done by sharp dissection, and dressing ointment was recommended at discharge. An excellent result was obtain. The estrogens deficiency seems to be the origin of this rare disease and it is not unusual the presence of another circumstances like lichen sclerous et atrophicus, diabetes mellitus or decreasing sexual activity.
Assuntos
Retenção Urinária/etiologia , Doenças da Vulva/complicações , Idoso de 80 Anos ou mais , Feminino , Humanos , Aderências TeciduaisRESUMO
OBJECTIVE: To determine the actual incidence of prostate cancer (PC) in the healthcare areas of Castilla-Leon in 2014. MATERIAL AND METHODS: A multicentre study was conducted with the participation of 7 of the 9 healthcare areas of Castilla-Leon. We collected retrospective data that included 87.8% of the target population (men diagnosed with PC with histopathological confirmation in 2014). We calculated the raw and age-adjusted incidence rates based on the direct method and consulted the community and national epidemiological data in the Spanish National Institute of Statistics. RESULTS: A total of 1198 new cases of PC were diagnosed, with a raw incidence rate in the community of 109.54 cases per 100,000 men. The adjusted rates for the Spanish and European populations were 115.41 and 110.07, respectively. The age group with the highest diagnostic concentration was the 60-70-year group, with 41.97% of the diagnoses. The group with the highest incidence was the 70-80-year group, with 438.87 cases per 100,000 inhabitants. There were differences in the raw and age-adjusted incidence rates and in the age at diagnosis among the various included healthcare areas. CONCLUSIONS: The community raw incidence rate was higher than most existing data. We observed significant differences among the various geographical areas, which could be explained mainly by the age distribution and the opportunistic screening policies for each area.
Assuntos
Neoplasias da Próstata/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Programática de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Espanha/epidemiologiaRESUMO
INTRODUCTION: Nocturia is the main cause of insomnia or sleep interruption in adult men, which has a negative impact on daily activities, quality of life (QoL) and quality of sleep (QoS). The assessment of nocturia and its impact on QoL and QoS in patients suffering from benign prostatic hyperplasia (BPH) has been poor in terms of clinical research, moreover there is a lack of specific methods to assess this impact. OBJECTIVES: The objectives of BPH treatment should include the improvement of patient's QoL by controlling both diurnal and nocturnal symptoms. In order to assess how nocturia affects QoL and also QoS, some specific tools, such as N-QoL questionnaire or the number of Hours of Undisturbed Sleep (HUS), have been recently developed. Therefore, it would be interesting to assess how nocturia reduction due to LUTS/BPH treatment can impact on some objective parameters such as HUS and also how nocturia reduction improves QoS and QoL. This assessment should be developed during the application of pharmacological treatments in clinical practice by means of these specific tools. With the aim of tackling nocturia as an urologic problem in patients with LUTS/BPH, as well as knowing the physiology of sleep and the effect of nocturia on the sleep and QoL, a meeting of expert urologists, that gathered about fifty specialists of all around Spain, was held in Madrid. This article presents the main ideas and concepts exposed in this meeting. CONCLUSIONS: Nocturia is a symptom with a high prevalence in older patients with STUI/BPH. The PreNoc study has showed a Nocturia prevalence in Spain of 83% in patients > or =60 years old diagnosed of BPH. Nocturia is the most bothersome symptom in patients with STUI/BPH.
Assuntos
Noctúria/etiologia , Hiperplasia Prostática/complicações , Qualidade de Vida , Sono , Humanos , Masculino , Terminologia como AssuntoRESUMO
Presentation of one case of lithiasis as complication of female urethra diverticulum. Etiopathogenic factors, signs and symptoms, diagnosis, complications and therapy options are commented.
Assuntos
Divertículo/complicações , Uretra , Doenças Uretrais/complicações , Cálculos Urinários/complicações , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To report what could be the first reference of a prepucial congenital abnormality which has been termed an "igloo-like prepuce". The presence of a prepuce completely covering the glans and presenting the outer opening on the ventral side, resembles the ice constructions used as temporary dwelling by certain groups of eskimos. METHODS: Two cases with this unusual abnormality seen in two young brothers are described. RESULTS AND CONCLUSIONS: The "igloo-like prepuce" is a prepucial congenial abnormality with rare incidence which carries no other genitourinary condition but which translates in a merely aesthetic alteration.
Assuntos
Pênis/anormalidades , Adolescente , Humanos , MasculinoRESUMO
A fibrosarcoma of the penis is an infrequent finding. This paper contributes one case found in the perineo-scrotal region emphasising some aspects of local staging procedures, as well as the differential diagnosis with other mesenchymal tumours; there is no validated treatment protocol, although there is widespread agreement that extensive surgical excision should be performed, such as was performed in this patient.
Assuntos
Fibrossarcoma/patologia , Neoplasias Penianas/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Presentation of a new case of tumoral-like eosinophilic cystitis mistaken for a vesical carcinoma until completion of anatomopathological study.
Assuntos
Cistite/diagnóstico , Eosinofilia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Cistite/complicações , Cistite/patologia , Erros de Diagnóstico , Eosinofilia/complicações , Eosinofilia/patologia , Humanos , Masculino , Neoplasias da Bexiga Urinária/diagnósticoRESUMO
A case of renal metastasis from lung epidermoid carcinoma with florid clinic is presented. We point out the great diagnostic help obtained by using Computerized Axial Tomography (C.A.T.) and echo-monitored fine needle aspiration puncture (F.N.A.P.).
Assuntos
Carcinoma de Células Escamosas/secundário , Neoplasias Renais/secundário , Neoplasias Pulmonares/patologia , Biópsia por Agulha/métodos , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Report on our experience with Fabian's prothesis as alternative therapy to benign prostate hyperplasia (B.P.H.) surgery. Throughout 1990 ten patients with various surgical contraindications were implanted the above device. In spite of the series small size (10 patients) and short follow-up (4 to 11 months), we believe the 70% good results obtained is very encouraging and can either be of help to banish the ominous indwelling vesical catheter, a permanent evidence of Urologists' failure in the prostate obstructive disease, or it will allow us to relief patients with B.P.H. non-secondary to other more aggressive therapies.
Assuntos
Hiperplasia Prostática/complicações , Próteses e Implantes , Retenção Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Retenção Urinária/etiologiaRESUMO
Presentation of one case of Urethral Duplicity of the Blind Epispadias variant, also known as Congenital Prepubic Sinus. This form of accessory urethra is a congenital malformation which consists in a pseudofistular passage which starts at the proximity of the bladder's anterior side-though uncommunicated with it-and spreads to the skin of the pubic area where it ends. No other malformative condition was found in the comprehensive study conducted, and only the existence of repeat episodes of mucopurulent drainage material advised its removal. This manoeuvre was followed by a complete cure and, after more than two years follow-up, the patient remains asymptomatic.
Assuntos
Uretra/anormalidades , Pré-Escolar , Humanos , MasculinoRESUMO
An AIDS case, with a Candida urinary infection causing papillary necrosis and accompanied by occurrence of fungal lumps is reported. The paper remarks on the incidence and peculiarities of urinary affectation in these patients, emphasizing the usefulness of percutaneous nephrostomy as a diagnostic, and above all as a therapeutic procedure, in cases of expanded urinary tract.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Candidíase/microbiologia , Necrose Papilar Renal/microbiologia , Infecções Urinárias/microbiologia , Adulto , Candidíase/complicações , Candidíase/diagnóstico , Dilatação Patológica/microbiologia , Humanos , Necrose Papilar Renal/complicações , Necrose Papilar Renal/diagnóstico , Masculino , Infecções Urinárias/complicações , Infecções Urinárias/diagnósticoRESUMO
Another case of eosinophilic cystitis is reported. Special interest is placed in the incorrectly assigned nature of this disease entity. Most of the authors tend to subdivide eosinophilic cystitis into two subtypes with its own clinical, histological, and evolutive aspects: allergic eosinophilic cystitis (AEC) and eosinophilic cystitis (EC). Several hypotheses have been put forward to explain its origin which, however, remains unclear. There is no specific treatment and its course tends to develop towards chronicity, with periods of remission and unpredictable exacerbation that warrant continuous monitoring. Diagnosis is by anatomopathological findings and differential diagnosis is warranted to distinguish it from bladder neoplasm (with which it is invariable confused), tuberculosis, etc.
Assuntos
Cistite , Eosinofilia , Idoso , Cistite/diagnóstico , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Feminino , Humanos , Neoplasias da Bexiga Urinária/diagnósticoRESUMO
We report a case of leiomyosarcoma of the spermatic cord that we consider singular because of the excellent outcome. The patient is alive and tumor-free 8 years following the initial diagnosis. We discuss the management of these patients, a controversial subject since there are no definitive therapeutic guidelines because of the very limited series of patients.
Assuntos
Neoplasias dos Genitais Masculinos/patologia , Leiomiossarcoma/patologia , Cordão Espermático , Idoso , Idoso de 80 Anos ou mais , Humanos , MasculinoRESUMO
OBJECTIVES: The present study focuses attention on intermittent testicular torsion, a well-differentiated but underdiagnosed entity. METHODS: Four cases of intermittent testicular torsion are described. The presence of recurrent acute testicular pain that remits spontaneously or following self-manipulation and the horizontal of the testis (bell clapper) are sufficient to make the diagnosis. RESULTS: All four cases underwent bilateral orchipexy with excellent results. At years' follow-up all patients remain asymptomatic. CONCLUSIONS: Intermittent testicular torsion must be considered appropriately since these patients comprise the largest group at high risk for developing acute testicular torsion. Bilateral orchidopexy will ensure the viability of the testis with 100% good results.
Assuntos
Torção do Cordão Espermático , Adolescente , Adulto , Criança , Humanos , Masculino , Recidiva , Torção do Cordão Espermático/diagnósticoRESUMO
We report on a case of infected solitary renal cyst following rupture and communication of the excretory tract from a ureteral calculus. The etiopathogenic mechanisms, the diagnostic difficulties encountered in this uncommon disease process, and the usefulness of radiologic and ultrasound assessment are discussed.
Assuntos
Doenças Renais Policísticas/complicações , Cálculos Ureterais/complicações , Doenças Ureterais/etiologia , Obstrução Ureteral/etiologia , Idoso , Humanos , Masculino , Nefrite Intersticial/etiologia , Ruptura Espontânea , Infecções Urinárias/etiologiaRESUMO
We present two case of inverted vesical papillomas, one of a trabecular histology and the other glandular, which--in view of the appearance in the last few years of inverted papillomas coexisting alongside other urothelium tumorous states, recurring and even malignant inverted papillomas--raise the possibility of them being considered as superficial urothelium carcinomas. We propose the use of post-surgical endo-vesical chemotherapy, above all in the patients affected by the trabecular variety of inverted papillomas, due to their high indices of recurrence and high possibilities of malignancy.