Características clínico-patológicas de las lesiones malignas del tracto urinario inferior / Clinicopathological features of malignant lesions of the lower urinary tract / Características clínico-patológicas de lesões malignas do trato urinário inferior

RESUMEN Introducción: El cáncer de vejiga es un tumor mucho más frecuente de lo que a veces nos transmiten las estadísticas o los medios de comunicación. Ocupa el noveno lugar en cuanto al número de diagnósticos de cáncer a nivel mundial y se reporta aproximadamente cinco veces más frecuente en varones que en mujeres. Objetivo: Describir las características clínico-patológicas de los tumores malignos del tracto urinario inferior. Método: Se realizó un estudio descriptivo y transversal de 186 pacientes con tumores malignas del tracto urinario inferior diagnosticados anatomo-patológicamente en el Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres", de Santiago de Cuba, entre los años 2017 al 2020. Una vez recopilados los datos se procesaron mediante el sistema estadístico SPSS, en su versión 21.0. Resultados: En la serie la mayoría de los afectados fueron hombres entre los 60 y 79 años de edad, siendo más frecuente en el sexo masculino. Predominaron los carcinomas uroteliales con el 96,4 % del total en su variedad papilar y de alto grado de malignidad. Conclusiones: Los tumores malignos del tracto urinario inferior son un problema de salud de baja frecuencia cuya trascendencia es la afectación individual a quien lo padece, y su comportamiento clínico patológico, en sentido general, fue similar a lo reportado por la literatura nacional e internacional, salvo pequeñas y puntuales diferencias relativo a los síntomas, el diagnóstico histológico, en parte, y el grado de malignidad de las lesiones.

ABSTRACT Introduction: Bladder cancer is a more common tumor that sometimes the statistics database or media conveyed to us. It ranks ninth concerning cancer diagnoses worldwide and it is reported to be approximately five times more frequent in males than in females. Objective: To describe the clinicopathologic features of malignant lower urinary tract tumors. Method: A descriptive and cross-sectional study involving a total of 186 patients was conducted. Anatomical and pathological diagnoses were carried out to all patients with malignant lower urinary tract tumor at the Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" in Santiago de Cuba, from 2017 throughout 2020. Once the data were collected, they were processed using the SPSS statistical system, version 21.0. Results: Most affected patients with lower urinary tract tumor had an average age of 60 to 70, arising most frequently in males. The 96.4 % of the total of the patients were diagnosed with urothelial carcinomas (predominant), described in its papillary variety and the high degree of malignant transformation. Conclusions: Malignant lower urinary tract tumors are health problems labeled as the low frequency which differ in their transformation according to the patient. The clinical pathological behavior of the tumor, in a general sense, was similar to that reported in the national and international literature, except for small and pointed differences regarding symptoms, histological diagnosis, and the degree of the lesions´ malignant transformation.

RESUMO Introdução: O câncer de bexiga é um tumor mais comum do que às vezes o banco de dados de estatísticas ou a mídia veiculada por nós. Ele ocupa o nono lugar em diagnósticos de câncer em todo o mundo e é relatado ser aproximadamente cinco vezes mais frequente em homens do que em mulheres. Objetivo: Descrever as características clínico-patológicas dos tumores malignos do trato urinário inferior. Método: Foi realizado um estudo descritivo e transversal envolvendo um total de 186 pacientes. Os diagnósticos anatômicos e patológicos foram realizados a todos os pacientes com tumor maligno do trato urinário inferior no Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" em Santiago de Cuba, de 2017 a 2020. Uma vez coletados os dados, eles foram processados ​​no SPSS sistema estatístico, versão 21.0. Resultados: A maioria dos pacientes afetados com tumor do trato urinário inferior tinha uma idade média de 60 a 70 anos, surgindo mais frequentemente no sexo masculino. 96,4% do total dos pacientes foram diagnosticados com carcinomas uroteliais (predominantes), descritos em sua variedade papilar e alto grau de transformação maligna. Conclusões: Os tumores malignos do trato urinário inferior são problemas de saúde rotulados como de baixa frequência e que diferem em sua transformação de acordo com o paciente. O comportamento clínico-patológico do tumor, de um modo geral, foi semelhante ao relatado na literatura nacional e internacional, exceto por pequenas e pontuadas diferenças quanto à sintomatologia, ao diagnóstico histológico e ao grau de transformação maligna das lesões.

Syringoceles of Cowper's ducts and glands in adult men / 亚洲男科学杂志(英文版)

Cowper's syringoceles are uncommon, usually described in children and most commonly limited to the ducts. We describe more complex variants in an adult population affecting with varying degrees of severity, the glands themselves, and the complications they may lead to. One hundred consecutive urethrograms of patients with unreconstructed strictures were reviewed. Twenty-six patients (mean age: 41.1 years) with Cowper's syringoceles who were managed between 2009 and 2016 were subsequently evaluated. Presentation, radiological appearance, treatment (when indicated), and outcomes were assessed. Of 100 urethrograms in patients with strictures, 33.0% demonstrated filling of Cowper's ducts or glands, occurring predominantly in patients with bulbar strictures. Only 1 of 26 patients with non-bulbar strictures had a visible duct/gland. Of 26 symptomatic patients, 15 presented with poor flow. In four patients, a grossly dilated Cowper's duct obstructed the urethra. In the remaining 11 patients, a bulbar stricture caused the symptoms and the syringocele was identified incidentally. Eight patients presented with perineal pain. In six of them, fluoroscopy and magnetic resonance imaging (MRI) revealed complex multicystic lesions within the bulbourethral glands. Four patients developed perineoscrotal abscesses. In the 11 patients with strictures, the syringocele was no longer visible after urethroplasty. In three of four patients with urethral obstruction secondary to a dilated Cowper's duct, this resolved after transperineal excision (n = 2) and endoscopic deroofing (n = 1). Five of six patients with complex syringoceles involving Cowper's glands were excised surgically with symptomatic relief in all. In conclusion, Cowper's syringocele in adults is more common than previously thought and may cause lower urinary tract symptoms or be associated with serious complications which usually require surgical treatment.

Correlation of tools for objective evaluation of infravesical obstruction of men with lower urinary tract symptoms

ABSTRACT Purpose To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other. Materials and methods The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free uroflowmetry. Results There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free uroflowmetry (p <0001; c=-0.26); and between IPSS and free uroflowmetry (p <0001, c=-0.21) were observed. Conclusion In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.

The relationship between histological prostatitis and lower urinary tract symptoms and sexual function

ABSTRACT This prospective analysis assessed the effect of histological prostatitis on lower urinary tract functions and sexual function. The patients were separated into two groups as histologically observed prostatitis (Group A) and no prostatitis (Group B) according to the biopsy outcomes. International prostate symptom score, international index of erectile function-5 scores, maximal and average flow rate, and residual urine volumes were compared statistically between groups. There was no significant difference (P>0.05) in baseline age (t=0.64), body mass index value (t=0.51), prostate volume (t=0.87), prostate-specific antigen levels (t=0.43), maximal (t=0.84) and average flow rate (t=0.59), and post-void residual urine volume (t=0.71). Mean international prostate symptom score in patients with prostatitis was numerically but not significantly higher than that in those without prostatitis (t=0.794, P=0.066). Mean international index of erectile function-5 score in the prostatitis group was significantly lower than that in those without prostatitis (t=1.854, P=0.013). Histological prostatitis notably affected sexual function of patients and may serve as a major risk factor for sexual dysfunction while having little effect on lower urinary tract symptoms.

Effects of prostatic inflammation on LUTS and alpha blocker treatment outcomes

Purpose To evaluate the association between prostatic inflammation and lower urinary tract symptoms (LUTS), and to identify the effects of prostatic inflammation on the treatment with an alpha blocker. Materials and Methods 111 Participants who were aged ≥ 50 years, the presence of LUTS (maximal flow rate < 20 m/s, IPSS ≥ 11), and an elevated PSA level (3-20ng/mL) were treated with tamsulosin 0.2mg once daily for 3 months after prostate biopsies. Prostatic inflammation was scored as none (0), mild (I), moderate (II), or marked (III). LUTS parameters including urine flow rates, IPSS, PSA, and prostate volume were evaluated. Results Inflammation grading resulted in 25, 60, and 26 patients that were grade 0, I, and II, respectively. Lower grade inflammation was related to higher urine flow rate at baseline. Patients with higher inflammation grades had larger prostate volumes, larger total and transitional zone volumes, and higher PSA levels. Overall, urine flow rates and residual urine volume were improved after 3 months of alpha blocker therapy. Eighty percent of patients with grade 0 inflammation, 73% of patients with grade I inflammation, and 92.3% of patients with grade II inflammation showed improvement of LUTS after treatment. Longer duration of treatment was related to a decreased chance of improvement of LUTS. Patients with increased IPSS voiding subscales could be predictive of improvement of LUTS. Conclusions Patients with high grade inflammation had lower flow rates and higher prostatic volumes than patients with low grade inflammation. Inflammation grade did not affect the outcomes of alpha blocker treatment. .

Incidence and clinical characteristics of lower urinary tract symptoms as a presenting symptom for patients with newly diagnosed bladder cancer

PurposeThe incidence of lower urinary tract symptoms (LUTS) as the sole presenting symptom for bladder cancer has traditionally been reported to be low. The objective of this study was to evaluate the prevalence and clinical characteristics of newly diagnosed bladder cancer patients who presented with LUTS in the absence of gross or microscopic hematuria.Materials and MethodsWe queried our database of bladder cancer patients at the Atlanta Veteran’s Affairs Medical Center (AVAMC) to identify patients who presented solely with LUTS and were subsequently diagnosed with bladder cancer. Demographic, clinical, and pathologic variables were examined.Results4.1% (14/340) of bladder cancer patients in our series presented solely with LUTS. Mean age and Charlson Co-morbidity Index of these patients was 66.4 years (range = 52-83) and 3 (range = 0-7), respectively. Of the 14 patients in our cohort presenting with LUTS, 9 (64.3%), 4 (28.6%), and 1 (7.1%) patients presented with clinical stage Ta, carcinoma in Situ (CIS), and T2 disease. At a median follow-up of 3.79 years, recurrence occurred in 7 (50.0%) patients with progression occurring in 1 (7.1%) patient. 11 (78.6%) patients were alive and currently disease free, and 3 (21.4%) patients had died, with only one (7.1%) death attributable to bladder cancer.ConclusionsOur database shows a 4.1% incidence of LUTS as the sole presenting symptom in patients with newly diagnosed bladder cancer. This study suggests that urologists should have a low threshold for evaluating patients with unexplained LUTS for underlying bladder cancer.

Second to fourth digit ratio: its relationship with core cancer volume and Gleason score in prostate biopsy

OBJECTIVE: To investigate the relationships between 2nd to 4th digit ratio (digit ratio) and prostate cancer detection rate and biopsy findings, including Gleason score. MATERIALS AND METHODS: In 770 consecutive men aged 40 years or older that presented with lower urinary tract symptoms (LUTS), right hand 2nd and 4th digit lengths were measured prior to PSA determinations, DRE and transrectal ultrasonography (TRUS). Among these, 166 men with a prostate specific antigen (PSA) level ≥ 3 ng/mL or abnormal digit rectal examination (DRE) prospectively underwent prostate biopsies. The relationship between digit ratio and prostate cancer detection rate and biopsy findings was investigated. RESULTS: The study subjects were allocated to two groups by digit ratio (group A: digit ratio < 0.95; n = 420; group B: digit ratio ≥ 0.95; n = 350). Despite similar biopsy rates (22.4% vs. 20.6%, p = 0.544), group A had higher cancer detection rate (46.8% (44/94) vs. 23.6% (17/72), p = 0.002; OR = 2.847, 95% CI = 1.445-5.610). When we analyzed 408 positive biopsy cores (group A: digit ratio < 0.95, n = 282; group B: digit ratio ≥ 0.95, n = 126), group A had higher percentage of core cancer volume (46.7% vs. 37.1%, p = 0.005) and more biopsy cores with high Gleason score (sum of Gleason score ≥ 9: 18/282 (6.4%) vs. 1/126 (0.8%), p = 0.010; primary Gleason score = 5: 12/282 (4.3%) vs. 0/126 (0.0%), p = 0.021). CONCLUSIONS: A lower digit ratio is related to an increased detection rate of prostate cancer, a high percentage of core cancer volume and a high Gleason score.