Comparison between PSA density, free PSA percentage and PSA density in the transition zone in the detection of prostate cancer in patients with serum PSA between 4 and 10 ng/ml

OBJECTIVE: Compare the capacity of the PSA density (PSAD), Free PSA percentage ( percentFPSA) and PSA transition zone density (PSATZ) in improving the sensitivity and specificity of the PSA to detect prostate cancer (PCa) in men with a PSA between 4 and 10 ng/mL. MATERIALS AND METHODS: One hundred and forty five men with PSA between 4 and 10 ng/mL were prospectively studied. Blood collection for the total PSA and free PSA was performed as well as transrectal ultra-sound with prostate biopsy and measurement of the total prostate volume (TPV) and transition zone volume (TZV). Patients with initial negative biopsy were followed and the prostate biopsy was repeated in those that presented PSA increase. The capacity of the PSAD, percentFPSA and PSADTZ in improving the sensitivity and specificity pf the PSA test to the detection of the PCa was assessed by univariate and multivariate analyses and through the ROC curve. RESULTS: Of the 145 patients, 38 (26.2 percent) had PCa and in 107 (73.8 percent) a benign prostate disease was diagnosed. No difference among the PSAD, percentFPSA and PSADTZ was found. The multivariate analysis showed that the PSADTZ, percentFPSA, TZV and age were those more powerful and highly significant PCa predictors. CONCLUSION:The determination of percentFPSA and PSAD can allow a better discrimination between PCa and benign disease that the isolated use of PSA. The combination of PSADTZ, percentFPSA, TZV and age promote a high accuracy for PCa detection.

Testicular schistosomiasis mimicking tumour

Schistosomiasis or bilharziasis is a disease caused by Schistosoma. When infecting men the most common parasites are Schistosoma mansoni, Schistosoma japonicum and Schistosoma haematobium. The Schistosoma mansoni is the only endemic parasite in Brazil. We present a case of testicular schistosomiasis simulating malignancy. The case was treated successfully by excisional biopsy and praziquantel therapy. A review of the literature is discussed.

Post-cheotherapy residual mass in non-siinomatous testicular cancer: the role of retroperitoneal lymph node dissection

PURPOSE: to determine the role of RPLND for residual masses following chiotherapy in patients with non-siinomatous germ cell tumors (NSGCT) stage T1N2 and T1N3 (IIB and IIC). MATERIALS AND METHODS: We have preformed retrospective analysis of 11 patients who underwent RPLND for residual masses following chiotherapy in an oncologic reference center between January 1997 and Deciber 2002. All patients harbored either pure nonsiinomatous or mixed tumors in the testis tissue and had undergone 4 cycles of primary chiotherapy with bleomycin, etoposide and cisplatin. The residual masses were assessed by abdominal computed tomography preoperatively. RESULTS: There were perioperative complications in 3 cases owing to vascular iatrogenic lesion. One of who died in the early postoperative period due to extensive iliac thrombosis. The other 2 patients had an inferior vena cava injury owing to the difficulty in rioving the attached lymph nodes. The injuries were repaired by continuous suture with Prolene 5-0. All patients had tumors in the final pathological report and were referred to other 2 cycles of chiotherapy with the same drugs. Seven patients (63.3 percent) had complete response and riained free of the disease in a mean follow up of 38.3 months (ranging from 12 to 72). The riaining 3 patients had disease progression, 2 of which died 6 and 12 months after surgery, respectively, and one patient missed the follow-up after salvage chiotherapy. CONCLUSION: Retroperitoneal lymph node dissection for residual masses after chiotherapy is a high-morbidity procedure, even by experienced surgeons, although it riains an efficient modality of treatment in advanced germ cell carcinoma. The high frequency of tumor found in the RPLFN following chiotherapy might have been caused by the small number of patients in this study.

Variables predictive of voiding disfunction following aponeurotic sling surgery: multivariate analysis

INTRODUCTION: Aponeurotic sling surgeries can evolve with obstruction or voiding dysfunction in 5 to 20 percent of patients. There are few studies on factors that could possibly predispose to voiding difficulties or urinary retention. The objective of this work is to identify these potential clinical or urodynamic factors. MATERIALS AND METHODS: Records from 130 patients who underwent aponeurotic sling surgeries were reviewed. All patients underwent a throughout urodynamic study during pre-operative investigation. The variables studied were age above 65 years, previous pelvic surgeries, concomitant surgeries, post-voiding residue higher than 100 mL, vesical obstruction (according to Blaivas-Groutz nomogram) and urinary flow under 12 mL/s. Post-voiding residue was assessed on the seventh post-operative day through vesical catheterization. Recovering of spontaneous voiding after 7 post-operative days or with a residue higher than 100 mL, was regarded as voiding dysfunction. Univariate analysis was performed with qui-square test and Fisher's exact test, and multivariate analysis was performed by logistic regression with alpha = 5 percent. RESULTS: Age in the studied group ranged from 41 to 83 years (mean 56.7 years), with 69 (53 percent) patients having urethral hypermobility and 61 (47 percent) having intrinsic urethral lesion. Normal voiding occurred in 97 (75.6 percent) women with 7 post-operative days. The only significant variable in the univariate (p = 0.014) and multivariate (p = 0.017) analysis was post-voiding residue higher than 100 mL. CONCLUSION: Pre-operative presence of a post-voiding residual urine higher than 100 mL was the only variable predictive of voiding dysfunction.

Use of cadaveric fascia lata to correct grade IV cystocele

We describe a modification of the cadaveric prolapse repair and sling - CaPS technique that uses the sling surgery principles to correct grade IV cystocele. In this modification, the central and paravaginal defects reconstitution are performed using cadaveric fascia lata fixed over rectus abdominis muscle, eliminating the need of pubic fixation by screws, as proposed by the original technique. The modification described, besides presenting the benefits of CaPS, i.e., not using impaired tissues to reconstruct vesical support, and lower risks of perineal hypercorrection, also reduces the probability of complications of bone fixation

Relato de caso: angiossarcoma de glândula adrenal / Case report: angiosarcoma of adrenal gland

Angiossarcoma de glândula supra-renal é um tumor extremamente raro, näo tendo nenhum caso publicado na literatura brasileira. Nós relatamos o primeiro caso desta neoplasia no Brasil

Sensibilidade de dados da história clínica na detecçäo da incontinência urinária de esforço do tipo esfincteriana / Sensitivity of clinical history data in detection of sphincteric stress urinary incontinence

Foram avaliadas 78 mulheres portadoras de incontinência urinária de esforço, para identificar dados da história clínica (esforçco físico e número de absorventes vaginais em 24 horas), que pudessem predizer casos de incontinência urinária esfincteriana. Submetemos todas as pacientes ao estudo urodinâmico completo para a determinaçäo da pressäo de perda sob manobra de Valsalva. A distribuiçäo dos tipos de incontinência foi a seguinte: 22 classificadas como incontinência urinária tipo I, 26 tipo II e 30 tipo III. Do total de pacientes 45 pacientes, 45 mulheres (57,6 porcento) foram submetidas previamente a cirurgias, e entre essas 17 (37,7 porcento) apresentavam incontinência urinária esfincteriana. A associaçäo de incontinência urinária tipo III e cirurgia prévia mostrou-se näo significativa estatisticamente. O uso de 2 ou mais absorventes em 24 horas foi estatisticamente significativo para as pacientes com incontinência esfincteriana. Nossos resultados demonstram que mulheres com perdas aos pequenos esforços e uso de 2 ou mais absorventes vaginais apresentam alta probabilidade de lesäo esfincteriana (p<0,05). Entretanto, o estudo urodinâmico é o único exame comprovativo do diagnóstico de incontinência urinária esfincteriana