[Effectiveness and treatment satisfaction in patients with erectile dysfunction in Spain: EDOS study]. / Efectividad y satisfacción con el tratamiento en pacientes con disfunción eréctil en España: estudio EDOS.

INTRODUCTION: Erectile dysfunction (ED) is a worldwide health problem with an ever increasing prevalence, affecting the quality of life of many patients. OBJECTIVE: The aim of this study was to describe treatment effectiveness and patient satisfaction with ED treatment in the Spanish cohort of the EDOS study. MATERIAL AND METHODS: This observational, pan-European study, assessed treatment effectiveness and patient satisfaction with ED treatment under routine clinical settings, using standard questionnaires. Men > or =18 years about to initiate or change ED treatment were enrolled. Patients were assessed at baseline, 3 and 6 months. RESULTS: A total of 1,029 patients were analyzed (12.8% of the total European sample). In general, the Spanish population characteristics are consistent with the overall population. At baseline 56.6% of patients received tadalafilo, 16.6% sildenafilo, 19.6% vardenafilo, and 7.2% received other treatments. At 3 months, a higher proportion of patients on tadalafil reported improved erections (GAQ 1: 96.5% tadalafil, 85.7% sildenafil and 87.2% vardenafil), satisfaction with treatment (EDITS: 84.2% tadalafil, 75.0% sildenafil and 76.0% vardenafil), and sexual self confidence (SF-PAIRS: 2.73 tadalafil, 2.39 sildenafil and 2.55 vardenafil), in comparison with sildenafil and vardenafil. At 6 months, differences between treatments were not significant. The mean+/-SD time elapsed from drug intake to sexual intercourse was higher for patients on tadalafil (18.6+/-26.4 h) compared to sildenafil (3.6+/-7.5) and vardenafil (8.6+/-19.4). CONCLUSION: The longer duration of action for tadalafil, and thus, the longer period of time between dosing and sexual intercourse may contribute to enhance sexual spontaneity, patient satisfaction with the treatment and greater self-confidence.

Efectividad y satisfacción con el tratamiento en pacientes con disfunción eréctil en España: Estudio EDOS / Effectiveness and treatment satisfaction in patients with erectile dysfunction in Spain: EDOS study

Introducción: La disfunción eréctil (DE) es un problema de salud mundial con una prevalencia creciente que afecta la calidad de vida de muchos pacientes. Objetivo: Analizar la efectividad y satisfacción con el tratamiento en la cohorte española de pacientes con DE incluidos en el estudio observacional de disfunción eréctil. Material y método: Estudio observacional, paneuropeo, que analizó la efectividad y satisfacción de los tratamientos para la DE en la práctica clínica habitual, utilizando cuestionarios estándares. Participaron varones ≥18 años que iniciaron o cambiaron su tratamiento para la DE. Los pacientes fueron evaluados en la visita basal, a los 3 y 6 meses. Resultados: Se analizaron 1.029 pacientes (12,8% de la muestra europea total). En general, las características de la población española son consistentes con las de la población global. En la visita basal 56,6% recibió tadalafilo, 16,6% sildenafilo, 19,6% vardenafilo y 7,2% otros tratamientos. A los 3 meses, una mayor proporción de pacientes con tadalafilo experimentó mejorías en la erección (cuestionario de evaluación global 1: 96,5% tadalafilo, 85,7% sildenafilo, 87,2% vardenafilo), se observó una mayor satisfacción con el tratamiento (inventario de satisfacción con el tratamiento para la DE: 84,2% tadalafilo, 75,0% sildenafilo y 76,0% vardenafilo) y mayor autoconfianza (escalas psicológicas y de relaciones interpersonales: 2,73 tadalafilo, 2,39 sildenafilo y 2,55 vardenafilo). A los 6 meses, las diferencias entre tratamientos no resultaron significativas. El tiempo medio±desviación estándar entre la toma del fármaco y la relación sexual fue mayor en los pacientes con tadalafilo (18,6±26,4h) vs. sildenafilo (3,6±7,5) y vardenafilo (8,6±19,4). Conclusiones: La mayor duración del efecto de tadalafilo y en consecuencia el mayor tiempo medio entre la toma y la relación sexual podría contribuir a aumentar la espontaneidad en las relaciones sexuales, la satisfacción con el tratamiento y mayor autoconfianza (AU)

Introduction: Erectile dysfunction (ED) is a worldwide health problem with an ever increasing prevalence, affecting the quality of life of many patients. Objective: The aim of this study was to describe treatment effectiveness and patient satisfaction with ED treatment in the Spanish cohort of the EDOS study. Material and methods: This observational, pan-European study, assessed treatment effectiveness and patient satisfaction with ED treatment under routine clinical settings, using standard questionnaires. Men ≥18 years about to initiate or change ED treatment were enrolled. Patients were assessed at baseline, 3 and 6 months. Results: A total of 1,029 patients were analyzed (12.8% of the total European sample). In general, the Spanish population characteristics are consistent with the overall population. At baseline 56.6% of patients received tadalafilo, 16.6% sildenafilo, 19.6% vardenafilo, and 7.2% received other treatments. At 3 months, a higher proportion of patients on tadalafil reported improved erections (GAQ 1: 96.5% tadalafil, 85.7% sildenafil and 87.2% vardenafil), satisfaction with treatment (EDITS: 84.2% tadalafil, 75.0% sildenafil and 76.0% vardenafil), and sexual self confidence (SF-PAIRS: 2.73 tadalafil, 2.39 sildenafil and 2.55 vardenafil), in comparison with sildenafil and vardenafil. At 6 months, differences between treatments were not significant. The mean±SD time elapsed from drug intake to sexual intercourse was higher for patients on tadalafil (18.6±26.4 h) compared to sildenafil (3.6±7.5) and vardenafil (8.6±19.4). Conclusion: The longer duration of action for tadalafil, and thus, the longer period of time between dosing and sexual intercourse may contribute to enhance sexual spontaneity, patient satisfaction with the treatment and greater self-confidence (AU)

[Therapeutic approach in adrenal melanoma. Review of the literature]. / Actitud terapéutica en el melanoma suprarrenal. Revisión de la literatura.

OBJECTIVE: To review the treatment strategies for adrenal melanoma and to emphasize the role of curative surgical resection and adjuvant treatment in selected patients with melanoma metastatic to the adrenal gland versus chemotherapy alone in the treatment of patients with advanced malignant melanoma. METHODS: A case of adrenal gland metastasis of a cutaneous melanoma (Clark IV, Breslow 5 mm.) treated by excision one year before that was referred to the Urology Department for Wünderlich syndrome is presented. RESULTS: The analyzed series of programmed adrenalectomy for adrenal metastases from melanoma describe survivals of 26 (3), 36 (9), 59 (3) and 72 (5) months. In our case the patient died at home one month later due to stroke, although concomitant brain metastasis is suspected. Autopsy was not performed. CONCLUSIONS: In the differential diagnosis of an incidentaloma, metastatic disease is likely in a patient with a history of malignant disease. The frequency of malignant melanoma among metastatic adrenal disease varies between 1% and 8.6%; the majority are asymptomatic and incidental findings. We believe that in selected patients with advanced malignant melanoma, with no major coexisting morbidity factors who have isolated melanoma metastatic to the adrenal gland or with limited extra-adrenal sites of disease, curative surgical resection and adjuvant treatment may improve their survival. It must be emphasized that all patients should be followed after surgical resection of the primary tumor because it will facilitate staging of the disease and avoid emergency situations of ruptured friable metastases that make complete resection difficult.

[Differential diagnosis of epididymal leiomyoma. Report of a new case]. / Diagnósticos diferenciales del leiomioma de epidídimo. Aportación de un nuevo caso.

OBJECTIVE: A case of epididymal leiomyoma is presented. This lesion is uncommon and sometimes misdiagnosed. The literature is briefly reviewed. METHODS/RESULTS: A 29-year-old patient presented with a tumor in the tail of the right epididymis that was initially diagnosed as scrotal hematoma or complex cyst in the tail of the epididymis. RESULTS/CONCLUSIONS: Ultrasound has an important role in distinguishing testicular from epididymal tumors. However, if the diagnosis is unclear, surgical resection and subsequent anatomopathological analysis must be performed.

[Primary neuroectodermal tumor (PNET) of the kidney: 26 cases. Current status of its diagnosis and treatment]. / Tumor neuroectodérmico primitivo renal (PNET): 26 casos. Estado actual de su diagnóstico y tratamiento.

OBJECTIVE: To report a case of primitive neuroectodermal tumor (PNET) of the kidney and review the literature and the 25 cases previously reported as PNET. METHODS: A 39-year-old man who consulted for nephric colic is described. Ultrasound evaluation disclosed a mass arising from the left kidney. The clinical, radiological and pathologic features, treatment and differential diagnosis of small cell tumors are discussed, as well as the important role of immunohistochemical techniques (positive staining with O13 or 12E7 antibodies) and cytogenetic analysis [a characteristic chromosomal translocation t(11;22) (q24;q12) or variant translocation, such as t(21;22) (q22;q12), may be detected by fluorescence in situ hybridization (FISH) or polymerase chain reaction-reverse transcriptase (PCR-RT)]. RESULTS: Survival of our patient was 20 months. Only three of the 25 previously reported cases had a longer survival: 60, 48 and 24 months. Mean survival was 10 months. 95.24% of the cases were positive for NSE. Immunostaining (CD99) was performed in 16 patients and was found to be positive in all cases. Cytogenetic and molecular analyses were performed in 11 cases; PCR-RT was negative in two, as well as in the case described herein. CONCLUSIONS: PNET is a highly aggressive neoplasm that tends to recur locally and to metastasize. Despite the poor response to standard therapy combining surgical resection, postoperative irradiation and chemotherapy, the results might change due to current research on genetic therapy based on creating antisense oligonucleotides against the EWS-FLI 1 fusion gene.

[Stromal tumor of the rectum and leiomyosarcoma of the prostate as a cause of urinary syndrome attributable to BPH]. / Tumor estromal de recto y leiomiosarcoma de próstata como causa de síndrome miccional atribuible a HBP.

OBJECTIVE: To discuss the classifications of patients with lower urinary tract symptoms ascribed to BPH, in order to define the indication for treatment for patients with similar features but of a different etiology. The literature is also reviewed. METHODS/RESULTS: Two patients, aged 62 and 63 years, diagnosed as having BPH were found to have a gastrointestinal stromal tumor (GIST) and a leiomyosarcoma of the prostate, respectively. The first patient had undergone retropubic resection. Frozen section analysis revealed a GIST. The second patient had undergone TURP twice. A perineal biopsy at the last medical examination showed a leiomyosarcoma of the prostate. This patient finally underwent pelvic tumorectomy. The international classification of BPH is discussed: PQSF (P: prostatic weight determined by transrectal US or DRE; Q: quality of life assessment; S: international prostate symptom score (IPSS); F: maximum urinary flow rate by uroflowmetry--Qmax). CONCLUSIONS: The classifications are practical, but should be improved. In our view, details useful in orienting the diagnosis could be lost by oversimplification.

[Neurophysiologic techniques in the diagnosis of erectile dysfunction: study of 105 cases]. / Técnicas neurofisiológicas en el diagnóstico de la disfunción eréctil: estudio de 105 casos.

OBJECTIVE: To present the results of the neurophysiological diagnostic evaluation in patients with erectile dysfunction. METHODS: 105 consecutive patients with complaints of erectile dysfunction were evaluated. The patients were divided into five groups according to their history: surgery/trauma, diabetes, vascular disease, toxicity, and no antecedents. Neurophysiological examination, laboratory tests, hormone and vascular studies were performed. Patient evaluation included neurophysiological studies on nerve conduction velocity (NCV), bulbocavernosus reflex (BCR), spinal and scalp somatosensory evoked potentials from the posterior tibial nerves (SEPt) and from the dorsal penile nerve (SEPp). In selected cases, electromyography and neuroimaging studies were done. RESULTS: 71 patients (67.62%) showed organic alterations; 57 of these patients had abnormal neurophysiological tests. Ranked in order of incidence, the tests were abnormal for NCV in 46/105 patients, SEPt 37/105, BCR 35/105 and SEPp in 30/105 patients. The incidence of BCR abnormalities was higher than that of the NCV only in the surgery/trauma group, probably due to a higher prevalence of local injuries, while NCV showed the highest incidence of abnormal results in the other groups of patients. Only 8 patients showed normal NCV with abnormal BCR, SEPp and/or SEPt (14.04% of patients had neurophysiological disturbances). CONCLUSION: In this study, most of our patients showed vascular, neurologic or both abnormalities, and were rarely associated with other factors. In our view, NCV is the technique of choice in the assessment of neurological disorders in patients with erectile dysfunction, whereas the other less sensitive tests are considered to be indicated basically in erectile dysfunction highly suspected as having an underlying neurogenic cause.

[Anatomophysiology of ejaculation]. / Recuerdo anatomofisiológico de la eyaculación.

OBJECTIVES: The present study reviews the anatomophysiological and neurological aspects of ejaculation and ejaculatory disorders. METHODS/RESULTS: The different phases of the ejaculatory process and the male genitalia are analyzed. CONCLUSIONS: Ejaculation is a complex psychobiological process whose innermost mechanisms have yet to be elucidated. Further studies are warranted to obtain further insight into ejaculatory disorders whose impact on the male population cannot be overemphasized.

[Surgical correction of congenital penile curvatures using the Nesbit technique. Apropos of 24 cases]. / Corrección quirúrgica de curvaduras congénitas de pene, según técnica de Nesbit. A propósito de 24 casos.

We present our experience of 24 cases with congenital penile deviation without hypospadias. Treatment was by surgical correction of the curvature using the Nesbit technique. We briefly describe the diagnostic methods and the parameters utilized for surgical planning and evaluation of the results of surgery. This simple procedure achieved good results in all of our cases.

[Polycythemia as the first and only manifestation of renal adenocarcinoma]. / Policitemía como primera y única manifestación de adenocarcinoma renal.

We report on a 40-year-old patient with adenocarcinoma of the right kidney whose first and only manifestation was the erythrocytosis that had been detected on routine analytical work up. The diagnostic methods (US, IVP, CT, aspiration biopsy cytology and renal arteriography) and treatment (right nephrectomy via extended thoracophrenolaparotomy incision at the level of the ninth rib) are briefly described. The polycythemia remitted following nephrectomy. The etiopathogenesis and hypotheses that have been put forward relative to polycythemia in renal adenocarcinoma are briefly discussed. Renal tumor, particularly renal adenocarcinoma, should be suspected in the presence of polycythemia of unknown origin. Persistent or recurrent polycythemia should prompt us to suspect incomplete tumor excision or metastasis. Surgical risks (embolism, hemorrhage, etc.) may be reduced if hematocrit levels are brought down to within normal levels by bleeding.

[Kidney injuries: a review of 149 cases. A change in the diagnostic and therapeutic approaches]. / Traumatismos renales: revisión de 149 casos. Cambio en la actitud diagnóstica y terapéutica.

We reviewed 149 cases of renal trauma that were seen at the Urology Service of Hospital de Navarra from January, 1975 to December, 1989. The severity of the renal injury, type (open or closed), the presence of previous lesions, renal changes, and the diagnostic and therapeutic approaches were analyzed. The follow-up urologic and nephrologic controls are briefly described. Most of the cases with important renal injury have been followed for one to five years. We observed as increased incidence of renal injuries from road traffic accidents in younger patients with a prevalence in the male. Treatment is more conservative and less nephrectomies have been performed. CT, US, renal arteriography and isotope studies have become widely available. The endourological and transcutaneous techniques have been widely used in the treatment of these patients.

[Surgical adrenal gland pathology. Urologist's pathology]. / Patología quirúrgica suprarrenal. Patología propia del urólogo.

We reviewed 6 cases of unilateral adrenal tumor that had been treated during a 5-year period. The Turner-Warwick modified lateral approach was performed in all 6 cases. In our view, surgical treatment of unilateral adrenal tumors should be performed by the urologist. The high lumbar approach appears to be the most appropriate for unilateral adrenal tumor masses not larger than 6 cm. The surgical anatomy of the adrenal gland is briefly described.

[Unusual presentation form of testicular neoplasms. Report of 5 cases]. / Forma de presentación no habitual en las neoplasias testiculares. A propósito de cinco casos.

Testicular tumors have a typical form of presentation, but there are also unusual forms that must always be considered. We report on 5 cases of testicular tumors that had an uncommon form of presentation: 3 seminomas (1 anaplastic), 1 teratocarcinoma and 1 carcinoma in situ. All testicular changes, particularly in the young male, must be suspected as being a testicular neoplasm and a complete work up must be performed until the exact diagnosis can be made. Currently, evaluation of the testes by ultrasound is a necessary procedure in the diagnosis of this pathological condition. Because it is non-invasive, simple and low-cost, it is the ideal method of evaluation.

[Primary ureteral adenocarcinoma. Ureteroscopic diagnosis]. / Adenocarcinoma ureteral primario. Diagnóstico ureteroscópico.

A case of primary adenocarcinoma of the ureter that had been diagnosed by ureteroscopy is described, highlighting the form of presentation and treatment. The anatomopathological features as well as the method employed for diagnosis make this an extremely uncommon case.

[Image diagnosis in primary retroperitoneal tumors]. / Diagnóstico por la imagen en los tumores retroperitoneales primitivos.

We present our experience in the diagnosis-through-image with 25 primitive retroperitoneal tumours over a period of 17 years. The histological type most frequently found was that derived from mesodermal tissue (64%). Abdominal pain and mass were the typical symptoms of the presentation. The paper analyzes the radiological studies used (except NMR) with regard to the diagnostic value they have in this sort of pathology. UIV continues to be the initial examination when a retroperitoneal tumour is suspected, obtaining a diagnostic orientation of 70%. The remaining diagnostic techniques (except arteriography and CAT) should be used as a diagnostic supplement or to assess the disease progression, unless the initial clinical symptoms make their use advisable, since the diagnostic orientation provided is usually below 50%. The use of CAT together with monitored aspiratory puncture provided a diagnostic reliability over 90%, so we conclude this should be the examination technique of choice when retroperitoneal tumour is suspected.