4Kscore Test, Prostate Cancer Prevention Trial-Risk Calculator y European Research Screening Prostate-Risk Calculator en la predicción del cáncer de próstata de alto grado; estudio preliminar / A Preliminary Study of the Ability of the 4Kscore test, the Prostate Cancer Prevention Trial-Risk Calculator and the European Research Screening Prostate-Risk Calculator for Predicting High-Grade Prostate Canc

Introducción: Frente al sobrediagnóstico y al sobretratamiento en cáncer de próstata (CaP) se establecen estrategias terapéuticas como la vigilancia activa o la terapia focal, o métodos para precisar el diagnóstico del CaP de alto grado (CaP-AG), Gleason ≥ 7, como la resonancia magnética multiparamétrica o nuevos marcadores como el 4Kscore Test (4KsT). Es nuestro propósito testar mediante un estudio piloto la capacidad del 4KsT como identificador de CaP-AG (suma de Gleason ≥ 7) en biopsia de próstata (Bx) y compararlo con otros modelos pronósticos multivariantes disponibles, como el Prostate Cancer Prevention Trial-Risk Calculator 2.0 (PCPTRC 2.0) y elEuropean Research Screening Prostate Cancer-Risk Calculator 4 (ERSPC-RC 4). Material y métodos: Cincuenta y un pacientes sometidos a BxP según práctica clínica habitual, con un mínimo de 10 cilindros. Diagnóstico de CaP-AG consensuado por 4 uropatólogos. Comparación de las predicciones ofrecidas por los diferentes modelos mediante prueba U Mann-Whitney, áreas bajo la curva ROC (AUC) (test de DeLong), funciones de densidad de probabilidad, diagramas de caja y curvas de utilidad clínica (CUC). Resultados: Un 43% presentaron CaP y un 23,5% CaP-AG. Las medianas de probabilidad de 4KsT, PCPTRC 2.0 y ERSPC-RC 4 fueron significativamente diferentes entre los pacientes con CaP-AG y no CaP-AG (p ≤ 0,022), siendo más diferenciadas en el caso de 4KsT (mediana en CaP-AG: 51,5% [percentil 25-75: 25-80,5%], frente a 16% [P 25-75: 8-26,5%] en no CaP-AG [p = 0,002]). Todos los modelos mostraron AUC por encima de 0,7 sin diferencias significativas entre ninguno de ellos y 4KsT (p ≥ 0,20). Las funciones de densidad de probabilidad y diagramas de caja muestran una buena capacidad discriminativa, especialmente en los modelos de ERSPC-RC 4 y 4KsT. Las CUC muestran como un punto de corte del 9% de 4KsT identifica a todos los CaP-AG y permite un ahorro del 22% de biopsias, similar a lo que ocurre con los modelos de ERSPC-RC 4 y un punto de corte del 3%. Conclusiones: Los modelos predictivos evaluados ofrecen una buena capacidad de discriminación del CaP-AG en Bx. 4KsT es un buen modelo clasificatorio en su conjunto, seguido de ERSPC-RC 4 y PCPTRC 2.0. Las CUC permiten sugerir puntos de corte de decisión clínica: 9% para 4KsT y 3% en ERSPC-RC 4. Este estudio preliminar debe ser interpretado con cautela por su limitado tamaño muestral

Introduction: To prevent the overdiagnosis and overtreatment of prostate cancer (PC), therapeutic strategies have been established such as active surveillance and focal therapy, as well as methods for clarifying the diagnosis of high-grade prostate cancer (HGPC) (defined as a Gleason score ≥7), such as multiparametric magnetic resonance imaging and new markers such as the 4Kscore test (4 KsT). By means of a pilot study, we aim to test the ability of the 4 KsT to identify HGPC in prostate biopsies (Bx) and compare the test with other multivariate prognostic models such as the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPTRC 2.0) and the European Research Screening Prostate Cancer Risk Calculator 4 (ERSPC-RC 4). Material and methods: Fifty-one patients underwent a prostate Bx according to standard clinical practice, with a minimum of 10 cores. The diagnosis of HGPC was agreed upon by 4 uropathologists. We compared the predictions from the various models by using the Mann-Whitney U test, area under the ROC curve (AUC) (DeLong test), probability density function (PDF), box plots and clinical utility curves. Results: Forty-three percent of the patients had PC, and 23.5% had HGPC. The medians of probability for the 4 KsT, PCPTRC 2.0 and ERSPC-RC 4 were significantly different between the patients with HGPC and those without HGPC (p≤.022) and were more differentiated in the case of 4 KsT (51.5% for HGPC [25-5 percentile: 25-80.5%] vs. 16% [P 25-75: 8-26.5%] for non-HGPC; p=.002). All models presented AUCs above 0.7, with no significant differences between any of them and 4 KsT (p≥.20). The PDF and box plots showed good discriminative ability, especially in the ERSPC-RC 4 and 4 KsT models. The utility curves showed how a cutoff of 9% for 4 KsT identified all cases of HGPC and provided a 22% savings in biopsies, which is similar to what occurs with the ERSPC-RC 4 models and a cutoff of 3%. Conclusions: The assessed predictive models offer good discriminative ability for HGPCs in Bx. The 4 KsT is a good classification model as a whole, followed by ERSPC-RC 4 and PCPTRC 2.0. The clinical utility curves help suggest cutoff points for clinical decisions: 9% for 4 KsT and 3% for ERSPC-RC 4. This preliminary study should be interpreted with caution due to its limited sample size

A Preliminary Study of the Ability of the 4Kscore test, the Prostate Cancer Prevention Trial-Risk Calculator and the European Research Screening Prostate-Risk Calculator for Predicting High-Grade Prostate Cancer.

INTRODUCTION: To prevent the overdiagnosis and overtreatment of prostate cancer (PC), therapeutic strategies have been established such as active surveillance and focal therapy, as well as methods for clarifying the diagnosis of high-grade prostate cancer (HGPC) (defined as a Gleason score ≥7), such as multiparametric magnetic resonance imaging and new markers such as the 4Kscore test (4KsT). By means of a pilot study, we aim to test the ability of the 4KsT to identify HGPC in prostate biopsies (Bx) and compare the test with other multivariate prognostic models such as the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPTRC 2.0) and the European Research Screening Prostate Cancer Risk Calculator 4 (ERSPC-RC 4). MATERIAL AND METHODS: Fifty-one patients underwent a prostate Bx according to standard clinical practice, with a minimum of 10 cores. The diagnosis of HGPC was agreed upon by 4 uropathologists. We compared the predictions from the various models by using the Mann-Whitney U test, area under the ROC curve (AUC) (DeLong test), probability density function (PDF), box plots and clinical utility curves. RESULTS: Forty-three percent of the patients had PC, and 23.5% had HGPC. The medians of probability for the 4KsT, PCPTRC 2.0 and ERSPC-RC 4 were significantly different between the patients with HGPC and those without HGPC (p≤.022) and were more differentiated in the case of 4KsT (51.5% for HGPC [25-75 percentile: 25-80.5%] vs. 16% [P 25-75: 8-26.5%] for non-HGPC; p=.002). All models presented AUCs above 0.7, with no significant differences between any of them and 4KsT (p≥.20). The PDF and box plots showed good discriminative ability, especially in the ERSPC-RC 4 and 4KsT models. The utility curves showed how a cutoff of 9% for 4KsT identified all cases of HGPC and provided a 22% savings in biopsies, which is similar to what occurs with the ERSPC-RC 4 models and a cutoff of 3%. CONCLUSIONS: The assessed predictive models offer good discriminative ability for HGPCs in Bx. The 4KsT is a good classification model as a whole, followed by ERSPC-RC 4 and PCPTRC 2.0. The clinical utility curves help suggest cutoff points for clinical decisions: 9% for 4KsT and 3% for ERSPC-RC 4. This preliminary study should be interpreted with caution due to its limited sample size.

[Versatility of axial penile skin fasciocutaneous flap in reconstruction of pendulous urethra]. / Versatilidad del colgajo axial fasciocutáneo de piel de pene en la reconstrucción de la uretra péndula.

PURPOSE: We describe three cases, with different features, of anterior urethral strictures that were treated with the same technique: a circular axial penile fasciocutaneous flap. MATERIAL AND METHODS: We report three cases of patients with urethral strictures that affected the whole glandar and penile urethra. In one case the stricture affected the bulbar urethra. No patient has the preputial skin disposable, because of a previous circumcision, and all has been treated with different techniques. In one patient, a first step urethroplastia was performed previously, open all the penile urethra. All the cases were successfully treated with a circular axial fasciocutaneous penile flap in one stage. In case number one the reconstruction was combined with a scrotal flap. In case number three, the glandar urethra was reconstructed. CONCLUSIONS: The circular axial fasciocutaneous penile flap is a versatile technique that can be use to correct various type of strictures of the whole glandar and penile urethra alone or associated with strictures of the bulbar urethra.

Versatilidad del colgajo axial fasciocutáneo de piel de pene en la reconstrucción de la uretra péndula / Versatility of the axial fasciocutaneous penile flap for the pendulous urethral reconstruction

OBJETIVO: Describir tres casos de estenosis de uretra que afectaba a uretra peneana y glandarcon diferentes características, pero que fueron tratadas mediante el uso del mismo recurso técnico:el colgajo axial circular fasciocutáneo de piel de pene. MATERIAL Y MÉTODOS: Presentamos tres casos de estenosis de uretra que afectaba a toda la ure-trapeneana y glandar. En uno de ellos (caso nº1) también se encontraba afecta la uretra bulbar. Todoslos pacientes se encontraban circuncidados en el momento de realizar la cirugía uretral, asimismotodos habían sido tratados mediante diversas técnicas siendo estenosis de muy larga evolución. Enuno de ellos (caso nº 2), de modo previo, se había realizado una puesta a plano de toda la uretra pene-anay glandar. Todos fueron tratados mediante un colgajo axial circular fasciocutáneo de piel de pene,realizándose la técnica quirúrgica en un solo tiempo. En el primer caso se utilizó de modo combina-doun colgajo de rafe medio escrotal. En el tercer caso se reconstruyó la uretra glandar. CONCLUSIONES: El colgajo axial fasciocutáneo de piel de pene es una opción terapéutica versátil,que puede corregir las muy diversas situaciones que la estenosis de toda la uretra peneana nos puedepresentar (AU)

[Bladder tumor lethality. Results in the autonomous community of Rioja between 1975-1991]. / Letalidad por tumor vesical. Resultados en la comunidad autónoma de la Rioja entre los años 1975-1991.

Between 1975-1991, a total of 557 cases of bladder carcinoma were identified in the Autonomous Community of La Rioja (CAR) which were followed up to December 1994. The overall lethality was 21.9%. 492 cases with 22.35% lethality were identified in males. In females, however, there was 65 cases with 18.46% lethality. The comparison of males and females lethality resulted in p = 0.525. Lethality between cases diagnosed within each 5-year period analyzed is: 1975-1981: 177 cases, lethality 23.72%. 1982-1986: 168 cases, lethality 30.95%. 1987-1991: 212 cases, lethality 13.20%. Between the first and the second 5-year periods, p = 0.132; between the first and third 5-year periods p = 0.007 and between the second and third 5-year periods p < 0.000. Bladder tumours accounts in CAR for a 22.35% lethality. Lethality is higher in males that in females but the difference is not statistically significant. In the last 5-year period assessed, 1987-1991, a reduction of lethality from bladder neoplasms has been documented.

[Influence of sex differences in biological aggressivity of bladder urothelial tumor at first diagnosis]. / Influencia de la diferencia de sexo en la agresividad biológica del tumor urotelial vesical en su primer diagnóstico.

RATIONALE: To investigate whether, in the same way incidence is affected, biological aggressiveness of bladder cancer at diagnosis is greater in men than in women. METHOD: Using data from a retrospective study on urothelial cancer of the bladder between 1975 and 1991 in La Rioja (Spain), an estimate was made of total Relative Risk, Mantel-Haenszel relative weighted risk and Greenland-Robins 95% confidence interval of suffering infiltrant bladder cancer in male versus female, assuming that the tumour affecting the muscle layer was infiltrant. RESULTS: Total Relative Risk (1.05). Mantel-Haenszel relative weighted risk (1.08), and Greenland-Robins confidence interval (0.65-Relative Risk-1.08). CONCLUSIONS: It is concluded that sex differences have no influence on the risk to develop infiltrant urothelial cancer of the bladder at diagnosis.

[Bone metaplasia of the bladder associated with urothelial tumor. A clinical case]. / Metaplasia ósea de la vejiga asociada a tumor urotelial. Caso clínico.

One case report of bone metaplasia of the bladder wall associated to urothelial tumour located on the urothelium coating the lesion. Suspicion diagnosis started from findings identified in the transurethral resection. A stone-like mass attached by a pedicle to the bladder wall was found during the examination. The pathoanatomical study confirmed the diagnosis of bone metaplasia of the bladder wall, identifying nests of urothelial tumour adjacent to the urothelium. No report of similar cases has been found in the literature referring to the association of urothelial tumour and bone metaplasia of the bladder wall.

[Bladder cancer survival, study of 557 cases identified at the autonomous community of La Rioja from 1975 to 1991]. / Supervivencia por cáncer de vejiga, estudio de 557 casos identificados en la Communidad Autónoma de La Rioja entre 1975 y 1991.

OBJECTIVE: To analyze survival in 557 cases of bladder cancer that had been detected in La Rioja (Spain) from 1975 to 1991. METHODS/RESULTS: The Kaplan Meier and Mantel and Haenszel methods were used for the statistical analyses. The survival rate for each 5-year period analyzed was 69%, 58% and 73%, respectively. Most deaths occurred within the first 24 months. The survival rates were 25%, 21% and 0%, respectively, for infiltrating tumors and 84%, 76% and 85% for superficial tumors was of the. The survival rates for males and females were not statistically significant. CONCLUSION: The survival rate in patients with bladder cancer has increased. Patients with infiltrating bladder tumors have a worse prognosis. The survival rates for males and females are not statistically significantly different.

[Retrotrigonal bladder lymphoma]. / Linfoma vesical de localización retrotrigonal.

Presentation of one case of vesical involvement due to lymphoma in an 82-year old female which presented as a micturition syndrome, abdominal mass and later picture of obstructive uropathy with acute renal function impairment. Diagnosis was achieved by ultrasound and abdominal CAT, cystoscopy with of vesical biopsy, transvaginal mass biopsy and immunohistochemical techniques. The difficulties of a correct differential diagnosis with other vesical neoplasias as well as the need to differentiate primary from systemic vesical lymphoma were discussed, not only because of the separate prognosis but also for the different therapeutical approaches.

[Bladder leiomyosarcoma. Report of 2 cases]. / Leiomiosarcoma vesical. Presentación de dos casos.

OBJECTIVES: The difficulties encountered in making the differential diagnosis and the highly malignant nature of leiomyosarcoma of the bladder, an uncommon tumor type, have prompted us to report on these two cases. MATERIAL AND METHODS: Two cases of leiomyosarcoma of the bladder are described: a 64-year-old female that was treated sequentially by TUR and chemotherapy and died of metastatic disease after 14 months, and an 81-year-old male with metastasis at the time of diagnosis. The literature is reviewed and the clinical pathological immunohistochemical features and treatment are discussed. CONCLUSIONS: The differential diagnosis of this tumor type is complex and requires immunohistochemical data. The diagnosis of leiomyosarcoma is confirmed by the expression of myogenic antigens. Historically, patient survival has been poor and management has been based upon information obtained from a relatively small number of cases with diverse treatment regimens. Because the efficacy of chemotherapy and radiotherapy remains unclear, the treatment of choice is by radical cystectomy or partial cystectomy when tumor location and size permit.

[Klinefelter's syndrome as the only pathology associated with priapism. A clinical case]. / Síndrome de Klinefelter como única patología asociada a priapismo. Caso clínico.

OBJECTIVE: An unusual case of Klinefelter's syndrome with ischemic priapism is described. METHODS: The clinical course of the present case is described and discussed. CONCLUSIONS: This unusual case cannot be completely ascribed to the hormonal changes in Klinefelter's syndrome, although hormone imbalance may have favoured the development of ischemic priapism.

[Occupation and bladder tumor. Results of a study of incident cases]. / Ocupación y tumor vesical. Resultados de un estudio de casos incidentes.

Presentation of the results from the occupation analysis in a study of incident cases of vesical tumour over a 16-year interval (1975-1991) conducted in La Rioja Autonomous Community. Out of the 557 cases identified, occupation was found in 455, 151 of them are farmers (33.18%), 71 are in the industrial sector (15.60%), and 233 in the services sector (51.20%). Percentage of individuals affected by production sectors according to 1985 data are 1.22% farmers, 0.3% industrial sector and 0.6% services sector.

[Superficial and infiltrating bladder tumor. Epidemiologic differences in a study of incident cases]. / Tumor vesical superficial e infiltrante. Diferencias epidemiológicas en un estudio de casos incidentes.

An attempt has been made to identify the epidemiological factors associated with occurrence of biologically aggressive vesical tumours. In the Autonomous Community of La Rioja, a survey was conducted between 1975-1991 of incidental vesical tumours, recording in each case the patient's sex, age and occupation. It was found that the male sex, the sixth decade of life and being a farmer were associated to a higher incidence of vesical tumour. All this data was subsequently analyzed, segregating surface from infiltrant tumours depending on whether they affected (infiltrant) or not affected (surface) the vesical muscle layer. After both groups had been compared, no statistically significant differences were identified with regard to age, sex or occupation. The epidemiological factors associated to the occurrence of vesical tumours have no influence on its biological aggressiveness at the time of diagnosis.

[Quinolone-resistant Escherichia coli in the health area of a 650-bed hospital]. / Escherichia coli resistente a quinolonas en el area sanitaria de un hospital de 650 camas.

Report of a retrospective study to evaluate susceptibility of Escherichia coli to quinolones covering the March-December 1992 interval. During this time, intra and extra-hospital strains were indistinctly studied in patients with urinary infections seen in a health district serving a total of 200.000 inhabitants. Resistance to Pipemidic acid, Norfloxacin and Ciprofloxacin was evaluated. The values found were 14.8% resistance to Pipemidic acid, 11.1% to Norfloxacin and 8.5% to Ciprofloxacin. It seems necessary to develop and apply methods addressed to minimize the appearance of quinolone resistance, which should be implemented in order to preserve the usefulness of these drugs.

[The incidence of bladder tumor in the Autonomous Community of La Rioja in 1975 to 1991. A comparison with other studies]. / Incidencia de tumor vesical en la Comunidad Autónoma de La Rioja en el periodo 1975 a 1991. Comparación con otros estudios.

Presentation of a study on the incidence of vesical tumours in the Autonomous Community of 'La Rioja' over the 1975-1991 period and comparison of our results with those obtained in similar studies. A total of 557 vesical tumours were identified, with a mean rate of 13.5/100,000 inhabitants, and a standardized rate of 20.5 in men and 1.75 in women. Our rate is close to that of Zaragoza and lower than that found in the Basque country and Tarragona in men. Also, it is lower in all women series.

[The accidental diagnosis of giant urethral lithiasis of long-term evolution. A clinical case]. / Diagnóstico accidental de litiasis uretral gigante de larga evolución. Caso clínico.

Presentation of one case of giant urethral lithiasis found accidentally. No associated urethral pathology was identified which could justified the bulbar urethra location or the large size. Lithiasis was removed through urethrolithotomy, closing in one operation the urethral wall.

[Perirenal hematoma after ESWL in a patient with stage T1 renal tumor]. / Hematoma perirrenal post ESWL en paciente con tumor renal estadio T1.

We report a case of perirenal hematoma post ESWL in a patient with controlled hypertension and a previously undiagnosed stage T1 kidney neoplasm. The foregoing complication can be partly ascribed to the renal tumor. It must therefore be taken into account that a small kidney mass may be overlooked during urography and consequently an ultrasound study of the kidney should be done before the patient is submitted to X-ray-guided lithotripsy.

Blunt traumatic rupture of the high right ureter, repaired with appendix interposition.

We report the first case of upper lumbar ureteral replacement with the vermiform appendix, in a blunt traumatic ureter rupture with important urinoma. In selected cases, in which the appendix has a required caliber and length, the vermiform appendix is a very good autograft for ureteral substitution. The vermiform appendix must be preserved if possible in the abdominal surgery.

[Non-stenotic anterior urethral lesions. Diagnosis by echographic urethrography]. / Lesiones de uretra anterior no estenóticas. Diagnóstico por uretrografía ecográfica.

The results of a study using sonographic urethrography, radiologic retrograde urethrography and urethroscopy to evaluate 11 different types of non-stenotic lesions of the urethra are presented. Sonographic urethrography accurately diagnosed all of the findings and radiologic retrograde urethrography had 7 false negatives. Based on the foregoing results, we advocate the use of sonographic urethrography as a valid alternative in the evaluation of non-stenotic urethral lesions.

[Complete separation between epididymis and testis associated with cryptorchism. Presentation of a case and review of the literature]. / Desunión completa epidídimo testicular asociada a criptorquidia. Presentación de un caso y revisión de la literatura.

We report a case of complete separation of the epididymis and testis discovered during surgery for cryptorchidism. The epididymis was found in the scrotum and the testis in the inguinal canal. Although this malformation has been reported sporadically, the incidence in patients with cryptorchidism may be higher. These cases support the hypothesis that testicular descent is guided by the tail of the epididymis.