Furan and p-xylene as candidate biomarkers for prostate cancer.

BACKGROUND: Prostate cancer (PCa) is the most frequently diagnosed noncutaneous malignant tumor among males in the Western world. Prostate-specific antigen has been considered the most important biomarker for PCa detection; however, it lacks specificity, leading to the search for alternative biomarkers. Volatile organic compounds (VOCs) are released during cell metabolism and can be found in exhaled breath, urine, and other fluids. VOCs have been used in the diagnosis of lung, breast, ovarian, and colorectal cancers, among others. The objective of this study was to identify urinary VOCs that may be sensitive and specific biomarkers for PCa. METHODS: The study included 29 patients with PCa and 21 with benign prostatic hyperplasia. Urine samples were obtained from all participants before and after prostate massage. VOCs were identified by gas chromatography-mass spectrometry. IBM SPSS Statistics v.20 was used for statistical analysis. Sample normality and homogeneity of variances were studied and, according to the distribution normality, ANOVA or the Kruskal-Wallis test was applied to evaluate significant differences between groups. The Pearson test was used to establish correlations. RESULTS: Fifty-seven VOCs were identified. Samples gathered before prostate massage showed significant between-group differences in urinary levels of furan (P≤ 0.001), 2-ethylhexanol (P = 0.032), 3,5-dimethylbenzaldehyde (P = 0.027), santolin triene (P = 0.032), and 2,6-dimethyl-7-octen-2-ol (P = 0.003). Samples gathered after prostate massage showed significant differences in urinary levels of furan (P≤ 0.001), 3- methylphenol (P = 0.014), p-xylene (P = 0.002), phenol (P≤ 0.001), and 2-butanone (P = 0.001). CONCLUSIONS: Significant differences between PCa and BPH patients were found in urinary levels of certain VOCs both before and after prostate massage, supporting the proposal that VOCs may serve as PCa-specific biomarkers.

Drenaje transperineal ecodirigido de un absceso prostático. A propósito de un caso y revisión de la literatura / Ultrasound-guided transperineal drainage of prostatic abscess. A case report and literature review

El absceso prostático es un proceso poco común que se ha asociado a sondajes permanentes, instrumentación genitourinaria, prostatitis crónicas, diabetes mellitus, síndrome de inmunodeficiencia adquirida, hemodiálisis u otras condiciones que comprometan la inmunidad. Actualmente Escherichia coli y otros agentes gramnegativos son los principales responsables en el desarrollo de los abscesos prostáticos. La ecografía transrectal es considerada una prueba sensible para el diagnóstico, así como para adoptar una actitud terapéutica. El tratamiento estándar del absceso prostático, en la mayoría de los casos, consiste en una amplia cobertura antibiótica y drenaje del absceso mediante diferentes técnicas y vías de acceso. Presentamos el caso de un paciente de 74 años con un absceso prostático producido por Enterococcus faecalis, el cual fue tratado con antibioterapia y drenaje percutáneo transperineal ecodirigido (AU)

Prostatic abscess is a rare process that has been associated with permanent catheterization, genitourinary instrumentation, chronic prostatitis, diabetes mellitus, acquired immunodeficiency, hemodialysis or other conditions that compromise immunity syndrome. Currently, Escherichia coli and other Gram negative agents are primarily responsible for the development of prostatic abscess. Transrectal ultrasound is considered a sensitive test for the diagnosis as well as the therapeutic approach. Standard treatment of prostatic abscess, in most cases, consisting of a wide spectrum antibiotics and abscess drainage using different techniques and paths. We report the case of a patient of 74 years with a prostatic abscess caused by Enterococcus faecalis which was treated with antibiotics and ultrasound-guided transperineal percutaneous drainage (AU)

Fractura testicular por traumatismo cerrado / Testicular fracture by closed trauma

No disponible

Abscesos testiculares: abordaje quirúrgico. A propósito de 2 casos / Surgical approach to testicular abscesses: A report of 2 cases

El absceso testicular es una enfermedad poco frecuente, y la mayoría de los casos son una complicación de casos avanzados o no tratados de orquiepididimitis. Los síntomas clínicos y la exploración física no siempre permiten un diagnóstico de certeza, ya que el dolor y la inflamación limitan la palpación correcta del contenido escrotal. De ahí que la ecografía escrotal sea la técnica de imagen de primera elección para determinar la naturaleza de una masa escrotal y también para detectar la presencia de abscesos escrotales. Aunque el tratamiento inicial es médico, en ocasiones hay que recurrir a la orquiectomía. El objetivo de este trabajo es proponer el abordaje inguinal para el tratamiento quirúrgico de los abscesos testiculares, el cual permite mantener aislado el proceso infeccioso y evitar la «violación del escroto» en caso de tratarse de un tumor. Presentamos 2 casos de absceso testicular tratados de manera satisfactoria mediante orquiectomía inguinal (AU)

Testicular abscess is a rare condition that often arises due to complications of untreated or advanced orchiepididymitis. Clinical symptoms and physical exam do not always provide an accurate diagnosis because the pain and swelling often limit adequate palpation of the scrotal contents. Therefore, scrotal ultrasound is the imaging technique of choice to determine the nature of the scrotal mass and also to detect presence of scrotal abscesses. Although initial treatment is medical, it is sometimes necessary to resort to orchiectomy. This purpose of this paper is to propose inguinal approach for the surgical treatment of testicular abscesses. This approach makes it possible to maintain the infectious process isolated and thus avoid ‘‘violation of the scrotum’’ in the case of a tumor.We report two cases of testicular abscess successfully treated by inguinal orchiectomy (AU)

Análisis clínico y coste económico-sanitario de nuestra serie de 65 casos de incurvación de pene / Clinical analysis and economic-health cost of 65 cases of penile incurvation

Introducción. El objetivo del estudio es analizar las características epidemiológicas y clínicas, el gasto sanitario global medio y las variables que se han relacionado de forma estadísticamente significada con la aparición de la incurvación de pene. Material y métodos. el estudio analiza retrospectivamente 65pacientes intervenidos de incurvación peneana entre enero del 2000 y octubre del 2011. Para comprobar qué variables se relacionaban con la incurvación del pene, se utilizó el test chi-cuadrado de Pearson con corrección por continuidad, y Fisher en los casos que no se cumplieron las condiciones de aplicabilidad. Para las variables cuantitativas se utilizó el test t de Student. Resultados. La mediana de edad fue de 53años. La incurvación peneana diagnosticada con mayor frecuencia fue la dorsal (49,25%). El 80% de las incurvaciones fueron adquiridas. En la exploración se palpó placa indurada en el 50,8% de los pacientes con incurvación adquirida. La técnica quirúrgica empleada en el 81,5% de los casos fue la plicatura de la albugínea de Essed-Schröder. La estancia hospitalaria media fue de 24h. Se observó una relación estadísticamente significativas entre hipertensión (p=0.013), diabetes (p=0,033) y palpación de placa (p=0,009) e incurvación dorsal. En el 60% de los pacientes con incurvación ventral esta fue de causa congénita, encontrando una asociación estadísticamente significativa entre ambas (p=0,003). El coste sanitario global medio de un paciente intervenido de incurvación de pene fue de 2.142euros. Conclusiones. La incurvación de pene se está convirtiendo en una patología emergente en las consultas de urología, y presenta resultados quirúrgicos satisfactorios (AU)

Introduction. The aim of this study is to analyze the epidemiological and clinical characteristics, average overall health cost, and variables that have a statistically significant relationship with the appearance of penile incurvation. Materials and methods. This retrospective study analyzes 65 patients who received treatment for penile incurvation between January 2000 and October 2011. Pearson's chi-square test with correction for continuity was used to verify which variables are related to penile incurvation. Fisher's exact test was used in cases where applicability conditions were not met. The Student's t test was used for the quantitative variables. Results. Median age was 53years. Dorsal type (49.25%) was the most frequently diagnosed penile incurvation with 80% of the incurvations being acquired. Upon exploration, an indurated plaque was palpable in 50.8% of the patients with acquired incurvation. Schroeder-Essed plication of the tunica albuginea was the surgical technique used in 81.5% of the cases. Mean hospital stay was 24hours. A statistically significant relationship was observed between dorsal incurvation and hypertension (P=.013), diabetes (P=.033), and plaque palpation (P=.009). In 60% of the patients with ventral incurvation, it resulted from congenital causes, a statistically significant association being found between both (P=.003). Overall average health cost of a patient treated for penile incurvation was 2,142euros. Conclusions. Penile incurvation is an emerging condition in urology consultations with some satisfactory surgical results (AU)

Randomized clinical trial on antimicrobial prophylaxis for flexible urethrocystoscopy.

OBJECTIVES: One of the main drawbacks of flexible urethrocystoscopy is the risk of urinary tract infection (UTI). In order to reduce this risk, antimicrobial prophylaxis has been considered, however there is not a unanimous view regarding indications, dosage, type of antibiotic, and so on. To clarify this uncertainty, we practiced a pilot and experimental study aimed at assessing the effectiveness of chemoprophylaxis with 3 grams of fosfomycin trometamol in the prevention of UTI after urethrocystoscopy. METHODS: Sixty patients were entered into a pilot randomized clinical trial between March and August 2011. Thirty patients were assigned to a control group without receiving any antibiotic dose, and the intervention group (30 patients) received 3 g fosfomycin trometamol. Ten days later urine culture and sediment analysis were performed in all patients. Significant bacteriuria was considered from > 105 CFU /ml. One month later a telephone survey was developed to assess urinary symptoms, and assistance to the family doctor. We estimated the cumulative incidence of bacteriuria, pyuria and microhematuria in both groups, and we compared the results using a strategy of analysis per protocol and intention to treat. RESULTS: The incidence of bacteriuria, pyuria and microhematuria in the control group was 10%, 23.3% and 26.7% respectively and in the intervention groups the values differed depending on the type of analysis. Considering only the 27 patients (per protocol analysis), the incidence would be 11.1%, 37.0% and 29.6% respectively. If we include the three patients who did not completed the study (per intention to treat analysis) and considering their results as negative, the results were 10%, 33.3% and 26.7% respectively. Finally, in the case the three cultures not performed in this group had produced a positive result, the impact would have been 20.0%, 43.3% and 36.7%. In any of the three cases, the differences with the control group were not statistically significant. CONCLUSIONS: In a selected population and with appropriate aseptic measures, antibiotic chemoprophylaxis does not appear to show a clinically relevant reduction in the incidence of UTI in patients undergoing flexible urethrocystoscopy.

Ensayo clínico aleatorizado sobre profilaxis antibiótica en la uretrocistoscopia flexible / Randomized clinical trial on antimicrobial prophylaxis for flexible urethrocystoscopy

OBJETIVO: Uno de los principales inconvenientes de la uretrocistoscopia flexible es el riesgo de infección del tracto urinario (ITU). Para intentar reducir dicho riesgo se ha recurrido a la profilaxis antimicrobiana, aunque aún no hay un criterio unánime en cuanto a la pertinencia de su indicación, dosis, vía de administración y tipo de antibiótico de la misma. Para clarificar esta incertidumbre, hemos planteado un estudio experimental con el objetivo de valorar la eficacia de la quimioprofilaxis con 3 g de fosfomicina trometamol en la prevención de la ITU post uretrocistoscopia. MÉTODOS: Sesenta pacientes fueron incluidos en un ensayo clínico randomizado entre Marzo y Agosto del 2011. Treinta pacientes fueron asignados a un grupo control, que no recibió ninguna dosis de antibiótico, y el grupo de intervención (30 pacientes) recibió 3 g de fosfomicina trometamol. Díez días más tarde se realizó a todos los pacientes un sedimento y cultivo de orina. La bacteriuria significativa fué considerada a partir de > 105 UFC/ml. Un mes más tarde se llevó a cabo una encuesta telefónica para recoger los síntomas urinarios y la asistencia a su médico de familia. Estimamos la incidencia acumulada de bacteriuria, piuria y microhematuria en ambos grupos, y comparamos los resultados usando una estrategia de análisis por protocolo y por intención de tratar(AU)

RESULTADOS: La incidencia de bacteriuria, piuria y microhematuria fué en el grupo control del 10%, 23.3% y 26.7% respectivamente y en el de intervención los valores difirieron dependiendo del tipo de análisis. Considerando solamente los 27 pacientes (análisis por protocolo), las incidencias serían del 11,1%, 37,0% y 29,6%, respectivamente. Si incluimos los tres pacientes que no finalizaron el estudio (análisis por intención de tratar) y consideramos sus resultados como negativos, los resultados serían del 10%, 33,3% y 26,7%, respectivamente. Finalmente, en el caso de que los tres cultivos no realizados en este grupo hubieran arrojado un resultado positivo, las incidencias habrían sido de 20,0%, 43,3% y 36,7%. En cualquiera de los tres supuestos, las diferencias con respecto al grupo control no son estadísticamente significativas. CONCLUSIONES: En una población seleccionada y con unas medidas de asepsia adecuadas, la quimioprofilaxis no parece mostrar una reducción clínicamente relevante en la incidencia de ITU en pacientes sometidos a uretrocistoscopia flexible(AU)

OBJECTIVES: One of the main drawbacks of flexible urethrocystoscopy is the risk of urinary tract infection (UTI). In order to reduce this risk, antimicrobial prophylaxis has been considered, however there is not a unanimous view regarding indications, dosage, type of antibiotic, and so on. To clarify this uncertainty, we practiced a pilot and experimental study aimed at assessing the effectiveness of chemoprophylaxis with 3 grams of fosfomycin trometamol in the prevention of UTI after urethrocystoscopy. METHODS: Sixty patients were entered into a pilot randomized clinical trial between March and August 2011. Thirty patients were assigned to a control group without receiving any antibiotic dose, and the intervention group (30 patients) received 3 g fosfomycin trometamol. Ten days later urine culture and sediment analysis were performed in all patients. Significant bacteriuria was considered from > 105 CFU /ml. One month later a telephone survey was developed to assess urinary symptoms, and assistance to the family doctor. We estimated the cumulative incidence of bacteriuria, pyuria and microhematuria in both groups, and we compared the results using a strategy of analysis per protocol and intention to treat(AU)

RESULTS: The incidence of bacteriuria, pyuria and microhematuria in the control group was 10%, 23.3% and 26.7% respectively and in the intervention groups the values differed depending on the type of analysis. Considering only the 27 patients (per protocol analysis), the incidence would be 11.1%, 37.0% and 29.6% respectively. If we include the three patients who did not completed the study (per intention to treat analysis) and considering their results as negative, the results were 10%, 33.3% and 26.7% respectively. Finally, in the case the three cultures not performed in this group had produced a positive result, the impact would have been 20.0%, 43.3% and 36.7%. In any of the three cases, the differences with the control group were not statistically significant. CONCLUSIONS: In a selected population and with appropriate aseptic measures, antibiotic chemoprophylaxis does not appear to show a clinically relevant reduction in the incidence of UTI in patients undergoing flexible urethrocystoscopy(AU)

Complicación derivada del uso de Hem-o-lok ® en la prostatectomía radical laparoscópica / A complication arising from the use of Hem-o-lok ® in laparoscopic radical prostatectomy

Se presenta una rara complicación posoperatoria, la formación de pseudodivertículo uretral, que se produce después de una prostatectomía radical laparoscópica con preservación de nervios; procedimiento llevado a cabo con la colocación de Hem-o-lok® sobre los pedículos lateroprostáticos en un paciente con cáncer de próstata clínicamente localizado. Por tanto, estos dispositivos deben utilizarse con precaución en la región de la anastomosis vesicouretral (AU)

We present a rare postoperative complication, that is, pseudodiverticulum urethral formation, which occurred after a laparoscopic radical prostatectomy with nerve-sparing procedure carried out with the placement of Hem-o-lok® in the latero-prostatic pedicles in a patient with clinically localized prostate cancer. Consequently, these devices should be used with caution in the region of the vesicourethral anastomosis (AU)

Meta-analysis of studies analyzing the role of human papillomavirus in the development of bladder carcinoma.

PURPOSE: We aimed to ascertain the degree of association between bladder cancer and human papillomavirus (HPV) infection. MATERIALS AND METHODS: We performed a meta-analysis of observational studies with cases and controls with publication dates up to January 2011. The PubMed electronic database was searched by using the key words "bladder cancer and virus." Twenty-one articles were selected that met the required methodological criteria. We implemented an internal quality control system to verify the selected search method. We analyzed the pooled effect of all the studies and also analyzed the techniques used as follows: 1) studies with DNA-based techniques, among which we found studies with polymerase chain reaction (PCR)-based techniques and 2) studies with non-PCR-based techniques, and studies with non-DNA-based techniques. RESULTS: Taking into account the 21 studies that were included in the meta-analysis, we obtained a heterogeneity chi-squared value of Q(exp)=26.45 (p=0.383). The pooled odds ratio (OR) was 2.13 (95% confidence interval [CI], 1.54 to 2.95), which points to a significant effect between HPV and bladder cancer. Twenty studies assessed the presence of DNA. The overall effect showed a significant relationship between virus presence and bladder cancer, with a pooled OR of 2.19 (95% CI, 1.40 to 3.43). Of the other six studies, four examined the virus's capsid antigen and two detected antibodies in serum by Western blot. The estimated pooled OR in this group was 2.11 (95% CI, 1.27 to 3.51), which confirmed the relationship between the presence of virus and cancer. CONCLUSIONS: The pooled OR value showed a moderate relationship between viral infection and bladder tumors.

Impacto de una vía clínica para pacientes intervenidos con resección transuretral en próstata y vejiga / Impact of a clinical pathway in cases of transurethral resection of the prostate and bladder

Objetivo. Conocer, desde una triple perspectiva, clínica, económica y centrada en el paciente, la efectividad de una vía clínica. Método. Para ello, se diseñó un estudio experimental, en el que participaron 122 pacientes intervenidos de hiperplasia benigna de próstata o carcinoma vesical mediante resección transuretral (RTU), divididos en 2 grupos, experimental y control. La aleatorización se realizó sobre los listados de espera y, al ser hospitalizados, se controló que el ingreso no se produjera en la misma habitación que otro paciente incluido en distinto grupo, para mantener el simple ciego. Resultados. La comparación de ambos grupos detectó diferencias respecto a los días de estancia (desviación estándar [DE]): 3,59 (1,54) frente a 2,92 (1,18), p = 0,008. Los pacientes del grupo control, en promedio, estaban 0,67 días de más hospitalizados (intervalo de confianza [IC] del 95%, 0,18-1,17) que los del grupo al que se le aplicó la vía clínica. No se detectaron diferencias estadísticamente significativas en cuanto a presentación de complicaciones (el 3,6 frente al 1,8%; p = 0,55), ni en la satisfacción (el 90,9 frente al 94,5%; p = 0,46). Conclusiones. Las vías clínicas producen una reducción de la estancia, si bien el mecanismo por el que lo hacen efectivo no está claro

Objective. To determine the effectiveness of a clinical pathway from a triple perspective: clinical, economic, and patient-centered. Methods. We designed an experimental study. A total of 122 patients undergoing surgery for benign prostatic hyperplasia or cancer of the bladder through transurethral resection were divided into 2 groups: experimental and control. Patients on the waiting list for surgery were randomized to one of the two groups. To guarantee simple blinding, admitted patients were not assigned to the same ward as another patient in the other group. Results. Comparison of the two groups revealed differences in the length of hospital stay (SD): 3.66 (1.42) versus 2.98 (1.42), p = 0.015. On average, length of hospital stay was 0.68 days (95% CI, 0.13-1.21) longer in the control group than in patients in whom the clinical pathway was applied. No significant differences were detected in the complication rate (3.6% versus 1.8%, p = 0.55) or in patient satisfaction (94.5% versus 90.9%, P = 0.46). Conclusions. Clinical pathways reduce the length of hospital stay, although the mechanism through which this reduction is achieved is not entirely clear