The impact of time from biopsy to radical prostatectomy on Gleason score undergrading and other related factors. / Impacto del tiempo desde la biopsia a la prostatectomía radical en la infragradación del grado de Gleason y análisis de factores relacionados.

INTRODUCTION: Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD: Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS: Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥50% of cylinders and a DPSA ≥0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS: The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU.

Actual incidence of prostate cancer in healthcare areas of the autonomous community of Castilla-Leon during 2014. CAPCYL registry data. / Incidencia real de cáncer de próstata en las áreas sanitarias de la comunidad autónoma de Castilla y León durante el año 2014. Datos del registro CAPCYL.

OBJECTIVE: To determine the actual incidence of prostate cancer (PC) in the healthcare areas of Castilla-Leon in 2014. MATERIAL AND METHODS: A multicentre study was conducted with the participation of 7 of the 9 healthcare areas of Castilla-Leon. We collected retrospective data that included 87.8% of the target population (men diagnosed with PC with histopathological confirmation in 2014). We calculated the raw and age-adjusted incidence rates based on the direct method and consulted the community and national epidemiological data in the Spanish National Institute of Statistics. RESULTS: A total of 1198 new cases of PC were diagnosed, with a raw incidence rate in the community of 109.54 cases per 100,000 men. The adjusted rates for the Spanish and European populations were 115.41 and 110.07, respectively. The age group with the highest diagnostic concentration was the 60-70-year group, with 41.97% of the diagnoses. The group with the highest incidence was the 70-80-year group, with 438.87 cases per 100,000 inhabitants. There were differences in the raw and age-adjusted incidence rates and in the age at diagnosis among the various included healthcare areas. CONCLUSIONS: The community raw incidence rate was higher than most existing data. We observed significant differences among the various geographical areas, which could be explained mainly by the age distribution and the opportunistic screening policies for each area.

Fusión de labios mayores: causa excepcional de obstrucción urinaria / Labial adhesion: unusual cause of urinary obstruction

Presentamos un caso de fusión labial en una mujer anciana. La paciente fue atendida en el servicio de urología al referir síntomas miccionales. El diagnóstico se realizó por la mera inspección de la región vulvar. Bajo anestesia se practicó tratamiento quirúrgico con disección roma, y con la aplicación de pomadas de estrógenos al alta, se consiguió un resultado exitoso. El déficit estrogénico parece estar en la base de este raro proceso al que se pueden añadir circunstancia como liquen esclero atrófico, diabetes, o disminución de la actividad sexual entre otros (AU)

A case of labial adhesions in an elderly woman is reported. The patient was admitted in the urology department since she related urinary symptoms. The diagnosis was been made by simple inspection of the genital region. Under anaesthesia, surgical procedure was done by sharp dissection, and dressing ointment was recommended at discharge. An excellent result was obtain. The estrogens deficiency seems to be the origin of this rare disease and it is not unusual the presence of another circumstances like lichen sclerouset atrophicus, diabetes mellitus or decreasing sexual activity (AU)

[Labial adhesions: unusual cause of urinary obstruction]. / Fusion de labios mayores: causa excepcional de obstrucción urinaria.

A case of labial adhesions in an elderly woman is reported. The patient was admitted in the urology department since she related urinary symptoms. The diagnosis was been made by simple inspection of the genital region. Under anaesthesia, surgical procedure was done by sharp dissection, and dressing ointment was recommended at discharge. An excellent result was obtain. The estrogens deficiency seems to be the origin of this rare disease and it is not unusual the presence of another circumstances like lichen sclerous et atrophicus, diabetes mellitus or decreasing sexual activity.

[Importance of nocturia and its impact on quality of sleep and quality of life in patient with benign prostatic hyperplasia]. / Importancia de la nocturia y su impacto en la calidad del sueño y en la calidad de vida en el paciente con hiperplasia benigna de próstata.

INTRODUCTION: Nocturia is the main cause of insomnia or sleep interruption in adult men, which has a negative impact on daily activities, quality of life (QoL) and quality of sleep (QoS). The assessment of nocturia and its impact on QoL and QoS in patients suffering from benign prostatic hyperplasia (BPH) has been poor in terms of clinical research, moreover there is a lack of specific methods to assess this impact. OBJECTIVES: The objectives of BPH treatment should include the improvement of patient's QoL by controlling both diurnal and nocturnal symptoms. In order to assess how nocturia affects QoL and also QoS, some specific tools, such as N-QoL questionnaire or the number of Hours of Undisturbed Sleep (HUS), have been recently developed. Therefore, it would be interesting to assess how nocturia reduction due to LUTS/BPH treatment can impact on some objective parameters such as HUS and also how nocturia reduction improves QoS and QoL. This assessment should be developed during the application of pharmacological treatments in clinical practice by means of these specific tools. With the aim of tackling nocturia as an urologic problem in patients with LUTS/BPH, as well as knowing the physiology of sleep and the effect of nocturia on the sleep and QoL, a meeting of expert urologists, that gathered about fifty specialists of all around Spain, was held in Madrid. This article presents the main ideas and concepts exposed in this meeting. CONCLUSIONS: Nocturia is a symptom with a high prevalence in older patients with STUI/BPH. The PreNoc study has showed a Nocturia prevalence in Spain of 83% in patients > or =60 years old diagnosed of BPH. Nocturia is the most bothersome symptom in patients with STUI/BPH.

[Prepuce simulating an igloo]. / Prepucio semejante a un "iglú".

OBJECTIVE: To report what could be the first reference of a prepucial congenital abnormality which has been termed an "igloo-like prepuce". The presence of a prepuce completely covering the glans and presenting the outer opening on the ventral side, resembles the ice constructions used as temporary dwelling by certain groups of eskimos. METHODS: Two cases with this unusual abnormality seen in two young brothers are described. RESULTS AND CONCLUSIONS: The "igloo-like prepuce" is a prepucial congenial abnormality with rare incidence which carries no other genitourinary condition but which translates in a merely aesthetic alteration.

[Fibrosarcoma of the penis]. / Fibrosarcoma del pene.

A fibrosarcoma of the penis is an infrequent finding. This paper contributes one case found in the perineo-scrotal region emphasising some aspects of local staging procedures, as well as the differential diagnosis with other mesenchymal tumours; there is no validated treatment protocol, although there is widespread agreement that extensive surgical excision should be performed, such as was performed in this patient.

[Congenital prepubic sinus]. / Sinus prepúbico congénito.

Presentation of one case of Urethral Duplicity of the Blind Epispadias variant, also known as Congenital Prepubic Sinus. This form of accessory urethra is a congenital malformation which consists in a pseudofistular passage which starts at the proximity of the bladder's anterior side-though uncommunicated with it-and spreads to the skin of the pubic area where it ends. No other malformative condition was found in the comprehensive study conducted, and only the existence of repeat episodes of mucopurulent drainage material advised its removal. This manoeuvre was followed by a complete cure and, after more than two years follow-up, the patient remains asymptomatic.

[Intermittent testicular torsion]. / Torsión testicular intermitente.

OBJECTIVES: The present study focuses attention on intermittent testicular torsion, a well-differentiated but underdiagnosed entity. METHODS: Four cases of intermittent testicular torsion are described. The presence of recurrent acute testicular pain that remits spontaneously or following self-manipulation and the horizontal of the testis (bell clapper) are sufficient to make the diagnosis. RESULTS: All four cases underwent bilateral orchipexy with excellent results. At years' follow-up all patients remain asymptomatic. CONCLUSIONS: Intermittent testicular torsion must be considered appropriately since these patients comprise the largest group at high risk for developing acute testicular torsion. Bilateral orchidopexy will ensure the viability of the testis with 100% good results.

[A case of leiomyosarcoma of the spermatic cord]. / Un caso de leiomiosarcoma del cordón espermático.

We report a case of leiomyosarcoma of the spermatic cord that we consider singular because of the excellent outcome. The patient is alive and tumor-free 8 years following the initial diagnosis. We discuss the management of these patients, a controversial subject since there are no definitive therapeutic guidelines because of the very limited series of patients.

[First results of our experience with the Fabian's prosthesis]. / Primeros resultados de nuestra experiencia con la prótesis de Fabián.

Report on our experience with Fabian's prothesis as alternative therapy to benign prostate hyperplasia (B.P.H.) surgery. Throughout 1990 ten patients with various surgical contraindications were implanted the above device. In spite of the series small size (10 patients) and short follow-up (4 to 11 months), we believe the 70% good results obtained is very encouraging and can either be of help to banish the ominous indwelling vesical catheter, a permanent evidence of Urologists' failure in the prostate obstructive disease, or it will allow us to relief patients with B.P.H. non-secondary to other more aggressive therapies.

[Intradiverticular lithiasis in female urethra. Report of a case]. / Litiasis intradiverticular en uretra femenina. A propósito de un caso.

Presentation of one case of lithiasis as complication of female urethra diverticulum. Etiopathogenic factors, signs and symptoms, diagnosis, complications and therapy options are commented.

[Bladder adenocarcinoma. Presentation of 3 new cases]. / Adenocarcinoma vesical. Presentación de tres nuevos casos.

Three additional cases of primary adenocarcinoma of the bladder, an uncommon tumor type, seen at our department during the past years are described. These may arise from urachal remnants or metaplastic changes occurring in bladders with cystitis cystica or glandularis. Clinically, their behaviour is not unlike the rest of the infiltrating urothelial tumors. Treatment is by partial cystectomy for urachal adenocarcinoma and radical cystectomy for those arising from other sites of the bladder. Radio- and chemotherapy have a very limited efficacy in this tumor type.

[Rupture of the excretory tract to renal cyst, its sequestration and later infection, as a complication of ureteral lithiasis]. / Rotura de la vía excretora a quiste renal, secuestro del mismo y posterior infección, como complicación de litiasis ureteral.

We report on a case of infected solitary renal cyst following rupture and communication of the excretory tract from a ureteral calculus. The etiopathogenic mechanisms, the diagnostic difficulties encountered in this uncommon disease process, and the usefulness of radiologic and ultrasound assessment are discussed.

[Renal metastasis caused by an epidermoid carcinoma of the lung]. / Metástasis renal por carcinoma epidermoide de pulmón.

A case of renal metastasis from lung epidermoid carcinoma with florid clinic is presented. We point out the great diagnostic help obtained by using Computerized Axial Tomography (C.A.T.) and echo-monitored fine needle aspiration puncture (F.N.A.P.).

[Eosinophilic cystitis: a new cause of diagnostic error]. / Cistitis eosinofílica: de nuevo causa de error diagnóstico.

Presentation of a new case of tumoral-like eosinophilic cystitis mistaken for a vesical carcinoma until completion of anatomopathological study.

[Papillary necrosis and formation of fungal balls in a patient with AIDS: a clinical case and brief review]. / Necrosis papilar y formación de pelotones de hongos en paciente afecto de SIDA: caso clínico y breve revisión.

An AIDS case, with a Candida urinary infection causing papillary necrosis and accompanied by occurrence of fungal lumps is reported. The paper remarks on the incidence and peculiarities of urinary affectation in these patients, emphasizing the usefulness of percutaneous nephrostomy as a diagnostic, and above all as a therapeutic procedure, in cases of expanded urinary tract.

[Eosinophilic cystitis]. / Cistitis eosinofílica.

Another case of eosinophilic cystitis is reported. Special interest is placed in the incorrectly assigned nature of this disease entity. Most of the authors tend to subdivide eosinophilic cystitis into two subtypes with its own clinical, histological, and evolutive aspects: allergic eosinophilic cystitis (AEC) and eosinophilic cystitis (EC). Several hypotheses have been put forward to explain its origin which, however, remains unclear. There is no specific treatment and its course tends to develop towards chronicity, with periods of remission and unpredictable exacerbation that warrant continuous monitoring. Diagnosis is by anatomopathological findings and differential diagnosis is warranted to distinguish it from bladder neoplasm (with which it is invariable confused), tuberculosis, etc.

[Inverted papilloma or inverted urothelial carcinoma. A problem not yet resolved in its totality. Contribution of two new cases to the literature]. / Papillome inversé ou carcinome urothélial inversé. Un problème qui encore aujourd'hui n'a pas été résolu dans sa totalité. Apport de deux nouveaux cas à la littérature.

We present two case of inverted vesical papillomas, one of a trabecular histology and the other glandular, which--in view of the appearance in the last few years of inverted papillomas coexisting alongside other urothelium tumorous states, recurring and even malignant inverted papillomas--raise the possibility of them being considered as superficial urothelium carcinomas. We propose the use of post-surgical endo-vesical chemotherapy, above all in the patients affected by the trabecular variety of inverted papillomas, due to their high indices of recurrence and high possibilities of malignancy.

[A new case of multilocular cyst]. / Un nuevo caso de quiste multilocular.

We report another case of multilocular cyst of the kidney. We underscore the current theory on the neoplastic and not cystic origin of this disease entity. Attention is drawn to the confusion arising from a wide variety of terms (17) used to refer to this disease entity. Its clinical features, diagnosis, and treatment are briefly discussed. We highlight the need to follow currently available diagnostic criteria in diagnosing multilocular cyst of the kidney.