Curva de aprendizaje de la ecografía renal en una unidad docente pluriprofesional / Renal ultrasound learning curve performed in a multiprofessional teaching unit

Introducción: El objetivo de esta experiencia fue analizar un módulo formativo inserto en la práctica asistencial de un departamento de urología con la participación de enfermeras especializadas en ecografía urológica como monitoras. Material y métodos: Participaron en el estudio 12 estudiantes de medicina carentes de cualquier conocimiento de ultrasonografía. Su formación corrió a cargo de dos enfermeras con gran experiencia en ecografía. Después de dos sesiones de entrenamiento, se analizó la concordancia entre sus hallazgos en la exploración de los riñones y los de un urólogo especialista. Para analizar la experiencia desde todos los puntos de vista, se exploró el grado de aceptación del módulo formativo por parte de los usuarios y la tolerancia de los profesionales involucrados en términos de síndrome de desgaste profesional (SDP). Por último, se calcularon los costes. Resultados: El coeficiente kappa de concordancia entre el experto y los estudiantes fue bueno (≥ 0,67) en el 58,3% de los casos. No se detectaron rasgos de SDP entre los involucrados en la experiencia. La participación de las enfermeras como monitoras redujo el coste del operativo en un 25% en comparación con los costes en los que se podría haber incurrido caso de docentes urólogos senior. Conclusiones: Las enfermeras pueden proporcionar los rudimentos de la formación en ecografía a legos en la materia. La exploración de individuos con cálculos renales o ureterohidronefrosis se traduce en una mayor concordancia entre observadores. El usuario involucrado acepta de buen grado la experiencia. El operativo resulta inocuo para el personal participante.

Introduction: The objective of this experience was to analyze a training module inserted in the care practice of an urology department, with the participation of nurses specialized in urological ultrasound as monitors. Material and methods: Twelve medical students with no knowledge of ultrasonography participated in the study. His training was carried out by two nurses with extensive experience in ultrasound. After two training sessions, the agreement between their kidney examination findings and those of a specialist urologist was analyzed. To analyze the experience from all points of view, the degree of acceptance of the training module by the users was explored, as well as the tolerance of the professionals involved in terms of professional burnout syndrome (PBS). Finally, the costs of the operation were calculated. Results: The kappa coefficient of agreement between the expert and the students was good (≥ 0.67) in 58.3% of the cases. No traits of PBS were detected among involved in the experience. The participation of nurses as monitors reduced the cost of the operation by 25% compared to the costs that could have been incurred if they had been senior urologist teachers. Conclusions: Nurses can provide the rudiments of sonography training to laymen. Examination of individuals with kidney stones or ureterohydronephrosis results in greater interobserver agreement. In general, the user involved willingly accepts the experience. The operation is harmless for the participating staff.

Amplio estudio (283 mujeres) sobre la eficacia de Manosar(R): 2 g de d-manosa + 140 mg de proantocianidinas (PAC), de liberación prolongada frente a 240 mg de PAC de liberación prolongada en la prevención a 6 meses por vía oral de las infecciones urinarias recurrentes / Large study (283 women) on the effectiveness of Manosar(R): 2 g of d-mannose + 140 mg of proanthocyanidins (PAC), of prolonged release

OBJETIVO: Comparar la eficacia y seguridad de la profilaxis de las infecciones del tracto urinario (ITUs) con un complemento alimenticio que contiene D-manosa como principio activo principal (Manosar(R)), en comparación con otro preparado cuyo principio activo único son las proantocianidinas (PAC), ambos de liberación continuada, tras su administración durante24 semanas. MÉTODOS: Estudio experimental multicéntrico, aleatorizado y doble ciego. Se incluyeron 283 mujeres con historia de ITUs recurrentes sin evidencias de complicación. Se randomizaron 1:1 en dos grupos. En un grupo se administró 1 sobre diario oral de Manosar®, y en el otro 1 sobre diario oral de un compuesto de 240 mg de PAC de liberación continuada. Previo a la inclusión en el estudio se confirmó el episodio de ITU al menos por la sintomatología clínica y positividad del test de Combur. RESULTADOS: Se obtuvieron datos válidos de 184 pacientes con edad media de 49,5 años: 90 recibieron Manosar(R) y 94 PAC aislado. Un total de 72 pacientes padecieron una ITU por E.coli: 25 pacientes en el brazo con Manosar(R) frente a 47 pacientes en el grupo de PAC aislado, siendo esta diferencia estadísticamente significativa (p = 0,002). El tiempo libre de nuevas recurrencias de ITU fue de 98,6 días en el grupo tratado con Manosar(R) y de 84,6 días en el grupo con PAC aislado. CONCLUSIÓN: La toma oral de un sobre al día de Manosar(R) es eficaz y segura en la prevención de las ITUs recurrentes en la mujer, siendo superior a la toma oral de PAC aislado

OBJECTIVE: To compare the efficacy and safety in the prophylasis of urinary tract infections (UTIs) with a food supplement that contains D-mannose like active ingredient (Manosar(R)), in comparison to another preparation in which the active ingredient are the proanthocyanidins (PAC), both of them, in prolonged released, after, they was administered for 24 weeks. METHODS: A multicenter, randomized and double blind experimental study was carried out. 283 women with a history of recurrent UTIs without evidence of complication were included. They were randomized 1: 1 in two groups. In one group, 1 oral sachet of Manosar(R) a day was administered, and in the other group 1 oral sachet of a compound of 240 mg of continuous-release PAC. Prior to inclusion in the study, the episode of UTI was confirmed at least by the clinical symptoms and positivity of the Combur test. RESULTS: Valid data were obtained from 184 patients with an average age of 49.5 years: 90 received Manosar(R) and 94 isolated PAC. A total of 72 patients suffered an UTI due to E.coli: 25 patients in the arm with Manosar(R) versus 47 patients in the isolated PAC group, this difference being statistically significant (p = 0.002). The free time of new UTI recurrences was 98.6 days in the group treated with Manosar(R) and 84.6 days in the group with isolated PAC. CONCLUSION: The oral taking of a daily sachet of Manosar(R) is effective and safe in preventing recurrent UTIs in women, being superior to the oral taking of isolated PAC

Large study (283 women) on the effectiveness of Manosar®: 2 g of d-mannose + 140 mg of proanthocyanidins (PAC), of prolonged release. / Amplio estudio (283 mujeres) sobre la eficacia de Manosar®: 2 g de d-manosa + 140 mg de proantocianidinas (PAC), de liberación prolongada frente a 240 mg de PAC de liberación prolongada en la prevención a 6 meses por vía oral de las infecciones urinarias recurrentes.

OBJECTIVE: To compare the efficacy and safety in the prophylasis of urinary tract infections (UTIs) with a food supplement that contains D-mannose like active ingredient (Manosar®), in comparison to another preparation in which the active ingredient are the proanthocyanidins (PAC), both of them, in prolonged released, after, they was administered for 24 weeks. METHODS: A multicenter, randomized and double blind experimental study was carried out. 283 women with a history of recurrent UTIs without evidence of complication were included. They were randomized 1: 1 in two groups. In one group, 1 oral sachet of Manosar® a day was administered, and in the other group 1 oral sachet of a compound of 240 mg of continuous-release PAC. Prior to inclusion in the study, the episode of UTI was confirmed at least by the clinical symptoms and positivity of the Combur test. RESULTS: Valid data were obtained from 184 patients with an average age of 49.5 years: 90 received Manosar® and 94 isolated PAC. A total of 72 patients suffered an UTI due to E.coli: 25 patients in the arm with Manosar® versus 47 patients in the isolated PAC group, this difference being statistically significant (p=0.002). The free time of new UTI recurrences was 98.6 days in the group treated with Manosar® and 84.6 days in the group with isolated PAC. CONCLUSION: The oral taking of a daily sachet of Manosar® is effective and safe in preventing recurrent UTIs in women, being superior to the oral taking of isolated PAC.

OBJETIVO: Comparar la eficacia y seguridad de la profilaxis de las infecciones del tracto urinario (ITUs) con un complemento alimenticio que contiene D-manosa como principio activo principal (Manosar®), en comparación con otro preparado cuyo principio activo único son las proantocianidinas (PAC), ambos de liberación continuada, tras su administración durante24 semanas.MÉTODOS: Estudio experimental multicéntrico, aleatorizado y doble ciego. Se incluyeron 283 mujeres con historia de ITUs recurrentes sin evidencias de complicación. Se randomizaron 1:1 en dos grupos. En un grupo se administró 1 sobre diario oral de Manosar®, y en el otro 1 sobre diario oral de un compuesto de 240 mg de PAC de liberación continuada. Previo a la inclusión en el estudio se confirmó el episodio de ITU al menos por la sintomatología clínica y positividad del test de Combur. RESULTADOS: Se obtuvieron datos válidos de 184 pacientes con edad media de 49,5 años: 90 recibieron Manosar® y 94 PAC aislado. Un total de 72 pacientes padecieron una ITU por E.coli: 25 pacientes en el brazo con Manosar® frente a 47 pacientes en el grupo de PAC aislado, siendo esta diferencia estadísticamente significativa (p=0,002). El tiempo libre de nuevas recurrencias de ITU fue de 98,6 días en el grupo tratado con Manosar® y de 84,6 días en el grupo con PAC aislado.CONCLUSIÓN: La toma oral de un sobre al día de Manosar® es eficaz y segura en la prevención de las ITUs recurrentes en la mujer, siendo superior a la toma oral de PAC aislado.

[Efficacy and safety of D-mannose (2 g), 24h prolonged release, associated with Proanthocyanidin (PAC), versus isolate PAC, in the management of a series of women with recurrent urinary infections.] / Eficacia y tolerancia terapéutica de la D­manosa (2 g) de liberación prolongada 24 horas (asociada a proantocianidinas), frente a proantocianidinas aisladas en el manejo de una serie de mujeres con infecciones urinarias recurrentes.

OBJECTIVE: To compare the efficacy and safety of dietary supplement "Manosar®" composed of D-mannose (2 g), 24 h prolonged release, associated with Proanthocyanidin (PAC) (140 mg), ursolic acid (7.98 mg), A, C, and D vitamins and the oligoelement zinc, versus 240 mg of PAC in recurrent urinary tract infections (UTI), for a designed follow-up of 24 weeks, in women. METHODS: A multicenter randomized experimental double-blind study was carried out. The study was approved by review board of "Complejo Hospitalario de Toledo" (Spain), and all patients gave informed consent. A total of 150 women with non complicated UTI were screened for participation. Valid data was obtained from 93, with mean age of 48 years. Fortyfour patients were assigned to the Manosar® group and 51 patients to the PAC group. Patients were followed during six months. A previous UTI was defined based on a combination of symptoms and a positive reactive urine trip. Confirmation of a new UTI was based on symptoms, reactive urine strip and urine culture. RESULTS: Thirty-three patients (35%) had an UTI during the six months follow-up. The percentage of UTI of the Manosar® group during this period was 24%, while the percentage of the PAC group was 45% (p〈0.05). The disease-free time for the Manosar® group was 95 days, while this time was 79 days for the PAC group. The incidence of side effects was low. Diarrhea was the most frequent side-effect in both groups. CONCLUSION: Manosar® (oral once a day) is more effective than single dose PAC (240 mg daily orally) to prevent recurrent UTI in women.

Eficacia y tolerancia terapéutica de la D-manosa (2 g) de liberación prolongada 24 horas (asociada a proantocianidinas), frente a proantocianidinas aisladas en el manejo de una serie de mujeres con infecciones urinarias recurrentes / Efficacy and safety of D-mannose (2 g), 24h prolonged release, associated with Proanthocyanidin (PAC), versus isolate PAC, in the management of a series of women with recurrent urinary infections

Objetivo: Comparar la eficacia y seguridad de un complemento alimenticio (Manosar®) (2 gramos de D-manosa, 140 mg de PAC y 7,98 mg de ácido ursólico junto con las vitaminas A, C y E, y el oligoelemento Zinc) en la recurrencia de la ITU y su comparación con un compuesto basado con 240 mg proantocianidinas (PAC aislado), con una duración de administración esperada de 24 semanas. Métodos: Estudio experimental multicéntrico, aleatorizado y doble ciego. Aprobado por el Comité Ético de Investigación clínica del "Complejo Hospitalario de Toledo". Todos los pacientes firmaron el consentimiento. Se incluyeron 150 mujeres con historia de ITU recurrentes sin evidencias de complicación. Se obtuvieron datos válidos de 93 pacientes con edad media de 47,62 años. 42 recibieron Manosar y 51 PAC aislado. Controles cada 30 días durante 6 meses. La confirmación del episodio clínico previo de ITU fue definido al menos por la sintomatología clínica y tira de orina Combur (positiva a leucocito-esterasa y/o nitritos). La confirmación del nuevo episodio incidente durante el estudio fue confirmado por la sintomatología clínica, tira de orina y urinocultivo. Resultados: 33 pacientes (35,48%) padecieron una ITU durante el periodo de 6 meses de seguimiento. En el grupo tratado con Manosar® se observó ITU a los seis meses en un 23,8%, mientras que en el grupo control (PAC aislado) fue de 45,1% (p<0,05). El tiempo libre de enfermedad fue de 78,81 días en el grupo control (PAC aislado) y de 94,7 días en el grupo tratado con Manosar®. Se observó una baja incidencia de acontecimientos adversos, siendo la diarrea el más frecuente en ambos grupos. Conclusión: La toma oral de Manosar®, un sobre al día, es más eficaz que la toma oral de 240 mg de PAC aislado, un sobre al día, en la prevención de las infecciones urinarias de repetición en la mujer (AU)

Objetive: To compare the efficacy and safety of dietary supplement "Manosar®" composed of D-mannose (2 g), 24 h prolonged release, associated with Proanthocyanidin (PAC) (140 mg), ursolic acid (7.98 mg), A, C, and D vitamins and the oligoelement zinc, versus 240 mg of PAC in recurrent urinary tract infections (UTI), for a designed follow-up of 24 weeks, in women. Methods: A multicenter randomized experimental double-blind study was carried out. The study was approved by review board of "Complejo Hospitalario de Toledo" (Spain), and all patients gave informed consent. A total of 150 women with non complicated UTI were screened for participation. Valid data was obtained from 93, with mean age of 48 years. Fortyfour patients were assigned to the Manosar® group and 51 patients to the PAC group. Patients were followed during six months. A previous UTI was defined based on a combination of symptoms and a positive reactive urine trip. Confirmation of a new UTI was based on symptoms, reactive urine strip and urine culture. Results: Thirty-three patients (35%) had an UTI during the six months follow-up. The percentage of UTI of the Manosar® group during this period was 24%, while the percentage of the PAC group was 45% (p<0.05). The disease-free time for the Manosar® group was 95 days, while this time was 79 days for the PAC group. The incidence of side effects was low. Diarrhea was the most frequent side-effect in both groups. Conclusion: Manosar® (oral once a day) is more effective than single dose PAC (240 mg daily orally) to prevent recurrent UTI in women (AU)

[Emphisematous cystitis with multiorganic embolism: Case report.] / Cistitis enfisematosa con embolismo multiorgánico: a propósito de un caso.

OBJECTIVE: We present an unusual case of emphysematous cystitis with multiple septic embolisms to several organs. METHOD AND RESULTS: Case description and selection of related pictures. Review of the existing literature. CONCLUSIONS: Emphysematous cystitis is a rare condition but potentially severe. Prognosis depends on a rapid diagnosis and treatment.

Cistitis enfisematosa con embolismo multiorgánico: a propósito de un caso / Emphisematous cystitis with multiorganic embolism: case report

OBJETIVO: Presentamos un raro caso de cistitis enfisematosa con embolismo séptico gaseoso en múltiples órganos. MÉTODO Y RESULTADO: Descripción de caso clínico y aportación de iconografía. Revisión de la literatura relacionada. CONCLUSIONES: La cistitis enfisematosa es una condición rara, aunque potencialmente grave cuyo pronóstico depende de un rápido diagnóstico y tratamiento

OBJECTIVE: We present an unusual case of emphysematous cystitis with multiple septic embolisms to several organs. METHOD AND RESULTS: Case description and selection of related pictures. Review of the existing literature. CONCLUSIONS: Emphysematous cystitis is a rare condition but potentially severe. Prognosis depends on a rapid diagnosis and treatment

[Prognostic factors for the efficacy of Silodosin in the treatment of symptomatic Benign Prostatic Hyperplasia. Subanalysis of the URAL study.] / Factores pronósticos de la eficacia de la Silodosina en el tratamiento de la Hiperplasia Benigna Prostática sintomática. Subanálisis del estudio URAL.

OBJECTIVE: To identify the prognostic factors influencing the clinical and urodynamics results on symptomatic benign prostatic hypertrophy (BHP) treatment in a series of patients with silodosin therapy from the URAL study. METHODS: A retrospective study was performed in a cohort of 318 patients with BPH which underwent silodosine treatment, during at least 12 weeks. RESULTS: Univariate analysis demonstrated that the variables in relationship with a decrease of urinary symptoms` punctuation postreatment (measured with the IPSS Questionnaire), a maximum peak flow (Q max) postreatment equal or superior to 15 ml/s, a postreatment postvoid residual lower to 100 ml, and a postreatment obstruction index ( Bladder Outlet Obstruction Index: BOOI) equal or lower to 20 cm H2O, presented such both as a clinical and urodynamic character. The multivariate analysis demonstrated that a decreased punctuation of IPSS Questionnaire postreatment was in relationship to: a pretreatment cystometry bladder capacity (direct relationship), pretreatment Qmax (direct relationship), pretreatment postvoid residual (inverse relationship), and pretreatment BOOI (inverse relationship). CONCLUSION: The urodynamic study was very useful in the assessment of the prognostic factors in these patients.

Factores pronósticos de la eficacia de la Silodosina en el tratamiento de la hiperplasia benigna prostática sintomática. Subanálisis del estudio URAL / Prognostic factors for the efficacy of Silodosin in the treatment of symptomatic Benign Prostatic Hyperplasia. Subanalysis of the URAL study

OBJETIVO: Determinar los factores pronósticos que influyen en el resultado clínico y urodinámicos del tratamiento de la hiperplasia benigna prostática (HBP) sintomática, en el subgrupo de pacientes tratados con silodosina, del estudio URAL. MÉTODOS: Se realizó un estudio (clínico y flujométrico) retrospectivo en una cohorte de 318 pacientes (en 40 de ellos, y de manera consecutiva, un estudio urodinámico completo) con HPB sometidos a tratamiento con silodosina al menos durante 12 semanas. RESULTADOS: El análisis univariante mostró que las variables relacionadas con: la disminución de la puntuación de síntomas urinarios medidas por el cuestionario IPSS, un flujo miccional máximo (Qmax) postratamiento superior o igual a 15 ml/s, un residuo postmiccional inferior a 100 ml y un índice de obstrucción (BOOI) inferior o igual a 20 cm H20, fueron tanto clínicas como urodinámicas. El análisis multivariante demostró que la mejoría del IPSS estaba condicionada por la capacidad vesical cistomanométrica previa (relación directa) y la del Qmax (relación directa), residuo postmiccional (relación inversa) y BOOI (relación inversa) por sus valores previos al tratamiento. CONCLUSIONES: El estudio urodinámico demuestra su utilidad en la valoración de estos factores pronósticos

OBJECTIVE: To identify the prognostic factors influencing the clinical and urodynamics results on symptomatic benign prostatic hypertrophy (BHP) treatment in a series of patients with silodosin therapy from the URAL study. METHODS: A retrospective study was performed in a cohort of 318 patients with BPH which underwent silodosine treatment, during at least 12 weeks. RESULTS: Univariate analysis demonstrated that the variables in relationship with a decrease of urinary symptoms` punctuation postreatment (measured with the IPSS Questionnaire), a maximum peak flow (Q max) postreatment equal or superior to 15 ml/s, a postreatment postvoid residual lower to 100 ml, and a postreatment obstruction index (Bladder Outlet Obstruction Index: BOOI) equal or lower to 20 cm H2O, presented such both as a clinical and urodynamic character. The multivariate analysis demonstrated that a decreased punctuation of IPSS Questionnaire postreatment was in relationship to: a pretreatment cystometry bladder capacity (direct relationship), pretreatment Qmax (direct relationship), pretreatment postvoid residual (inverse relationship), and pretreatment BOOI (inverse relationship). CONCLUSION: The urodynamic study was very useful in the assessment of the prognostic factors in these patients

[Preliminary data of the Spanish contribution to the European Randomized Study on Screening of Prostate Cancer (ERSPC)]. / Datos preliminares de la contribución española al estudio randomizado europeo de screening del cancer de próstata (ERSPC).

OBJECTIVES: Data from the participation of our department in the ERSPC study in terms of detection and PSA diagnostic yield, staging, therapeutic management and mortality in the context of a multicentric randomized screening study for prostate cancer. METHODS: Patients were recruited between February 1996 and June 1999, randomized in screening and control arms, with several rounds for screening patients with four-year intervals, with PSA analysis and sextant prostate biopsy (t PSA > 4 ng/ml before May 1998, tPSA > 2.99 ng/ml after May 1998). These tests were not done in the control group. All deaths were studied (date and cause) RESULTS: A total of 4278 patients were included, 24 16 in the screening arm (56.4%) and 1862 in the control arm (43.5%), with an age between 45 and 70 years (mean age 57.8 years, 95 CI 57.6-58.0). Median follow-up was 8.77 years. 142 prostate cancers were found, 113 in the screening arm (accumulated detection rate 4.7%) and 29 in the control arm (1.6%). Detection rates were 1.7%, 2.2% and 0% in the first, second and third round respectively. Organ confined cancers (T1 and T2) were 102 in the screening arm (90.3%) and 24 in the control arm (82.8%), p = 0.254 . Metastatic disease was found in six patients (4.2% out of 142), 3 in the screening arm ( 2.7%) and three in the control arm (10.3%), p = 0.187. Radical prostatectomy was the most frequently performed treatment: 47 cases in the screening arm (41.6%), 10 in the control arm (34.5%). 151 patients have died, 82 in the screening arm and 69 in the control arm. Only 3 of this deaths were secondary to prostate cancer, all of them in the screening arm (p = 0.308). CONCLUSIONS: We observed a non significant tendency to lower clinical stages in patients undergoing screening. Radical surgery was the treatment of choice in patients with prostate cancer. Even with the current follow-up in the series (close to 9 years), no differences have been observed in terms of prostate cancer mortality between both study arms.

Datos preliminares de la contribución española al estudio randomizado europeo de screening del cáncer de próstata (ERSPC) / Preliminary data of the Spanish contribution to the European RAndomized Study on Screening of Prostate Cancer (ERSPC)

OBJETIVO: Datos de la participación de nuestro Centro en el ERSPC en términos de detección y rendimiento diagnóstico del PSA, estadiaje, manejo terapéutico y mortalidad, en el contexto de un estudio multicéntrico randomizado de screening del cáncer de próstata (CaP). MÉTODOS: Se reclutaron pacientes entre febrero de 1996 y junio de 1999, randomizando en brazos screening y control, realizado varias rondas a los pacientes del brazo screening con intervalo de 4 años, con determinación de PSA y biopsia prostática sextante (PSAt >4ng/mL hasta mayo de 1998, posteriormente PSAt >2.99ng/mL), sin realizar dichos tests en los varones del grupo control. Se investigaron los fallecimientos (fecha de defunción y causa de la misma). RESULTADOS: Se incluyeron un total de 4.278 pacientes, 2.416 del brazo screening (56,4%) y 1.862 del brazo control (43,5%), con edad entre 45 a 70 años y media de 57,8 años (IC95 57,6-58,0). La mediana del tiempo de seguimiento fue de 8,77 años. Se encontraron 142 cánceres, 113 del brazo screening (tasa de detección acumulada 4,7%) y 29 del brazo control (1,6%). Las tasas de detección fueron de 1,7%, 2,2% y 0% en la primera, segunda y tercera ronda respectivamente. Los cánceres órgano confinados (T1 y T2) fueron 102 en el brazo screening (90,3%) y 24 en el control (82,8%), p=0,254. Se detectaron 6 pacientes con enfermedad metastásica (4,2% de 142), 3 del brazo screening (2,7%) y 3 del control (10,3%), p=0,187. El tratamiento más realizado fue la prostatectomía radical: 47 del brazo screening (41,6%) y 10 del control (34,5%). Se han producido 151 fallecimientos, 82 en el brazo screening y 69 en el control, de estos sólo 3 fallecimientos por CaP, todos del brazo screening (p=0,308). CONCLUSIONES: Se observa tendencia no significativa hacia estadíos clínicos más precoces en los pacientes sometidos a screening. El tratamiento de elección en los pacientes con CaP fue la cirugía radical. Aún con el seguimiento actual de esta serie (cercano a los 9 años), no se han observado en nuestro Centro diferencias en cuanto a la mortalidad por CaP entre los dos brazos del estudio

OBJECTIVES: Data from the participation of our department in the ERSPC study in terms of detection and PSA diagnostic yield, staging, therapeutic management and mortality in the context of a multicentric randomized screening study for prostate cancer. METHODS: Patients were recruited between February 1996 and June 1999, randomized in screening and control arms, with several rounds for screening patients with four-year intervals, with PSA analysis and sextant prostate biopsy (t PSA > 4 ng/ml before May 1998, tPSA > 2.99 ng/ml after May 1998). These tests were not done in the control group. All deaths were studied (date and cause) RESULTS: A total of 4278 patients were included, 2416 in the screening arm (56.4%) and 1862 in the control arm (43.5%), with an age between 45 and 70 years (mean age 57.8 years, 95 CI 57.6-58.0). Median follow-up was 8.77 years. 142 prostate cancers were found, 113 in the screening arm (accumulated detection rate 4.7%) and 29 in the control arm (1.6%). Detection rates were 1.7%, 2.2% and 0% in the first, second and third round respectively. Organ confined cancers (T1 and T2) were 102 in the screening arm (90.3% ) and 24 in the control arm ( 82.8% ) , p = 0.254 . Metastatic disease was found in six patients ( 4.2% out of 142 ) , 3 in the screening arm ( 2.7% ) and three in the control arm ( 10.3% ) , p = 0 . 187 . Radical prostatectomy was the most frequently performed treatment: 47 cases in the screening arm (41. 6 %), 10 in the control arm (34. 5 %). 151 patients have died, 82 in the screening arm and 69 in the control arm. Only 3 of this deaths were secondary to prostate cancer, all of them in the screening arm (p = 0.308). CONCLUSIONS: We observed a non significant tendency to lower clinical stages in patients undergoing screening. Radical surgery was the treatment of choice in patients with prostate cancer. Even with the current follow-up in the series (close to 9 years), no differences have been observed in terms of prostate cancer mortality between both study arms

[Impact of the weather on the serum levels of prostatic specific antigen (PSA)]. / Impacto de la climatología sobre el nivel sérico de antígeno especifico prostático (PSA).

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). EXCLUSION CRITERIA: prostate cancer diagnosis, PSA > = 10 ng/ml, or PSA > = 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value > = 3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p < 0.001), minimum temperature (p = 0.001) and age (p < 0.001) as independent predictors of a PSA value > = 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of < = 15 degrees C, 16-20 degrees C, 21-25 degrees C and > =26 degrees C were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters.

Impacto de la climatología sobre el nivel sérico de antígeno específico prostático (PSA) / Impact of the weather on the serum levels of prostatic specific antigen (PSA)

OBJETIVO: Analizar el impacto de la estación climática y de ciertos parámetros meteorológicos sobre el nivel de PSA sérico en varones sin cáncer de próstata. MÉTODOS: Estudio retrospectivo que incluye registros de la rama Española del European Randomized Study of Screening for Prostate Cancer (ERSPC). Los criterios de exclusión fueron el diagnóstico de cáncer de próstata, presentar PSA >= 10 ng/ml, o bien PSA >= 3 ng/ml y/o anomalías en el tacto rectal a menos que se disponga de una biopsia prostática negativa para malignidad. Se investigó la relación univariante entre nivel de PSA y estación climática, así como varios parámetros meteorológicos. Se empleó un modelo multivariante de regresión logística para identificar predictores independientes de la obtención de un nivel de PSA >=3 ng/ml. RESULTADOS: Un total de 2.147 varones fueron incluidos en el estudio. Las medianas de edad y PSA fueron 57 años y 0,9 ng/ml respectivamente. Se observó una tendencia no significativa hacia niveles de PSA más elevados durante las estaciones de otoño e invierno. El modelo multivariante de regresión logística identificó únicamente las temperaturas máxima (p= 3 ng/ml. Los niveles medios de PSA ajustado a la edad en los rangos de temperatura máxima =26ºC fueron 1,25, 1,20, 1,17 y 1,09 ng/ml respectivamente. CONCLUSIONES: Los niveles de PSA sérico son ligeramente más elevados durante condiciones de frío climático. Debido a la pequeña magnitud de esta elevación, no recomendamos cambiar la indicación de biopsia prostática basándonos únicamente en factores climáticos

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Exclusion criteria: prostate cancer diagnosis, PSA >= 10 ng/ml, or PSA >= 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value >=3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p= 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of =26ºC were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters

[Cystic ectasia of the rete testis]. / Ectasia quística de la rete testis.

OBJECTIVES: The cystic ectasia of the rete testis is a benign entity with a typical ultrasound appearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component. METHODS: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period. RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all the indication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up. CONCLUSIONS: The knowledge of the ultrasound characteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy.

Ectasia quística de la rete testis / Cystic ectasia of the rete testis

OBJETIVO: La ectasia quística de la rete testis es una entidad benigna y típicamente en la ecografíaaparece como una colección de pequeñas estructurasanecoicas en la confluencia del mediastinum testis. La importancia clínica de esta entidad radica en hacer un adecuado diagnóstico diferencial con la neoplasiatesticular con componente quísticoMÉTODO: De forma retrospectiva, se revisa en la base de datos de la Unidad de Ecografía del Servicio de Urología el número de pacientes diagnosticados de ectasiaquística de la rete testis durante un periodo de 6 años.RESULTADOS: Durante los 6 años revisados se han diagnosticado 3 casos de ectasia quística de la rete testis y la ecografía fue realizada por dolor testicular. La edad media de los pacientes fue de 62 años. Ningún paciente ha desarrollado durante el tiempo de seguimientoun tumor testicularCONCLUSIONES: El conocimiento de las característicasecográficas encontradas en la ectasia quística de la rete testis permite hacer un adecuado diagnóstico de esta entidad benigna sin necesidad de recurrir a la biopsia testicular

OBJECTIVES: The cystic ectasia of the rete testis is a benign entity with a typical ultrasoundappearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component.METHODS: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period.RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all theindication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up.CONCLUSIONS: The knowledge of the ultrasoundcharacteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy

[Subcapsular orchiectomy in the treatment of prostate cancer: results]. / Resultados de la orquiectomía subalbugínea en el cáncer de próstata.

OBJECTIVES: To analyze the role of orchiectomy in the management of metastasic prostate cancer in our environment. METHODS: We studied 76 patients with the diagnosis of prostate cancer who underwent subcapsular orchiectomy. RESULTS: Mean age was 72 years, median Gleason score was 7, and only 17% had organ confined tumors. Mean follow-up was 2.3 yr. and hospital stay median three days. Ten of the 76 patients in the study died from cancer, being overall five-year survival 75%. Regarding cost analysis, surgical castration was cheaper in the long-term but has the disadvantage of its greater psychological impact. CONCLUSIONS: Orchiectomy is a valid hormonal blockade option when estimated patient survival is longer than one year.

[Stone Cone: a device that prevents ureteral stone migration during intracorporeal lithotripsy]. / Stone Cone: un dispositivo que previene la migración de litiasis ureteral durante la litotricia intracorpórea.

OBJECTIVES: Proximal migration of stone fragments during ureteroscopic lithotripsy is a common problem influenced by pressure of irrigation solution, type of energy for lithotripsy, site and degree of fixation of the stone to the ureteral wall, and degree of proximal ureteral dilation. The Stone Cone (Boston Scientific & Spencer) is a device that helps to prevent proximal migration of fragments and favours a safe extraction during ureteroscopic lithotripsy. TECHNIQUE: The Stone Cone is an helical device made of stainless steel and nitinol alloy, which consists of an internal guide wire and a sheath-like radiopaque catheter with a 3 Fr. calibre. Once the cone is placed above the stone it is maintained in that position during lithotripsy to avoid fragment migration. The external catheter is used to coil and unroll the cone, and allows access to place the cone above the stone. METHODS: We describe two cases of urinary calculi in the left lumbar ureter treated by ureteroscopy and intracorporeal lithotripsy with holmium YAG laser using the Stone Cone to avoid migration of fragments. RESULTS: One month after surgery no lithiasic fragments were observed in the imaging tests. CONCLUSIONS: The Stone Cone decreases the need to perform repeated ureteral instrumentations, and is also a safer and simpler method for the extraction of stone fragments. The use of Stone Cone seems to have more advantages than Dormia's basket during ureteroscopic lithotripsy in terms of lower incidence of residual fragments and reoperation rate.

[Idiopathic local bladder amyloidosis]. / Amiloidosis vesical primaria localizada idiopática.

OBJECTIVE: To report one case of primary bladder amyloidosis. METHODS: We studied a male patient with asymptomatic hematuria by means of transurethral resection. RESULTS: Pathologic features were consistent with amyloidosis of the bladder wall. We cannot prove either sites of amyloid deposits or an etiology for this disease. CONCLUSIONS: Local idiopathic bladder amyloidosis is a very rare disease and the most common presenting symptom is painless hematuria. It may be difficult to differentiate between this disease and a urothelial bladder neoplasia.

Resultados de la orquiectomía subalbugínea en el cáncer de próstata / Subcapsular orchiectomy in the treatment of prostate cancer: results

OBJETIVO: El propósito de este trabajoha sido analizar el papel de la orquiectomía en elmanejo del cáncer de próstata en nuestro ámbito.MÉTODOS: Para ello se han estudiado 76 sujetosdiagnosticados de cáncer de próstata y sometidos aorquiectomía subalbugínea.RESULTADOS: La edad media fue de 72 años, lamediana de Gleason de 7 y solo un 17% tenían tumoresorganoconfinados. El tiempo medio de seguimientofue de 2,3 años y la mediana de estancia hospitalariade 3 días. Diez de los 76 pacientes estudiados fallecieronpor su enfermedad siendo la supervivencia a los5 años fue del 75% para toda la serie. En cuanto alanálisis de costes, el bloqueo quirúrgico es a largoplazo más económico pero tiene como desventaja unmayor impacto psicológico.CONCLUSIONES: La orquiectomía es una opción debloqueo hormonal válida cuando se estima una supervivenciasuperior al año

OBJECTIVES: To analyze the role of orchiectomy in the management of metastasic prostate cancer in our environment. METHODS: We studied 76 patients with the diagnosis of prostate cancer who underwent subcapsular orchiectomy. RESULTS: Mean age was 72 years, median Gleason score was 7, and only 17% had organ confined tumors. Mean follow-up was 2.3 yr. and hospital stay median three days. Ten of the 76 patients in the study died from cancer, being overall five-year survival 75%. Regarding cost analysis, surgical castration was cheaper in the long-term but has the disadvantage of its greater psychological impact. CONCLUSIONS: Orchiectomy is a valid hormonal blockade option when estimated patient survival is longer than one year

Stone ConeTM: un dispositivo que previene la migración de litiasis ureteral durante la litotricia intracorpórea / Stone ConeTM: a device that prevents ureteral stone migration during intracorporeal lithotripsy

OBJETIVO: La migración proximal defragmentos durante la litroticia ureteroscópica es unaproblema común influenciado por la presión del suerode irrigación, el tipo de energía litotriptora utilizada, ellugar y grado de impactación del cálculo en el uréterasí como el grado de dilatación ureteral proximal. ElStone ConeTM (Boston Scientific, Spencer) es un dispositivoque ayuda a prevenir la migración proximal delos fragmentos y favorece una extracción segura deéstos durante la litroticia ureteroscópica.MÉTODO: El Stone ConeTM es un dispositivo helicoidalhecho de una aleación de acero inoxidable y nitinol,que está formado por un alambre guía interno y uncatéter a modo de vaina de características radiopacascon un calibre de 3 Fr. El cono, una vez alojado cranealmenteal cálculo tiene como finalidad mantenerloen esa posición durante la litotricia y evitar la migraciónde fragmentos. El catéter externo sirve para desenrollary enderezar el cono, así como constituye el accesopara alojar el cono por encima del cálculo. Se describendos casos de litiasis alojadas en uréter lumbarizquierdos, que fueron tratados con ureteroscopia ylitroticia intracorpórea con láser Holmium-YAG, usándoseel Stone ConeTM para evitar la migración de restoslitiásicos.RESULTADOS: Al mes de la cirugía no se observan restoslitiásicos en las pruebas de imagen realizadas.CONCLUSIONES: El uso del Stone ConeTM supone undescenso en la necesidad de practicar repetidas manipulacionesureterales, así como un método más sencilloy seguro para la extracción de fragmentos litiásicos. Suutilización parece tener más ventajas sobre la cesta deDormia durante la litotricia ureteroscópica en términosde menor incidencia de fragmentos residuales y denecesidad de reintervenciones

OBJECTIVES: Proximal migration of stonefragments during ureteroscopic lithotripsy is a commonproblem influenced by pressure of irrigation solution,type of energy for lithotripsy, site and degree of fixationof the stone to the ureteral wall, and degree of proximalureteral dilation. The Stone Cone TM (Boston Scientific& Spencer) is a device that helps to prevent proximalmigration of fragments and favours a safe extractionduring ureteroscopic lithotripsy.TECHNIQUE: The Stone Cone TM is an helical devicemade of stainless steel and nitinol alloy, which consistsof an internal guide wire and a sheath-like radiopaquecatheter with a 3 Fr. calibre. Once the cone is placedabove the stone it is maintained in that position duringlithotripsy to avoid fragment migration. The externalcatheter is used to coil and unroll the cone, and allowsaccess to place the cone above the stone.METHODS: We describe two cases of urinary calculi inthe left lumbar ureter treated by ureteroscopy andintracorporeal lithotripsy with holmium YAG laser usingthe Stone Cone TM to avoid migration of fragments.RESULTS: One month after surgery no lithiasic fragmentswere observed in the imaging tests.CONCLUSIONS: The Stone Cone TM decreases theneed to perform repeated ureteral instrumentations, andis also a safer and simpler method for the extraction ofstone fragments. The use of Stone Cone TM seems tohave more advantages than Dormia`s basket duringureteroscopic lithotripsy in terms of lower incidence ofresidual fragments and reoperation rate