Utilidad de la resonancia magnética en la valoración postquirúrgica de pacientes con prótesis hidráulica de pene / Usefulness of magnetic resonance imaging in the postsurgical assessment of patients with inflatable penile prostheses

Objetivo. Describir los tipos de prótesis de pene y sus componentes, revisar el protocolo de adquisición adecuado en resonancia magnética (RM), describir los hallazgos de imagen normales y las posibles complicaciones en pacientes con prótesis hidráulica de pene. Conclusión. Las prótesis hidráulicas tricompartimentales de pene son el último eslabón en la cadena terapéutica de la disfunción eréctil. Pueden presentar complicaciones, que se clasifican en no infecciosas vinculadas a la técnica quirúrgica, infecciosas y por fallo mecánico del dispositivo. La RM es la técnica de imagen más adecuada en la evaluación postquirúrgica de las prótesis de pene. Se realiza con secuencias de alta resolución espacial con la prótesis en reposo y en los tres planos del espacio, y se repite la adquisición triplanar con la prótesis activada (AU)

Objective. To describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants. Conclusion. Three-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated (AU)

Usefulness of magnetic resonance imaging in the postsurgical assessment of patients with inflatable penile prostheses. / Utilidad de la resonancia magnética en la valoración postquirúrgica de pacientes con prótesis hidráulica de pene.

OBJECTIVE: To describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants. CONCLUSION: Three-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated.

Análisis de riesgos competitivos de mortalidad en cáncer de próstata tratado mediante prostatectomía radical / Competing risk analysis of mortality in prostate cancer treated with radical prostatectomy

Objetivo: Estimar el riesgo de muerte cáncer específica (MCE) frente al riesgo competitivo de mortalidad por otras causas (MOC) en pacientes con cáncer de próstata localizado (CaP-Lo) tratados mediante prostatectomía radical (PR). Material y método: Estudio observacional de una cohorte de 982 pacientes con CaP-Lo tratados mediante PR seleccionados de la base de datos del registro de CaP de nuestro servicio. Se ha realizado un análisis de riesgos competitivos calculando la probabilidad de MCE en presencia del riesgo competitivo por MOC. Se han construido curvas de incidencia acumulada y se han llevado a cabo estimaciones puntuales a 5, 10 y 15 años. El análisis se ha estratificado por edad (≤ 65 vs. > 65 años) y por grupos de riesgo: bajo (Gleason ≤ 6 y pT2abc); intermedio (Gleason = 7 y pT2abc) y elevado (Gleason 8-10 o pT3ab). Resultados: Con una mediana de seguimiento de 60 meses, la probabilidad global de fallecer por CaP fue del 3,5% y la de fallecer por otras causas del 9%. Se evidenció un efecto competitivo por MOC. El riesgo de MOC fue de casi 3 veces superior al de MCE. Este efecto se mantuvo para todos los grupos de riesgo, si bien su magnitud disminuyó progresivamente conforme aumentó el nivel del grupo de riesgo. A 10 años, la MCE fue únicamente de 0, 1 y 2% para los grupos de riesgo bajo, intermedio y elevado respectivamente, mientras que la probabilidad MOC fue de 4, 4 y 10%. El riesgo de fallecer se evidenció a partir de 10 años de seguimiento y fue más frecuente por otras causas no atribuibles al CaP y en pacientes de edad > 65 años. Conclusiones: El beneficio de la PR puede estar sobreestimado, ya que el riesgo de MOC es superior al de MCE independientemente del grupo de edad y grupo de riesgo, sobre todo a partir de los 10 años de seguimiento. Lo único que varía es la magnitud de la razón MCE/MOC. Esta información puede ayudar a decidir el tratamiento activo en pacientes con CaP-Lo y corta expectativa de vida

Objective: To determine the risk of cancer-specific mortality (CSM) versus the competing risk of mortality by other causes (MOC) in patients with localised prostate cancer (LPC) treated with radical prostatectomy (RP). Material and method: An observational cohort study of 982 patients with LPC treated with RP selected from our department’s PC registry database. A competing risk analysis was performed, calculating the probability of CSM in the presence of the competing risk of MOC. Cumulative incidence curves were constructed, and point estimates were performed at 5, 10 and 15 years. The analysis was stratified by age (≤ 65 vs. > 65 years) and risk group: low (Gleason score ≤ 6 and pT2abc); intermediate (Gleason score of 7 and pT2abc) and high (Gleason score of 8-10 or pT3ab). Results: With a median follow-up of 60 months, the overall probability of dying from PC was 3.5%, and the probability of dying from other causes was 9%. A competing effect for MOC was observed. The risk of MOC was almost 3 times greater than that of CSM. This effect remained for all risk groups, although its magnitude decreased progressively according to the risk group level. At 10 years, CSM was only 0%, 1% and 2% for the low, intermediate and high-risk groups, respectively, while the likelihood of MOC was 4%, 4% and 10%, respectively. The mortality risk was shown after 10 years of follow-up and was higher for other causes not attributable to PC and for patients older than 65 years. Conclusions: The benefit of RP might be overestimated, given that the risk of MOC is greater than that of CSM, regardless of the age group and risk group, especially after 10 years of followup. The only parameter that varied was the magnitude of the CSM/MOC ratio. This information could help in choosing the active treatment for patients with LPC and short life expectancies

Competing risk analysis of mortality in prostate cancer treated with radical prostatectomy. / Análisis de riesgos competitivos de mortalidad en cáncer de próstata tratado mediante prostatectomía radical.

OBJECTIVE: To determine the risk of cancer-specific mortality (CSM) versus the competing risk of mortality by other causes (MOC) in patients with localised prostate cancer (LPC) treated with radical prostatectomy (RP). MATERIAL AND METHOD: An observational cohort study of 982 patients with LPC treated with RP selected from our department's PC registry database. A competing risk analysis was performed, calculating the probability of CSM in the presence of the competing risk of MOC. Cumulative incidence curves were constructed, and point estimates were performed at 5, 10 and 15 years. The analysis was stratified by age (≤65 vs. >65 years) and risk group: low (Gleason score ≤6 and pT2abc); intermediate (Gleason score of 7 and pT2abc) and high (Gleason score of 8-10 or pT3ab). RESULTS: With a median follow-up of 60 months, the overall probability of dying from PC was 3.5%, and the probability of dying from other causes was 9%. A competing effect for MOC was observed. The risk of MOC was almost 3 times greater than that of CSM. This effect remained for all risk groups, although its magnitude decreased progressively according to the risk group level. At 10 years, CSM was only 0%, 1% and 2% for the low, intermediate and high-risk groups, respectively, while the likelihood of MOC was 4%, 4% and 10%, respectively. The mortality risk was shown after 10years of follow-up and was higher for other causes not attributable to PC and for patients older than 65years. CONCLUSIONS: The benefit of RP might be overestimated, given that the risk of MOC is greater than that of CSM, regardless of the age group and risk group, especially after 10years of follow-up. The only parameter that varied was the magnitude of the CSM/MOC ratio. This information could help in choosing the active treatment for patients with LPC and short life expectancies.

[De novo urological neoplasms in kidney transplant patients: experience in 1,751 patients]. / Neoplasias urológicas de novo en pacientes trasplantados renales: experiencia en 1.751 pacientes.

INTRODUCTION: Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. OBJECTIVE: To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. MATERIALS AND METHODS: A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. RESULTS: Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2-121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17-70) years, and median age at tumor diagnosis was 56.4 (19-79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. CONCLUSIONS: In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate.

Neoplasias urológicas de novo en pacientes trasplantados renales: experiencia en 1.751 pacientes / De novo urological neoplasms in kidney transplant patients: experience in 1.751 patients

Introducción: el tratamiento inmunosupresor en pacientes que reciben un trasplante renal favorece el desarrollo de neoplasias. La prevalencia de neoplasias en trasplantados es de 4 a 5 veces mayor que en la población general. Además se sabe que los tumores en trasplantados se comportan con una mayor agresividad. Objetivo: evaluar mediante un análisis descriptivo las neoplasias de novo urológicas en pacientes trasplantados renales y analizar la supervivencia de los mismos. Material y métodos: estudio retrospectivo desde enero de 1980 hasta diciembre de 2006 sobre 1.751 pacientes trasplantados. Se excluyeron aquellos en los que la neoplasia apareció durante el primer año tras el trasplante. Se consideraron las principales variables: sexo, edad al trasplante, edad al diagnóstico de la neoplasia, localización, estadio clínico, tratamiento y evolución. Para el análisis estadístico univariante se utilizó la prueba de Chi cuadrado. La supervivencia fue evaluada mediante el método de Kaplan Meier. Resultados: se diagnosticaron 29 (1,6%) neoplasias de novo en un total de 1.751 trasplantados, con una mediana de seguimiento de 35,28 meses (2-121) desde el diagnóstico de la neoplasia. La distribución por sexos fue de 24 varones (82%) frente a 5 mujeres (18%). La mediana de edad en el momento del trasplante fue de 50,8 (17-70) años y la mediana de edad en el diagnóstico de neoplasia fue de 56,4 (19-79) años. Se diagnosticó a 11 pacientes (38%) de cáncer próstata, a 7 pacientes (24%) de neoplasias de vejiga a 4 (60%) no músculo invasivas y a tres (40%) de tumor músculo invasivo y en 6 pacientes (20%) se diagnosticó un adenocarcinoma renal sobre el riñón primitivo. En 5 sujetos (18%) se detectó una neoplasia del riñón trasplantado. La mediana de supervivencia fue de 75 meses para tumores de vejiga, 82 meses en el cáncer de próstata, 59 meses en el riñón primitivo y 86 meses para el riñón trasplantado. Conclusiones: en nuestra serie las neoplasias urológicas de novo en trasplantados renales son más frecuentes en varones. El cáncer de próstata es la neoplasia más frecuente y el adenocarcinoma renal del riñón primitivo es la de menor supervivencia(AU)

Introduction: Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. Objective: To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. Materials and methods: A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. Results: Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2-121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17-70) years, and median age at tumor diagnosis was 56.4 (19-79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. Conclusions: In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate(AU)

Penile foreign bodies.

OBJECTIVE: To describe 8 cases of penile foreign bodies. METHODS/RESULTS: We provide an essentially visual overview of various objects or foreign bodies affecting the penis. CONCLUSIONS: The presence of penile foreign bodies is rarely due to an accident. These objects are placed for a wide variety of reasons, but primarily for erotic or self-arousal purposes. The consequences of penile foreign bodies can be mild or very severe, resulting in penile amputation.

[Urological findings in spinal cord ischemia]. / Manifestaciones urológicas de los accidentes vásculo-medulares.

INTRODUCTION: Spinal cord ischemia is a circulatory disorder of acute or subacute establishment and neurological clinic of medullar section, usually incomplete. We describe clinical and anatomical characteristics, as well as diagnostic methods and therapeuthic used in these patients. MATERIAL AND METHODS: Since 1987 to 2007, 65 patients were diagnosed of spinal cord ischemia in our hospital. Clinical interview, neurological examination and image study were performed. Urodynamic study was performed after medullar shock phase, including cystometry, pressure flow study and external urinary sphincter electromyography. We have reviewed treatment applied in these patients. RESULTS: 65 patients (27 women and 38 men), median age 63 years (15-87). 28 patients (43%) presented high lesion (upper to T7), 32 (49%) middle (T7-L2) and 4 (6%) low lesion (below L2). Flaccid paraplegia and acute urinary retention were the most frequent clinical findings at the begining. Aetiology was determined mainly by Magnetic Resonance. Urodynamic study revealed: 9 patients (47.4%) with high spinal cord lesion and detrusor overactivity (with or without dyssynergia), and 6 (31.5%) with arreflexia; 11 patients (47.8%) with middle spinal cord lesion and detrusor overactivity and 7 patients with arreflexia (30.4%); one patient with low spinal cord lesion and detrusor overactivity, and another one with arreflexia (33%). CONCLUSIONS: There is a good correlation among lesion level and clinical findings in traumatic spinal cord injuries, but this is not the same in spinal cord ischemia. Probably, incomplete and patched lesions in vascular spinal cord injuries could explain this lack of correlation. Therefore, it is mandatory to performe an exhaustive neurological and urological evaluation of these patients in order to select the best treatment and prevent upper urinary tract damage in the future.

Manifestaciones urológicas de los accidentes vásculo-medulares / Urological findings in spinal cord ischemia

Introducción: Nuestro objetivo es describir las características anatomoclínicas de los accidentes vasculomedulares, así como los métodos diagnósticos y terapéuticos empleados. Material y Métodos: Estudio retrospectivo desde 1982 hasta 2007, que incluye a 65 pacientes diagnosticados de AVM. Se realizó anamnesis general con exploración neurológica completa y estudio diagnóstico por imagen. La evaluación urodinámica consistió en cistomanometría, estudio de presión flujo y electromiografía del esfínter externo tras la fase de shock medular. Resultados: De los 65 pacientes (27 mujeres-38 hombres), con una mediana de edad de 63 años (15-87 años), 28pacientes (43%) presentaron lesión alta (superior a T7), 32 (49%)lesión media (entre T7-L2) y 4 (6%) baja (inferior a L2). El debut clínico más frecuente fue la paraplejía fláccida con retención aguda de orina. La etiología del AVM se determinó mediante pruebas de imagen, principalmente Resonancia Magnética. El estudio urodinámico mostró los siguientes resultados: lesión medular alta con hiperactividad vesical (asociando o no disinergia) 9 pacientes (47,4%) y 6 pacientes(31,5%) con arreflexia; lesión medular media con hiperactividad 11 pacientes (47,8%) y con arreflexia 7 pacientes (30,4%); lesión medular baja con hiperactividad un paciente (33%), arreflexia en otro (33%). Conclusiones: No existe una clara correlación entre el nivel anatómico lesionado y el comportamiento vésico esfinteriano. Esto es debido a que las lesiones medulares de origen vascular suelen ser incompletas y parcheadas, afectándose diferentes niveles. Es necesario, por tanto, realizar una exhaustiva exploración neurológica y urológica en estos pacientes, para poder establecer el patrón funcional que nos permita indicar el tratamiento idóneo (AU)

Introduction: Spinal cord ischemia is a circulatory disorder of acute or subacute establishment and neurological clinic of medullar section, usually incomplete. We describe clinical and anatomical characteristics, as well as diagnostic methods and therapeuthic used in these patients. Material and methods: since 1987 to 2007, 65 patients were diagnosed of spinal cord ischemia in our hospital. Clinical interview, neurological examination and image study were performed. Urodynamic study was performed after medullar shock phase, including cystometry, pressure flow study and external urinary sphincter electromyography. We have reviewed treatment applied in these patients. Results: 65 patients (27 women and 38 men), median age 63 years (15-87). 28 patients (43%) presented high lesion (upper to T7), 32 (49%) middle (T7-L2) and 4 (6%) low lesion (below L2). Flaccid paraplegia and acute urinary retention were the most frequent clinical findings at the begining. Aetiology was determined mainly by Magnetic Resonance. Urodynamic study revealed: 9 patients (47,4%) with high spinal cord lesion and detrusor overactivity (with or without dyssynergia), and 6 (31,5%) with arreflexia; 11 patients (47,8%) with middle spinal cord lesion and detrusor overactivity and 7 patients with arreflexia (30,4%); one patient with low spinal cord lesion and detrusor overactivity, and another one with arreflexia (33%).Conclusions: there is a good correlation among lesion level and clinical findings in traumatic spinal cord injuries, but this is not the same in spinal cord ischemia. Probably, incomplete and patched lesions in vascular spinal cord injuries could explain this lack of correlation. Therefore, it is mandatory to performe an exhaustive neurological and urological evaluation of these patients in order to select the best treatment and prevent upper urinary tract damage in the future (AU)

Sintomatología obstructiva en mujer joven por hidrosalpinx izquierdo / Obstructive symptopms in young woman by left hydrosalpins

Se describe el caso de una mujer de 43 años con sintomatología de llenado y vaciado tras realización de histerectomía con estudio urodinámico compatible con obstrucción infravesical. Se diagnosticó un hidrosalpinx izquierdo que fue tratado quirúrgicamente tras el cual la paciente quedo asintomática (AU)

We describe the case of a 43 years old woman with obstructive and irritative symptoms after having an hysterectomy. Bladder outlet obstruction was observed in an urodinamyc study. She was later diagnosed with left hidrosalpinx. Salpingectomy was performed, as a result all symptoms have disappear (AU)

[Traumatic testicular dislocation]. / Dislocación testicular postraumática.

Testicular dislocation is an uncommon injury after blunt scrotal trauma (with only 150 cases reported) that must be properly diagnosed and treat in order to avoid a testicular atrophy. We presented a case report of traumatic dislocation of right testicle after a motorcycle accident. This type of testicular injury should be included in the whole evaluation of every polytrauma patient and usually requires a surgical treatment. The aim of this report is to clarify some aspects of the management of such rare entity.

Dislocación testicular postraumática / Traumatic testicular dislocation

Presentamos el caso clínico de un paciente politraumatizado, conductor de motocicleta, con dislocación testicular derecha. Se trata de una lesión infrecuente tras traumatismo contuso que requiere diagnóstico y tratamiento precoz con el fin de evitar la atrofia testicular. Esta lesión deberá tenerse en cuenta en toda evaluación del politraumatizado, requiriendo tratamiento quirúrgico. El objetivo del caso clínico es aportar un nuevo caso a la literatura, siendo este el sexto caso publicado por autores españoles, con el fin de clarificar el manejo y tratamiento

Testicular dislocation is an uncommon injury after blunt scrotal trauma (with only 150 cases reported) that must be properly diagnosed and treat in order to avoid a testicular atrophy. We presented a case report of traumatic dislocation of right testicle after a motorcycle accident. This type of testicular injury should be included in the whole evaluation of every polytrauma patient and usually requires a surgical treatment. The aim of this report is to clarify some aspects of the management of such rare entity