[Transitional cell carcinoma of the bladder: behavior in young adults]. / Carcinoma transicional de'vejiga: comportamiento en adultos jóvenes.

OBJECTIVES: Transitional cell carcinoma of the bladder is uncommon in the first three decades of life. Some authors claim that these age groups generally have low grade and superficial tumors. Our experience in the diagnosis and management of transitional cell carcinoma of the bladder in patients < or = 30 years old are analyzed. METHODS: The study comprised thirty-four patients (29 males and 5 females) who had been treated at the Fundación Puigvert from September, 1977 to November, 1993. RESULTS: Pathological analyses of the TUR and biopsy specimens showed most of the patients had low grade (88%) and stage (93%) tumors. The mean follow up was 66 months, range 12-168 months; 28 patients (83%) had a minimum follow-up of 12 months. Fourteen patients were stage Ta, 9 were T1, one T2, and there were 4 cases whose tumor stage could not be assessed (Tx). Tumor recurrence was observed in 9 of 28 patients (32%) and tumor progression in 1 patient. CONCLUSIONS: This tumor type is uncommon in patients < or = 30 years old. This age group generally has low grade/stage tumors. Although the incidence of tumor progression is low and these patients have a good prognosis, treatment and subsequent follow-up depend on tumor grade and stage at the time of diagnosis.

[Evolutive orchiepididymitis or ischemic testis?: that is the question]. / Orquioepididimitis evolutiva o testículo isquémico?: he ahí la cuestión.

We report a case of deferred acute scrotum in a young teenager. Even though initially the aetiological diagnosis seemed clear (partially treated epididymo-orchitis), glandular viability remained uncertain due to ultrasound findings and the time elapsed since initial diagnosis. Colour Doppler Ultrasound is examined as the most useful ancillary method in differential diagnosis in this setting, as well as the different ultrasound findings in subsequent stages of spermatic cord torsion and epididymo-orchitis. Possible testicular ischaemia in this clinical setting is emphasized, explaining its pathophysiology.

[Analysis of 895 consultations for hematuria in the emergency department in an urology unit]. / Analyse de 895 consultations pour hématurie dans le département des urgences d'un service d'urologie.

OBJECTIVE: To study efficacy of our diagnostic approach in patients with haematuria, as well as the information provided by the different tests. PATIENT AND METHODS: The computerization of our emergency department, and the study of the data base have permitted us to study retrospectively 722 cases of hematuria seen at our center over a period of 10 months. The relation between the benign or malignant etiology of the hematuria, and the presence or absence of associated symptoms and the intensity of the hematuria is shown, as well as the relation between the intensity of the hematuria and the decrease in the hemoglobin rates detected. RESULTS: Fifty eight percent of the 722 patients, 39% of them due to neoplasm. The intensity of had one symptom only hematuria was significantly superior in the patients with the final diagnosis of neoplams. The accomplishment of reactive strip, basic imaging techniques and urine sediment has permitted in our series to direct the diagnosis in 67.3% of patients. Cystoscopy has shown great efficacy in diagnosing the cases of monosymptomatic hematuria with normal radiological studies. CONCLUSION: Monosymptomatic hematuria deserves a work-up to rule out malignancy. Reactive strip, urine sediment, KUB and ultrasonography allow to direct the diagnosis in most cases.

[The digital rectal exam, prostate-specific antigen and transrectal echography in the diagnosis of prostatic cancer]. / Tacto rectal, antígeno prostático específico y ecografía transrectal en el diagnóstico del cáncer prostático.

OBJECTIVES: This study analyzes the three available clinical methods in the diagnosis of prostate cancer (PC): digital rectal examination (DRE), serum prostate specific antigen (PSA) and transrectal ultrasound (TRUS), and attempts to establish the best system in the early detection of PC. METHODS: The findings of DRE, serum PSA and TRUS of the prostate in patients in which a TRUS-guided prostate biopsy was performed initially, and prostate surgery afterwards (TURP in 72%, radical retropubic prostatectomy in 20% and simple prostatectomy in 8%), are retrospectively analyzed. RESULTS: PC was eventually found in 50 patients (56%). Seventy-eight patients had an abnormal DRE, 44 of which had a final diagnosis of PC (sensitivity = 94%, specificity = 20.5%). Serum PSA levels were available in 60 cases before diagnosis. Levels > 4 ng/ml were found in 32 of 38 cases with PC (sensitivity = 84%, specificity = 31%). The TRUS finding with the highest positive predictive value (PPV) for PC was diffuse prostate heterogeneity (77.8%). When a hypoechoic nodule was seen in the prostate peripheral zone, PC was found in 53.7%. Different combinations of the three methods are analyzed, trying to increase the diagnostic capabilities of each isolated test. Transrectal ultrasound-guided prostate biopsy detected 44 (88%) of the 50 cases with PC, its negative predictive value being 86.7%. Prostate tissue valid for histologic diagnosis was obtained in 97% of the cases, and the predictive value of the true tumor grade was 84.1%. The general complication rate attained 3.4%, none being of the septic type. CONCLUSIONS: When parallel testing was examined (one or more tests being abnormal), the most efficient combination in the early detection of PC was when DRE was suspicious or serum PSA > 4 ng/ml (sensitivity = 95%, PPV = 62%). When at least two diagnostic tests were abnormal (serial testing), the most efficient combination to confirm the presence of this tumor was an abnormal TRUS and a serum PSA > 10 ng/ml (specificity = 86%, PPV = 88%).

[The IPPS questionnaire in patients and controls. Psychometric validation]. / Cuestionario IPSS en pacientes y controles. Validación psicométrica.

The translation into Spanish of the AUA/International Prostatic Symptom (AUA/IPS) Score hadn't been validated in spanish. METHODS. AUA/IPS questionnaire was self administered by 103 consecutive patients and by 24 healthy volunteers. An alternative formulation to question 4 (ALT-4) was added. RESULTS. 51 patients (49%) and 17 controls (79%) completed al questions (Feasibility). Reliability was measured by: a) Crohnbach's alpha (0.68 and 0.70 with ALT-4) b) Kendall's coefficient of concordance (0.097, significance < 0.001) and c) retesting 17 patients within 2 months. The relation of the AUA/IPS scores with quality of life (Construct validity) showed a Spearman's correlation coefficient of 0.57 (confidence = 0.0001), and 0.52/0.0004 with ALT-4. The relation with uroflowmetry (Concurrent empirical validity) was poor as shown in ROC curves. CONCLUSIONS. The Spanish version of the AUA/IPS questionnaire given in an easy format improves feasibility without alteration of reliability or validity. The relation of the AUA/IPS score with uroflowmetry is poor, although the questionnaire can be considered valid and reliable.

[From shock-waves even to ureterolithotomy: various practical cases]. / Des ondes de choc jusqu'à l'urétérolithotomie: quelques cas pratiques.

The Puigvert Urology Centre in Barcelona reports the detailed results of five cases of ureteric stones all treated by first-line shock wave lithotripsy. Only one case obtained a positive result (after 4 sessions). In the other four cases, shock wave therapy had to be completed by ureteroscopy (1 case) or by open surgery (3 cases) to achieve cure.

Splenic hematoma in acute pancreatitis. Role of coagulation disorders.

Splenic hematomas are infrequent complications of acute pancreatitis. In some cases, local factors that may play a role in the pathogenesis of the hematoma (thrombosis of the splenic artery or veins, intrasplenic pseudocysts, perisplenic adhesions, enzymatic digestion) are found. In the absence of local factors, the etiology of splenic hemorrhage remains unknown. We report two cases of splenic hematoma occurring during an acute necro-hemorrhagic pancreatitis associated with renal failure that required renal replacement therapy (hemodialysis and continuous arteriovenous hemodialysis). In both cases, more than half of splenic parenchyma was affected by multiple infarctions. No local factors responsible for the splenic abnormalities were detected in either case. Thrombosis of the splenic arterial microcirculation and a coagulation disorder consistent with disseminated intravascular coagulation was detected in one patient. In the second patient, coagulation disorders secondary to either liver disease, pancreatitis and its septic complications, or extracorporeal circuit heparinization for renal replacement therapy were present. Coagulation disorders should be considered whenever a splenic hematoma is found in a patient with acute pancreatitis. Disseminated intravascular coagulation may be the etiology of a splenic hematoma in acute pancreatitis.