Extrauterine Retroperitoneal Leiomyomas: 3 Case Reports and Review of the Literature.

Leiomyomas are benign mesenchymal tumors which originate from smooth muscle cells. Extrauterine leiomyomas are rare and they may arise where smooth muscle cells are found. Their diagnosis is challenging due to their heterogeneous ways of presentation. Histological analysis may reveal areas of sarcomatous differentiation; therefore, complete resection of the entire tumor is the only curative treatment. There is no adjuvant therapy proved to increase overall survival. It is essential to develop a standardized protocol, detailing how to follow up these patients since it is not reported in the literature to date; however, it is advisable to follow them because the local recurrence rate is high if small implants remain. In this review, we present 3 cases of extrauterine leiomyomas diagnosed and treated in our hospital. The management was different in each case, highlighting the heterogeneity of this condition. According to the literature, there are no solid guidelines on their management. We compare our experience with the data available to date in order to support the existing knowledge and provide our expertise for future studies.

Ureteral Stenosis and Fistula after Kidney Transplantation.

INTRODUCTION: Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center. METHODS: Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas. RESULTS: Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948). CONCLUSION: Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival.

[Late kidney transplant complications treatment.] / Tratamiento de las complicaciones tardías del trasplante renal.

OBJECTIVES: Late kidney transplant complication might compromise graft durability, thus the need for early detection and treatment. MATERIAL AND METHODS: A PubMed review including the following MeSH terms was included: kidney transplant¨, ¨complications¨, ¨vascular complications¨,¨transplant renal artery stenosis¨, ¨ureteral obstruction¨,¨urologic complications¨, ¨forgotten stent¨, ¨vesicoureteralreflux¨, ¨urinary lithiasis¨ e ¨incisional hernia¨. Metanalysis and systematic review in spanish and English were included from January 2015 till February 2021, as well as relevant selected manuscripts. RESULTS: We defined as late complications those appearing at 3 months from kidney transplant. Those include vascular complications (renal artery stricture), urinary tract (ureteral stricture, permanent double Js, pyelonephritis due to reflux, urinary stones) and abdominal wall (incisional hernia). CONCLUSIONS: Late kidney transplant complications remain high still with advancement on surgical technique and immunotherapy. Those complication might compromise the graft durability and so early detection is or primary importance.

OBJETIVO: Las complicaciones tardías del trasplante renal pueden comprometer de manera importante la viabilidad del injerto, por lo que debemos detectarlas y tratarlas de manera precoz.MATERIAL Y MÉTODOS: Realizamos una revisión bibliográfica en PubMed utilizando los términos MeSH ¨kidney transplant¨, ¨complications¨, ¨vascular complications¨, ¨transplant renal artery stenosis¨, ¨ureteralobstruction¨, ¨urologic complications¨, ¨forgotten stent¨,¨vesicoureteral reflux¨, ¨urinary lithiasis¨ e ¨incisionalhernia¨. Se incluyeron metaanálisis, revisiones y revisiones sistemáticas en inglés y español, desde enero de2015 hasta febrero de 2021, así como las referencias más relevantes incluidas en los artículos seleccionados. RESULTADOS: Definimos como complicaciones tardías aquellas que suelen aparecer a partir del tercer mes trasla realización del trasplante. Dentro de ellas se incluyen complicaciones vasculares (estenosis de la arteria renal), de la vía urinaria (estenosis ureteral, catéteres ureterales no retirados, pielonefritis secundarias a reflujovesico-ureteral y litiasis urinaria) y de pared (hernia incisional). CONCLUSIONES: A pesar de los avances, tanto médicos (inmunosupresión) como en la técnica quirúrgica, en el trasplante renal, todavía son frecuentes las complicaciones a largo plazo. Estas complicaciones pueden comprometer la viabilidad del injerto renal, lo que hace necesario que sean detectadas lo antes posible, y no demorar su tratamiento.

Tratamiento de las complicaciones tardías del trasplante renal / Treatment of late complications of renal transplantation

Objetivo: Las complicaciones tardíasdel trasplante renal pueden comprometer de maneraimportante la viabilidad del injerto, por lo que debemosdetectarlas y tratarlas de manera precoz.Materiales y métodos: Realizamos una revisión bibliográfica en PubMed utilizando los términos MeSH ̈kidney transplant ̈, ̈complications ̈, ̈vascular complications ̈, ̈transplant renal artery stenosis ̈, ̈ureteralobstruction ̈, ̈urologic complications ̈, ̈forgotten stent ̈, ̈vesicoureteral reflux ̈, ̈urinary lithiasis ̈ e ̈incisionalhernia ̈. Se incluyeron metaanálisis, revisiones y revisiones sistemáticas en inglés y español, desde enero de2015 hasta febrero de 2021, así como las referenciasmás relevantes incluidas en los artículos seleccionados. Resultados: Definimos como complicaciones tardíasaquellas que suelen aparecer a partir del tercer mes trasla realización del trasplante. Dentro de ellas se incluyen complicaciones vasculares (estenosis de la arteriarenal), de la vía urinaria (estenosis ureteral, catéteresureterales no retirados, pielonefritis secundarias a reflujo vesico-ureteral y litiasis urinaria) y de pared (herniaincisional).Conclusiones: A pesar de los avances, tanto médicos (inmunosupresión) como en la técnica quirúrgica,en el trasplante renal, todavía son frecuentes las complicaciones a largo plazo. Estas complicaciones puedencomprometer la viabilidad del injerto renal, lo que hacenecesario que sean detectadas lo antes posible, y nodemorar su tratamiento.(AU)

Objetives: Late kidney transplant complication might compromise graft durability, thus theneed for early detection and treatment.Material and methods: A PubMed review including the following MeSH terms was included: kidneytransplant ̈, ̈complications ̈, ̈vascular complications ̈, ̈transplant renal artery stenosis ̈, ̈ureteral obstruction ̈, ̈urologic complications ̈, ̈forgotten stent ̈, ̈vesicoureteral reflux ̈, ̈urinary lithiasis ̈ e ̈incisional hernia ̈. Metanalysis and systematic review in spanish and Englishwere included from January 2015 till February 2021,as well as relevant selected manuscripts. Results: We defined as late complications those ap-pearing at 3 months from kidney transplant. Those include vascular complications (renal artery stricture),urinary tract (ureteral stricture, permanent double Js, pyelonephritis due to reflux, urinary stones) and abdominalwall (incisional hernia).Conclusions: Late kidney transplant complicationsremain high still with advancement on surgical techniqueand immunotherapy. Those complication might compromise the graft durability and so early detection is or primary importance.(AU)

Observational study over 8-year period evaluating microbiological characteristics and risk factor for isolation of multidrug-resistant organisms (MDRO) in patients with healthcare-associated infections (HAIs) hospitalized in a urology ward.

Objective: To analyze, in a urology ward, the prevalence and characteristics of healthcare-associated infections (HAIs) due to multidrug-resistant organisms (MDRO). Methods: We carried out an observational study from 2012 to 2019, evaluating MDRO among patients with HAIs, who were hospitalized in the urology ward. MDRO include Pseudomonas spp., resistant to at least three antibiotic groups, extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae or those resistant to carbapenems, and Enterococcus spp. resistant to vancomycin. Results: Among patients with HAIs, MDRO were isolated in 100 out of 438 (22.8%) positive cultures. Univariate and multivariate analyses reported that prior urinary tract infection (UTI) [OR 2.45; 95% CI 1.14-5.36; p=0.021] and immunosuppression [OR 2.13; 95% CI 1.11-4.10; p=0.023] were risk factors for MDRO. A high prevalence of MRDO was found in patients with a catheter in the upper urinary tract; 27.6% for double J stent, 29.6% in those with a nephrostomy tube, and 50% in those with a percutaneous internal/external nephroureteral (PCNU) stent. MDRO were isolated in 28.4% of cultures with Enterobacteriaceae (23.8% and 44.7% in those with E. coli and Klebsiella spp.); 7% of Enterobacteriaceae showed resistance to carbapenems (1.3% and 10% for E. coli and Klebsiella spp., respectively). Three out of 80 Enterococcus spp. were vancomycin-resistant. The rate of Pseudomonas aeruginosa resistant to at least three antibiotic groups was 36.3%. Conclusions: The isolation of MDRO, in up to 25% of positive cultures in a urology ward, constitutes a challenge for the selection of antibiotics. MDRO are more common in immunosuppressed patients, those with previous UTIs, and those with a catheter in the upper urinary tract.

Acute Page kidney after angioplasty in kidney transplant allografts.

Acute Page kidney (APK) in kidney transplantation is a rare entity often related to interventional techniques. Percutaneous angioplasty remains an exceptional cause of APK. Herein we describe the clinical course and outcome of APK following percutaneous angioplasty for transplant renal artery stenosis in four kidney transplant recipients, where external compression of the graft was caused by subcapsular haematomas. All patients were treated with surgical drainage, after which two cases recovered baseline kidney function, one developed advanced chronic kidney disease and one remained dialysis-dependent. To our knowledge, the present series is the largest to describe APK in kidney allografts after percutaneous angioplasty.

Iterative renal transplantation: our experience on third transplants.

PURPOSE: To report our experience on third kidney transplantation, analyzing the complications and graft survival rates as compared to previous transplants. METHODS: Retrospective study of third renal transplants performed at our center. Outcomes were compared with a cohort of first and second transplants. RESULTS: Of a total of 4143, we performed 72 third transplants in 46 men and 26 women with an average age of 46 years and mean time on dialysis of 70 months. Thirty-seven patients were hypersensitized [panel-reactive antibody (PRA) > 50%]. They were all from deceased donors, with a mean cold ischemia time of 19.2 h. The extraperitoneal heterotopic approach was used in 88.8%, transplantectomy was performed in 80.6% and vascular anastomoses were realized mostly to external iliac vessels, using the common iliac artery in 15 cases, and the inferior vena cava in 16. The main ureteral reimplantation technique was the Politano-Leadbetter (76.4%). Third transplantation reported a significantly higher incidence of lymphocele (13.9% vs. 3.2% in first and 4.5% in second transplants; p < 0.001), rejection (34.7% vs. 14.9% and 20.5%, p < 0.001) and urinary obstruction (11.1% vs. 3.6% and 6.3%, p 0.002). Graft survival rates for first, second and third transplants were 87%, 86% and 78% at 1 year, 83%, 82% and 74% at 3 years and 80%, 79% and 65% at 5 years, respectively. CONCLUSION: Iterative transplantation constitutes a valid therapeutic option with adequate surgical and survival results compared to previous transplants. It is a challenging procedure which must be performed by experienced surgeons.

Cystoscopy Real-Time Self-Visualization and Its Impact in Patient's Pain Perception.

OBJECTIVES: To determine if self-visualization of ambulatory cystoscopy provides a decrease in pain perception in male and female patients. METHODS: A quasi-randomized controlled trial involving patients scheduled for ambulatory cystoscopy from August to November 2017. The indications were: hematuria, bladder cancer surveillance, lower urinary tract symptoms, and incontinence. The patients were quasi-randomized into two groups by scheduled date. Both groups received the same explanation before and during cystoscopy. The variables analyzed were gender, age, Visual Analog Scale (VAS) score, number of previous cystoscopies, and indication and positivity of the test for bladder neoplasia. All patients were analyzed by group and gender separately. The statistical tests used were: Wilcoxon rank-sum, Kruskal-Wallis, Mann-Whitney U test, Pearson correlation, and linear regression. RESULTS: Four hundred four patients were included (318 males and 86 females) and divided into two groups, group A (no self-visualization, n = 239) and group B (self-visualization, n = 165). In males, mean VAS score was 2.6 for group A and 2.5 for group B (p = 0.276); in females, VAS score was 2.78 for group A and 1.64 for group B (p = 0.008). Regarding the remaining variables analyzed, neither positivity of the test for neoplasia (p = 0.14) nor cystoscopy indication (p = 0.597) had any influence. In patients with two or more previous cystoscopies, a reduction in mean VAS score was seen in both genders. In males having their first cystoscopy the mean VAS score was 3.1 and decreased to 2.1 for the third or more (p = 0.001); in females the mean VAS score was 2.89 for the first and 1.56 for the third or more (p = 0.02), although this benefit tended to disappear when the number of previous cystoscopies was taken into account. CONCLUSION: In male patients, self-visualization of cystoscopy did not impact pain perception, while in female patients, it seemed to provide a benefit. The number of previous cystoscopies had an influence, diminishing the perception of pain, regardless of whether the patient visualized the procedure or not.

Extended-Spectrum Beta-Lactamase-Producing Bacteria in a Urology Ward: Epidemiology, Risk Factors and Antimicrobial Susceptibility Patterns.

INTRODUCTION: Our aim was to describe the incidence and risk factors associated with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and their resistance rate in a urological ward. MATERIAL AND METHODS: We carried out a prospective observational study from November 2011 to December 2014, reviewing healthcare-associated infections (HAIs) in our department. We evaluated the infections caused by ESBL-producing Enterobacteriaceae. RESULTS: The incidence of HAIs in our urology ward was 6.8%. Enterobacteriaceae including Escherichia coli (24.9%), Klebsiella spp. (12.1%), Enterobacter spp. (5.9%), Morganella spp. (1.5%), Proteus spp. (1.5%), and Citrobacter spp. (1.5%) represented 47.4% of the isolated pathogens. The percentage of ESBL-producing Enterobacteriaceae was 26.4. Risk factors associated with a higher incidence of ESBL-producing bacteria were prior urinary tract infection (UTI; p < 0.001), hypertension (p = 0.042), immunosuppression (p = 0.004), and urinary stone (p = 0.027). The multivariable analysis confirmed prior UTI, immunosuppression and urinary stone as risk factors. ESBL-producing strains showed resistance rates of 85.3% for fluoroquinolones and 11.8% for carbapenems. Moreover, 16.7% of ESBL-Klebsiella were resistant to carbapenems. CONCLUSIONS: ESBL-producing enterobacteria are associated with higher cross resistance to antibiotics such as quinolones. Higher resistance rates are reported in ESBL-producing Klebsiella. Among patients admitted in a urology ward, risk factors for ESBL-producing strains were previous UTI, immunosuppression, and urinary stone.

Grade 3a Clavien grade complication following percutaneous nephrolithotomy. Related factors and review of the literature.

OBJECTIVE: We review the literature about bleeding complications of percutaneous nephrolithotomy (PCNL) and the application of the modified Clavien system classification. METHODS: We present a 38 year old man who underwent left PCNL with acute severe hematuria during the immediate postoperatory time. We review the literature and analyze the usefulness of the modified Clavien system to grade perioperative complications. RESULTS: Conservative management was insufficient so we had to perform arteriography and superselective embolization to solve the acute arterial bleeding. According to Clavien's classification, our case would be included within the grade 3a group complications. CONCLUSIONS: The complications following a PCNL are not uncommon. However most of them are not severe. The modified Clavien system, used for classifying complications after performing PCNL, can be useful for reporting results in an objective and replicable way.

Factores relacionados con una complicación grado IIIa de Clavien tras una nefrolitotomía percutánea. Revisión de la literatura / Grade 3a Clavien grade complication following percutaneous nephrolithotomy. Related factors and review of the literature

OBJETIVO: Revisamos la literatura a propósito de las complicaciones hemorragicas derivadas de una Nefrolitotomia Percutánea (NLP) y la aplicación del sistema modificado de Clavien para su clasificación. MÉTODOS: Presentamos el caso de un varón sometido a una NLP izquierda que presentó de forma aguda durante el postoperatorio inmediato una hematuria severa y anemizante secundaria a un sangrado arterial. Revisamos la literatura al respecto y analizamos la utilidad del sistema de clasificación de Clavien para las complicaciones quirúrgicas. RESULTADOS: Mediante arteriografía y embolización percutánea supraselectiva del vaso sangrante se consiguió el control definitivo del sangrado arterial. Representado así una complicación grado IIIa según el sistema de Clavien. CONCLUSIONES: Las complicaciones tras una NLP, en su mayoría leves, no son infrecuentes. El sistema modificado de Clavien adaptado para clasificar las complicaciones tras una NLP puede ser de utilidad para notificar resultados de forma objetiva y reproducible

OBJECTIVE: We review the literature about bleeding complications of percutaneous nephrolithotomy (PCNL) and the application of the modified Clavien system classification. METHODS: We present a 38 year old man who underwent left PCNL with acute severe hematuria during the immediate postoperatory time. We review the literature and analyze the usefulness of the modified Clavien system to grade perioperative complications. RESULTS: Conservative management was insufficient so we had to perform arteriography and superselective embolization to solve the acute arterial bleeding. According to Clavie's classification, our case would be included within the grade 3a group complications. CONCLUSIONS: The complications following a PCNL are not uncommon. However most of them are not severe. The modified Clavien system, used for classifying complications after performing PCNL, can be useful for reporting results in an objective and replicable way

Donation after cardiac death: results of the SUMMA 112 - Hospital 12 de Octubre Program.

BACKGROUND: In 2005, our center started a donation after cardiac death (DACD) program, by which patients who present an irreversible cardiac arrest outside hospital are brought to our center with the purpose of organ donation. We reviewed the outcomes of our program of kidney transplants from DACD. METHODS: We conducted a retrospective study of the DACD, and we reviewed the procedures carried out in our institution between July 2005 and December 2010 and descriptively analyzed the results obtained for kidney donation. RESULTS: One hundred and fifty-two of 274 potential donors were transferred to our hospital. Of them, 126 (82.8%) were connected to cardiopulmonary bypass machine, and organs were procured in 113 donors (74.3%). The discarded grafts were mainly due to inadequate perfusion. One hundred and fifty-six kidneys were transplanted (51.3%). Over a median follow-up period of 18 ± 13.7 months, the median creatinine clearance was 78.2 ± 10.2 ml/min. 8.6% of the grafts had no primary function, and 85% had a delayed graft function. Recipient survival and graft survival were 98% and 87%, respectively. CONCLUSIONS: DACD is an adequate source of organs for kidney transplantation. Our functional and survival results are encouraged in the short term, although further work is required to increase the program's benefits.

Complicaciones infecciosas tras biopsia prostática transrectal. Análisis de nuestra experiencia / Infectious complications after transrectal ultrasound-guided prostatic biopsy. Analysis of our experience

OBJETIVO: Establecer la tasa de complicaciones infecciosas derivadas de la realización de una biopsia prostática transrectal ecodirigida (BPTRE), identificar su perfil microbiológico y los factores de riesgo relacionados.MÉTODOS: Diseñamos un estudio prospectivo no aleatorizado donde se incluyeron 220 pacientes sometidos a BPTRE en nuestro centro entre Abril y Septiembre de 2008. Los criterios de inclusión fueron: tacto rectal sospechoso, PSA >10ng/ml y en aquellos con PSA 4-10 ng/ml se tiene valora el cociente PSA libre/total. Los criterios de exclusión empleados fueron: ser portador de catéter urinario, administración de tratamiento antibiótico la semana previa a la realización de la biopsia, manipulación de la vía urinaria en el mes previo a la biopsia, alergia a quinolonas y riesgo de endocarditis, incumplimiento de la pauta de profilaxis antibiótica y pérdida de seguimiento.Analizamos la relación entre ser diabético, inmunodeprimido, ITU o prostatitis previas y urocultivo prebiopsia positivo con la aparición de fiebre, disuria o bacteriuria tras la biopsia.RESULTADOS: La edad media fue de 69,5 años (+/-7,9), el PSA total medio 12,7ng/ml (+/-28,7), el volumen prostático medio 50,6cc (+/-29,6) y el número medio de cilindros obtenidos por biopsia 13,5 (+/-1,7).El 25% de los pacientes tenía disuria tras la biopsia, el 3,2% fiebre, el 4,5% bacteriuria. El E.coli fue el patógeno más frecuentemente hallado en los urocultivos pre y post biopsia.No encontramos relación estadísticamente significativa entre la aparición de disuria y la fiebre con la condición de diabético, inmunosupresión, ITU o prostatitis previas, volumen prostático y número de cilindros obtenidos en la biopsia.Únicamente la existencia de un urocultivo prebiopsia positivo y una biopsia con más de 14 cores, demostraron tener asociación estadísticamente significativa con la existencia de bacteriuria tras la biopsia, p=0,007 y p= 0,018 respectivamente. CONCLUSIONES: Nuestra tasa de complicaciones infecciosas fue similar a la descrita para otras series. La existencia de un urocultivo prebiopsia positivo y obtener más de 14 cilindros por biopsia demostró tener relación estadísticamente significativa con la existencia de bacteriuria tras la biopsia. El E.coli fue el patógeno más frecuentemente aislado (AU)

OBJECTIVES: To establish the rate of infectious complications derived from the use of transrectal ultrasound-guided prostate biopsy (TRUS), identify its mi-crobiological profile and related risk factors.METHODS: We designed a prospective non-randomi-zed study in which we enrolled 220 patients undergoing TRUS biopsy at our centre between April and September 2008. The inclusion criteria were: suspicious digital rectal exa-mination, PSA >10 ng/ml, and free/total ratio of PSA is assessed in patients with PSA 4-10 ng/ml. The exclu-sion criteria were: having an indwelling urinary catheter, the administration of antibiotic treatment in the week before the needle biopsy, manipulation of the urinary tract in the month prior to the needle biopsy, allergy to quinolones and risk of endocarditis, failure to comply with the anti-biotic prophylaxis regimen and loss to follow-up.We analyzed the relationship between diabetes, immunodepression, previous UTI or prostatitis and positi-ve pre-biopsy urine culture with the appearance of fever, dysuria or bacteriuria following needle biopsy.RESULTS: Mean age was 69.5 years (+/-7.9), mean total PSA 12.7ng/ml (+/-28.7), mean prostate volu-me 50.6 cc (+/-29.6) and mean number of cores ob-tained by needle biopsy 13.5 (+/-1.7). 25% of the patients had dysuria following needle biopsy, 3.2% fever and 4.5% bacteriuria. E.coli was the pathogen most frequently found in pre- and post-biopsy urine cultures.No statistically significant relationship was found bet-ween the appearance of dysuria and fever and being diabetic, having immunosuppression, previous UTI or prostatitis, prostate volume and number of cores obtai-ned in the biopsy.Only the existence of a positive pre-biopsy urine culture and biopsy with more than 14 cores proved to have a statistically significant association with the existence of bacteriuria following biopsy, p=0.007 and p= 0.018, respectively. CONCLUSIONS: Our rate of infectious complications was similar to that described in other series. The existence of a positive pre-biopsy urine cul-ture and obtaining more than 14 cores per biopsy was related, with statistical significance, to the existence of bacteriuria following the biopsy. E.coli was the most frequently isolated pathogen (AU)

Biopsias de saturación para la detección de cáncer de próstata: efectividad, seguridad y factores predictivos / Saturation biopsies for prostate cancer detection: effectiveness, safety and predictive factors

OBJETIVO: Determinar la rentabilidad y seguridad de las biopsias de saturación para la detección del cáncer de próstata (CaP), e identificar variables relacionadas con la presencia del tumor.MÉTODOS: Revisamos de forma transversal y retrospectiva 144 biopsias de saturación (enero/06-julio/09). Los criterios de inclusión fueron: al menos 2 sets de biopsias sin evidencia de malignidad y cifras de Antígeno Prostático Específico (PSA) > 10 ng/ml o cinética de PSA sugestiva de malignidad (velocidad > 0,75 ng/ml/año) y pacientes con atipias en biopsia/s previa/s. Las variables analizadas fueron: edad, tacto rectal sospechoso (TRS), PSA total, cociente PSA libre/total, volumen prostático, densidad de PSA, anatomía patológica previa, número de cilindros obtenidos y complicaciones. Se analiza estadísticamente mediante test de CHI-2, t de Student y regresión logística(AU)

RESULTADOS: La edad media fue de 66 años (DS±6,4), el PSA total medio 14,4 ng/ml (DS±12,6), el cociente medio PSA libre/total 0,09 (DS±0,09), el volumen prostático medio 61,6 cc (DS±27,4), la densidad media de PSA 0,27 (DS±0,26) y el número medio de cilindros obtenidos de 30,45 (DS±3,8).Diagnosticamos un 32% de adenocarcinoma prostático. La densidad de PSA fue mayor en el grupo con CaP, 0,39 (DS±0,36) frente a 0,21 (DS±0,18) en los pacientes sin cáncer (p=0,003). En el 58% de los pacientes con TRS se observó adenocarcinoma en la biopsia, frente a un 28% con TR normal (p=0,009). El volumen prostático medio del grupo con CaP fue de 52,5 (DS±24,7) frente a 66 (DS±27,7) del grupo sin cáncer (p=0,006).En el análisis multivariante, la densidad de PSA (p=0,02; IC 95% 1,36 - 37,36) es la única variable que predice de forma independiente la existencia de adenocarcinoma.Para el resto de variables analizadas, tanto en el análisis univariante como en el multivariante, no se hallaron diferencias estadísticamente significativas.La incidencia de complicaciones derivadas del procedimiento fue similar a la descrita en la literatura para otras series.CONCLUSIONES: La biopsia de saturación es efectiva y segura para determinar la presencia de cáncer de próstata. La densidad de PSA es el único factor que se han mostrado como variable predictiva independiente para el diagnóstico de tumor(AU)

OBJECTIVES: To determine the effectiveness and safety of saturation biopsies for prostate cancer detection of and to identify predictive variables for cancer.METHODS: We conducted a retrospective transversal study in which we analyzed 144 saturation biopsies (January ‘06 - July ‘09). Inclusion criteria: at least two sets of biopsies without evidence of malignancy and Prostate Specific Antigen (PSA) levels >10ng/ml or PSA kinetics suggestive of malignancy (rate >0.75ng/ml/year) and patients with atypia in a previous biopsy.The variables analyzed were: age, abnormal digital rectal examination (DRE), total PSA, free/total PSA ratio, prostate volume, PSA density, previous histopathology, number of cylinders obtained and complications. Statistical analysis was performed using the Chi-square test, Student’s t-test and logistic regression.RESULTS: Mean age was 66 years (SD ± 6.4), mean total PSA 14.4 ng/ml (SD ± 12.6), mean free/total PSA ratio 0.09 (SD ± 0.09), mean prostate volume 61.6 cc (SD ± 27.4), mean PSA density 0.27 (SD ± 0.26) and mean number of cylinders obtained 30.45 (SD ± 3.8).We diagnosed 32% of the patients with prostatic adenocarcinoma. We observed PSA density was higher in the prostate cancer group, 0.39 (SD ± 0.36), compared to 0.21 (SD ± 0.18) in patients without cancer (p=0.003). Adenocarcinoma was found in 58% of the biopsies in patients with suspicious DRE, compared to 28% with normal DRE (p=0.009). Mean prostate volume in the prostate cancer group was 52.5 (SD ± 24.7) compared to 66.0 (SD ± 27.7) in the group without cancer (p=0.006).In the multivariate analysis, the PSA density (p=0.02; 95% CI 1.36 - 37.36) was the only variable that independently predicted the presence of adenocarcinoma. No statistically significant differences were found in either univariate or multivariate analysis for the remaining variables analyzed. The incidence of complications was similar to that described in the literature for other series(AU)

CONCLUSIONS: Saturation biopsy is safe and effective for detection of prostate cancer. PSA density was the only factor that was shown to be independent predictive variable for tumor diagnosis(AU)