[The natural history of sperm cleareance after vasectomy]. / La historia natural del aclaramiento de espermatozoides en el semen tras la vasectomía.

OBJECTIVE: To study the time required to obtain a negative sperm analysis after vasectomy. MATERIAL AND METHODS: We reviewed 239 consecutive vasectomies performed between september 1998 and september 1999. All of them were done in an ambulatory basis. Follow up interval was 41-853 days (mean 144, median 104). The first semen analysis was requested between 1 and 6 months after the surgical procedure. If the sample still showed spermatozoa, then a new one was requested every two months. Probability of becoming azoospermic was studied with Kaplan-Meier curves. RESULTS: Persistent spermatozoa could be found in 31 patients (13%) at the end of follow-up. Despite having a positive semen analysis, 10 patients (4.2%) discontinued medical visits. Time required to obtain a negative sperm count ranged from 58 to 362 days (mean 133, median 99). The probability of being azoospermic 200 and 260 days after vasectomy was 80-90% respectively. A total of 328 semen analysis were requested (range 1-4, mean 1.37, median 1) CONCLUSIONS: A minimum of 200 days (6.6 months) are needed to clear all the spermatozoa in semen after vasectomy in 80% of our patients. Requesting the first semen sample 7 months after vasectomy is cost-effective, reducing unnecesary medical visits and increasing the rentability of this test.

La historia natural del aclaramiento de espermatozoides en el semen tras la vasectomía / The natural history of sperm cleareance after vasectomy

OBJETIVO: Estudiar el tiempo necesario para obtener un seminograma negativo tras la vasectomía. MATERIAL Y MÉTODO: Revisamos 239 vasectomías consecutivas durante un año. Todas ellas fueron realizadas de forma ambulatoria. El tiempo de seguimiento fue de 41-853 días (media 144, mediana 104).El primer seminograma fue solicitado entre 1 y 6 meses tras la intervención. A los pacientes que presentaron espermatozoides en la primera muestra de semen, se les solicitó una nueva muestra cada dos meses hasta que el seminograma fuese negativo. La probabilidad de azoospermia fue estudiada mediante curvas de Kaplan-Meier. RESULTADOS: Al final del periodo de seguimiento, 31 pacientes (13%) seguían teniendo espermatozoides en el seminograma. A pesar de ello, 10 pacientes (4,2%) dejaron de acudir a la consulta. El tiempo requerido para obtener un seminograma negativo osciló entre 58 y 362 días (media 133, mediana 99). La probabilidad de quedar azoospérmico a los 200 y 260 días tras la vasectomía, fue del 80 y 90% respectivamente. Se realizaron un total de 328 seminogramas (rango 1-4, media 1,37, mediana 1).CONCLUSIONES: Se necesita un mínimo de 200 días (6,6 meses) para que el 80% de nuestros pacientes queden azoospérmicos. Solicitar el primer seminograma 7 meses tras la vasectomía es rentable, reduciendo el número de visitas médicas innecesarias e incrementando la rentabilidad de esta prueba (AU)

OBJECTIVE: To study the time required to obtain a negative sperm analysis after vasectomy. MATERIAL AND METHODS: We reviewed 239 consecutive vasectomies performed between September 1998 and September 1999. All of them were done in an ambulatory basis. Follow up interval was 41-853days (mean 144, median 104). The first semen analysis was requested between 1 and 6 months after the surgical procedure. If the sample still showed spermatozoa, then a new one was requested every two months. Probability of becoming azoospermic was studied with Kaplan-Meier curves. RESULTS: Persistent spermatozoa could be found in 31 patients (13%) at the end of follow-up. Despite having a positive semen analysis, 10 patients (4.2%) discontinued medical visits. Time required to obtain a negative sperm count ranged from 58 to 362 days (mean 133, median 99). The probability of being azoospermic 200 and 260 days after vasectomy was 80-90% respectively. A total of 328 semen analysis were requested (range 1-4, mean 1.37, median 1). CONCLUSIONS: A minimum of 200 days (6.6 months) are needed to clear all the spermatozoa in semen after vasectomy in 80% of our patients. Requesting the first semen sample 7 months after vasectomy is cost-effective, reducing unnecesary medical visits and increasing the rentability of this test (AU)

[Detection of prostatic cancer in the PSA range between 3 and 3.9 ng/ml]. / Deteccion del cáncer de próstata en el rango de PSA entre 3 y 3,9 ng/ml.

OBJECTIVE: In our study, we analyze the benefit of lowering the PSA cutoff point for which a prostate biopsy is indicated from 4 to 3 ng/ml. MATERIALS AND METHODS: We have considered 4.278 individuals coming from a prostate cancer screening program. We studied 1.217 interventions in which PSA was determined, indicating the prostate biopsy with PSA > or = 3 ng/ml. Digital rectal examination was never the indication for the biopsy. All biopsies were sextant and assisted by transrectal ultrasound. We compared the performance of the biopsy using 4 and 3 ng/ml as cut points. RESULTS: Of the 1.217 interventions performed, 947 had PSA values lower than 3 ng/ml, 80 between 3 and 3.9 ng/ml and 190 over 4 ng/ml. A total of 189 patients (70% of these two last groups) underwent a prostate biopsy. With 4 ng/ml as the cut point, 134 biopsies were indicated, detecting 28 cancers (positive predictive value 20.9%). However 189 biopsies were indicated and 34 cancers detected by lowering the cut point to 3 ng/ml (positive predictive value 17.9%). The reduction in the biopsy performance was not statistically significant (OR = 0.89). None of the 6 additional cancers detected was palpable or ecographically visible (T1c), all of them had a Gleason score under 7 and half of them could be considered clinically relevant. CONCLUSIONS: Lowering PSA cutoff point from 4 to 3 ng/ml improved the detection rate in 21.4% not jeopardizing the biopsy performance. Therefore we think that the group of patients with PSA between 3 and 3.9 ng/ml as candidates for prostate biopsy, should be included in screening programs.

Deteccion del cáncer de próstata en el rango de PSA entre 3 y 3,9 ng/ml / Prostate cancer detection in the PSA range of 3 to 3,9 ng/ml

OBJETIVO: En este estudio se analiza el beneficio de reducir el valor de PSA para el cual se indica una biopsia prostática de 4 a 3 ng/ml. MATERIAL Y MÉTODOS: Partimos de 4.278 pacientes procedentes de un programa de screening de cáncer de próstata. Consideramos 1.217 actuaciones en las que se realizó determinación sérica de PSA, indicando la biopsia prostática cuando el PSA era 3 ng/ml. En ningún caso el TR (TR) fue la indicación para realizar la misma. Todas las biopsias fueron sextantes y ecodirigidas por vía transrectal. Comparamos el rendimiento de la biopsia al emplear como puntos de corte 4 y 3 ng/ml. RESULTADOS: De las 1.217 actuaciones realizadas, 947 presentaron valores de PSA inferiores a 3 ng/ml, 80 entre 3 y 3,9 ng/ml y 190 por encima de 4 ng/ml. De los 270 pacientes que componen estos dos últimos grupos, 189 (70 per cent) se sometieron a una biopsia prostática. Con el nivel de corte establecido de forma habitual (4 ng/ml) se indicaron 134 biopsias y se detectaron 28 cánceres (valor predictivo positivo 20,9 per cent). Sin embargo al reducir el punto de corte a 3 ng/ml el número de biopsias indicadas ascendió a 189, detectando 34 cánceres (valor predictivo positivo 17,9 per cent). El descenso en el rendimento de la biopsia no fue significativo (OR=0,89). De los 6 tumores detectados al reducir el punto de corte, ninguno era palpable o visible (T1c), todos presentaron un score de Gleason menor de 7 y la mitad cumplían criterios de tumor clínicamente relevante. CONCLUSIONES: La reducción del valor de PSA a 3 ng/ml como punto de corte para indicar una biopsia prostática ha supuesto un incremento en la tasa de detección del cáncer de próstata de un 21,4 per cent, sin reducir significativamente el rendimiento de la biopsia. Por tanto, creemos que la inclusión del grupo de pacientes con PSA entre 3 y 3,9 ng/ml como candidatos a biopsiar es importante en un programa de screening precoz de cáncer de próstata (AU)

[Preliminary results of the treatment of high grade (T1G3) superficial tumors of the bladder with transurethral resection]. / Resultados preliminares del tratamiento de los tumores vesicales superficiales de alto grado (T1G3) mediante resección transuretral.

OBJECTIVE: To examine the results of monotherapy with TUR in the treatment of primary T1G3 transitional cell carcinoma (TCC). METHODOLOGY: Thirty-two patients with primary TCC of the bladder were allocated into a surveillance program. Risk factors for progression to muscle-invasive disease were determined. Immediately, projections of disease-free and progression-free survival were calculated. RESULTS: Five patients (15.6%) were lost in follow-up. Twenty-three (85%) had superficial recurrences. Four patients (14.8%) progressed to muscle-invasive or metastatic disease. No independent risk-factors for progression were disclosed. Median disease-free survival was 8 months. Projection of the risk of recurrence at 79 months was 84.9%. Median time to progression has not been reached yet. Projection of progression at 79 months was 46.3%. CONCLUSIONS: The above mentioned treatment schedule is associated with very high recurrence rates. In addition, recurrences are very frequent. Nevertheless, in the medium run, projections of progression suggest that surveillance can be an alternative to other treatments in the management of T1G3 TCC of the bladder.

Resultados preliminares del tratamiento de los tumores vesicales superficiales de alto grado (T1G3) mediante resección transuretral / Monotherapy with transurethral resection in evaluating and in managing patients with bladder tumors

OBJETIVO: Analizar los resultados del tratamiento de los tumores vesicales superficiales (TVS) primarios en estadio T1G3 mediante RTU como monoterapia. METODOLOGÍA: Treinta y dos pacientes con TVS primarios estadio T1G3 fueron incluidos en un programa de vigilancia. Para este estudio se analizaron los factores clínicos para la progresión. Acto seguido, se establecieron las proyecciones de la supervivencia libre de enfermedad y libre de progresión. RESULTADOS: Cinco individuos (15,6 por ciento) resultaron perdidos en su seguimiento. Veintitrés (85 por ciento) sufrieron recidivas de carácter superficial. En cuatro pacientes (14,8 por ciento) la enfermedad progresó a infiltración mus-cular o se diseminó. No fue posible identificar factores de riesgo independientes para la progresión. La mediana de tiempo a la recidiva fue de 8 meses. La proyección del riesgo de recidivar a los 79 meses fue del 84,9 por ciento. La mediana de tiempo a la progresión todavía no se ha alcanzado. La proyección del riesgo de progresar a los 79 meses de seguimiento se situó en el 46,3 por ciento. CONCLUSIONES: Bajo el esquema de tratamiento descrito, la mayoría de los tumores recidivan, y lo hacen con gran frecuencia. Sin embargo, las proyecciones de progresión a medio plazo permiten considerar la vigilancia como una alternativa a otros tratamientos (AU)

[Characteristics of prostatic cancer undetected in the first assessment of a screening program. Quality control]. / Características de los cánceres de próstata no detectados en la primera evaluación de un programa de screening. Un control de calidad.

OBJECTIVE: To study the results of the second round in the subjects with negative tests in the first round of a prostate cancer screening program and to analyze the characteristics of the tumors that were not detected in the first round. METHODS: Of 5188 males evaluated in a prostate cancer screening program, 976 with negative tests in the first round (804 with PSA < or = 4 ng/ml; 172 with PSA > 4 ng/ml and a negative biopsy) accepted to undergo subsequent tests. During the second round, 163 biopsies were indicated. The biopsy results and the characteristics of the tumors detected were analyzed. RESULTS: The biopsy yield was higher (but not significantly) in the first round (80 cancers/481 biopsies; 16.6%) than in the second round (13 cancers/115 biopsies; 11.3%). Of the 163 biopsies indicated in the second round, 115 were performed and 13 cancers were detected (10 of these patients had a high PSA in the first round). The univariate analysis showed no differences for age, PSA, PSA density, prostate volume, transrectal US findings, or Gleason score in the cases diagnosed in the first round and those detected in the second round. However, there was a higher proportion of tumors with abnormal DRE in the cancers detected in the first round than in the second round, (31.3% vs 7.7%, respectively; p = 0.02). There was a higher proportion of tumors clinically detected in the second round than in the first round (100% vs 75%, respectively; p = 0.043). The multivariate analysis only showed differences for the DRE findings (p = 0.045). CONCLUSION: A significant number of tumors are undetected in prostate cancer screening programs. Although the biopsy yield may be slightly lower in subsequent rounds, there is a strong trend of detecting more localized tumors (and therefore potentially curable). We have found no correlation between a greater prostate volume and tumors that were undetected in the first round.