Comparison between different bone treatments on areal bone mineral density (aBMD) and bone microarchitectural texture as assessed by the trabecular bone score (TBS).

PURPOSE: The objective of the study was to assess longitudinal effects of different osteoporosis treatments on TBS and aBMD at lumbar spine. METHOD: We analyzed 390 patients (men: 72; women: 318; age>40 years; mean follow-up of 20 months and BMI<37 kg/m(2)). We stratified the cohort by treatments: Naive of treatment (Naive, n=67), Calcium and Vitamin D (CaVitD, n=87), Testosterone (Te, n=36), Alendronate (AL, n=88), Risedronate (Ri, n=39), Denosumab (Dmb, n=43) and Teriparatide (PTH, n=30). The follow-up changes from baseline were normalized at 24 months. RESULTS: After 24 months, Naive group TBS decreased by 3.1% (p<0.05) whereas a non-significant increase was observed for spine aBMD (Δ=+0.5%). Compared to the Naive group, significant improvement (p<0.05) was observed in both TBS and aBMD for Te, AL, Ri, Dmb and PTH groups and in the CaVitD group for TBS. At the end of the follow-up, significant improvement have been observed for aBMD in Te (+4.4%), AL (+4.1%), Ri (+4.8), D (+8.8%) and PTH (+8.8%) groups. Significant improvement was observed only in the AL (+1.4%), Dmb (+2.8%) and PTH (+3.6%) groups for TBS. CONCLUSION: As expected, TBS of Naive subjects decreased with age. As expected a TBS preservation has been observed under AL and Ri. Te and CaVitD effects on TBS were evaluated for the first time: a similar preservation effect has been observed. A significant TBS increase was observed under Denosumab and PTH. TBS could be a useful tool to monitor treatment effects.

Effects of testosterone treatment on bone mineral density in men with testosterone deficiency syndrome.

The decline in testosterone levels found in men with testosterone deficiency syndrome (TDS) is associated with a decrease in bone mineral density (BMD). To study the safety profile and efficacy of testosterone treatment on BMD in patients with TDS. In this 2-year prospective open-label study, patients were administered 50 mg of testosterone gel daily (adjustable after 3 months up to 75-100 mg or down to 25 mg) for 12 months, followed by treatment with 1000 mg of testosterone undecanoate every 2-3 months from months 12-24. Outcome measures were as follows: (i) Changes in clinical chemistry safety parameters and total testosterone, sex hormone binding globulin and calculated free testosterone (cFT) levels; (ii) Changes in Aging Males' Symptoms Scale (AMS) and International Prostate Symptom Score scores; and (iii) Changes in lumbar spine and hip BMD. A total of 50 men aged 50-65 years with TDS (AMS >26 and cFT <0.250 nmol/mL) took part in the study. There was no significant impact of testosterone on safety. Prostate-specific antigen and haematopoietic parameters increased significantly, although the changes were not clinically significant. Total and cFT increased significantly after 3 months (p < 0.001) and there were significant improvements after 3 months in AMS scores (p < 0.001). BMD improved significantly in L2-L4 (2.90 and 4.5%), total femur (0.74 and 3%) and trochanter (1.09 and 3.2%) at 12 and 24 months respectively. Testosterone treatment in men with TDS has a good safety profile, leads to significant improvement in lumbar spine and hip BMD, and improves symptoms, as assessed by the AMS questionnaire.

Déficit de testosterona como factor de riesgo de fractura de cadera en hombres de edad avanzada / Testosterone-Deficiency as a Risk Factor for Hip Fracture in Eldery Men

Objetivos: La pérdida progresiva de la densidad mineral ósea debilita los huesos y aumenta la probabilidad de fracturas osteoporóticas. Es conocida la acción de los andrógenos en el mantenimiento de la densidad mineral ósea. Este hecho nos hace pensar que podría existir una relación entre los niveles de esteroides sexuales y la fracturas osteoporóticas de cadera. Material y métodos: Se realiza un estudio caso-control, donde los casos correspondieron a 54 varones con fractura de cadera, cuyos datos fueron apareados por edad con 54 controles varones. A todos los pacientes se les determinó niveles de testosterona total, globulina transportadora de hormonas sexuales, albúmina y estradiol para el cálculo de la testosterona libre y la testosterona biodisponible. Resultados: Los pacientes con fractura de cadera presentaron unos niveles de testosterona inferiores a los controles (8,74 n/mol/l frente a 11,16 nmol/l; p=0,116) al igual que de testosterona libre (155,1pmol/l frente a 204,4pmol/l; p=0,02). Los niveles de testosterona biodisponible fueron inferiores en pacientes con fractura de cadera (2,69nmol/l frente a 3,89nmol/l; p=0,002), siendo esta última el mejor predictor para fractura (OR: 1,58). Conclusiones: Los pacientes con fractura de cadera presentan unos niveles significativamente inferiores de testosterona libre calculada y biodisponible en nuestra población a estudio. Estos hallazgos sugieren que los niveles de testosterona libre y biodisponible son predictores independientes de fractura de cadera osteoporótica en pacientes de edad avanzada (AU)

Objetives: Progressive loss of bone mineral density weakens the bones and increases the probability of osteoporotic fractures. It is well known that sex steroids play a role in the maintenance of bone density. This fact makes us think there might be a correlation between sex steroid levels and osteoporotic hip fractures. Material and methods: A case-control study was performed. The cases were 54 men who suffered from hip fracture. They were compared with 54 age-matched male control subjects. Levels of total testosterone, sex hormone binding globuline, albumin and oestradiol were measured in all subjects in order to calculate free testosterone and bio-testosterone levels. Results: Men who suffered from hip fracture had lower serum total testosterone (8.74 nmol/L versus 11.16 nmol/L; p=0.116) and lower free testostenone (155.1pmol/L versus 204.4pmol/L; p=0.02) than control subjects. Bio-testosterone levels were lower in patients with hip fracture (2.69 nmol/L versus 3.89 nmol/L; p=0.002), being the latter the best fracture predictor (OR: 1.58). Conclusions: In our study population, men with hip fractures had significantly lower levels of calculated free testosterone and bio-testosterone. These findings suggest that free testosterone and bio-testosterone levels are independent predictors for osteoporotic hip fracture in eldery men (AU)

[Testosterone-deficiency as a risk factor for hip fracture in eldery men]. / Déficit de testosterona como factor de riesgo de fractura de cadera en hombres de edad avanzada.

OBJECTIVES: Progressive loss of bone mineral density weakens the bones and increases the probability of osteoporotic fractures. It is well known that sex steroids play a role in the maintenance of bone density. This fact makes us think there might be a correlation between sex steroid levels and osteoporotic hip fractures. MATERIAL AND METHODS: A case-control study was performed. The cases were 54 men who suffered from hip fracture. They were compared with 54 age-matched male control subjects. Levels of total testosterone, sex hormone binding globuline, albumin and oestradiol were measured in all subjects in order to calculate free testosterone and bio-testosterone levels. RESULTS: Men who suffered from hip fracture had lower serum total testosterone (8.74 nmol/L versus 11.16 nmol/L; p=0.116) and lower free testostenone (155.1pmol/L versus 204.4pmol/L; p=0.02) than control subjects. Bio-testosterone levels were lower in patients with hip fracture (2.69 nmol/L versus 3.89 nmol/L; p=0.002), being the latter the best fracture predictor (OR: 1.58). CONCLUSIONS: In our study population, men with hip fractures had significantly lower levels of calculated free testosterone and bio-testosterone. These findings suggest that free testosterone and bio-testosterone levels are independent predictors for osteoporotic hip fracture in eldery men.

[Our experience in high-flow priapism due to uni-or bilateral arterio-lacunar fistula]. / Nuestra experiencia en el priapismo de alto flujo por fístula arterio-lacunar uni y bilateral.

OBJECTIVE: To present our experience in both uni-and bilateral priapism, highlighting good results obtained with supraselective embolisation. MATERIAL AND METHODS: We present 5 cases of high-flow priapism secondary to perineal trauma, with a mean age of 31 years (24-43 years). The mean time to presentation from the moment of the trauma was 18, 6 days (1-60 days). Diagnosis was confirmed through gasometry of the corpora cavernosa, penile Doppler ultrasound (2 cases) and selective arteriography of the pudendal artery. In all cases treatment was by supralective embolisation with gelatin sponge. In the two bilateral cases, embolisation was performed in the same act. RESULTS: In the short-term was a recovery of flaccidity and in the long-term (3-4 months) a recovery of erection with no fibrotic sequelae of the corpora cavernosa. CONCLUSIONS: Embolisation of the lacerated artery, in a single procedure in cases of bilateral lacerations, provides excellent results.

Nuestra experiencia en el priapismo de alto flujo por fístula arterio-lacunar uni y bilateral / Our experience in high-flow priapism due to uni-or bilateral arterio-lacunar fistula

Objetivo: Presentar nuestra experiencia en el priapismo de alto flujo tanto uni como bilateral, resaltando los buenos resultados obtenidos con la embolización supraselectiva. Material y método: Presentamos 5 casos de priapismo de alto flujo secundarios a traumatismo perineal, con una edad media de 31 años (24-43 a). El tiempo medio de consulta desde el momento del traumatismo fue de 18,6días (1-60 d). El diagnóstico se confirmo mediante gasometría de los cuerpos cavernosos, eco-doppler peneano (2 casos) y arteriografía selectiva de la pudenda. En todos los casos el tratamiento fue la embolización supraselectiva con esponja de gelatina. En los dos casos bilaterales la embolización se realizo en el mismo acto. Resultados: A corto plazo fueron la recuperación de la flacidez y a largo plazo (3-4 meses) la recuperación de la erección sin secuelas fibróticas de los cuerpos cavernosos en todos los casos. Conclusiones: La embolización de la arteria lacerada, y en caso de que sea bilateral en un solo tiempo, reporta excelentes resultados

Objective: To present our experience in both uni-and bilateral priapism, highlighting good results obtained with supraselective embolisation. Material and methods: We present 5 cases of high-flow priapism secondary to perineal trauma, with a mean age of 31 years (24-43 years). The mean time to presentation from the moment of the trauma was 18,6 days (1-60 days). Diagnosis was confirmed through gasometry of the corpora cavernosa, penile doppler ultrasound (2 cases) and selective arteriography of the pudendal artery. In all cases treatment was by supralective embolisation with gelatin sponge. In the two bilateral cases, embolisation was performed in the same act. Results: In the short term was a recovery of flaccidity and in the long term (3-4 months) a recovery of erection with no fibrotic sequelae of the corpora cavernosa. Conclusions: Embolisation of the lacerated artery, in a single procedure in cases of bilateral lacerations, provides excellent results

[Intracavernosal methoxamine self-injection for the treatment of low-flow recurrent priapism]. / Tratamiento del priapismo recurrente de bajo flujo mediante autoinyección intracavernosa domiciliaria de metoxamina.

We report the case of a young man with a recurrent idiopathic priapism, successfully treated with methoxamine intracarvenosal self-injections. The patient was instructed in intracorporeal self-injection of this pure alpha-1 adrenergic agonist, which provided complete detumescence. The patient became asymptomatic after one month of domiciliary treatment. We conclude that intracavernosal self-administered methoxamine can be a useful treatment of recurrent idiopathic priapism.

Tratamiento del priapismo recurrente de bajo flujo mediante autoinyección intracavernosa domiciliaria de metoxamina / Intracavernosal methoxamine self-injection for the treatment of low-flow recurrent priapism

Presentamos un caso de priapismo recurrente de bajo flujo de etiología desconocida; comprobado durante su ingreso hospitalario la eficacia y buena tolerancia a la administración intracavernosa de metoxamina, se aleccionó al paciente en la autoinyección domiciliaria, realizando ésta durante aproximadamente un mes, con desaparición del priapismo recurrente. El paciente conservó su función eréctil

We report the case of a young man with a recurrent idiopathic priapism, successfully treated with methoxamine intracarvenosal self-injections. The patient was instructed in intracorporeal self-injection of this pure alpha-1 adrenergic agonist, which provided complete detumescence. The patient became asymptomatic after one month of domiciliary treatment. We conclude that intracavernosal self-administered methoxamine can be a useful treatment of recurrent idiopathic priapism

[Incomplete urethral duplication]. / Duplicidad uretral incompleta.

Urethral duplicity is a rare congenital malformation. We report a case of one 25 years old male suffering recurrent urinary infections. The diagnostic of uncompleted urethral duplicity was performed by retrograde urethrography and micturating cystourethrogram. The accessory channel was excised by a perineal approach. Clinical results were satisfactory, remaining an asintomatic patient two years after surgery, with normal mictional behavior.

Duplicidad uretral incompleta / Incomplete urethral duplication

La duplicidad uretral masculina es una malformación congénita poco frecuente. Presentamos el caso de un varón de 25 años con infecciones urinarias de repetición que fue diagnosticado mediante uretrografía retrógrada y cistouretrografía miccional de duplicidad uretral incompleta. El tratamiento consistió en la resección quirúrgica por vía perineal de la uretra duplicada incompleta. El resultado clínico fue excelente, quedando el paciente asintomático con funcionalidad uretral dentro de la normalidad (AU)

Urethral duplicity is a rare congenital malformation. We report a case of one 25 years old male suffering recurrent urinary infections. The diagnostic of uncompleted urethral duplicity was performed by retrograde urethrography and micturating cystourethrogram. The accessory channel was excised by a perineal approach. Clinical results were satisfactory, remaining an asintomatic patient two years after surgery, with normal mictional behavior (AU)

Tratamiento con la técnica de Nesbit en pacientes con la enfermedad de Peyronie / Nesbit's technique treatment in patients with Peyronie disease

OBJETIVO: Evaluar los resultados obtenidos mediante la técnica de Nesbit en los pacientes con enfermedad de Peyronie. MATERIAL Y MÉTODOS: Entre enero de 1990 y julio del 2002, hemos aplicado la técnica de Nesbit para la corrección de la incurvación peneana en la enfermedad de Peyronie en 45 pacientes. La edad media era de 57,6 años (Rango 41-73 años ), siendo la incurvación dorso-lateral (42,28 por ciento) la más frecuente. RESULTADOS: Se consiguió la corrección total de la incurvación en 40 pacientes (88,88 por ciento) y un grado de satisfacción elevado por la cirugía en 39 pacientes (86,66 por ciento). CONCLUSIONES: La técnica de Nesbit es una intervención quirúrgica sencilla y efectiva para la corrección de la enfermedad de Peyronie (AU)

[Treatment with the Newbit technique in patients with Peyronie's disease]. / Tratamiento con la técnica de Nesbit en pacientes con la enfermedad de Peyronie.

OBJECTIVE: Evaluate the results of Nesbit's technique in patients with Peyronie's disease. METHODS AND MATERIALS: Between 1990 and 2002, 45 patients were treated using the Nesbit's procedure to correct Peyronie's disease curvature. Mean age was 57.6 (range 41-73). Dorso lateral incurvation was the most common. RESULTS: Total correction of the curvature in 40 patients (88%). High grade of satisfaction in 39 patients (86.66%). CONCLUSION: Nesbit's operation is an easy and effective surgical technique in the peyronie's disease for curvature correction.

Patologia vásculo-renal / Renovascular diseases

Como órgano apo-exocrino, el riñón cumple con dos importantes funciones: el control de la homeostasis y de la presión arterial. Cualquier patología que altere el flujo sanguíneo del riñón tendrá dos efectos inmediatos: la hipertensión arterial (HA) y la insuficiencia renal (IR). Su corrección debe buscar prioritariamente la mejoría de la función renal ya que la respuesta de la HA vendrá por añadidura. El Objetivo de este trabajo es el de actualizar la sofisticada metodología diagnóstica (Angiografía, EcoDoppler, Angio-Tac, Angio-Resonancia y Angioscopia; el uso de contrastes de potenciación), de funcionalidad (Radionefrograma o RMN con Captopril) y terapéutica (Angioplastia transluminal percutánea, Stents simples o cubiertos, Embolizaciones, uso de Balones oclusivos, Fibrinolisis y Tromboaspiración, Cirugía arterial directa y Autotrasplantación renal), en y de las distintas patologías vasculares renales (Lesiones traumáticas vasculares, Estenosis, Aneurismas, Fístulas arteriovenosas, Oclusiones agudas o Trombosis arterial y venosa, Síndrome de Cascanueces). Se apunta y se discute la posibilidad de existir un Síndrome de Fraley venoso inverso a raíz de un caso clínico. Conclusiones. Se establece una controversia de las tecnologías punta más actuales estableciéndose unas líneas guía de actuación para cada situación patológica. (AU)

[Our experience with the implant of single component integrated prostheses (Hydroflex-Dynaflex)]. / Nuestra experiencia en el implante de prótesis integradas de un solo componente (Hydroflex--Dynaflex).

INTRODUCTION AND OBJECTIVES: To present our experience with Hydroflex and Dynaflex self-contained inflatable penile prosthesis. MATERIAL AND METHODS: Between october 1988 and december 2000 a total of 63 men underwent implantation of 8 Hydroflex and 55 Dynaflex penile prosthesis. The follow-up period ranged from 12 and 127 months (mean 54.5). RESULTS: A total of 124 cylinders were implanted (in 2 cases only 1 cylinder was implanted). During implantation 3 corpora cavernosun ruptures were present, but implantation was possible in 2. Specific complication rates after implantation were as follow: early infection, 3 patients (4.7%); late infection, 1 patient (1.6%); pain that needed readmission 2 cases (3.2%); mechanical device failure, 7 cylinders in 6 men (mean time 83.5 months). 7 men (11.1%) needed prolonged teaching time to operate the prosthesis. Only 6 men (9.5%) wer dissatisfied with the prosthesis. It was possible to change only 1 cylinder when needed. CONCLUSIONS: Self-contained inflatable prosthesis brings good results on long time use. The mechanical malfunction rate is low and it is possible to change only one cylinder if needed. An important number of patients need intensive and prolonged teaching time to obtain a successful result.

Nuestra experiencia en el implante de prótesis integradas de un solo componente / Our experience with Hydroflex and Dinaflex self-contained prosthesis

INTRODUCCIÓN Y OBJETIVOS: Presentamos nuestra experiencia en el implante de prótesis de pene hinchables, Hydroflex y Dynaflex. MATERIAL Y MÉTODOS: Entre octubre de 1988 y diciembre del 2000, implantamos en 63 pacientes, 8 prótesis de pene Hydroflex y 55 Dynaflex. El período de seguimiento estuvo entre los 12 y 127 meses (media 54,5).RESULTADOS: Implantamos un total de 124 cilindros (en 2 casos se implantó 1 solo cilindro). Durante la implantación tuvimos 3 rupturas de cuerpos cavernosos, siendo posible el implante en 2 casos. Las complicaciones aparecidas en el seguimiento fueron: 3 casos de infección precoz (4,7 per cent); 1 caso de infección tardía (1,6 per cent); dolor persistente que requirió reingreso en 2 casos (3,2 per cent); fallos mecánicos en 7 cilindros de 6 pacientes (tiempo medio de aparición 83,5 meses), 7 pacientes (11,1 per cent) necesitaron un entrenamiento prolongado después de la operación de la prótesis, sólo 6 pacientes (9,5 per cent) se declararon insatisfechos de la prótesis. Es posible el cambio de 1 solo cilindro si se necesita. CONCLUSIONES: Las prótesis integradas de un solo componente presentaron buenos resultados a largo plazo. La aparición del fallo mecánico fue tardía, y además es posible cambiar un solo cilindro. Un importante número de pacientes necesitó una enseñanza intensiva y prolongada en el tiempo para obtener resultados satisfactorios (AU)

[Treatment of urethral stenosis with thermo-expandable prosthesis "Memotherm". Our experience]. / Tratamiento de la estenosis uretral mediante prótesis termoexpandible "Memotherm". Nuestra experiencia.

OBJECTIVE: To report our experience in the treatment of recurrent urethral stricture in the male with the Memotherm heat-expansible stent. METHODS: From December 1995 to March 1999, the Memotherm heat-expansible stent was utilized in 4 patients with urethral stricture that had undergone urethrotomy procedures, periodic urethral dilatation and in those cases with post-traumatic stricture, open surgery for urethroplasty and urethral reattachment. All patients had multiple recurrences of the urethral stricture that was not amenable to the treatments utilized, therefore the intraurethral stent was inserted. RESULTS: All patients had a good postoperative course with unhampered voiding and ample stream. The patients were followed in the outpatient setting by a 6-monthly assessment of micturition and a yearly endoscopic control evaluation to detect hypertrophic growth of the urethral mucosa and/or intraluminal calcification. All the stents were completely enveloped in the urethral wall 12 months after insertion. The only side effects observed was limited postvoid leaking during the first few months following insertion of the prosthesis and one case of transient hemospermia. CONCLUSIONS: The Memotherm intraurethral heat-expansible stent is a valid treatment option for selected cases of recurrent urethral stricture. Although this approach can be utilized before performing urethroplasty, which is often a complicated technique with uncertain results, currently it is a valid treatment option in case of failure.

[Penile erectile dysfunction secondary to hypophyseal adenoma]. / Disfunción erectil peneana secundaria a adenoma hipofisario.

Increased production of prolactin by the pituitary is a factor to be taken into account as a cause of peneal erectile dysfunction (PED), which varies depending on the series from 1 to 16%. 1,2,7 We contribute in this paper one patient with infertility and erectile dysfunction secondary to a prolactin-producing pituitary tumour, prolactin plasma levels returning to normal after treatment with bromocriptine, which also achieved a remission of the clinical picture.

[Renal angioscopy]. / Angioscopia renal.

Presentation as a novelty of the application of endoscopic methods in the display of the renal artery (angioscopy). Review of findings seen in the renal artery of a donor corpse with polytraumatism using direct view with a MiniScope-type rigid urethroscopy and the possible future application of this technique.

[Cyst of the prostatic utricle]. / Quiste de utrículo prostático.

Presentation of a case of prostatic utriculus cyst which due to its size and the patient's history suggested a differential diagnosis with a urethral or vesical diverticulum. Awareness of frequent association to urethral malformations and azoospermia would be very useful when choosing a treatment strategy in such cases.

[Rigid ureteroscopy: results and complications]. / Ureteroscopia rígida: resultados y complicaciones.

We make an evaluation of 66 ureteroscopies (URS) carried out in our Service over a period of 18 months. In 55 cases it was done for therapeutic purposes in ureteral lithiasis, and in 11 cases it was for diagnostic purposes. In the treatment of lithiasis resolutive effectivity at the first attempt was 68%, in 9% ureterolithotomy had to be performed due to the impossibility of approaching the calculus, and in 23% supplementary treatment was carried out by means of external litrotripsy. In the diagnostic field, effectivity was 72%. Notable complications arose in 6 cases (9%), 6 ureteral perforations, in three of which a urinoma was formed, all settled with a double J catheter. Open surgery was not resorted to in any case. No sequelae were observed and this technique therefore showed itself to be safe and effective.