[Urogenital alterations in hereditary and sporadic neurodegenerative ataxias]. / Alteraciones urogenitales en las ataxias neurodegenerativas hereditarias y esporádicas.

INTRODUCTION: Sporadic and hereditary ataxias (HA) represent a group of clinically and genetically heterogeneous syndromes characterized by spinocerebellar degeneration producing a motoneuron coordination disorder. In these diseases urinary and sexual symptoms are commonly associated to the neurological alterations. OBJECTIVE: To define the prevalence of functional low urinary tract symptoms in an ataxic population and to compare them with the symptomatology control a group of in healthy subjects. PATIENTS AND METHODS: An observational, descriptive, transversal study of 491 subjects recruited from the HA regional associations of Spain was conducted. In addition, a case-control study of prevalent ataxic patients and healthy subjects matched by sex and age was also performed. RESULTS: Among 195 patients included, 138 (70.8 %) had Friedreich ataxia (FA) and 57 (29.2 %) non-Friedreich ataxia (nFA). Global mean age was 32.3 years in FA and 43.7 in nFA patients (p < 0.05). Combined irritative and obstructive symptoms were present in 48.7 %, only irritative in 16.4 % and obstructive in 15 % of patients. Erectile dysfunction in 30.3 % (p < 0.01) and decreased libido in 13.4 % (p < 0.01), were the most common sexual problems. CONCLUSIONS: In HA, urinary symptoms are present in 80 % of patients, with mainly irritative symptoms in 2/3 of them. A complete urodynamic evaluation in symptomatic patients is recommended in order to characterize potential neurogenic vesico-urethral dysfunction. Even though sexual dysfunction may be related to neurological causes, additional etiologic organic factors should be excluded.

Alteraciones urogenitales en las ataxias neurodegenerativas hereditarias y esporádicas / Urogenital alterations in hereditary and sporadic neurodegenerative ataxias

Introducción. Las ataxias hereditarias (AH) y esporádicas comprenden un grupo de síndromes clínica y genéticamente heterogéneos, caracterizados por un trastorno variable de coordinación motora secundario a degeneración espinocerebelosa. Cabe esperar, como en otras enfermedades neurológicas, que junto al cuadro clínico neurológico se asocien síntomas urinarios y sexuales. Objetivo. Conocer la prevalencia de síntomas urinarios y sexuales en una población definida de pacientes atáxicos respecto a un grupo control de sujetos sanos. Pacientes y métodos. Estudio observacional, descriptivo, de corte transversal sobre una muestra de pacientes atáxicos pertenecientes a las asociaciones regionales de AH en España. Los sujetos a estudio fueron evaluados mediante un cuestionario de síntomas. Se trata de un estudio comparativo caso-control sobre una serie de casos prevalentes de sujetos atáxicos y un grupo control de población sana, pareado por sexo y edad. Conceptualmente se investiga la situación clínica referida a abril de 2002, aunque la recogida de información se prolongó durante 6 meses. Resultados. En abril de 2002 estaban asociados en España 491 pacientes atáxicos. Disponemos de datos sobre 195 pacientes, de los que 138 (70,8 %) eran ataxias de Friedreich (AF) y 57 (29,2 %) ataxias no Friedreich (NF). Edad media global de la AF era de 32,3 años frente a los 43,7 años de las NF (p < 0,05). En su evolución presentaron síndrome urinario mixto el 48,7 %, síntomas urinarios irritativos el 16,4 % y síntomas urinarios obstructivos el 14,9 %. Los trastornos sexuales más frecuentes en varones fueron disfunción eréctil (30,3 %) (p < 0,01) y disminución del deseo sexual (13,4 %) (p < 0,01). Conclusiones. En las AH neurodegenerativas pueden presentarse síntomas urinarios leves o moderados en un alto porcentaje de pacientes, predominando los síntomas urinarios irritativos. Recomendamos estudio urodinámico completo en pacientes sintomáticos con objeto de caracterizar la posible disfunción neurógena vesicouretral. Aunque la disfunción sexual puede atribuirse a fenómeno neurológico, existen otros factores orgánicos involucrados en su patogenia, lo que implica un enfoque multidisciplinar

Introduction. Sporadic and hereditary ataxias (HA) represent a group of clineally and genetically heterogeneous syndromes characterized by espinocerebellar degeneration producing a motoneuron coordination disorder. In these diseases urinary and sexual symptoms are commonly associated to the neurological alterations. Objective. To define the prevalence of functional low urinary tract symptoms in an ataxic population and to compare them with the symptomatology control a group of in healthy subjects. Patients and methods. An observational, descriptive, transversal study of 491 subjects recruited from the HA regional associations of Spain was conducted. In addition, a case-control study of prevalent ataxic patients and healthy subjects matched by sex and age was also performed. Results. Among 195 patients included, 138 (70.8 %) had Friedreich ataxia (FA) and 57 (29.2 %) non-Friedreich ataxia (nFA). Global mean age was 32.3 years in FA and 43.7 in nFA patients (p<0.05). Combined irritative and obstructive symptoms were present in 48.7 %, only irritative in 16.4 % and obstructive in 15 % of patients. Erectile dysfunction in 30.3 % (p < 0.01) and decreased libido in 13.4 % (p < 0.01), were the most common sexual problems. Conclusions. In HA, urinary symptoms are present in 80 % of patients, with mainly irritative symptoms in 2/3 of them. A complete urodynamic evaluation in symptomatic patients is recommended in order to characterize potential neurogenic vesico-urethral dysfunction. Even though sexual dysfunction may be related to neurological causes, additional etiologic organic factors should be excluded

[Therapeutic options for patients with localized prostatic carcinoma: our experience with 454 patients]. / Alternativas terapéuticas en el cáncer de próstata localizado. Experiencia sobre 454 pacientes.

OBJECTIVES: To evaluate the influence of different therapeutic options on progression-free survival (PFS), overall survival (OS) and specific survival (SS) in a cohort of 454 patients with localized prostatic carcinoma, taking into account different prognostic factors, and to compare our results to those reported in the world literature. MATERIAL AND METHODS: Between 1983 and 2000 we have diagnosed 706 new cases of prostatic carcinoma and 454 were clinically localized tumors. The different therapeutic options employed in our series of patients have been: follow-up (FU) (103 patients); radical prostatectomy (RP) (108 patients); radiotherapy without hormonal blockade (RT) (148 patients); and hormonal blockade (HB) (95 patients). We have determined the PFS, the OS and the SS for each group of patients and compared them in patients with different prognostic factors at the time of diagnosis, including age, PSA levels, Gleason's grading and TNM staging. We have also analysed the influence of the tumor progression on the OS. The mean follow-up time has been 5.6 years (range: 0.1-19.2; median: 5.2). RESULTS: For PFS: the disease progressed in 145 patients (32%) and the PFS at 5 and 10 years has been 77% and 67% for FU; 61% and 50% for RP; 63% and 25% for RT; and 73% and 67% for HB, respectively. The differences between RT and RP were not statistically significant. For the subgroup of patients with PSA levels <10 and Gleason <8 the differences between FU, RP and RT did not reach statistical significance. For OS: 126 patients of our series died (28%) and the OS at 5 and 10 years has been 80% and 61% for FU; 90% and 76% for RP; 85% and 67% for RT; and 64% and 32% for HB, respectively. We have found no significant differences between FU, RP and RT. For SS: 31 patients of our series died of disease (6.8%). The SS at 5 and 10 years has been 100% and 94% for FU; 98% and 98% for RP; 97% and 88% for RT; and 83% and 77% for HB, respectively. We have found no significant differences in the OS between patients with disease progression and without disease progression treated with FU, RP and RT. CONCLUSIONS: Determination of PSA levels has allowed diagnosis of prostatic carcinomas in early stages of disease; however, our results and those reported in the literature cannot define which is the best therapeutic option in these patients. We should offer the patients individualized information both in the phase of early diagnosis and of therapeutic decisions.

Alternativas terapéuticas en el cáncer de próstata localizado. Experiencia sobre 454 pacientes / Therapeutic options for patients uit localized prostatic carcinoma: our experience with 454 patients

OBJETIVOS: Evaluar en una cohorte de 454 pacientes con cáncer de próstata no diseminado tratados con diversas alternativas terapéuticas la supervivencia libre de progresión (SLP), supervivencia global (SG) y supervivencia específica (SE) en función de distintos factores pronósticos y comparar nuestros resultados con la bibliografía. MATERIAL Y MÉTODOS: Entre 1983 y 2000 hemos diagnosticado 706 pacientes de cáncer de próstata, de los que 454 eran clínicamente tumores no diseminados. Los tratamientos utilizados para estos 454 pacientes han sido: observación (OBS) (103 pacientes), prostatectomía radical (PR) (108), radioterapia no asociada a tratamiento hormonal (RT) (148) y bloqueo hormonal (BH) (95). Hemos analizado la SLP, SG y SE en cada grupo y comparativamente en función de distintos factores pronósticos en el momento del diagnóstico: edad, PSA, Gleason y estadio. También analizamos la repercusión de la progresión en la SG. El seguimiento medio ha sido de 5,6 años (0,1-19,2 años; mediana 5,2). RESULTADOS: SLP: han progresado 145 pacientes (32%), a 5 años la SLP para OBS: 77%, PR: 61%, RT: 63%, BH: 73%. A 10 años: 67, 50, 25 y 67%, respectivamente. No diferencias significativas entre PR y RT. En pacientes con PSA <10 y Gleason <8 no diferencias entre OBS, PR y RT. SG: han fallecido 126 pacientes (28%), a 5 años la SG fue: 80, 90, 85 y 64% y a 10 años: 61, 76, 67 y 32%. No diferencias entre OBS, PR y RT. SE: han fallecido por su tumor 31 (6,8%). SE a 5 años: 100, 98, 97 y 83%. A 10 años: 94, 98, 88 y 77%. No diferencias en la SG entre los pacientes en progresión comparados con los pacientes sin progresión tumoral en los tratados con OBS, PR y RT. CONCLUSIONES: La determinación del antígeno PSA ha trasladado el diagnóstico del cáncer de próstata a estadios muy precoces, sin embargo nuestros datos y la revisión de la bibliografía no permiten definir cual es la mejor estrategia terapéutica incluyendo la alternativa observacional. Debemos dar la suficiente información individualizada tanto en la fase de diagnóstico precoz como a la hora de decidir un tratamiento

OBJECTIVES: To evaluate the influence of different therapeutic options on progression-free survival (PFS), overall survival (OS) and specific survival (SS) in a cohort of 454 patients with localized prostatic carcinoma, taking into account different prognostic factors, and to compare our results to those reported in the world literature. MATERIAL AND METHODS: Between 1983 and 2000 we have diagnosed 706 new cases of prostatic carcinoma and 454 were clinically localized tumors. The different therapeutic options employed in our series of patients have been: follow-up (FU) (103 patients); radical prostatectomy (RP) (108 patients); radiotherapy without hormonal blockade (RT) (148 patients); and hormonal blockade (HB) (95 patients). We have determined the PFS, the OS and the SS for each group of patients and compared them in patients with different prognostic factors at the time of diagnosis, including age, PSA levels, Gleason’s grading and TNM staging. We have also analysed the influence of the tumor progression on the OS. The mean follow-up time has been 5.6 years (range: 0.1-19.2; median: 5.2). RESULTS: For PFS: the disease progressed in 145 patients (32%) and the PFS at 5 and 10 years has been 77% and 67% for FU; 61% and 50% for RP; 63% and 25% for RT; and 73% and 67% for HB, respectively. The differences between RT and RP were not statistically significant. For the subgroup of patients with PSA levels <10 and Gleason <8 the differences between FU, RP and RT did not reach statistical significance. For OS: 126 patients of our series died (28%) and the OS at 5 and 10 years has been 80% and 61% for FU; 90% and 76% for RP; 85% and 67% for RT; and 64% and 32% for HB, respectively. We have found no significant differences between FU, RPand RT. For SS: 31 patients of our series died of disease (6.8%). The SS at 5 and 10 years has been 100% and 94% for FU; 98% and 98% for RP; 97% and 88% for RT; and 83% and 77% for HB, respectively. We have found no significant differences in the OS between patients with disease progression and without disease progression treated with FU, RP and RT. CONCLUSIONS: Determination of PSA levels has allowed diagnosis of prostatic carcinomas in early stages of disease; however, our results and those reported in the literature cannot define which is the best therapeutic option in these patients. We should offer the patients individualized information both in the phase of early diagnosis and of therapeutic decisions

[Treatment approach for vesicogenital fistula. Retrospective analysis of our data]. / Planteamiento terapéutico de las fístulas vesicogenitales. Análisis retrospectivo de nuestra serie.

The vesicogenital fistula are abnormal communications between female genitalia and urinary bladder. We recorded all the vesicogenital fistula diagnosed since 1986, analyzing aetiology, treatment applied, complications and results. Total number of fistula have been 20 (18 vesicovaginal and 2 vesicouterine). The distribution in vesicovaginal fistula was iatrogenic in 15 cases (83%) and tumoral in 3 cases (17%). Vesicouterine fistula were due to cesarean. The initial treatment of the iatrogenic fistula was conservative using foley catheter. Twenty percent of the patients were cured with this treatment (3 cases). Surgical repair was necessary for the other patients, using different surgical approach according to the type of the fistula, intensity and patient age. It was successful in 91% of the patients. The results shows that simple surgical approach generate less morbidity and the early intervention is not less efficient.

[Prostate cancer in the Community of Madrid in the year 2000. III. Study of tumor extent]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. III--Estudio de extensión tumoral.

OBJECTIVE: To identify a potential relationship between two variables, risk of metastasis and use of imaging techniques, in an extension study in prostate cancer patients diagnosed in the Autonomous Community of Madrid in 2000. MATERIAL AND METHODS: 1,127 patients with available data on the tumour extension study were analysed. Performance and non performance of bone scans and CTs were correlated to risk variables for developing metastasis as described in the literature (PSA, Gleason and stage) and to therapy administered. RESULTS: The proportion of patients with risk variables for metastasis when bone scans were performed was between 7% to 14% greater than in patients with no variables. No differences were seen for CTs based on risk variables. With matching risk variables, more imaging techniques were used in patients receiving radiotherapy that in those managed with prostatectomy. CONCLUSION: Based on current recommendations imaging techniques were used in excess in the extension study in patients with no risk variables for metastasis. Conduct of a further study in the Autonomous Community seems advisable to confirm the likelihood of implementing such recommendations considering our prevalence of metastatic disease.

[Prostate cancer in the Community of Madrid in the year 2000. IV. Treatment]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. IV Tratamiento.

OBJECTIVE: To know the therapeutic options used in patients diagnosed with prostate cancer in the Autonomous Community of Madrid in 2000. MATERIAL AND METHODS: The study was conducted on 1,745 patients referred by hospitals taking part in the study. Data on treatment used was available for 1,104 (63%) patients. Treatment modality was correlated to clinical stage and patient age. RESULTS: Most frequent choice was hormone therapy (35%) followed by radical prostatectomy (34%) and radiotherapy (25%). Prostatectomy was most commonly used in patients with localised (42.3%) disease while hormone therapy was preferred for locally advanced (45.6%) or disseminated (94%) disease. There are significant differences in therapeutic indications between the various Health areas participating in the survey. Median age of patients with localised and locally advanced disease was lower in patients managed with prostatectomy (65 and 64 years, respectively) than in those managed with radiotherapy (70 and 69 years, respectively). CONCLUSION: The therapeutic modality indicated by urologists in the Madrid Autonomous Community for managing patients with prostate cancer generally meets with literature recommendations.

[The prostate cancer in the community of Madrid in 2000 I.- Incidence]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. I--Incidencia.

OBJECTIVE: To know the incidence in the year 2000 of prostate cancer in the Autonomous Community of Madrid and its breakdown by Health Areas. MATERIAL AND METHOD: Study of histologically confirmed prostate cancer case reports and retrospective data acquisition for 2000 in the Autonomous Community of Madrid, both from Public and Private Health Care hospitals. RESULTS: Gross incidence of prostate cancer in the Autonomous Community of Madrid was 100.4 cases per 100,000 males. The incidence adjusted for the Spanish, European and Worldwide population was 120.1, 103.5 and 68.6 cases per 100,000 males, respectively. Mean age at diagnosis was 70 +/- 7.8 (40-94) years, median of 70 years. The age group with higher incidence was 70 to 79 years. CONCLUSIONS: The incidence of prostate cancer in the Autonomous Community of Madrid is lower than that in the US but higher than in most countries or regions in the EU. The different way of using PSA testing in the Health Areas of the Autonomous Community may explain the differences seen in terms of incidence by Area.

[The prostate cancer in the community of Madrid in 2000. II Presentation and diagnosis]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. II--Presentación y diagnóstico.

OBJECTIVE: To know the presentation form, diagnostic method and clinical stage at the time of diagnosis in subjects with prostate cancer (PC) in the Autonomous Community of Madrid in 2000. MATERIAL AND METHOD: Data from 1745 patients with histologically confirmed prostate cancer obtained from 15 Hospitals participating in the study was analysed. The variables studied were: associated disease, reason for visiting the hospital, digital rectal examination (DRE), PSA, diagnostic method, graded Gleason score, tests performed in the tumoral extension study and tumour staging. The qualitative variables are given in percentages of the overall number and the quantitative variables are expressed as the median, standard deviation, maximum and minimum values and 25%, 50% (median) and 75% percentiles. RESULTS: 67% cases had an associated disease. In most (75%) patients the reason for visiting the hospital was prostatic syndrome. DRE revealed that 42.7% has no tumour. At the time of diagnosis half the patients had PSA levels lower than or equal to 11 ng/ml. Transrectal ultrasound-guided biopsy was used for diagnosis in 93% subjects. The most commonly reported Gleason scores were 6 (31.3%) and 7 (28.7%). In 75% subjects the disease was considered to be clinically limited to the prostate, in 12.5% locally advanced and in 12.5% metastatic. CONCLUSIONS: Most patients came to the hospital because of symptoms not related to PC. Transrectal ultrasound-guided biopsy is confirmed as the choice technique for PC diagnosis. When a comparison is made to historical series in our Autonomous Community a pattern of earlier diagnosis can be seen.

Planteamiento terapéutico de las fístulas vesicogenitales. Análisis retrospectivode nuestra serie / Treatment approach for vesicogenital fistula. Restrospective analysis of our data

Las fístulas vesicogenitales son comunicaciones anómalas de la vejiga urinaria con cualquier parte del aparato genital femenino. En el presente trabajo analizamos nuestra serie de fístulas vesicogenitales diagnosticadas y tratadas desde 1986, analizando las causas etiológicas, tratamientos aplicados, complicaciones y resultados de los mismos.El número total de fístulas han sido 20 (18 vesicovaginales y 2 vesicouterinas). De las fístulas vesicovaginales 15 (83 por ciento) eran yatrógenas y 3 (17 por ciento) neoplásicas. Las fístulas vesicouterinas aparecieron tras sendas cesáreas.El tratamiento inicial de las fístulas yatrógenas fue conservador con sondaje vesical, produciéndose su resolución en el 20 por ciento de las mismas (3 casos). En el resto de las pacientes se realizó tratamiento quirúrgico por vía abdominal con distintas técnicas según el tipo de fístula, intensidad y edad de la paciente, resultando satisfactorio en el 91 por ciento de los casos. La utilización de técnicas sencillas que generan menor morbilidad así como la actuación precoz no implica un peor resultado en las fístulas yatrógenas simples. (AU)