Predictive factors of post-HoLEP incontinence: differences between stress and urgency urinary incontinence.

INTRODUCTION: The analysis of post-HoLEP urinary incontinence (UI) has traditionally focused on stress UI. Our aim is to evaluate the factors associated with stress and urgency UI in the first month after the surgery. METHODS: Data were obtained from patients who underwent HoLEP by the same experienced surgeon. UI was evaluated at one month and at 6 months after the surgery. Three groups were defined: continent patients, patients with pure urgency UI and patients with stress or mixed UI. Preoperative, intraoperative, urodynamic and clinical variables were analyzed and compared between the three groups. RESULTS: In total, 235 subjects were included. One month after the surgery, 156 (66.5%) were continent (group 1), 49 (20.8%) reported pure urgency UI (group 2), and 30 (12.7%) reported some level of stress UI (group 3). In Group 2, the factors associated with urgency UI in the univariate analysis were age, presurgical urgency UI, having diabetes or hypertension. In Group 3, age, prostatic volume, preoperative PSA, time of enucleation, weight of the resection in grams, having an IDC or being diabetic were significant in the univariate analysis. In the multivariate analysis, age predicts both types of UI, while prostatic volume and having an IDC predict stress or mixed UI. CONCLUSION: In the first month post-HoLEP, age is a predictive factor of urgency UI and stress UI. In addition, prostatic volume and the presence of an indwelling urinary catheter are predictive factors of stress UI.

[Can a single value of a perypheric inflammatory response marker predict the response to BCG?] / Ratios neutrófilo/linfocito y plaqueta/linfocito: ¿Se asocian con la respuesta al tratamiento con BCG en tumores vesicales no músculoinvasivos de alto grado?

OBJECTIVES: To evaluate the association of neuthophyl/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) with BCG intravesical responses in patients with initial diagnosis of non/muscle invasive bladder tumor high-risk (NMIBC). MATERIAL AND METHODS: Retrospective multicenter study on patients with initial diagnosis of high-grade NMIBC treated with BCG between January 2016 and December 2017. Initially a total of 74 patients were collected. Those patients with mixt pathology, cis, chronic corticoid usage and lost to follow-up, were excluded. Induction BCG (x6) and BCG maintenance schedules were administered (x9) over 1 year. Demographic variables (sex, age, BMI) and blood variables (NLR, PLR) before BCG instillation were collected. Response to treatment was defined as absence of recurrence and/ or progression. A statistical analysis with T-student, Chi square, ANOVA and ROC curves was performed. RESULTS: Final study cohort included a total of 50 patients. 10 females and 40 males. Median age was 70 year old. All patients had pure urothelial carcinoma, 12 with pTa and 38 with pT1. Median follow-up was 24 months. A total of 28% had a recurrence. No correlation between NLR or PLR and BCG response was observed (p=0.738; p= 0.768). Neither a cut off was established through ROC curves. At multivariate analysis, there was no significative relationship between recurrence and the clinical and blood samples analyzed (sec, age, BMI, NLR, PLR)CONCLUSION: No correlation between NLR and PLR has been reported with BCG response on high-grade NMIBC.

OBJETIVOS: Evaluar la asociación de la ratio neutrófilo/linfocito (RNL) y ratio plaqueta/linfocito (RPL) con la respuesta al tratamiento mediante instilaciones de Bacilo Calmette Guerin (BCG) intravesical, en pacientes con diagnóstico inicial de tumor vesical no músculo-invasivos (TVNMI) de alto riesgo.MATERIAL Y MÉTODOS: Estudio retrospectivo multicéntrico con pacientes diagnosticados de tumor vesical inicial de alto riesgo y sometidos a instilaciones endovesicales con BCG entre enero 2016 y diciembre 2017. Inicialmente se recogieron 74 pacientes con tumor vesical inicial. Se excluyeron aquellos sin estirpe urotelial pura, con carcinoma in situ (Cis) asociado, con tratamientos corticoideos crónicos y perdidos durante el seguimiento. Instilamos dosis completa de BCG (81mg) con pauta de inducción (6 dosis) y mantenimiento (9 dosis) durante un año. Se recogieron variables demográficas (sexo, edad e índice de masa corporal) y analíticas (RNL y RPL) previas al inicio del tratamiento con BCG. Definimos respuesta al tratamiento como ausencia de recidiva y/o progresión. Se realizó análisis estadístico mediante t de student, Chi cuadrado, ANOVA y curvas ROC. RESULTADOS: La cohorte del estudio incluyó finalmente 50 pacientes: 10 mujeres y 40 varones, con una edad media de 70 años. Todos estos pacientes tenían tumor urotelial puro alto grado, 12 de ellos estadio Ta y 38 estadio T1. El seguimiento mínimo fue de 24 meses, presentando recidiva tumoral un 28% de los pacientes. No se encontró relación entre RNL y éxito de la BCG (p=0,738) ni entre RPL y éxito de BCG (p=0,768). Tampoco pudimos establecer un punto de corte mediante curvas ROC. En el análisis multivariante, no encontramos significación estadística entre la recidiva tumoral y los datos analizados (Variables demográficas: Edad, sexo, índice de masa corporal y variables analíticas: RNL/RPL).CONCLUSIÓN: Pese a lo descrito en la literatura, no hemos encontrado asociación entre la RNL ni la RPL con la respuesta al tratamiento con BCG en TVNMI de alto riesgo.

Ratios neutrófilo/linfocito y plaqueta/linfocito: ¿se asocian con la respuesta al tratamiento con bcg en tumores vesicales no músculoinvasivos de alto grado? / Neutrophil/lymphocyte and platelet/lymphocyte ratios: are they associated with response to bcg treatment in high-grade non-muscle-invasive bladder tumors?

Objetivos: Evaluar la asociación de laratio neutrófilo/linfocito (RNL) y ratio plaqueta/linfocito(RPL) con la respuesta al tratamiento mediante instilaciones de Bacilo Calmette Guerin (BCG) intravesical, enpacientes con diagnóstico inicial de tumor vesical nomúsculo-invasivos (TVNMI) de alto riesgo.Material y métodos: Estudio retrospectivo multicéntrico con pacientes diagnosticados de tumor vesicalinicial de alto riesgo y sometidos a instilaciones endovesicales con BCG entre enero 2016 y diciembre2017. Inicialmente se recogieron 74 pacientes contumor vesical inicial. Se excluyeron aquellos sin estirpeurotelial pura, con carcinoma in situ (Cis) asociado, con tratamientos corticoideos crónicos y perdidos durante elseguimiento. Instilamos dosis completa de BCG (81mg)con pauta de inducción (6 dosis) y mantenimiento (9 dosis) durante un año. Se recogieron variables demográficas (sexo, edad e índice de masa corporal) y analíticas(RNL y RPL) previas al inicio del tratamiento con BCG.Definimos respuesta al tratamiento como ausencia derecidiva y/o progresión. Se realizó análisis estadísticomediante t de student, Chi cuadrado, ANOVA y curvasROC.Resultados: La cohorte del estudio incluyó finalmente50 pacientes: 10 mujeres y 40 varones, con una edadmedia de 70 años. Todos estos pacientes tenían tumorurotelial puro alto grado, 12 de ellos estadio Ta y 38estadio T1. El seguimiento mínimo fue de 24 meses,presentando recidiva tumoral un 28% de los pacientes.No se encontró relación entre RNL y éxito de la BCG(p=0,738) ni entre RPL y éxito de BCG (p=0,768). Tampoco pudimos establecer un punto de corte mediantecurvas ROC.En el análisis multivariante, no encontramos significación estadística entre la recidiva tumoral y los datos analizados (Variables demográficas: Edad, sexo, índice demasa corporal y variables analíticas: RNL/RPL).Conclusion: Pese a lo descrito en la literatura, nohemos encontrado asociación entre la RNL ni la RPL con...(AU)

Objetives: To evaluate the associationof neuthophyl/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) with BCG intravesical responses inpatients with initial diagnosis of non/muscle invasivebladder tumor high-risk (NMIBC).Materials and methods: Retrospective multicenterstudy on patients with initial diagnosis of high-gradeNMIBC treated with BCG between January 2016 andDecember 2017. Initially a total of 74 patients werecollected. Those patients with mixt pathology, cis, chronic corticoid usage and lost to follow-up, were excluded.Induction BCG (x6) and BCG maintenance scheduleswere administered (x9) over 1 year. Demographic variables (sex, age, BMI) and blood variables (NLR, PLR)before BCG instillation were collected. Response totreatment was defined as absence of recurrence and/or progression. A statistical analysis with T-student, Chisquare, ANOVA and ROC curves was performed.Results: Final study cohort included a total of 50 patients. 10 females and 40 males. Median age was 70year old. All patients had pure urothelial carcinoma, 12with pTa and 38 with pT1. Median follow-up was 24months. A total of 28% had a recurrence. No correlationbetween NLR or PLR and BCG response was observed(p=0.738; p= 0.768). Neither a cut off was established through ROC curves.At multivariate analysis, there was no significative relationship between recurrence and the clinical and bloodsamples analyzed (sec, age, BMI, NLR, PLR)Conclusion: No correlation between NLR and PLRhas been reported with BCG response on high-gradeNMIBC.(AU)

[Conventional transrectal ultrasound guided biopsy. Current role, indications, techniques and limitations]. / Biopsia transrectal ecodirigida convencional. Papel actual, indicaciones, técnicas y limitaciones.

OBJECTIVES: The objective of this work is to evaluate the current role of conventional transrectal ultrasound guided biopsy of the prostate in the diagnosis of cancer. With this aim we review its indications, the various techniques, associated complications and limitations of this test. METHODS: We performed a bibliographic review through NCBI-PUBMED. We also evaluated the information and recommendations of the available clinical guidelines with their respective evidence levels. Lastly, some of the appraisals included are based on our group's personal experience that has performed more than 7000 prostate biopsies with various protocols and methodologies over two decades of health care practice. RESULTS: Conventional prostatic biopsies lack precision; they are not close to reality in terms of tumor amount, localization and grading. The number and localization of the cores to be taken is not clear; there are too many biopsy schemes, making it less reliable and reproducible than expected. Although it is a good tool, there is an obvious risk of over diagnosis of clinically non-significant tumors. The lack of standardization of the various biopsy schemes has clear prognostic and decision-making implications. Another limitation is the scarce number of results attributable to biopsies targeted at ultrasound visible lesions. Obviously, the complications, discomfort, and distress generated by conventional biopsy and repeated biopsy programs are some of their limitations and the reasons for patient rejection. We are in a crossroad where multiple groups try to demonstrate the sensitivity and reproducibility of targeting the biopsy, by means of various techniques, to the lesions found in multiparametric MRI. CONCLUSIONS: Ultrasound guided prostatic biopsy is the main diagnostic method for prostate cancer yet. The information it gives is greatly relevant for staging, prognostic evaluation and therapeutic decision-making. Nevertheless, its limitations are evident: low sensitivity, overdiagnosis, complicacions, patient's distress, etc. There are two lines of development to improve its efficiency. The one aiming to reduce the number of biopsies and cores by selectively targeting the findings of the MRI and the one that continues systematizing schemes with increasing number of cores to achieve the optimal sampling. Technical advances, such as image fusion, will maybe allow us in the future to translate the MRI findings into verified and reproducible clinical results. We must standardize the conventional techniques of prostate biopsy in our centers, using protocols and making them safe for patients. We must review our results to ensure reasonable detection rates, as well as our indications, considering patient's age, comorbidities and expectations about therapy. We must include, as far as possible, other tools, such as multiparametric MRI to enable biopsy rationalization and improve their efficacy.

Biopsia transrectal ecodirigida convencional. Papel actual, indicaciones, técnicas y limitaciones / Conventional transrectal ultrasound guided biopsy. Current role, indications, techniques and limitations

OBJETIVO: El objetivo del presente trabajo es evaluar el papel actual de la Biopsia transrectal eco-dirigida convencional de la próstata en el diagnóstico de cáncer. Para ello repasaremos sus indicaciones, las diferentes técnicas, las complicaciones que comporta y las limitaciones de esta prueba. MÉTODOS: Para cumplir nuestros objetivo hemos realizado una revisión de la literatura utilizando como herramienta el PubMed-NCBI. También se ha valorado la información y recomendaciones de las guías clínicas disponibles, con su respectivo nivel de evidencia. Por último, alguna de las apreciaciones reflejadas se basan en la experiencia personal de nuestro grupo que ha practicado más de 7000 biopsias prostáticas con diferentes protocolos y metodologías a lo largo de dos décadas de trabajo asistencial. RESULTADOS: Las biopsias prostáticas convencionales son poco precisas, poco cercanas a la realidad en cuanto a la cantidad, ubicación y gradación de tumores. No está claro el número y localización de los cilindros a tomar, existiendo demasiados esquemas, lo que las hace menos fiables y reproductibles de lo requerido. Aunque son una buena herramienta, comportan un riesgo obvio de sobre-diagnóstico de tumores clínicamente insignificantes. La falta de estandarización de los diferentes esquemas de biopsias tiene claras implicaciones pronósticas y en la toma de decisiones. Otra limitación son los escasos resultados atribuibles a las biopsias dirigidas a las lesiones visualizables por ecografía. Evidentemente, las complicaciones, el disconfort y la angustia que generan los programas de biopsias y rebiopsias convencionales constituyen una de sus limitaciones y de los motivos de rechazo por parte de los pacientes. Nos hallamos en una encricijada en la que múltiples grupos intentan demostrar la sensibilidad y reproductibilidad de dirigir mediante diferentes técnicas las biopsias hacia los hallazgos de la resonancia multiparamétrica. CONCLUSIONES: La biopsia prostática ecodirigida sigue siendo el método principal de diagnóstico del cáncer de la próstata. La información que proporciona es de gran relevancia en el estadiaje, en la evaluación pronóstica y en la toma de decisiones terapéuticas. No obstante, son patentes sus limitaciones: baja sensibilidad, el sobrediagnóstico, las complicaciones, la angustia de los pacientes, etc. Existen dos líneas de desarrollo para mejorar su eficiencia. La que busca reducir el número de biopsias y de cores persiguiendo selectivamente los hallazgos de las resonancias y la que sigue sistematizando esquemas con aumento del número de cores para conseguir el muestreo óptimo. Los avances técnicos, como la fusión de imágenes, tal vez nos permitirán en un futuro traducir los hallazgos de las resonancias en resultados clínicos contrastados y reproducibles. Debemos estandarizar en nuestros Centros las técnicas convencionales de biopsia de próstata, protocolizándolas y haciéndolas seguras para los pacientes. Hemos de revisar nuestros resultados para asegurar tasas de detección razonables, así cmo nuestras indicaciones, teniendo en cuenta la edad, la comorbilidad y la expectativa de tratamiento de los pacientes. Debemos incluir, en la medida de lo posible, otras herramientas, como la RMN multiparamétrica, para permitir racionalizar las biopsias y aumentar su eficacia

OBJECTIVES: The objective of this work is to evaluate the current role of conventional transrectal ultrasound guided biopsy of the prostate in the diagnosis of cancer. With this aim we review its indications, the various techniques, associated complications and limitations of this test. METHODS: We performed a bibliographic review through NCBI-PUBMED. We also evaluated the information and recommendations of the available clinical guidelines with their respective evidence levels. Lastly, some of the appraisals included are based on our group's personal experience that has performed more than 7000 prostate biopsies with various protocols and methodologies over two decades of health care practice. RESULTS: Conventional prostatic biopsies lack precision; they are not close to reality in terms of tumor amount, localization and grading. The number and localization of the cores to be taken is not clear; there are too many biopsy schemes, making it less reliable and reproducible than expected. Although it is a good tool, there is an obvious risk of over diagnosis of clinically non-significant tumors. The lack of standardization of the various biopsy schemes has clear prognostic and decision-making implications. Another limitation is the scarce number of results attributable to biopsies targeted at ultrasound visible lesions. Obviously, the complications, discomfort, and distress generated by conventional biopsy and repeated biopsy programs are some of their limitations and the reasons for patient rejection. We are in a crossroad where multiple groups try to demonstrate the sensitivity and reproducibility of targeting the biopsy, by means of various techniques, to the lesions found in multiparametric MRI. CONCLUSIONS: Ultrasound guided prostatic biopsy is the main diagnostic method for prostate cancer yet. The information it gives is greatly relevant for staging, prognostic evaluation and therapeutic decision-making. Nevertheless, its limitations are evident: low sensitivity overdiagnosis, complicacions, patient`s distress, etc. There are two lines of development to improve its effi- ciency. The one aiming to reduce the number of biopsies and cores by selectively targeting the findings of the MRI and the one that continues systematizing schemes with increasing number of cores to achieve the optimal sampling. Technical advances , such as image fusion, will maybe allow us in the future to translate the MRI findings into verified and reproducible clinical results. We must standardize the conventional techniques of prostate biopsy in our centers, using protocols and making them safe for patients. We must review our results to ensure reasonable detection rates, as well as our indications, considering patient's age, comorbidities and expectations about therapy. We must include, as far as possible, other tools, such as multiparametric MRI to enable biopsy rationalization and improve their efficacy

[Neuroendocrine tumor in a horseshoe kidney: relative risk of association of two related entities]. / Tumor neuroendocrino en el riñón en herradura: riesgo relativo de asociacion de dos entidades relacionadas.

OBJECTIVE: Primary renal neuroendocrine tumor (NET) is a very rare neoplasia with a higher frequency of appearance in horseshoe kidney (HK). From 1966, when Resnick published the first case, approximately 2 of each 10 new cases appear in kidneys with this malformation. From the diagnosis of a case of primary NET in a HK, we calculated the relative risk of their presentation as associated entities. METHODS: 63-year-old male with the incidental diagnosis of an 8 cm solid renal mass in the isthmus of a HK. At the time of diagnosis there were no signs of local-regional extension of the primary neoplasia neither metastasis. The patient underwent nephrectomy and pathologic study confirmed the diagnosis of NET. After a systematic review using multiple search platforms (Blackwell, Ovid, Proquest, PubMed, Science Direct, and Wiley) our case is No. 11 of NET in HK from a total of 57 renal NET. RESULTS: Despite its very low frequency 19.3% of NET present in HK. Using 1/400 as the incidence of HK in general population, the calculated relative risk in HK is 77 times greater than that of a normal kidney CONCLUSIONS: The relative risk of presentation of NET in HK is enormously superior than that of general population. This diagnosis must be suspected in patients with HK, mainly if the tumor is located in the renal isthmus. Due to its potentially aggressive clinical course and poor response to other therapies, measures for improvement of surgical treatment must be considered priority.

Tumor neuroendocrino en el riñón en herradura: riesgo relativo de asociación de dos entidades relacionadas / Neuroendocrine tumor in a horseshoe kidney: relative risk of association of two related entities

Objetivo: El tumor neuroendocrino (TNE) renal primario es una neoplasia muy rara aunque con una mayor frecuencia de aparición en el riñón en herradura (RH). Desde que en 1966 Resnik publicó el primer caso, aproximadamente 2 de cada 10 nuevos diagnósticos aparecen en riñones con esta malformación. A partir del diagnóstico de un caso de TNE primario en RH, calculamos su riesgo relativo de presentación como entidades asociadas Métodos: Varón de 63 años al que descubrimos incidentalmente una masa sólida de 8 cm. ubicada en el istmo de un RH. En el momento del diagnóstico no se evidenciaron signos de extensión locoregional, sospecha de otra neoplasia primaria extrarrenal. El paciente fue sometido a heminefrectomía y el estudio histológico confirmó el diagnóstico de TNE. Tras una revisión sistemática de la literatura utilizando múltiples plataformas (Blackwell, Ovid, Proquest, PubMed, Science Direct y Wiley), el nuestro, representa el caso decimoprimero de TNE en RH de un total de 57 TNE originados en riñón. Resultados: Pese a su escasa frecuencia, un 19.3% de los TNE se presentan en un RH. Utilizando una incidencia de RH en la población general de 1/400, el riesgo relativo calculado de TNE en RH respecto al de un riñón normal es 77 veces mayor. Conclusiones: El riesgo relativo de presentación de un TNE en el RH es enormemente superior al de la población general. Este diagnóstico debe sospechase en pacientes con RH, sobre todo si el tumor asienta en el istmo renal. Dado su potencial curso clínico agresivo y pobre respuesta a otras terapias, las medidas encaminadas a mejorar el tratamiento quirúrgico deben ser consideradas prioritarias (AU)

Objective: Primary renal neuroendocrine tumor (NET) is a very rare neoplasia with a higher frequency of appearance in horseshoe kidney (HK). From 1966, when Resnick published the first case, approximately 2 of each 10 new cases appear in kidneys with this malformation. From the diagnosis of a case of primary NET in a HK, we calculated the relative risk of their presentation as associated entities. Methods: 63-year-old male with the incidental diagnosis of an 8 cm solid renal mass in the isthmus of a HK. At the time of diagnosis there were no signs of local-regional extension of the primary neoplasia neither metastasis. The patient underwent nephrectomy and pathologic study confirmed the diagnosis of NET. After a systematic review using multiple search platforms (Blackwell, Ovid, Proquest, PubMed, Science Direct, and Wiley) our case is No. 11 of NET in HK from a total of 57 renal NET. Results: Despite its very low frequency, 19.3% of NET present in HK. Using I/400 as the incidence of HK in general population, the calculated relative risk in HK is 77 times greater than that of a normal kidney. Conclusions: The relative risk of presentation of NET in HK is enormously superior than that of general population. This diagnosis must be suspected in patients with HK, mainly if the tumor is located in the renal isthmus. Due to its potentially aggressive clinical course and poor response to other therapies, measures for improvement of surgical treatment must be considered priority (AU)

[Localization of prostate cancer within the central gland by endorectal MR spectroscopic imaging]. / Localización del cáncer de próstata en la glándula central mediante espectroscopia de resonancia magnética endorectal.

OBJECTIVES: The endorectal MR spectroscopic imaging is a new imaging test which allows more accurate and reliable localization and staging of prostate cancer than simple endorectal MRI. The combination of spectroscopic MR and MRI has recently achieved technical improvements that increased reliability in the detection of prostate cancer. Our group is now working in the detection of prostate cancer with the spectroscopic MR, in co-operation with the Agency for the Evaluation of Technology for Medical Research (Agencia de Evaluación de Tecnología para la Investigación Médica-AATRM); although we are waiting for definitive results, we can advance that this technique may be used as a good alternative for localization of prostate cancer in patients with previous negative biopsies in whom the suspicion of prostate cancer persists. METHODS: We present a series of 5 patients under control for permanent elevation of PSA with previous negative biopsies. We were performing ultrasound guided sextant biopsies every 6 months, after blood test for PSA. Endorectal MRI and spectroscopic MRI were performed to try to localize the prostate cancer so diminishing the number of biopsies. RESULTS: All patients in the series had a low intensity lesion within the normal low intensity of the central gland, with an obvious spectroscopic metabolic abnormality suggesting the existence of prostate cancer, as it was then demonstrated by biopsy. CONCLUSIONS: The endorectal MR spectroscopic imaging is a non invasive method which offers the ability to detect prostate cancer within the central gland with a higher reliability in selected patients. The central gland is an area in which prostate cancer is less commonly localized, but it often shows the same signal intensity than hyperplastic tissue, so that it is difficult to be detected by purely morphological methods. Endorectal MR spectroscopic imaging allows evaluating the metabolic disturbances in the whole gland, increasing the reliability of detection of prostate cancer both in the central and peripherical glands.

Localización del cáncer de próstata en la glándula central mediante espectroscopia de resonancia magnética endorectal / Localization of prostate cancer within the central gland by endorectal MR spectroscopic imaging

OBJETIVO: La espectroscopia de resonanciamagnética endorectal (E-RME) es una nueva técnicade imagen que permite una evaluación más acuraday fiable de la localización y estadiaje del cáncerde próstata (CaP) que la resonancia magnética endorectalsola. La combinación de la RME y la E-RME haconseguido recientemente mejorías técnicas que hanpermitido aumentar la fiabilidad en la detección delCaP. Nuestro grupo está actualmente trabajando con laE-RME en la detección del CaP, en colaboración con laAgencia de Evaluación de Tecnología para laInvestigación Médica (AATRM), y en espera de resultadosdefinitivos podemos avanzar que ésta técnicapuede ser utilizada como una buena alternativa en lalocalización de CaP en pacientes con biopsias previasnegativas pero en quienes persiste la sospecha de CaP.MÉTODOS: Presentamos aquí una serie de 5 casos clínicosde pacientes controlados por elevación persistentedel PSA y biopsias previas negativas. Realizamosbiopsias por sextantes mediante ecografía transrectal aintervalos de 6 meses, después de determinar los valoresde PSA. La RME y E-RME se realizó para intentarlocalizar el CaP y de este modo intentar minimizar elnúmero de biopsias.RESULTADOS: Todos los pacientes en esta serie presentaronuna lesión de baja intensidad localizada en lahipointensidad normal de la glándula central, pero conuna clara alteración metabólica en la espectroscopiaque sugería la existencia de un CaP, tal como sedemostró posteriormente por biopsia.CONCLUSIONES: La E-RME es un método poco invasivoque ofrece la capacidad de detectar el CaP en laglándula central con mayor fiabilidad en pacientesseleccionados. La glándula central es una zona en laque el CaP se localiza con menor frecuencia, pero amenudo adopta la misma intensidad de señal que eltejido hiperplásico, y por tanto, resulta difícil de detectarpor métodos puramente morfológicos. La E-RME permiteevaluar las alteraciones metabólicas en toda laglándula y aumentar así la fiabilidad en la deteccióndel CaP, tanto en la glándula central como en la periférica

OBJECTIVES: The endorectal MRspectroscopic imaging is a new imaging test whichallows more accurate and reliable localization andstaging of prostate cancer than simple endorectal MRI.The combination of spectroscopic MR and MRI hasrecently achieved technical improvements that increasedreliability in the detection of prostate cancer. Our groupis now working in the detection of prostate cancer withthe spectroscopic MR, in co-operation with the Agencyfor the Evaluation of Technology for Medical Research(Agencia de Evaluación de Tecnología para laInvestigación Médica-AATRM); although we are waitingfor definitive results, we can advance that this techniquemay be used as a good alternative for localization ofprostate cancer in patients with previous negative biopsiesin whom the suspicion of prostate cancer persists.METHODS: We present a series of 5 patients undercontrol for permanent elevation of PSA with previousnegative biopsies. We were performing ultrasound guidedsextant biopsies every 6 months, after blood test forPSA. Endorectal MRI and spectroscopic MRI wereperformed to try to localize the prostate cancer sodiminishing the number of biopsies.RESULTS: All patients in the series had a low intensitylesion within the normal low intensity of the centralgland, with an obvious spectroscopic metabolicabnormality suggesting the existence of prostate cancer,as it was then demonstrated by biopsy.CONCLUSIONS: The endorectal MR spectroscopicimaging is a non invasive method which offers theability to detect prostate cancer within the central glandwith a higher reliability in selected patients. The centralgland is an area in which prostate cancer is lesscommonly localized, but it often shows the same signalintensity than hyperplastic tissue, so that it is difficult tobe detected by purely morphological methods.Endorectal MR spectroscopic imaging allows evaluatingthe metabolic disturbances in the whole gland, increasingthe reliability of detection of prostate cancer both in thecentral and peripherical glands

[Laparoscopic radical prostatectomy. Review of our first year]. / Prostatectomía radical laparoscópica. Revisión del primer año.

OBJECTIVES: To present our series of laparoscopic radical prostatectomy, comparing to the published results up to date. METHODS: From november 2001 to november 2002, we have practiced 27 laparoscopic radical prostatectomies without lymphadenectomy. We have used the Montsouris technique with some modifications. All cases started by laparoscopy are included in the report. RESULTS: Laparoscopic approach was indicated in 27 patients; 17 cases were completed and 10 converted to open surgery. Among the last 17 consecutive cases only two were converted. Mean operative time was 296 minutes (190-480 minutes, MAY: SD 60). Global morbidity was 18.5%, without severe complications, reoperations or mortality. Transfusion rate was 11%. There was not any incontinent patient and three patients developed an anastomostic stenosis. 57% of previously potent patients have erections with a follow-up over six months. Positive surgical margins incidence is 33% overall and 17.6% in laparoscopic cases. Only one of the patients with a follow-up above six months has a biological (PSA) recurrence (7%). CONCLUSIONS: Laparoscopic radical prostatectomy is feasible, reproducible and within reach of interested urologists. It may substitute, once sufficient experience is acquired, conventional surgery.

Prostatectomía radical laparoscópica. Revisión del primer año / Laparoscopic radical prostatectomy. Review of our first year

OBJETIVOS: Presentar nuestra serie de prostatectomía radical laparoscópica, comparándola con los resultados publicados hasta el momento. MÉTODOS: Desde noviembre de 2001hasta noviembre de 2002 hemos realizado 27 prostatectomías radicales laparoscópicas sin linfadenectomía. La cirugía se ha practicado según la técnica de Montsouris con algunas modificaciones. Se han incluido todos los casos iniciados por vía laparoscópica. RESULTADOS: Se ha indicado el abordaje laparoscópico en 27 pacientes, habiendo completado 17 y reconvertido a cirugía abierta 10 casos. Entre los últimos 17 casos consecutivos sólo se han reconvertido dos. El tiempo quirúrgico medio ha sido de 296 minutos (190-480 minutos, ds 60). Han presentado una morbilidad global del 18,5 por ciento, sin complicaciones graves, reintervenciones o mortalidad. El índice de transfusión ha sido del 11 por ciento. No tenemos ningún caso de incontinencia urinaria y tres pacientes han presentado estenosis de la anastomosis. Un 57 por ciento de los pacientes previamente potentes con seguimiento superior a seis meses tienen erecciones. La incidencia de márgenes quirúrgicos positivos es del 33 por ciento globalmente y del 17,6 por ciento en las laparoscópicas. Sólo uno de los pacientes con un seguimiento superior a seis meses ha presentado una recidiva biológica (PSA) (7 por ciento). CONCLUSIONES: La técnica de la prostatectomía radical laparoscópica es factible, reproducible y al alcance de aquellos urólogos con interés. Puede sustituir, una vez adquirida la experiencia necesaria, a la cirugía convencional (AU)