[Clinical usefulness of free PSA/total PSA ratio in the early diagnosis of prostatic cancer]. / Utilidad clínica de la ratio PSA libre/PSA total en el diagnóstico precoz del cáncer de próstata.

OBJECTIVES: To determine the clinical utility of free/total PSA ratio and PSA density in the early diagnosis of prostate cancer (patients with serum PSA between 4 and 10 ng/ml) and to determine the differences, if any, in the free/total PSA ratio in patients with cancer and those with benign prostatic hyperplasia (BPH). METHODS: A prospective and descriptive study was conducted on 61 patients with low grade obstructive symptoms and total serum PSA between 4 and 10 ng/ml (group 1), and 42 patients who underwent prostate surgery and had an anatomopathologically confirmed diagnosis of BPH (group 2). Free and total PSA were determined, as well as prostate volume by transrectal US, in all cases. Prostate biopsy was performed in all patients with a total PSA value between 4-10 ng/ml. The sensitivity, specificity, positive and negative prognostic values of free/total PSA ratio and PSA density were analyzed. RESULTS: The mean age of the patients in group 1 was 67.7 years and 68.3 years in group 2. The mean prostate volume by US was 55.2 and 47.1, respectively (n.s.). The mean total PSA was 6.39 ng/ml for group 1 and 5.73 ng/ml for group 2 (n.s.). No significant difference was found between the mean free PSA values of both groups. However, the free/total PSA ratio and PSA density were significantly different (p < 0.000). In group 1 (total PSA 4-10 ng/ml), prostate biopsy was positive in 32.8% of the patients. In this group of patients, there were no significant differences in the parameters analyzed. Application of different cutoffs for both tests showed a higher clinical utility for the 0.24-0.30 range. CONCLUSIONS: At similar mean prostate volume and mean total PSA, significant differences were found in the free/total PSA ratio and PSA density of patients submitted to surgery for BPH and those with a total PSA value of 4-10 ng/ml. However, these results were not observed when patients with PSA of 4-10 ng/ml were analyzed for presence or absence of evidence of malignancy in the prostate biopsy.

[Paratesticular rhabdomyosarcoma. Report of a case and review of the literature]. / Rabdomiosarcoma paratesticular. Aportación de un caso y revisión de la literatura.

Case report of an embryonary paratesticular rhabdomyosarcoma. The paper includes a literature review and discusses the current diagnostic, prognostic and therapeutic criteria analyzing in detail the current role of retroperitoneal lymphadenectomy and the value of adjuvant radiotherapy or chemotherapy.

[Retroperitoneal germinal tumor: extragonadal or burned out phenomenon of testicular primary? Presentation of a clinical case]. / Tumor germinal retroperitoneal: estragonadal o fenómeno de burned-out del primario testicular? Presentación de un caso clínico.

Clinical record case of a retroperitoneal seminoma with "burned-out" phenomenon in the testicular primary, in a 38 year old male with no background of interest who consults for a picture of left nephritic colic. The ipsilateral testis study detects a fibrotic area with hyalinosis and hemosiderin deposits, although there are no tumoral debris, compatible with the "burned-out" phenomenon. Management is through surgery plus a chemotherapy protocol. Discussion of the diagnostic algorithm of retroperitoneal tumours and the literature on extragonadal germinal tumours.

[Perineal tuberculous abscess. Presentation of a clinical case]. / Absceso tuberculoso perineal. Presentación de un caso clínico.

OBJECTIVE: To describe a case of perineal abscess caused by Koch's bacillus in a patient with a history of bladder tumor. METHODS/RESULTS: The patient described herein had consulted at the emergency services for perineal abscess. He had previously undergone transurethral resection of a bladder tumor and had received prophylactic intravesical BCG instillation thereafter. A culture of the exudate led to the diagnosis of tuberculosis, with no microbiological relation to BCG therapy. During the course of the disease, the patient developed a urethrocutaneous fistula which resolved after specific medical treatment. CONCLUSIONS: In a patient with clinical features of tuberculosis and a recent history of exposure to BCG, it does not necessarily follow that this bacillus is the cause of the tuberculosis. Furthermore, not all tuberculous fistulas progress to chronicity or require surgical treatment.

[Adenomatoid tumor of the epididymis. Report of a new case]. / Tumor adenomatoide de epididimo aportación de un nuevo caso.

OBJECTIVES: To report on an additional case of adenomatoid tumor of the right epididymis, a rare benign intrascrotal mass. METHODS/RESULTS: A 41-year-old man consulted for severe scrotal pain. Physical examination disclosed a mass in the right epididymis which was confirmed by scrotal ultrasound. A right orchidectomy was performed. Histological analysis of the surgical specimen disclosed a benign adenomatoid tumor of the epididymis. CONCLUSIONS: Although most scrotal solid masses are malignant tumors, those arising in the epididymis are frequently benign; therefore a conservative approach is recommended.

[Argon laser treatment of urethral angioma. Report of the first case]. / Tratamiento con láser de Argón de un angioma uretral. Aportación del primer caso.

OBJECTIVES: This report documents the usefulness of the argon laser in the treatment of urethral hemangioma. METHODS/RESULTS: We report a case of urethral hemangioma in a 45-year-old patient who referred a 10-year history of urethrorrhagia following normal erection. The hemangioma was treated successfully by argon laser in a single outpatient session with no postoperative complications. CONCLUSION: To our knowledge, this is the first reported case of hemangioma of the urethra treated with the argon laser, an effective therapeutic option which causes little trauma to the urethra and provides comfort to our patients.

[Bilateral obstructive uropathy secondary to encrusted cystitis. Report of a case]. / Uropatía obstructiva bilateral secundaria a cistopatía incrustante. A propósito de un caso.

OBJECTIVES: Bilateral urinary obstruction is usually secondary to tumors or bilateral lithiasis. A rare case of encrusted cystitis causing bilateral hydronephrosis is described. METHODS/RESULTS: A 70-year-old woman presented with severe dysuria and vesical tenesmus. She had previously undergone pelvic surgery and received radiotherapy for a gynecological tumor. She was diagnosed as having encrusted cystitis. Treatment with urinary acidification and antibiotics achieved complete radiological and functional recovery. CONCLUSIONS: Some cases of urinary obstruction can be managed conservatively. An accurate diagnosis is necessary to avoid surgery in these cases.

[Synchronous multiple renal carcinoma. Review of the literature and report of a new case]. / Carcinoma renal múltiple bilateral sincrónico. Revisión de la literatura y aportación de un nuevo caso.

OBJECTIVES: Herein we describe an additional case of bilateral multiple renal cell carcinoma, a rare condition outside the context of phacomatosis. METHODS/RESULTS: A 57-year-old man presented with asymptomatic hematuria. He had no other remarkable medical or urological history. Radiological evaluation disclosed multiple tumors in both kidneys that required bilateral nephrectomy. CONCLUSION: Multiple syncronous renal cell carcinoma has been described in Von Hippel Lindau disease or the polycystic conditions of chronic renal failure. A few cases have been reported in patients who did not have the foregoing conditions or were asymptomatic as the case described herein, who required bilateral nephrectomy.

[Usefulness of the urodynamic study of the lower urinary tract in renal transplantation]. / Utilidad del estudio urodinámico del tracto urinario inferior en el trasplante renal.

OBJECTIVES: To analyze the indications, diagnostic cost-effectiveness and therapeutic implications of urodynamic assessment of the lower urinary tract in two groups of patients: 1) those awaiting renal transplantation and those with a functioning renal graft and voiding disturbances. METHODS: The first group comprised 22 patients who were evaluated before renal transplantation for a total of 32 urodynamic studies. The second group comprised 10 patients with a functioning renal graft for a total of 14 post-transplant urodynamic studies. The etiology of the chronic renal failure, indications for urodynamic assessment and videourodynamic findings in both groups were compared. RESULTS: Interstitial nephropathy associated with vesicoureteral reflux was the most common cause of chronic renal failure in the pre-transplant group, whereas glomerular nephropathy was the most common cause of chronic renal failure in the posttransplant group. Vesicoureteral reflux was the most frequent videourodynamic finding and was associated with other urodynamic disturbances in 75% of the cases. Lower urinary tract obstruction was the most common finding in the posttransplant group. CONCLUSIONS: The indications for urodynamic study in patients awaiting renal transplantation are: 1) interstitial nephropathy associated with vesicoureteral reflux, neurogenic bladder and congenital malformations; 2) patients aged 45 or older with a flowmetry suggesting obstruction; 3) those with urinary diversion, and 4) systemic diseases potentially associated with neurological damage.

[Endourologic treatment of uretero-ileal stenosis]. / Tratamiento endourológico de las estenosis ureteroileales.

OBJECTIVES: Ureterointestinal stricture represents a serious problem whose management has traditionally been by open surgery. Endourological treatment is an alternative that is generally free from the complications of open surgery, but with a lower success rate. The efficacy of endourological treatment is analyzed in 14 cases of ureteroileal stricture (12 patients) and the different treatment options are discussed. METHODS: Ureteroileal stricture was managed endourologically in 9 of 13 cases (69%) by dilatation (6 cases), incision+dilatation (2 cases) and stenting (1 case). RESULTS: Of the 6 cases submitted to dilatation, 3 recurred at 6 months, 2 remained patent at 18 and 24 months, respectively, and 1 was lost to follow up because the patient underwent reimplantation (40% success rate). The two cases submitted to incision are patent at 18 and 19 months, respectively. CONCLUSIONS: The overall success rate for endourological treatment of ureteroileal stricture is 28% (4/14 cases) at 19 months mean follow up.

[Renal infarction following pulmonary surgery in a 13-year-old boy]. / Infarto renal postcirugía pulmonar en varón de 13 años de edad.

We report a case of renal polar infarction in a 13-year old boy following surgical excision of contralateral congenital lobar emphysema. Patient history was unremarkable and yielded no data suggestive of any other underlying pathology or systemic disease. The diagnosis was made on the CT, arteriography and DMSA scan findings. The etiology could not be determined. The patient was treated conservatively with prophylactic antibiotic therapy and followed closely. There were no complications; the patient was asymptomatic one month after the episode. The control IVP showed residual segmental atrophy and ultrasound evaluation disclosed cortical atrophy. The most common cause of this condition, the diagnostic algorithm, treatments and their indications are discussed. Renal graft infarction, which may be associated with acute rejection or venous and/or arterial thrombosis, warrants special attention. The treatment and clinical course are significantly different, although the diagnosis is made using the same methods.

[Endoscopic treatment of congenital paraureteral diverticuli and cavities]. / Tratamiento endoscópico de los divertículos y cavidades paraureterales congénitos.

We report 4 cases of primary congenital paraurethral diverticula or cavities (3 diverticula and 1 cyst of Cowper's glands) that were treated by endoscopic surgery. All the foregoing cases were diagnosed as primary in the absence of coexisting pathologies or associated disorders. The wall between the diverticulum and the urethral lumen was sectioned endoscopically. All patients recovered normal clinical and morphological status.

[Percutaneous nephrolithotomy for coralliform lithiasis in a patient with bilateral triplicated ureters]. / Nefrolitotomía percutánea por litiasis coraliforme en paciente con triplicidad ureteral bilateral.

We report on a rare case of bilateral ureteral triplicity with a definitive urinary diversion (Brickner loop ureteroileostomy) who presented a staghorn stone in the upper calyx of the left kidney. The patient was submitted to percutaneous nephrolithotomy with direct access to the upper calyx of the anomalous kidney. We discuss the indication for this treatment, which resolved the lithiasis in a single session and with no complications. Furthermore, this treatment modality is compared with ESWL and open surgery, which we reserve for failures or those cases where the percutaneous approach is contraindicated. Percutaneous nephrolithotomy can be considered a therapeutic alternative for lithiasis in patients with congenital malformation and/or urinary diversion.

[Blind bifid ureter associated with duplicity and contralateral vesicoureteral reflux]. / Uréter bífido ciego asociado a duplicidad y reflujo vesicoureteral contralateral.

We report on a pediatric patient who was evaluated for recurrent episodes of urinary tract infection. Evaluation by IVP, cystography and retrograde ureteropyelography revealed a complete ureteral duplicity, grade II vesicoureteral reflux in the lower half of the left kidney and a blind bifid ureter arising at the distal third of the right ureter. This is an uncommon condition (about 150 cases have been reported) difficult to diagnose if undetected by conventional radiological evaluation and retrograde ureteropyelography may be required. It may be associated with urological or other types of malformations. It is generally asymptomatic and with scant consequences, thus treatment is initially conservative. Surgical excision of the blind bifid ureter is warranted only when complications present. In the present case, prophylactic antibiotic therapy was instituted. At one year follow up, the patient is asymptomatic and urine cultures are negative.