[Immunohistochemical expression of p53, p21, p16, and cyclin D1 in superficial bladder cancer. A tissue microarray study]. / Expresión inmunohistoquímica de p53, p21, p16 y ciclina D1 en el cáncer de vejiga superficial. Estudio en un soporte de tissue microarray.

INTRODUCTION AND OBJECTIVES: To retrospectively assess the relationship between immunohistochemical expression of p53, p21, p16, and cyclin D1, with recurrence, progression and survival in superficial bladder cancer. METHODS: 163 patients undergoing transurethral resection for superficial bladder cancer between February 1995 and March 2004. Tumor samples were included in a tissue microarray support that was serially sectioned for immunohistochemical staining. Grade and stage associations for each marker were evaluated by the Chi-square test. Assessment of the relationship with recurrence, progression, and survival Kaplan-Meier curves and log-rank test were used. RESULTS: There were no statistically significant differences in marker expression depending on tumor grade and stage, with the exception of Cyclin D1, that was significantly different depending on tumor stage (p=0.030). p21 expression was related to tumor recurrence (p=0.035), progression (p=0.008) and survival (p=0.034). p16 expression was also related to recurrence (p=0.048) and survival (p=0.047), but not to tumor progression (p=0.116). p53 and Cyclin D1 were not statistically associated with tumor recurrence, progression or survival. CONCLUSIONS: In our experience, only p16 and p21 may be useful in the management of superficial bladder tumors, as they are predictors of recurrence and survival in Ta and T1 patients.

Expresión inmunohistoquímica de p53, p21, p16 y Ciclina D1 en el cáncer de vejiga superficial. Estudio en un soporte de tissue microarray / Immunohistochemical expression of P53, P21, P16, and cyclin D1 in superficial Bladder cancer. A tissue microarray study

Introducción y objetivos: Evaluar, de forma retrospectiva, la relación entre la expresión inmunohistoquímica de p53, p21, p16 y ciclina D1, con la recurrencia, progresión tumoral y supervivencia en los carcinomas vesicales superficiales. Métodos: 163 pacientes sometidos a resección transuretral de tumor vesical superficial entre febrero de 1995 y marzo de 2004. Las muestras tumorales evaluadas estaban contenidas en un soporte de tissue microarray, al que se le realizaron varias secciones consecutivas para tinción inmunohistoquímica. La asociación del grado y estadio tumoral con los marcadores se valoró según el test de Chi-cuadrado y para valorar la relación con la recurrencia, progresión y supervivencia se utilizaron las curvas de Kaplan-Meier y se compararon con el log-rank test. Resultados: No se observaron diferencias estadísticamente significativas en la expresión de los marcadores según el grado y estadio tumoral a excepción de la Ciclina D1, que sí mostraba diferencias significativas según el estadio tumoral (p=0,030). La expresión de p21 se relacionó con la recurrencia tumoral (p=0,035), progresión (p=0,008) y supervivencia (p=0,034). La expresión de p16 también se relacionó con la recurrencia (p=0,048) y supervivencia (p=0,047), pero no con la progresión tumoral (p=0,116). La expresión de p53 y ciclina D1 no mostraron asociación estadísticamente significativa con la recurrencia y progresión tumoral ni con la supervivencia. Conclusiones: En nuestra experiencia, sólo los marcadores p16 y p21 pueden ser útiles en el manejo de los tumores vesicales superficiales por ser predictores de recurrencia y supervivencia en pacientes con estadios Ta y T1

Introduction and objectives: To retrospectively assess the relationship between immunohistochemical expression of p53, p21, p16, and cyclin D1, with recurrence, progression and survival in superficial bladder cancer. Methods: 163 patients undergoing transurethral resection for superficial bladder cancer between February 1995 and March 2004. Tumor samples were included in a tissue microarray support that was serially sectioned for immunohistochemical staining. Grade and stage associations for each marker were evaluated by the Chi-square test. Assessment of the relationship with recurrence, progression, and survival Kaplan-Meier curves and log-rank test were used. Results: There were no statistically significant differences in marker expression depending on tumor grade and stage, with the exception of Cyclin D1, that was significantly different depending on tumor stage (p=0.030). p21 expression was related to tumor recurrence (p=0.035), progression (p=0.008) and survival (p=0.034). p16 expression was also related to recurrence (p=0.048) and survival (p=0.047), but not to tumor progression (p=0.116). p53 and Cyclin D1 were not statistically associated with tumor recurrence, progression or survival. Conclusions: In our experience, only p16 and p21 may be useful in the management of superficial bladder tumors, as they are predictors of recurrence and survival in Ta and T1 patients

[Results and complications of TVT procedure in the surgical treatment of female stress incontinence]. / Resultados y complicaciones de la técnica TVT en el tratamiento de la incontinencia de esfuerzo femenina.

OBJECTIVES: To evaluate the efficacy and safety of Tension-free vaginal tape (TVT) for treatment of female stress urinary incontinence (SUI). To determine the mid-term outcome of TVT performed during other pelvic floor reconstructive procedures. PATIENTS AND METHODS: 100 women with SUI undergoing TVT procedure under spinal anesthesia from January 2000 to November 2002 were studied. 76 women were treated with TVT alone. 24 patients were treated with TVT and pelvic floor reconstruction: we repaired 24 cystoceles grade II-III, 3 rectoceles and 4 concomitant vaginal histerectomies. RESULTS: Mean age was 49.3 years (range 35-78). Mean parity: 2 (range 0-6) and mean operative time was 38 minutes (range 20 to 50). The postoperative hospital stay was 24 hours for women treated with TVT alone. Only 1 patient (1%) need bladder catheterization during 7 days due to urinary retention. Mean followup was 18 months (range 12-48). Objective cure rate was 95%. In our study the rate of de novo post-operative urge symptoms (16%) was the most frequent complication. Bladder injury was the most grave problem and it happened in 1 patient (1%). CONCLUSION: The results confirm the feasibility and safety of TVT for treatment of SUI. Moreover, TVT procedure is economical and efectiveness. Pelvic floor defects, benign uterine disorders and SUI can be safely treated with TVT and vaginal procedures during the same surgical time.

Resultados y complicaciones de la técnica TVT en el tratamiento de la incontinencia de esfuerzo femenina / Results and complications of TVT procedure for surgical treatment of female stress incontinence

Objetivos: Evaluar la eficacia y seguridad de la cinta vaginal sin tensión (TVT) en el tratamiento de la incontinencia urinaria de esfuerzo femenina (IUE).Analizar los resultados a medio plazo de la asociación de la TVT con la corrección quirúrgica de prolapsos genitales. Pacientes y método: Se estudian 100 pacientes con IUE intervenidas de forma consecutiva en nuestro centro bajo anestesia regional. A todas ellas se les implantó la TVT y en 24 casos además, se corrigió un cistocele grado II-III. Fue necesario en 3de estas 24 pacientes reparar un rectocele y se practicaron 4 histerectomías vaginales en el mismo acto quirúrgico. Resultados: La edad media de las mujeres fue de 49,3 años (35-78), el número promedio de partos de 2 (0-6), la duración media de la intervención de 38 minutos (20-50) y todas las pacientes a las que se colocó la TVT sin otras correcciones quirúrgicas obtuvieron el alta hospitalaria a las 24 horas de la intervención. Tan sólo una paciente precisó de sonda varios días por retención urinaria. El tiempo medio de seguimiento fue de 18 meses (12-48) y la IUE se solucionó en el 95% de los casos. Como complicación más frecuente observamos la aparición de hiperactividad detrusorial sintomática “de novo” en el 16% de la serie; la perforación vesical en una de las pacientes fue el problema más grave. Conclusiones: La TVT es una técnica sencilla, segura, eficaz y relativamente económica para el tratamiento de la IUE. La TVT puede asociarse con éxito a la corrección quirúrgica de prolapsos genitales. Este hecho prolonga la estancia hospitalaria en 48 horas sin incrementar la morbilidad de la cirugía (AU)

Objetives: To evaluate the efficacy and safety of Tension-free vaginal tape (TVT) for treatment of female stress urinary incontinence(SUI).To determine the mid-term outcome of TVT performed during other pelvic floor reconstructive procedures. Patients and methods: 100 women with SUI undergoing TVT procedure under spinal anesthesia from January 2000 to November 2002 were studied.76 women were treated with TVT alone. 24 patients were treated with TVT and pelvic floor reconstruction: we repaired 24cystoceles grade II-III, 3 rectoceles and 4 concomitant vaginal histerectomies. Results: Mean age was 49,3 years (range 35-78). Mean parity: 2 (range 0-6) and mean operative time was 38 minutes (range20 to 50). The postoperative hospital stay was 24 hours for women treated with TVT alone. Only 1 patient (1%) need bladder catheterization during 7 days due to urinary retention. Mean follow up was 18 months (range 12-48). Objetive: cure rate was 95%. In our study the rate of de novo post-operative urge symptoms (16%) was the most frequent complication. Bladder injury was the most grave problem and it happened in 1patient (1%). Conclusion: The results confirm the feasibility and safety of TVT for treatment of SUI. Moreover, TVT procedure is economical and efectiveness. Pelvic floor defects, benign uterine disorders and SUI can be safely treated with TVT and vaginal procedures during the same surgical time (AU)

[Analysis of medical/surgical complications of cutaneous ileostomy]. / Análisis de las complicaciones médico-quirúrgicas en las ileostomías cutáneas.

OBJECTIVE: Our objective is to carried out a descriptive study about medical-surgical complications and alterations about quality of life in stoma patients secondary to bladder tumour. PATIENTS AND METHOD: The series are composed of 67 patients. The mean age was 70.3 years. We analyse the following variable: early and late medical-surgical complications, the body mass index (BMI) change and the alteration of quality of life. RESULTS: The most frequent early complication is the ischemic necrosis (7%) without posterior repercussion. The late complications in frequency order are: peristomal dermatitis (18%), plane stoma (12%), peristomal hernia (12%), stenosis (9%) and granuloma (6%). The BMI changes don't conditionate a increase in the complications. The psychological adaptation is good in 92%, although the majority affirm a little changes in life-style, but they don't have a repercussion on quality of life. CONCLUSIONS: In this series we estimate a low incidence of complications. The preoperative counsel and the posterior following by the stoma care nurse-surgeon team, play a fundamental role on psychological adaptation after surgery.

Análisis de las complicaciones médicoquirúrgicas en las ileostomías cutáneas / Analysis about quality of life variables in stoma patients medical-surgical complications

OBJETIVOS: Nuestro objetivo es realizar un estudio descriptivo de las complicaciones médico-quirúrgicas y alteraciones de la calidad de vida de los pacientes portadores de derivación cutánea uretero-ileal por patología tumoral vesical. PACIENTES Y MÉTODO: La serie consta de 67 pacientes con una edad media de 70,3 años. Se analizan las siguientes variables: las complicaciones médico-quirúrgicas precoces tempranas y tardías, las variaciones del índice de masa corporal (IMC) y la afectación de la calidad de vida. RESULTADOS: La complicación precoz más frecuente es la necrosis de mucosa (7%) sin repercusión posterior. Las complicaciones tardías en orden de frecuencia son las dermatitis (18%), estoma plano (12%), hernia paraestomal (12%), estenosis (9%) y granulomas (6%). Las variaciones del IMC no condicionan un aumento del número de complicaciones. La adaptación psicológica es buena en el 92%, aunque la mayoría reconoce pequeños cambios en sus hábitos que no repercute en su calidad de vida. CONCLUSIÓN: En esta serie se aprecia una baja incidencia de complicaciones. Los consejos preoperatorios y el seguimiento posterior por el equipo cirujano-estomaterapeuta juega un papel fundamental en la adaptación psicológica después de la cirugía

OBJECTIVE: Our objective is to carried out a descriptive study about medical-surgical complications and alterations about quality of life in stoma patients secondary to bladder tumour. PATIENTS AND METHOD: The series are composed of 67 patients. The mean age was 70.3 years. We analyse the following variable: early and late medical-surgical complications, the body mass index (BMI) change and the alteration of quality of life. RESULTS: The most frequent early complication is the ischemic necrosis (7%) without posterior repercussion.The late complications in frequency order are: peristomal dermatitis (18%), plane stoma (12%), peristomal hernia (12%), stenosis (9%) and granuloma (6%).The BMI changes don’t conditionate a increase in the complications.The psychological adaptation is good in 92%, although the majority affirm a little changes in life-style, but they don’t have a repercussion on quality of life. CONCLUSIONS: In this series we estimate a low incidence of complications. The preoperative counseland the posterior following by the stoma care nurse-surgeon team, play a fundamental role on psychological adaptation after surgery

[Histopathologic validation of the tissue-microarray technology of urothelial cancer. Our experience]. / Validación histopatológica de la tecnología tissue-microarray de cáncer de urotelio. Nuestra experiencia.

INTRODUCTION: The array technology offers: a big advance to clinic and basic investigator, it provides a variety of technics (immunohistochemistry, FISH, proteomics) to understand the molecular mechanisms of cancer. It offers scale economy in reagents versus the conventional methods. Array most be ratified because the sample is so reduced. MATERIAL AND METHODS: 52 consecutive cases have been chosen from paraffin blocks of bladder and ureteral cancer which are 5-7 years old, a tissue array has been made; disks have been arranged in lines and columns, in an aleatory way, in order to guide it's reading. It has been evaluated by a pathologist with any relation to specimen selection. RESULTS: 87 sheets ha been obtained. Number 1 has been dyed with HE. Has been discrepancy in 27% of sample's stage. Has not been a discrepancy in histopathologic diagnostic. There is no sample's representation in 11 points (17%). DISCUSSION: Our results offer good results in sample's validation. The sample's antigenicity of tissue is conserved. Array sample's represent a 97%, similarly to all unit of conventional sections of the specimen.

[Doxazosin in the gastrointestinal therapeutic system (GITS) formulation and trial without catheter after acute urinary retention due to BPH. Dose increase action on recovery effect]. / Doxazosina en formulación de liberación retardada en la retención aguda de orina por hiperplasia benigna de próstata. Acción del incremento de dosis sobre el efecto rescate.

OBJECTIVE: Prospective and randomised study to assess the effectiveness of doxazosin in sustained release formulation in Acute Urinary Retention (AUR) treatment due to benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: The trial was carried out with a cohort of 40 males who had all suffered their first attack of AUR caused by BPH. Twenty were randomly selected and treated for 7 days with 4 mg of sustained release doxazosin before removing the catheter. The patients not treated that could not spontaneously urinate were also administered 4 mg of doxazosin. Finally, all the patients that still had a catheter due to unsuccessful removal were treated with 8 mg of doxazosin and the percentage of patients responding to treatment was assessed. The predictive value of the response to treatment for age, IPSS, QoL, retained urine volume, prostate volume and the evolution time of the prostratism was determined by means of logistic regression analysis. RESULTS: 82.5% of the patients (33/40) could urinate after removal of the catheter. 84.8% (28/33) were treated with doxazosin (21 with 4 mg and 7 with 8 mg). In the first attempt at removal, 60% of the patients (12/20) treated with 4 mg of doxazosin could spontaneously urinate, while only 25% (5/20) of those not treated, p=0.02. Similarly, 60% of the patients (9/15) treated with 4 mg of doxazosin in the second attempt could spontaneously urinate. Fifty per cent (7/14) of the patients still with a catheter, after the treatment with 4 mg of doxazosin, could urinate with 8 mg. In the logistic regression analysis, none of the variables analyzed allowed us to predict the response to the treatment. CONCLUSION: The treatment for 7 days with 4 mg of sustained release doxazosin shows greater success when removing the catheter after suffering AUR due to BPH. With this treatment, 60% of the patients could spontaneously urinate again. By increasing the dose to 8 mg, the catheter can be removed in half the patients that did not initially respond. Before removing the catheter it is not possible to predict which patients would be able to spontaneously urinate.

Validación histopatológica de la tecnología tissue-microarray de cáncer de urotelio. Nuestra experiencia / Histopatological validation of tissue-microarray technology in uroletial cancer. Our experience

INTRODUCCIÓN: La tecnología array ofrece: gran ventaja a los investigadores clínicos y básicos, facilita aplicar gran cantidad de técnicas (inmunohistoquímica, FISH, proteómica) para comprender los mecanismos moleculares del cáncer, ofrece economía de escala en los reactivos versus los procedimientos convencionales. Dado que la representación de la muestra es muy reducida, es exigible previamente validar el array. MATERIAL Y MÉTODOS: A partir de bloques de parafina de carcinomas de urotelio almacenados, cuya antigüedad oscilaba entre 5-7 años, se han seleccionado 52 casos consecutivos; se ha construido un array de tejido; los discos se colocaron en filas y columnas de manera aletoria, dibujando un topograma para guía de lectura. Se validó por otro patólogo ajeno a la selección de las muestras. RESULTADOS: Se han obtenido 87 laminillas. La número 1 se ha teñido con HE. Ha habido discrepancia en el 27% de las muestras en el estadiaje. No ha existido discrepancia en el diagnóstico histológico. En 11 puntos (17%) no hay representación de la muestra. DISCUSIÓN: Nuestros resultados ofrecen unos buenos resultados en la validación de las muestras. La antigenicidad del tejido está conservada. Las muestras seleccionadas en el array representan alrededor del 97%, similar a todo el conjunto de las secciones convencionales de la muestra problema (AU)

INTRODUCTION: The array technology offers: a big advance to clinic and basic investigator, it provides a variety of technics (immunohystochemistry, FISH, proteomics) to undestand the molecular mechanisms of cancer. It offers scale economy in reagents versus the conventional methods. Array most be ratified because the sample is so reduced. MATERIAL AND METHODS: 52 consecutive cases have been cloosen from paraffin blocks of bladder and ureteral cancer which are 5-7 years old, a tissue array has been made; disks have been arranged in lines and columns, in an aleatory way, in order to guide it’s reading. It has been evaluated by a pathologist with any relation to specimen selection. RESULTS: 87 sheets ha been obtained. Number 1 has been dyed with HE. Has been discrepancy in 27% of sample’s stage. Has not been a discrepancy in hystopathologic diagnostic. There is no sample’s representation in 11 points (17%). DISCUSSION: Our results offer good results in sample’s validation. The sample’s antigenicity of tissue is conserved. Array sample’s represent a 97%, similary to all unit of conventional sections of the specimen (AU)

Doxazosina en formulación de liberación retardada en la retención aguda de orina por hiperplasia benigna de próstata. Acción del incremento de dosis sobre el efecto rescate / Doxazosin in the gastrointestinal therapeutic system (gits) formulation and trial without catheter after acute urinary retention due to bph. Dose increase action on recovery effect

OBJETIVO: Estudio prospectivo y randomizado para valorar la utilidad de la doxazosina en formulación de liberación retardada en la retención aguda de orina (RAO) por hiperplasia benigna de próstata (HBP).MATERIAL Y MÉTODOS: Se estudia una cohorte de 40 varones consecutivos con un primer episodio de RAO por HBP. Veinte son tratados aleatoriamente durante 7 días con 4 mg de doxazosina de liberación retardada antes de la retirada del catéter. Los pacientes no tratados que no restablecieron las micciones espontáneas recibieron también 4 mg de doxazosina. Finalmente, todos los pacientes que persistieron con catéter por retirada infructuosa fueron tratados con 8 mg de doxazosina, evaluándose el porcentaje de pacientes respondedores. Se determina mediante análisis de regresión logística el valor predictivo de la respuesta al tratamiento de la edad, IPSS, QoL, volumen de orina retenido, volumen prostático y tiempo de evolución del prostatismo. RESULTADOS: El 82,5 por ciento de los pacientes (33/40) consiguieron la micción tras la retirada del catéter. El 84,8 por ciento (28/33) fueron tratados con doxazosina (21 con 4 mg y 7 con 8 mg). En el primer intento de retirada, el 60 por ciento de los pacientes (12/20) tratados con 4 mg de doxazosina consiguieron micción espontánea, mientras tan sólo el 25 por ciento (5/20) de los no tratados, p=0,02. Igualmente, el 60 por ciento de los pacientes (9/15) tratados con 4 mg de doxazosina en segunda intención, consiguieron micción espontánea. Finalmente, el 50 por ciento (7/14) de los pacientes portadores de catéter tras el tratamiento con 4 mg de doxazosina consiguieron micción con 8 mg. En el análisis de regresión logística, ninguna de las variables analizadas permitió predecir la respuesta al tratamiento. CONCLUSIÓN: El tratamiento durante 7 días con 4 mg de doxazosina de liberación sostenida permite retirar con mayor éxito el catéter tras RAO por HBP. Con este tratamiento, el 60 por ciento de los pacientes consiguen reanudar la micción espontánea. Incrementando la dosis a 8 mg es posible la retirada del catéter hasta en la mitad de los pacientes inicialmente no respondedores. No es posible predecir, antes de la retirada del catéter, que pacientes conseguirán la micción espontánea (AU)

[Cystoscopic impression versus histologic diagnosis in bladder tumors. Do they coincide?]. / La impresión cistoscópica frente al diagnóstico histológico en los tumores vesicales. Coinciden?

OBJECTIVE: How quality control in a university hospital and immediatly after to resents publications; we planed to evaluation of the correlation of cystoscopy impression with the histologic diagnosis after of transurethral resection (TUR). MATERIAL AND METHODS: To give more truthfulness to the study, we requested to all department member's, that to base in your experience to describe the endoscopic characteristic of the next bladder tumors groups: superficial and low-grade GI-II Ta, superficial and high-grade GIII Ta and high grade and/or T1-< T2. In a total of 172 patients, we evaluated the initial cystoscopy impression and we to compared it with histologic diagnosis after to TUR. RESULTS: In 172 tumors the cystoscopy classifed in 69 cases how superficial and low grade GI-II Ta-T1, 40 how superficial and high grade and 55 how high grade and/or invasive tumors GIII T1-< T2. When, we compared it with the histologic diagnosis, the cystoscopy to coincided in 46 de 69 cases (66.6%) (PNS) with the group of low-grade GI-II Ta-T1 in 13 of 40 (32.5%) (P < 0.005) with the group of superficial high grade GIII Ta and 45 of 51 (88.2%) (PNS) with the group of GIII T1 and/or invasive tumors. In 15 of 172 the endoscopic description its not conclusive. And finally in 12 cases the histologic diagnosis were normal. CONCLUSIONS: In order of this results, we to consider that in a university hospital is essential the histologic diagnosis before any therapeutic decision, because the initial cystoscopy impression have a low correlation with the histologic diagnosis. We are disagreement with recent publication that propose the outpatient cystoscopy with fulguration to base only to the cystoscopy impression.

La impresión cistoscópica frente al diagnóstico histológico en los tumores vesicales. ¿Coinciden? / The cystoscopy impression in front of histologic diagnosis in the bladder tumors. To coincide?

OBJETIVO: Como control de calidad en un hospital docente como el nuestro y a raíz de publicaciones recientes al respecto, nos propusimos evaluar la correlación existente entre la impresión cistoscópica de los tumores vesicales y el diagnóstico histológico posterior a la resección transuretral (RTU).MATERIAL Y MÉTODOS: Para darle mayor objetividad al estudio, solicitamos a todos los miembros del servicio (tanto staff como residentes) que, basados en su experiencia describieran, las características endoscópicas de los siguientes grupos de tumores vesicales: superficiales de bajo grado (T.S.B.G.) GI-II Ta-T1, superficiales de alto grado (T.S.A.G.) GIII Ta, y tumores de alto grado y/o invasivos GIII T1-

OBJETIVE: How quality control in a university hospital and immediatily after to recents publications; we planed to evaluation of the correlation of cystoscopy impression with the histologic diagnosis after of transurethral resection (TUR). MATERIAL AND METHODS: To give more truthfulness to the study, we requested to all departament member’s, that to base in your experience to describe the endoscopic characteric of the next bladder tumors groups: superficial and low-grade GI-II Ta, superficial and high-grade GIII Ta and high grade and/or T1-

[Vesico-sphincter dysfunction in 108 cases of multiple sclerosis]. / Disfunción vésico-esfinteriana en 108 casos de esclerosis múltiple.

OBJECTIVE: To study vesicosphincteric dysfunction in 108 patients with multiple sclerosis. METHODS: We reviewed the clinical records of 108 patients with multiple sclerosis and analyzed those with voiding symptoms ascribable to multiple sclerosis. These patients underwent complete urodynamic assessment and complementary tests according to their symptoms. The Blaivas classification was used for the clinical classification of multiple sclerosis. RESULTS: 64 of the 108 patients presented voiding symptoms ascribable to multiple sclerosis (59.2%). The clinical features presented as episodes in 75% and were progressive in 25% of the cases. In 6% of the patients, the voiding symptoms were the first symptoms of multiple sclerosis. Urodynamic assessment showed detrusor hyperreflexia in 73% of the patients, hyporeflexia in 14%, and 13% showed normal urodynamics. All complications were infective; no patient showed upper urinary tract complications. CONCLUSIONS: Vesicosphincteric dysfunction in multiple sclerosis is frequent. Most of the patients present bladder hyperreflexia. The urological complications are usually infective. Involvement of the upper urinary tract is rare.

Efecto del tratamiento antibiótico sobre el psa y porcentaje de psa libre en pacientes con criterios bioquímicos de biopsia prostática / Effect of antibiotic treatment on serum PSA and percent free PSA levels in patients with biochemical criteria of prostatic biopsy

INTRODUCCIÓN: La determinación de la concentración sérica de PSA es la principal herramienta en el diagnóstico precoz del cáncer de próstata. Sin embargo, es conocida su falta de especificidad por el solapamiento existente con patologías benignas. Aunque es conocido que la inflamación puede contribuir a esta falta de especificidad, existe discrepancia sobre la influencia de los focos inflamatorios prostáticos sobre la concentración de PSA total y libre en pacientes sin evidencia clínica de prostatitis. OBJETIVOS: Analizar las variaciones biológicas intra-individuales de la concentración de PSA y porcentaje de PSA libre (% PSAL) en pacientes con criterios bioquímicos de biopsia prostática, y compararlos con la variación inducida por el tratamiento antibiótico en una cohorte de pacientes con historia de procesos infecciosos. PACIENTES Y MÉTODO: Se analizan 60 pacientes con antecedentes infecciosos, tacto rectal no sospechoso y PSA entre 4 y 20 ng/ml. Se determina la concentración de PSA y % PSAL. Treinta son tratados con 3 semanas de ofloxacino tras lo que se repite la determinación de marcadores. Todos los pacientes son sometidos a biopsia prostática ecodirigida por sextantes. RESULTADOS: 45 pacientes presentaron HBP (29 con focos de prostatitis) y 15 cáncer (T1c). Se encontraron variaciones significativas en el PSA (6,97 ng/ml vs 5,82 ng/ml, p = 0,001) y % PSAL (14,73 % vs 17,77 %, p = 0,01) sólo en los pacientes tratados. Estas diferencias fueron significativas para los pacientes con HBP y HBP con prostatitis asociada y no para los pacientes con cáncer. La tendencia de los pacientes tratados fue a disminuir el PSA (13 pacientes tratados con PSA < 4 ng/ml vs 2 pacientes no tratados) y a incrementar el % PSAL. La variación mediana del % PSAL fue superior a la del PSA y no estuvo influenciada ni por el PSA inicial ni por el volumen prostático. Estableciendo el punto de corte para el % PSAL en 25, se podría reducir el 18,3% de biopsias innecesarias tras la 1ª determinación y el 20% tras la 2ª. Asociando la reducción del PSA se podría reducir hasta el 56% en los pacientes tratados. CONCLUSIÓN: Los criterios bioquímicos de biopsia prostática pueden verse modificados en los pacientes con antecedentes inflamatorios debido a variaciones superiores a las explicadas por la variación biológica intra-individual, y pueden estar inducidas por el tratamiento. Estos resultados sugieren que los focos inflamatorios pueden influir en el PSA y % PSAL (AU)

[Effect of antibiotic treatment on PSA and percentage of free PSA in patients with biochemical criteria of prostatic biopsy]. / Efecto del tratamiento antibiótico sobre el PSA y porcentaje de PSA libre en pacientes con criterios bioquímicos de biopsia prostática.

INTRODUCTION: PSA serum level measurement in the most important tool in the early diagnosis of prostate cancer patients. However, it is recognised it low specificity is due mainly to prostatic benign diseases. Although it is known that inflammation can contribute on this lack of specificity, there is disagreement in the effect of no symptomatic prostatic inflammatory focus on total PSA and percent free PSA serum levels. AIM: To analyse the biological variability in total PSA and percent free PSA serum levels in patients with biochemical criteria of prostatic biopsy and to compare them with the antibiotic induced variability in a previous urinary infections cohort patients. PATIENTS AND METHODS: We analysed 60 patients with previous urinary infections, normal digital rectal examination and PSA between 4 and 20 ng/ml. We measured total PSA and percent free PSA serum levels. Thirty were treated with 3 weeks of ofloxacin and following a new marker determination. Sextant ultrasound guided prostatic biopsy was performed in all cases. RESULTS: 45 patients demonstrated BPH (29 with prostatitis) and 15 prostate cancer (T1c). Significant variations were found on total PSA serum levels (6.97 ng/ml vs 5.82 ng/ml, p = 0.001) and percent free PSA (14.73% vs 17.77%, p = 0.01) only in treated patients. These differences were significant in BPH and BPH with prostatitis patients but not in prostate cancer patients. Treated patients trend was to decrease PSA (13 treated patients shown PSA < 4 ng/ml vs 2 control patients) and to increase percent free PSA. The median variation of percent free PSA was higher than total PSA and was not influenced by PSA level or prostatic volume. Taking 25 as cut-off of percent free PSA, 18.3% of prostatic biopsies could be avoided in the first determination and 20% in the second. Adding the total PSA reduction, 56% of prostates biopsies in the treated patients could be avoided. CONCLUSIONS: Biochemical criteria of prostatic biopsy could be modified in patients with previous urinary infections due to higher variations on serum markers than those explained by biological variations. These variations could be induced by the antibiotic treatment. These results suggested that the inflammatory focus could influence on total PSA and percent free PSA serum levels.

[Incidental diagnosis of bladder carcinoma]. / Diagnóstico incidental del carcinoma vesical.

OBJECTIVE: To analyze the prognostic factors of incidentally diagnosed bladder carcinomas with special reference to the complementary diagnostic tests. METHODS: 308 cases of carcinoma of the bladder were reviewed. These were divided into two groups: those that had been diagnosed on the basis of the clinical features and those that had been incidentally detected. The prognostic factors of size, grade, histological type, and pathological stage were analyzed. RESULTS: Local tumor stage was the only statistically significant prognostic factor. 14.7% of the superficial and 3.6% of the infiltrating carcinomas had been incidentally diagnosed. Ultrasound was the most frequently utilized diagnostic method (87.2%). CONCLUSIONS: In our series, the incidentally diagnosed carcinoma of the bladder has a higher probability of being a superficial lesion than those that are symptomatic and therefore the prognosis is better. Since ultrasound was the most frequently utilized diagnostic method, it might be advisable to assess the bladder in patients undergoing abdominal ultrasound evaluation.

[Predictive factors of locally advanced disease in patients with prostatic cancer treated with neoadjuvant hormone therapy and radical prostatectomy]. / Factores predictivos de enfermedad localmente avanzada en pacientes con cáncer de próstata tratados con hormonoterapia neoadyuvante y prostatectomía radical.

AIM: To analyze the predictors of local adverse pathological findings (positive surgical margins and seminal involvement) in prostate cancer patients treated with neoadjuvant hormonotherapy and radical prostatectomy. PATIENTS AND METHODS: We studied seventy-eight patients treated with neoadjuvant androgen blockade prior to radical prostatectomy between 1995 and 1998. Age, PSA, prostate volume determined by transrectal ultrasound and/or magnetic resonance imaging, clinical stage, Gleason score, duration of blockade, pathological stage and tumoral volume were analyzed. RESULTS: 34.6% of patients (27/78) had adverse pathology (odds: 0.53). No significant differences were found in age, PSA, prostate volume, duration of blockade and Gleason score between organ-confined and locally advanced patients. Differences were found in tumor volume (p = 0.0001) but this was not different in order to positive or negative digital rectal examination (p = 0.5334). The efficacy for predicting pathological adverse findings was represented by ROC curves (PSA: 0.628, clinical stage: 0.612 and Gleason score: 0.545). Predictive table of extracapsular disease for different PSA levels, clinical stage and Gleason score were developed. No variable predicted positive margins in logistic regression model. CONCLUSIONS: Clinical variables do not predict locally advanced disease in prostate cancer patients treated with neoadjuvant androgen blockade. This is associated with higher tumor volumes. The probability of positive margins or seminal involvement increases with PSA level and Gleason score.

Factores predictivos de enfermedad localmente avanzada en pacientes con cáncer de próstata tratados con hormonoterapia neoadyuvante y prostatectomía radical / Predictors of local adverse pathological findings in prostate cancer before neoadjuvant androgen with drawal therapy and radical prostatectomy

OBJETIVO: Analizar los factores predictivos de la enfermedad localmente avanzada (márgenes positivos y afectación seminal) en pacientes con cáncer de próstata tratados con hormonoterapia neoadyuvante y prostatectomía radical. PACIENTES Y MÉTODO: Se evalúan 78 pacientes tratados con bloqueo completo neoadyuvante y cirugía radical desde 1995 hasta 1998. Se analizan la edad, el PSA inicial, el volumen prostático determinado mediante ecografía transrectal y/o resonancia magnética, el estadio clínico, el grado de Gleason, el tiempo de bloqueo, el estadio patológico y el volumen tumoral. RESULTADOS: El 34,6 por ciento de los pacientes (27/78) presentaron márgenes positivos o afectación seminal (Odds: 0,53). No existieron diferencias significativas en la edad, el PSA inicial, el volumen prostático, el tiempo de bloqueo ni el grado de Gleason entre los pacientes con tumor órgano-confinado o localmente avanzado. Si existieron diferencias en el volumen tumoral (p = 0,0001). No obstante, el volumen tumoral no fue diferente en los pacientes con enfermedad palpable o no palpable (p = 0,5334). La eficacia para predecir los hallazgos patológicos adversos fue representada mediante curvas ROC (PSA: 0,628, estadio clínico: 0,612 y Gleason: 0,545). Se crearon tablas predictivas de la afectación extraprostática con diversos niveles de corte de PSA, estadio clínico y grado de Gleason. En el modelo de regresión logística ninguna de las variables analizadas demostró poder predecir de manera independiente la existencia de los márgenes positivos. CONCLUSIÓN: Las actuales variables clínicas no permiten predecir de manera fidedigna la existencia de enfermedad localmente avanzada en los pacientes tratados con neoadyuvancia. Esta se asocia, no obstante, a volúmenes tumorales grandes. La probabilidad de márgenes positivos o afectación seminal aumenta con la concentración de PSA y con el grado de Gleason (AU)

[The preoperative diagnosis of complex renal cystic masses]. / Diagnóstico preoperatorio de las masas quísticas renales complejas.

OBJECTIVE: To analyze the preoperative diagnostic methodology in a series of patients with complicated cystic renal masses in relation to the definitive anatomopathological findings. METHOD: 20 cases of asymptomatic complicated cystic renal masses in 19 patients submitted to surgical exploration are described. All cases were evaluated by US and CT. Fine needle punction-aspiration biopsy (FNPA) was done in 17 of the 20 masses and pre and postoperative anatomopathological analyses were performed. RESULTS: Following the Bosniak classification for complicated cystic masses, the US study showed two cases were type I, 5 type II, 10 type III, and 3 type IV, while the CT findings showed no type I, 8 type II, 9 type III and 3 type IV. The definitive anatomopathologic diagnosis was that of renal cell carcinoma in 11 cases. All but one (type II) of these 11 cases were Bosniak III or IV. Nine had a preoperative FNPA which showed malignant cells in two cases, while the remaining 7 were negative. The preoperative biopsy was negative in one of the 11 cases with renal cell carcinoma. The remaining 9 cases of complicated renal mass were simple cysts complicated by hemorrhage or infection. CONCLUSIONS: In our series, the use of the Bosniak classification system preoperatively highly correlated with the presumed benign or malignant nature of the lesion. FNPA biopsy, however, was not found to be very useful in the preoperative diagnosis of complicated cystic renal masses; it showed a sensitivity of 22% and a negative predictive value of 46.7%. Although the foregoing data have no statistical significance, a negative FNPA biopsy of a complicated cystic renal mass that raises reasonable doubts does not change the indication for a surgical exploration.

[Management of hyposalivation caused by oxybutynin chloride in the treatment of the unstable bladder]. / Manejo de la hiposialia producida por el cloruro de oxibutinina en el tratamiento de la vejiga inestable.

OBJECTIVE: To know the incidence of adverse reactions from Oxybutynin Chloride, with special reference to salivary hyposecretion and to evaluate the effectiveness of the different alternatives employed to solve it. MATERIAL AND METHOD: 144 adult patients with signs and symptoms of voiding urgency and detrusor-hyperactivity incontinence, who were treated with Oxybutynin 5 to 15 mg/day. Hyposecretion of several exocrine glands was evaluated using a questionnaire that included subjective and objective parameters. For managing purposes, patients were divided into 3 groups: 1) General measures; 2) Therapy with sialagogues; and 3) Replacement therapy with artificial saliva. RESULTS: 42% patients treated with Oxybutynin developed mild-to-moderate hyposialism. 26% had severe hyposialism, always related to high dose Oxybutynin. 6% skin dryness, 3% eye dryness and 2% dryness in all the above glands (dry syndrome). Regarding treatment, most patients with mild-to-moderate hyposialism were managed with simple general measures. In severe hyposialism, both sialagogues (Eledoisine) and artificial saliva (Bucalsone) were resolutive in over 90% cases. CONCLUSIONS: Oxybutynin is an effective drug to stop detrusor hyperactivity, but it has a high rate of anticholinergic adverse reactions. There is a number of effective therapeutic options available to alleviate these effects, which allow the patient to continue with the treatment.