[Evaluation of our series of first biopsies and rebiopsies by applying a prostate cancer risk calculator.] / Evaluación de nuestra serie de primeras biopsias y rebiopsias mediante la aplicación de calculadora de riesgo de cáncer de próstata.

OBJECTIVES: 1.- To know the risk of detectable Prostate Cancer (PC) and significant PC by applying a Risk Calculator to patients who underwent a prostate biopsy (PB) and to analyze if there are significant differences between the risk of patients who had positive versus negative biopsies. 2.- To compare the risk of those patients with positive results who were detected in the first biopsies vs re-biopsies. 3.- To compare our results with those obtained if we had applied the cut points established in the CP risk calculator. METHODS: Through a retrospective descriptive analytical study, we studied 496 prostate biopsies (PB) performed during 3 years (2014-2016), applying the SWOP risk calculator, analyzing if there are significant differences between those patients who had a positive vs negative result and those submitted to re-biopsies. RESULTS: The mean risk of detectable PC by the calculator for positive PB was 34.98% versus 24.71% of negative PB; in relation to the risk of significant PC, for positive PB it was 19.13% versus 8.8% of the negative PB, with significant differences (p<0.01) in both comparisons. When patients were grouped by first biopsies vs re-biopsies, we observed that patients with the first positive biopsy had an estimated risk by the calculator of 44% compared to 31% of the first negative prostate biopsies, this difference being statistically significant. CONCLUSIONS: The application of a prostate cancer risk calculator in candidates for first biopsy allows optimization of the test, although it loses effectiveness in patients with previous negative PB.

OBJETIVOS: 1.- Conocer el riesgo de Cáncer de Próstata (CP) detectable y el riesgo de CP significativo mediante la aplicación retrospectiva de una Calculadora de Riesgo de los pacientes a los que se les realizó una biopsia de próstata y analizar si existen diferencias significativas entre el riesgo de los pacientes que tuvieron resultado de biopsias positivas vs negativas. 2.- Comparar el riesgo de aquellos pacientes con resultado positivo que fueron detectados en primeras biopsias vs rebiopsias. 3.- Comparar nuestros resultados con los obtenidos si hubiéramos aplicado los puntos de cortes establecidos en la calculadora de riesgo de CP. MÉTODOS: Mediante estudio analítico descriptivo retrospectivo estudiamos las 496 biopsias de próstata (BP) realizadas durante 3 años (2014-2016), aplicando la calculadora de riesgo SWOP analizando si existen diferencias significativas entre aquellos pacientes que tuvieron un resultado positivo vs negativo así como los sometidos a rebiopsias. RESULTADOS: La media de riesgo de CP detectable mediante la calculadora para las BP positivas fue del 34,98% frente al 24,71% de las BP negativas; en cuanto al riesgo de CP significativo las BP positivas tuvieron una cifra de 19,13% frente al 8,8% de las BP negativas, existiendo diferencias significativas (pambas comparaciones. Al agrupar los pacientes por primeras biopsias vs rebiopsias observamos que los pacientes con primera biopsia positiva tenían un riesgo estimado por la calculadora del 44% frente al 31% de las primeras biopsias de próstata negativas siendo esta diferencia estadísticamente significativa. CONCLUSIONES: La aplicación de una calculadora de riesgo de CP en pacientes candidatos a primera biopsia, permite la optimización de la prueba, si bien, parece perder eficacia en pacientes con BP negativas previas.

[First prostate biopsy vs rebiopsy: Analysis of our series.] / Primeras biopsias prostáticas vs rebiopsias: análisis de nuestra serie.

INTRODUCTION: Prostate re-biopsydoes not guarantee detection of prostate cancer(PC), sometimes leading to overdiagnosis of clinicallyinsignificant tumors. The present study shows theincidence of PC in our hospital and analyzes thedistribution of risk groups and prognosis depending inthe diagnosis obtained by first biopsy vs rebiopsy. OBJECTIVES: 1. To know the incidence of ProstateCancer (PC) in patients biopsied in our hospital duringthe years 2014, 2015 and 2016 as well as thedistribution by risk and prognosis groups.2. To know if there are significant differences in thedistribution of risk and prognostic groups among patientsdiagnosed of PC by first biopsy vs rebiopsies in ourhospital in the years 2014, 2015 and 2016. MATERIALS AND METHODS: A longitudinal retrospectivedescriptive and analytical study was performed with496 patients undergoing prostate biopsy (PB) in ourhospital between January 1st 2014 and December31st 2016. We analyze the results of prostate biopsy,Gleason score and distribution by prognosis group toverify if there were significant differences between firstbiopsy vs prostate biopsy. RESULTS: The rate of positive PB in first biopsy was38.3% compared to 26.8% in rebiopsy. There weresignificant differences (p=0.01). In our series wediagnosed in first biopsy 71.8% of significant PC andthe 90% of the of bad or very bad prognosis PC (groups4 and 5 according to the ISUP classification). CONCLUSIONS: There are significant differences inthe diagnosis of prostate cancer between a first biopsyand a rebiopsy. Tumors diagnosed by rebiopsies havea better prognosis than those diagnosed by first biopsy.We must adopt mechanisms to increase the diagnosticyield of re-biopsies.

INTRODUCCIÓN: La rebiopsia no garantiza la detección de cáncer de próstata (CP) conllevando en ocasiones al sobrediagnostico de tumores clínicamente no significativos. El presente trabajo exponela incidencia de CP en nuestro centro y analiza la distribución por grupos de riesgo y pronóstico según hayan sido diagnosticados mediante primera biopsia vs rebiopsias. OBJETIVOS: 1.Conocer la incidencia de Cáncer de Próstata (CP) en los pacientes biopsiados en nuestro hospital durante los años 2014, 2015 y 2016 así como conocer también la distribución por grupos deriesgo y pronóstico. 2.Conocer si existen diferencias significativas en la distribución de grupos de riesgo y pronóstico entre los pacientes diagnosticados de CP mediante primera biopsia vs rebiopsias en nuestro hospital en los años 2014, 2015 y 2016.MÉTODOS: Se realizó un estudio analítico descriptivo retrospectivo longitudinal con 496 pacientes sometidos a biopsia de próstata (BP) en nuestro centro entre el 1 de Enero de 2014 y el 31 de diciembre de 2016. Analizamos los resultados de biopsia prostática, score Gleason y distribución por grupos pronósticos para comprobar si existían diferencias significativas entre los pacientes sometidos a primera biopsia vs rebiopsia. RESULTADOS: La tasa de BP positivas en primera biopsia fue de 38,3% frente a los 26,8% diagnosticados en rebiopsias existiendo diferencias significativas con p=0,01. En nuestra serie el 71,8% de los CP significativos y el 90% de los CP de malo o muy mal pronóstico (Grupo 4 y 5 según la ISUP) son diagnosticados en primera biopsia. CONCLUSIONES: Existen diferencias significativas en el diagnóstico de cáncer de próstata cuando se realiza una primera biopsia en comparación con la realización de rebiopsia. Los tumores diagnosticados mediante rebiopsias son de mejor pronóstico que los diagnosticados mediante primera biopsia. Debemos adoptar mecanismos para aumentar la rentabilidad diagnóstica de las rebiopsias.

Vascular abnormalities in horseshoe kidney.

50 year old male with history of renal colic presenting to the emergency room with left colic pain. On ultrasound horseshoe kidneys were visualized without hydronephrosis or stones. CT scan: horseshoe kidney with inferior isthmus, no signs of nephrolithiasis or urolithiasis. There are multiple associated vascular anomalies (there are at least five right renal arteries and two left, double venous return is seen in both hemi-kidneys).

Antopol-Goldman lesion: a rare clinical entity in the differential diagnosis of macroscopic hematuria.

OBJECTIVE: To describe the case of a patient with gross hematuria. The pathological study revealed a subepithelial hematoma of the renal pelvis (Antopol-Goldman lesion). METHODS/RESULTS: An 86 year-old woman presented with gross hematuria through the right ureteral orifice. A filling defect is visualized in the right renal pelvis on CT and right nephroureterectomy was carried out after the diagnosis of suspicious upper urinary tract tumor. The pathological study revealed the presence of a subepithelial hematoma without evidence of malignancy. CONCLUSION: Antopol-Goldman lesion is a benign condition that one must have in mind in the work up of patients with hematuria and filling defects in the urinary tract who present a predisposing factor for pyelic hematoma.

[Malacoplakia of the testis: a new case report and a literature review]. / Malacoplaquia testicular: aportación de un nuevo caso y revisión de la literatura científica.

Malakoplakia is a uncommon chronic granulomatous condition of a benign nature preferentially occurring in the genitourinary tract. Testes are affected in 12% of cases, and the first case of testicular malakoplakia was reported in 1958. Forty cases have been reported worldwide since that date. We report a new case of testicular and epididymal malakoplakia in a 68-year-old male patient diagnosed of complicated orchiepididymitis who underwent orchidectomy to rule out a malignant tumor. The histopathological study demonstrated a chronic inflammatory infiltrate with histiocytes with an eosinophilic cytoplasm containing the characteristic Michaelis-Gutmann bodies diagnostic of malakoplakia. In connection with this new case and because of its unusual presentation, the literature on testicular malakoplakia is reviewed.

[Correlation between Gleason score on prostate biopsies diagnostic of adenocarcinoma and radical prostatectomy specimens]. / Estudio de correlación entre las sumas de Gleason de las biopsias de próstatas con adenocarcinoma y de las piezas de prostatectomía radical.

OBJECTIVES: We analyse the concordance between Gleason scores on prostate biopsies diagnostic of adenocarcinoma and radical prostatectomy specimens. METHODS: We reviewed the charts of 214 patients who underwent radical prostatectomy between January 1992 and November 2002. We calculated the percentage of correct diagnosis, understaging and overstaging for individual Gleason and for groups with scores between 2-4, 5-6, 7 and 8-10. We performed the statistical analyses of concordance for the groups using the kappa weighted index (< 0.4 low reliability, 0.4-0.75 good reliability; > 0.75 excellent reliability). RESULTS: 41 patients were excluded. The percentages of right diagnosis, understaging and overstaging for the remainder 173 were 32.3%, 44% and 23.7% respectively for individual Gleason scores, and 52.6%, 32.4% and 15% respectively for grouped Gleason scores. Statistical analysis resulted in a kappa weighted index of 0.52, a result which did not vary after excluding patients treated with neoadjuvant hormonal therapy CONCLUSIONS: In our series, the statistical correlation obtained for grouped Gleason scores is good. However, understaging is the biggest problem for prostate biopsies diagnostic of adenocarcinoma when compared with definitive pathologic results on the specimen. Besides, and in opposition, more than 50% of our patients deemed as less differentiated (Gleason score 7 and 8-10) presented lower grades in the specimen. Both limitations should be taken into consideration when therapeutic options are exposed to our patients.

[Collecting duct (Bellini) carcinoma]. / Carcinoma de ductos colectores de Bellini.

OBJECTIVES: To report one case of collecting duct (Bellini) carcinoma and to review the national bibliography. To analyze the clinical, diagnostic, and therapeutic features of this malignant renal tumor. METHODS/RESULTS: A 36-year-old male presenting with monosymptomatic hematuria and clot retention was diagnosed of left renal mass suggestive of renal carcinoma. Radical nephrectomy with interaortocaval lymphadenectomy through an "L" abdominal incision (inverted Makuuchi) and postoperative radiotherapy were carried out. The pathologic report showed a collecting duct (Bellini) carcinoma. The patient died 34 months after surgery, having been treated with two courses of chemotherapy and palliative vertebral radiotherapy. CONCLUSIONS: The collecting duct (Bellini) carcinoma is an infrequent malignant renal tumor. It does not differ from the clear cell adenocarcinoma either clinically or epidemiologically. However, it presents its own embryological, pathologic, immunohistochemical, and cytogenetic characteristics. Radical nephrectomy is the treatment of choice. Prognosis is ominous because of the aggressive behaviour and diagnosis in advanced stages.

[High-flow priapism caused by bilateral arterio-lacunar fistula]. / Priapismo de alto flujo por fístula arterio-lacunar bilateral.

OBJECTIVE: Literature review about arterial priapism cases secondary to bilateral postraumatic arterial-lacunar fistula, with special attention to therapeutic management by bilateral supraselective embolization. METHODS: Bibliographic search using MEDLINE. A new case of high flow priapism secondary to bilateral postraumatic arterial-lacunar fistula is reported. RESULTS: There are a total of ten cases of arterial priapism secondary to bilateral postraumatic arterial-lacunar fistula. Only one patient was treated by embolization in two steps with reabsorbable material; non reabsorbable material was used for embolization in three patients; in four cases embolization was performed as a single procedure and the remainder two cases resolved spontaneously. Erectile function was recovered independently of the therapeutic option performed. CONCLUSIONS: Embolization in two steps with reabsorbable material has been postulated as the treatment for arterial priapism secondary to bilateral postraumatic arterial-lacunar fistula or in cases of high flow status and drepanocytosis which do not resolve with other therapeutic measures. Nevertheless, if supraselective embolization is performed, it could not be mandatory to follow this therapeutic criteria, as it is suggested by erectile function results obtained.

[Renal artery embolism]. / Embolia de la arteria renal.

OBJECTIVES: To report a case of renal artery embolism. To review the clinical, diagnostic and therapeutic features of this disease interesting for the urologist. METHODS/RESULTS: Case of a 47 year old male with history of cardiovascular disease who presents in the emergency room with left flank pain. Radiological studies (Intravenous pyelogram (IVP) and ultrasound) ruled out urinary tract obstruction and oriented to renal vascular disease. Arteriography was performed showing left renal artery embolism. Fibrinolytic therapy was successful. CONCLUSIONS: Renal artery embolism is an unusual non traumatic vascular urologic emergency. Generally, it appears in patients with emboligenous heart diseases, mainly auricular fibrillation associated with mitral stenosis. More than half the cases are asymptomatic; if they have symptoms, the most common presentation is sudden onset of intense flank pain, resistive to analgesia. Laboratory tests show hematuria, pyuria, proteinuria, leucocytosis, increased LDH, GOT and alkaline phosphatase, and variable renal function impairment. An ultrasound showing no signs of obstructive uropathy and absent function in the IVP lead to diagnosis. In the case of early diagnosis, intra-arterial fibinolysis is the treatment of choice, leaving surgery for cases where renal function is in danger. Main complications are vasculorenal hypertension and renal failure.