Comparability and reproducibility of adult male anogenital distance measurements for two different methods.

The distance from the genitals to the anus, anogenital distance, reflects androgen concentration during prenatal development in mammals. The use of anogenital distance in human studies is still very limited and the quality and consistency of measurements is an important methodological issue. The aim of this study was to assess the feasibility and reproducibility of adult male anogenital distance measurements by two different methods. All men were attending an outpatient clinic at a university hospital and underwent an andrological examination and completed a brief questionnaire. Two variants of anogenital distance [from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP )] by two methods (lithotomy or frog-legged position) were assessed in 70 men. Within and between coefficient of variations, intra-class correlation coefficients, two-way repeated-measures analysis of variance, and scatter and Bland-Altman plots were calculated. The two methods produced similar values for AGDAP but different estimates for AGDAS . Nonetheless, the overall agreement (ICC ≥ 0.80) was acceptable for both measures. Therefore, both methods are internally consistent and adequate for epidemiological studies, and may be used depending on the available medical resources, clinical setting, and populations.

Corrección de curvatura peneana utilizando la técnica de "Plicatura de 16 puntos" / Corrrection of penile curvature using the 16-Dot plication technique

En 1965 Nesbit describió por primera vez la corrección quirúrgica de la curvatura de pene siendo posteriormente modificadapor múltiples autores. Presentamos dos pacientes con incurvación peneana corregida mediante la técnica de "plicatura de 16 puntos" (AU)

In 1965 Nesbit first described the surgical correction of penile curvature that was later modified by many authors. We present two patients with penile curvature corrected using the 16-dot plication technique (AU)

Cumplimentación del consentimiento informado para la transfusión de hemoderivados en los Servicios de Urología y Cirugía / Enforcement of informed consent request for blood transfusion in urology and surgery departments

Objetivo: Aplicar un círculo de mejora a la petición de consentimiento informado (CI) para la transfusión de hemoderivados en los servicios de Cirugía General y Urología. Métodos: Durante 8 meses se incluyeron 120 pa­cientes intervenidos en el Hospital General Reina Sofía de Murcia. Tras realizar un análisis de causa-efecto de Ishikawa, se establecieron 4 criterios: C1: identifica­ción del médico; C2: identificación del paciente; C3: firma del paciente; C4: fecha del documento. En el pri­mer periodo se incluyeron 60 pacientes. Se analizaron Ias causas de incumplimiento y se aplicaron las medidas correctoras, reevaluando los criterios en otros 60 pacientes. Resultados: Todos los criterios estaban por debajo del estándar: C1: 3%; C2: 95%; C3: 16% y C4: 65%. En la segunda evaluación el cumplimiento de C1 (70%), C3 (98%) y C4 (88%) mejoró significativamente pero aún así los resultados continúan, también significativamente, por debajo de los estándares establecidos. Los resultados se expresan en porcentaje de cumplimiento con un intervalo de confianza del 95%. Conclusiones: La realización de un ciclo de mejora ha permitido detectar y corregir incumplimientos en el C1 de transfusiones sanguíneas. El nivel de cumplimiento de los criterios mejoró en la segunda evaluación aunque continuamos por debajo del estándar establecido. Hemos conseguido una mayor concienciación por parte de los profesionales a la hora de cumplimentar el consentimiento.

Objective: To analyze the degree of compliance with a variety of standards defined for the quality control of the informed consent request for human blood products transfusion in our departments of Surgery and Urology. Material and method: Retrospective study of patients treated during 8 consecutive months in a university teaching hospital (n=120). Assessment of quality was performed through measurements of compliance using 4 criteria: C1, Physician Identification; C2, patient identification; C3, patient signature; C4, document date. In the first period 60 patients were included. Corrective measures aimed at resolving the quality problem were applied to the deficient criteria during one month, paying particular attention to those criteria with the highest percentage of errors in the study. During a third period of six months (60 patients) the information of all criteria was gathered again and the improvement with regard to the standard values and to the compliance of the first period was evaluated. Results: Compliance of all criteria was significantly below standard values in the first evaluation: C1 :3%; C2: 95%; C3: 16% and C4: 65%. In the second period all the criteria below its standard improved with regard to the first period; nonetheless the results are, also significantly, below the established standards. Conclusions: This improvement cycle enabled us to detect and correct breaches on the informed consent request for human blood products transfusion. Corrective measures introduced were effective since it was improved in all the criteria below standard. We have achieved a good awareness of health professionals to complete the authorization.

Cumplimentación del consentimiento informado para la transfusión de hemoderivados en los Servicios de Urología y Cirugía / Enforcement of informed consent request for blood transfusion in urology and surgery departments

Objetivo: Aplicar un círculo de mejora a la petición de consentimiento informado (CI) para la transfusión de hemoderivados en los servicios de Cirugía General y Urología. Métodos: Durante 8 meses se incluyeron 120 pa¡cientes intervenidos en el Hospital General Reina Sofía de Murcia. Tras realizar un análisis de causa-efecto de Ishikawa, se establecieron 4 criterios: C1: identifica¡ción del médico; C2: identificación del paciente; C3: firma del paciente; C4: fecha del documento. En el pri¡mer periodo se incluyeron 60 pacientes. Se analizaron Ias causas de incumplimiento y se aplicaron las medidas correctoras, reevaluando los criterios en otros 60 pacientes. Resultados: Todos los criterios estaban por debajo del estándar: C1: 3%; C2: 95%; C3: 16% y C4: 65%. En la segunda evaluación el cumplimiento de C1 (70%), C3 (98%) y C4 (88%) mejoró significativamente pero aún así los resultados continúan, también significativamente, por debajo de los estándares establecidos. Los resultados se expresan en porcentaje de cumplimiento con un intervalo de confianza del 95%. Conclusiones: La realización de un ciclo de mejora ha permitido detectar y corregir incumplimientos en el C1 de transfusiones sanguíneas. El nivel de cumplimiento de los criterios mejoró en la segunda evaluación aunque continuamos por debajo del estándar establecido. Hemos conseguido una mayor concienciación por parte de los profesionales a la hora de cumplimentar el consentimiento. (AU)

Objective: To analyze the degree of compliance with a variety of standards defined for the quality control of the informed consent request for human blood products transfusion in our departments of Surgery and Urology. Material and method: Retrospective study of patients treated during 8 consecutive months in a university teaching hospital (n=120). Assessment of quality was performed through measurements of compliance using 4 criteria: C1, Physician Identification; C2, patient identification; C3, patient signature; C4, document date. In the first period 60 patients were included. Corrective measures aimed at resolving the quality problem were applied to the deficient criteria during one month, paying particular attention to those criteria with the highest percentage of errors in the study. During a third period of six months (60 patients) the information of all criteria was gathered again and the improvement with regard to the standard values and to the compliance of the first period was evaluated. Results: Compliance of all criteria was significantly below standard values in the first evaluation: C1 :3%; C2: 95%; C3: 16% and C4: 65%. In the second period all the criteria below its standard improved with regard to the first period; nonetheless the results are, also significantly, below the established standards. Conclusions: This improvement cycle enabled us to detect and correct breaches on the informed consent request for human blood products transfusion. Corrective measures introduced were effective since it was improved in all the criteria below standard. We have achieved a good awareness of health professionals to complete the authorization. (AU)

Prostatectomía radical laparoscópica. ¿Afecta la anatomía patológica de la pieza en la forma de seguimiento posterior? / Laparoscopic radical prostatectomy. Does the histopathological examination of the specimen have an effect on the postoperavie follow-up?

OBJETIVO. Analizar la capacidad predictiva del Gleason definitivo, la afectación extracapsular y la afectación de márgenes respecto a la recurrencia bioquímica y al PSA Doubling Time, en pacientes con prostatectomía radical. MATERIAL Y MÉTODO. Estudio retrospectivo. Se realizó un análisis de supervivencia de Kaplan-Meyer y una comparación de medias del PSA DT mediante la “t” de Student. RESULTADOS. De 110 pacientes estudiados, 9 presentaron recidiva bioquímica. La media de seguimiento fue de 22.57 meses. La media de meses libres de recurrencia bioquímica fue de 65.28 meses para Gleason <7 y de 35.29 meses para ?7 (p=0.03). La media de PSA DT en el grupo con afectación extracapsular fue de 24.83 meses mientras que en los que no la tenían fue de 35.66 (p=0,028). CONCLUSIONES. Pese al limitado número de pacientes y el escaso tiempo de seguimiento demostramos que un Gleason elevado, o la afectación extracapsular pueden indicar la necesidad de un seguimiento más exhaustivo (AU)

OBJECTIVE. Our aim was to analyze the predictive ability of final Gleason score, extracapsular extension and peritumoral margins affection with regard to the biochemical relapse and the PSA Doubling Time, in patients treated with radical prostatectomy. MATERIAL AND METHODS. Retrospective study. The Kaplan Meier method was used for survival analysis. The nonpaired Student's t test was used to compare the mean PSA DT. RESULTS. Of the 110 patients studied, 9 presented biochemical relapse. Median follow-up period was 22.57 (DE 16,2) months. Mean time from surgery to biochemical relapse was 65.28 months for Gleason <7 and 35.29 months for ?7 (p=0.03). The average PSA-DT for the patients in the group with extracapsular affection was 24.83 months whereas in the group without extension it was 35.66 (p=0.028). CONCLUSIONS. Despite the limited number of patients and the scarce follow-up time, our study suggests that patients with high Gleason grade or extracapsular affection are likely to need of a more exhaustive control (AU)

[Bladder carcinoma with osteoclast-type giant cells. A case with a rare presentation. Review of the literature]. / Carcinoma con células gigantes tipo osteoclasto de vejiga. Un caso de rara presentación. Revisión de la literatura.

We report a case of neoplasm of the urinary bladder with pseudosarcomatous stromal differentiation. Heterologous carcinosarcomas are extremely rare malignant neoplasms (seventy-eight cases have been previously described). This is a case of carcinoma containing numerous osteoclast type giant cells that stained for vinmentin and acid phosphatase and were negative for cytokeratin and lysozyme.

[Nephrogenic bladder adenoma associated with glandular cystitis. Immunohistochemical study and significance]. / Adenoma nefrogénico vesical asociado a cistitis glandular. Estudio inmunohistoquímico y significado.

A histopathological and immunohistochemical study of a case of nephrogenic adenoma of the bladder associated to glandular cystitis is presented with a very similar immunostaining to adenomatoid tumors in other organs and probably of a mesothelial origin. Its pathogenesis seems to correspond to a metaplastic change of the bladder's urothelium through anomalous differentiation of the reserve cells faced with different irritating agents. Because of its benign characteristics, we think that treatment can be confined to endoscopic observation and conservative technique.

Adenoma nefrogénico vesical asociado a cistitis glandular. Estudio inmunohistoquímico y significado / Nephrogenic adenoma asociated with glandular cystitis. Significated and immunohistochemical study

Presentamos un estudio histopatológico e inmunohistoquímico de un adenoma nefrogénico vesical asociado a cistitis glandular, que muestran una expresión inmunohistoquímica similar a los tumores adenomatoides en otros órganos y de probable origen mesotelial. Su patogénesis parece corresponderse con cambios metaplásicos del urotelio de la vejiga, a través de una diferenciación anómala de las células de reserva ante diferentes agentes irritativos. Debido a sus características benignas, pensamos que su tratamiento debe ser conservativo y limitado al control endoscópico de la lesión (AU)

[Hemorrhagic cystitis caused by BK and JC polyomavirus in patients treated with bone marrow transplantation: clinical features and urologic management]. / Cistitis hemorrágica por poliomavirus BK y JC en pacientes sometidos a transplante de médula ósea: aspectos clínicos y manejo urológico.

INTRODUCTION: Differential diagnosis of hematuria after bone marrow transplantation (B.M.T.) may include polyomavirus (BK and JC)-associated haemorrhagic cystitis. Many reports have implied BK virus as the major pathogen in the development of hemorrhagic cystitis after BMT. BK viruria is also associated with ureteric stenosis in renal allografts recipients. Viral urinary tract infections are uncommon in healthy individuals, but we can find them frequently in patients under immunosuppressive conditions. MATERIAL AND METHODS: Retrospective study of 123 consecutive B.M.T. recipients in the period from 1995 to 2000, evaluating those with polyomavirus-associated hemorrhagic cystitis. We present patient's characteristics, primary disease, clinical features, diagnosis aspects and treatment of these "hidden hosts of urinary tract". RESULTS: 7 patients (5.7% of B.M.T.) developed BK or JC virus-associated hemorrhagic cystitis; 3 men and 4 women; median patient age was 29 years (range 14 to 45 years). Bacterial, mycobacterial and parasitic urine cultivates had negative results in all of them. The clinical course was characterized by a late onset of haemorrhagic cystitis (days +30 to +132 after BMT). All 7 patients developed macroscopic haematuria (duration 3 to 30 days). In 6 cases Graft Versus Host Disease (G.V.H.D.) criteria were found. Ultrasonographic studies revealed diffuse thickening of bladder wall in 5 patients. Hematuria was managed by hyperhydratation, blood transfusions, transurethral catheter and evacuation of blood clots, continuous bladder irrigation, urine alkalinization and antiviral therapy. No other more aggressive measures were required to stop the bleeding. Only 1 case of transient elevated creatinine. CONCLUSIONS: Polyomavirus-associated haemorrhagic cystitis must be considered in differential diagnosis of hematuria in bone marrow transplantation recipients. Urological management, according with the severity and duration of hematuria, is frequently required.

Cistitis hemorrágica por poliomavirus BK y JC en pacientes sometidos a trasplante de medula osea: aspectos clínicos y manejo urológico / Polyomavirus BK and JC associated haemorrhagic cystitis in patients under bone marrow transplantation clinical features and urological management

INTRODUCCION: Dentro del diagnóstico diferencial de la hematuria en pacientes receptores de un trasplante de médula ósea (T.M.O.) debemos considerar la cistitis hemorrágica por poliomavirus BK y JC. Algunos han implicado al virus BK como el principal agente en su desarrollo. La viruria por BK también se ha asociado a estenosis ureteral en pacientes sometidos a trasplante renal. Las infecciones urinarias virales, excepcionales cuando existe indemnidad del sistema inmune, pueden aparecer con frecuencia en situaciones de inmunocompromiso.MATERIAL Y MÉTODOS: Estudio retrospectivo de 123 pacientes consecutivos sometidos a trasplante de médula ósea (1995-2000). analizando los casos en que se presentó cistitis hemorrágica con aislamiento de poliomavirus BK y JC en orina. Se estudian: características poblacionales, enfermedad de base, manifestaciones clínicas y radiológicas, métodos diagnósticos y medidas terapéuticas. Realizamos una revisión de los principales aspectos de estos "desconocidos huéspedes del aparato urinario".RESULTADOS: Se presentó cistitis hemorrágica asociada a poliomavirus en 7 casos (5,7 por ciento de los TMO), 6 por BK y 1 por JC. Corresponden <: a 3 varones y 4 mujeres, con una edad media de 29 años (14-45). Todos los pacientes con urocultivos bacteriológicos, micóticos y parasitológicos negativos. Presentación clínica como hematuria macroscópica en todos los casos (aparición entre los días +30 y+132 post-trasplante), cuya duración osciló entre 3 y 30 días. En 6 casos existían criterios de Enfermedad de Injerto Contra Huésped. Eeográficamente, en 5 pacientes se evidenció un engrosamiento difuso de la pared vesical. En todos se instauró tratamiento mediante hiperhidratación, sondaje vesical y extracción de coágulos, lavado endovesical continuo, alcalinización urinaria y antivirales sistémicos. No fueron necesarias actuaciones " más agresivas. Como complicación, un caso de insuficiencia renal leve, reversible.COMENTARIOS: La cistitis hemorrágica por poliomavirus es una entidad que considerar en pacientes que han recibido un T.M. O., debiendo realizar diagnóstico diferencial ante toda hematuria que se presente en estos casos. Es necesario un adecuado manejo urológico de la hematuria, que puede llegar a comprometer la vida del paciente. (AU)

[Primary vaginal lithiasis associated with urethrovaginal fistula. Report of a case and review of the literature]. / Litiasis vaginal primaria asociada a fístula uretrovaginal. Presentación de un caso y revisión de la literatura.

Vaginal stones are rare. We can classify them as primary or secondary, depending on the presence or the absencse of a foreign body nidus. Various cases can led to stone formation. Most of them developed in women with a vesicovaginal or urethrovaginal fistula, as well as in patients with congenital anomalies of the genitourinary tract, previous pelvic radiotherapy, neuropathic bladder and other different causes of vaginal outlet obstruction. Secondary vaginal stones, formed around foreign bodies, are not so frequent. Radiological examination and urethro-vaginoscopy make easy the right diagnosis. Sometimes the stone may be fragmented by lithotripsy before the extraction. The associated etiology should be treated concomitantly in order to prevent recurrence. We report a case of primary vaginal stone associated with an urethrovaginal fistula in a 25 years old women and a review of the related literature.

Litiasis vaginal primaria asociada a fístula uretrovaginal. Presentación de un caso y revisión de la literatura / Primary vaginal stones associated to a urethrovaginal fistula. A case presentation and bibliography review

Las litiasis vaginales son poco frecuentes. Se clasifican en primarias o secundarias, en función de la existencia o no de un cuerpo extraño que haya actuado como matriz para la formación del cálculo. Además, varias condiciones pueden contribuir a su desarrollo. La mayoría de los casos están asociados a fístulas vésico-vaginales o uretrovaginales, apareciendo también en casos de malformaciones congénitas genitourinarias, vejigas neurógenas, radioterapia pélvica u otras etiologías que condicionen obstrucción a nivel vulvovaginal. Las debidas a la presencia de un cuerpo extraño son menos frecuentes. Los exámenes radiológicos y la uretrovaginoscopia permiten establecer el diagnóstico. Para su extracción puede ser necesaria la litofragmentación previa. Es necesario corregir al mismo tiempo la etiología subyacente para prevenir las recurrencias. Presentamos un caso de litiasis vaginal asociada a fístula uretrovaginal en una joven de 25 años, y realizamos una revisión de los aspectos más importantes existentes en la literatura (AU)

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[Juvenile gangrenous vasculitis of the scrotum. Report of a new case and review of the literature]. / Vasculitis gangrenosa juvenil del escroto. Aportación de un nuevo caso y revisión de la literatura.

Juvenile gangrenous vasculitis of the scrotum is a peculiar form of scrotal gangrene of undetermined etiology, with clinical and pathological features of its own, described in 1973 by Piñol et al. We report a new case, considering this entity as part of the differential diagnosis of scrotal gangrene, and a review of relative literature.

Vasculitis gangrenosa juvenil del escroto. Aportación de un nuevo caso y revisión de la literatura / Juvenile gangrenous vasculitis of the scrotum. Contribution with a new case and a revision of the literature

La vasculitis juvenil del escroto es una forma peculiar de gangrena escrotal de etiología desconocida y características clínicas y patológicas propias, descrita en 1973 por Piñol y colaboradores. Presentamos un nuevo caso de esta entidad, dentro del diagnóstico diferencial de las gangrenas escrotales y revisamos la literatura existente al respecto (AU)

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[Synchronous tumor of the upper urinary tract with bladder cancer. Opportunity for nephroureterectomy and block-cystectomy]. / Tumor sincrónico de vías altas con cáncer vesical. Oportunidad de nefroureterectomía y cistectomía en bloque.

OBJECTIVE: One of the basic characteristics of urothelial carcinoma is its tendency to synchronous or metachronous multifocality. Thus the need to explore the entire urinary tract of patients with urothelial neoformations. The aim of this article is to study the tumors of the upper urinary tract that appear synchronously with infiltrating carcinoma of the bladder. The clinicopathological characteristics and the morbidity and mortality of en bloc surgery of both tumors are analyzed. METHODS: A retrospective study was carried out on 170 radical cystectomies for infiltrating bladder tumor performed in our department over a 13-year period. Patient history, clinicopathological characteristics, complementary tests, type of surgery performed, postoperative complications and follow-up were analyzed. RESULTS: Tumor of the upper urinary tract appeared in 14 (1 bilateral) of these patients and were synchronous in 10 cases. All patients were male; mean age 63 years. Three were localized in the pelvis, 2 in the proximal ureter and 6 in the distal third. Diagnosis was made by IVP in 6 patients and by US and antegrade pyelography in the other 4 patients. Nephroureterectomy and radical cystectomy were performed en bloc in 8 cases; 6 had a Bricker procedure and 2 ileal substitution. Salvage radical cystectomy + distal ureterectomy were performed in the other two patients. Two patients submitted to en bloc surgery had postoperative complications; one presented prolonged ileua and the other required surgery for retroperitoneal hemorrhage. The two patients submitted to palliative surgery died of and sepsis during the postoperative period. At 33 months' mean follow-up, 3 patients have shown tumor progression. CONCLUSIONS: There is a high proportion of synchronous tumor of the upper urinary tract in our series of patients with infiltrating carcinoma of the bladder undergoing radical cystectomy, therefore we consider it necessary to explore the entire urinary system. Surgical removal of both tumors en bloc does not increase the morbidity and mortality.

[Prostatic mucinous adenocarcinoma. Report of a new case and review of the literature]. / Adenocarcinoma mucinoso de próstata. Presentación de un nuevo caso y revisión de la literatura.

OBJECTIVE: To present an additional case of mucinous adenocarcinoma of the prostate gland. The histochemical and immunohistochemical findings demonstrating its prostatic origin are presented and the literature is reviewed. METHODS/RESULTS: A 53-year-old male with no previous symptoms or signs presented for a prostatic examination. DRE was normal and PSA was 35 ng/ml. A prostate biopsy demonstrated adenocarcinoma of the prostate with a Gleason score of 3 + 3. Complementary studies were negative. The patient was submitted to radical prostatectomy. Anatomopathological analysis of the surgical specimen demonstrated a prostatic mucinous adenocarcinoma. At one-year follow-up, the patient is alive and disease-free and PSA values have returned to normal. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is a rare anatomopathological variant whose natural history and prognosis are not well-known. This tumor type generally does not respond to any treatment and is hormone-resistant.

[Metastasis priapism. Report of 4 new cases and review of the literature]. / Priapismo metastásico. Presentación de cuatro nuevos casos y revisión de la literatura.

OBJECTIVE: Four additional cases of malignant priapism or priapism secondary to penile metastasis from urogenital tumors are presented and the literature is reviewed. METHODS: Chest and abdominal radiological evaluation, cavernosal and abdominal US, abdominal and pelvic CT and MRI, and cavernosal biopsy were performed for the localization and staging of the primary tumor. RESULTS: Conservative palliative management achieved a survival of only a few months in three of the patients with tumor dissemination to adjacent vital organs. Radical surgery was performed in one patient with tumor localized to the genital area. Currently, this patient has no clinical symptoms, although the follow-up is only 4 months. CONCLUSIONS: Malignant priapism is rare and usually secondary to GU tumors. The prognosis is poor since it generally indicates the presence of multiorgan metastasis. However, the prognosis is better for single metastasis, which is an indication for radical surgery.

[Cystic pyeloureteritis and infection. Presentation forms and review of the literature]. / Pieloureteritis quística e infección. Formas de presentación y revisión de la literatura.

OBJECTIVE: To present three illustrative cases of pyeloureteritis cystica and review the literature. METHODS: Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed. RESULTS: Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter. CONCLUSIONS: Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.

[Trigonocervicoprostatomy. Indications and results from 100 case reports]. / La trigonocervicoprostatotomía. Indicaciones y resultados de 100 casos.

Trigonocervicotomy is a barely invasive technique for the treatment of infravesical obstruction, first introduced in the 60's by Turner-Warkic and Orandi. To achieve good results with this procedure, the selection criteria must take into account a series of parameters such as age, sexual activity, PSA, prostate weight (below 30 grams) and others. In addition to its low morbidity, a larger percentage of patients preserve ejaculation than with the use of other techniques, also the neck sclerosis rate being lower as seen in all our series and expertise. The efficacy of this technique was studied on 100 patients.