Cuerpos extraños en pene / Penile foreign bodies

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Amiloidosis vesical primaria de tipo AA: caso clínico y revisión de la literatura / AA Type primary amyloidosis of the urinary bladder: Clinical case and bibliographic review

OBJETIVO: La amiloidosis es una enfermedad caracterizada por el depósito de material hialino eosinofílico en distintos tejidos, siendo muy infrecuente la afectación vesical. Nuestro objetivo es dar a conocer un nuevo caso de amiloidosis vesical primaria de tipo AA y una revisión de la literatura al respecto. MÉTODO: Varón de 66 años de edad que acude a consulta por referir hematuria intermitente de dos semanas de evolución, junto con urgencia y nicturia de 10-12 veces. La exploración física abdominal y genital resultó anodina así como el sedimento, urocultivo y citologías (microhematuria e inflamación). En cistoscopia se apreció, a nivel de trígono y fondo vesical, una mucosa con lesiones eritematosas-amarillentas, ligeramente sobreelevadas que se biopsian. El resultado anatomopatológico fue de mucosa urotelial con marcada inflamación crónica y acúmulos perivasculares de material hialino de aspecto amiloide. Se completó el tratamiento con resección transuretral de la lesión vesical confirmando el diagnóstico de amiloidosis vesical tipo AA (propio de formas secundarias). El estudio de probable afectación sistémica fue normal. RESULTADOS: Tras dos años de seguimiento el paciente se encuentra asintomático, sin evidencia de recidiva en las cistoscopias. CONCLUSIONES: Las formas de amiloidosis vesical primaria de tipo AA son una patología muy infrecuente, con pocos casos descritos en la literatura urológica internacional. No obstante debemos tenerla en cuenta en el diagnóstico diferencial ante un paciente con hematuria y/o sintomatología urinaria persistente (AU)

OBJECTIVE: Amyloidosis is a disease characterised by deposition of eosinophilic hyaline material in different tissues. Urinary bladder involvement is uncommon with less than 200 cases of the primary form published in the literature. We present a new case of primary AA type amyloidosis of the urinary bladder (typical of secondary forms). METHODS: A 66-year-old male was seen in the outpatient urology consultation with several-weeks history intermittent haematuria with decreased voiding urinary calibre. In addition, he had intense nocturia, 10-12 times per night, and occasional urgency. Physical examination of the abdomen and genitals was unremarkable. Urine sediment and blood tests were normal. Urine cytology studies were requested and revealed urothelial cells with no atypical cells and a moderate quantity of neutrophils and erythrocytes. Cystoscopy was performed and revealed yellowish erythematous lesions at the level of the vesicoureteric junction and the fundus. The lesions were biopsied. Pathology studies revealed urothelial mucosa with marked chronic inflammation and accumulations of amyloid-appearing hyaline material in the area of the vessels with green birefringence on polarised light. TUR of the bladder was later performed with the goal of completely resecting the lesion. The result of the pathology studies confirmed the biopsy findings and immunohistochemistry studies revealed AA type amyloid (typical of secondary forms). RESULTS: Two years after the intervention, the patient remains asymptomatic with normal endoscopic follow-up studies. CONCLUSIONS: Primary AA type amyloidosis of the bladder is a very uncommon pathology with few cases reported in the international urology literature. Nevertheless, we must keep it in mind in the differential diagnosis when faced with a patient with haematuria and/or persistent urinary symptoms (AU)

Primary tuberculosis of the glans penis.

OBJECTIVE: Tuberculosis of the penis is an extremely rare disease with few cases reported in the literature. METHOD: We present the case of a 64 year-old man with a whitish papular-ampullary eruption in the glans penis. After antibiotic/antimycotic therapy and several topical ointments for 3 months without response he was referred to our Department. Biopsy of the ulceration edge was performed and pathology result showed a chronic granulomatous inflammatory necrotizing lesion with granulomatous vasculitis lesions, without tumor infiltration. Systemic examination to rule out other tuberculosis foci was negative. With de suspicion of primary tuberculosis of the glans penis, anti tuberculosis therapy with Isoniazid and Piridoxine was started. RESULTS: Within a period of five months the ulceration healed significantly. Currently, the patient is still asymptomatic without glans penis lesions. CONCLUSIONS: Primary glans penis tuberculosis is a rare disease, but we must consider it (both primary and secondary forms) to try to avoid diagnostic delays that may cause prejudice for the patient. This condition promptly responds to anti tuberculosis therapy as evidenced by our case and many other reports.

Tuberculosis primaria a nivel de glande / Primary tuberculosis of the glans penis

OBJETIVOS: Aportar un nuevo caso de tuberculosis primaria de pene dada su infrecuente incidencia, con pocos casos descritos en la literatura. MÉTODO: Presentamos el caso de un varón de 64 años de edad, sin antecedentes urológicos de interés, que acude a consulta de dermatología por aparición de lesión ampollosa blanquecina en glande de tres meses de evolución que no mejora con antibióticos-antimicóticos tópicos (Médico de Atención Primaria). Se realiza biopsia de glande con resultado anatomopatológico de inflamación granulomatosa necrotizante con lesiones de vasculis granulomatosa, sin infiltración tumoral. Tras descartar posibles focos tuberculosis a nivel sistémico comienza tratamiento con Isoniazida más Piridoxina. RESULTADOS: A los cinco meses de evolución el paciente presenta gran mejoría clínica, con disminución de la lesión peneana y asintomático desde el punto de vista urológico. CONCLUSIONES: La tuberculosis primaria de pene es una patología infrecuente aunque debemos tenerla en mente (tanto formas primarias como secundarias), para así intentar evitar el retraso diagnóstico con el consecuente perjuicio para el paciente. El inicio de una terapia antituberculosa muestra respuestas favorables en la mayoría de los casos de forma relativamente precoz

OBJECTIVE: Tuberculosis of the penis is an extremely rare disease with few cases reported in the literature. CLINICAL CASE: We present the case of a 64 year-old man with a whitish papular-ampullary eruption in the glans penis. After antibiotic/antimycotic therapy and several topical ointments for 3 months without response he was referred to our Department. Biopsy of the ulceration edge was performed and pathology result showed a chronic granulomatous inflammatory necrotizing lesion with granulomatous vasculitis lesions, without tumor infiltration. Systemic examination to rule out other tuberculosis foci was negative. With de suspicion of primary tuberculosis of the glans penis, anti tuberculosis therapy with Isoniazid and Piridoxine was started. RESULTS: Within a period of five months the ulceration healed significantly. Currently, the patient is still asymptomatic without glans penis lesions. CONCLUSIONS: Primary glans penis tuberculosis is a rare disease, but we must consider it (both primary and secondary forms) to try to avoid diagnostic delays that may cause prejudice for the patient. This condition promptly responds to anti tuberculosis therapy as evidenced by our case and many other reports

Cost-effectiveness analysis of the surgical treatment of female urinary incontinence using slings and meshes.

OBJECTIVE: To determine the cost-utility and cost-effectiveness of the surgical treatment of female urinary incontinence using suburethral slings and prolapse meshes compared with therapeutic abstention. STUDY DESIGN: An economic analysis was performed on 69 women receiving surgical treatment for urinary incontinence using suburethral slings and prolapse meshes. To calculate the procedure's cost-effectiveness, an incremental analysis up to one year was performed using the incremental cost-effectiveness ratio (ICER). The costs were calculated using a cost-by-process model. Answers to the health-related quality of life questionnaires EQ-5D (generic) and International Consultation Incontinence Questionnaire Short-form (specific) were collected before the operation and as well as one month and one year post-operation to calculate the utility, using quality-adjusted life years (QALY), and the effectiveness, respectively. To complete the economic evaluation, we derived confidence ellipses and acceptability curves. The analysis was conducted for the entire sample and also for each type of urinary incontinence. RESULTS: In total, 45 women presented with stress incontinence, 15 with mixed incontinence and 9 with incontinence associated with prolapse. The average cost per patient at one year post-operation was 1220 €. The QALY achieved at one year was 0.046. The results reveal an ICER at one year of 26,288 €/QALY, which is below the cost-effectiveness threshold considered acceptable, and this value was lower for stress incontinence (21,191 €/QALY). The cost-effectiveness was 106.5 €/International Consultation Incontinence Questionnaire Short-form unit. CONCLUSION: Surgery for female urinary incontinence using slings is cost-effective compared with abstention in our public health environment.

Efficiency of different strategies to detect autoantibodies to extractable nuclear antigens.

Autoantibodies to extractable nuclear antigens (anti-ENA) are identified mainly in samples positive for antinuclear antibodies (ANA). Although the method of choice for ANA screening is indirect immunofluorescence (IIF), several techniques are available to detect anti-ENA. The aim of this study was to compare the efficiency of five different strategies to determine anti-ENA. During a 2-year period we screened ANA in 30375 samples with IIF, and the 4475 samples ANA positive were tested for anti-ENA by double immune diffusion screening or fluoroenzymeimmunoassay (Screening FI); anti-ENA specificities were then determined by line immunoassay (LIA) or fluoroenzymeimmunoassay (FI). We compared five strategies that involved FI or LIA identification of anti-ENA with or without prior screening, or an algorithm that combined fluorescence pattern, number of anti-ENA specificities requested by the clinician and ANA dilution titer. One cost unit (CU) was defined as the cost of 1 test of ANA determination. We detected 553 anti-ENA positive samples. The most efficient strategy was the algorithm, at a cost of 3.3 CU per sample processed, the second most efficient strategy was screening plus FI identification (cost=3.8 CU), and the third most efficient strategy was screening plus LIA identification (cost=3.9 CU). The fourth most efficient strategy was FI identification without prior screening (13.3 CU per sample) and the least efficient was LIA identification without prior screening (13.6 CU per sample). In conclusion, an algorithm that combined techniques for detection, ANA titer, fluorescence pattern and number of specificities requested was the most efficient strategy for determining anti-ENA.