[Value of prostate-specific antigen density and transitional-zone prostate-specific antigen density in the diagnosis of prostate cancer]. / Valor de la densidad del antígeno prostático específico y de la densidad del antígeno prostático específico de la zona transicional en el diagnóstico del cáncer de próstata.

INTRODUCTION: With serum prostate specific antigen (PSA) levels of 4.1 to 10 ng/ml a significant number of patients are unnecessary subjected to biopsy. We try to determine if the calculation of prostate specific antigen density (PSAD) and prostate specific antigen density of the transition zone (PSADTZ) improve the capacity to discriminate between non-malignant disease and prostate cancer. METHODS: A prospective study including 314 males with PSA levels between 4.1 and 10 ng/ml is reported. Transrectal ultrasonography and prostatic biopsy were performed in all of them and total prostate and transition-zone volumes were calculated. PSA density and PSA density of the transition zone were calculated for each patient. Receiver operating characteristics (ROC) curves for PSA, PSAD and PSADTZ were constructed for all the patients and for those patients with digital rectal examination unsuspicous of malignancy, determining the sensitivity and specificity for several cutoff values. RESULTS: The area under the curve for both, PSAD and PSADTZ, were greater than for PSA (p < 0.05), without any significant differences between PSADTZ and PSAD. The cutoff value of greatest diagnostic efficiency for PSAD was 0.17 ng/ml/cc (71.4% sensitivity and 55.7% specificity), while it was 0.41 ng/ml/cc for DPSATZ (70% sensitivity and 61.5% specificity). For those cases of normal digital rectal examination, no differences were observed between PSA and PSAD but they were between PSA and PSADTZ. In any event, the area under ROC curves was always less than 0.7, and, in order to avoid a large number of biopsies (high specificity), a large number of cancers are left without diagnosis (low sensitivity). CONCLUSIONS: We conclude that PSAD and PSADTZ are not excessively useful for adequately discriminating between patients with prostate cancer and those with non-malignant disease, particularly when digital rectal examination is normal.

Valor de la densidad del antígeno prostático específico y de la densidad del antígeno prostático específico dela zona transicional en el diagnóstico del cáncer de próstata / Value of prostate specific antigen density and prostate specific antigen density of the transition zone for the diagnosis of prostate cancer

INTRODUCCIÓN: Cuando el antígeno prostático específico (PSA) sérico se encuentra entre 4,1 y 10 ng/ml un número importante de pacientes son sometidos a biopsia de forma innecesaria. Intentamos determinar si el cálculo de la densidad de PSA (DPSA) y la densidad de PSA de la zona de transición (DPSAZT) mejoran la capacidad del PSA para discriminar entre enfermedad benigna y cáncer. MÉTODOS: Estudio prospectivo en el que se incluyeron 314 varones con cifras de PSA entre 4,1 y 10 ng/ml. En todos ellos se realizó ecografía transrectal y biopsia prostática, calculando el volumen prostático y de la zona de transición. Se calculó la DPSA y la DPSAZT para cada paciente. Se realizaron curvas de rendimiento diagnóstico (ROC curves) para PSA, DPSA y DPSAZT para la totalidad de los pacientes y seleccionando aquellos con tacto rectal no sospechoso de malignidad. Se calculó sensibilidad y especificidad para diferentes puntos de corte para el DPSA y DPSAZT. RESULTADOS: Para la totalidad de la muestra, tanto DPSA como DPSAZT mostraron un área bajo la curva mayor que PSA (p<0,05), sin que se apreciasen diferencias entre DPSAZT y DPSA. El punto de corte con mayor eficiencia diagnóstica para DPSA fue de 0,17 ng/ml/cc (sensibilidad de 71,4 por ciento y especificidad de 55,7 por ciento) y para DPSAZT de 0,41 ng/ml/cc (sensibilidad 70 por ciento y especificidad de 61,5 por ciento). Cuando el tacto rectal era normal no se observaron diferencias entre PSA y DPSA y sí entre PSA y DPSAZT. En cualquier modo el área bajo la curva o exactitud fue siempre inferior al 70 por ciento y para evitar un número considerable de biopsias (alta especificidad) se dejan por diagnosticar un número considerable de cánceres (baja sensibilidad). CONCLUSIONES: Consideramos que la DPSA y DPSAZT no son métodos excesivamente útiles para discriminar adecuadamente entre pacientes con cáncer prostático y enfermedad benigna, especialmente cuando el tacto rectal es negativo (AU)

[Percentage of tumor in prostatic biopsy cylinders as prognosis factor of organ-limited disease in candidates for radical prostatectomy]. / El porcentaje de tumor en cilindros de biopsia prostática como factor pronóstico de enfermedad órganoconfinada en pacientes candidatos a prostatectomía radical.

UNLABELLED: The present study analyzes the prognostic influence of tumor percentage in cylinders of prostatic biopsy in this patient group. MATERIAL AND METHODS: Retrospective study of 68 patients with a diagnosis of adenocarcinoma, clinical stage T1-T2 who had undergone a radical prostatectomy from May 1997 to october 2000. Following preoperative parameters were analyzed: age, PSA, clinical staging, Gleason and six cylinders of ultrasonography-leaded transrectal prostatic biopsy, studying the amount of positive biopsies, the tumor percentage of the total amount of biopsies and the maximum percentage of tumor in one cylinder. Univariate (square-Chi, Student t) and multivariate (multiple logistic regression) analysis are performed in order to study the relationship of these parameters with the presence or not of an organ-located disease. RESULTS: An organ-located disease was shown at 44 patients through the piece of radical prostatectomy. The univariate analysis gave all studied parameters, except age, a prognostic value of the existence or not of an organ-located disease. In the multivariate analysis only the total percentage of biopsy tumors (p = 0.0002) and PSA (p = 0.005) behaved as independent prognostic factors. CONCLUSION: Tumor percentage in prostatic biopsy seems to be a factor with a high predictive value of an organ-located disease, possibly because it is an index of tumoral volume.

El porcentaje de tumor en cilindros de biopsia prostática como factor pronóstico de enfermedad órganoconfinada en pacientes candidatos a prostatectomía radical / Tumor percentage in prostatic biopsy cylinders as a prognostic factor of organ-located disease in patients candidate to radical

En el presente estudio analizamos la influencia pronóstica del porcentaje de tumor en los cilindros de biopsia prostática en los pacientes candidatos a prostatectomía radical. MATERIAL Y MÉTODOS: Estudio retrospectivo con 68 pacientes diagnosticados de carcinoma de próstata en estadio clínico T1-T2 sometidos a prostatectomía radical desde mayo de 1997 a octubre de 2000. Se analizan los siguientes parámetros preoperatorios: edad, PSA, estadio clínico, Gleason y 6 cilindros de biopsia prostática transrectal ecodirigida, estudiando el nº de biopsias positivas, el porcentaje de tumor en el total de biopsias y el porcentaje máximo de tumor en un cilindro. Se realiza análisis univariante (Chi-cuadrado, t de Student) y multivariante (regresión logística múltiple) para estudiar la relación de estos parámetros con la presencia o no de enfermedad organoconfinada. RESULTADOS: En 44 pacientes se comprobó enfermedad organoconfinada en la pieza de prostatectomía radical. En el análisis univariante todos los parámetros estudiados salvo la edad son factores que se asocian con la existencia o no de enfermedad organoconfinada. En el análisis multivariante únicamente el porcentaje total de tumor en las biopsias (p=0,0002) y el PSA (p=0,005) se comportaron como factores pronósticos independientes. CONCLUSIÓN: El porcentaje de tumor en los cilindros de biopsia prostática parece ser un factor con un alto valor predictivo de enfermedad órganoconfinada, probablemente por ser un índice del volumen tumoral (AU)

Prognostic factors for response to sildenafil in patients with erectile dysfunction.

OBJECTIVE: To assess the clinical efficacy of sildenafil as treatment for erectile dysfunction (ED) the factors associated with treatment failure were investigated. METHODS: Open, prospective study including 244 patients suffering from ED who were evaluated by anamnesis, physical exploration, blood test, dynamic penile color duplex ultrasonography and Sexual Health Inventory for Male (SHIM). The efficacy of sildenafil was assessed by repeating the SHIM 2 months after therapy, independent of the final dose used. Side effects were also recorded. Factors influencing treatment outcome were evaluated by univariate and multivariate statistical analysis. RESULTS: Overall, sildenafil was effective in 56.8% of 213 eligible patients. When the etiologic diagnosis was not included in the multivariate analysis, antecedents of diabetes mellitus, non-nerve-sparing radical prostatectomy and SHIM basal score were selected as predictors of a poor response. In a second analysis including etiologic diagnosis, only SHIM basal score and etiological diagnosis proved to be of prognostic value. Side effects were noticed by 24.4% of patients, none of them being severe. CONCLUSIONS: Sildenafil is a rather effective and well-tolerated treatment for ED. The basal severity of ED and etiological diagnosis are the prognostic factors most significantly associated with treatment outcome.

[Retroperitoneal germ cell tumor]. / Tumor de células germinales retroperitoneal.

We report a case of retroperitoneal extragonadal germ-cell tumor in an 17 years old patient who presented with aedema and pain in left inferior extremity asociated with hemopthysis caused by pulmonar metastasis, who was treated with chemotherapy and resection of residual mass and pulmonary nodes. Dyagnosis was stableshed by fine neadle aspiration biopsy of the wass. We comment on the difficult of stableshing differential dyagnosis between retroperitoneal extragonadal germ-cell tumor and metastasis of a testicular tumor. Dyagnosis is stableshed by the finding of a histologically malignant germ-cell tumor with normal testis. We considered physical examination and ecographyc exploration enough for a correct dyagnosis.

[Cystic lymphangioma of the adrenal gland in adults. Review of the literature and report of a new case]. / Linfangioma quístico de la glándula suprarrenal del adulto. Revisión de la literatura y aportación de un nuevo caso.

Presentation of one case of cystic lymphangioma of the suprarenal gland in a 34-year-old female patient with a background of lower urinary tract infections, presenting with continuous and aggravating pain in left lumbar area and with no other associated symptomatology, diagnosed with ultrasound, IVU and CAT. A review of the literature is made. The present study pretends to give an overall view of a rare and benign disease, commenting upon the difficulties found in its diagnosis and the different therapeutical options.

[Bladder leiomyoma. Review and report of a case]. / Leiomioma vesical. Revisión y presentación de un caso.

OBJECTIVE: The present study reviews bladder leiomyoma, an uncommon pathology. The problems of differential diagnosis and the therapeutic options are discussed and the literature reviewed. METHODS/RESULTS: A 33-year-old female with anterolateral intramural leiomyoma of the bladder is described. Patient evaluation included US, cystography, CT, cystoscopy and ultrasound-guided suprapubic puncture. CONCLUSIONS: Leiomyoma is an uncommon benign tumor of the bladder. To our knowledge, only 235 cases have been reported in the literature. We advocate the use of ultrasound-guided suprapubic puncture, a simple procedure that is frequently diagnostic, in the evaluation of this tumor type.

[Acquired enterovesical fistulas]. / Fístulas enterovesicales adquiridas.

We report on 23 patients with acquired vesicoenteric fistula treated during the past 12 years: 48% of these were of inflammatory etiology (11 cases), 35% were caused by neoplasms (8 cases) and 17% were iatrogenic (4 cases). The most frequent symptoms were pneumaturia and fecaluria (78% of cases). Cystoscopy was the most useful diagnostic procedure in detecting fistula (13 of 18 cases). Other imaging techniques, though less effective for diagnosis, were useful in assessing the status of the GI tract and, at times, in determining the etiology of the fistulae. Treatment depends on the etiology, localization and patient general condition. The technique most frequently applied in our series was resection of the fistulous tract, together with the compromised intestinal segment, and bladder suture.

[A 10-month experience with extracorporeal shockwave therapy of urolithiasis]. / Nuestra experiencia tras diez meses de tratamiento de la litiasis urinaria mediante litotricia extracorpórea por ondas de choque.

From November 1987 treatment of urinary lithiasis regardless location was initiated in our Service of extracorporal renal lithofragmentation using shockwaves. Up until August 1988 (10 months), 411 patients have been treated representing a total of 590 lithiasis and 699 sessions on which the present communication is based; treatment included calculus of various chemical composition, as well as different sizes and locations. Also the relationship between sex, age, number of waves, use of analgesia, hospital stay, etc, has been considered. Results obtained after a 2.5 months follow-up are: 60.34% fragments-free and 39.41% in expulsion stage. Monotherapy was chosen in 98% cases and multiple drug therapy in the remaining 2%. There has been no case of complementary open surgical therapy. Thus, we consider extracorporal renal lithofragmentation as the ideal treatment for urinary lithiasis, as long as the indication is correct. And we believe it to be the ideal treatment since it is a simple procedure, highly effective and with few complications.

[Segmental kidney dysplasia]. / Displasia renal segmentaria.

The frequency of segmental renal dysplasia was studied in 15 patients with complete pyeloureteral duplication whose anatomopathologic diagnosis of the lesions of some of the renal segments of duplication were available (14 partial nephrectomies, one open renal biopsy). Evidence of dysplasia was found in 10 cases (67%), the remaining 5 were diagnosed as having chronic pyelonephritis. All patients had a coexisting ureteric anomaly that drained the dysplastic renal segment: 6 ureteral ectopias, 3 ectopic ureteroceles, 1 vesicoureteral reflux. The clinical and pathogenic importance of the associated anomalies of the excretory tract, the diagnostic difficulties arising from the minimally- or non-functioning dysplastic renal segment, and the therapeutic modalities utilized are discussed.

Multiple mucosal biopsies and postoperative urinary cytology in patients with bladder cancer.

Seventy-one patients with bladder tumors of stage Ta, T1 or T2 were studied by bladder mucosal biopsies. In 34 (48%) patients abnormal histology was found in at least one of the biopsies. The occurrence and severity of mucosal abnormalities were related to tumor grade and stage. Urinary cytology after complete tumor resection was positive in 18 of 19 patients with abnormal biopsies and in 6 of 12 patients with normal biopsies. Postoperative urinary cytology seems to be a good indicator for the presence of urothelial atypia.