[Testicular torsion in the geriatric patient. Review of the literature apropos of a case]. / Torsión testicular en el paciente geriátrico. Y revisión de la literatura: a propósito de un caso.

Testicular torsion in adult, is an uncommonly etiology, but we should make differencial diagnosis in every person over thirty years old, with acute scrotum. The wrong diagnosis raises the incidence orchiectomy in adults for vascular etiology. We report a male of 74 years old with acute scrotum and review of the literature.

Torsión testicular en el paciente geriátrico y revisión de la literatura: a propósito de un caso / Testicular torsion in adults and literature revision: a propos of one case

La torsión testicular en el adulto, es una nosología infrecuente aunque debe de entrar dentro del diagnostico diferencial de cualquier adulto de mas de treinta años, con cuadro de escroto agudo. El retraso e incorrecto diagnóstico, aumenta la frecuencia de orquiectomías por procesos vasculares en el adulto frente al niño. Presentamos el caso de varón de 74 años con escroto agudo, y revisión de la literatura (AU)

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[A reliability analysis of transrectal echographic estimation of prostatic volume]. / Análisis de la fiabilidad de la estimación ecográfica transrectal del volumen prostático.

OBJECTIVE: To establish the reliability of transrectal ultrasound to estimate prostatic volume. MATERIAL AND METHODS: Study of 27 patients diagnosed with prostate cancer who were managed with radical prostatectomy. Transrectal ultrasound assessment of prostatic volume was performed using the revolution ellipsoid equation V = (pi/6) x L x T x AP. The values obtained were compared to those from radical prostatectomy specimens calculated by the same method and with the weights of the specimens. RESULTS: Mean prostatic volume estimated through transrectal ultrasound was 38.77 cc vs. 38.46 cc in the pathoanatomical specimens. Mean difference between both was 0.31 cc (not significant). The coefficient of correlation that related both values was 0.80 and the coefficient of correlation between transrectal ultrasound volume and weight was 0.86. CONCLUSIONS: Prostatic transrectal ultrasound is an accurate tool to calculate total prostatic volume.

[A diagnostic algorithm based on transrectal echography in failure of surgery correcting stress urinary incontinence]. / Algoritmo diagnóstico basado en la ecografía transrectal en los fracasos de la cirugía correctora de la incontinencia urinaria de stress.

Transrectal ultrasound is a dynamic imaging diagnostic technique for the study of stress urinary incontinence (SUI). The highest efficiency is obtained in the study of failed corrective surgery of SUI. Our group studied 23 patients reporting clinical SUI after undergoing corrective surgery, 23.3% patients with transrectal ultrasound showed no condition that could justify it (bladder neck hypermobility, intrinsic sphincteral incompetence, calcification of suspension threads, urethra diverticulum...); 34.8% showed bladder neck hypermobility, indicative of failed corrective surgery; 34.8% showed presence of open urethra at rest, an echographic sign of intrinsic sphincteral incompetence; and in 4.3% cases the existence of intravesical calcifications of the suspension threads was diagnosed. Transrectal ultrasound can become the choice test to perform in this group of patients, leading to the performance of other diagnostic tests and offering an adequate customized solution for each patient's problem.

[Macroscopic and histologic analysis of the rat prostate after denervation]. / Análisis macroscópico e histológico de la próstata de la rata tras la denervación.

OBJECTIVE: To determine the role of autonomic innervation in the preservation of the prostate gland structure, we analyzed the gross and histological features of the rat prostate submitted to denervation by resection of the pelvic ganglia. METHODS: The study comprised 80 male Sprague-Dawley rats aged 3 months; 42 were anesthetized and resection of the right pelvic ganglia was performed via laparotomy. Thirty days thereafter they were sacrificed. Gross and microscopic analyses of the right ventral lobe were performed. Computerized morphometric analyses of the areas occupied by the lumen, epithelial and stromal compartments, the height of the epithelium and the vascular pattern were performed. The results were compared with those obtained from the 38 ventral lobes of rats of the same age that had not undergone denervation. RESULTS: Gross examination of denervated rat ventral lobe demonstrated atrophy and weighted 36% less (p < 0.001). Histological analysis of the compartments showed 27.9% were epithelial, 48.3% stromal and 51.8% glandular--epithelial and lumen--for the control group versus 14.8% (p < 0.001), 55.7% and 44.4% (not significant), respectively, for the denervated group. Denervated rat epithelial height measured 39.7% less. No differences in the vascular pattern were found. CONCLUSIONS: Resection of the rat pelvic ganglia, thereby inducing near-total vesico-prostatic denervation, causes structural and functional changes in the rat prostate compatible with atrophy. The observed changes were a reduction in weight and volume, as well as in the height and surface area of the secretory epithelium.

[Results of transrectal echography in the study of female urinary stress incontinence]. / Resultados de la ecografía transrectal en el estudio de la incontinencia urinaria de esfuerzo femenina.

The development of echographic transducers allows now to study Female Urinary Exertional Incontinence (FUEI) using different approaches (vaginal, perineal and transrectal). A total of 122 transrectal echographies were performed. Based on the clinical symptoms: 14 patients are continent, 15 report micturition urgency, 11 micturition urgency plus FUEI, and 82 FUEI. All parameters Xrest, Yrest, AUVPrest, Xexertion, Yexertion, AUVPexertion, X', Y', AUVP' were measured. Three groups were defined: Group I, normal ultrasound diagnosis; Group II, vesical neck hypermobility; Group III, FUEI using Kolmogorov-Smirnov's test, the data fits a standard distribution curve and the results were analyzed through a variance analysis and Newman-Keul's test. During Valsalva's manoeuvre, patients with FUEI show greater caudal mobility of the vesical neck which becomes more significant as the degree of FUEI increases. Dorsal mobility is also greater in patients with FUEI although this parameter is of no use to quantify the degree of FUEI. Posterior urethro-vesical angle variability only discriminates patients with no FUEI from those with a higher degree of FUEI.

[A bladder nephrogenic adenoma. A case report]. / Adenoma nefrogénico vesical. Descripción de un caso.

OBJECTIVE: To report an additional case of nephrogenic adenoma of the bladder. METHODS/RESULTS: A case of nephrogenic adenoma of the urinary bladder in a 28-year-old female is described. Patient clinical history and diagnostic imaging findings are presented. CONCLUSIONS: Nephrogenic adenoma of the bladder is a rare benign tumor with specific histological features that has been associated with previous surgery, trauma, infections and lithiasis. Although it is currently not considered to be a premalignant lesion, its rate of recurrence is high (37%-49%). The treatment of choice is by transurethral resection and yearly cytological, ultrasound and cystoscopic follow-up evaluation to detect recurrence.

[Echographic diagnosis of female urethral diverticulum]. / Diagnóstico ecográfico del divertículo uretral femenino.

OBJECTIVE: To describe the utility of transrectal ultrasound as an alternative imaging technique in the diagnosis of diverticulum of the female urethra. METHODS/RESULTS: A 35-year-old female that had been initially diagnosed as having a benign tumor of the vagina is described. The voiding cystogram, positive pressure urethrography with a double balloon catheter and urethroscopy were falsely negative for urethral diverticulum of the female urethra. Subsequent evaluation by transrectal ultrasound disclosed on oval-shaped, anechoic lesion located posteriorly to base of the bladder. CONCLUSIONS: Transrectal ultrasound could be the diagnostic imaging technique of choice in patients suspected as having diverticulum of the female urethra.

[Inguinal hernia containing the urinary bladder. Description of a case]. / Hernia inguinal que contiene vejiga urinaria. Descripción de un caso.

OBJECTIVE: Hernial pathology has a high incidence in the adult population. However, involvement of the urinary tract system in a hernial process constitutes an uncommon finding. This rare condition is analyzed in the present article. METHODS/RESULTS: A case of an inguinal hernia containing urinary bladder is described. No complications were found and surgical treatment was not required. CONCLUSIONS: Inguinal bladder hernia is rare and usually has no associated complications and the symptoms are scanty. Diagnosis is established by ultrasound and cystography. Treatment is by surgery, although in many cases this condition requires no treatment.

[Value of transrectal ultrasonography in the assessment of failures of stress urinary incontinence surgery in women]. / Valor de la ecografía transrectal en la evaluación de los fracasos de la cirugía de la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: To describe the role of transrectal ultrasonography as an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. METHODS: The means of independent samples of transrectal ultrasound parameters of two groups of patients (group I, patients who were continent after surgery; group II, patients who remained incontinent after surgery) were compared. RESULTS: Patients who were continent after surgery showed scanty caudal and dorsal mobility of the bladder neck and proximal urethra during the periods of increased intraabdominal pressure. The US finding in this group of patients is characterized by a funnel surrounding the bladder neck and the proximal urethra. The existence of an intrinsically incompetent sphincter can also be determined with this technique. CONCLUSIONS: Transrectal ultrasonography constitutes an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. It permitis determining whether incontinence is due to a failed procedure, the existence of an intrinsically incompetent sphincter, or whether other causes of incontinence should be investigated.

[PGE1 program in erectile dysfunction: etiopathogenic and pharmacologic aspects]. / Programa de PGE1 en la disfunción eréctil: aspectos etiopatogénicos y farmacológicos.

Since Ishii et al.2 first described in 1986 the use of PGE1 in erectile dysfunction, a number of studies have been conducted using this vasoactive drug. Use in self-injecting programs, without additional drugs associated due to the ease of use and minimal complications, is currently becoming increasingly common as the choice therapy for erectile dysfunction. The paper analyzes our series of 66 patients included in self-injecting programs with PGE1 with no other drugs associated. Follow-up time has been 9.8 months (1-39). Mean age of our patients was 55. Our larger etiological groups were vascular (42%), diabetic (19%) and psychological (21%) patients. Dose increase over time has been significant in vascular and diabetic patients relative to the other groups. It has been found that program compliance has basically depended on the severity of the causative disease, which was significant in vascular and diabetic patients. Local complications have been: pain (19.6%), prolonged erection (3%), and priapism (1.5%).

[Obstructive nature of the "double-J" ureteral catheter in idiopathic retroperitoneal fibrosis]. / El carácter obstructivo del catéter ureteral en "doble-J" en la fibrosis retroperitoneal idiopática.

INTRODUCTION AND OBJECTIVES: "Double-J" ureteral stents are commonly used for ureteral diversion, Obstruction of these devices is rare in the absence of certain circumstances. The objective of this article is to discuss the origin of stent obstruction in the Idiopathic Retroperitoneal Fibrosis (IRF) context, and to suggest the most suitable type of urinary diversion. METHODS AND RESULTS: We presented three cases of extrinsic ureteral compression due to IRF who were inserted soft polyurethance "double-J" stents (Urosoft, Angiomed brand), 7 Fr. with multiple side holes. These stents finally turned out as obstructive ones, and needed to be changed for other types of diversion. CONCLUSIONS: Steroid treatment constitutes the first option for these patients, but if ureteral obstruction occurs, diversion should be carried out. We prefer internal ureteral diversion with spiral-reinforced ureteral stents, being also valid options percutaneous nephrostomy or external ureteral stents made of a more rigid type of polyurethane, according to the case. When a soft polyurethane stent is used in a patient with FRI, we should perform a very strict follow-up with appropriate image studies, since the possibility of being not effective always exists.

[Erectile dysfunction: clinical course with intracavernous PGE1]. / Disfunción eréctil: aspectos evolutivos con la PGE1 intracavernosa.

OBJECTIVES: The results achieved with PGE1 therapy in 66 patients with erectile dysfunction in our self-injection program are presented. METHODS: Patients with severe conditions (cancer, infectious disease, renal and hepatic failure, etc.), psychological or hormonal disorders were discarded from the study. All patients were tested with PGE1, the dose was adjusted according to individual response, the patient was instructed how to inject the vasoactive drug and included in the self-injection program. Statistical analysis of the data was performed using the chi-square and the Student 't' test. RESULTS: The mean follow-up was 9.8 months (range 1-39). Twenty-five patients (37%) withdrew from the program. Six patients (9%) received another treatment due to pain or poor response. A penile prosthesis was implanted in five patients and one patient was treated with a vacuum erection device. Although not statistically significant, local pain was associated with a shorter follow-up. Prolonged erection was also observed but did not influence the length of follow-up. CONCLUSIONS: Local pain has been associated with a shorter follow-up. A small number of non-responders warranted another therapy.

[Yield of ultrasonography-guided transrectal biopsy in the diagnosis of carcinoma of the prostate]. / Rendimiento de la biopsia transrectal ecodirigida en el diagnóstico del carcinoma de próstata.

OBJECTIVES: The present study analyzes the combination of digital rectal examination (DRE), prostate specific antigen (PSA), transrectal ultrasound (TRUS) and ultrasound-guided transrectal biopsy in the diagnosis of prostate cancer. METHODS: 115 of 224 patients (51.3%) were biopsied due to a suspicious DRE and/or PSA > 4 ng/ml, and/or DPSA > 0.15, and/or the presence of a hypoechoic lesion on TRUS. RESULTS: Adenocarcinoma of the prostate was diagnosed in 28 (24.3%) of these 115 patients. The positive predictive value (PPV) for carcinoma of the prostate was 4.76% if PSA was < 4 ng/ml, 5.12% if PSA was 4.1 to 10 ng/ml, and 48% if PSA was > 10 ng/ml. If DPSA is considered, the PPV is 7.4% if PSA is 4.1 to 10 ng/ml and 51.02% if PSA is > 10 ng/ml. If DRE is suspicious, the PPV is 43.6%, with a sensitivity of 85.7% and a specificity of 63.9%. The PPV for carcinoma of the prostate was 34% for a hypoechoic lesion on TRUS, 50% if DRE is suspicious, 53.5% is PSA is > 10 ng/ml and 65% if DRE is suspicious and PSA > 10 ng/ml. CONCLUSIONS: The detection rate of carcinoma of the prostate is increased when DRE, PSA, TRUS and US-guided transrectal biopsy are used in combination.

[Transrectal ultrasonography technique in stress urinary incontinence in women]. / Técnica de la ecografía transrectal en la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: This study describes the use of transrectal ultrasound as an alternative to cystography in the assessment of female stress urinary incontinence. The procedure and the different parameters that must be evaluated are also described herein. METHODS: The patients were evaluated in the standing position and saggital sections were obtained with a transrectal transducer. The bladder was filled with saline and the test was done at rest using the Valsalva maneuver with or without a bladder catheter. RESULTS: In these patients with female stress urinary incontinence, bladder neck movement was dorsal and caudad, the most important observation being bladder neck descent. Furthermore, we found an increased posterior urethrovesical angle. CONCLUSIONS: Transrectal US is an alternative imaging technique in the assessment of patients with stress urinary incontinence that is easy to learn and avoids exposure of the patients to radiation.

[The relationship of PSA to age and prostatic volume in patients with benign prostatic hypertrophy]. / Relación del PSA con la edad y el volumen prostático en pacientes con hiperplasia benigna de próstata.

Prostate specific antigen (PSA) is the most useful market for the diagnosis, staging and monitoring of prostate cancer. However, the effect of benign prostate hyperplasia on PSA levels is less well known. It has been reported that 20-45% of all adult males with BPH have PSA values over the normal range. To study this confounding factor we have analyzed the likely relationships between monoclonal PSA, age and prostate size as determined by ultrasound, in our series of 163 patients with BPH undergoing adenomectomy. Within the studied factors, the most conditioning parameter of PSA variability was prostate size. The correlation coefficient (r) was 0.61, with the determination coefficient (r2) being 0.037 (p < 0.001). Age correlation, although less important (r = 0.31), was statistically significant. Both variables were independent and resulted jointly in a correlation coefficient of 0.64. Also included is the mathematical formula used in our series to correlate PSA with age and prostate volume. Its application could mean an increased specificity of this tumoral marker.

[Diagnostic and therapeutic retrograde ureterorenoscopy (URS)]. / Ureterorrenoscopia retrograda (URS) diagnostica y terapeutica.

Presentation of results obtained in 50 procedures of retrograde ureterorenoscopy (URS), and discussion based on the literature and our results, on the current indications for URS with regard to extracorporeal lithofragmentation (ECL) for the treatment of pelvic ureteral lithiasis and the diagnosis and/or treatment of other conditions. Fifty URS were performed in 47 patients between February 1992 and March 1994: 35 were conducted to treat ureteral lithiasis, achieving a 97% success rate and a mean post-surgery hospital stay of 48 hours; and for diagnostic and/or therapeutic reasons. There were no major complications, and a description is made of minors cases. We prefer to use URS in those cases of distal ureteral lithiasis, as compared to ECL, because of its level of efficacy (higher than or equal to ECL), low cost/benefit ratio, low morbidity and shorter hospital stay involved. The paper emphasizes the major diagnostic and therapeutical indications for URS, and finally, it is noted that URS can avoid undertaking other more aggressive urinary by-passes, since it allows to catheterize the ureters where a false intramural route is conducted.

The value of transrectal ultrasonography in the diagnosis and treatment of partial obstruction of the seminal duct system.

We report a case of male subfertility with ejaculate volume less than 1 cc and moderate oligoasthenozoospermia. Partial obstruction of the seminal duct system was suspected and transrectal ultrasonography revealed a müllerian duct cyst. We confirmed the diagnosis with transperineal puncture and contrast filling of the cyst and seminal vesicles. This procedure allowed us to avoid scrotal vasostomy and perform conventional vasography as well as to measure the distance between the ceiling of the cyst and the urethra, which facilitated subsequent transurethral surgery.

[Transrectal echography in tuberculous prostatitis]. / Ecografía transrectal en la prostatitis tuberculosa.

Tuberculous prostatitis is diagnosed incidentally, when the pathologist is studying a specimen of transurethral resection of the prostate or a prostatic biopsy. There is scant literature on the role of transrectal ultrasound in the diagnosis of this pathology. A case of tuberculous prostatitis is presented, with special reference to the transrectal ultrasound pattern. A complete review of the references on the imaging techniques in this pathology is done.