Utilidad del cociente psa-l/psa-t y la dpsa para la discriminación entre hipertrofia benigna de próstata y cáncer de próstata / Usefulness of free/total prostate-specific antigen (PSA) ratio and PSA density to enhance differentiation of benign prostatic hyperplasia from prostate cancer

OBJETIVO: Investigar la rentabilidad diagnóstica del cociente PSA-L/PSA-T y densidad de PSA, en el diagnóstico del cáncer de próstata en pacientes con cifras de PSA-T en la zona gris de decisión diagnóstica entre 4-10 ng/ml. Establecer el punto de corte para hacer el diagnóstico diferencial entre enfermedad benigna de la próstata y cáncer, con el fin de evitar biopsias innecesarias. MÉTODO: Estudio prospectivo realizado a 136 varones de edades comprendidas entre 54 y 87 años (media 70,6). Los pacientes acuden a la consulta de urología por síntomas urinarios. Se les solicita una prueba de PSA-T, PSA-L, cociente de PSA-L/PSA-T, se realiza tacto rectal y ecografía transrectal con biopsia en octantes, se mide el volumen de la próstata y se calcula la densidad de PSA. A 113 pacientes se solicita estudio anatomopatológico, encontrándose 82 casos de HBP y 31 de carcinoma de próstata en diferentes estadios. RESULTADOS: No se encontraron diferencias significativas entre el grupo de pacientes con HBP y CAP para el PSA-T, PSA-L, cociente PSA-L/PSA-T ni tacto rectal. La DPSA y el volumen de la próstata son significativamente diferentes p < 0,05 en los pacientes con HPB y CAP. Para una sensibilidad del 94% (78,5-99), el punto de corte para el cociente de PSA sería de 0,28 y la especificidad del 11% (5,2-19,8). Con una sensibilidad del 96,2% (80,3-99,4) el punto de corte obtenido para DPSA es de 0,109 y la especificidad de 25% (15,5-36,6).CONCLUSIONES: En pacientes con cifras de PSA-T entre 4 y 10 ng/ml el cociente PSA-L/PSA-T no tiene ventajas sobre el PSA-T en el diagnóstico precoz del cáncer de próstata. La DPSA puede mejorar la especificidad, sin comprometer el diagnóstico de CAP (AU)

[Post-traumatic high flow priapism in a child]. / Priapismo de alto flujo postraumático infantil.

We report on the case of a post-traumatic high-flow priapism in a 14 year-old boy, which was confirmed by cavernous blood gas measurement color flow Doppler sonography, and arteriography. It was successfully treated with superselective embolization of the right internal pudendal artery, resulting a clear disappearance of cavernus rigidity.

Priapismo de alto flujo postraumático infantil / Post-traumatic high-flow priapism in childhood

Presentamos el caso de un priapismo de alto flujo tras traumatismo perineal directo en un varón de 14 años, que se confirmó mediante gasometría de cuerpos cavernosos, estudio Eco-doppler peneano, y arteriografía pudenda. Se trató satisfactoriamente mediante embolización supraselectiva de una rama de arteria pudenda interna derecha, obteniendo disminución manifiesta de la rigidez cavernosa (AU)

[Usefulness of free/total PSA ratio and PSA density in distinguishing benign prostatic hypertrophy from prostatic cancer]. / Utilidad del cociente PSA-L/PSA-T y la DPSA para la discriminacion entre hipertrofia benigna de próstata y cáncer de próstata.

OBJECTIVE: To investigate the clinical significance of the free-to-total prostate-specific antigen ratio (f/tPSA) and PSA density (PSAD) for prostate cancer detection in patients with intermediate tPSA levels (4-10 ng/ml). To establish a cutoff to discriminate between benign prostatic disease (BPH) and prostate cancer (CaP), avoiding unnecessary biopsies. METHODS: This prospective study included 136 men, aged between 54 and 85 (mean 70.6) years old. Urinary tract symptoms were present in these patients. Serum samples were obtained to measure tPSA, fPSA, and f/tPSA; digital rectal examination and transrectal ultrasound eight-sector biopsies were performed. Prostate volume was measured and PSAD calculated. The pathologic study, carried out in 113 patients, showed 82 with BPH and 31 with prostate cancer in various stages. RESULTS: There were no significant differences between patients with BPH and CaP when comparing tPSA, fPSA, f/tPSA or digital rectal examination. PSAD and prostate volume were significantly different in patients with BPH and CaP. With a sensitivity of 94% (78.5-99), the f/tPSA cutoff was 0.28 with a 11% (5.2-19.8) specificity. With a sensitivity of 96.2% (80.3-99.4) cutoff for PSAD was 0.109 and specificity 25% (15.5-36.6). CONCLUSIONS: In patients whose tPSA level is between 4 and 10 ng/ml, f/tPSA has no advantages over tPSA measurement for early detection of prostate cancer. DPSA can improve specificities, without compromising the detection of CaP.

[Bilateral isolated infiltration in the epididymis and sperm cord as first sign of chronic lymphatic leukemia]. / Infiltración aislada bilateral de epidídimo y cordón espermático como primer signo de leucemia linfática crónica.

OBJECTIVE: Involvement of extralymphatic tissue in chronic lymphocytic leukemia (CLL) is uncommon and that of the epididymis and spermatic cord is rare. This paper describes an unusual case with metastasis to both epididymis and the spermatic cord as the first sign of reactivation of CLL. METHODS/RESULTS: A patient with CLL is described. The first sign of disease progression was the involvement of both epididymis and the spermatic cord. The literature on tumors of the epididymis and spermatic cord and CLL is briefly reviewed. CONCLUSION: Metastatic tumors of the epididymis and spermatic cord are rare. The importance of the pathological findings in making the diagnosis is underscored.

[Bilateral abscess of cavernous bodies]. / Absceso bilateral de cuerpos cavernosos.

Report of a rare case of abscess in both cavernous bodies. Its peculiarity is based on the location, the bilateral nature and the absence of a clear causative factor, although it was probably related of a local septic focus (rectal or prostatic). Diagnosis was established with CAT because of the primarily posterior location and the significant peripheral inflammatory reaction. The patient was treated successful with a vigorous antibiotic therapy and open drainage from both cavernous bodies with no development of sequelae such as fibrosis and penial incurvation or impotence.

[Retrospective study of the treatment of 329 patients with prostatism syndrome and review of the literature]. / Análisis retrospectivo del tratamiento de 329 pacientes con síndrome de prostatismo y revisión de la bibliografía.

OBJECTIVES: New drugs for the treatment of prostatism have been developed in recent years; only surgery, however, has been demonstrated to achieve cure. Each modality of drug therapy may afford symptomatic relief in those patients in whom surgery is not indicated and a symptom-based stepwise indication could be established. METHODS: 329 patients with prostatism were treated by surgery, administration of finasteride, alphablockers or plant extracts, according to the recommendations of the WHO. Patient evaluation included abdominal US. PSA determination and uroflowmetry. Patients with urodynamic or other derangements were excluded from the study. RESULTS: Patients with a worse quality of life and important obstructive symptoms underwent surgery. Patients with important obstructive symptoms and no complications requiring surgery (infection, urinary retention, etc.) received finasteride, which proved to be effective in these patients, although 16.6% required another type of treatment and two presented impotence. Patients treated with plant extracts had moderate prostatism; 17% of these patients required another type of treatment. Patients treated with alphablockers presented symptoms that were similar to those treated with plant extracts, but they had a more important irritative component; 24% of these patients withdrew from the study due to the side effects or inefficacy of their treatment regimen. CONCLUSIONS: Further studies and a longer follow-up are warranted to determine whether these new drugs can replace or effectively delay (avoiding the appearance of complications) surgery. We believe that the indications for each treatment should be established according to the different stages of prostatism. Moreover, further insight into the pathogenesis of BPH, appropriate diagnostic methods and patient selection are essential to the development of new therapeutical modalities and to achieving enhanced results.

[Malignant bilateral pheochromocytoma and von Recklinghausen disease]. / Feocromocitoma bilateral maligno y enfermedad de Von Recklinghausen.

OBJECTIVES: To review the main features of malignant pheochromocytoma and its relationship to von Recklinghausen's neurofibromatosis. METHODS/RESULTS: We report on a case of malignant bilateral pheochromocytoma with hepatic and pulmonary metastasis, associated with von Recklinghausen's neurofibromatosis. Surgery achieved good results and the patient is well seven years postoperatively. CONCLUSIONS: Approximately 10% of the pheochromocytomas are malignant and treatment is principally by surgery. (131) metaiodobenzylguanidine may be useful in cases with metastasis, residual tumor or local relapse.

[Review of 408 cases of prostatism syndrome. Have the new classifications improved its practical management?]. / Revisión de 408 casos de síndrome de prostatismo. Han mejorado las nuevas clasificaciones su manejo práctico?

To the variety of symptoms known as prostatism, ultrasound, flowmetry, PSA and other complementary testing has been added over the last few years in an attempt to define it better. Also, several score tables such IPSS have been used to grade more objectively each symptom. It remains to be seen, however, whether all this is really useful to define a specific treatment in the clinical practice. To this end, we intend to analyze our own series taking advantage of a table of symptoms routinely used for years, together with the patient's own perception of his quality of life, checking which factors have more influence on the latter. We believe that the use of different overall scores in the usual practice is not effective, although they could be added to the patient's evaluation since they seem a good tool to establish comparisons between different communities.

[Pyeloureterostomy in stenosis of the pyeloureteral junction of an incomplete collecting system]. / Pieloreterostomía en estenosis de la unión pieloureteral de un doble sistema colector incompleto.

OBJECTIVES: The possible solutions to a case of ureteral duplication complicated by obstruction of one of the collecting systems are reviewed. METHODS/RESULTS: We report an uncommon case of ureteropelvic junction obstruction in the lower system of an incomplete duplication of the collecting systems that was resolved by pyeloureterostomy. CONCLUSIONS: Anastomosis of the lower renal pelvis to the upper ureter may provide a simple solution for the functional recovery of an important renal segment.

[Epididymal leiomyoma. Report of 2 cases]. / Leiomioma de epidídimo. Presentación de dos casos.

At present, the paratesticular tumors are not frequent, but when they appear, the most common location is on spermatic cord and epididymis. Within the epididymal tumors the most frequent (75%) are benign tumors, been the second one the leiomyoma after the adenomatoid tumor. We want to show two clinical cases about epididymal leiomyoma in patients who had different ages. We achieve the definitive diagnostic after the tumor removed by histological analysis. We also checked the medical literature.

[Long-term results of endoscopic urethrotomy]. / Resultados a largo plazo de la uretrotomía endoscópica.

OBJECTIVES: To analyze the long-term results of treatment of urethral strictures by internal endoscopic urethrotomy, a simple, easily reproducible procedure that carries a low morbidity and requires a short period of convalescence. MATERIAL AND METHODS: We report our experience of 78 cases submitted to urethrotomy as primary treatment. The results at 19.7 months mean follow-up (range 6 months--5 years) are presented. A maximum of three Sachse procedures were performed if stricture recurred. RESULTS: The complications were rare. Although the results were poor in only 21% of the patients 6 months postoperatively, 46% had recurrent strictures. Moreover, nearly 50% of these strictures recurred after a second or third urethrotomy. CONCLUSIONS: The nature of the stricture, determined by spongiofibrosis, is the main prognostic factor. Internal urethrotomy is indicated in urethral strictures without exorbitant spongiofibrosis, otherwise stricture will recur after internal urethrotomy and other treatment modalities will be required.

[Our experience with renal adenocarcinoma (II): clinical course, diagnosis, and prognostic factors before surgical treatment]. / Nuestra experiencia en adenocarcinomas renales (II): Clínica, diagnóstico y factores pronósticos antes del tratamiento quirúrgico.

OBJECTIVES: We evaluated the form of presentation, clinical features and analytical values and their relationship with survival in renal cell carcinoma patients and analyzed the efficiency of different diagnostic and staging procedures. METHODS: We reviewed the form of presentation, clinical features, staging procedures and analytical values of 229 consecutive renal cell carcinomas diagnosed at our hospital between 1975 and 1991. RESULTS: Malaise and weight loss or symptoms different from those of the classical triad (hematuria, pain and a flank mass) are factors of poor prognosis and lower survival. The time of presentation of symptoms does not influence prognosis. Computerized tomography was found to be the best imaging technique, with a low sensitivity and a high specificity in our experience. We have found a correlation between hypercalcemia and lower survival, but not for the more advanced tumoral stage. There was a correlation between the levels of hemoglobin and alkaline phosphatase and survival: patients with hemoglobin levels less than 14 g/dl or alkaline phosphatase levels greater than 85 U/l had a lower survival rate and a more advanced tumoral stage. CONCLUSIONS: Computerized tomography was found to be the best imaging technique. Symptoms different from those of the classical triad, malaise and weight loss, hypercalcemia, low levels of hemoglobin or high levels of alkaline phosphatase are factors of poor prognosis.

[Renal leiomyoma. Report of a new case]. / Leiomioma renal. Aportación de un nuevo caso.

Though renal leiomyoma is an unusual tumour, symptomatic tumours are even more uncommon. They often raise problems with differential diagnosis from malignant tumours which not even the most advanced imaging techniques manage to elucidate. On the other hand, their sarcomatous degeneration has been described. Considering these premises, doubts arise on their therapeutical approach, on which we here present our own views.

[Penile incarceration at its base with metallic object]. / Incarceración de pene por objeto metálico en su base.

Herein we describe a case of penile incarceration due to a nut at the base of the penis which was resolved by cutting the metallic object. The literature on penile strangulation describes different foreign bodies and methods of management of constrictive penile band injury.