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ABSTRACT: Serum markers for prostate carcinoma are widely applied for the purpose of early detection of cancer and the differentiation between benign and malignant disease, for the pre-treatment staging of detected prostatic cancers, and for the monitoring of prostate cancer after curative or palliative therapies. Since its discovery in 1979, serum PSA has been the most powerful marker of prostate cancer, but, when used alone, PSA is not sufficiently sensitive or specific to consider it an ideal tool for the early detection or staging of prostate cancer. To optimize the use of PSA, the concepts of PSA velocity, PSA density, and age-related PSA values were developed. Moreover, the molecular forms of PSA, especially the percentage of free PSA, seem to be useful tools for the detection of prostate cancer in men with slightly elevated total PSA. Human kallikrein 2 (hK2), a serine protease closely related to PSA that also is expressed predominantly in the prostate, is a new complementary marker to PSA for early detection of prostate cancer. In this review, we examine PSA testing and its effectiveness in the diagnosis of prostate cancer. Further, we also evaluate recent literature regarding the use of hk2.
Actas urologicas españolas 06/2008; 32(6):575-88. · 0.46 Impact Factor
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ABSTRACT: Prostate brachytherapy is a first-line therapeutic approach for localized prostate cancer in selected patients. We present our experience in brachytherapy and a thorough review of the literature.
A review of the literature and evaluation of patient's selection was done. Furthermore the implantation technique, oncological results according to the different risk groups and acute and chronic complications were also analyzed.
The biochemical relapse-free 10 year survival rate was 87-96% in low risk tumours and 63-86% in intermediate risk tumours. A total of 3-24% underwent urinary retention that required TURP in 0-8,7%. Other complications were urinary incontinence in 0-6,7%, proctitis in 0-15,5%, erectile dysfunction in 6,3-30%, rectal ulcer/fistula in 0-5,4%.
Prostate brachytherapy is a safe and effective treatment in low and intermediate risk patients with prostate cancer.
Actas urologicas españolas 06/2007; 31(5):452-68. · 0.46 Impact Factor
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ABSTRACT: [corrected] To review urethrorrhagia cases, the need of complementary test, its management and natural history.
A retrospective analysis was carried out for the 12 patients who suffered from urethrorrhagia, consecutively diagnosed in our department. Parameters as age, and micturitional habit were evaluated. In this way, we described the diagnostic techniques used, assessment and the follow-up of each patient.
All cases correspond to male children with an average age of 8.7 years (range: 18 months-14 years). Urethrorrhagia appears in 100% of the patients, episodes which were daily in 58.4%. 33% (4/12) of them also present other micturitional symptoms. 75% (9/12) had a lazy micturitional habit. Among the urological backgrounds we found: 1 patient was circumcised 3 years ago, a meatotomy was done in other due to meatus stenosis 2 years before, and a last one had an electrocoagulation of a urethral polyp just 1 month before. 83.4% (10/12) of urine cultures were negative. An urethrocystoscope was done in 9 patients finding a verum hypertrophy in 4, inflammatory changes next to membranous urethra in 3, scar at the bulbar urethra in 1 and in a last one no abnormalities were found. Out of 8 patients with lazy micturitional habit, 75% (6/8) resolve spontaneously once they correct their habits after a mean follow-up of 9 months. Only 2 patients needed surgery (TUR). In the other 2 patient, symptoms.
Urethrorrhagia in childhood is a benign condition in most cases, which is almost always cured spontaneously during the first 2 years of follow-up. Radiological studies as well as endoscopic procedures are unnecessary in the early management of these patients thus being relegated to recurrent or persistent bleeding.
Actas urologicas españolas 02/2007; 31(1):29-32. · 0.46 Impact Factor
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ABSTRACT: Small cell carcinoma of the bladder is a rare entity characterized by an aggressive clinical behaviour with a high incidence of systemic metastases. We report a case of small cell carcinoma of the bladder in a young man. The primary local tumour was treated by radical surgery, pelvic radiation therapy and polychemotherapy according CDDP protocol. The patient died six months after surgery because disease progression. We also review and update the literature concerning this infrequently tumour.
Actas urologicas españolas 04/2006; 30(3):326-30. · 0.46 Impact Factor
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ABSTRACT: Approximately 15% of cases of renal cell carcinoma present cystic configuration on radiologic and pathologic examination. These lesions are often difficult to differentiate from the multiloculated renal cyst or other benign cystic lesions such as hemorrhagic cyst and so on. We report a case of multilocular cyst of the right kidney complicated with clear cell type renal cell carcinoma in which MRI suggested benign cyst. The diagnosis of complicated benign cyst must be proposed very cautiously and the persistence of doubtful images justifies surgical exploration.
Actas urologicas españolas 10/2004; 28(8):610-3. · 0.46 Impact Factor
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ABSTRACT: Nocardiosis is a very rare, opportunistic infection caused by microorganisms of the genus Nocardia, and is associated with significant morbidity and mortality in kidney transplant patients receiving immunosuppressive therapy.
Since 1980, our Renal Transplant Unit has carried out 1239 kidney transplants, and five cases of Nocardia infection have occurred during this time. In this retrospective study, special consideration is given to clinical manifestations, treatment response (efficacy and side-effects) and the evolution of both the patient and the graft. Microbiological factors studied included biochemical profiles and antimicrobial sensitivity.
Nocardiosis was observed in five men with a mean age of 49.2 years who had received immunosuppressive therapy (generally cyclosporin/azathioprine and prednisone) for a mean of 47.8 months (range 1-148 months). Four of the patients had good previous renal function. The clinical presentation of nocardiosis was as follows: pleuropulmonary pattern of infection, n = 3; subcutaneous abscess, n = 1; and fulminant multi-organ disseminated nocardiosis, n = 1. In all cases, direct observation using modified Ziehl-Neelsen staining proved positive, and in vitro culture revealed good sensitivity to trimethoprim-sulfamethoxazole and variable sensitivity to the other groups of antibiotics. Nocardia brasiliensis was isolated in two cases, and Nocardia asteroides in three. Two patients died, one due to multiple organ involvement and the other due to acute respiratory failure associated with severe hepatopathy caused by hepatitis C virus. The remaining cases improved.
A low incidence of nocardiosis following kidney transplantation was observed. Fatal cases occurred in patients with bacteremia and serious comorbid medical conditions, in whom early diagnosis and specific treatment was required.
Scandinavian Journal of Urology and Nephrology 02/2004; 38(2):168-73. · 0.99 Impact Factor
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ABSTRACT: Epidermoid cysts of the testis are rare in children (3% of all the testicular tumors). Bilateral appearance has only been described in the pediatric age in 2 cases and none associated to Klinefelter's syndrome. We present, for our knowledge, the first case of bilateral epidermoid testicular cyst associated to klinefelter's syndrome in a boy, highlighting its management and therapeutic approach. We analyze the different kinds of treatment.
Actas urologicas españolas 11/2003; 27(9):742-4. · 0.46 Impact Factor
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ABSTRACT: To determine the current state of vesicouterine fistulae in our hospital, the factors associated with their development and the findings obtained from the treatments used.
We carry out a retrospective study on a group of patients suffering from vesicouterine fistulae who were treated in our service for the last 25 years with a 2 year minimum follow-up.
6 cases of vesicouterine fistulae were evaluated. In 83.3% (5/6) of the cases occurred following caesarean section. The average age of the patients was 36.5 years old. In 50% of the cases, urinary incontinence immediately after surgery determined an early diagnosis. In 5 patients deferred abdominal surgical approach was carried out. All of the patients remained asymptomatic during the follow-up years. Two pregnancies were recorded 24 months after repair with a full term delivery.
The vesicouterine fistula, despite being infrequent, is no longer an exceptional diagnosis. Currently, the low segmentarian caesareans constitute the major isolated risk factor for fistula development. We recommend a deferred surgical repair without discarding a conservative approach for those cases of small and early fistula.
Actas urologicas españolas 11/2003; 27(9):707-12. · 0.46 Impact Factor
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ABSTRACT: Since its clinical introduction ureteroscopy (URS) has experienced an impressive development due to the technical improvements of new and smaller urological armamentarium. Currently, ureteroscopy is a worldwide procedure with a varied number of diagnostic and therapeutic possibilities. However, the technique has complications.
We analyse the complications of URS in a series of 4.645 ureteroscopic procedures performed from january 1990 to december 2001, 2972 (64%) female and 1673 (36) male. The objectives of URS were diagnostic (haematuria) and therapeutic (ureteral stones, tumors, strictures and placement of stents).
Fever was the most frequent complication (11.7%), with sepsis in 15 patients. Another complications were: ureteral perforation (1.2%), ureteral avulsion (0.06%), renal injury (0.04%), extrusion (0.4%) and uretero-iliac fistulae (0.02%). The most common treatment was conservative with endourological approach.
Carefully performed ureteroscopy is a superb tool for the urologist either for diagnostic or therapeutic purposes with a low ratio of complications. The majority of these complications can be solved with conservative management.
Actas urologicas españolas 11/2003; 27(9):692-9. · 0.46 Impact Factor
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ABSTRACT: To asses the impact of augmentation enterocystoplasty on the success of cadaveric renal transplantation in patients with dysfunctional bladders.
Between 1980 and 2001, 3 men and a woman with severe dysfunctional lower urinary tract underwent a total of 4 cadaveric renal transplantations. The etiologies of the bladder dysfunction were bladder contraction secondary to urinary tuberculosis in all cases. In 3 patients were performed an enterocystoplasty with ileocecal segment and one with ileon.
The overall allograft survival was 58.7 months. Two patients have functioning grafts 27 and 74 months after transplant, 1 has died due to an intestinal disease and other had chronic rejection after follow-up of 98 months. Technical complications occurred in 3 patients. All patients remain continent without catheterization after the transplantation.
Enterocystoplasty is a safe and effective method of restoring lower urinary tract function in the patient with end stage renal disease and a small non compliant bladder.
Actas urologicas españolas 05/2003; 27(4):281-5. · 0.46 Impact Factor
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ABSTRACT: We illustrate a case of penile skin necrosis in a patient suffering from urinary incontinence caused by a secondary neurogenic bladder that, in turn, results from a spinal cord injury. The skin necrosis developed out of continuous pressure from the condom catheter. We report the case bearing into consideration that these complications are extremely rare and that references in the literature to the topic are likewise scarce. However, due to the high frequency of patients suffering from incontinence who use these devices, we believe it necessary to account for the possible consequences which might derive from an incorrect use of them.
Actas urologicas españolas 03/2003; 27(2):155-8. · 0.46 Impact Factor
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ABSTRACT: INTRODUCTION: C. albicans is the most frequent fungus causing opportunist infections of the urinary tract. Agglutination of necrotic tissue nucleus (papilary necrosis), mucosus debri and chirurgic or lithiasic debri, originates a fungus ball, which can obstruct the urinary tract at any level. CLINICAL DATA: We present 2 patients with obstructive urinary lithiasis developing fungus ball in the dilated upper urinary tract. Patient 1 was bilaterally affected and never had systemic symptoms. Treatment consisted of uretherorrenoscope for removal of fungus ball, bilateral urinary diversion and anphotericine B irrigations and systemic. Patient 2 developed a candidemia and was treated with systemic liposomal anphotericine B, uretherorrenoscopy with removal of ureteric calculus and fungus ball, and placement of a double J catheter and nephrostomy tube for anphotericine B irrigation. DISCUSSION: Urinary lithiasis is a risk factor for fungal infection of the upper urinary tract, provided there is no other predisponent factor for opportunistic fungal infections. Calculi facilitates fungal growth by means of obstruction and subsequent retrograde estasis and creating a nucleus for growth, aggregation and ramification of mycelium. The infection pathway is probably ascendent and may turn into fungemia and septicaemia. Systemic antimicotics, urinary diversion and local irrigations with antimicotics, and endourologic technics, are the three basic items in the treatment. Ureterorrenoscopy plays an important roll as a diagnostic and therapeutic tool as it may solve the obstruction and allows removal of fungus ball.
Actas urologicas españolas 02/2003; 27(1):60-4. · 0.46 Impact Factor
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ABSTRACT: Pure small cell carcinoma of the prostate is rare (less than 1% of all prostatic neoplasm). As a result there are few reports in the literature that describe the salient features and appropriate management of this cancer (less than 200 cases reported). Small cell carcinomas of the prostate are a heterogeneous group of tumors, a number of them have neuroendocrine differentiation and are highly aggressive, commonly with visceral metastases at time of diagnosis. Complete temporary remission has been reported with chemotherapy but this tumor has a poor prognosis. The median overall survival from the time of diagnosis is between 5-17.5 months. We report 2 new cases of small cell carcinoma of the prostate and a review of the literature.
Actas urologicas españolas 10/2002; 26(8):585-8. · 0.46 Impact Factor
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ABSTRACT: To analyze the efficacy and complication rates of extracorporeal shock wave lithotripsy in the paediatric age group.
From 1989 to 2000, 29 children (mean age 8 years, range 1-14) underwent ESWL for urinary calculi at our institution. A total of forty-four ESWL sessions were performed in 36 calculi and a previous double pigtail stent was inserted in 11 patients. Intravenous anesthesia was used in the vast majority of cases.
Complete removal of all stone fragments was achieved in 24 (66.7%) renal units after a first session, 6 (16.7%) after a second session. The rest of the patients became stone-free after 3 sessions in 3 patients, open lithotomy in 1 patient and ureteroscopy in another patient. In one case a watchful waiting was decided after the failure of the first session of ESWL. Mean hospital stay was 3.2 days (range 1-11) for each session. Complications appeared in 10 patients: 4 had renal colic, 3 haematuria, 2 fever and 1 subcutaneous hematoma.
ESWL is a safe and effective treatment for paediatric urolithiasis so it should be considered the first-line treatment.
Actas urologicas españolas 02/2002; 26(1):15-9. · 0.46 Impact Factor
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ABSTRACT: Primary retroperitoneal tumors are a very uncommon group of neoplasias in urology. Sixty-four primary retroperitoneal tumors admitted and treated in our hospital from january 1974 to october 2000 were reviewed retrospectively. Clinical presentation, diagnostic, treatment and evolution are analyzed. Five cases were benign (7.8%) and the remains malign (92.2%). Mesodermic tumors were the most frequent. Surgery was performed in 59 patients (92.2%). Radical resection was possible in 100% of benign tumors and 44.5% of malignant tumors. Palliative radiotherapy was performed as the only treatment in 3 patients. Two patients received only symptomatic treatment. Adjuvant chemotherapy (32 patients, 50%) and radiotherapy (19 patients, 29.6%) completed the treatment. Benign tumors 5-year global survival was 100%, malignant tumors 1-year survival was 47.4%, 3-year survival 15.2% and 5-year survival 10.1%. Mean survival was 20.15 months. As it's frequent to find an advanced neoplasm at the diagnostic, surgery must be planned with radical intention. Radiotherapy and chemotherapy could be useful in the therapeutic strategy of these tumors with poor prognosis.
Actas urologicas españolas 02/2002; 26(1):29-35. · 0.46 Impact Factor
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Actas urologicas españolas 30(10):1046. · 0.46 Impact Factor
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ABSTRACT: Testicular dislocation after blunt scrotal trauma is a rare event. This injure must be recognized and treated promptly to maximize the likelihood of testicular salvage. We describe a new case of unnoticed traumatic testicular dislocation with secondary testicular lost. We discuss the chain of events leading toward the correct diagnosis and treatment based on a review of published reports.
Actas urologicas españolas 26(10):804-5. · 0.46 Impact Factor
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ABSTRACT: Brucellosis is a cause of human disease, especially in regions whose brucellosis in animals is enzootic. Brucella orchitis is a rare complication of systemic brucellosis (2-14%). Necrotizing orchitis is posible and it must be distinguished from necrotizing involvement arising from other pathogens (TB or Salmonella). Treatment with specific antimicrobial medication helps to avoid unnecessary orchiectomy and prevent infectious disease in the contralateral testis as well as systemic manifestations. We report a case of brucellar epididymo-orchitis presenting as an acute scrotal mass in a 19 years old male who lived in a city. The anamnesis was crucial in the diagnosis of this rare testicular infection. We review the diagnosis and management of this patology.
Actas urologicas españolas 28(10):774-6. · 0.46 Impact Factor
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ABSTRACT: Sacral nerve neuromodulation is a new treatment modality for patients with chronic voiding dysfunction (CVD). The aim of this treatment is to restore the disbalanced micturition reflexes by electrical stimulation ot the sacral roots. Peripheral Nerve Evaluation (PNE) is the first step needed to determine wether sacral nerve stimulation for the control of lower urinary tract dysfunction is appropriate for a given patient, yielding accurate information about the location, integrity and function of sacral nerves, and motor and sensorial responses to electrical stimulation.
43 PNE in 28 patients (13 man and 15 women) were performed between january 2000 and november 2001 (mean age 56.3 years old, 22-76). Every patient have been diagnosed of CVD: 13 Urinary Urge Incontinence (UUI). 5 Urgency-Frequency Syndrome (UFS), 7 Dysfunctional Voiding (DV) and 3 Mixed Syndromes (1 patient UFS + DV and two patients with UUI + DV).
Every acute stimulation showed positive sensory and motor responses. There was premature lead migration in 8 PNE (18.6%), preventing an appropriate evaluation of the temporal stimulation. 35 PNE were evaluated after a 6.5 days period (3-15) of electrical stimulation. There were no significative complications, and PNE was well tolerated. Good clinical results (> 50% reduction in symptoms) were observed in 7/13 patients with UUI (53.8%), 2/5 patients with UFS (40%), 1/7 patients with DV (14.2%) and 1/3 patients with mixed syndromes (UUI + DV) (33.3%). 11 of 28 patients with CVD (39.2%) have been selected as candidates for permanent implantation.
Actually, PNE is the first step needed to determine wether sacral nerve stimulation for the control of lower urinary tract dysfunction is appropriate for a given patient. With PNE we can select properly adequate candidates for permanent implantation. It is an easy and well tolerated technique, and can be performed in any medical center in an outpatient basis.
Actas urologicas españolas 27(7):491-500. · 0.46 Impact Factor
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ABSTRACT: Endometriosis affecting the urinary tract is very rare and the most common site of involvement is urinary bladder. The clinical features are urgency and frequency, hipogastric pain and hematuria. Cistoscopic examination is the most valuable diagnostic test but definitive diagnosis requires histologic confirmation. We report 2 cases of endometriosis in 2 young women, one with previously cesarean section, in which surgical treatment was effective. After 1 and 3 years of follow-up respectively the patients remain assymptomatic.
Actas urologicas españolas 28(10):789-91. · 0.46 Impact Factor
