Search

Objectives: Ultrasound guided prostatic biopsy is still the reference method for the diagnosis of prostate cancer. Nevertheless, multiparametric magnetic resonance imaging (mpMRI) has become the best imaging method to identify clinically significant tumors. Form this new situation derives the search of the best method to enable the biopsy of the lesions identified by mpMRI and are not visible on ultrasound. The objective of this work is to review the current role of MRI and the various modalities of MRI based biopsies., Methods: Non-structured literature review about the current status of prostatic mpMRI and the various methods of biopsy of the lesions identified with it: in bore, cognitive and different commercial fusion software biopsy methods available for directed biopsies., Results: Although results in the literature are very heterogeneous, all three bore biopsy, cognitive biopsy in experienced hands and the various fusion/biopsy software platforms enable a precise biopsy of mpMRI/identified lesions, increasing the yield of each sample obtained. Fusion systems do not imply a clear advantage in global detection over systematic biopsy, except in the subgroup of patients with previous negative biopsy. Nevertheless, they do demonstrate a higher detection rate for clinically significant tumors that increases in patients with a first negative biopsy. Its role in the new therapeutic approaches for prostate cancer is yet to be defined, but it will be growing and essential in a near future., Conclusions: Multiparametric MRI is already an essential test in diagnostic algorithms for prostate cancer and the systems that enable to biopsy the lesion identified are day by day a more integrated tool in the urological daily practice, and urological procedures that will enable a more precise diagnosis leading to a personalized treatment for each patient.

Objectives: The microbubbles enhanced ultrasound contrast is a novel technique that informs us in real time of renal perfusion and microcirculation., Method: We reviewed the literature about its use in the study of renal masses in order to show their actual clinical performance in this condition., Result: This technique is useful in the differential diagnosis of pseudotumors, characterization and monitoring of small renal masses, the study of complex renal cysts and controlling the progression of renal masses that underwent ablative treatments. Like any diagnostic technique has some limitations on usage;its rapid contrast wash, being operator-dependent, require some experience and need special software to be correctly interpreted., Conclusions: The microbubbles enhanced ultrasound contrast is a useful and economic technique for the study and differential diagnosis of the renal masses.

Objectives: To perform an update on the usefulness of ultrasound in the study of small size renal tumors and its current possibilities., Methods: We review the results of ultrasound in this pathology with the addition of the most recent technological advances such as a harmonic digital converters and power color Doppler. We analyze its contribution to the differential diagnosis of the cystic pathology, to the definition of solid masses, to the detection and characterization of small size masses, and to the definition of the vascular patterns of various tumors., Results: Ultrasonography offers a diagnostic safety of 98% in cystic masses, being able to detect them from 0.5 cm diameter in favourable conditions. The differential diagnosis of multiloculated masses, multivesicular hydatid cyst, multiloculated cystic nephroma, and multiloculated cystic carcinoma still poses great difficulty, the same way it happens with other radiological tests. For solid masses, the greater image resolution has lead to a progressive increase in the incidental detection of tumors and the percentage of patients candidates to conservative surgery due to the decrease in size. It is easy to differentiate between adenocarcinoma and angiomyolipoma, up to 85% of the cases, but the rest of the tumors do not have specific characteristics. For small size masses, smaller than 3 cm, ultrasound sensitivity is clearly inferior to CT scan. Power color Doppler helps to confirm the existence of solid masses and helps a better differential diagnosis with pseudo tumors., Conclusions: The modern ultrasound techniques provide a high cost-effectiveness both in detection and definition of the nature of small size renal masses.

Objectives: Although transrectal ultrasound-guided (TRUS) prostatic biopsy is the procedure of choice for the diagnosis of prostate cancer (PC), neither the ideal number of cores nor the number of repeated biopsies, nor the required diagnostic yield have been established. After our experience of ten years with TRUS biopsy we perform a review of the technique and its indications., Methods: PSA, ultrasound features, and pathologic data of 6000 patients undergoing modified sextant TRUS biopsy between 1994 to December 2002 were collected. 222 patients undergoing ten-core TRUS biopsy were included in an experimental group to study the role of the extended biopsy. The contribution of the extra cores to the diagnostic yield in the experimental group was studied to determine the effectiveness of the extended biopsy, using as a control group 552 patients undergoing sextant TRUS biopsy during 2002. Both groups were comparable for the study variables at the start of the study., Results: The incidence of PC in the first biopsy in the group of 6000 patients was 39.1% (2345/6000). Patients with PSA between 4 and 10 ng/ml have an incidence of PC greater than 50% among prostates smaller than 20 cc, diminishing down to 8.9% in those greater than 50 cc. The percentage of PC among patients with negative digital rectal examination (DRE), normal TRUS, and PSA below 4 ng/ml was 16.7%. The diagnostic yield for PSA density lower than 0.11 ng/ml/cc was lower than 8%. The free/total PSA ratio shows a 13.7% incidence of PC with values higher than 0.24. Multivariate logistic regression analysis showed that the only non-significant parameter was free/total PSA. Sixty (27.15%) patients of the extended TRUS biopsy group had PC. Only 2.25% of the 221 patients benefited from the augmented number of biopsies. There were no significant differences in the figures of prostate cancer between groups. Only PSA and volume where significant in the multivariate logistic regression analysis; number of samples, PSA density and age lacked of influence in the detection of PC., Conclusions: The sextant biopsy model obtaining cores from the lateral horns of the prostate continues to be the reference for TRUS biopsy, and the extended biopsy is not applicable to all patients from the beginning do to the small increase in the diagnostic yield. Isolated PSA may not be the unique reference to indicate TRUS biopsy, being volume, in our experience, a definitive factor for the adjustment of high risk levels.

Objectives: The aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH)., Methods: A total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound., Results: The first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected., Conclusions: Ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH.

Objectives: To review the contribution of ultrasound to the differential diagnosis of scrotal pathology, both testicular and adnexal., Methods: We performed a bibliographic review on the topic, adding the experience of our Unit over the years; we classified the pathology in testicular and extratesticular, separating liquid and solid lesions, and a miscellaneous group of unclassifiable cases., Results: Currently, ultrasonography with high frequency equipment allows not only to differentiate between intra and extratesticular lesions, but also to identify specific lesions, the manage of which may include follow-up without need of unavoidable surgery., Conclusions: Ultrasonography is a painless simple test that may be repeated without inconvenience so that it is the first test to be indicated for any problem of the scrotal content.

Objectives: To perform a historical review of varicocele and male infertility with the aim to find descriptions that first related them. In parallel, we review the evolution of treatment for varicocele up to date., Methods/results: We refer to multiple authors and their treaties on Medicine, from first to 20th Century, in which descriptions of these pathologies are found, focusing on descriptions of the surgical technique for treatment of varicocele and their application in Spain., Conclusions: Varicocele was already described in treaties from the first century having bee of n its treatment predominantly surgical from the first description to our days. Not identified as a cause of infertility until late, by the end of the 19th century, it is the main indication for treatment nowadays. The surgical technique has suffered many modifications over time, both in the approach as in the "radicality" of a vascular ligature applied.

Objectives: To report one case of prostate carcinoma with metastasis to the corpora cavernosum., Methods: We report the case of a 79-year-old patient with the diagnosis of Gleason 9 prostatic adenocarcinoma who presented a hard lesion on the glans penis one year after starting androgen blockade. The patient underwent palliative TURP and biopsy of the lesion., Results: Pathology reported a penile metastasis of prostatic adenocarcinoma., Conclusions: Penile metastasis are rare, usually appearing in advanced stages of the primary disease; their treatment is palliative and should only be carried out in symptomatic patients.

Objectives: To report the 7th case of pararenal angiomyolipoma published in the world literature and to review the international bibliography., Methods: We report the case of a 46-year-old female with history of renal colic and a complex mass on radiological tests., Results/conclusions: Extrarenal retroperitoneal angiomyolipoma is a rare pathology with no more than 7 published cases. The diagnostic difficulty and radiological similarities with liposarcoma make surgery the treatment of choice.

Objective: To present a series of 63 patients with urinary incontinence due to sphincteric incompetence who underwent the implantation of an AMS-800 artificial sphincter., Methods: From 1984 to December 2002 a total of 69 patients received this prosthesis, 63 of which were available for review. The cause of incontinence was sphincter incompetence in all cases, said secondary to prostate surgery, neurogenic bladder, post-traumatic urethral lesion, and epispadias. 52 of them were placed in the bulbar urethra, and 11 in the bladder neck. The cuff diameters varied from 4 to 10 cm and reservoir pressures from 51-60 to 71-18 H2O cm., Results: The complications that appeared, ordered by frequency, were: malfunction, infection and rejection or exteriorization, fistula, and unappropriate size. The total number of reoperations was 39 in 28 patients. Functional results were successful in 48 cases and failure in 15., Conclusions: The use of an AMS-800 prosthesis for the treatment of urinary incontinence due to sphincteric incompetence is effective but not without complications. The most frequent indication was following prostate surgery, being this group the one that obtains the best results. Patients with incontinence of neurogenic origin have the highest complication rate, and the worst results in relation to vascularization and tissue trophism abnormalities. In female patients we prefer other techniques that have similar results, are technically easier and more economic.

Objectives: To report one case of lithiasis transference from the donor associated with renal transplant., Methods: 53-year-old female with obstructive uropathy within the first post transplant month., Results/conclusions: Lithiasis transference after transplant is a cause of early obstructive uropathy after kidney transplantation. The low the incidence of lithiasis transference does not justify the performance of x-ray and/or ultrasound of the donor organ in terms of cost effectiveness. Extracorporeal shockwave lithotripsy is a valid therapeutic option on transplanted kidneys.

Objectives: To report one clinical case of obstructive uropathy secondary to bladder pseudotumor., Methods: We report the case of a 74-year-old male with obstructive acute renal failure of unknown etiology., Results: After resolution of the acute renal failure by percutaneous nephrostomy, action was undertaken to control possible etiologic causes, resolving the bilateral ureter entrapment and bladder inflammatory process., Conclusions: Glandular cystitis is a nosological entity which in its severe forms behaves clinically and radiologically as a bladder pseudotumor, so that should be considered as a part of the differential diagnosis with bladder tumors. Final diagnosis comes from pathology. For treatment, it is basic to eliminate any predisposing factor, either infectious, or irritative, or obstructive; if no action is carried out on these factors other therapeutic measures as the aforementioned are not effective. Strict follow-up should be undertaken (every six months) because of the high incidence of bladder adenocarcinoma.

Objectives: To review the main images that can be observed by ultrasound, trying to highlight what decision to take after their finding: exploratory surgery, orchyectomy, or follow-up., Methods: We performed a bibliographic review about the topic and incorporated our personal experience with scrotal ultrasound. Given that there is an extensive variety of anomalies that can be observed we divide them in liquid and solid lesions, and these in intra or extratesticular, plus a group of lesions that do not qualify in the previous groups., Results: The development of high frequencies transducers (8-10 Mhz) and a greater experience today allows to diagnose not only testicular tumors but also a number of benign clinical entities, with enough specificity in some of them as to avoid surgery., Conclusions: Ultrasound is a simple test, painless, and can be repeated without trouble, so that it is the first test that should be ordered when managing any intra scrotal problem.

Objectives: We report six cases of adrenal cyst, a rare pathologic entity which poses diagnostic problems and therapeutic controversies., Methods: We report six cases of adrenal cysts in 4 female and 2 male patients ages 26 to 68 years. All cases underwent surgical treatment., Results: Pathologic studies showed that all were adrenal cysts without malignancy in any case., Conclusions: Adrenal cysts are a rare disease of which correct diagnosis is difficult so that many times patients undergo surgery without a proper preoperative diagnosis. There are controversies about the right management of adrenal cysts.

Objectives: Bleeding secondary to severe vesicoprostatic pathology (mainly neoplasic disease and radiation cystitis) may be a serious clinical management problem due to its morbidity and associated increased resources demand in the form of admissions, transfusions and other measures. We review a series of patients embolized for this purpose, its efficacy, tolerability and adverse events., Methods: We review 8 patients who underwent hypogastric arteries embolization between July 1998 and December 2001, analyzing indications, efficacy and duration, tolerability, and consequences. Right femoral artery access was undertaken in all except one case that needed bilateral femoral accesses. Embolization was achieved by means of coils and particles. All procedures were performed under local anaesthesia., Results: 9 procedures were performed in 8 patients. 3 patients presented with hematuria due to radiation cystitis, 3 from prostatic carcinoma, and 2 with urethrorragy from urethral relapses after cystectomy. 7/9 embolizations were effective achieving immediate complete or almost complete bleeding control; in one case control was partial; another one had limited or no effect. Selective embolization of distal arteries was performed in 3 cases; all the remainders underwent direct hypogastric trunk embolization sparing the superior gluteal artery. Effect lasted between 1 and 31 months. 4 patients died, 3 of them without haematuria, 1 because of an intercurrent disease, and the others from disease progression. 2 patients underwent posterior surgery, one due to recurrent haematuria, and the other, a case of urethral tumour, due to partial failure; partial cystectomy and urethrectomy were performed respectively. 2 patients needed administration of morphic derivatives after embolization, all the others were managed with magnesium metamizol. Only one patient referred mild transitory gluteal claudication., Conclusions: Percutaneous arterial embolization is an effective instrument to treat patients with haematuria or urethrorragy and severe lower urinary tract pathology in whom curative treatments are not applicable due to their general status, life expectancy, or tumor status.

Objectives: To establish the role of MRI in renal disease, its indications, advantages and disadvantages. To briefly describe the main MRI techniques and renal features depicted on MRI before and after administration of a contrast agent, and present the MRI findings in different renal conditions., Methods: The images were obtained with the GE MR 0, 5 T. T1- and T2-weighted spin echo and echo gradient sequences were utilized according to the protocol described in the article., Results/conclusions: MRI is very useful in the study of renal disease due to its high spatial resolution. Its cost, and because it is not widely available, have limited the indications of MRI to those cases whose diagnosis cannot be established by other imaging techniques (US and CT) and patients in whom iodated contrast material (i.e., allergy to iodine or renal failure) or ionizing radiation (i.e., pregnancy) is contraindicated. MR has a high diagnostic reliability in the evaluation of the extent of the renal tumors. MR angiography and MR urography permit adequate and non-invasive assessment of the vascular and collecting systems without the need to utilize iodated contrast agents.

The authors present a case of adenomatoid tumour of the vaginal testicle tunica, found by chance during a post-mortem study in a 70-year old male. After reviewing the literature they reveal its infrequency. According to the latest, histochemical and ultrastructural investigations carried out by several authors, its origin is mesothelial and therefore it may be called a benign mesothelioma.