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Objective: To determine the correlation between two methods of measurement of total PSA (PSA-T) and free PSA (PSA-F) and the utility of the PSA-F/PSA-T ratio in patients with PSA-T between 4 and 10 ng/ml suspected as having prostate cancer., Methods: Determinations of both PSA-T and PSA-F were performed using two different techniques in 91 patients suspected as having prostate cancer. Diagnosis was made on the findings of biopsy and the complementary tests., Results: The following correlation was found for the two techniques: R = 0.99 and p < 0.05 for PSA-T, and R = 0.85 and p < 0.05 for PSA-F. For PSA-T values of 4-10 ng/ml and PSA-F greater than 25%, we found two patients with prostate cancer. For a PSA-F/PSA-T ratio less than 9%, all cases had prostate cancer. Three cases with bone metastasis had PSA-T values less than 10 ng/ml., Conclusions: A PSA-F/PSA-T ratio greater than 25% does not exclude malignancy in patients with a total PSA of 4-10 ng/ml; values less than 9% correspond to prostate cancer. Bone metastasis was found with both methods in patients with total PSA values less than 10 ng/ml.

Objective: To establish the current indication in our milieu of seminal vesicles (s.v.) biopsy and laparoscopic pelvic lymphadenectomy in prostate cancer., Material and Methods: The prospective study of s.v. biopsy includes 128 patients. Overall efficacy of the technical procedure, incidence of seminal infiltration in relation to clinical staging, PSA, Gleason or the association of both are all analyzed. The second part of the project involves a retrospective statistical study applied to the lymphadenectomy series over a period of 10 years on 202 cases (69 laparoscopic and 133 open ceiling), analyzing several risk factors for nodular invasion., Results: Seminal and nodular infiltration was related to clinical stage, PSA and Gleason. PSA > 20 and Gleason > or = 7 is clinically the most useful association for the diagnosis of seminal infiltration. Increased PSA and Gleason involved greater nodular infiltration; the optimal cut-off point is 40 and 7 respectively., Conclusions: S.V. biopsy should be performed in T3 stage or in earlier stages with PSA greater or equal to 20 and/or Gleason greater or equal to 7. If biopsy is tumour negative, laparoscopic lymphadenectomy should be performed at T3 stage (regardless of PSA or Gleason), and in < T3 with PSA greater or equal to 40, Gleason greater or equal to 8 and when Gleason is 7 and PSA > 20.

Objectives: The present study investigated the somatosensory evoked potential (SSEP) from the dorsal penile nerve and the bulbocavernosus reflex (BCR) in healthy volunteers and patients with erectile dysfunction in order to establish a model of normality and investigate the abnormal neuro-urophysiological measurements in patients with erectile dysfunction and their relationship with different factors (age, neurological disease)., Methods: 30 healthy volunteers and 102 patients who had consulted for erectile dysfunction underwent neuro-urophysiological diagnostic evaluation (dorsal penile nerve SSEP and BCR). The mean age was 51.2 years (range 27 to 66)., Results: The group of healthy volunteers showed SSEP mean latency of 46.374 ms and a BCR mean latency of 43.721 ms. Thirty-four patients (33.33%) had at least one abnormal neuro-urophysiological measurement, the SSEP were abnormal in 7 (20.58%), the BCR in 5 (14.70%) and both in 22 (64.70%). We found an increased SSEP latency and BCR latency in the patients with erectile dysfunction and with no urological disease. Comparison of the older with the younger patients was only statistically significant for increased BCR latency in patients > 60 years old., Conclusions: The study revealed neuro-urophysiological abnormalities in 34 impotent patients (33.33%). The finding of abnormalities in both BCR and SSEP was the most frequent.

The authors present the results obtained using a program for early diagnosis in symptomatic patients, within a specific population area. The effectiveness of this diagnosis program for prostate cancer, which is expected to be used also for diagnosis of less advanced stages, is established with the analysis of results obtained in 1000 patients: 42.5% positive biopsies. Biopsy indication in case of suspicious rectal examination and/or PSA over 10 ng/ml is considered useful. There are more reservations towards this indication with PSA values between 4 and 10 ng/ml, where evaluation of other complementary options is considered necessary.

Objective: Difficulties for a precise staging of patients with prostate cancer are huge. This article presents the initial results from a study to investigate the contribution that various clinical and analytical parameters, together with the study of prostate biopsy for staging, could have on our environment., Material and Methods: 70 patients undergoing curative radical prostatectomy were studied through an analysis of their PSA. PSAD, and PSAD ad pre-operative levels and, in the biopsy cylinders, the tumour unilateral or bilateral nature, Gleason grade, percentage and total number of involved cylinders, and percentage of cancer length over the cylinders' total length. This data was then correlated to the pathological stage. Gleason's grade and tumoral volume of the surgical specimen., Results: 97% of patients studied showed clinical organ confinement versus only 64.28% after examination of the surgical specimen. (I Kappa = 0.1). Concordance between the biopsy's Gleason grade and the prostatectomy specimens was moderate (I Kappa = 0.34). Pre-operative PSA showed no statistically significant difference (SSD) between organ-confined and non-organ-confined tumours (p = 0.15), opposite to PSAD (p = 0.039) and PSAD ad (p = 0.038) which did. The tumour's unilateral or bilateral nature in the cylinders, and the total number or percentage of affected cylinders showed no SSD with regard to organ confinement of tumours. Neither the length percentage of the affected cylinders showed SSD in relation to the tumour's organ confinement. The specimen's tumoral volume was significantly correlated to the length percentage of cancer and positive biopsies, as well as with clinical stage, PSA, PSAD, and PSAD ad., Conclusions: Both PSAD and PSAD ad, and the sum of the biopsy's Gleason may contribute to predict the pathological stage. The percentage and total number of biopsy cylinders affected by the tumour, as well as the total length percentage of cancer affected cylinders are correlated to the tumoral volume but not to the organ confinement of the tumoral disease, not meeting the clinical stage in our patients (selected according to our group's staging algorithm). These findings must be ratified by further study of larger series.

Presentation and analysis of results from an early diagnosis program for prostate cancer in symptomatic patients. Output of density-PSA (PASD-d), density-PSA of the transitional area (PSAD-ad) and free PSA/total PSA ratio, applied to patients with total PSA between 4 and 10 ng/ml is analyzed.

Rationale: Exposition of our experience in the early diagnosis of prostate cancer, based on the initial selection of patients., Methods: Evaluation of patients from within the area covered by our hospital and seen for signs and symptoms of prostatism. Those with suspicion rectal examination (RE) or PSA greater than 4 ng/ml were further evaluated with transrectal ultrasound and prostate biopsy., Results: Based on the biopsies of 700 patients, prostate carcinoma was diagnosed in 294/700 (42%). 55.72% patients with suspicion RE, and 47.5% with PSA > 4 had cancer. In patients with PSA > 4 and non-suspicion RE, cancer was detected in 16.44%. The percentage of neoplasia in patients with PSA 4-10 ng/ml and non-suspicion RE was 10%. As a result of these findings, 88 radical prostatectomies were performed. PASD and PASD ad. showed significant differences between patients with and without cancer, whether with (+)RE (p = 0.0001) or (-)RE (p < 0.0004), unlike PSA that showed no differences. The diagnostic value shown by PSAD ad. in ROC curves was similar to that of PSAD. Value of age-adjusted PSA was not higher than PSAD., Conclusion: Performance of prostate biopsy with a suspicion RE is recommended. If RE shows no suspicion, biopsy should be performed when PSA is > 10 ng/ml, and with PSA 4-10 ng/ml a biopsy is advocated with PSAD > 0.15.

Purpose: Prostate cancer patients were differentiated using seminal vesicle biopsies related to clinical staging, prostate specific antigen (PSA), Gleason scores and PSA density values., Materials and Methods: A total of 75 patients underwent seminal vesicle biopsies. Patients with no seminal vesicle invasion and negative lymphadenectomy results underwent radical prostatectomy., Results: Efficacy of seminal vesicle biopsy was 90.9%. Infiltration rates were 69% for disease stage T2b or greater, 68% for PSA greater than 10 ng./ml., 78% for PSA greater than 20 ng./ml. and 73% for type 4 and/or 5 Gleason scores. For the prognosis of seminal vesicle invasion, 0.40 was the best PSA density cutoff point., Conclusions: We recommend seminal vesicle biopsy in patients with stage T2b or greater disease, and with a lower clinical stage when the PSA level is 20 ng./ml. or greater and/or the Gleason score is 7 or greater.

Internal urethrotomy is the endoscopic technique most commonly performed in order to resolve urethral stenosis. This paper describes a new technique which associates transrectal ultrasound to internal endoscopic urethrotomy for the resolution of unsurmountable stenosis of the urethra. Presentation of 6 cases, with a 100% success rate. The authors believe that the association of transrectal ultrasound with internal endoscopic urethrotomy is a simple technique, and very useful for the resolution of unsurmountable stenosis of the urethra.

Presentation of the initial results from a program for early diagnosis of prostate cancer, implemented a year ago at the Urology Unit of the Miguel Servet Hospital with the collaboration of the Region's specialists. All patients attending the Urology services, regardless the pathology, are evaluated when rectal examination is suspicious or the plasma PSA levels are higher than 4 ng/ml. Assessment is made through transrectal ultrasound scanning, with random or ultrasound-directed prostatic biopsy depending on the findings. A total of 83 prostatic biopsies have been analyzed n patients thus selected, presence of prostatic carcinoma becoming apparent in 52 (62.6%), 19 of which have undergone radical prostatectomy. The association suspected rectal examination/increased PSA has produced the higher percentages of diagnostic precision (80%) clearly improving those of rectal examination and PSA alone. The methods for local and nodular staging are analyzed, considering the systematic use of laparoscopic lymphadenectomy and biopsy of seminal vesicles highly useful for higher diagnostic precision in these patients. The diagnostic relevance of prognostic factors in advanced cancer is analyzed, this analysis being mandatory to evaluate the different therapeutic.

The prostatic surface antigen (PSA), exclusively secreted by the prostatic epithelial cells, can be raised in the sera of patients with various prostatic pathologies. Serum levels of this marker depend on many factors (prostatic manipulation, associated inflammation, volume of benign node hyperplasia, volume and grading of tumour differentiation), all of which will have to be taken into account when interpreting any specific level. The usefulness of this antigen has a distinctive role in the suspected diagnosis, staging and monitoring following treatment of prostate cancer. PSA has shown to be more effective than other markers in the diagnosis of prostate cancer. Following the review of 106 patients with prostate cancer in various clinical stages, PSA was higher in 76.5% and PAP only in 49%. There is also a correlation between PSA and the extension of the disease. Of 43 patients surgically (stages B, C, D1) or radiologically (stages D2) staged, increases PSA has been found in 25% B stages, 77.7% C stages and 88.4% D stages. With regard to post-treatment monitoring, PSA is highly useful to determine its effectiveness, detect any residual illness and predict a recurrence or progression.

In recent years technical and technological advancements in the field of urology have led to the enhancement of iatrogenic lesions of gynecological origin. Herein we describe our experience of 15 years during which 76 renal units were treated with a mean follow-up of 29.3 months. In 46 renal units diversion was performed previously. The surgical technique was a therapeutic success in 89.28% of the cases. Ureterovesical reinsertion with vesical lateralization was the most commonly used technique. We underscore the importance of microsurgical transureteroureterostomy as a useful alternative as well as the use of effective less invasive endourological procedures.

We report a case of direct renal trauma with formation of subcapsular hematoma in an anticoagulated patient. After an initial conservative approach, patient condition spontaneously evolved to subcapsular rupture resulting in perirenal spread of the hematoma enveloping the ureter up to the sacral level thus causing severe hydronephrosis. Surgical exploration permitted ureterolysis and postoperative radiologic work up revealed patency. We briefly discuss the current controversy relative to the different therapeutic approaches.

A case of systemic candidiasis is presented in a patient with one kidney in the post-operative period from a cysto-prostatouretrectomy with Bricker ureteroileal derivation, performed due to multifocal superficial vesical tumour non controllable by endoscopy. The clinical picture developed with anuria and temporary diuresis periods associated to a severe septic picture; a deep Candida albicans infection was demonstrated by laboratory tests and a fungus ball ureteral obstruction was demonstrated by radiology. Urinary derivation by means of percutaneous nephrostomy, associated with oral treatment with ketoconazole and local treatment with amphotericin B solution intermittently irrigated through the nephrostomy allowed the patient's resuperation and the fungus ball was spontaneously ejected after 30 days of treatment. The different forms of presentation of urinary candidiasis are discussed together with the diagnostic methods and present therapeutical options, with special reference to the imidazole derivative ketoconazole and irrigation solutions.

We present a case of incoercible hemorrhagic cystitis provoked by the therapeutic association of systemic cyclophosphamide and pelvic radiotherapy in a woman with disseminated mammary carcinoma disease. The conservative treatment, including vesical irrigation with aluminum salts, did not succeed in stopping the bleeding. A "sauvatage" cystectomy was carried out with Bricher-Wallace II type urinary derivation. We conclude by pointing out how the simultaneity of two therapies with individual vesical toxicity risk were boosted and how cystectomy continues to be the definitive treatment once conservative measures have been used up.

We present a retrospective study of 30 new cases of Klinefelter's syndrome and set forth our customary diagnostic and therapeutic schedule. We analyse the results obtained and single out the fact that 100% of the patients displayed high gonadotropins and 45% apparent plasmatic testosterone normality at the time of diagnosis. There is a relationship between lower semen fructose concentration, smaller volume of semen and higher degree of hypoandrogenism in Klinefelter's syndrome. Long duration hormonal treatment with testosterone esters is effective in improving the physical psychic and sexual state of patients. The interval between the last administration and the control hormone determination should be uniform for correct result evaluation.

We present a case of renal angiomyolipoma associated with tuberous sclerosis affecting the regional lymphatic ganglia. We analyse the possible etiopathogenesis of this affection and conclude, like most authors, that it may reflect the multifocalization of this tumour rather than malignity or metastatic lesion.

The nephroblastoma is a rare tumour in the adult and there are 240 cases reported in the world literature. We offer a new case and then review the literature, analysing the major features of diagnosis, treatment and evolution of this tumour.

We present a new case of emphysematous cystitis, commenting on some of the more interesting aspects of the etiopatogeny diagnosis and treatment of this entity. We underline the importance of early diagnosis and effective treatment of the disease as well as of the coadjuvant factors.

A case is presented of spontaneous rupture of a double-J catheter in a 61-year-old patient suffering from carcinoma of the prostate gland with urethral entrapment. The patient did not attend visits for periodical catheter changes, suffering the rupture of the catheter in two occasions remaining under those conditions for 20 and 18 months respectively. Removal of the fragments and placing of a new double Pit-Tail, required in both occasions a combination of cystoscopic and percutaneous maneuvers.

The ureteropelvic junction (UPJ) is the most common site of upper urinary tract obstruction. We report on 46 adult patients (50 renal units) that had been treated for a UPJ anomaly at our department over a 10-year period. The most common clinical manifestations observed were lumbar pain and/or colic (82.6%) and infection (34.8%). Genitourinary malformations were observed in 21.8% of the patients. The following treatment modalities were performed: 8 nephrectomies, 39 repair surgery procedures, 3 renal units with mild dilatation and no obstruction did not undergo surgery and were closely followed. The Anderson-Hynes pyeloplasty procedure was performed in 37 (95%) renal units and the Foley Y-V plasty in 2 (5%). The most important complications were anastomotic stricture (4) and urinary fistula (2). Overall, the results of repair surgery were good in 69.2%, fair in 20.5% and poor in 10.3% of the cases. Better results were achieved in those cases with moderate (86% good results) than in those with severe (47% good results) dilatation. Following pyeloplasty, 95% of the patients were pain-free, 1 (2.3%) patient had episodes of symptomatic infection and deterioration of renal function was observed in only 1 patient with a single kidney and severe chronic renal failure prior to surgery. At 2 years, dilatation had improved in 64%, remained unchanged in 31%, and became worse in 5%. In the management of pyelocaliceal dilatation, we believe it is fundamental to clearly establish the presence of obstruction and predict the functional recovery of the obstructed kidney. Our diagnostic and therapeutic approach is described. For upper urinary tract dilatation, the following is performed: simple or diuresis IVP, diuresis renography, ultrasonography and CUMS (if reflux is suspected). When doubts exist or when the results are unclear, pressure flow urodynamic studies are performed. Thus, we perform repair surgery in dilatations with functional obstruction to avoid progressive renal deterioration. The literature on the diagnostic techniques for the assessment of obstruction and functional recovery is reviewed.

Stone mass is a fundamental parameter that determines the approach to reno-ureteral lithiasis. Reference to stone size based on a single diameter gives us an imprecise idea about stone volume. For this reason, we recommend using the term "stone surface" to express stone mass. Stone surface is obtained by multiplying the longitudinal by the transversal diameter expressed in millimeters, using the plain film for radiopaque and the urogram for radiolucent calculi. Stone surface is a parameter which can be determined easily and is a more reliable way to determine stone volume. In 1,500 renal units with reno-ureteral calculi treated by ESWL and percutaneous techniques, we corroborated that the surface of calculus is directly associated with the number of shock waves required for fragmentation. Thus, as stone surface increases, more shock waves will be required to achieve fragmentation. The surface area of the calculus correlates very significatively with urinary tract obstruction post-ESWL. As the surface of the fragmented stone increases, there exists a higher incidence of obstruction. Obstruction is more severe and more ancillary maneuvers to remove obstruction are warranted. The incidence of renal colic post-ESWL is significantly influenced by the surface area of the calculus. There is a higher incidence of reno-ureteral colic following fragmentation of large stones. Furthermore, stone surface significantly determines the rate at which fragments are passed, and the persistence of stone sand at 3 months. Thus, as stone surface increases, there will be more fragments that can and cannot be spontaneously passed following treatment with ESWL. Finally, it must be emphasized that stone surface is a fundamental parameter that determines the combination of ancillary techniques prior to ESWL and significantly influences the efficacy of the approach in the treatment of reno-ureteral calculi.