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Treatment of LUTS from BPH has evolved from surgical therapy to medical monotherapy to combination therapy. First-line medical therapy for men with LUTS remains agents that decrease outlet resistance: αadrenergic antagonists and 5α-reductase inhibitors. Alpha-adrenergic agents decrease smooth muscle tone in the prostate and bladder neck. The mechanism of action of 5α-reductase inhibitor is reduction in prostate volume. First-line therapy for OAB symptoms are antimuscarinic agents. There has been reluctance to prescribe these agents to men with BPH due to the perceived risk of precipitating urinary retention. Alpha-adrenergic antagonists, 5α-reductase inhibitors, and antimuscarinic agents have all been shown to be safe and effective when administered to men with BPH and LUTS. The combination of 5α-reductase inhibitors with α-adrenergic antagonists is effective in men with LUTS secondary to BPH. The combination of α-adrenergic antagonists plus antimuscarinic agents and the combination of 5α-reductase inhibitors with antimuscarinic agents are safe and effective in patients with LUTS, evidence of BPH, and OAB symptoms. At present only combination therapy with 5αreductase inhibitors with α-adrenergic antagonists is recommended in clinical practice guidelines. MTOPS and ComBAT have demonstrated superiority of combination therapy over monotherapy in preventing disease progression. Further studies are required to elucidate which specific patient population benefits most from particular combination therapies.
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OBJECTIVES: To determine the clinical significance of diagnosis and treatment of prostate cancer diagnosed in asymptomatic patients, in terms of survival and to face its disadvantages.METHODS: We reviewed the literature in order to know the number of men that must be reviewed through analysis of PSA, biopsy and surgery to prevent the death of one of them, as well as knowing the amount of disadvantages associated with the process.RESULTS: We summarized, in the case of men older than 50 years, that 1 in 9 have PSA greater than 4 ng/ml. We must biopsy 3 men if PSA is between 4 - 10 ng/ml to find one prostate cancer. In order to prolong the life of one patient it is necessary a total of 18.5 prostatectomies if the tumor is palpable and the number of prostatectomies needed in the case of non-palpable tumors is estimated five times higher. In return, there will be one death per 9791 males initially checked, one incontinence per 147 males and one impotence per 58 male impotence. Three papers report that tumor spread may be caused by the biopsies.CONCLUSIONS: We highlight the limited evidence for the data in terms of survival. It warns about the difference in results between the centers of excellence and the rest, and creates doubts about the definition of cancer when it cannot be demonstrated beyond the biopsy.The usefulness of finding and treating early prostate cancers is questionable in terms of cost-benefit, recommending the transfer of this information to patients, before deciding on one or another option. We stress the need for long-term prospective investigations to clarify which cases need to be treated and to prevent overdiagnosis. We should consider whether it is worth looking further histological findings, in increasingly younger males and with lower PSA limits.
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OBJECTIVES: To determine the frequency of primary circulating prostate cells in men with prostate cancer at the time of diagnosis, the association with micrometastasis, sub-classification for CD82 and the relation with pathological stage. To determine their clinical usefulness to identify patients in whom radical prostatectomy would be first choice therapy.METHODS: Men with the diagnosis of prostate cancer before definitive therapy. Blood and bone marrow samples were taken, mononuclear cells separated by differential centrifugation and prostate cells identified with immunocytochemistry using anti-PSA. Positive samples were sub-classified with anti-CD82. Details of serum PSA, Gleason score and pathological stage were registered. RESULTS: Of 77 men 58 (75.3%) had primary CPCs detected, there was an association with stage but not Gleason. 31 (40.3%) had micrometastasis with an association with stage and Gleason score. CPC-negative patients had fewer micrometastasis detected, 1/19 versus 30/58 (p<0.003).There was an inverse relation between CD82 expression and Gleason score, men with CPCs expressing CD82 had fewer micrometastasis. The combined group of CPC negative and CPC positive CD82 positive men showed a sensitivity of 87% and specificity of 73.9% for the absence of micrometastasis.CONCLUSIONS: The detection of CPCs and sub-classification with CD82 could be clinically useful to identify men with a significantly lower risk of micrometastais and as a consequence to identify men in whom radical prostatectomy could be the best initial treatment.
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OBJECTIVES: To assess the bladder compliance in a series of cystoceles referred for urodynamic study. METHODS: Retrospective study of a series of patients with cystocele undergoing medical history, videurodynamic study, pelvic MRI and lower urinary tract, urological ultrasound and cystoscopy. We Excluded cases with neurogenic dysfunction and urinary infection. The terminology followed the criteria of the ICS, if not specified otherwise. The series includes 3333 cases of cystocele 616 of which are grade III cystocele. There were 3 cases with low bladder compliance; this is 0.0009% of total (1:1000) and 0.5% of grade III cystocele (1:200) RESULTS: All cases of cystocele whit low compliance were associated with feeling of a bulk in the vagina and functional symptoms of lower urinary tract (LUTS). No urinary incontinence was related to cough. These patients also showed urodynamic alterations in the voiding phase, type hypo / acontractile detrusor and postvoid residual. The patients were subjected to various techniques of abdominal and transvaginal cystocele repair (with preventive anti-incontinence surgery), getting a vagina bulk disappearance, improvement of symptoms of lower urinary tract function, normalization of bladder compliance and detrusor contractility, with elimination of the postvoid residual. CONCLUSIONS: Although they are not frequent, high-risk cystoceles should be discarded in high-grade cystocele that apart from low bladder accommodation, have a hipo/acontractile detrusor and postvoid residual. Surgical correction of cystocele not only reduces the bulk and LUTS, but normalizes urodynamic alterations.
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OBJECTIVES: Nocturia is a frequent urinary symptom in overactive bladder (OAB) patients, which usually exerts a negative impact upon their quality of life. This study describes the profile of the OAB patient with nocturia, in order to contribute to the adequate identification and medical management of these subjects.METHODS: Multicenter, national observational study of 1454 patients over 18 years of age,previously diagnosed with OAB. The relationship between nocturia and different personal and clinical variables was studied, and logistic regression models were used to identify variables independently associated with nocturia in both women and men.RESULTS: 84.6% of the patients presented nocturia, considering the restrictive criterion of two or more micturition episodes per night (96.8% according to the ICS definition). Urinary symptoms of frequency, urgency and urge incontinence were associated in a bivariate analysis with nocturia for both genders, while the voiding difficulty variable “pain” was only associated in women, and the voiding difficulty variable “straining” only in men. Older age and presence of comorbidities were associated both in bivariate analysis and independently in logistic regression models to the presence of nocturia in OAB patients of both genders.CONCLUSIONS: This study revealed that the profile of subjects with previously diagnosed OAB and nocturia corresponded to older age and the presence of comorbidities of a certain impact for both men and women. The profile for OAB patients with nocturia differs from those previously reported for patients suffering from nocturia and other urinary pathologies.
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Retroperitoneal Laparoscopic Lymph node Dissection (RPLND) seems to offer similar staging accuracy and long term outcomes to Open RPLND. It is also a reasonable option in terms of morbidity. However, solid laparoscopic skills are necessary to safely perform this surgery.In the following article, we assess indications, access, surgical technique, complications and controversies of the laparoscopic RPLND.
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OBJECTIVES: The wide use of imaging tests has increased the number of patients with abdominal and retroperitoneal lymph nodes that should be studied with biopsy. The laparoscopic approach has been used to identify lymph nodes of gynecologic origin and lymphomas among others.We present a series of four patients submitted to laparoscopic resection for non-testicular pathology.METHODS: From July 2008 until May 2009, four patients have undergone laparoscopic resection, using the same technique and dissection pattern of testicular carcinoma.RESULTS: All surgeries were completed by laparoscopic approach. All patients achieved a resected lymph node suitable for pathologic diagnosis.Mean operative time was 95 min (40-135). The average estimate bleeding was 60cc (0-80). There were no perioperative complications.CONCLUSIONS: In patients with abdominal lymph nodes not from testicular origin it is possible to perform laparoscopic resection with low morbidity and excellent effectiveness.
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OBJECTIVE: To report a case of severe hemorrhagic cystitis successfully treated by bilateral percutaneous nephrostomy.METHODS: The case of a 67-year-old female patient who had monosymptomatic gross hematuria with clots is reported.RESULTS: Standard conservative treatments failed and the patient developed a clot-retention plugged bladder. Endoscopic evacuation and electrocoagulation of bleeding areas was unsuccessful. Due to persistent hematuria and development of renal failure and hemodynamic instability, bilateral percutaneous nephrostomy was performed. At 24 hours, hematuria ceased, patient recovered hemodynamic stability, and no additional blood transfusions were required.CONCLUSIONS: Bilateral percutaneous nephrostomy may be a valuable option for the treatment of hemorrhagic cystitis when standard conservative measures have failed and as a prior step to performance of other more invasive procedures.
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OBJECTIVE: We report two new cases of Sertoli cell testicular tumors, and a Cochrane and Medline search of cases published worldwide.METHODS: We reviewed our series of testicular tumors, the stromal tumor incidence, clinical presentation, treatment and prognosis, and the experience reflected in the literature.RESULTS: The prevalence of testicular tumors in our health area is of 0.09%, and 2.3% of them are Sertoli cell neoplasms. This figure is slightly higher than the found in other series in which Sertoli tumors range from 0.4% to 1.5% of testicular malignancies in adults and reach 4% in children.CONCLUSIONS: Sertoli cell tumor has an incidence not exceeding 4%. The most common symptom is a painless mass; in cases with endocrine manifestation, up to 10% are malignant depending on the age of the patient.
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OBJECTIVE: To report the first case described of genitourinary infection by Corynebacterium Thommsenii in a man.METHODS: Descriptive study of a testicular infection by an atypical unknown germ in a patient, which was identified and diagnosed thank to the use of Polymerase chain reaction (PCR). We performed a bibliographic search of similar cases. RESULTS: We only found one case of pleural infection by Corynebacterium Thommsenii in the human being, with no case of genitourinary involvement described.CONCLUSIONS: To date there is only one case described of infection by Corynebacterium Thommsenii in human beings, possibly due to underdiagnosis for the slow grow of this pathogen. Genetic amplification methods by PCR should be demanded more frequently by clinicians because they provide an advance in the microbiologic diagnosis is slow-growing pathogens.
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