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The Bayes theorem provides a formula tocalculate the probability of an event to occur conditionedby the occurrence of an anterior one (conditionedprobability). In medicine it has been applied to calculatethe probability of suffering a disease when having apositive result in a given test. This formula emphasizes theimportance of prevalence of a disease (or a prioriprobability of the positive predictive value of a diagnostictest).The novelty of applying the bayesian methodology inclinical practice results from taking into considerationprevious external information (or "a priori probability"),and to calculate how it is modified by the evidence (or"verisimilitude") provided by certain empirical tests, toobtain a new probability conditioned by the empiricalevidence (or "a posteriori probability"). It also allows toperform sequential analysis (repeated observation of agiven event a number of times not fixed in advance) and toincorporate the subjective probabilities to the reasoning.Some authors have proposed the use of bayesianmethodology in research studies, such as clinical trials.Nevertheless, this methodology does not adapt well to thiskind of reasoning which is hypothetical -deductive.
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OBJECTIVES: To investigate the presenceof macrophages in human semen samples and the functionthey carry out in the seminal fluid. Their presence wasstudied in relation to spermatic morphology, percentageof spermatozoids with native DNA, and presence ofantispermatic antibodies.METHODS and RESULTS: The work was performedwith semen samples from 31 unfertile males from 63couples in which the "female factor" was ruled out as thecause of infertility. Sperm study according toWHO(1992)was carried out in all samples, in addition to: DNA studywith acridine orange as fluorocrom, macrophage concentration by neutral red in a Neubauer camera, anddetection of antispermatic antibodies with a mixedagglutination test (TAC II) (validated with Mar Screen-Fertility technologies). Sperm morphology was evaluatedby Papanicolaou test.19/31 selectedspermsamples (61.3%)showedincreasedconcentration of macrophages,13 of them (41.9%) withdenaturalized DNA, and 8 (25.8%) abnormal morphology.Six samples showed increased macrophage concentrationand predominance of native DNA, whereas 11 samplesshowedincreasedmacrophagesandabnormalmorphology.Among 18 (58.1%) samples showing antispermaticantibodies 14 (77.7%) had an increased concentration ofmacrophages.Statistical analysis resulted inahigh correlationbetweenmacrophage concentration and increased percentage ofspermatozoids with denaturalized DNA (p < 0.05). Anincreased concentration of macrophages is associatedwith the presence of antispermatic antibodies (p < 0.05).There was not evidence of significant association betweenconcentration of macrophages and percentage ofmorphologically normal spermatozoids (p < 0.5).CONCLUSIONS: We can conclude that macrophagesare present in human semen and participate inimmunovigilance contributing to improve the seminalquality.
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OBJECTIVES: To present a series of 63patients with urinary incontinence due to sphinctericincompetence who underwent the implantation of an AMS-800 artificial sphincter.METHODS: From 1984 to December 2002 a total of 69patients received this prosthesis,63of whichwereavailablefor review. The cause of incontinence was sphincterincompetence in all cases, said secondary to prostatesurgery, neurogenic bladder, post-traumatic urethrallesion, and epispadias. 52 of them were placed in thebulbar urethra, and 11 in the bladder neck. The cuffdiameters varied from 4 to 10 cm and reservoir pressuresfrom 51-60 to 71-18 H2O cm.RESULTS: The complications that appeared, orderedby frequency, were: malfunction, infection and rejectionor exteriorization, fistula, and unappropriate size. Thetotal number of reoperations was 39 in 28 patients.Functional results were successful in 48 cases and failurein 15.CONCLUSIONS: The use of an AMS-800 prosthesis forthe treatment of urinary incontinence due to sphinctericincompetence is effective but not without complications.The most frequent indication was following prostatesurgery, being this group the one that obtains the bestresults. Patients with incontinence of neurogenic originhave the highest complication rate, and the worst results in relation to vascularization and tissue trophismabnormalities. In female patientsweprefer other techniquesthat have similar results, are technically easier and moreeconomic.
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OBJECTIVES: We report one case ofurachus diverticulum. It is very rare in adults so that thelevel of diagnostic suspicion is low.METHODS: 50-year-old male without history ofurologic diseases who presented with recurrent urinarytract infections over a two-year period. There were notfindings on physical examination. Abdominal ultrasoundshowed a 3 × 2 cm cystic image with internal echoes on thebladder dome. CT scan confirmed the cystic lesion whichthickened the bladder wall at the dome. The patientunderwent surgery for the excision of a suspected urachalcyst.RESULTS and CONCLUSIONS: In order of frequency,the 4 types of urachal congenital abnormalities are:permeable urachus (50%), urachal cyst (30%), urachalsinus (15%), and urachal diverticulum (5%). Theindicationof surgery comes from the possibility of infection andmalignant transformation; the cyst should be excised witha bladder dome cuff due to the risk of existence of urachalremnants at that level and their potential to degenerate toadenocarcinoma.
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OBJECTIVES: To perform a descriptiveanalysis of 57 cases of renal adenocarcinoma treated inour department, trying to identify those variables thatmodify survival, and to evaluate the impact of incidentaldiagnosis on survival.METHODS: 57 cases of renal cell carcinoma treated inour department from 1996 to 2001 were retrospectivelyreviewed. Mean follow-up time was 30 months. The impacton survival of incidental diagnosis, stage, and othervariables was evaluated.We used the chi-square test to study the associationbetween qualitative variables, and the prevalenceproportion with 95% confidence intervals to quantify themagnitude of the association.RESULTS: Mean age on presentation was 63+/- 12.57yr.The most frequent histological type was classic renalcell carcinoma (83.6%).Hematuria was the presenting sign in most cases.19.3%wereincidentallydiagnosedwitha24monthsurvivalwas 100% in comparison to 59% of the patients presentingwith clinical signs/symptoms (p = 0.0218); 24 monthsurvival rates for stages I-II was 95.83% in comparison to48.48% for stages III-IV.CONCLUSIONS: Renal cell adenocarcinoma is anaggressive tumor with a variety of clinical presentationswhich delay its diagnosis. Tumor stage is one of the mainprognostic factors.Nowadays, the greater availability of radiological tests,mainly ultrasounds, has resulted on an increase in thenumber of incidental diagnosis and therefore a greaternumber of early stages; it is advisable to perform a renalpathology screening on every patient who undergoesabdominal ultrasound for any other reason.
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OBJECTIVES: To evaluate the necessityof performing ureteral reimplantation in patients withvesicoureteral reflux secondary to neurogenic bladder.METHODS: Retrospective review of 19 patients (10males and 9 females), between 2 and 19 years of age (Meanage 7 years), with neurogenic bladder and vesicoureteralreflux (VUR) treated from May 1990 to July 2000. No onepatient had a satisfactory response to the therapy withanticholinergic drugs and clean intermittentcatheterization. All 19 patients underwent augmentationcystoplasty (15 using sigmoid colon and 4 ureter). Tenpatients,16 renal units, underwent simultaneous ureteralreimplantation.RESULTS: All patients improved their bladder capacityand compliance after bladder augmentation. VURdisappeared in 17 patients. Two patients (3 renal units) inthe group without ureteral reimplantation remained witha minor degree of reflux.CONCLUSIONS:Bladder augmentation alone resolvesVURsecondary to neurogenic bladder in a high percentageof patients.
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OBJECTIVES: To make an analysis of theusefulness of urodynamic tests and what can be obtainedfrom them.METHODS: We also perform and analytical deductionof those parameters that define detrusor behaviour, suchas the constant defining bladder compliance, the bladderelastic constant, in its tensile properties, and we found theexpression of resistances and calculate the abdominalpressure formula; therefore we don’t need to introduce arectal catheter to know the value of those parameters thatdefine bladder dynamics.RESULTS: Although they are provisional, they allowforeseeing a promising future for this application of awell-known device.CONCLUSIONS: Currently, we can only define thebladder behaviour, its resistances, the detrusor drive andcompliance with the only discomfort of a perineal Dopplerultrasound. Time will open new possibilities.
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OBJECTIVES: Critical update of transurethral surgery options based on the last decade most relevant bibliography.METHODS: Comparative study between Incision/TUR of the prostate and alternative techniques, accordingly to data from 30 randomized studies and 28 clinical studies. We evaluate efficiency, retreatment index, morbidity, post operative number of days with catheter, anesthetic requirements, and cost. Data are expressed as percentages resulting from a differential formula in randomized studies and simple percentages or numeric expression for relevant clinical data. RESULTS: Efficiency: all alternative treatments show a symptomatic improvement (> 50%) similar to that achieved by transurethral surgery; post treatment flowmetry percentage increase is inferior in all alternatives except vaporization, holmium laser and prosthesis. Re-Treatmentrequirements:theywerehigherinallalternatives except the ablative ones (vaporization and holmium laser). Morbidity: all of them had an operative estimated blood loss inferior to TUR and similar to prostatic incision; contact laser and vaporization had more irritative symptoms than incision, and VLAP and TUMT more than TUR; TUMT and interstitial laser have a higher rate of post operative infection; all alternatives except the ablative ones had lower percentages of urethral stenosis and retrograde ejaculation. Number of days of catheter post operative: it was comparatively longer after vaporization and very long after VLAP, interstitial laser and TUMT. All treatments except TUNA and TUMT require the same anesthesia than transurethral surgery. The cost/benefit has not been sufficiently evaluated, but it is superior with holmium laser, contact laser and vaporization than with transurethral surgery.CONCLUSIONS: Based on study data we can accept holmium laser as a real alternative,TUMT in cases when surgery is questioned and intraprostatic prosthesis when it is not possible.
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OBJECTIVES: To report a technicalvariation in the retropubic adenomectomy operation whichimproves the standards for this type of open surgerysignificantly.METHODS: We review the charts of the last 35 patientsundergoing surgery with this technical variation, with aminimum follow-up of one year, following a pooledexperience of 1033 cases of retropubic open surgery forBPH by the hemostatic transcervical adenomectomytechnique.RESULTS/CONCLUSIONS: During surgery thisvariation allows a better access to the prostatic bedfacilitating direct haemostasis and search for adenomaremnants. In the same way it allows to perform prostatebiopsies in those cases of BPH with PSA values overnormal range and previous negative biopsies. Finally,"vesicalization" of the prostatic bed contributes to avoidpost operative spasms and it would be the anatomicalbasis for avoidance of bladder neck retraction in themiddle term.Withall reservations implied in the applicationof a recent technical variation, the limited number ofcases, and short follow-up, we may say that significantimprovements have been seen in immediate standardssuch as intraoperative and postoperative blood loss,bladder spasms, post surgical analgesics requirements,and hospital stay reduction.
Case Report
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OBJECTIVES: To describe one case of renalfibrosarcoma in a patient who presented with left flank pain, feverand palpable mass. We review clinical data, diagnosis, therapeuticaspects and prognostic factors for this type of tumor.METHODS: The study of the patient included intravenousurography, ultrasound, and CT scan. Left radical nephrectomy wasperformed.RESULTS: The patient remained asymptomatic for 14 months,but then presented with a tumor in the frontal-parietal area, dying tenmonths later due to generalized metastasis.CONCLUSIONS: Fibrosarcoma is an rare malignant tumorarising from renal mesenchyma with poor prognosis. In radiologicaltests renal sarcomas show malignant tumor characteristics, butwithout a specific histology they cannot be differentiated from arenal cell carcinoma.
Case Report
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OBJECTIVES: We report a new case of severegenital trauma to analyze the most frequent causes of genital areatraumatisms and their main presentations in the emergencydepartment.METHODS/RESULTS: A patient who presents to our hospitalwith severe genital laceration caused by a farm machine during hiswork. We describe clinical picture, surgical treatment, and clinicaloutcome. The result was satisfactory.CONCLUSIONS: An analysis of this pathology is carried out:classifications, decision taking in the emergency department andalso surgical treatment for reconstruction if necessary.
Case Report
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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.
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OBJECTIVES: To show the imaging testscharacteristics and differential diagnosis of masses located withinthe retroperitoneal perirenal area.METHODS: Diagnostic imaging tests (KUB x-ray, ultrasound,helical CT scan with IV contrast) and follow-up in one case ofperirenal cell liposarcoma.RESULTS: The study of the surgical specimen after renaltumorectomy in a patient with a solitary kidney resulted in thepresent diagnosis.CONCLUSIONS: Liposarcoma is a malignant neoplasia derivedfromfattytissue.Approximately13%arelocatedintheretroperitonealarea, and less than 1/3 arise from perinephric fat.We report one case of liposarcoma located in the perirenal cellas an incidental finding during contralateral psoas muscle abscessfollow-up in a patient with a solitary kidney after surgery forxanthogranulomatous pyelonephritis. Successive controls duringthe last year allowed us to evaluate the evolution of this lesion’s.
Case Report
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OBJECTIVES: We presented one case of prostatic adenocarcinoma of ductal origin, known as endometrial adenocarcinoma before. The first case was published in 1967 by Mellicow. Since then we could only recover 8 cases by spanish authors. METHODS/RESULTS: 61-year-old patient presenting with urethral bleeding, PSA 12 ng/cc, and an exophytic urethral mass. Histology was compatible with ductal adenocarcinoma of the cribiform type. Radical prostatectomy was carried out with good outcome at six months follow up. CONCLUSIONS: Prostatic ductal adenocarcinoma is a rare tumor, accounting for 0.2-5% of prostatic tumours. Its behaviour is variable, similar to the acinar cell type. Strikingly, there are scarce references to this tumor type; accordingly to the statistics of incidence it should have been referred more often, which would help to its study in terms of outcomes, treatment, and prognosis.
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OBJECTIVES: Aneurysmatic processes of the renal artery after transplant are rare entities, generally secondary to technical defects or infectious pictures. Among other presentations, dissecting aneurysm are exceptional, having a particularly difficult diagnosis due to the lack of specific clinical data which could differentiate them from other processes such as graft rejection or acute tubular necrosis, as well as the absence of characteristic representative images. METHODS: We report one case of dissecting aneurysm after a kidney transplant resulting in graft loss. RESULTS: We analyze the presentation form, diagnostic procedures, pathologic studies, and possible therapeutic options. CONCLUSIONS: Dissecting aneurysm of the renal artery is a rare entity of difficult diagnosis due to the poorness of presenting symptoms and the difficulty of finding it in routine tests, being necessary to think of it and to perform angiography as the only diagnostic test. Treatment is carried out by hilar reconstruction or transplant nephrectomy when the former is not possible.
Case Report
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OBJECTIVES: To report one outstanding case offever and flank pain with the radiologic finding of air outlining thewhole left upper urinary tract (pneumopyelography).METHODS: The patient subject of this case had a history ofgynaecologic surgery five years before presentation and subsequentdiverticulitis one year later requiring discharge colostomy followedby reconstruction 7 months later. We performed a MEDLINE searchusign the terms "entero urinary fistula". Most papers are casereports with reviews of the diagnostic and therapeutic procedures,as well as the etiologic factors.RESULTS: Radiologic tests are key to make this finding clear andto determine its location. In our patient, once the acute picture wascontrolled and the confirmatory diagnosis was made by means ofbarium enema, we proceeded with left simple nephrectomy andlower intestine resection including the fistula tract.Real incidence is unknown; there is a female predominance in thepublished cases. Depending on the casual mechanism, they may beclassified as spontaneous or traumatic. Most of them are secondaryto bowel inflammatory diseases like diverticulitis, Crohn's disease,tumors, ulcers,... They can also be secondary to impacted urinarylithiasis, urothelial tumor, endoscopic procedures, etc. Other casesare secondary to previous surgery and radiotherapy.CONCLUSIONS: Thefinding of pneumopyelogram should promptand interventional algorithm including radiologic tests and otherexaminations to allow a proper diagnosis and to perform an effectivetreatment.
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OBJECTIVES: Tumors of the spermaticcord and epididymis are rare, and their exact incidence isdifficult to determine. Ninety percent of extra testiculartumors within the scrotum are found in the spermatic cord,where 30 % is malignant (1).METHODS: In this case report we present an unusualspermatic cord tumor, i.e. myositis ossificans (MO). To thebest of our knowledge, MO of the spermatic cord has notbeen reported before in the literature.CONCLUSIONS: MO should be considered in thedifferential diagnosis of the spermatic cord tumors.
