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OBJECTIVES: Bladder tumors are the second highest incidence urological tumor in the adult population. In recent years, new techniques such as pho-todynamic diagnosis have arisen in order to improve the sensitivity for the detection of non muscle invasive bladder cancer (NMIBC). We intend to update the role of photodynamic diagnosis in the diagnosis of NMIBC, in cases refractory to BCG and as a treatment in the recurrent bladder cancer.MATERIAL AND METHOD: We performed a descriptive study and bibliographic review on the usefulness of photodynamic diagnosis in NMIBC, early recurrence and refractoriness to BCG published in the universal medical literature.RESULTS: Photodynamic cystoscopy increases the detec-tion sensitivity for NMIBC, especially carcinoma in situ (CIS) from 15% to 30% according to the different series published. Regarding high-grade bladder cancer re-currence, photodynamic therapy increases disease-free time in 20% of patients. In the use of photodynamic techniques for the detection of CIS after BCG, studies indicate an increase in sensitivity with an increase in the rate of false positives.CONCLUSION: Photodynamic diagnosis could im-prove sensitivity for the early detection of patients with CIS and/or T1G3. May be, at the same time, an alter-native in the recurrence of bladder cancer, especially CIS.
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OBJECTIVE: To evaluate the association between anogenital distance (AGD), as a biomarker of prenatal androgen milieu, and risk of prostate cancer (PCa). METHODS: A case-control study was conducted on 260 men attending a university hospital where they underwent physical and andrological examination and completed a brief questionnaire. PCa patients were con-firmed by biopsy of the tumor. Controls were men with-out PCa attending the urology outpatient clinic for routine examinations. Two variants of AGD [from the anus to the posterior base of the scrotum (AGDAS) and to the ceph-alad insertion of the penis (AGDAP)] were measured. Unconditional multiple logistic regression was used to estimate the association between AGD measurements and presence of PCa, and Odds Ratios and 95% confi-dence intervals (CI) were calculated. RESULTS: Cases showed significantly shorter AGDAP and AGDAS than controls. Subjects with AGDAP and AGDAS in the lowest compared to the upper tertile were 2.6 times (95% CI 1.2-5.6) and 3.2 times (95% CI 1.5-6.9) more likely to have PCa, respectively. CONCLUSIONS: We found that shorter measurements of both distances (AGDAS and AGDAP) were associat-ed with higher risk of PCa. A previous study reported similar results, showing that longer AGDAP was associ-ated with lower risk of PCa, but this relationship was not found for AGDAS, as it was in our study with a larger sample size.
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INTRODUCTION: The limitations of serum PSA as a screening test to detect prostate cancer remain problematic, especially after an initial negative prostate biopsy. Detection of primary circulating prostate cells (CPCs) has been reported to be useful in the detection of prostate cancer in men with a serum PSA>4.0ng/ml. We present a prospective study comparing the detection of CPCs, total PSA, percent free PSA, digital rectal ex-amination (DRE) and prostate volumen (PV) to establish a predictive model for the detection of prostate cancer in men with an indication for a second prostate biopsy. OBJECTIVE: To establish a predictive model for the de-tection of prostate cancer using the number of CPCs de-tected per sample, DRE, age, total serum PSA, percent free PSA and PV in men with an indication for a second prostate biopsy.METHODS AND PATIENTS: A prospective, observation-al study carried out in the Hospital de Carabineros de Chile, between 2006 and 2014 including 199 men undergoing a second prostate biopsy. The variables, number of CPCs detected (nCPC), DRE, age, PSA, per-cent free PSA and PV were registered for each patient and based on these findings and comparing them with the results of the prostate biopsy a multivariate logistic re-gression analysis incorporating forward predictors. The model was evaluated for co-lineal tendency, reliability and error specificity, and analyzed using non-paramet-ric receiver operating characteristics and area under the curve decision for the combined model and for each variable separately.RESULTS: The single variable nCPC had a superior pre-dictive value with an area under the curve of 0.89 (95% CI 0.83-0.94). The final model incorporated nCPC (OR: 2.03 95% CI 1.63-2.53) age (OR: 1.1 95% CI 1.04-1.17) and PV (OR: 0.96 95% CI 0.93-0.99) with an area under the curve for the combined model of 0.92 (95% CI 0.88-0.97). The combined model performed better than the variables used alone. CONCLUSIONS: The model incorporating nCPC, age and PV had a greater diagnostic yield for the predicting prostate cancer at second biopsy.
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OBJECTIVES: Studying the psychosocial sphere of patients who undergo any treatment allows to have more information about its repercussion and can help the choice of an appropriate and personalized treatment. Due to the absence of specific instruments at present, the objective is to design and validate a health questionnaire regarding the treatment received with ESWL.METHODS: It was carried out in 6 phases using a sam-ple of 50 patients treated with ESWL in 2015 in our center, whom we interviewed by telephone. In phase 1 the items were proposed based on bibliographic re-view, in phase 2 those that scored below 7 were elim-inated according to the evaluation from 0 to 10 on the items made by specialists. In phase 3, values of 1 to 5 were assigned to each item and those with corrected correlation more than 0.2 and not significant (p>0.05) discriminant power with U-Mann Whitney were elimi-nated. In phase 4 the reliability of the questionnaire was checked with two indexes (Cronbach’s alpha and two Guttman’s halves). In phase 5, the factor analysis with Varimax rotation was performed to calculate the con-struct validity and in stage 6, the scores were analyzed to establish reference values.RESULTS: 50 patients (32 men, 18 women). Median age 59 years (27-79). In phase 1, 35 items were pro-posed, 9 of which were eliminated in phase 2. The ini-tial questionnaire with 26 items was distributed, with 18 being eliminated in phase 3. The final questionnaire was formed with 8 items. In phase 4 the results of Cronbach’s alpha and Guttman’s two halves index were 0.44 and 0.323 respectively. In phase 5 after factor analysis, we found 4 factors with 2 items each (background, impact of the acute picture, post-treatment, quality of life) able to explain 71.19% of the variance. The median scores of the scale, extreme values and quartiles studied in phase 6 were respectively: P50: 17 (minimum-maximum 9-25), P25: 14 and P75: 20.CONCLUSIONS: The study carried out has provided a new instrument for assessing satisfaction after treatment with ESWL with adequate reliability and validity values. Future studies will be necessary to contrast its true clinical usefulness.
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OBJECTIVES: To determine the usefulness of voiding diary (VD), uroflowmetry with electromyogra-phy (UF-EMG), bladder wall thickness (before micturition) (VWTUS) and residual urine (PVR) (ultrasound measure) in predicting the outcome of the first endoscopic treat-ment (1ENDT) of vesicoureteral reflux (VUR) in children > 3 years. METHODS: Cross-sectional ambispective study of 48 children with vesicoureteral reflux. Those with previ-ous endoscopic treatment, age < 4 years, anatomical or neurological abnormalities and a history of urethral or abdominal surgery were excluded. The outcome variable was the correctness (by isotopic cystography) three months after 1ENDT. Univariate and multivariate analyses were performed through a Multilayer Percep-tron network and a logistic regression model Empirical Bayesian penalized type LASSO Elastic net. Diagnostic accuracy were determined. RESULTS: Mean age of the sample was 6.8 +/- 2.28 years. The rate of VUR correction after 1ENDT was 77%. The variables selected by both methods were: VD-reten-tionist (OR 3.90), high PVR (OR 2.69), high VWTUS (OR 4.44). Normal UF-EMG was a preventive variable (OR 0.38). Diagnostic accuracy (p<0.005): VD (Se=98% Sp=48.7%), UF+EMG (Se=27.3% Sp=94.6%), PVR (Se=72.7% Sp=97.3%) (AUC=0.8 cut point 20 ml), VWTUS (Se=81.8% Sp=73%) (AUC=0.8 cut point 4.6 mm). There were no statistical differences between PVR and VWTUS. Combined use of UF+EMG+PVR (Se=90.9% Sp=92%) (p<0.05).CONCLUSIONS: Noninvasive voiding study is useful in predicting the persistence of VUR after 1ENDT in children > 3 years. After screening with a VD, UF-EMG + RPM combination could be useful to detect these pa-tients and propose a treatment that improves bladder voiding function prior to surgery.
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OBJECTIVES: Between 7-10% of school-age children are seen by specialists for non-neurogenic lower urinary tract dysfunction (LUTD). The objective of our study is to classify these functional alterations in different patterns of LUTD and to analyze the techniques used for the diagnosis and treatment in each pattern.MATERIAL AND METHODS: We reviewed patients re-ferred to our Urodynamic Unit for suspected LUTD for 3 years; We reviewed epidemiological data, supple-mentary test and treatments. We classified these patients according to their diagnosis and we stablished a LUTD pattern. We analyzed the incidence of each pattern and the differences in the management.RESULTS: We studied 96 patients. The mean age was 7.91 years; with 53.1% children and 46.9% girls. The most frequent symptom was diurnal urinary loss (75%), being also the most common reason for consultation (65%). 35.4% had bladder and bowel dysfunction (con-stipation 35.4% and/or fecal incontinence 12.5%). The prevalence of overactive bladder (56.4%), followed by: hypoactive bladder (21.9%), uncoordinated urination (6.3%), frequent urination syndrome (6.3%), urinary in-continence with Laughter (5.2%) and post-void dribbling (2.1%). 51% of the patients presented a postponing hab-it. In 41.7%, the pathology was resolved with conserva-tive measures. 52.1% of patients required anticholiner-gics and 11.4% other therapies such as biofeedback. CONCLUSIONS: LUTD is a common disorder that may be underestimated. The prognosis is favorable in most cases but serious long-term complications such as renal failure may occur. The symptoms of LUTD can negative-ly affect the child’s psychosocial development. The ad-vances in the knowledge of this pathology and the differ-ent patterns of dysfunction have allowed an advance in the treatment, making it more and more behavioral and preventive. Patients who do not improve with standard urotherapy recommendations should be referred to spe-cific units for proper diagnosis and treatment.
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INTRODUCTION: Urinary stone disease is less common in pediatric age group and it has an increasing incidence. In this study, our hypothesis is to evaluate if one of the techniques, PNL or RIRS is superior than the other in terms of stone free status (SFR), fluoros-copy time (FT), operation time (OT), complication rate (CR), JJ stent insertion rate, and hospitalization duration (HD) in children.METHODS: Between 2013 and 2016, 74 pa-tients(under 18 years- old) were operated for the treat-ment of renal stones between 1-2cm size. 37 patients were male (50%) and 37 of them (50%) were female. The study shows the experience of a single center. Data of the patients who underwent (surgery) were recorded. RESULTS: SFR was not different in both groups in short and long terms follow up, but hgb drop, FT, OT, and HD were detected to be worse in PNL group. There was lower complication rates for RIRS group comparing to PCNL group according to Clavien classification but grade I complications were higher in RIRS group.CONCLUSION: Although PNL is a cheaper treatment method, RIRS has less creatinine change, less FT, less OT, less CR, less HT with similar SFR for 1-2cm renal stones in children. Long term SFR were 83.8% for RIRS and 86.5% for PCNL. RIRS is a treatment of choice in children with 1-2 cm renal stones as it has more advan-tages but the costs must be considered.
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OBJECTIVES: To evaluate the efficacy and reliability of endourological procedures in patients with renal stones up to 2 cm that were found to be re-sistant to extracorporeal shock wave lithotripsy (ESWL). METHODS: 611 patients who had undergone ESWL due to renal stones up to 2 cm at the ESWL unit of our clinic, were retrospectively evaluated. Standard percu-taneous nephrolithotomy (PNL), micro-PNL, retrograde intrarenal surgery (RIRS) was performed on the patients who had stones resistant to ESWL. Demographic data, stone free rate, duration of hospital stay, duration of ope-ration, the duration of scopy, the rates of transfusion and the complications were recorded. RESULTS: The mean age of 611 patients included to the current study was 40.76±15.45 years, the mean size of stones was calculated as 205.47±90.5 mm2. While the renal stones were removed in 468 patients (76.59%) after ESWL, endourological procedures were performed in 142 patients (23.24%) who had ESWL resistant stones. Standard PNL was performed in 73 patients (51.4%), RIRS was performed in 51 patients (35.91%), micro-PNL was performed in 18 patients (12.68%). The success rates after the surgical procedu-res were 93.15%, 90.16% and 88.88%, respectively. No major complication was observed in patient groups who had undergone RIRS and microPNL.CONCLUSION: The surgical approaches, which are selected according to the size and localization of sto-nes, could provide a success rate of 98.03% in ESWL resistant stones and these procedures could be reliably performed with considerably lower complication rates.
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INTRODUCTION: We wanted to in-vestigate the potential effect of additional telerounding system on postoperative outcomes, patient and surgeon satisfaction rates in the patients who underwent percuta-neous nephrolithotomy (PNL).METHODS: Eighty patients who underwent PNL were included in the study. The patients were randomly di-vided to two groups. Group 1 included 40 patients who were followed-up with standard rounds and group 2 included 40 patients who were followed-up with tel-erounding in addition to standard rounds. Patient and surgeon satisfaction rates were assessed with a visual analog scale (VAS) where 0 point represents very dissat-isfied and 100 points very satisfied.RESULTS: Mean time of preoperative telerounding vis-it was 3.65±0.59 (2-4) minutes. Mean time of teler-ounding visits on the postoperative 1st and 2nd days was 3.80±0.62 and 2.9±0.91 minutes respectively. The VAS score evaluating the surgeon’s satisfaction rate for telerounding was 91±11.2 and patients expressed a high level of satisfaction with 72.5%. CONCLUSION: The use of additional telerounding in urological patient care provides high satisfaction rates for both the patients and the surgeon. However the find-ings of the present study don’t underestimate the impor-tance of personal surgeon-patient interaction.
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OBJECTIVE: To evaluate colonizations on biofilm layers of Double J (D-J) catheters implanted for kidney stones or ureteral stones under sterile conditions.METHODS: D-J catheters implanted between January 2012 and February 2014 and removed in 0-90 days, were examined in microbiology laboratory prospective-ly. Fifty two patients divided into three groups regarding the duration of the D-J catheters as; 0-30 days, 31-60 days, 61-90 days. The colonization (≥1.000 colony) was reported after biofilm layer on D-J catheter was hold in culture media. The upper, middle and lower parts of the catheters were analyzed seperately. RESULTS: Thirty five patients had symptomatic urinary tract infection or positive urine culture after implantation were excluded from the study. Colonization on biofilm layer was detected in 11 patients (21.15%) [Coagu-lase-negative staphylococci (CNS): 3, Escherichia coli (E. coli): 3, Candida species (Candida spp.): 3, Klebsiel-la species (Klebsiella spp.): 2]. The rates of colonization according to the duration of the catheterization were; 12.5% in 0-30 days, 18.51% in 30-60 days, 29.4% in 60-90 days (Group 1 vs 2; p=0.696 , group 1 vs group 3; p=0.356 , group 2 vs group 3; p=0.401). The rates of colonization according to the location of the catheter were; 100% in upper and lower parts, 54.4% in middle part (Group 1 vs 2; p=0.011, group 1 vs group 3; p=1, group 2 vs group 3; p=0.011).CONCLUSIONS: Colonization on catheters is possible even in the sterile urinary conditions according to the present findings. The risk of colonization increases 1.5 times in 30-60 days and 2.5 times in 60-90 days com-pared to the first 30 days. Besides the risk of coloniza-tion increases about 2 times in the convoluted edges of the catheter compared with the middle part. Thus, D-J catheter should be removed as soon as possible and the risk of colonization should be minimalized.
Case Report
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OBJECTIVE: Metastatic Renal Cell Carcino-ma (RCC) may develop in different anatomical locations and after a strict follow up within normal limits. We assess the importance of close follow up in patients with history of RCC through 3 clinical cases with unusual locations of metastatic RCC. METHODS: We present 3 cases of metastatic involvement of pituitary, thyroid and mammary glands. We retrospec-tively review our data base on metastatic RCC with 76 patients. DISCUSSION: There is not agreement about the time of follow up and image methods requested after surgery of RCC. The reason is the development of late onset and atyp-ical placement metastases. CONCLUSION: Metastatic disease of renal neoplasms can occur at any time and at any location. It is important to keep suspicion of metastatic renal disease in patients in this background, even in those with good progress and regardless of the years that have passed since the initial diagnosis.
Case Report
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OBJECTIVE: Paratesticular mesothelioma is an infrequent tumor and only 250 cases have been pub-lished. It originates in the scrotal tunica vaginalis. It rep-resents 0.3-1.4% of mesotheliomas and it predominates in patients with history of asbestos exposure and old age. Its diagnosis is usually casual. Our objective is to present the cases that occurred in our service with malignant paratestic-ular mesothelioma and to carry out a review of the current literature on this pathology.METHODS: We report two cases diagnosed with malig-nant paratesticular mesothelioma that happened in the last two years.RESULT: The first case was a 73-year-old male with as-ymptomatic hydrocele. The second was a 57-year-old male who had testicular pain and hydrocele. Both were diagnosed of mesothelioma after hydrocelectomy. The first treatment was radical orchiectomy in both cases. The first patient did not need more treatments. The second patient presented pulmonary nodules, lymphadenopathy and local relapse, which was treated with chemotherapy and local resection.CONCLUSION: Paratesticular mesothelioma is an infre-quent tumor. Scrotal mass associated with hydrocele is the typical form of presentation. Surgical treatment consists of radical orchiectomy. They have poor prognosis because in most cases there is rapid local and dissemination.
