OBJECTIVES: Treatment of calciumstones is based on diet and pharmacological measuressuch as the use of thiazides and other drugs. The aimof this study is to assess the effect of alendronate onhydrochlorothiazide on urinary calcium and bonemineral density in patients with calcium stones.METHODS: Prospective observational study involving77 patients with relapsing calcium stones divided into2 groups according to treatment received. Group 1: 36patients treated with alendronate 70 mg/week;Group 2: 41 patients treated with hydrochlorothiazide50 mg/day. All patients receive diet recommendationsand fluid intake. Studied and analyzed among othervariables were bone mineral density, bone turnovermarkers and calciuria before and after 2 years oftreatment. Statistical study with SPSS 17.0, statisticalsignificance p< 0.05.RESULTS: No statistically significant differences inthe distribution by sex or age of the patients betweengroups. In group 1 statistically a significant decreasewas observed in the b-crosslaps and improvement inbone mineral density, along with decreased urinarycalcium after 2 years of treatment. In Group 2 statisticallysignificant decrease in urinary calcium and fastingcalcium/creatinine was seen, along with improvement inbone mineral density after 2 years of treatment. In group 1,there is a more obvious and significant improvement inbone mineral density compared to 2 and b-crosslapsdecrease. However, in group 2 the decrease in urinarycalcium and calcium/creatinine was more significantthan in group 1.CONCLUSION: Treatment with thiazide decreasecalciuria and produces an improvement in bone mineraldensity, although not in the same range as treatment withalendronate.
Prostate-specific antigen (PSA) has been since the mid 80’s the most commonly used biomarker for measuring current and future risk of prostate cancer, for its early detection and to measure response to treatments and detecting recurrence in all stages of the disease. PSA’s early development came along with progress in the field of immunology, which allowed detection and study of antigens from different tissues and fluids when injecting them into rabbits to promote immune response.Rubin Flocks in 1960 was the first to investigate and discover prostate-specific antigens in benign and malignant tissue. Some years later, Hara, a Japanese forensic investigator, found “gamma seminoprotein”, that he used to detect human semen in rape cases. However, his work published in Japanese did not reach the Englishspeaking scientific community.In 1970 Ablin discovered both in prostatic fluid and tissue what he called “prostate-specific antigen”, but he didn’t characterize or describe it.Investigators Li and Beling, and Sensabaugh, approached the current PSA, but they were limited by available technology at that time.Dr T Ming Chu led a research team on prostate cancer in New York, USA and published their results in 1979. He finally received the patent for the discovery of “human purified prostate antigen” in 1984. Due to this work, the Food and Drug Administration (FDA), in USA, approved the use of PSA for monitoring recurrence after treatment.It was later known that PSA was not prostate-specific since it was produced in other tissues and fluids, but it was recognized that it was human species-specific.Works by Papsidero and Stamey showed new indications and utilities for PSA, but it was Catalona who first used it as a marker for prostate cancer in 1991. Thanks to these advances FDA authorized in 1994 the clinical use of PSA for early detection of prostate cancer.
Urethral stenosis is a common diseasein the clinical practice of urology, with a major impacton the quality of life of patients. The anastomoticurethroplasty is a technique with very precise indicationsusually membranous or bulbar urethra stenosis with alength of 3 cm or up to 7 cm when it is secondary tourethral disruptions (no stenosis) after pelvic trauma.OBJECTIVE: We review anastomotic urethroplastyperformed in our department between 2002 and 2015.METHODS: A retrospective, descriptive and inferentialanalysis on 107 patients out of 482 treated withAnastomotic urethroplasty by urethral strictures at theUrology Department of the Hospital “Virgen de la Victoria”(Malaga) from January 2002 to September 2015,establishing effectiveness and safety of the technique,as well as factors that might influence the results. Themain diagnostic method was retrograde urethrographyand voiding cystourethrography in 100% of patientsundergoing surgery, using voiding uroflowmetry forsubsequent monitoring. The definition of success was apostoperative flowmetry with Qmax>15 ml/s, and incase of lower flow, we perform a cystoscopy to verifyrecurrence of stenosis or exclude other pathology.RESULTS: The median age was 42 years, with amean follow up of 59 months. The length of stenosisvalued by retrograde urethrography and voidingcystourethrography was in 91.6% of cases of >1 cmand <2 cm. The most common etiology was idiopathicin 72.9%, followed by iatrogenic with 15.9%.Regarding the location, it was observed that the areamost often affected was the bulbar urethra with 82.2%,with the membranous urethra in second place. In 77.6%of patients anastomotic urethroplasty was the initialtreatment, followed in frequency by direct vision internalurethrotomy 9.3%.In the case of comorbidities associated with treatmentwith anastomotic urethroplasty it was observed thatonly Diabetes Mellitus had a tendency to statisticalsignificance, with p=0.092, not demonstrating suchsignificance in the case of hypertension or when thesubject presented Diabetes Mellitus together withhypertension. Finally, the intervention was successful in102 cases (95.3%), with only 5 cases (4.7%) whereit failed, 4 of them treated with a new Anastomoticurethroplasty, with resolution of the stricture.CONCLUSIONS: Anastomotic urethroplasty is thetreatment of choice for short bulbar urethral stricture, withhigh success rate and low complication rate, as well aslow recurrence of these.
OBJECTIVES: To determine the influenceof barbed suture in laparoscopic radical prostatectomy.METHODS: A retrospective study of 150 patientswho underwent laparoscopic radical prostatectomywas carried out by our department. The patients weredivided in two groups according to the kind of sutureused during the vesicourethral anastomosis: conventional3-0 absorbable multifilament running suture (Group 1)and bidirectional barbed suture (Quill®) (Group 2).Operating time, postoperative urinary fistula, hospitalstay and urinary catheter duration were analysed in bothgroups RESULTS: After the analysis of all the preoperativevariables, such as age, PSA, prostate volume, Gleasonand stage on biopsy, no statistically significantdifferences were found in both groups. Operatingtime was significantly shorter in Group 2 (169±43min vs 215±45 min, p=0.00). Statistically significantdifferences were found regarding postoperative urinaryfistula rate, hospital stay and urethral catheterizationduration, favourable to Group 2.CONCLUSIONS: The use of bidirectional barbed suture(Quill®) for vesicourethral anastomosis in laparoscopicradical prostatectomy, when compared with theconventional suture, shortens surgical time, reducesurinary fistula rate, catheter duration and hospital stay,as the anastomosis is easily performed and preventsleakage
OBJECTIVE: To report an unusual case of softtissueneoplasm and to review the literature on this type oftumour.METHODS: We report an accidentally found tumour closelyrelated to the spermatic cord that was diagnosed in a70 year-old man when he was being operated on for aninguinal hernia repair.RESULTS: After thorough analysis by experienced pathologistsit was not possible to determine the nature of the tumour thatwas removed at surgery.CONCLUSIONS: Soft tissues neoplasms of the spermaticcord may occur in an unusual way and they may be a realchallenge to diagnose.@ CORRESPONDENCIAGuillermo Fernández