OBJECTIVES: Ultrasound guided prostaticbiopsy is still the reference method for the diagnosis ofprostate cancer. Nevertheless, multiparametric magneticresonance imaging (mpMRI) has become the bestimaging method to identify clinically significant tumors.Form this new situation derives the search of the bestmethod to enable the biopsy of the lesions identified bympMRI and are not visible on ultrasound. The objectiveof this work is to review the current role of MRI and thevarious modalities of MRI based biopsies.METHODS: Non-structured literature review aboutthe current status of prostatic mpMRI and the variousmethods of biopsy of the lesions identified with it: inbore, cognitive and different commercial fusion softwarebiopsy methods available for directed biopsies.RESULTS: Although results in the literature are veryheterogeneous, all three bore biopsy, cognitive biopsyin experienced hands and the various fusion/biopsysoftware platforms enable a precise biopsy of mpMRIidentifiedlesions, increasing the yield of each sampleobtained. Fusion systems do not imply a clear advantagein global detection over systematic biopsy, except inthe subgroup of patients with previous negative biopsy.Nevertheless, they do demonstrate a higher detectionrate for clinically significant tumors that increases inpatients with a first negative biopsy. Its role in the newtherapeutic approaches for prostate cancer is yet to bedefined, but it will be growing and essential in a nearfuture.CONCLUSIONS: Multiparametric MRI is alreadyan essential test in diagnostic algorithms for prostatecancer and the systems that enable to biopsy the lesionidentified are day by day a more integrated tool in theurological daily practice, and urological proceduresthat will enable a more precise diagnosis leading to apersonalized treatment for each patient.
OBJECTIVE: : To determine the importanceof fasting calcium/creatinine ratio in patients withcalcium stones and its relation with hypercalciuria andphospho-calcium metabolism.METHODS: Cross-sectional study including 143patients divided into two groups according to fastingcalcium/creatinine. Group 1: 66 patients (calcium/creatinine< 0.11); Group 2: 77 patients (calcium/creatinine> 0.11). A comparative study is performedbetween groups including phospho-calcium metabolismparameters and excretion of urinary lithogenic markers.Linear correlation studying calciuria and fasting calcium/creatinine was performed. SPSS 17.0 statistical analysissoftware was used, considering p≤0.05.RESULTS: It is noteworthy that group 2 had increased24 h urine calcium excretion in comparison to group1 (229.3 vs 158.1; p=0.0001) and calcium/citrate(0.47 vs 0.34; p=0.001). There is a positive andsignificant correlation between calcium levels in 24 h urineand fasting calcium/creatinine (R=0.455; p=0.0001)and a cutoff is set at 0.127 (sensitivity 72%, specificity66%) to determine hypercalciuria (>260 mg in 24 h).CONCLUSION: Increased fasting calcium/creatininedetermines increased 24 hours calcium excretion,although the sensitivity and specificity to determinehypercalciuria is not high.
OBJECTIVE: To compare thecharacteristics, clinical course, and survival of pairs ofrenal grafts from the same donor, with special interestin cold ischemia times (CIT) as a risk factor for graftsurvival.METHODS: We retrospectively reviewed paired graftsoriginating from the same cadaver donor from our prospectively recorded database of kidney transplants,from 1987 to 2015. We selected and divided them intotwo groups depending on whether they corresponded tothe first or second graft.RESULTS: We studied a total of 860 paired kidneys.Mean CIT for the first and second groups were 15.12and 19.16 hours, respectively. In the second group weobserved higher incidences of acute tubular necrosisand initial delayed graft function (59.9% vs. 69.4%and 54.9% vs. 63.5%, respectively; p<0.001). Nosignificant differences in either creatinine clearancerate or the rate of dialysis were observed between thetwo groups. No difference was found between the firstand second groups in terms of graft survival (18.4 vs.18.1 years, respectively; log-rank, p=0.667), andno differences were found by dividing the grafts intodifferent categories according to their CIT (<14, 14-17,17-20, >20 hours). For the set of grafts studied, CIT didnot act as a risk factor for graft survival (hazard ratio[HR]=1.014; p=0.312).CONCLUSIONS: The proportion of ATN and DGF weregreater in second transplants. However, there were nodifferences in long-term graft survival. Furthermore, wefound no evidence that a CIT for less than 24 hoursacted as a risk factor to graft survival
Hypospadias is a congenital pathology of the male genitalia that we diagnose and treat more every day. Due to an increase of case load we must have at hand a large quantity of surgical techniques for its correct treatment. Ventral corporoplasty of the corpora cavernosa is one of them that will help us to successfully treat the most severe cases within this variety which is the pathology itself. We performed a prospective study in Malaga, Spain between 2010-2015. We review the technic and its indications, and the authors personal series with 20 cases performed by 2 surgeons using the same protocol and technics. The outcomes showed good results without complications in all cases. Corporoplasty is one of the surgical technique for the treatment of the most sever cases of penile incurvation.