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The 3-Tesla multiparametric MRI (mpMRI) system represents a diagnostic advance for prostate cancer. Our aim is to demonstrate that the results in 1.5-Tesla mpMRI are not inferior compared to the 3-Tesla for the correct diagnosis of prostate cancer.Non-inferiority comparative cross-sectional study between fusion-guided prostate biopsy results. 344 patients with clinical suspicion of prostate cancer (elevated PSA and/or suspicious DRE) and mpMRI interpreted and verified by the same radiologists in all cases, 270 in 1.5-Tesla and 74 in 3-Tesla, with at least one lesion PIRADSv2≥ 3. Exclusion criteria were positive biopsy or previous prostate treatment. We consider malignancy as ISUP≥ 1 and significant tumor as ISUP≥ 2. We used Wilcoxon and t-student test (central tendency measures), diagnostic test (gold standard: ISUP of targeted biopsy), Chi2 test and Z-test (comparison of prevalences and 95%CI malignancy and significant tumor according to mpMRI).Median prostate volume 50cc(IQR:33.5) and PSA 6.11ng/ml(IQR:3.39). Mean age 67.4±8.1years. Number of suspi-cious lesions/patient: mpMRI 1.3 (1.5-Tesla) and 1.5 (3-Tesla). No differences were found between mpMRI (homogeneous and comparable samples). 57% (1.5-Tesla) vs 66% (3-Tesla) of targeted biopsies were malignant, and 34%vs38% were significant tumor, with no significant differences. Se, Sp, PPV and NPV for malignancy (1.5-Tesla vs 3-Tesla) were 96%vs90%, 38%vs44%, 67%vs76%, and 86%vs69%, with no significant differences.There are no significant differences between 1.5-Tesla vs 3-Tesla mpMRI regarding targeted biopsy results. Not to have 3-Tesla mpMRI may not be a limitation to use 1.5-Tesla as a diagnostic test for the better diagnosis of prostate cancer.

Prostate Fusion biopsy (MRI + prostate ultrasound) is described in literature as superior to classic random transrectal biopsy in order to identify suspicious lesion.To evaluate the Prostate Imaging Reporting and Data System (PI-RADS) proposed by the European Society of Urogenital Radiology (ESUR) for detection of prostate cancer by multiparametric MRI in a consecutive cohort of patients with MRI and transrectal ultrasound prostate fusion-guided biopsy.87 patients with suspected Prostatic Cancer on prostate MRI underwent fusion transperineal prostate biopsy in our Department. 37 patients had at least one prior negative classic prostatic transrectal biopsy. Clinically significant tumor was described as Gleason 7(3+4) or higher. The Chi-square test was used to analyze the relationship between prostate cancer and the different PIRADS stages, as well as logistic regression and linear trend tests, comparing the proportions using measures of association intensity. We use the HITACHI Real-Time Virtual Sonography (HI-RVS) system, and the STATA/IC v.14.2 software for statistical analysis.64.37% patients had tested positive for malignancy. Median age 67.89 years old. Median PSA 9.15 ng/ml, and average prostate volume was 54.05 cc. 124 suspicious lesions were described in prostate MRI (25% PIRADS III, 57% PIRADS IV and 17% PIRADS V). 5/31 lesions PIRADS III, 47/71 PIRADS IV and 18/22 PIRADS V were positive for malignancy, with a statistically significant linear relationship between PIRADS and malignancy (p0.001) - HR 4.10 (CI 95% 1.81 to 9.32) for PIRADS IV and HR 5.07 (CI95% 2.22 to 11.59) for PIRADS V vs. PIRADS III. 3.23% lesions PIRADS III, 32.39% PIRADS IV and 63.64% PIRADS V corresponded to significant tumors. A statistically significant association between PIRADS and significant tumors (p0.001) - HR 10.04 (CI95% 1.42 to 71.09) for PIRADS IV and HR 19.73 (CI95% 2.80 to 139.18) for PIRADS V vs PIRADS III was observed -.Our results show that transperineal targeted prostate biopsy using multiparametric MRI and transrectal ultrasound fusion is a safe procedure with excellent outcomes to obtain an accurate diagnosis of prostate cancer. Fusion biopsy has the potential to improve the diagnosis of malignancy and clinically significant tumors while reducing overdiagnosis.INTRODUCCIÓN: La biopsia prostática por fusión se describe como superior a la biopsia transrectal sistemática para identificar lesiones sospechosas de carcinoma de próstata.OBJETIVOS: Evaluar la clasificación PIRADS propuesto por la Sociedad Europea de Radiología Urogenital para la detección de cáncer de próstata mediante RNM en una cohorte consecutiva de pacientes con RNM y biopsia guiada por fusión.MATERIAL Y MÉTODOS: Estudio observacional transversal. 87 pacientes con sospecha de cáncer de próstata sometidos a biopsia de próstata transperineal y fusión con RNM en nuestro centro. Describimos tumor significativo como Gleason ≥7(3+4), y carcinoma de alto riesgo como Gleason ≥8. Utilizamos la prueba de Chi-cuadrado para analizar la relación entre cáncer de próstata y PIRADS, así como regresión logística y pruebas de tendencia lineal, comparando las proporciones con medidas de intensidad de asociación. Empleamos el sistema HITACHI Real-Time Virtual Sonography y el software STATA/IC v.14.2 para el análisis estadístico.RESULTADOS: 64,37% pacientes presentaron resultado positivo para malignidad. Media de edad 67,89 años (SD7,42), de PSA total 9,15 ng/ml (SD7,85), y de volumen prostático 54,05 cc (SD22,92). Se biopsiaron 124 lesiones sospechosas en RNM (25% PIRADS III, 57,26% PIRADS IV y 17,74% PIRADS V). 5/31 lesiones PIRADS III, 47/71 PIRADS IV y 18/22 PIRADS V fueron positivas para malignidad, con relación lineal estadísticamente significativa entre PIRADS y malignidad (p0,001), razón de prevalencias (RP) 4,10 (IC95% 1,81-9,32) para PIRADS IV, y RP 5,07 (CI95% 2,2211,59) para PIRADS V respecto a PIRADS III. 3,23% lesiones PIRADS III, 32,39% PIRADS IV y 63,64% PIRADS V correspondieron a tumores significativos. Encontramos asociación estadísticamente significativa entre PIRADS y tumores significativos (p0,001), RP 10,04 (IC95% 1,42-71,09) para PIRADS IV y RP 19,73 (IC95% 2,80139,18) para PIRADS V respecto a PIRADS III.CONCLUSIÓN: Nuestros resultados muestran que la biopsia de próstata ecodirigida y por fusión utilizando RNM es una técnica segura con excelentes resultados para obtener un diagnóstico preciso de cáncer de próstata, y puede mejorar el diagnóstico de malignidad y de tumores significativos reduciendo el sobrediagnóstico.

To determine the risk factors of recurrent urinary infections (rUTIs) in patients with Multiple Sclerosis (MS).A retrospective cohort study was conducted including 114 patients with MS, 84 women (74%) and 30 men (26%), with a mean age of 49. They underwent videourodynamic study and selective sphincter electromyography due to urinary symptoms (LUTS). Clinical data (both neurological and urological) and videourodynamic data (including free flowmetry, cystomanometry and pressure flow study) were collected. In 37 patients (32%), the presence of rTUIs was demonstrated.Statistically significant differences were demonstrated between the patients with and without rUTIs with respect to the following clinical variables: the time of evolution of the symptoms (greater in the case of rUTIs), time from the diagnosis of MS (higher in the case of rUTIs), EDSS score (Expanded Disability Staus Scale) (higher in the case of rUTIs) and the EM type [higher frequency of rUTIs in the progressive types (primary and secondary)]. Urodynamic variables with significant differences were: maximum flow in free flowmetry (lower in patients with rUTIs), voiding volume in free flowmetry (lower in patients with rUTIs), micturition efficiency (higher percentage of residual urine in patients with rUTIs), stress urinary incontinence (SUI) (higher frequency of rUTIs in patients with SUI), detrusor pressure at maximum flow (lower in patients with rUTIs) and bladder contractility index (lower in patients with rUTI). No significant difference was demonstrated in relation to the presence and type of neurogenic lower urinary tract dysfunction (NLUTD).The severity and duration of MS is a risk factor for rUTIs. Urodynamic risk factors are compatible with a lower contractile capacity in patients with rUTIs, while the existence of NLUTD would not imply any specific risk factor.Determinar los factores de riesgo de infecciones urinarias recurrentes (rUTIs) en pacientes con Esclerosis Múltiple (EM).MÉTODOS: Se realizó un estudio de cohortes retrospectivo en 114 pacientes, 84 mujeres (74%) y 30 varones (26%), de edad media 49 años con EM sometidos a estudio videourodinámico y electromiografía selectiva esfinteriana por presentar síntomas urinarios (LUTS). Se recogieron los datos clínicos (tanto neurológicos como urológicos) y videourodinámicos (incluyendo flujometría libre, cistomanometría y estudio presión flujo). En 37 pacientes (32%) se demostró la presencia de rTUIs.Se demostraron diferencias estadísticamente significativas entre los pacientes con y sin rUTIs respecto de las siguientes variables clínicas: el tiempo de evolución de los síntomas (mayor en el caso de rUTIs), antigüedad de la EM (mayor en el caso de rUTIs), la puntuación EDSS (Expanded Disability Staus Scale) (mayor en el caso de rUTIs) y el tipo EM [mayor frecuencia de rUTIs en los tipos progresivos (primario y secundario)]. Las variables urodinámicas con diferencias significativas fueron: el flujo máximo en la flujometría libre (menor en pacientes con rUTIs), el volumen miccional en la flujometría libre (menor en pacientes con rUTIs), la eficiencia miccional (mayor porcentaje de residuo en pacientes con rUTIs), la incontinencia urinaria de esfuerzo (SUI) (mayor frecuencia de rUTIs en pacientes con SUI), la presión del detrusor a flujo máximo (menor en pacientes con rUTIs) y el índice de contractilidad vesical (menor en pacientes con rUTI). No se demostró ninguna diferencia significativa en relación con la presencia y tipo de disfunción neurógena del tracto urinario inferior (NLUTD).La gravedad y duración de la EM constituye un factor de riesgo para las rUTIs. Los factores de riesgo urodinámicos son compatibles con una menor capacidad contráctil en los pacientes con rUTIs, mientras que la existencia NLUTD no supondría ningún factor de riesgo específico.

To investigate urodynamic changes during the voiding phase in males with detrusor underactivity (DU) undergoing bladder catheterization for urinary retention.From a total of 64 patients with urinary retention, a follow-up study was performed in 17 males with a mean age of 77 years. Patients received a urodynamic diagnosis of DU based on a Bladder Contractility Index (BCI) score of 100 and underwent permanent bladder catheterization (16 cases) or clean intermittent catheterization (1 case) for acute urinary retention (14 cases), or post void residual urine (3 cases). Patients underwent a second urodynamic study after a mean 13 months of follow-up. Fisher's exact test was used with categorical variables and Student's t test with parametric variables. The level of significance was set at p 0.05 for a two-sided test.The second urodynamic study showed a significant increase in maximal detrusor pressure, pressure at maximum flow rate, BCI score, Bladder Outlet Obstruction Index (BOOI) score, and number of patients who urinated during the pressure-flow study.Bladder catheterization in men with DU significantly improves bladder contractility and revealed obstructions of the lower urinary tract that were masked by insufficient detrusor pressure in relation to the DU of these patients. These findings could have diagnostic as well as prognostic and therapeutic applications.Determinar los cambios urodinámicos de la fase miccional en varones con hipocontractilidad del detrusor (DU) sometidos a cateterismo vesical por retención urinaria. MÉTODOS: De un total de 64 pacientes con retención urinaria, se realizó un estudio de seguimiento en 17 varones de edad media 77 años, diagnosticados urodinámicamente de DU por presentar un Índice de Contractilidad Vesical (BCI) menor de 100, sometidos a sonda vesical a permanencia (16 casos) o cateterismo vesical limpio intermitente (1 caso) por retención aguda de orina (14 casos), o residuo postmiccional patológico (3 casos). Los pacientes fueron sometidos a un segundo estudio urodinámico a los 13 meses de seguimiento de media. Las pruebas estadísticas utilizadas fueron el test exacto de Fisher para variables cualitativas y el test de comparación de media de la t de Student para variables paramétricas. El nivel de significación se fijó en p 0,05 bilateral. RESULTADOS: En el segundo estudio urodinámico, se observó un aumento significativo de la presión máxima del detrusor, la presión a flujo máximo, el BCI y el Índice de Obstrucción de Salida Vesical (BOOI) y del número de pacientes que orinaron durante el estudio presión/ flujo. CONCLUSIONES: El cateterismo vesical en varones con DU mejora significativamente la contractilidad vesical y permiten desenmascarar obstrucciones del tracto urinario inferior que estaban ocultas por una insuficiente presión del detrusor en relación a la DU de estos pacientes. Esto podría tener no sólo aplicaciones diagnósticas, sino pronósticas y terapéuticas.

To identify the prognostic factors influencing the clinical and urodynamics results on symptomatic benign prostatic hypertrophy (BHP) treatment in a series of patients with silodosin therapy from the URAL study.A retrospective study was performed in a cohort of 318 patients with BPH which underwent silodosine treatment, during at least 12 weeks.Univariate analysis demonstrated that the variables in relationship with a decrease of urinary symptoms` punctuation postreatment (measured with the IPSS Questionnaire), a maximum peak flow (Q max) postreatment equal or superior to 15 ml/s, a postreatment postvoid residual lower to 100 ml, and a postreatment obstruction index ( Bladder Outlet Obstruction Index: BOOI) equal or lower to 20 cm H2O, presented such both as a clinical and urodynamic character. The multivariate analysis demonstrated that a decreased punctuation of IPSS Questionnaire postreatment was in relationship to: a pretreatment cystometry bladder capacity (direct relationship), pretreatment Qmax (direct relationship), pretreatment postvoid residual (inverse relationship), and pretreatment BOOI (inverse relationship).The urodynamic study was very useful in the assessment of the prognostic factors in these patients.

Introduction: The periurethral electromyography (EMGs) alterations in men who underwent pelvic radiotherapy (RT), either isolated or combined with surgery, have not been frequently described in the literature. Objective: The study aimed to compare the EMG's data in men undergoing RT versus the non-irradiated control group. Material and Methods: The study included 61 consecutive males, who had undergone RT (27 of them had been operated) and 99 control consecutive patients who underwent a retrospective assessment. The EMGs were performed using a concentric electrode needle perineally, localizing the sphincter by visual and auditory signal (electromyograph MMS Solar Active). Results: 14.8% denervation, 62.9% reinnervation, 14.9% denervation + reinnervation and 7.4% EMG normal. The age (p < 0.001) and neurogenic bladder data (p < 0.001) are risk factors. The smaller the prostate size (obtained by rectal examination) post-RT, the more the chance for an abnormal EMG (p < 0.001). The fact of having had received RT (p < 0.001) is the only risk factor. Conclusion: RT produces lesions over the pudendal nerve, showing denervation even in late periods. The surgery did not behave as a risk factor.

To describe and quantify the long-term adverse effects on filling phase of lower urinary tract function in males submitted to radiotherapy.We performed a retrospective comparative study on a cohort of 99 men undergoing EBRT a mean of 4.7 years before for clinically localized prostate, rectum or colon neoplasia, and another cohort formed by 97 men over 50 years who did not undergo radiotherapy.Cystometric bladder capacity and bladder capacity at first voiding desire were significantly lower in the radiotherapy group. Univariate analysis showed that the radiotherapy group evinced a risk to present a diminished compliance of 3.5 times more and 9.3 times more to find stress urinary incontinence, but we did not found increased risk for detrusor overactivity. In multivariate analysis the history of radical surgery acted as a confounding factor in the risk of stress urinary incontinence, but not to suffer diminished bladder compliance.The main long-term adverse effect of pelvic radiotherapy on male bladder function during filling is the increased risk of low bladder compliance.

Mondor's disease is a superficial thrombophlebitis and usually occurs in the anterior and lateral chest. The scrotal vein thrombosis is a fairly rare disease.Thirty-four year old male who consulted for inguinal tumor and pain in the postoperative period of an umbilical hernia repair, which resulted in a subsequent scrotal vein thrombosis treated conservatively.It was resolved with conservative treatment, with recanalization of the scrotal veins.Mondor's disease is a rare entity, related to multiple etiological factors. The diagnosis is made easily with Doppler ultrasound and most resolve with conservative treatment.

Our objective is to verify the diagnostic usefulness of ultrasound measurement of the thickness of the bladder wall, and the correlation with clinical/ urodynamic findings in patients with symptomatic BPH.We performed a prospective cross-sectional study (cross-sectional study '') in a series of 74 males (age chi= 72.4 S = 7.1 (56-84 years) with symptomatic BPH. Patients completed the IPSS and determined the plasma level of PSAt (ng / ml). Before performing the urodynamic study, was determined by transabdominal ultrasonography (3.5 MHz transducer): prostate volume (cc) by the ellipsoid formula, and bladder wall thickness (mm) measured on the anterior bladder wall. Statistical analysis was performed using ANOVA, the Pearson correlation, and ROC curve.It was a significant correlation of the sonographic thickness of the bladder wall with the IPSS (p = 0001, r = 0.38) (parameter in turn highly correlated with prostate volume and PSA (p = 0.01, r = 0.62)), as well as the detrusor hyperactivity (p = 0.03, r =0.21), cut off ROC curve: 3.85 mm. Instead, it was not shown a significant correlation between the sonographic thickness of the bladder wall and the urodynamic diagnosis of obstruction (Abrams and number Griffths p = 0223, r = 0.14) or the detrusor contractile power, measured in power at peak flow (Pw) (p = 0642 r =- 0.55), nor with age (p = 0303, r = 0.12). Neither correlation was observed with other non-invasive urodynamic measures (the maximum urinary flow flowmetry (p = 0318, r = 0.12) and percentage postmicturition residual (p = 0696, r = 0.05)).The ultrasound measurement of bladder wall thickness, although it has not proved useful ness in our series in the diagnosis of the voiding phase (lower urinary tract obstruction and detrusor contractility impairment), on the contrary it can be introduced as a diagnostic technique for non-invasive studies in the alterations of the filling phase, in the form of detrusor hyperactivity in also patients with symptomatic BPH, and present a significant correlation with prostate growth.

Update on the urodynamic evaluation in patients with prostate cancer who have incontinence.To review the urodynamic studies in prostate cancer patients who suffer from incontinence, irrespective of the treatment carried out.The largest amount of information on urodynamic studies in patients with prostate cancer and incontinence was found in those with post-prostatectomy incontinence. There is much more limited work on irradiated patients, and after medical treatment.The urodynamic study in these patients may help clarify the etiopathogenic mechanisms of incontinence, try to predict risk factors before treatment and help the therapeutic decision making. Further studies are needed, especially in patients undergoing radiotherapy, to further assess the mechanisms involved in lower urinary tract abnormalities that occur in these patients.