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Objetivo: Determinar la relación existente entre los niveles de hormonas sexuales y la composición corporal, la salud ósea y la calidad de vida en hombres por encima de los 50 años. Material y métodos: Estudio transversal en el que se incluyen 230 pacientes. Se determina la composición corporal utilizando parámetros antropométricos directos como el peso, la talla, la circunferencia de la cintura, la circunferencia del brazo dominante, el pliegue cutáneo tricipital, el pliegue en brazo dominante y el pliegue subcapsular. Se calculan parámetros antropométricos indirectos. Se realizan medidas cuantitativas de densidad ósea mediante ecografía del calcáneo, así como marcadores de recambio óseo (N-telopéptidos de excreción urinaria y relación calcio/ creatina). La calidad de vida se evalúa mediante el cuestionario abreviado de calidad de vida SF-36. Los análisis sanguíneos incluyen la determinación de testosterona total, globulina transportadora de hormonas sexuales (SHBG), testosterona libre calculada (TLc), sulfato de dehidroepiandrosterona (S-DHEA), androsteriona, 17-β-estradiol y gonadotropinas. Resultados: La TLc se asocia con un incremento muscular y una disminución del contenido graso, aun ajustándolo por edad (p

Objetivo: Determinar la relación existente entre los niveles de hormonas sexuales y la composición corporal, la salud ósea y la calidad de vida en hombres por encima de los 50 años. Material y métodos: Estudio transversal en el que se incluyen 230 pacientes. Se determina la composición corporal utilizando parámetros antropométricos directos como el peso, la talla, la circunferencia de la cintura, la circunferencia del brazo dominante, el pliegue cutáneo tricipital, el pliegue en brazo dominante y el pliegue subcapsular. Se calculan parámetros antropométricos indirectos. Se realizan medidas cuantitativas de densidad ósea mediante ecografía del calcáneo, así como marcadores de recambio óseo (N-telopéptidos de excreción urinaria y relación calcio/ creatina). La calidad de vida se evalúa mediante el cuestionario abreviado de calidad de vida SF-36. Los análisis sanguíneos incluyen la determinación de testosterona total, globulina transportadora de hormonas sexuales (SHBG), testosterona libre calculada (TLc), sulfato de dehidroepiandrosterona (S-DHEA), androsteriona, 17-β-estradiol y gonadotropinas. Resultados: La TLc se asocia con un incremento muscular y una disminución del contenido graso, aun ajustándolo por edad (p

Resumen Introduccion La investigacion en terapia celular y medicina regenerativa, desarrollada en su mayor parte en torno al estudio de las celulas madre, esta obteniendo resultados prometedores en todas las especialidades medicas. En urologia estan llevandose a cabo grandes avances en este campo, si bien existen ciertas dificultades, pues, por ejemplo, a fecha de hoy aun no ha sido posible la completa identificacion y aislamiento de las celulas madre uroteliales ni prostaticas humanas, aunque muchos grupos se estan acercando cada vez mas a ello. Material y metodos Realizamos una busqueda electronica mediante la base de datos Pubmed, tanto de articulos originales como de revisiones, utilizando los criterios de busqueda stem cells urology, urothelial stem cells, bladder stem cells, prostate stem cells, urethra stem cells, cell therapy urology, tissue engeneering urology y regenerative medicine urology . Resultados Hemos hecho una revision de 30 trabajos publicados hasta noviembre de 2009, tratando con ello de hacer una recopilacion lo mas completa posible, para poder conocer un poco mejor los avances realizados en este campo, desde los inicios hasta nuestros dias. Conclusion Aunque existen aun importantes numerosas incognitas, la mayor de ellas conseguir la identificacion, aislamiento y cultivo de las celulas madre renales, uroteliales y prostaticas humanas, esto no debe impedir a los investigadores el poder trasladar los resultados obtenidos en el laboratorio a la clinica.

Resumen Introduccion Los progresos alcanzados en los ultimos anos en el estudio de las celulas madre y la ingenieria tisular demuestran que probablemente se trate de unos de los campos de la investigacion mas prometedores para el futuro. Gran parte de las enfermedades urologicas podrian beneficiarse del desarrollo de disciplinas como la medicina regenerativa, pues en la actualidad ya se han conseguido resultados esperanzadores en esta materia. Material y metodos Realizamos una busqueda electronica mediante la base de datos Pubmed, tanto de articulos originales como de revisiones, utilizando los criterios de busqueda «stem cells urology», «kidney stem cells», «testis stem cells», «urinary sphincter», «cell therapy urology», «tissue engeneering urology» y «regenerative medicine urology». Resultados Hemos revisado un total de 33 trabajos publicados hasta enero de 2010, intentando resumir los hallazgos mas relevantes de los ultimos anos y su aplicacion clinica, asi como el punto en el que nos encontramos hoy en dia. Conclusion La terapia celular y la medicina regenerativa se estan imponiendo como uno de los campos de investigacion urologica mas en auge en los ultimos anos. Sin embargo, queda aun mucho por investigar para que todos los rapidos avances de la investigacion basica puedan ser trasladados a la clinica.

Introducción: Los progresos alcanzados en los últimos años en el estudio de las células madre y la ingeniería tisular demuestran que probablemente se trate de unos de los campos de la investigación más prometedores para el futuro. Gran parte de las enfermedades urológicas podrían beneficiarse del desarrollo de disciplinas como la medicina regenerativa, pues en la actualidad ya se han conseguido resultados esperanzadores en esta materia. Material y métodos: Realizamos una búsqueda electrónica mediante la base de datos Pubmed, tanto de artículos originales como de revisiones, utilizando los criterios de búsqueda «stem cells urology», «kidney stem cells», «testis stem cells», «urinary sphincter», «cell therapy urology», «tissue engeneering urology» y «regenerative medicine urology». Resultados: Hemos revisado un total de 33 trabajos publicados hasta enero de 2010, intentando resumir los hallazgos más relevantes de los últimos años y su aplicación clínica, así como el punto en el que nos encontramos hoy en día. Conclusión: La terapia celular y la medicina regenerativa se están imponiendo como uno de los campos de investigación urológica más en auge en los últimos años. Sin embargo, queda aún mucho por investigar para que todos los rápidos avances de la investigación básica puedan ser trasladados a la clínica. Introduction: Progress in stem cell study and tissue engineering reached during the last times proves that this may be one of the most promising research fields in the future. Most urological diseases could profit from the development of disciplines such as regenerative medicine as, up to now, there have been encouraging results in this subject. Material and methods: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: "stem cells urology", "kidney stem cells", "testis stem cells", "urinary sphincter", "cell therapy urology", "tissue engeneering urology" y "regenerative medicine urology". Results: We reviewed 33 articles published up to January 2010, trying to summarize the most relevant findings within the last years, the clinical applications and the point we have come to this day. Conclusion: Cell therapy and regenerative medicine are showing themselves to be one of the most promising fields within urological basic investigation in the last years. However, there is much work to be done yet, to make the advances reached in basic research be applicable to the clinic.

El cáncer testicular bilateral suponen el 2-5 % de todos los tumores de testículo, aunque actualmente esa prevalencia va aumentando. La edad media de aparición es de los 15-35 años y el 75 % de ellos se presenta metacrónicamente. Suele haber hallazgos histológicos similares en ambos testículos, siendo el tipo histológico más frecuente el seminoma. El factor de riesgo más importante en el desarrollo del cancer testicular es la presencia de neoplasia intratubular de células germinales. El tratamiento de elección es la orquiectomía radical , aunque en algunos casos seleccionados se puede realizar una cirugía conservadora del testículo Presentamos 4 casos atendidos en nuestro servicio, analizamos los factores de riesgo, manejo de los tumores y realizamos una revisión de la literatura médica.

Resumen En el presente estudio analizamos la influencia pronostica del porcentaje de tumor en los cilindros de biopsia prostatica en los pacientes candidatos a prostatectomia radical Material y metodos Estudio retrospectivo con 68 pacientes diagnosticados de carcinoma de prostata en estadio clinico T1-T2 sometidos a prostatectomia radical desde mayo de 1997 a octubre de 2000. Se analizan los siguientes parametros preoperatorios: edad, PSA, estadio clinico, Gleason y 6 cilindros de biopsia prostatica transrectal ecodirigida, estudiando el no de biopsias positivas, el porcentaje de tumor en el total de biopsias y el porcentaje maximo de tumor en un cilindro. Se realiza analisis univariante (Chi-cuadrado, t de Student) y multivariante (regresion logistica multiple) para estudiar la relacion de estos parametros con la presencia o no de enfermedad organoconfinada Resultados En 44 pacientes se comprobo enfermedad organoconfinada en la pieza de prostatectomia radical. En el analisis univariante todos los parametros estudiados salvo la edad son factores que se asocian con la existencia o no de enfermedad organoconfinada. En el analisis multivariante unicamente el porcentaje total de tumor en las biopsias (p=0,0002) y el PSA (p=0,005) se comportaron como factores pronosticos independientes Conclusiones El porcentaje de tumor en los cilindros de biopsia prostatica parece ser un factor con un alto valor predictivo de enfermedad organoconfinada, probablemente por ser un indice del volumen tumoral

To assess if testicular sperm cryopreservation is a valid alternative to repetition of testicular sperm retrieval techniques, results of a cryopreservation technique in pills have been retrospectively analyzed. Enough motile spermatozoa for ICSI were obtained in 172 from 190 (90.5%) frozen-thawed testicular sperm samples. Overall, 249 couples underwent 390 ICSI cycles, 156 using fresh and 234 using cryopreserved testicular sperm. Mean two-pronuclear fertilization rates per cycle were not significantly different after ICSI with fresh (62.0%) or with cryopreserved (63.2%) spermatozoa. Mean embryo cleavage rate per cycle was higher in the fresh (90.6%) than in the cryopreserved (84.6%) group (P = 0.016). However, clinical pregnancy rates per cycle (28.2% with fresh vs 27.8% with cryopreserved), implantation rates (12.2% vs 13.1%) and ongoing pregnancy rates per cycle (22.4% vs 21.8%) were not significantly different. Cryopreservation of testicular spermatozoa is an effective technique that can be used both in obstructive and in non-obstructive azoospermia.

Objective: To isolate CD49f+ cells from testicular sperm extraction (TESE) samples of azoospermic patients and induce meiosis by coculturing these cells with Sertoli cells. Design: Prospective analysis. Setting: Research center. Patient(s): Obstructive azoospermic (OA) and nonobstructive azoospermic (NOA) patients. Intervention(s): TESE, with enzymatic dissociation of samples to obtain a cell suspension, which was cultured for 4 days with 4 ng/mL GDNF. The CD49f+ cells were sorted using fluorescence-activated cell sorting (FACS) as a marker to identify spermatogonial stem cells (SSCs), which were cocultured with Sertoli cells expressing red fluorescent protein (RFP) in knockout serum replacement (KSR) media with addition of 1,000 IU/mL of follicle-stimulating hormone (FSH), 1 mu M testosterone, 40 ng/mL of GDNF, and 2 mu M retinoic acid (RA) for 15 days in culture at 37 degrees C and 5% CO2 to induce meiotic progression. Cells were collected and analyzed by immunofluorescence for meiosis progression with specific markers SCP3 and CREST, and they were confirmed by fluorescence in situ hybridization (FISH). Main Outcome Measure(s): Isolation of CD49f+ cells and coculture with Sertoli cells, meiosis progression in vitro, assessment of SSCs and meiotic markers real-time polymerase chain reaction (RT-PCR), immunohistochemical analysis, and FISH. Result(s): The CD49f+ isolated from the of total cell count in the TESE samples of azoospermic patients varied from 5.45% in OA to 2.36% in NOA. Sertoli cells were obtained from the same TESE samples, and established protocols were used to characterize them as positive for SCF, rGDNF, WT1, GATA-4, and vimentin, with the presence of tight junctions and lipid droplets shown by oil red staining. After isolation, the CD49f+ cells were cocultured with RFP Sertoli cells in a 15-day time-course experiment. Positive immunostaining for meiosis markers SCP3 and CREST on days 3 to 5 was noted in the samples obtained from one NOA patient. A FISH analysis for chromosomes 13, 18, 21, X, and Y confirmed the presence of haploid cells on day 5 of the coculture. Conclusion(s): In vitro coculture of SSCs from TESE samples of NOA patients along with Sertoli cells promoted meiosis induction and resulted in haploid cell generation. These results improve the existing protocols to generate spermatogenesis in vitro and open new avenues for clinical translation in azoospermic patients. (Fertil Steril (R) 2012; 98:580-90. (C) 2012 by American Society for Reproductive Medicine.)

Introducción: La investigación en terapia celular y medicina regenerativa, desarrollada en su mayor parte en torno al estudio de las células madre, está obteniendo resultados prometedores en todas las especialidades médicas. En urología están llevándose a cabo grandes avances en este campo, si bien existen ciertas dificultades, pues, por ejemplo, a fecha de hoy aún no ha sido posible la completa identificación y aislamiento de las células madre uroteliales ni prostáticas humanas, aunque muchos grupos se están acercando cada vez más a ello. Material y métodos: Realizamos una búsqueda electrónica mediante la base de datos Pubmed, tanto de artículos originales como de revisiones, utilizando los criterios de búsqueda stem cells urology, urothelial stem cells, bladder stem cells, prostate stem cells, urethra stem cells, cell therapy urology, tissue engeneering urology y regenerative medicine urology. Resultados: Hemos hecho una revisión de 30 trabajos publicados hasta noviembre de 2009, tratando con ello de hacer una recopilación lo más completa posible, para poder conocer un poco mejor los avances realizados en este campo, desde los inicios hasta nuestros días. Conclusión: Aunque existen aún importantes numerosas incógnitas, la mayor de ellas conseguir la identificación, aislamiento y cultivo de las células madre renales, uroteliales y prostáticas humanas, esto no debe impedir a los investigadores el poder trasladar los resultados obtenidos en el laboratorio a la clínica. Introduction: Investigation in cell therapy and regenerative medicine, mainly developed around stem cell research, is reaching promising results in every medical specialities. There are also being great advances in Urology, despite the difficulties researchers are facing, as complete identification and isolation of human urothelial and prostatic stem cells has not been possible yet, although many groups are close to achieve it. Material and methods: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: "stem cells urology", "urothelial stem cells", "bladder stem cells", "prostate stem cells", "urethra stem cells", "cell therapy urology", "tissue engeneering urology" y "regenerative medicine urology". Results: We reviewed 30 articles published up to November 2009, trying to summarize thoroughly the most relevant findings and the last advances in this fild, from the first steps to this day. Conclusion: Despite the great lack of knowledge existing, especially the need for achieving the identification of kidney, urothelium and prostate stem cells, this shouldn't prevent researchers from translating the laboratory results to the clinical work.

Investigation in cell therapy and regenerative medicine, mainly developed around stem cell research, is reaching promising results in every medical specialities. There are also being great advances in Urology, despite the difficulties researchers are facing, as complete identification and isolation of human urothelial and prostatic stem cells has not been possible yet, although many groups are close to achieve it.We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: "stem cells urology", "urothelial stem cells", "bladder stem cells", "prostate stem cells", "urethra stem cells", "cell therapy urology", "tissue engineering urology" y "regenerative medicine urology".We reviewed 30 articles published up to November 2009, trying to summarize thoroughly the most relevant findings and the last advances in this field, from the first steps to this day.Despite the great lack of knowledge existing, especially the need for achieving the identification of kidney, urothelium and prostate stem cells, this shouldn't prevent researchers from translating the laboratory results to the clinical work.

Progress in stem cell study and tissue engineering reached during the last times proves that this may be one of the most promising research fields in the future. Most urological diseases could profit from the development of disciplines such as regenerative medicine as, up to now, there have been encouraging results in this subject.We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: stem cells urology, kidney stem cells, testis stem cells, urinary sphincter, cell therapy urology, tissue engineering urology y regenerative medicine urology.We reviewed 33 articles published up to January 2010, trying to summarize the most relevant findings within the last years, the clinical applications and the point we have come to this day.Cell therapy and regenerative medicine are showing themselves to be one of the most promising fields within urological basic investigation in the last years. However, there is much work to be done yet, to make the advances reached in basic research be applicable to the clinic.

Introducción: Los progresos alcanzados en los últimos años en el estudio de las células madre y la ingeniería tisular demuestran que probablemente se trate de unos de los campos de la investigación más prometedores para el futuro. Gran parte de las enfermedades urológicas podrían beneficiarse del desarrollo de disciplinas como la medicina regenerativa, pues en la actualidad ya se han conseguido resultados esperanzadores en esta materia. Material y métodos: Realizamos una búsqueda electrónica mediante la base de datos Pubmed, tanto de artículos originales como de revisiones, utilizando los criterios de búsqueda «stem cells urology», «kidney stem cells», «testis stem cells», «urinary sphincter», «cell therapy urology», «tissue engeneering urology» y «regenerative medicine urology». Resultados: Hemos revisado un total de 33 trabajos publicados hasta enero de 2010, intentando resumir los hallazgos más relevantes de los últimos años y su aplicación clínica, así como el punto en el que nos encontramos hoy en día. Conclusión: La terapia celular y la medicina regenerativa se están imponiendo como uno de los campos de investigación urológica más en auge en los últimos años. Sin embargo, queda aún mucho por investigar para que todos los rápidos avances de la investigación básica puedan ser trasladados a la clínica.

To investigate the changes in sexual hormones in a selected male population older than 50 years of age. To assess the frequency of biochemical hypogonadism and which factors are related to testosterone levels.A Cross-sectional study was carried out on 230 Spanish men older than 50 years of age. Blood tests were performed including: total testosterone, SHBG, calculated free testosterone, dehidroepiandrosterone sulfate, androstendione, estradiol, bioavailable estradiol, FSH, LH, and prolactin. Clinical and socio-demographic backgrounds were investigated. The frequency of biochemical hypogonadism was established using total and free testosterone levels as diagnostic criteria. Factors that may influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression model was used to determine which factors can predict biochemical hypogonadism according to free testosterone levels.Age was associated with a significant decrease (p0.05) in total testosterone (0.6% per year), free testosterone (1.3% per year), dehydroepiandrosterone sulfate (1.8% per year) and bioavailable estradiol (0.69% per year). Moreover, an increase in SHBG, LH, and FSH was observed (p0.05). According to total testosterone levels, 4.8% of the men were hypogonadal, whereas 24.8% were hypogonadal when free testosterone was considered. In the univariate analysis, obesity, diabetes mellitus and hyperlipemia were related to lower total testosterone levels, while free testosterone levels were lower in men with sedentary life, lower levels of education, obesity or diabetes mellitus. In the multivariate analysis age, diabetes mellitus and obesity were inversely related to total and free testosterone levels. Free testosterone was also inversely related to hyperlipemia. For biochemical hypogonadism, simple logistic regression analysis selected age, sedentary life, obesity and diabetes mellitus. In the multivariate analysis age, obesity and diabetes mellitus had significant independent prognostic value.Starting from 50 years of age, a significant age-related decrease in total testosterone, free testosterone, dehydroepiandrosterone sulfate and bioavailable estradiol is observed. The frequency of biochemical hypogonadism is higher when free testosterone levels are used for diagnosis. Total testosterone levels were related to age, diabetes mellitus and obesity. Free testosterone was related to age. diabetes mellitus, obesity and hyperlipemia. The probability of suffering low free testosterone levels increases with age, diabetes mellitus and/or obesity.

To identify if there is a group elderly patients with clinical suspicion of prostate cancer in which pathological confirmation may be unnecessary, and if prostatic transrectal fine needle aspiration (FNA) may be a useful diagnostic tool for old patients.A total of 72 patients aged 75-93 years were evaluated by means of prostatic transrectal FNA. Antibiotic prophylaxis, analgesia or cessation of anticoagulant therapy were not necessary.In 35 patients (48.6%) cytological diagnosis was positive for prostatic adenocarcinoma, whereas in 37 cytology was negative for cancer. In 100% of patients with PSA30 ng/ml or with PSA20 ng/ml and suspicious digital rectal examination FNA results were positive for cancer. 4.1% minor and 1.3% major (acute prostatitis) complications after FNA were observed.In male patients older than 75 years with PSA30 ng/ml or with PSA20 ng/ml and suspicious digital rectal examination, histological confirmation of carcinoma by prostatic biopsy may be not necessary, because of the high probability of a positive result. When histological confirmation of prostatic carcinoma is required in elderly patients, transrectal prostatic FNA is a valid alternative to transrectal biopsy, due to its excellent tolerance and low complication rate.

Resumen Objetivos Identificar si existe algun grupo de varones ancianos con sospecha clinica de cancer de prostata, en el cual la confirmacion anatomopatologica del diagnostico puede no ser necesaria, y valorar si la puncionaspiracion con aguja fina (PAAF) transrectal de prostata puede ser adecuada para el diagnostico en la poblacion anciana Material y metodo Se evaluaron mediante PAAF transrectal a 72 pacientes de edades comprendidas entre 75 y 93 anos. No fue necesaria la administracion de ningun tipo de profilaxis antibiotica, analgesia, ni el abandono o sustitucion de medicacion anticoagulante Resultados En 35 de estos pacientes (48,6%) el resultado de la citologia fue positivo para adenocarcinoma de prostata, mientras que en 37 fue negativo para tumor. En el 100% de los pacientes con PSA > 30 ng/ml o con PSA > 20 ng/ml y tacto rectal sospechoso de cancer, la PAAF fue positiva. Se detecto un 4,1% de complicaciones menores y un 1,3% de complicaciones mayores (prostatitis aguda) Conclusiones En varones mayores de 75 anos con PSA > 30 ng/ml o con PSA > 20 ng/ml y tacto rectal sospechoso puede no ser necesaria la confirmacion histologica de cancer de prostata mediante biopsia dada la elevada probabilidad de que esta sea positiva. Cuando se considere necesaria la confirmacion anatomopatologica del diagnostico de cancer de prostata en pacientes de edad avanzada, la PAAF constituye una buena alternativa a la biopsia transrectal, dada su excelente tolerancia y baja tasa de complicaciones

Bilateral testicular cancer represents from 2 to 5% of all testicle tumors, even though this prevalence nowadays is increasing. The median age of presentation was from 15 to years and in approximately 75% of them occurred metachronously. There used to be concordance in histological findings between both testicles, being seminoma the most common histological type. The most important risk factor in the development of testicular cancer is the presence of intratubular germ cell neoplasia. Radical orquiectomy is the treatment to choose, although in some carefully selected patients testis-sparing surgery may be considered. We present four cases attended in our medical service, we analize the risk factors, management of tumors and a medical literature review is done.

The best indicators to the diagnosis of hypogonadism are free and bioavailable testosterone circulating levels. Free and bioavailable testosterone measurements are complex. However, simple kits for direct measurement of free testosterone by analog immunoassay are available. We examined the utility of an enzymoimmunoassay kit for free testosterone measurement.One hundred thirty-three healthy males were included. Total testosterone, SHBG, albumin and free testosterone was measured. We used two different methods to free testosterone estimation: direct measurement by enzymoimmunoassay and mathematical calculation with Vermeulen's formula, which uses albumin concentration, total testosterone and SHBG to calculate free testosterone (method recommended by the International Society for the Study of the Aging Male). We compared the two methods means values and a linear regression study was performed.Mean age was 37 +/- 11 years. Mean serum concentration for total testosterone was 21.43 +/- 6.8 nm ol/L. The mean value for free testosterone measured by direct and mathematical method was 0.0508 +/- 0.0118 nmol/L and 0.474 +/- 0.123 nmol/L respectively. In linear regression study exists a positive correlation between both methods (p0.05), although correlation coefficient is very low (r = 0.25).There are significant statistical differences between the measurements of free testosterone by direct and mathematical methods. Although certain correlation is observed, this is very low. In conclusion, free testosterone measurement by enzymoimmunoassay is not reliable.

Introducción y objetivos: Los mejores indicadores bioquímicos para el diagnóstico del hipogonadismo son la testosterona libre y la biodisponible. La determinación de ambas fracciones de testosterona es compleja, aunque se han desarrollado técnicas de inmunoanálisis que permiten la determinación de la testosterona libre de manera directa y sencilla. Valoramos la utilidad de una técnica no evaluada de enzimoinmunoanálisis para la determinación de testosterona libre. Material y métodos: En el estudio se incluyeron 133 varones sanos en los que se determinó la testosterona total, la SHBG, la albúmina y la testosterona libre. La testosterona libre fue determinada mediante 2 métodos diferentes: determinación directa mediante enzimoinmunoanálisis (DSL 10-49100 ACTIVE® Free Testosterone EIA, Diagnostics System Laboratories) y mediante cálculo matemático utilizando la fórmula desarrollada por Vermeulen, que utiliza la concentración de albúmina, testosterona total y SHBG para calcular la testosterona libre (método recomendado por la "International Society for the Study of the Aging Male"). Comparamos los valores obtenidos mediante un test de comparación de medias y realizamos un análisis de regresión para observar el grado de correlación existente entre ambos tipos de determinaciones. Resultados: La edad media fue de 37 ± 11 años. Los niveles medios de testosterona total fue de 21,43 ± 6,8 nmol/L y los de testosterona libre de 0,0508 ± 0,0118 nmol/L para el método directo y de 0,474 ± 0,123 nmol/L para el método matemático (p

With serum prostate specific antigen (PSA) levels of 4.1 to 10 ng/ml a significant number of patients are unnecessary subjected to biopsy. We try to determine if the calculation of prostate specific antigen density (PSAD) and prostate specific antigen density of the transition zone (PSADTZ) improve the capacity to discriminate between non-malignant disease and prostate cancer.A prospective study including 314 males with PSA levels between 4.1 and 10 ng/ml is reported. Transrectal ultrasonography and prostatic biopsy were performed in all of them and total prostate and transition-zone volumes were calculated. PSA density and PSA density of the transition zone were calculated for each patient. Receiver operating characteristics (ROC) curves for PSA, PSAD and PSADTZ were constructed for all the patients and for those patients with digital rectal examination unsuspicous of malignancy, determining the sensitivity and specificity for several cutoff values.The area under the curve for both, PSAD and PSADTZ, were greater than for PSA (p0.05), without any significant differences between PSADTZ and PSAD. The cutoff value of greatest diagnostic efficiency for PSAD was 0.17 ng/ml/cc (71.4% sensitivity and 55.7% specificity), while it was 0.41 ng/ml/cc for DPSATZ (70% sensitivity and 61.5% specificity). For those cases of normal digital rectal examination, no differences were observed between PSA and PSAD but they were between PSA and PSADTZ. In any event, the area under ROC curves was always less than 0.7, and, in order to avoid a large number of biopsies (high specificity), a large number of cancers are left without diagnosis (low sensitivity).We conclude that PSAD and PSADTZ are not excessively useful for adequately discriminating between patients with prostate cancer and those with non-malignant disease, particularly when digital rectal examination is normal.

INTRODUCCIÓN: Cuando el antígeno prostático específico (PSA) sérico se encuentra entre 4,1 y 10 ng/ml un número importante de pacientes son sometidos a biopsia de forma innecesaria. Intentamos determinar si el cálculo de la densidad de PSA (DPSA) y la densidad de PSA de la zona de transición (DPSAZT) mejoran la capacidad del PSA para discriminar entre enfermedad benigna y cáncer. MÉTODOS: Estudio prospectivo en el que se incluyeron 314 varones con cifras de PSA entre 4,1 y 10 ng/ml. En todos ellos se realizó ecografía transrectal y biopsia prostática, calculando el volumen prostático y de la zona de transición. Se calculó la DPSA y la DPSAZT para cada paciente. Se realizaron curvas de rendimiento diagnóstico (ROC curves) para PSA, DPSA y DPSAZT para la totalidad de los pacientes y seleccionando aquellos con tacto rectal no sospechoso de malignidad. Se calculó sensibilidad y especificidad para diferentes puntos de corte para el DPSA y DPSAZT. RESULTADOS: Para la totalidad de la muestra, tanto DPSA como DPSAZT mostraron un área bajo la curva mayor que PSA (p

The present study analyzes the prognostic influence of tumor percentage in cylinders of prostatic biopsy in this patient group.Retrospective study of 68 patients with a diagnosis of adenocarcinoma, clinical stage T1-T2 who had undergone a radical prostatectomy from May 1997 to october 2000. Following preoperative parameters were analyzed: age, PSA, clinical staging, Gleason and six cylinders of ultrasonography-leaded transrectal prostatic biopsy, studying the amount of positive biopsies, the tumor percentage of the total amount of biopsies and the maximum percentage of tumor in one cylinder. Univariate (square-Chi, Student t) and multivariate (multiple logistic regression) analysis are performed in order to study the relationship of these parameters with the presence or not of an organ-located disease.An organ-located disease was shown at 44 patients through the piece of radical prostatectomy. The univariate analysis gave all studied parameters, except age, a prognostic value of the existence or not of an organ-located disease. In the multivariate analysis only the total percentage of biopsy tumors (p = 0.0002) and PSA (p = 0.005) behaved as independent prognostic factors.Tumor percentage in prostatic biopsy seems to be a factor with a high predictive value of an organ-located disease, possibly because it is an index of tumoral volume.

Presentation of one case of cystic lymphangioma of the suprarenal gland in a 34-year-old female patient with a background of lower urinary tract infections, presenting with continuous and aggravating pain in left lumbar area and with no other associated symptomatology, diagnosed with ultrasound, IVU and CAT. A review of the literature is made. The present study pretends to give an overall view of a rare and benign disease, commenting upon the difficulties found in its diagnosis and the different therapeutical options.

The present study reviews bladder leiomyoma, an uncommon pathology. The problems of differential diagnosis and the therapeutic options are discussed and the literature reviewed.A 33-year-old female with anterolateral intramural leiomyoma of the bladder is described. Patient evaluation included US, cystography, CT, cystoscopy and ultrasound-guided suprapubic puncture.Leiomyoma is an uncommon benign tumor of the bladder. To our knowledge, only 235 cases have been reported in the literature. We advocate the use of ultrasound-guided suprapubic puncture, a simple procedure that is frequently diagnostic, in the evaluation of this tumor type.

In patients with obstructive azoospermia in whom standard microsurgical procedures fail or are unfeasible, the only source of spermatozoa is the testicle. In addition, in some azoospermic patients with severe spermatogenic failure, a few spermatozoa may be present in testicular biopsy specimens despite high serum follicle stimulating hormone concentrations. In all these cases, intracytoplasmic sperm injection (ICSI) with testicular biopsy-extracted spermatozoa may offer the chance of pregnancy. To assess the efficacy of this procedure, we compared the results of two series of ICSI cycles performed during the same time period: 21 cycles using testicular biopsy-extracted spermatozoa and 83 cycles using ejaculated spermatozoa. Mean fertilization rates (59% with testicular and 68% with ejaculated spermatozoa), mean cleavage rates (93% with testicular and 90% with ejaculated spermatozoa), embryo quality (77% good quality embryos in the testicular sperm group and 77% in the ejaculated sperm group) and clinical pregnancy rates (36.8% in the testicular sperm group and 28% in the ejaculated sperm group) were not significantly different in both groups. We conclude that high fertilization, cleavage and pregnancy rates can be achieved with intracytoplasmic testicular sperm injection, reaching levels comparable with those of ICSI using ejaculated spermatozoa.

We report on 23 patients with acquired vesicoenteric fistula treated during the past 12 years: 48% of these were of inflammatory etiology (11 cases), 35% were caused by neoplasms (8 cases) and 17% were iatrogenic (4 cases). The most frequent symptoms were pneumaturia and fecaluria (78% of cases). Cystoscopy was the most useful diagnostic procedure in detecting fistula (13 of 18 cases). Other imaging techniques, though less effective for diagnosis, were useful in assessing the status of the GI tract and, at times, in determining the etiology of the fistulae. Treatment depends on the etiology, localization and patient general condition. The technique most frequently applied in our series was resection of the fistulous tract, together with the compromised intestinal segment, and bladder suture.

The frequency of segmental renal dysplasia was studied in 15 patients with complete pyeloureteral duplication whose anatomopathologic diagnosis of the lesions of some of the renal segments of duplication were available (14 partial nephrectomies, one open renal biopsy). Evidence of dysplasia was found in 10 cases (67%), the remaining 5 were diagnosed as having chronic pyelonephritis. All patients had a coexisting ureteric anomaly that drained the dysplastic renal segment: 6 ureteral ectopias, 3 ectopic ureteroceles, 1 vesicoureteral reflux. The clinical and pathogenic importance of the associated anomalies of the excretory tract, the diagnostic difficulties arising from the minimally- or non-functioning dysplastic renal segment, and the therapeutic modalities utilized are discussed.

We have treated 10 patients with histologically diagnosed prostate carcinoma, in states C and D, with orally administered dosage of 1200 mg./day of ketoconazol, with the following results: Four patients were excluded through displaying gastrointestinal intolerance in the first days of treatment. Three patients treated had the dosage reduced to half due to poor tolerance, but no improvement was noted. Another three patients tolerated the treatment for four months and displayed transitory remission of ostealgia, which permitted the withdrawal of analgesics. In these patients the treatment was suspended due to digestive intolerance and to the appearance of a clinical picture compatible with suprarrenal corex hypoadrenalism.

We have used four lectins (PHA-L, HPA, RCA-120 and PNA) to characterise the oligosaccharides present in the membrane of the different cell layers of the human vesical urothelium, obtained from 27 normal biopsies of vesical mucus. In all the patients studied the PHA-L and HPA lectins showed an affinity for all the urothelial layers, and a progressive increase in fluorescence is observed from the basal to the surface stratum. The pattern observed when using lectin RCA-120 was a positive marking of all the urothelial layers studied, with a homogeneous intensity in all of them. The PNA lectin did not show reactivity to the normal urothelium in none of the cases studied. We comment on the applications of this type of study both for characterizing the glycid composition of the urothelial cell membrane and for ascertaining its variations in accordance with cell differentiation.

We studied the postoperative development of lymphocytes, T cells and lymphocyte subpopulations, in peripheral blood in 45 patients. Twenty-five of them were subjected to a TUR of a bladder tumor, 10 to a transvesical prostatectomy, 6 to a pyelolithotomy and 4 to a nephrectomy for renal atrophy secondary to lithiasis. We confirm a significant postoperative drop in the lymphocyte count and in the percentages of OKT 3+ (total T cells), OKT 4+ (helper T cells) and OKT 8+ cells (cytotoxic/suppressor T cells) 2-4 hours after the operation. Its duration varies according to the type of operation carried out. Despite the slight differences observed in the postoperative development of the lymphocyte subpopulations, at no time in the study did we report significant postoperative variations in the OKT 4+/OKT 8+ quotient.

We have studied 62 children with urinary infection simultaneously by means of micturitional cystoureterography (MCU) and indirect isotopic cystography. We confirm a correlation between the results of the MCU and in the indirect isotopic cystography in 86% of the ureters explored, whilst the results of the MCU and of the direct isotopic cystography coincided in 92% of the ureters explored. We discuss the advantages and drawbacks of isotopic cystography, concluding that it is a suitable method for the diagnosis and evolutive control of vesicoureteral reflux in infancy.

We studied two groups of patients in order to evaluate the frequency of association between renal dysplasia and vesicoureteral reflux. The first was composed of 19 patients with dysplastic kidneys, 15 of whom were studied by means of micturition cystourethrography. The second group was made up of 86 patients with 124 kidneys with reflux. In 16 of these we were able to obtain a histopathological diagnosis of the renal lesions (12 nephrectomies, 4 biopsies). In three cases the renal dysplasia was associated with a vesicoureteral reflux, which represents an incidence of reflux in 20% of the patients with renal dysplasia, and an incidence of dysplasia in 19% of the kidneys with reflux examined histopathologically. We contrast these results with the literature, discussing the pathogenic hypotheses that enable us to explain this association as well as the clinical consequences thereof.