Revista mexicana de urologia最新文献

Objective

To determine the prevalence of ED and associated risk factors among young Mexicans between 18 and 40 years of age.

Methods

An observational, cross-sectional, descriptive and analytic study was conducted. Data collection was achieved through a questionnaire. Participants completed the Urologic Health Survey for Men and the International Index of Erectile Function (IIEF-5) questionnaire. The study also included sociodemographic, clinical, and sexual behavior variables.

Results

Of the 373 questionnaires filled out, only 160 were answered completely and used for the analysis. The mean age was 25.59 ± 5.45 years. The prevalence of ED was 33.7% (mild 17.5%, mild-to-moderate 8.1%, moderate 6.3%, and severe 1.9%). The mean score for non-ED males was 24.38 ± 0.94 versus 15.41 ± 4.81 in the ED group. Univariate analysis showed a significant difference in the items of age (p < 0.01), having a stable sexual partner (p < 0.01), sleeping with the sexual partner (p < 0.01), sexual orientation (p = 0.04), and the number of sexual intercourse episodes per week (p < 0.01). In the multivariate analysis “Not having a stable sexual partner” remained a significant risk factor (p = 0.027, OR = 2.60 [CI 1.11–6.08]).

Conclusions

In our study, young Mexican adults had an ED prevalence of 33.7% and most of the cases were mild (17.5%). Partner availability was important. No organic variables were related to ED.

Background

Prostate-specific antigen (PSA) is a tumor marker used in the diagnosis of prostate cancer; it is organ-specific but it is not disease-specific. The effect of ejaculation on PSA concentration is controversial.

Aim

To evaluate the impact of PSA values after ejaculation on biopsy indication in a screened population.

Methods

Baseline PSA was measured in 100 patients that had abstained from sexual activity for at least 7 days. A second measurement was carried out 48 h after ejaculation. The numerical differences were compared using the Student's t test. The McNemar's test was used to analyze pre and post-ejaculation values and clinical significance was defined as a PSA value above a pre-established limit for biopsy indication.

Results

Mean age of the patients was 52.7 ± 8.6 years. The mean baseline PSA was 1.39 ± 1.43 ng/mL and after ejaculation was 1.48 ± 1.51 ng/mL (P = .54). Two patients had PSA values that increased sufficiently for biopsy indication, using a parameter of 4 ng/mL after ejaculation. The McNemar's test showed no statistically significant differences (P = .500).

Conclusions

There was no statistically significant difference in PSA after ejaculation and this change had no clinical relevance.

Aims

At the Complexo Hospitalario Universitario de Santiago de Compostela (Spain), retropubic radical prostatectomy has been performed since 1993 and laparoscopic radical prostatectomy since 2006. We decided to analyze our results and compare the two techniques.

Material and methods

A retrospective observational study was conducted that included all laparoscopic prostatectomies performed within the time frame of January 2011 and September 2013 (62 cases) and all the open prostatectomies performed in 2012 (100 procedures).

Results

We found no statistically significant differences in either the functional (p = 0.15) or oncologic (p = 0.07) results, but there was a statistically significant difference in relation to complications (p = 0.04). The laparoscopic approach is currently the most frequently performed surgical option in our center for the radical approach to prostate cancer.

Conclusions

Laparoscopic radical prostatectomy is a technique with a long learning curve. Nevertheless, we consider that this procedure provides benefits to the patient presenting with prostate cancer, especially with respect to pain, complications, and functional and oncologic results.

The association of renal cell carcinoma (RCC) and renal tuberculosis (TB) is uncommon. Whereas the incidental discovery of RCC in tuberculous kidneys is well described, the discovery of tuberculous lesions after radical nephrectomy for cancer is exceptional. The aim of this article was to report a case of locally advanced clear cell RCC whose histologic study revealed associated TB. There are very few published cases of kidney cancer and TB. A case of squamous cell carcinoma of the renal pelvis in a kidney with TB and a case of renal adenocarcinoma and TB have been reported. The present case describes locally advanced RCC with high tumor burden and retroperitoneal adenopathy that, before surgery, suggested metastatic disease to the lymph nodes. However, only histopathologic changes due to TB were found. No clinical or pathologic correlation has been found between these 2 entities, and clinical studies on the subject are lacking.

Numerous studies on the molecular basis of prostate cancer focus on the role of androgens, but estrogens have been shown to be linked to prostate cancer development and progression. In the present article, we reviewed the laboratory and clinical evidence, demonstrating that estrogens can be the cause of the development and progression of prostatic hyperplasia and prostate cancer. We also studied the more significant mechanisms related to estrogen action, which include: direct genotoxicity, hyperprolactinemia, inflammation, and receptor-mediated action. In addition, we analyzed the functions of the known estrogen receptors (alpha and beta) in diseases of the prostate. The evidence observed suggests that estrogen receptor alpha plays an essential role in the development of both the normal prostate and the cancer, whereas estrogen receptor beta is related to the differentiation of the prostatic epithelial tissue and numerous antiproliferative actions in prostate cancer. Nevertheless, some of their isoforms are associated with mechanisms of cancer initiation and progression. Finally, we believe that more studies related to estrogen action should be carried out to better understand the role estrogens play in the development of prostate cancer.

Melanoma of the bladder is a rare malignant neoplasia. Isolated primary cases have been reported, but the most common presentation is metastatic disease. The diagnosis of bladder melanoma is complicated and requires a thorough interdisciplinary study of the patient. In addition, there are no well-standardized histopathologic criteria confirming its primary site. Presented herein is the case of a 42-year-old man with bladder melanoma that manifested as suprapubic pain, dysuria, and weight loss. Both the clinical and histopathologic diagnoses were difficult and it was not possible to determine whether the lesion was a primary one, due to the advanced stage of presentation, as well as to the lack of complementary studies.

Background

Renal lithiasis is a very common pathology that has been described since Hippocrates. Its etiopathogenesis involves different theories on formation that include saturation, oversaturation, crystal nucleation, crystal growth, epitaxis, matrix, crystallization inhibitors, epidemiologic aspects, and heredity. Compared with classic lumbotomy, percutaneous nephrolithotomy is a less aggressive technique facilitating kidney stone treatment. Reduced hospital stay, low analgesic use, and a shorter recovery period make this a well-accepted surgical technique by patients and it is considered the first treatment option in many cases.

Aims

To present the experience at our institution with the modified version of the previously described technique.

Material and methods

All surgical notes on percutaneous nephrolithotomies in the modified Valdivia position performed within the time frame of January to August 2014 were reviewed.

Results

The mean age of the patients was 42 years. Of the 10 patients included in the study, 7 were men and 3 were women. Five of the patients presented with staghorn stones, 2 with pyelic stones, and the rest with pyelic and calyceal stones. Stone size ranged from 2 to 7 cm. A total of 2 (28.6%) stones were in the lower portion of the collecting system, 7 (64%) were in the middle portion, and one (7.1%) was in the upper portion. Estimated surgery duration was a mean of 120.5 min. The complication rate (Clavien-Dindo: I-IV) was 20%, one patient presented with bleeding that was controlled, and 80% of the patients were stone free.

Conclusions

In our experience, percutaneous nephrolithotomy with the modified Valdivia technique is a safe and effective option with a high success rate, anesthesiological advantages, and few complications.

Mixed epithelial and stromal tumor of the kidney is a rare benign kidney neoplasia that predominantly occurs in middle-aged women. It presents as a well-defined biphasic lesion with solid and cystic components in both tomography and magnetic resonance imaging, reflecting the proliferation of the stromal element and the presence of multiple cysts that are the manifestation of the epithelial element. Malignant transformation, recurrence, and metastasis are rare, but isolated cases and small series have been reported in the literature.

Background

The increasing resistance to quinolones has led to the consideration of other antibiotic options for the prevention of infectious complications in prostate biopsy. We present our experience using a single dose of piperacillin/tazobactam as prophylaxis.

Methods

A retrospective study of transrectal prostate biopsies performed at our institution from 2008 to 2013 was conducted. All patients received enemas before biopsy and a single 4.5 g dose of piperacillin/tazobactam was administered i.v. a few minutes before the biopsy. Clinical and microbiological variables were analyzed to find out risk factors for complications.

Results

A total of 543 biopsies were included. Ninety-two complications (16.9%) were reported in 74 (13.6%) patients, 4.2% of which were infectious complications. In these patients, the associated risk factors were a previous history of positive urine cultures within a 3-year period before biopsy, the presence of a transurethral indwelling catheter at the time of the biopsy, hospital admission within a month before biopsy, and a preoperative positive urine culture despite antibiotic therapy selected according to the resistance pattern.

Conclusions

Physicians and patients should be aware of the risk for complications, particularly if risk factors are present. A single dose of piperacillin/tazobactam is a reasonable option for prophylaxis, especially in countries with a high prevalence of quinolone-resistant pathogens.