C. Nuñez

The Value of C-reactive Protein Determination in Patients With Renal Colic to Decide Urgent Urinary Diversion

OBJECTIVES To analyze whether C-reactive protein (CRP) predicts the need for urgent urinary diversion in patients with renal colic and urolithiasis. CRP may help in the differential diagnosis of complicated hydronephrosis. METHODS Prospective study done on 110 consecutive patients with renal colic secondary to upper urinary tract calculi admitted in the emergency room. Clinical and analytical data were collected. Criteria for emergency drainage had been established in advance, based on the risk of sepsis, renal failure, persistence of pain, and findings on computed tomography scan. CRP was blindly determined using immunoturbidimetric assay on the Integra 700 analyzer. Statistical analysis included Mann-Whitney test, Cox multivariate analysis, and receiver operating characteristic curves, to determine optimum cut-off points to decide drainage based on laboratory data. RESULTS Mean CRP value was 47.6 mg/L (CI, 31.4-63.8), 139.6 mg/L (CI, 13-183.1) in 29 patients treated with diversion and 14.67 mg/L (CI, 6.7-22.5) in the control group (P <.001). Age, sex, rate of patients with hypertension, history of cardiovascular disease, leukocyte total count, and serum creatinine differed between groups (P <.05). Regression analysis revealed CRP (P <.0001) and age (P = .0001) were predictive of urinary diversion. Receiver operating characteristic analysis revealed 68.4% area under the curve for creatinine, 68.8% for leukocytosis, and 86.8% for CRP. A cut-off point for CRP of 28 mg/L achieved optimum sensitivity (75.8%) and specificity (88.9%) for determining the decision for drainage. CONCLUSIONS Determination of CRP in patients with renal colic due to urolithiasis provides an objective and useful parameter for deciding placement of urinary stent, which is even more valuable than leukocytosis or seric creatinine level.

Clinicopathological Study of Regressed Testicular Tumors (Apparent Extragonadal Germ Cell Neoplasms)

PURPOSE Testicular germ cell tumors sometimes regress spontaneously and manifest exclusively by metastasis. We report our experience with extragonadal germ cell tumors of probable testicular origin to study the frequency of this entity, and clinical, ultrasound and histopathological correlations in a series of patients. MATERIALS AND METHODS A retrospective 16-year review of 1.2 million inhabitants in Spain revealed 17 with regressed testicular tumors treated at a total of 4 institutions. We analyzed clinical information, ultrasound features and histopathological characteristics of testicular lesions and metastasis, and highlight the main findings. RESULTS A primary testicular origin was confirmed in all cases. This entity is more common than initially suspected since it accounts for 4% of consecutive germ cell tumors. Clinical manifestations varied according to metastatic site with an abdominal palpable mass (47% of cases), loin pain (35%) and transient testicular pain (29%) the most common complaints. No evidence of testicular neoplasms was found on physical examination in any case. Metastasis histology was nonseminomatous in 53% of cases, pure seminoma in 29% and mixed in 18%. The most common ultrasound features were calcifications in 65% of cases, hyperechogenic linear images in 59% and hypoechogenic nodular areas in 41%. Histological findings consisted of fibrotic areas in 100% of cases, hemosiderin deposits in 65%, seminiferous tubule atrophy in 59% and psammoma bodies in 29%. In testicular parenchyma or spermatic chord intratubular neoplasms and viable tumor foci were also noted (47% and 41% of cases, respectively). CONCLUSIONS Spontaneous regression of a germ cell testicular tumor should be considered in each patient with extragonadal germ cell neoplasms. Ultrasound diagnosis of and surgical treatment for these primary testicular tumors appear critical to prevent relapse because residual disease develops in a significant proportion of cases.

ACTIVE CIGARRETE SMOKING MAY HAVE AN INFLUENCE ON THE NATURAL HISTORY OF SUPERFICIAL BLADDER CANCER

INTRODUCTION AND OBJECTIVES: To evaluate the influence of knowledge of a urine-test outcome on the accuracy of cystoscopy (diagnostic review bias) during surveillance of patients with low-grade non-muscle invasive urothelial carcinoma (NMI-UC). METHODS: We conducted a prospective, single blinded, randomised multicenter clinical trial evaluating surveillance by a urine test (i.e. microsatellite analysis) of 448 patients with NMI-UC (pTa, pT1, G1, G2). Urine-test results (positive or negative) were only communicated to the urologist in the intervention arm (n=226), where patients had cystoscopy if the test was positive and at 3, 12, and 24 months. Results of the urine-test were not communicated in the control arm (n=222) with standard 3-monthly cystoscopy. Primary outcome measure was the number of histologically proven bladder cancer recurrences. The trial has been registered at ClinicalTrials.gov (NCT-00126958). RESULTS: During a median follow-up of 34 months, 336 recurrences were detected in the intervention arm, compared to 267 in the control arm (P log-rank = 0.008). In 131 cystoscopies performed with knowledge of a positive urine-test, 42 recurrences were detected. Only 6 recurrences were found for the 120 cystoscopies without information on the positive test result (P < 0.001; see Table). There was no difference in detection of recurrences when urine-test results were negative (intervention arm: 18/260 (7%), control arm 18/326 (6%), P = 0.45; see Table).