Teodoro Mayayo Dehesa

Diagnóstico y seguimiento de la hipertrofía prostática benigna mediante ecografía

OBJECTIVES: The aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH). METHODS: A total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound. RESULTS: The first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected. CONCLUSIONS: Ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH.

Rentabilidad de la biopsia ampliada con 10 muestras prostáticas: Estudio prospectivo sobre 222 pacientes

Resumen es: Objetivo: Actualmente no esta establecido ni el numero de muestras ni de biopsias para el correcto diagnostico del cancer prostatico. Presentamos nuestra...

Estudio ultrasonográfico de las masas renales de pequeño tamaño

OBJECTIVES: To perform an update on the usefulness of ultrasound in the study of small size renal tumors and its current possibilities. METHODS: We review the results of ultrasound in this pathology with the addition of the most recent technological advances such as a harmonic digital converters and power color Doppler. We analyze its contribution to the differential diagnosis of the cystic pathology, to the definition of solid masses, to the detection and characterization of small size masses, and to the definition of the vascular patterns of various tumors. RESULTS: Ultrasonography offers a diagnostic safety of 98% in cystic masses, being able to detect them from 0.5 cm diameter in favourable conditions. The differential diagnosis of multiloculated masses, multivesicular hydatid cyst, multiloculated cystic nephroma, and multiloculated cystic carcinoma still poses great difficulty, the same way it happens with other radiological tests. For solid masses, the greater image resolution has lead to a progressive increase in the incidental detection of tumors and the percentage of patients candidates to conservative surgery due to the decrease in size. It is easy to differentiate between adenocarcinoma and angiomyolipoma, up to 85% of the cases, but the rest of the tumors do not have specific characteristics. For small size masses, smaller than 3 cm, ultrasound sensitivity is clearly inferior to CT scan. Power color Doppler helps to confirm the existence of solid masses and helps a better differential diagnosis with pseudo tumors. CONCLUSIONS: The modern ultrasound techniques provide a high cost-effectiveness both in detection and definition of the nature of small size renal masses.

TOLERANCIA Y COMPLICACIONES DE LA BIOPSIA TRANSRECTAL ECODIRIGIDA PROSTÁTICA AMPLIADA A DIEZ CILINDROS. PAPEL DEL BLOQUEO DE HACES NEUROVASCULARES CON LIDOCAÍNA

OBJECTIVES The growing interest on increasing the number of biopsy samples during ultrasound guided prostatic biopsies moved us to evaluate the tolerability and complications of the extensive biopsy with/without blockage of neurovascular bundles. METHODS A group of 222 patients underwent prostatic biopsy with the aim to obtain 10 cores on each. After evaluation of the first 50 cases performed without anesthesia, decision was taken to proceed with neurovascular blockage with 2% lidocaine, comparatively evaluating both groups for results on tolerability, complications and global adverse events. RESULTS The aimed number of cores could not be completed in 16% of the patients without anesthesia in comparison with 2.33% with anesthesia (p < 0.002); the biopsy was qualified as painful or very painful by 10.9% and 1.9% respectively (p < 0.0002). The results of the visual analogical scale for pain were 2.46 +/- 1.67 and 4.5 +/- 2.11 for the anesthesia/without anesthesia groups respectively, with mild-moderate vagal reactions in 28% of these latter in comparison with 7.7% in patients receiving lidocaine. Rectal bleeding was the most worrying complication, being moderate-severe in 4.7% of the patients, with 2% hospital admission. CONCLUSIONS The increase in the number of ultrasound guided prostatic biopsy samples may be associated with a higher frequency of complications, mainly bleeding, and requires the application of local anesthesia due to worse tolerance. Neurovascular bundle blockage with lidocaine is very effective to diminish biopsy associated pain.Resumen es: OBJETIVO: El creciente interes por ampliar el numero de muestras obtenidas durante la biopsia transrectal ecodirigida prostatica nos ha hecho evaluar la ...

Ecografía en el diagnóstico de la incontinencia urinaria femenina

OBJECTIVES: The value of ultrasonography for the study of female urinary incontinence has been redefined over the last years. METHODS: We review the literature about the value of ultrasound in the workup of females with urinary incontinence, mainly transperineal ultrasound for the female stress urinary incontinence (SUI). RESULTS: Many papers have been published over the last few years. Upper urinary tract ultrasound has not a place in the workup of genuine female SUI. Transperineal ultrasound allows to evaluate the mobility of the bladder neck and urethra, the thickness of the bladder wall, the funnel shape of the bladder neck, the presence of SUI or pelvic organ prolapse (POP), to visualize mesh implants, to help with biofeedback, and to evaluate changes after surgical treatment. CONCLUSIONS: Ultrasounds in general, and transperineal or translabial ultrasound in particular, are in the process of becoming the standard diagnostic method in urogynecology. Their wide availability, the standardization of parameters, the possibility of evaluating not only the bladder but also the levator ani muscle or pelvic organ prolapses (POP) contribute to this fact. It allows to obtain data in a non invasive way before and after therapy.

RESULTADOS DE UNA SERIE DE 6000 PACIENTES CON BIOPSIA TRANSRECTAL ECODIRIGIDA DE PRÓSTATA. PARTE I: ANATOMÍA PATOLÓGICA, TACTO RECTAL, ECOGRAFÍA TRANSRECTAL Y PSA.

Resumen es: OBJETIVOS: Analizar los resultados de la Biopsia Transrectal Ecodirigida (BTE) prostatica realizadas en 6000 pacientes asi como su relacion con los difer...

Results of a series of transrectal ultrasound guided biopsy of the prostate in 6000 patients: Part II: PSA derived parameters

Resumen es: OBJETIVO: En esta serie se revisan los resultados de 6000 pacientes biopsiados en una o mas ocasiones por sospecha de CP, analizando el papel que puedan ...

Biopsia transrectal ecodirigida de próstata: aportación de una unidad urológica de diagnóstico ecográfico tras 10 años de experiencia

OBJECTIVES: Although transrectal ultrasound-guided (TRUS) prostatic biopsy is the procedure of choice for the diagnosis of prostate cancer (PC), neither the ideal number of cores nor the number of repeated biopsies, nor the required diagnostic yield have been established. After our experience of ten years with TRUS biopsy we perform a review of the technique and its indications. METHODS: PSA, ultrasound features, and pathologic data of 6000 patients undergoing modified sextant TRUS biopsy between 1994 to December 2002 were collected. 222 patients undergoing ten-core TRUS biopsy were included in an experimental group to study the role of the extended biopsy. The contribution of the extra cores to the diagnostic yield in the experimental group was studied to determine the effectiveness of the extended biopsy, using as a control group 552 patients undergoing sextant TRUS biopsy during 2002. Both groups were comparable for the study variables at the start of the study. RESULTS: The incidence of PC in the first biopsy in the group of 6000 patients was 39.1% (2345/6000). Patients with PSA between 4 and 10 ng/ml have an incidence of PC greater than 50% among prostates smaller than 20 cc, diminishing down to 8.9% in those greater than 50 cc. The percentage of PC among patients with negative digital rectal examination (DRE), normal TRUS, and PSA below 4 ng/ml was 16.7%. The diagnostic yield for PSA density lower than 0.11 ng/ml/cc was lower than 8%. The free/total PSA ratio shows a 13.7% incidence of PC with values higher than 0.24. Multivariate logistic regression analysis showed that the only non-significant parameter was free/total PSA. Sixty (27.15%) patients of the extended TRUS biopsy group had PC. Only 2.25% of the 221 patients benefited from the augmented number of biopsies. There were no significant differences in the figures of prostate cancer between groups. Only PSA and volume where significant in the multivariate logistic regression analysis; number of samples, PSA density and age lacked of influence in the detection of PC. CONCLUSIONS: The sextant biopsy model obtaining cores from the lateral horns of the prostate continues to be the reference for TRUS biopsy, and the extended biopsy is not applicable to all patients from the beginning do to the small increase in the diagnostic yield. Isolated PSA may not be the unique reference to indicate TRUS biopsy, being volume, in our experience, a definitive factor for the adjustment of high risk levels.

Papel del volumen prostático en la biopsia transrectal ecodirigida de próstata: ¿es un marcador tan importante como el PSA?

Resumen es: Resumen.- OBJETIVO: La limitacion del PSA para identificar a los pacientes con cancer prostatico ha hecho que se definan diferentes parametros que aument...