Bone Mineral Density and Androgen Levels in Elderly Males

To clarify the relationship of sex male hormones and bone in men, we studied in 140 healthy elderly men (aged 55–90 years) the relation between serum levels of androgens and related sex hormones, bone mineral density (BMD) at different sites, and other parameters related to bone metabolism. Our results show a slight decrease of serum-free testosterone with age, with an increase of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in a third of the elderly subjects studied. BMD decreased significantly with age in all regions studied, except in the lumbar spine. We found a positive correlation between body mass index (BMI) and BMD at the lumbar spine and femoral neck (P < 0.001). No relationship was found (uni- and multivariate regression analysis) between serum androgens or sex hormone-binding globulin (SHBG) and BMD. We found a positive correlation of vitamin D binding protein (DBP) and osteocalcin with lumbar spine BMD and with BMI, DBP, IGF-1, and PTH with femoral neck BMD. In conclusion, there is a slight decline in free testosterone and BMD in the healthy elderly males. However, sex male hormones are not correlated to the decrease in hip BMD. Other age-related factors must be associated with bone loss in elderly males. Received: 29 April 1997 / Accepted: 9 November 1997     

Changes in the number, proliferation rates, and bcl-2 protein immunoexpression of epithelial and periductal cells from rat epididymis during postnatal development

To investigate 1) the correlation between the proliferative activity of epididymal epithelium plus myoid cells and the increase in the number of these cells and 2) the role of the basal epithelial cells in the renewal of epididymal epithelium, a quantitative evaluation of the proliferation of both epithelial cells and periductal myoid cells in the different epididymal regions (caput, corpus, and cauda) has been carried out during postnatal development of the rat by immunohistochemical evaluation of BrdU-labeling indices. These data were correlated with cell numbers and counted by the optical dissector method. The presence of bcl-2 protein was immunohistochemically detected and evaluated. No significant differences in BrdU indices were observed among epididymal regions in any stage studied. Cell proliferation decreased from the prepubertal period to adulthood in both epithelial and myoid cells in the three regions of the epididymis, suggesting a close relationship between epithelial and mesenchymal components. The numbers of both cell types were significantly higher in the caput than in the corpus and cauda in all stages studied, suggesting functional differences between regions. A negative linear correlation between proliferative activity and cell numbers was noted that might be related to regulation of the cell population size. Basal cells showed a lower proliferation rate than principal cells, but most of the immunoreactive bcl-2 protein, in pubertal and adult epididymides, was observed in basal cells. Therefore, these cells might comprise a low-proliferating and apoptosis-resistant population.     

The long-term behavior of the valve bladder as a function of the initial treatment and its effect on early kidney failure

In approximately 25-40% of infants presenting with posterior urethral valves (PUV) renal insufficiency will develop before adolescence. In some these patients, renal dysplasia, bladder dysfunction and mismanagement may precipitate renal failure at even earlier age. The goals of this study were to determine whether long-term bladder dysfunction was more frequent in children who underwent early temporary pyelostomy than in those who underwent valve ablation, and to know if bladder dysfunction and mismanagement, in some patients, could be responsible of early renal failure. Urodynamic studies were performed in 59 boys with severe PUV divided into two groups based on initial treatment. A) Valve ablation (30 p.); B) Cutaneous pyeloureterostomy (29 p.). At the end of the study 22 boys had chronic renal failure. Of the 59 boys, 42% (25 p.) had bladders with overdistended or normal behaviour, 58% (34 p.) had bladder dysfunction (instability 37%, low compliance 15%, myogenic failure 5%). The 89% of low compliance bladders, 66% of myogenic failure and 23% of those with instability were in CRF. No difference at all was found in bladder function between boys treated as neonates by high diversion or valve ablation. Of the group in chronic renal failure (22 p.), only 7 patients (32%) had bladders with normal behaviour and in five of these patients a mismanagement was directly related with a quicker renal deterioration. The 58% of our boys with severe PUV have some type of bladder dysfunction. Neonatal pyelo-ureterostomy does not increase long-term bladder dysfunction. Surgical mismanagement should be added to bladder dysfunction as contributors to earlier renal failure.     

Encrusted alkaline cystitis and malacoplakia

Urinary infection due to urea splitting bacteria leads to a rise in urinary pH, favouring the precipitation of calcium salts and struvita crystals. If deposited on the surface of a bladder with chronic inflammation or some other previous lesion, may produce an alkaline encrusted cystitis, now a rare condition. In the case here presented, occurred in a 69-year-old male. Corynebacterium urealyticum grown in the urine, and some foci of malakoplakia were found in the area of encrustation endoscopically excised. This case seems to be the third example of alkaline encrusted cystitis associated with malakoplakia reported in the bibliography. These two conditions share similar clinical signs and may probably have a common aetiopathogenesis.     

Giant inguinal scrotal vesical hernia

Presentation of one case of scrotal hernia in a man of 64 years old patient. Diagnosed by cistography and ultrasound and treated by herniorraphy and posterior transuretral litolaplaxy of a vesical litiasis and RTU of prostate. Postoperative urography showed normal vesical morphology.     

Radical prostatectomy. The surgical complications

Study of 165 patients with prostate adenocarcinoma who underwent radical prostatectomy using a retropubic approach. Mean PSA is 19 ng/ml, mean age 63 years and median follow-up 26 months. 22 patients (13.2%) reported complications during the first month post-surgery, primarily urinary fistula of more than 5 days long in 5 patients and rectal injury in 3.49 patients (29%) reported complications after the first month, mainly urinary incontinence in 26 cases and stenosis of the urethrovesical juncture in 15. The group with early complications showed no significant differences compared to those who had none, neither in PSA (p = 0.3) or a worse pathological stage (p = 0.1), and no evidence is shown in terms of biochemical progression or in disease free progression (p = 1). Patients with urethrovesical juncture stenosis have higher mean PSA (p = 0.01), greater biochemical progression (p = 0.006), worse Gleason (p = 0.03 = and worse progression free survival (p = 0.01). Patients with stress incontinence showed no differences compared to the other groups relative to the studied factors.