Rectourethral Fistula Management.

Rectourethral fistula (RUF) is a rare condition that occurs, in most cases, as a consequence of prostate cancer treatments. Clinical suspicion and proper assessment prior to surgery are essential to adapt and successfully carry out an appropriate treatment plan. There are no randomized trials to guide clinical practice, and therefore, scientific evidence in this respect is limited. Expert recommendations seem to agree on the transperineal approach with flap interposition as the surgical treatment of choice in cases of complex fistulas, especially in those that have undergone prior radiation. Undoubtedly, the key to the successful treatment of the disease is the multidisciplinary and standardized management by physicians with experience in the field.

Penile Prosthesis First and Replacement Surgeries: Analysis of Patient and Partner Satisfaction.

INTRODUCTION: Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. Prosthesis replacement has become an accepted procedure in the event of device malfunction or complications, but to our knowledge, there are no data regarding the impact of implant replacement on patients and partner satisfaction. AIM: The aim of our study was to assess and to compare the level of satisfaction, with a first or second penile prosthesis implantation (PPI), in men with refractory erectile dysfunction and their partners. METHODS: A survey study based on a five-item questionnaire was carried out at our center between January 1999 and January 2012. MAIN OUTCOME MEASURES: The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after PPI. RESULTS: Of the 190 eligible patients, 149 (78%) completed the survey (110 underwent a first implant and 39 a reimplant). Seventy-nine percent of first-time implanted patients and 80% of the reimplanted patients (P > 0.05; not significant [ns]) reported satisfactory sexual intercourse (very or moderately satisfied), while 74% and 80% of their partners reported satisfactory intercourses, respectively (P > 0.05; ns). Overall, 73.7% of first implants and 70% of second implants reported that they would undergo the procedure again if the PPI failed (P > 0.05; ns). With regards to cosmetic aspects, 13% of the first implants' and 15% of second implants' partners reported either penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of first implants and 1% of reimplanted patients expressed difficulty in manipulating the device. CONCLUSIONS: PPI is successful in returning the ability for satisfactory sexual intercourse to both first implant and reimplanted patients and their respective partners.

[Anatomy and vascularization on the male urethra and penis]. / Anatomia y vascularizacion de la uretra y el pene.

In this review we present an update on the anatomy and vascularization of the male urethra. The real objective of this review is to make the following chapters more understandable, both to know the physio-pathological mechanisms of urethral pathology and also to help us in their surgical management.

[Recto-urethral fistula secondary to prostate cancer]. / Fístulas recto-uretrales secundarias a tratamiento de cáncer de próstata.

OBJECTIVES: There are various treatments forprostate cancer nowadays, including techniques that have been used for manyyears such as surgery and radiotherapy, and newer procedures that are gaining prominence in the Urological field like cryotherapy or HIFU (high intensity focused ultrasound). Rectourethral fistula is a rare complication that demands the urologist a great capacity; it may happen after either existent treatment. METHODS: PubMed literature review with articles published during the last 10 years using the terms "rectourethral fistula" and "prostate cancer". EVIDENCE SINTHESIS: We present the current situation of rectourethral fistula secondary to prostate cancer in terms of epidemiology, diagnosis and treatment, with special focus on the various types of fistulae and their management. We comment on general features in relation to surgical management of this pathology; type of approach, type of repair, use of flaps, concomitant fistula and urethralstenosis, delay of surgery and bowel diversion. We describe the surgical techniques more frequently used today and their limitations. We present the results published by different groups with each of these techniques, as well as the corresponding recommendations based on each group's experience. CONCLUSIONS: Rectourethral fistula is a surgical challenge for the urologist. We must choose the appropriate management in accordance to the characteristics of the fistula.

[Testosterone deficit syndrome in the chronic renal failure patient]. / Síndrome de déficit de testosterona en el paciente con insuficiencia renal crónica.

Hypogonadism may affect as much as 70% of the patients with chronic renal failure (CRF) in comparison with general population. Physiopathologically, it is a hypergonadotropic hypogonadism, with alterations in the pulsatile production of GnRH, FSH, LH and testicular testosterone, that is a general disorder of the hypothalamic-hypophysis-testicular axis. This disorder may determine important consequences in this population of patients, with varied sexual dysfunction, trophic and functional muscular and fatty tissue disorders, bone demineralization, anemia and increase of cardiovascular disease associated mortality.Treatment in these patients must be focused from a general point of view, increasing their clinical condition, the systemic complications associated with CRF, complementing in this way with exogenous testosterone replacement therapy. If possible, it seems that the most efficacious therapy will be renal transplantation.

[Research on the design and evaluation of sexual health prevention campaigns aimed at young people in Spain from 1987 to 2016]. / Investigación sobre el diseño y la evaluación de las campañas de prevención en salud sexual dirigidas a jóvenes en España desde 1987 a 2016.

INTRODUCTION: New HIV diagnoses and sexually transmitted infections (STIs) continue to be a public health problem in Spain. Since the beginning of HIV infection in our country, prevention campaigns have been developed by the Health Services regarding sexual and reproductive health. Several authors warn about the poor evaluation of these campaigns. OBJECTIVE: To evaluate the design and evaluation strategies of the sexual health campaigns developed in Spain from 1987 to 2016. METHODS: Observational epidemiological study based on a detailed retrospective collection of data obtained from the National AIDS Plan, official agencies and Health Services about the design and evaluation of developed sexual health campaigns. Statistical analysis was performed using UNAIDS indicators system. RESULTS: 82 campaigns have been developed since 1987, 27 have been aimed at young people. In 100% of campaigns aimed at young people, general information about HIV infection and the promotion of condom use has been addressed; however, other issues about risky sexual behavior have virtually not been included. The prevention of pregnancy in young people is present in less than 25% of campaigns. The quantity of planning and evaluation reports of the available campaigns is very low. CONCLUSION: The data indicate the need to improve actions aimed at sexually active young people, with more planned and evaluated actions for regarding UNAIDS criteria and efficacy indicators.

Effectiveness of two ultrasound-guided transrectal biopsy schemes in the diagnosis of prostate cancer. A randomized study.

OBJECTIVE: To determine whether a 10-core prostate biopsy scheme is superior to the sextant scheme in diagnosing prostate cancer in patients programmed for a first biopsy, with negative rectal digital examination and PSA between 3.5-20 ng/ml. METHODS: A randomized prospective study was performed comparing two prostate biopsy schemes, with randomization stratification according to prostate volume (< or = 50 ml and > 50 ml). Sample size predetermination yielded a minimum of 304 patients in order to achieve the primary objective. Statistical analysis was carried out on an intent-to-treat basis, using the chi-squared test and uni- and multivariate analysis via logistic regression. RESULTS: Cancer was detected in 27.3% of the cases. A significant association was observed between cancer diagnosis and age (p=0.03), prostate volume (p=0.0001) and ultrasound nodule identification (p=0.0001). No correlation was observed with the total number of cores in the series (p=0.37) or with prostate volume < or = 50 ml (p=0.87) or > 50 ml (p=0.09). In the multivariate analysis, age > 70 years (p=0.005), prostate volume < or = 50 ml (p=0.001), and ultrasound nodule identification (p=0.003) were identified as independent variables associated to cancer diagnosis. CONCLUSION: No statistically significant differences were found between the two prostate biopsy schemes. In glands over 50 ml in size, the sextant scheme may prove to be insufficient.

[Prostate cryotherapy: General principles.] / Crioterapia prostática: fundamentos y principios generales.

INTRODUCTION: Prostate cryotherapy has been consolidated as an alternative minimally invasive treatment. OBJECTIVE: To exposed its historical development, its action mechanism and the surgical technique. Regarding its indications, we expose the different option of treatment- primary cryotherapy, salvage and focal- emphasizing its oncological results in the absence of randomized studies. RESULTS: Cryotherapy is a safe technique with low complication rate, although incidence of erectile dysfunction is 40-90% in case of full-gland cryotherapy. Nowadays, it is recommended as a therapeutic alternative for low and intermediate risk localized prostate cancer, although in clinical trials. Recurrence-free survival is close to 96% in low-risk tumors and 90% in intermediate-risk tumors. On the other hand, it is a salvage treatment option for local recurrence after radiotherapy. Focal therapies including focal cryoablation have an important development, with recurrence-free survival of 75%. CONCLUSION: Waiting for randomized studies that provide more scientific evidence, available retrospective studies show cryotherapy as a safe and effective treatment option in patients with localized prostate cancer.

INTRODUCCIÓN: La crioterapia prostática se ha ido consolidando como una alternativa de tratamiento mínimamente invasiva. OBJETIVO: Exponer el desarrollo histórico de la crioterapia, su mecanismo de acción sobre el tejido prostático así como la técnica quirúrgica. Se discuten los distintos escenarios ­ crioterapia primaria, de rescate y focalhaciendo énfasis en sus resultados oncológicos a falta de estudios randomizados. RESULTADOS: La crioterapia es una técnica segura con un bajo índice de complicaciones, aunque destaca una incidencia de disfunción eréctil del 40-90% en el caso de crioterapia de glándula completa. En la actualidad se recomienda como alternativa terapéutica en el cáncer de próstata localizado de riesgo bajo e intermedio, aunque dentro de ensayos clínicos. La supervivencia libre de recidiva bioquímica es cercana al 96% en tumores de bajo riesgo y al 90% en tumores de riesgo intermedio. Por otro lado, es una opción de tratamiento de rescate en el caso de recidiva local tras radioterapia siempre que se cumplan una serie de criterios (Gleason ≤7 y PSA10ng/ml). La mejora en las técnicas de imagen está permitiendo el desarrollo de terapias focales incluyendo la crioablación focal, con supervivencia libre de recidiva bioquímica del 75%. CONCLUSIONES: A la espera de estudios randomizados que aporten mayor evidencia científica, los estudios retrospectivos disponibles muestran la crioterapia como una opción de tratamiento segura y eficaz en pacientes con cáncer de próstata localizado.

Investigación sobre el diseño y la evaluación de las campañas de prevención en salud sexual dirigidas a jóvenes en España desde 1987 a 2016 / Research on the design and evaluation of sexual health prevention campaigns aimed at young people in Spain from 1987 to 2016

Introducción: Los nuevos diagnósticos de VIH y las infecciones de transmisión sexual (ITS) continúan siendo un problema de salud pública en España. Desde el inicio de la infección de VIH en nuestro país se vienen desarrollando campañas de prevención de salud sexual por el Ministerio de Sanidad (MS). Diversos autores alertan sobre la escasa evaluación de estas campañas.Objetivo: Valorar las estrategias de diseño y evaluación de las campañas de salud sexual desarrolladas en España desde 1987 hasta 2016.Métodos: Estudio epidemiológico observacional basado en una pormenorizada recogida retrospectiva de datos disponibles por el Plan Nacional del Sida, organismos oficiales y MS acerca del diseño y la evaluación de las campañas de salud sexual desarrolladas. El análisis estadístico se realizó utilizando el sistema de indicadores de ONUSIDA.Resultados: Se han desarrollado 82 campañas desde el año 1987 hasta 2016, 27 de ellas dirigidas a jóvenes. De las 82 campañas, solo 24 (29%) contaron con informe de planificación previa. El número de informes disponibles de evaluación posterior de las campañas es menor del 15%. En el 100% de las campañas dirigidas a jóvenes se ha abordado información acerca de la infección por VIH y la promoción del preservativo; sin embargo, otros temas acerca del comportamiento sexual de riesgo no han sido tratados. La prevención del embarazo estuvo presente en menos del 25%.Conclusión: Los datos enfatizan la necesidad de incrementar las acciones individualizadas, dirigidas a jóvenes sexualmente activos, planificadas y evaluadas siguiendo las recomendaciones internacionales de ONUSIDA. (AU)

Introduction: New HIV diagnoses and sexually transmitted infections (STIs) continue to be a public health problem in Spain. Since the beginning of HIV infection in our country, prevention campaigns have been developed by the Health Services regarding sexual and reproductive health. Several authors warn about the poor evaluation of these campaigns.Objective: To evaluate the design and evaluation strategies of the sexual health campaigns developed in Spain from 1987 to 2016.Methods: Observational epidemiological study based on a detailed retrospective collection of data obtained from the National AIDS Plan, official agencies and Health Services about the design and evaluation of developed sexual health campaigns. Statistical analysis was performed using UNAIDS indicators system.Results: 82 campaigns have been developed since 1987, 27 have been aimed at young people. In 100% of campaigns aimed at young people, general information about HIV infection and the promotion of condom use has been addressed; however, other issues about risky sexual behavior have virtually not been included. The prevention of pregnancy in young people is present in less than 25% of campaigns. The quantity of planning and evaluation reports of the available campaigns is very low.Conclusion: The data indicate the need to improve actions aimed at sexually active young people, with more planned and evaluated actions for regarding UNAIDS criteria and efficacy indicators. (AU)

[Self-learning of ethics in medicine history. An attractive experience]. / Autoaprendizaje de Ética en Historia de la Medicina. Una Experiencia Atractiva.

Introduction. The concept of person-based medicine may be transmitted to undergraduate studies and the subject of History of Medicine can be a good chance for it, if we engage the students to confront them with the characters, values and actions of those personalities who achieved the principal scientific advances in biomedicine area. Material and Method. In this work, it is described a methodological experience in the transmission of knowledge of History of Medicine following a teaching model which was lead on 130 students who performed analysis on circumstances, actions and ethical values of physicians and scientists that led to significant advances in the field of biomedicine through history. Thus, each student was assigned the subject of one character for study and every one was asked to make an oral presentation with a brief written work including a personal reflection. Results. Oral presentations and written works showed how students were able to do a balance of ethical implications in 77% of the cases. Only 23% of students were not able to see ethical perspectives of the studied characters. The most frequently refered values were the attitudes of perseverance in the study, the selfless dedication to patients and the passionate effort on continuous learning. Conclussions. Undergraduate training in Health Sciences and Medicine offers an excellent training opportunities in ethics and transmission of values through humanistic subjects such as the History of Medicine. The self-reflection by students on the main characters of scientific advances seems to be a good education proposal to promote ethical awareness.

[Ethic evaluation of sexual health programs on adolescence]. / Valoración Ética de los Programas de Salud Sexual en la Adolescencia.

In public health services, the interest in sexuality seems to turning from traditional topics such as potential treatments for male erectile dysfunction, psychosomatic disorders, the control of premature ejaculation and contraception. Instead, an increasingly prominent role is being given to prevention strategies carried out by means of campaigns or through sexual health programme sin schools. The different teaching strategies that underlie these programmes, which in many cases lack social consensus but are often promoted by international organizations such as WHO or UNESCO, reveal not only divergent ethical conceptions and worldviews on the meaning of sexuality, but also conflicting starting points, means and goals, focusing either on barrier-contraceptive methods or on sexual abstinence and personal responsibility. There is therefore a pressing need to understand the scientific evidence underlying each educational approach and the ethical postulates of each pedagogical proposal. This paper presents an outline of a six-point adolescent sexuality education program, which is respectful of individuals' ethical convictions. Given that few works on preventive medicine issues include an ethical evaluation of the steps followed in their development, this article also proposes a systematic evaluation of strategies for sexual health in the community that is developed through four steps verifying the following aspects: 1) the accuracy of information, 2) the level of evidence, 3) efficiency and 4) non-maleficence about the target population of each health program. The methodology used in these sexual health programs is another aspect that will verify their ethical consistence or, conversely, their absence of ethical values. We emphasize the duty of designers of programme for children not to carry then out against the will of their parents or tutors, and not conceal sensitive and relevant information.

Caso: solicitud de reversión de vasectomía en varón VIH con pareja serodiscordante / Case: request for vasectomy reversion in HIV male with serodiscordant couple

No disponible

Microcefalia fetal asociada a virus del Zika y aborto. Consideraciones éticas no explicadas a propósito de un artículo / Zika virus associated with microcephaly and abortion, ethical procedures unexplained in relation to an article

No disponible

Valoración ética de la craneoplastia con vendaje compresivo como forma de limitación de tratamientos de soporte vital / Valoração ética da cranioplastia com curativo compressivo como forma de limitação de tratamentos de suporte vital / Ethical value of cranioplasty with oppressive binder as a way of limiting life support treatments

Este artículo analiza, desde una postura crítica, la utilización de la craneoplastia de compresión con vendaje como método de limitación de tratamiento de soporte vital (LTSV). Con esta técnica activa, algunos autores han propuesto provocar la muerte encefálica, posibilitando la donación de órganos. Al contrastar este procedimiento con las recomendaciones del documento de consenso sobre el tratamiento al final de la vida del paciente crítico, elaborado por el grupo de bioética de la SEMICYUC, se comprueba que los medios y fines de esta técnica no encajan con las actuaciones propias de la LTSV, que se basan en la retirada de medios de soporte vital o en su no inicio, al considerar dichos medios desproporcionados o extraordinarios en algunos casos, evitando así la obstinación terapéutica. La definición de LTSV permite clarificar los límites en los que, de un modo éticamente correcto y consensuado, las actuaciones al final de la vida se circunscriben a los fines de la medicina, evitando la sospecha de que dichas actuaciones puedan ser malinterpretadas como justificación para una obtención de órganos abusiva. El artículo concluye que la provocación directa de la muerte encefálica mediante la técnica de craneoplastia con vendaje no parece cumplir los criterios propios de la LTSV.

This article analyzes, from a critical perspective, the use of cranioplasty with oppressive binder as a method to limit life support treatment (LLST). Some authors have proposed that this active technique provokes encephalic death, allowing organ donation. Contrasting this procedure with the recommendations of the consent document about treatment of critical patients at the end of life, elaborated by the bioethics group of SEMICYUC, it is shown that the means and ends of this technique do not match with the proper actions of LLST, based on the withdrawal of life support means or in not starting them, considering such means disproportionate or extraordinary in some cases, thus avoiding the therapeutic obstinacy. The definition of LLST allows to clarify the limits in which, in a way ethically fair and with a consensus, the acts at the end of life are included in the medical goals, avoiding the suspicion that these acts may be misinterpreted as justifying an abusive extraction of organs. This article concludes that the direct provocation of encephalic death by the technique of cranioplasty with binder does not appear to fulfill the criteria proper of LLST.

Este artigo analisa, a partir de uma postura crítica, a utilização da cranioplastia de compressão com curativo como método de limitação de tratamento de suporte vital (LTSV). Com esta técnica ativa, alguns autores têm proposto provocar a morte encefálica, possibilitando a doação de órgãos. Ao contrastar este procedimento com as recomendações do documento de consenso sobre o tratamento do final de vida do paciente crítico, elaborado pelo grupo de bioética da SEMICYUC, se comprova que os meios e fins desta técnica não encaixam com as atuações próprias da LTSV, que se baseiam na retirada de meios de suporte vital ou em seu não início, ao considerar os ditos meios desproporcionados ou extraordinários em alguns casos, evitando assim a obstinação terapêutica. A definição de LTSV permite esclarecer os limites nos quais, de um modo eticamente correto e aceito, as atuações ao final da vida se circunscrevem às finalidades da medicina, evitando a suspeita de que ditas atuações podem ser mal interpretadas como justificativa para uma obtenção de órgãos abusiva. O artigo conclui que a provocação direta da morte encefálica mediante a técnica da cranioplastia com curativo não parece cumprir os critérios próprios da LTSV.

Autoaprendizaje de ética en Historia de la medicina. Una experiencia atractiva / Self- Learning of Ethics in medicine history. An atrractive experience

Introducción: El concepto de Medicina basada en la persona puede ser transmitido desde los estudios de pregrado. La asignatura de Historia de la Medicina puede ser un buen lugar para ello si se involucra al alumnado confrontándole con los protagonistas y las acciones que dieron lugar a diferentes avances científicos. Material y Método: En este trabajo se muestra la experiencia metodológica de la transmisión de conocimientos de Historia de la Medicina siguiendo un modelo de enseñanza compartida sobre 130 alumnos a través del análisis de las biografías de las personas que propiciaron relevantes avances en el ámbito de la biomedicina a través de su historia. Para ello, a cada alumno se le asignó uno de estos personajes y se le pidió que hiciera una exposición oral junto con un trabajo escrito en el que figurara su valoración personal sobre el mismo. Resultados: Las exposiciones y trabajos realizados mostraron cómo el alumnado fue capaz de hacer un balance de implicaciones morales en un 77 % de los casos. Sólo el 23% de los alumnos eludieron la perspectiva ética en los personajes estudiados. Las actitudes más frecuentemente valoradas fueron la perseverancia en el estudio, la dedicación abnegada hacia los pacientes y la pasión por el aprendizaje. Conclusiones: La formación de pregrado en Ciencias de la Salud ofrece excelentes posibilidades formativas en ética y valores a través de asignaturas como Historia de la Medicina. La autoreflexión por parte de los alumnos sobre sus protagonistas parece una buena pedagogía para favorecer esa sensibilización ética

Introduction: The concept of person-based medicine may be transmitted to undergraduate studies and the subject of History of Medicine can be a good chance for it, if we engage the students to confront them with the characters, values and actions of those personalities who achieved the principal scientific advances in biomedicine area. Material and Method: In this work, it is described a methodological experience in the transmission of knowledge of History of Medicine following a teaching model which was lead on 130 students who performed analysis on circumstances, actions and ethical values of physicians and scientists that led to significant advances in the field of biomedicine through history. Thus, each student was assigned the subject of one character for study and every one was asked to make an oral presentation with a brief written work including a personal reflection. Results: Oral presentations and written works showed how students were able to do a balance of ethical implications in 77% of the cases. Only 23% of students were not able to see ethical perspectives of the studied characters. The most frequently refered values were the attitudes of perseverance in the study, the selfless dedication to patients and the passionate effort on continuous learning. Conclussions: Undergraduate training in Health Sciences and Medicine offers an excellent training opportunities in ethics and transmission of values through humanistic subjects such as the History of Medicine. The self-reflection by students on the main characters of scientific advances seems to be a good education proposal to promote ethical awareness

Efectividad en el diagnóstico de cáncer de próstata de dos esquemas de biopsia transrectal ecodirigida. Estudio aletorizado / Effectiveness of two ultrasound-guided transrectal biopsy schemes in the diagnosis of prostate cancer. A randomized study

OBJETIVO: Evaluar si un esquema de biopsia de próstata de 10 cilindros es superior al esquema de 6 cilindros en el diagnóstico de cáncer de próstata, en pacientes que van a ser sometidos a una primera biopsia, con un tacto rectal no sospechoso y un PSA entre 3,5 y 20 ng/ml.MÉTODO: Estudio prospectivo aleatorizado entre 2 esquemas de biopsia de próstata con estratificación de la aleatorización por volumen prostático (<= 50 cc y > 50 cc.). Mediante predeterminación del tamaño muestral se obtuvo un mínimo de 304 pacientes para poder responder al objetivo principal. El análisis estadístico se realizó por “intención de tratar”, mediante el test de la Chi cuadrado y análisis uni y multivariante mediante regresión logística.RESULTADOS: Se detectó cáncer en el 27,3% de los casos. Existió una relación significativa entre el diagnóstico de cáncer y la edad (p=0,03), el volumen prostático (p=0,0001) y la existencia de nódulo ecográfico (p=0,0001). No se observó relación con el número de cilindros en el total de la serie (p=0,37), ni en la próstatas ≤ 50 cc (p=0,87) ni en las > 50 cc (p=0,09). En el análisis multivariante la edad > 70 años (p=0,005), el volumen de la próstata <= 50 cc (p=0,001) y la existencia del nódulo ecográfico (p=0,003) se identificaron como variables independientes asociadas al diagnóstico de cáncer.CONCLUSIÓN: No hemos encontrado diferencias estadísticamente significativas entre ambos esquemas de biopsia de próstata. En las glándulas mayores de 50 cc. el esquema de 6 cilindros puede ser insuficiente(AU)

OBJECTIVE: To determine whether a 10-core prostate biopsy scheme is superior to the sextant scheme in diagnosing prostate cancer in patients programmed for a first biopsy, with negative rectal digital examination and PSA between 3.5-20 ng/ml.METHODS: A randomized prospective study was performed comparing two prostate biopsy schemes, with randomization stratification according to prostate volume (<= 50 ml and > 50 ml). Sample size predetermination yielded a minimum of 304 patients in order to achieve the primary objective. Statistical analysis was carried out on an intent-to-treat basis, using the chi-squared test and uni- and multivariate analysis via logistic regression.RESULTS: Cancer was detected in 27.3% of the cases. A significant association was observed between cancer diagnosis and age (p=0.03), prostate volume (p=0.0001) and ultrasound nodule identification (p=0.0001). No correlation was observed with the total number of cores in the series (p=0.37) or with prostate volume ≤ 50 ml (p=0.87) or > 50 ml (p=0.09). In the multivariate analysis, age > 70 years (p=0.005), prostate volume <= 50 ml (p=0.001), and ultrasound nodule identification (p=0.003) were identified as independent variables associated to cancer diagnosis.CONCLUSION: No statistically significant differences were found between the two prostate biopsy schemes. In glands over 50 ml in size, the sextant scheme may prove to be insufficient(AU)

Priapismo recurrente "stuttering priapism": presentación de un caso y revisión de la literatura / Stuttering priapism: case report and bibliographic review

OBJETIVO: Revisar la forma de presentación, fisiopatología, diagnostico y alternativas terapéuticas del priapismo recurrente mediante la presentación de un nuevo caso.MÉTODOS: Varón de 25 años, estudiado en otro centro por presentar episodios recurrentes de priapismo desde hace aproximadamente 18 meses. Estos episodios se producen a diario, interfiriendo de forma importante con la calidad de vida del paciente.RESULTADOS: Se inicio tratamiento con Bicalutamida 50mg/24h sin mejoría. En la analítica, ecografía dopplerpeneana y arteriografía selectiva de arterias pudendas no se evidenciaron alteraciones. Se pautó Tadalafilo 5mg/24h durante dos meses sin respuesta. Posteriormente se instauró tratamiento con Diazepam 10 mg/24h y Terbutalina 5 mg/24h permitiendo el control de la enfermedad, quedando asintomático en la actualidad.CONCLUSIONES: El priapismo recurrente es una forma poco común de presentación de esta enfermedad, producida por una alteración en los mecanismos de regulación de la erección mediados por la 5PDE y el GMPc.Se han propuesto varios fármacos en su tratamiento con eficacia variable, aunque no existen series suficientemente largas para poder recomendar ninguno como primera opción. El uso de inhibidores de la 5PDE de forma prolongada, ha sido utilizado con éxito por algunos grupos.El conocimiento de estas alternativas, es importante para el tratamiento de esta compleja e infrecuente patología(AU)

OBJECTIVE: To review the presentation, physiopathology, diagnosis and therapeutic alternatives of stuttering priapism with the contribution of a new clinical case.METHODS: A 25 year old man, studied in another center for recurrent episodes of priaprism for about 18 months. These episodes occur daily, significantly interfering with patient´s quality of life.RESULTS: Initially he was treated with Bicalutamide 50mg/24h with no improvement. Blood test, penile Doppler ultrasound and selective arteriography of pudendal arteries showed no abnormalities. Tadalafil 5mg/24h was given for two months without response. Subsequently were treated with Diazepam 10 mg/24h and Terbutaline 5 mg/24h allowing control of the disease, remaining asymptomatic at present.CONCLUSIONS: Stuttering priapism is a rare form of presentation of this disease, caused by an alteration in the regulatory mechanisms of erection mediated by 5PDE and cGMP.Several drugs have been proposed in treatment with variable effectiveness, though there is no series long enough to recommend either as first choice. The use of inhibitors 5PDE so long, has been used successfully by some groups.Knowledge of these alternatives is important for the treatment of this complex and unusual pathology(AU)

Fístulas recto-uretrales secundarias a tratamiento de cáncer de próstata / Recto-urethral fistula secondary to prostate cancer

OBJETIVO: Actualmente existen diversos tratamientos para el cáncer de próstata que incluyen técnicas utilizadas desde hace muchos años, como la cirugía y la radioterapia, y procedimientos más novedosos que van tomando protagonismo en la Urología como la crioterapia o los ultrasonidos focalizados de alta intensidad (HIFU). La fístula rectouretral es una complicación poco frecuente que exige gran capacidad al urólogo y que puede acontecer tras cualquiera de los tratamientos existentes. ADQUISICIÓN DE EVIDENCIA: Revisión de la literatura existente en PubMed; artículos publicados en los últimos 10 años introduciendo como palabras clave: «rectourethral fistula» y «prostate cancer». SÍNTESIS DE EVIDENCIA: Presentamos la situación actual en cuanto a epidemiología, diagnóstico y tratamiento de la fístula rectouretral secundaria a tratamiento de cáncer de próstata poniendo especial interés en los distintos tipos de fístula y el manejo que debe hacerse en cada uno de ellos. Comentamos los aspectos generales relacionados con el manejo quirúrgico de esta patología: tipo de abordaje; tipo de reparación; utilización de colgajos; fístula y estenosis de uretra concomitante; demora de la cirugía y derivación digestiva. Describimos las técnicas quirúrgicas más utilizadas en la actualidad y sus limitaciones. Presentamos los resultados publicados por distintos grupos con cada una de estas técnicas así como las recomendaciones correspondientes basadas en la experiencia de cada grupo. CONCLUSIÓN: La fístula rectouretral supone un reto quirúrgico para el urólogo. Éste debe elegir el manejo apropiado en función de las características de la fístula

OBJECTIVES: There are various treatments for prostate cancer nowadays, including techniques that have been used for many years such as surgery and radiotherapy, and newer procedures that are gaining prominence in the Urological field like cryotherapy or HIFU (high intensity focused ultrasound). Rectourethral fistula is a rare complication that demands the urologist a great capacity; it may happen after either existent treatment. EVIDENCE ACQUISITION: PubMed literature review with articles published during the last 10 years using the terms «rectourethral fistula» and «prostate cancer». EVIDENCE SINTHESIS: We present the current situation of rectourethral fistula secondary to prostate cancer in terms of epidemiology, diagnosis and treatment, with special focus on the various types of fistulae and their management. We comment on general features in relation to surgical management of this pathology; type of approach, type of repair, use of flaps, concomitant fistula and urethralstenosis, delay of surgery and bowel diversion. We describe the surgical techniques more frequently used today and their limitations. We present the results published by different groups with each of these techniques, as well as the corresponding recommendations based on each group`s experience. CONCLUSIONS: Rectourethral fistula is a surgical challenge for the urologist. We must choose the appropriate management in accordance to the characteristics of the fistula

[Results of the use of donors under 3 years of age for pediatric renal transplantation]. / Resultados de la utilización de donantes de edad inferior a 3 años en trasplante renal pediátrico.

OBJECTIVES: To evaluate the functional results and incidence of complications in a series of pediatric renal transplants using grafts from pediatric donors under 3 years of age. METHODS: We review a serious of 19 renal transplants consecutively performed in pediatric receptors with donors under the age of 3 years. We analyze immediate function, medical and surgical complications, and long and mid-term graft and patient survivals. RESULTS: We observed initial graft dysfunction in 9 patients (47.4%). Six patients had vascular complications (31.5%). More vascular complications appeared in kidneys preserved with EC solution (35.3%) in comparison with UW solution (23.5%) (p < 0.05). 1, 5, 10, and 12 year actuarial graft survivals were 57.8%, 41.4%, 35.5% and 35.5%, respectively. Based on preservation solution, 1, 5, and 10 year actuarial graft survivals for EC were 44%, 33% and 16%, respectively; results improved with UW solution up to 60%, 50%, and 50% respectively (p < 0.001). CONCLUSIONS: Kidneys from donors under the age of the 3 years in pediatric receptors suffer a high incidence of vascular complications offering a low graft survival on the long-term, being these facts more evident when simpler preservation solutions are employed.