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)

[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.

[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.

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

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.

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.

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.

[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.

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

[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.

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

La Medicina Sexual en la Historia. Avances y controversias (Parte II) / Sexual Medicine beyond History. Advances and controversies (Part II)

El recorrido histórico de la Medicina Sexual y la Andrología por los 2 últimos siglos permite ver cómo el desarrollo científico se ha acelerado hasta un nivel que hubiera parecido imposible a nuestros predecesores. A ello han contribuido en gran parte los logros en la comprensión de la fisiología y, desde luego, la cirugía, con el descubrimiento de la anestesia y el control de las infecciones y la hemostasia, pero, sin duda, también han sido parte importante en esta historia la nueva mentalidad de trabajo en equipo y el intercambio de información, disponible de modo cada vez más dinámico y con una amplitud insospechada tan solo hace unas décadas. Por otra parte, estos avances en muchas ocasiones no han sido fáciles para quienes los han impulsado, y diferentes controversias han puesto de relieve tanto la necesidad de veracidad en la investigación realizada como la perseverancia ante las dificultades e incomprensiones. Por ello, el presente trabajo de investigación intenta recuperar la importancia del factor humano y las decisiones personales como ejes clave del avance científico, también en lo que corresponde al estudio y tratamiento de los problemas de la sexualidad humana (AU)

The historical journey of Sexual Medicine and Andrology over the last 2 centuries makes it possible to illustrate how scientific development has grown to such a level that would have seemed impossible to our ancestors. This growth has largely contributed to the understanding of the physiology and, of course, the surgery, with the discovery of anesthesia, infection control and hemostasis. However, undoubtedly, the new culture of teamwork and the new possibilities of an increasingly dynamic exchange of information having an extension that was unsuspected only a few decades ago has also played an important part in this history.Moreover, in many cases these advances have not been easy for those who have encouraged them. Different controversies have highlighted both the need for accuracy in the research and perseverance against difficulties and misunderstandings. Therefore, the present research work has tried to recover the importance of the human factor and personal decisions as a key to scientific advance, as well as in that corresponding to the study and treatment of the issues of human sexuality (AU)

[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.

Paciente con SDT en insuficiencia renal crónica o trasplantado / Testosterone deficit syndrome in the chronic renal failure patient

El hipogonadismo en la enfermedad renal crónica (ERC) puede llegar a afectar hasta un 70% de los pacientes frente a la población general. Se trata, fisiopatológicamente, de un hipogonadismo hipergonadotropo, con alteraciones en la producción pulsátil de GnRH, FSH y LH y testosterona testicular, es decir, una alteración general del eje hipotálamo-hipofiso-testicular. Esta alteración puede condicionar consecuencias importantes en esta población de pacientes, con disfunción sexual variada, alteraciones tróficas y funcionales musculares y del tejido adiposo, desmineralización ósea, anemia e incremento de la mortalidad asociada a enfermedad cardiovascular. El tratamiento de estos pacientes debe enfocarse desde un punto de vista general, mejorando su condición clínica, las complicaciones sistémicas asociadas a la ERC, complementado de esta manera el tratamiento sustitutivo con testosterona exógena. En la medida de lo posible, parece que la opción terapéutica más eficaz será el trasplante renal (AU)

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 (AU)

La Medicina Sexual en la Historia. Avances y controversias (Parte I) / Sexual Medicine beyond History. Advances and controversies (Part I)

La función sexual, su fisiología y su patología, han sido tremendamente mal entendidas a lo largo de la historia. Por otra parte, un aura de misterio relacionada con la incomprensión de los mecanismos que intervienen en la transmisión de la vida ha acompañado las teorías que, hasta el siglo XIX , han sido elaboradas sobre la concepción. Además, prejuicios, datos erróneos de investigación y, en algunas ocasiones, aportaciones fraudulentas, han enmarañado aún más los posibles conocimientos científicos sobre el papel de la sexualidad humana, dando lugar aun a mayores controversias. Por todo ello, los avances en posibles terapias quizás hayan sido más difíciles de conseguir que en otras áreas del conocimiento, aunque, finalmente, se hayan obtenido importantes logros tanto a nivel farmacológico como quirúrgico. El presente artículo realiza un recorrido sobre dichos avances y reflexiona sobre lo conseguido y lo que falta por conseguir(AU)

Sexual function, its physiology and pathology, have been widely misunderstood throughout history. Moreover, an aura of mystery regarding the misunderstanding of the mechanisms involved in the transmission of life has accompanied these theories until the nineteenth century. In addition, prejudice, wrong research data and, in some cases, fraudulent contributions, have further misdirected possible scientific knowledge on the role of human sexuality, leading to even greater controversies. This is why advances in potential therapies might have been more difficult to achieve than in other areas of knowledge although, in the end, important pharmacological and surgical achievements have been obtained. This article takes a journey on these developments and reflects on what has been achieved and what still needs to be achieved(AU)

Crioterapia de Rescate en el cáncer de próstata después de Radioterapia / Rescue cryotherapy for prostate cancer after radiotherapy

La Radioterapia es una forma de tratamiento común para el cáncer de próstata localizado. Aproximadamente 1/3 de los pacientes diagnosticados de cáncer de próstata elegirán esta opción para tratar su enfermedad. A pesar de modificaciones en la técnica como la modulación de intensidad, radioterapia conformacional 3-D, braquiterapia asistida por ordenador, un porcentaje significativo de estos pacientes mostrarán un incremento significativo posterior en los valores de PSA. La recidiva local con ausencia de enfermedad a distancia es subsidiaria de tratamiento de rescate. La crioterapia es actualmente ya una opción de intento de tratamiento curativo en pacientes con tumor comprobado por biopsia que muestran una enfermedad localizada, PSA < 10 ngrs/ml. Los avances más recientes tanto tecnológicos como técnicos de la crioterapia de rescate han reducido de forma dramática la morbilidad asociada y hacen que se incremente cada vez más el interés por esta alternativa de tratamiento en esta situación(AU)

Radical Radiotherapy constitutes a useful therapeutic option for localized prostate cancer. Almost one third of prostate cancer patients choose this alternative to treat the disease. Despite modifications in the technique as intensity modulation, 3D conformational radiotherapy or computer-assisted brachytherapy, a significant percentage of these patients will show an increase in PSA values after radiation. Local relapse without distant disease and PSA less than 10 ng/ml are candidates for salvage therapy. Cryotherapy has already become a curative treatment option in this group of patients. Recent technological as well as surgical advances in salvage-cryotherapy have reduced dramatically complications and progressively increase the interest on this alternative(AU)

[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.