[Rectal injury during radical surgery of bladder and/or prostate]. / La lesión del recto en el transcurso de la cirugía radical de la vejiga y/o próstata.

Contribution of 42 patients, aged 57 to 69 (mean age 58) with infiltrant vesical neoplasia who underwent radical cystoprostatectomy according to the technique described by P.C. Walsh (38/42) or radical cystectomy with hysterectomy (4/42). Neoplasia stages were as follows: 7 T2G-III; 13 T3aGII: 15 T3aG-III and 7 T3bG-III. Ten (10) patients, aged between 48 and 70 (mean age 57), with prostate neoplasia who were performed radical prostatectomy using the technique described by the above author, were also ascribed to the last group. Prostate neoplasias were at the following stages: 4 T2c; 5 T3a and 1T3b. T3 stages had been given hormonal therapy prior to the procedure. No patient received radiotherapy. Rectal injury occurred in 2 of the 52 (2/52) patients described. One was a female patient who was being performed cystectomy and hysterectomy plus double adnexectomy. Urinary by-pass in this case was C.F.C. detubulized ureterosigmoidostomy. The second case was a male patient undergoing radical prostatectomy. In both cases pre- and post-operative discharge colostomy was performed. Suture of rectal injury was also done in the patient where colostomy was performed during the procedure. The authors emphasise that no rectal injury that may take place during radical prostatectomy or cystoprostatectomy should be disregarded. They raise and answer questions of great practical interest such as: Is simple suture of the rectum enough? Should the omentum be used in rectal repair? Is it indispensable to perform discharge colostomy? and, is prognosis more serious when the gut is not prepared?

[Ureterosigmoidostomy detubularized with surgical staplers: C.F.C. (Original technique)]. / Ureterosigmoidostomía destubulizada mediante súturas mecánicas: C.F.C. (Técnica original).

Description of our modification of the detubulized ureterosigmoidostomy surgical technique (Castiñeiras-Ferragut-Camacho). In an attempt to shorten the surgery time, we used for these changes absorbable mechanical sutures (Poli Gia and T.A.). This paper analyzes the technical details of interest as well as the anatomicosurgical considerations that should be known prior to carry out this type of by-pass. The anatomicophysiological principles on which our developments are based are those referred by N.G. Kock15 and used by R. Hohenfellner and R. Fisch14, when they described the detubulized ureterosigmoidostomy performed manually. We believe that both surgical procedures, R. Hohenfellner & R. Fisch14 and ours (detubulized ureterosigmoidostomy, C.F.C.), are suitable alternatives to conventional ureterosigmoidostomy.

[Ultrasonographic (intra- and extraluminal) pattern of cervico-urethral anastomosis after radical prostatectomy]. / Patrón sonográfico (intra y extraluminal) de la anastomosis cérvico-uretral tras la prostatectomía radical.

Thirteen patients, mean age 61 years (range 54 to 71), diagnosed with prostate adenocarcinoma underwent radical prostatectomy. To achieve a diagnosis they were all performed blood PSA determination, digital rectal examination, transrectal ultrasound and a prostate ultrasound-guided biopsy by automatic gun puncture. Serum PSA quantification, digital rectal examination and transrectal ultrasound were repeated in the immediate post-operative, and three and six months after surgery. Through the information obtained with endocavitary ultrasound, the lumen of the cervicourethral anastomosis and the perianastomotic tissue was assessed. Transrectal ultrasound plays a relevant role in the follow-up of patients undergoing radical prostatectomy. When a patient with prostate radical surgery shows an elevation of serum PSA and/or abnormal digital rectal examination, an ultrasound-guided biopsy (at the node or perianastomotic area) is indicated.

[C.F.C.-type ureterosigmoidostomy. Results]. / Ureterosigmoidostomía tipo C.F.C. Aportación de resultados.

This paper presents the results obtained with a C.F.C. type ureterosygmoidostomy technique described by us. A total of 25 patients aged between 52 and 74 years (mean age, 65 years), 23 (23/25) male and 2 (2/25) female were evaluated. 24 of the total 25 patients had infiltrant neoplasia of the bladder (pT2: 8; pT3a: 12; pT3b: 4) which was graded as moderately differentiated (G2: 10) or undifferentiated (G3: 14). The remaining patient, a female, had tuberculous microbladder. Male patients underwent radical cystoprostatectomy (23/25); while in two females traditional cystectomy was performed (2/25). Patients with neoplasia of the bladder (24/25) were performed bilateral lymphadenectomy prior to radical surgery. All 25 patients were performed C.F.C. type ureterosygmoidostomy (Actas Urol Esp 20: 324, 1996). Follow-up of patients was carried out over a mean period of 27 months (July 1994-October 1997). The complications reported were 4 cases of ureterointestinal stricture and one stercoral fistula. The strictures were resolved with endoscopic techniques and the fistula through discharge colostomy. Death (6/25) occurred as a result of the tumour progression, and in no case was related to the surgical technique. All patients showed daytime continence (100%), and 22/25 were also continent during the nighttime (88%): there were occasional leaks in 5/25 (20%). No metabolic disorders were seen in any of the patients. (All patients were given drug therapy to prevent metabolic acidosis).

[Histologic-ultrasonographic correlation of gland asymmetry and "pseudoruptures" of the prostatic capsule]. / Correlación histoecográfica de la asimetría glandular y de las "pseudorupturas" de la cápsula prostática.

An histo-ultrasound correlation was carried out between the information obtained with pre-operative transrectal ultrasound and that obtained with the histopathological study of 29 prostate specimens from patients with mean age 63 years (range, 52 to 71 years), who underwent radical cystoprostatectomy for infiltrant neoplasia of the bladder (22/29) and radical prostatectomy for prostate cancer (7/29). The (extrinsic and intrinsic) ultrasound parameters were analyzed focusing in the study of the prostatic capsule or "pseudocapsule". With this comparative, echographic and histological study the concept of capsular "pseudorupture" that results from the presence of (arterial and/or venous) vessels, nerves and fibromuscular folds at the periprostatic fat tissue is introduced. The interruption of the capsular echogram was seen as an indication of tumoral involvement of the capsule, and extracapsular spread. Our results allow us to suggest that this assertion should be reconsidered since these capsular "interruptions", "irregularities" or "pseudoruptures" are present in the normal prostate. Similarly, glandular asymmetry in relation with an heterogenous growth in one lobe in defined to differentiate it from that seen in neoplastic processes.

[Adolescence and contraception]. / Adolescencia y contracepción.

The birthrate has decreased for all age groups except for adolescents. 4.51% of all pregnancies in Spain fall within the 15-19 year old age group. The prevention of adolescent pregnancy indicates the need for making family planning services more accessible to young people. The object of this study was a review of medical consultations performed in 1993 with adolescents at a family planning service. Among the most significant results are the following: the average age of menarche and coitus primaris was 11.8 years (+ or -2.2 years) and 16 years (+ or -1.7) respectively. The period between coitus primaris and the act of going to a family planning center was 9.1 months (+ or -2.3). 81.7% of those adolescents were advised to take oral contraceptives, 12.4% condoms, 1.96% the I.U.D. and 3.9% none. Among the most common side effects noted after taking oral contraceptives for 6 to 12 months were: psychic alterations (changes of mood, etc.), spotting, digestive upset, migraines and weight increase. The number of sexual partners before and after contraceptive use did not change significantly.