Qualidade de vida e cateterismo urinário no contexto da enfermagem em reabilitação: uma revisão integrativa / Quality of life and urinary catheterization in the rehabilitation nursing context: an integrative review

Objetivo: identificar as evidências científicas sobre a atuação de enfermagem na qualidade de vida de crianças e adultos em uso do cateterismo urinário e seus cuidadores no contexto de reabilitação. Método: revisão integrativa de literatura, através de questão norteadora "Qual a produção de conhecimento sobre a atuação de enfermagem na Qualidade de Vida de crianças e adultos em uso do cateterismo urinário e seus cuidadores no contexto de reabilitação?", em três bases de dados com os descritores cateterismo urinário, qualidade de vida e enfermagem. Foram incluídos 23 estudos, publicados no período de 2011 a 2020, realizados em mais de um país, em especial na população brasileira. Resultados: as principais atuações da enfermagem foram: educação em saúde, atividades de orientação em grupo, uso de simuladores e teleatendimentos. Conclusão: as contribuições do enfermeiro em reabilitação estão direcionadas ao cuidado integral e eficaz para promoção de melhores terapêuticas e uma maior qualidade de vida.

Objective: to identify the scientific evidence on nursing performance in the quality of life of children and adults undergoing urinary catheterization and their caregivers in the context of rehabilitation. Methods: integrative literature review adopting the guiding question "What is the production of knowledge about the nursing performance in the quality of life of children and adults undergoing urinary catheterization and their caregivers in the context of rehabilitation?" performed in three databases with use of the following descriptors: urinary catheterization, quality of life and nursing. Twenty-three studies published between 2011 and 2020, conducted in more than one country, especially in the Brazilian population, were included. Results: the main actions of nursing were: health education, group orientation activities, use of simulators and telenursing. Conclusion: the contributions of rehabilitation nurses are directed to comprehensive and effective care to promote better therapies and a higher quality of life.

Caracterización de Candida spp. aisladas a partir de urocultivos en la ciudad de Medellín / Characterization of Candida spp isolated from urine cultures of Medellín

Resumen Candida spp. es un agente etiológico importante en infecciones del tracto urinario, principalmente en población con terapia antimicótica de amplio espectro y con catéteres urinarios. Candida albicans es la especie más frecuente, pero otras especies han surgido como patógenos emergentes. En este trabajo se recolectaron aislamientos de Candida spp. de urocultivos de pacientes que consultaron en Dinamica IPS entre enero 2016 y noviembre 2017. Para estimar la frecuencia de las especies y observar los patrones de sensibilidad, se realizó la identificación fenotípica y su perfil de sensibilidad con el sistema comercial Vitek 2® (BioMérieux, Inc.), adicionalmente se evaluaron mediante análisis de las secuencia y filogenética ITS1-5.8S-ITS2. En el estudio se incluyeron 78 aislamientos de Candida spp. Las frecuencias de especies de Candida identificadas empleando las herramientas moleculares fueron: C. albicans (38,5%), C. tropicalis (23,1%), C. glabrata (21,8%), C. parapsilosis (10,3%), C. metapsilosis y C. krusei (2,5%) y C. guillermondi (1,3%). La identificación por métodos moleculares y por el sistema Vitek 2 fue: C. albicans (93,3%), C. glabrata (94,1%), C. tropicalis (83,3%), C. parapsilosis (75%) C. guilliermondii y C. krusei (100%). La sensibilidad de todos los aislamientos al fluconazol fue 93,6%.

Abstract Candida spp is an important etiologic agent in urinary tract infections, mainly in patients in broad-spectrum antifungal therapy, with urinary catheters. Candida albicans is the most frequent specie; but other species have arised as emerging pathogens. In this study, isolates of Candida spp. of urine cultures from patients who consulted in Dinamica IPS between January 2016 and November 2017 were evaluated. To estimate the frequency of the species and to observe the sensitivity patterns, the phenotypic identification and its sensitivity profile was performed employed the Vitek 2® commercial system. (BioMérieux, Inc) In addition the isolates were evaluated by sequence analysis and phylogenetics ITS1-5.8S-ITS2. This study included 78 isolates of Candida spp. The frequencies of Candida species identified using the molecular tools were: C. albicans (38.5%), C. tropicalis (23.1%), C. glabrata (21.8%), C. parapsilosis (10.3%), C. guillermondi (1.3%) and C. metapsilosis and C. krusei (2.5%). The identification by molecular methods and by Vitek 2 system were: C. albicans (93.3%), for C. glabrata (94.1%), C. tropicalis (83.3%), C. parapsilosis (75%) and 100% for C. guilliermondii and C. krusei.. fluconazole sensitivity of all isolates was 93.6%

Caracterización clínica de las disfunciones de piso pélvico en mujeres chilenas sintomáticas que consultan en un hospital universitario / Clinical characterization of pelvic floor dysfunctions in symptomatic Chilean women who visit an academic hospital

INTRODUCCIÓN: La prevalencia de las disfunciones de piso pélvico (DPP) puede llegar hasta un 25%, y esta incrementando con los años. El objetivo de este estudio es mostrar las características clínicas de pacientes sintomáticas sometidas a cistometría simple en el Hospital La Florida, entre diciembre del 2015 y marzo 2020. MÉTODOS: Es un estudio retrospectivo transversal. Se evaluaron los datos de todos los resultados de cistometrías simples de pacientes derivadas por sintomatología de piso pélvico entre los años 2015 y 2020. RESULTADOS: Se evaluaron 1.211 cistometrías simples. El motivo de derivación más frecuente fue prolapso de órganos pélvicos + incontinencia de orina (IO) (39.6%). 13.5% tuvieron resultado normal. 58% presentó test de esfuerzo positivo. 22.5% tenían prueba de estrés con vejiga vacía positiva. 17.6% presentó IO oculta. 21.9% de IO mixta. De las pacientes derivadas por vejiga hiperactiva o IO mixta, en el 14.2% se constató la presencia de contracciones no inhibidas y en el 34.8% la presencia de urgencia. CONCLUSIONES: Nuestro estudio aporta información sobre las DPP en la mujer chilena en un hospital universitario.

INTRODUCTION: Prevalence of pelvic floor dysfunctions (PFD) can be as high as 25%, and it is increasing over the years. The objective if this study is to show the clinical characteristics of symptomatic patients undergoing simple cystometry at La Florida Hospital, between December 2015 and March 2020. METHODS: This is a cross-sectional study. The data of all simple cystometries of patients derived for pelvic floor symptoms between 2015 and 2020 were evaluated. RESULTS: 1211 simple cystometries were evaluated. The most frequent reason for referral was pelvic organ prolapse + urinary incontinence (UI) (39.6%). 13.% had a normal result. 58% presented positive stress test. 22.% had a positive empty stress test. 17.6% had occult UI. 21.9% mixed UI. Of the patients referred by overactive bladder or mixed UI, 12.2% had detrusor contractions and 34.8% had urgency. CONCLUSIONS: Our study provides information on PFD in Chilean women in a university hospital. .

Carcinoma urotelial del tracto urinario superior: a propósito de un caso y revisión de la literatura / Upper urinary tract urothelial carcinoma: case report and review of the literature

El carcinoma urotelial (CU) del tracto urinario superior es infrecuente y representa solo del 5%-10% de todos los CU. Estas neoplasias crecen a partir del urotelio de los cálices renales hasta el tercio distal del uréter. Se reporta el caso de un paciente masculino de 68 años de edad quien presenta enfermedad actual de 3 meses de evolución caracterizada por dolor lumbar izquierdo, tipo cólico, de leve a moderada intensidad, el cual atenúa parcialmente con el uso de AINES, asociado a hematuria visible total de predominio nocturno. El uroanálisis mostró hematuria macroscópica y la citología urinaria evidenció atipias sugerentes de carcinoma. La TAC abdomino-pélvica contrastada evidenció un defecto de llenado en relación al cáliz inferior de riñón izquierdo y plastrón ganglionar paraaórtico izquierdo. Se practicó nefroureterectomía radical izquierda evidenciando tumor de 3 x 3 x 1 cm en relación a pelvis renal extensiva a cáliz inferior invadiendo parénquima renal. El estudio histopatológico mostró un carcinoma urotelial papilar infiltrativo de alto grado con márgenes sin lesiones y ganglios linfáticos con metástasis. El paciente evoluciona satisfactoriamente durante el período postoperatorio y actualmente recibe terapia adyuvante. A pesar de ser una patología poco frecuente, puede presentarse y el urólogo debe estar en capacidad para poder enfrentarla(AU)

Upper urinary tract urothelial carcinoma (UC) is infrequent and represents only 5%-10% of all UCs. These neoplasms grow from the urothelium of renal calyces to the distal third of the ureter. A case of UC of the upper urinary tract is reported in a 68-year-old male patient with a 3-month history of left lumbar mild to moderate pain, which partially mitigates with the use of NSAIDs associated with visible total predominantly nocturnal hematuria. Macroscopic hematuria was evident and urinary cytology reported carcinoma suggestive atypias. Contrasted CT of abdomen and pelvis showed filling defect in relation to lower calyx of the left kidney and left para-aortic ganglion plastron. Radical left nephroureterectomy was performed showing a 3 x 3 x 1 cm tumor in relation to the renal pelvis extending to the lower cavity and invading renal parenchyma. Histopathology showed high grade infiltrative papillary CU with margins without lesions and lymph nodes with metastasis. Patient evolves satisfactorily in the postoperative period and is currently in adjuvant therapy. Although this pathology is rare, it can occur and the urologist must be able to face it(AU)

Papel da ultrassonografia no diagnóstico da torção do cordão espermático / Ultrasonography role in the diagnosis of spermatic cord torsion

Introdução: Escroto agudo é uma síndrome clínica caracterizada por aumento do volume escrotal, associada à dor, sudorese, febre, náuseas e vômitos. Entre suas causas, destaca-se a torção de cordão espermático, que corresponde a rotação testicular sob seu eixo vascular, comprometendo a irrigação tecidual. Trata-se de uma emergência urológica cujo tratamento é cirúrgico. Objetivo: Relatar um caso e revisar a literatura acerca desta patologia. Materiais e Métodos: Revisão do prontuário e revisão da literatura. Resultados: Homem de 14 anos com dor intermitente no testículo esquerdo há duas semanas. A ultrassonografia diagnosticou torção testicular e do cordão espermático à esquerda. O paciente realizou orquiectomia tendo alta no dia seguinte. Conclusão: Os relatos de casos relacionados à torção de cordão espermático têm sua importância baseados na necessidade do aprendizado e no reconhecimento rápido dessa condição pelo profissional médico, visando o manejo adequado e de prontidão dos pacientes acometidos pela condição.

Introduction: Acute scrotum is a clinical syndrome characterized by increased scrotal volume, which is associated with pain, sweating, fever, nausea, and vomiting. Among its causes, the spermatic cord torsion is easy noticed and corresponds to the testicular rotation under its vascular axis, compromising tissue irrigation. It is a urological emergency, and its treatment is surgical. Objective: Report a case and review the literature about this disease. Materials and Methods: Medical record review and literature review. Case Results: A 14-year-old man with pain in his left testicle for two weeks underwent an ultrasound scan that detected testicular and spermatic cord torsion. A left orchiectomy was performed and the man was discharged the next day. Conclusion: Case reports related to twisting of the spermatic cord have its importance based on the need for learning and rapid recognition of this condition by the medical professional, aiming at an adequate and ready management of the patients affected by the condition.

Impact of the COVID-19 pandemic on the urologist's clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period

This letter to the Editor aims to provide suggestions and recommendations for the management of urological conditions in times of COVID-19 crisis in Brazil and other low- and middle-income countries. It is important to highlight that one of the main characteristics of this pandemic is the oversaturation of the health system capacity, mostly due to a high demand for personal protective equipment (PPE), Hospital/ICU beds, as well as ventilators. In places with limited resources and where the health care systems are already saturated, such consideration is even more worrisome. Therefore, most worldwide authorities are recommending to avoid, as much as possible, patient's elective visits to hospitals, as well as a judicious use of the operating room in order to mitigate the strain put on the health system. While efforts should be directed to the care of COVID-19 patients, other conditions (especially urgencies and oncological cases) must continue to be assisted. Thus, through a panel of experts, we have prepared a practical guide for urologists based on the recommendations from the main Urologic Associations, as well as data from the literature to support the suggested management. We will try to follow the standard guideline recommendations from the American Urological Association (AUA) and European Association of Urology (EAU), with the aim of pursuing the best outcomes possible. However, some recommendations were based on the consensus of the panel, taking into consideration the reality of developing countries and the unprecedented situation caused by the COVID-19 crisis. Most importantly, all recommendations on this manuscript are based on the expectancy of a maximum 3-month duration of the crisis. If this period shall extended, these recommendations will be revised and updated. The format of the text will be given through questions and answers.(AU)

Etiological prevalence of urinary tract infections in symptomatic pregnant women in a high complexity hospital in Medellín, Colombia, 2013-2015 / Prevalencia etiológica de infección del tracto urinario en gestantes sintomáticas, en un hospital de alta complejidad de medellín, colombia, 2013-2015

RESUMEN Objetivo: determinar la prevalencia de infección del tracto urinario (ITU), el perfil microbiológico y la resistencia a los antibióticos en mujeres gestantes con sospecha de infección del tracto urinario. Materiales y métodos: estudio de corte transversal. Ingresaron gestantes con sospecha de infección del tracto urinario adquirida en la comunidad, remitidas a consulta externa desde su control prenatal o atención por urgencias, y hospitalizadas entre agosto de 2013 y septiembre de 2015 en un hospital universitario de referencia ubicado en Medellín, Colombia. Se excluyeron gestantes que hubieran recibido antibióticos el día anterior a la admisión. Muestreo aleatorio simple. Variables medidas: sociodemográficas, clínicas y bacteriológicos. Se aplicó estadística descriptiva. Resultados: la prevalencia de infección del tracto urinario fue del 29 %. Predominaron los aislamientos de bacterias Gram negativas, principalmente E. coli y K. pneumoniae en un 57,7 y 11,4 % respectivamente. Se observó resistencia a trimetoprim-sulfametoxazol en el 19,5 % y ampicilina-sulbactam en el 17,5 % de los aislamientos. Conclusiones: se requieren estudios de base poblacional para una mejor aproximación a la resistencia de las bacterias causantes de la ITU en la comunidad. Por otra parte, la alta resistencia observada podría sugerir que algunos antibióticos expuestos no sean incluidos en las guías locales de manejo de la ITU.

ABSTRACT Objective: To determine the prevalence of urinary tract infections (UTIs), the microbiological profile and antibiotic resistance in pregnant women with suspected urinary tract infection. Materials and methods: Cross-sectional study of pregnant women with suspected community- acquired urinary tract infection referred to the outpatient clinic by prenatal care practitioners or seen in the emergency room, and hospitalized between August 2013 and September 2015 in a referral teaching hospital located in Medellin, Colombia. Pregnant women who had received antibiotics on the day before admission were excluded. Random sampling. Measured variables: sociodemographic, clinical and bacteriological. Descriptive statistics were applied. Results: The prevalence of urinary tract infections was 29%. Gram negative bacteria isolates were found predominantly, the main ones being E. coli and K. pneumoniae at 57.7 and 11.4%, respectively. Resistance to trimethoprim- sulfamethoxazole and to ampicillin-sulbactam was observed in 19.5% and 17.5% of isolates, respectively. Conclusions: Population-based studies are needed to provide a better approach to bacterial resistance in community-acquired UTIs. On the other hand, the high resistance observed may suggest that some of the exposed antibiotics might not be included in the local guidelines for the management of UTIs.

Incidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence / Incidência de bacteriúria após estudo urodinâmico com ou sem profilaxia antibiótica em mulheres com incontinência urinária

Abstract Introduction The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study. Methods Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS. Results We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria.We didn't observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group. Conclusion The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.

Resumo Introdução A presença de bactéria na urina é denominada bacteriúria, que pode ser sintomática ou assintomática. A manipulação do trato urinário pelo estudo urodinâmico (EUD), que é um procedimento invasivo, pode resultar em infecção do trato urinário (ITU). Os estudos sobre o uso de profilaxia antibiótica para EUD são contraditórios. Alguns investigadores concluíram que era necessário e outros não. O objetivo deste estudo é avaliar a eficácia da antibióticoprofilaxia antes da realização do EUD. Trata-se de um estudo randomizado duplo-cego. Métodos Duzentas e dezessete mulheres comqueixa de incontinência urinária foram recrutadas para este estudo. Todas as pacientes apresentaram urocultura negativa antes do EUD. As pacientes foram randomizadas em quatro grupos: o grupo A recebeu placebo, o grupo B recebeu 500 mg de levofloxacina, o grupo C recebeu 80 mg de trimetoprim e 400 mg de sulfametoxazol e o grupo D recebeu 100 mg de nitrofurantoína. Uma urocultura foi realizada 14 dias após o EUD. Resultados Observamos bacteriúria assintomática após o EUD em cinco pacientes do grupo A, uma no grupo B, uma no grupo C e uma no grupo D. Apenas uma paciente do grupo A apresentou bacteriúria sintomática. Não observamos diferença estatística entre os grupos. Quando recategorizamos as pacientes em dois grupos, a incidência de bacteriúria foi significativamentemaior no grupo placebo emcomparação como grupo antibiótico. Conclusão A conclusão deste estudo é que a antibióticoprofilaxia antes do EUD não reduz a incidência de ITU nesse grupo de mulheres.

Predictive role of Trimprob associated with multiparametric MRI in the diagnosis of prostate cancer

ABSTRACT Objectives To evaluate the predictive value of TRIMprob test to detect prostate cancer (PCa) in patients referred to prostate biopsy (PB). Material and Methods Patients with PSA <10ng/mL and rectal exam without findings suggestive of prostate cancer were selected for TRIMprob evaluation. Exam was performed by a single operator through transperineal approach. Patients admitted for the study were submitted to TRIMprob and multiparametric magnetic resonance (mpMRI) and posteriorly to PB. Results In total, 77 patients were included. TRIMprob showed evidences of PCa in 25 (32.5%) and was negative in 52 patients (67.5%). The rate of detection of prostate cancer at biopsy was higher in patients with positive TRIMprob (16/25; 64.0%) than in patients with negative TRIMprob (11/52; 21.1%; p<0.001). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of TRIMprob were respectively 61.5%, 82.0%, 64.0%, 80.3% and 74.0%. ROC curve showed the following areas under the curve values for TRIMprob, mpMRI and combination of TRIMprob + mpMRI: 0.706; 0.662 and 0.741 respectively. At combined analysis, when both TRIMprob and mpMRI were negative for prostate cancer, accuracy was 96.3% or only 1 in 27 PB was positive (3.7%). Conclusions Trimprob had similar predictive value for PCa in patients submitted to PB as mpMRI. Combined TRIMprob and mpMRI showed higher accuracy than when performed singly.

Associated factors to urinary incontinence in women undergoing urodynamic testing / Factores asociados con la incontinencia urinaria en mujeres sometidas al estudio urodinámico / Fatores associados à incontinência urinária em mulheres submetidas ao exame urodinâmico

Abstract OBJECTIVE Analyzing factors associated with urinary incontinence (UI) among women submitted to urodynamic testing. METHOD A cross-sectional study of 150 women attended at a urological center. Data were analyzed using univariate and multivariate statistics. RESULTS White women (79.3%), overweight (45.3%), menopausal (53.3%), who drink coffee (82.7%), sedentary (65.3%), who had vaginal birth (51.4%), with episiotomy (80%), and who underwent the Kristeller maneuver (69%). 60.7% had Urethral Hypermobility (UH). A statistical association was found between: weight change and UH (p = 0.024); menopause, Intrinsic Sphincter Deficiency (ISD) and Detrusor Instability (DI) (p = 0.001); gynecological surgery, ISD and DI (p = 0.014); hysterectomy and all types of UI (p = 0.040); physical activity and mixed UI (p = 0.014). CONCLUSION Interventions and guidance on preventing UI and strengthening pelvic muscles should be directed at women who present weight changes, who are sedentary menopausal women, and those who have undergone hysterectomy or other gynecological surgery. Studies on pelvic strengthening methods are needed in order to take into account the profile of the needs presented by women.

Resumen OBJETIVO Analizar los factores asociados con la Incontinencia Urinaria (IU) entre mujeres sometidas al estudio urodinámico MÉTODO Estudio transversal llevado a cabo con 150 mujeres atendidas en un centro urológico. Los datos fueron analizados por medio de estadística uni y multivariada. RESULTADOS Mujeres blancas (79,3%), con sobrepeso (45,3%), en la menopausia (53,3%), que ingerían café (82,7%), sedentarias (65,3%), que tuvieron parto normal (51,4%), con episiotomía (80%), que sufrieron Maniobra de Kristeller (69%), el 60,7% presentaban Hipermovilidad Uretral (HU). Hubo asociación estadística entre: cambio de peso e HU (p = 0,024); menopausia, Deficiencia Intrínseca del Esfínter (DIE)e Inestabilidad del Detrusor (ID) (p = 0,001); cirugía ginecológica, DIE e ID (p = 0,014); histerectomía y todos los tipos de IU (p = 0,040); realización de actividad física e IU mixta (p = 0,014). CONCLUSIÓN Intervenciones y orientaciones en cuanto a la prevención de la IU y al fortalecimiento de la musculatura pélvica deben dirigirse a mujeres que presentan cambio de peso, sedentarias, que se hallan en la menopausia y las que realizaron histerectomía u otra cirugía ginecológica. Son necesarios estudios sobre métodos de fortalecimiento pélvico, de modo a contemplar el perfil de las necesidades presentadas por las mujeres.

Resumo OBJETIVO Analisar os fatores associados à Incontinência Urinária (IU) entre mulheres submetidas a estudo urodinâmico. MÉTODO Estudo transversal realizado com 150 mulheres atendidas em um centro urológico. Os dados foram analisados por meio de estatística uni e multivariada. RESULTADOS Mulheres brancas (79,3%), com sobrepeso (45,3%), na menopausa (53,3%), que ingeriam café (82,7%), sedentárias (65,3%), que fizeram parto normal (51,4%), com episiotomia (80%), que sofreram Manobra de Kristeller (69%). 60,7% apresentavam HipermobilidadeUretral (HU).Houve associação estatística entre: mudança de peso e HU (p=0,024); menopausa,Deficiência Esfincteriana Intrínseca (DEI) e Instabilidade Detrusora (ID) (p=0,001); cirurgia ginecológica, DEI e ID (p=0,014); histerectomia etodos os tipos de IU (p=0,040); realização de atividade física eIU mista (p=0,014). CONCLUSÃO Intervenções e orientações quanto à prevenção da IU e ao fortalecimento da musculatura pélvica devem ser voltadas amulheres que apresentam mudança de peso, sedentárias, que se encontram na menopausa e àquelas que realizaram histerectomia ou outra cirurgia ginecológica. São necessários estudos sobre métodos de fortalecimento pélvico, de modo a contemplar o perfil dasnecessidades apresentadaspelas mulheres.

Relationship between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with urinary tract symptoms

ABSTRACT Objective: To evaluate correlation between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with lower urinary tract symptoms. Material and Methods: This is a cross sectional study conducted at a university Hospital. Sixty-seven adult male patients>50 years of age were enrolled in the study after signing an informed consent. Qmax and voided volume recorded at uroflowmetry graph and at the same time VPSS were assessed. The education level was assessed in various defined groups. Pearson correlation coefficient was computed for VPSS and Qmax. Results: Mean age was 66.1±10.1 years (median 68). The mean voided volume on uroflowmetry was 268±160mL (median 208) and the mean Qmax was 9.6±4.96mLs/sec (median 9.0). The mean VPSS score was 11.4±2.72 (11.0). In the univariate linear regression analysis there was strong negative (Pearson's) correlation between VPSS and Qmax (r=848, p<0.001). In the multiple linear regression analyses there was a significant correlation between VPSS and Qmax (β-http://www.blogapaixonadosporviagens.com.br/p/caribe.html after adjusting the effect of age, voided volume (V.V) and level of education. Multiple linear regression analysis done for independent variables and results showed that there was no significant correlation between the VPSS and independent factors including age (p=0.27), LOE (p=0.941) and V.V (p=0.082). Conclusion: There is a significant negative correlation between VPSS and Qmax. The VPSS can be used in lieu of IPSS score. Men even with limited educational background can complete VPSS without assistance.

Assessing variability of the 24-hour pad weight test in men with post-prostatectomy incontinence

ABSTRACT Purpose: Decision-making regarding surgery for post-prostatectomy incontinence (PPI) is challenging. The 24-hour pad weight test is commonly used to objectively quantify PPI. However, pad weight may vary based upon activity level. We aimed to quantify variability in pad weights based upon patient-reported activity. Materials and Methods: 25 patients who underwent radical prostatectomy were prospectively enrolled. All patients demonstrated clinical stress urinary incontinence without clinical urgency urinary incontinence. On three consecutive alternating days, patients submitted 24-hour pad weights along with a short survey documenting activity level and number of pads used. Results: Pad weights collected across the three days were well correlated to the individual (ICC 0.85 (95% CI 0.74–0.93), p<0.001). The mean difference between the minimum pad weight leakage and maximum leakage per patient was 133.4g (95% CI 80.4–186.5). The mean increase in 24-hour leakage for a one-point increase in self-reported activity level was 118.0g (95% CI 74.3–161.7, p<0.001). Pad weights also varied significantly when self-reported activity levels did not differ (mean difference 51.2g (95% CI 30.3–72.1), p<0.001). Conclusions: 24-hour pad weight leakage may vary significantly on different days of collection. This variation is more pronounced with changes in activity level. Taking into account patient activity level may enhance the predictive value of pad weight testing.

Urodynamic characteristics of awake rats under retrained versus freely moving condition: Using a novel model / 华中科技大学学报（医学）（英德文版）

Urodynamic investigation in conscious rats is widely employed to explore functional bladder disorders of various etiologies and pathogeneses. Rats can be placed in restraining cages or wide cabinets where they are allowed to move freely during cystometry. However, the requirements of special devices hampered the application of urodynamic test in freely moving rats, and whether the restraint has any effects on urodynamic parameters in conscious rats remains obscure. In the present study, we described a novel approach for urodynamic investigation in both restrained and freely moving conscious rats. In addition, we for the first time systematically compared the urodynamic parameters of rats in the two conditions. With the current method, we successfully recorded stable and repeatable intravesical pressure traces and collected expected reliable data, which supported the idea that the restraint does not affect the activity of the micturition reflex in rats, provided sufficient and appropriate measures could be applied during cystometry. Fewer technique problems were encountered during urodynamic examination in restrained rats than in freely moving ones. Taken together, conscious cystometry in rats placed in restraining cages with proper managements is a reliable and practical approach for evaluating the detrusor activity and bladder function.

Dynamic infusion cavernosometry and cavernosography for the diagnosis and classification of venous erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the procedures of dynamic infusion cavernosometry and cavernosography (DICC) and their application in the diagnosis and classification of venous erectile dysfunction (VED).</p><p><b>METHODS</b>This study included 103 ED patients, aged 20 to 43 years, highly suspected of VED, with disease courses of 4 months to 6 years. DICC was performed and analyses were made on the results, especially the parameters of flow-to-maintain (FTM) and pressure decay (PD) in the corpus cavernosum.</p><p><b>RESULTS</b>Based on the parameters of FTM and PD, 21 of the patients were normal, 5 were suspected of VED, 39 had mild VED, 25 had moderate VED, and 13 had severe VED. Penile subcutaneous hematoma was found in 4 of the patients, all recovered after 3 to 5 days, with no other complications.</p><p><b>CONCLUSION</b>DICC is a reliable, safe and minimally invasive method for the diagnosis and classification of VED.</p>

Escala predictiva diagnóstica de infección urinaria en neonatos febriles sin foco aparente / A diagnostic predictive scale for urinary tract infection in febrile infants without an apparent focus

Introduction: Urinary tract infection (UTI) is the most frequent bacterial infection in infants with nonspecific clinical manifestations. Objective: To validate a predictive scale for UTI in febrile infants without apparent source and hospitalized in a neonatal unit. Patients and Method: A nested case-control study was conducted on 158 infants with febrile UTI, culture-confirmed, and on 346 febrile infants without apparent focus in whom UTI was ruled out, and also, hospitalized in a neonatal unit. The analysis was performed using Stata® 11. Associations were determined using odds ratio (OR) with 95 percent confidence interval. To find the predictive scale, multivariate analysis was performed using logistic regression and establishing major and minor criteria according to regression coefficient. Yield was calculated by sensitivity, specificity and area under ROC curve. The new predictive scale was validated by 108 new febrile neonates. Results: The major criteria to predict UTI were abnormal urinalysis and Gram positive cells without centrifugation, and among the minor criteria, male, age at time of fever, previous neonatal hospitalization, abnormal temperature (38.5°C or more, persistent fever, hypothermia) and 1.7 mg/dL C reactive protein or higher, resulting positive with the presence of one mayor or three minor criteria. It showed good performance with 100% sensitivity (CI 95 percent:98.3-100 percent), 92.3 percent specificity (CI 95 percent: 85.8-98.9 percent) and 0.962 area under ROC (95 percent CI: 0.932-0.991) when validated on 108 new febrile neonates without focus. Conclusions: The new predictive scale allows predicting UTI with good yield in infants with fever without an identified source.

Introducción: La infección de tracto urinario (ITU) es la infección bacteriana más frecuente en neonatos, con manifestaciones clínicas inespecíficas. Objetivo: Validar una Escala Predictiva de ITU en neonatos febriles sin foco aparente, hospitalizados en una unidad neonatal. Pacientes y Método: Estudio caso control anidado en una cohorte, realizado en 158 neonatos febriles con ITU, confirmada por cultivo y 346 neonatos febriles sin foco aparente, en quienes se descartó ITU, hospitalizados en una unidad neonatal. El análisis se realizó con Stata® 11. Las asociaciones se determinaron mediante odds ratio (OR), con su intervalo de confianza de 95 por ciento. Para hallar la Escala Predictiva, se realizó análisis multivariado mediante regresión logística, estableciendo criterios mayores y menores de acuerdo al coeficiente de regresión, mientras el rendimiento se determinó con sensibilidad, especificidad y área bajo ROC. La nueva Escala Predictiva se validó con 108 neonatos febriles nuevos. Resultados: Los criterios mayores para la predicción diagnóstica de ITU fueron uroanálisis alterado y Gram de orina sin centrifugar positivo, y los criterios menores, sexo masculino, edad al momento de la fiebre mayor a 7 días, hospitalización neonatal previa, alteración de la temperatura (38,5°C o más, fiebre persistente, hipotermia) y proteína C reactiva 1,7 mg/dL o mayor, siendo positiva con un criterio mayor o tres menores. Esta mostró buen rendimiento con sensibilidad 100 por ciento (IC 95 por ciento: 98,3-100 por ciento), especificidad 92,3 por ciento (IC 95 por ciento: 85,8-98,9 por ciento) y área bajo ROC 0,962 (IC 95 por ciento: 0,932-0,991) cuando se validó en 108 nuevos neonatos febriles sin foco. Conclusiones: La nueva Escala Predictiva permite con buen rendimiento predecir una ITU en neonatos con fiebre sin foco aparente.

Exposición radiológica en urología: conocimientos y medidas preventivas generales en Chile / Radiation exposure in urology: knowledge and general preventive measures in Chile

Existe una creciente exposición a la radiación ionizante en la práctica médica habitual tanto para el paciente como para el médico tratante, debido a un incremento en exámenes imagenológicos solicitados como al uso de rayos X como soporte en procedimientos y cirugías. Parte importante de la práctica médica en urología involucra exposición a radiación. Por este motivo, decidimos evaluar el nivel de conocimientos y medidas preventivas que realizan los urólogos y residentes de urología en Chile al exponerse a la radiación. MATERIAL Y MÉTODO: Se aplicó una encuesta a residentes de urología y urólogos que ejercen dicha especialidad en Chile. Esta encuesta fue aplicada de manera voluntaria y anónima vía e-mail y evaluó los conocimientos generales y medidas preventivas frente a la exposición radiológica. Se analizan resultados según año de residencia y nivel de formación académica. RESULTADOS: Existe un bajo nivel de conocimientos y de prácticas preventivas de tanto los residentes como especialistas encuestados en el tema de protección radiológica. No se observaron diferencias significativas entre los distintos niveles de formación. CONCLUSIÓN: Se detectó un bajo nivel de conocimiento y un bajo empleo de medidas preventivas. Se postula la necesidad de incorporar un curso obligatorio de exposición radiológica durante la residencia de urología.

There has been an increase in the exposure to ionizing radiation in current medical practice in the past few decades. This raise is the result of an increase in the amount of radiological images solicited and use of X-rays in procedures and surgeries. Clinical practice in urology involves high levels of exposure. We decided to evaluate knowledge and preventive measures when urology specialists and residents are exposed to radiation. MATERIALS AND METHODS: A survey previously utilized in international centers for similar purposes was applied to urology residents and specialists that practice medicine in Chile. This survey was applied electronically via email and evaluated general knowledge and preventive measures when exposed to ionizing radiation. Results are analyzed between years of residency and academic formation. RESULTS: A low level of knowledge and preventive measures were detected among both urology residents and specialists. No significant differences were observed when analyzing results according to year of residency. CONCLUSION: Given the low level of knowledge and preventive measures utilized when exposed to radiation, we propose to include an obligatory course in radiologic exposure during urology residency.

Pielonefritis aguda recurrente en mujeres / Recurrent acute pyelonephritis in women

Se realizó un estudio descriptivo transversal para describir el comportamiento de la pielonefritis aguda recurrente en mujeres de 18 y más años de edad, que ingresaron en el Hospital Mártires del 9 de Abril de Sagua la Grande, de enero de 2004 a junio de 2007. El universo estuvo constituido por las 593 pacientes ingresadas con ese diagnóstico. Se realizó un muestreo no probabilístico por criterios y la muestra quedó constituida por 67 pacientes. Las edades fluctuaron entre 18 y 85 años. Las manifestaciones clínicas más comunes fueron: dolor lumbar, fiebre y síntomas urinarios bajos. En el examen físico se halló dolor a la palpación profunda de las fosas lumbares, prácticamente, en todos los casos. El diagnóstico de certeza se realizó por el urocultivo, en 104 ocasiones. Los gérmenes que con mayor frecuencia infectaron las vías urinarias altas fueron bacilos gramnegativos y E. Coli fue el más común. La mayor sensibilidad fue a la amikacina y la mayor resistencia, a ampicillina, ciprofloxacilo y ácido nalidíxico. Muchas de las pacientes con mayor cantidad de ingresos tenían anomalías estructurales de las vías urinarias. La enfermedad subyacente más frecuentemente asociada fue la diabetes mellitus

A descriptive cross-sectional study was conducted to describe the behavior of recurrent acute pyelonephritis in women of 18 years of age and older who were admitted to Mártires del 9 de Abril Hospital in Sagua La Grande, from January 2004 to June 2007. The universe was composed of the 593 patients who were admitted with this diagnosis. A non-probabilistic sampling criterion was performed and then, the sample was composed of 67 patients. The ages ranged from 18 to 85 years. The most common clinical manifestations were low back pain, fever and low urinary symptoms. On physical examination, pain on deep palpation of the lumbar fosses was found, practically, in all cases. The diagnosis of certainty was made by urine culture in 104 occasions. The most common germs that infected the upper urinary tracts were gram-negative bacilli, and E. coli was the most common. The greatest sensitivity was seen for Amikacin and the resistance was greater to Ampicillin, Ciprofloxacin and Nalidixic Acid. Many of the patients with the majority of admissions presented structural anomalies of the urinary tract. The most frequently associated underlying disease was diabetes mellitus

Disfunção do trato urinário inferior: um diagnóstico comum na prática pediátrica / Lower urinary tract dysfunction: a common diagnosis in the pediatrics practice

Disfunção do trato urinário inferior indica uma função anormal do trato urinário inferior para a idade da criança, que pode levar à perda da capacidade coordenada de armazenamento e eliminação de urina. É uma entidade comum em crianças, embora subdiagnosticada na prática clínica, e que, além de representar um risco para o trato urinário superior, causa um constrangimento emocional aos pais e às crianças, devido à incontinência urinária e à frustração em lidar com o problema. A aquisição da continência urinária diurna ocorre na maioria das crianças até os 4 anos e a noturna até os 5 anos de idade. Após esta idade, a incontinência urinária torna-se um problema social. Apesar da importância clínica, muitas vezes, os pais desconhecem os sintomas dessa disfunção. Esse artigo tem como objetivo abordar os principais aspectos relacionados ao diagnóstico dessa disfunção.

Lower urinary tract dysfunction indicates an abnormal function of the lower urinary tract to the child's age, which can lead to loss of coordinated capacity storage and elimination of urine. It is a common entity in children, although under-diagnosed in clinical practice, and that, besides representing a risk to the upper urinary tract, causes an emotional embarrassment to parents and children, due to urinary incontinence and frustration in dealing with the problem. The acquisition of daytime urinary continence occurs in most children until age 4 and night, until 5 years of age. After this age, urinary incontinence becomes a social problem. Despite the clinical importance often parents are unaware of the symptoms of this dysfunction. This article aims to address the key issues related to the diagnosis of this dysfunction.