Antibiotics prophylaxis at the time of catheter removal after radical prostatectomy: a systematic review of the literature and meta-analysis

Purpose: To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections. Methods: A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords "antibiotics" AND "prostatectomy" AND "urinary catheter." Results: Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio-OR = 0.51; 95% confidence interval-95%CI 0.27-0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12-1.24; p = 0.11; I2 = 73%). Conclusions: In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy.

Diagnóstico y tratamiento de pacientes con vejiga neurogénica en la Unidad Técnica de Cirugía Pediátrica / Diagnosis and treatment of patients with Neurogenic bladder in the Surgery Technical Unit Pediatric

El presente trabajo toma como base el documento: "Manejo Urológico del Mielomeningocele" de las Guías de Atención Pediátrica, del Hospital De Pediatría "Juan P. Garrahan" de la ciudad de Buenos Aires - Argentina; de los autores: Dra. Carol Burek y Dra. Liliana Campmany. En la Unidad Técnica de Cirugía Pediátrica del Hospital de Especialidades Carlos Andrade Marín, se atienden por mes unos 50 a 70 pacientes afectos de vejiga neurogénica desde el nacimiento hasta la adolescencia. Es una enfermedad crónica que requiere un diagnóstico correcto con estudios de imagen y función de la vía urinaria además de un posterior manejo diario por parte de los padres con la guía del médico especialista.

This work is based on the document: "Urological Management of Myelomeningocele" from the Pediatric Care Guidelines of the Hospital De Pediatría "Juan P. Garrahan" of the city of Buenos Aires - Argentina; by the authors: Dr. Carol Burek and Dr. Liliana Campmany. In the Pediatric Surgery Technical Unit of the Carlos Andrade Marín Specialties Hospital, 50 to 70 patients affected by neurogenic bladder from birth to adolescence are treated every month. It is a chronic disease that requires a correct diagnosis with imaging and urinary tract function studies, as well as subsequent daily management by the parents under the guidance of the specialist.

Takayasu arteritis associated with focal and segmentary glomerulosclerosis

Takayasu arteritis (TA) is a large vessel vasculitis that affects young people, related to cardiovascular outcomes and chronic kidney disease. We present the case of a 20-year-old male with a diagnosis of TA, who developed chronic kidney disease, impaired renal blood flow was ruled out, renal biopsy was compatible with focal and segmental glomerulosclerosis of a collapsing variety, other possible aetiologies were excluded. The mechanisms that mediate this association have not been determined, immune-mediated mechanisms are proposed. According to our review, this is the second reported case of this association and the first with a collapsing variety.

La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a personas jóvenes y se relaciona con desenlaces cardiovasculares y enfermedad renal crónica. Se presenta el caso de un paciente masculino de 20 arios, con diagnóstico de arteritis de Takayasu, que desarrolla enfermedad renal crónica. Se descartan alteraciones en el flujo sanguíneo renal, en tanto que la biopsia renal resulta compatible con glomeruloesclerosis focal y segmentaria de variedad colapsante. Se excluyeron otras posibles etiologías. No se han determinado los mecanismos que median en esta asociación; se proponen mecanismos inmunomediados. Según nuestra revisión, se trata del segundo caso reportado de esta asociación y el primero con variedad colapsante.

Ejercicio y educación mejoran equilibrio y la calidad de vida en mujeres con incontinencia urinaria de esfuerzo / Exercise and education improve balance and quality of life in women with stress urinary incontinence

Introducción: La incontinencia urinaria por esfuerzo (IUE) tiene una alta prevalencia en mujeres adultas, afectando variables psicológicas, sociales y funcionales como la disminución de capacidad de equilibrio, debido a una escasa contribución en los movimientos del tronco hacia una corrección postural. Objetivo: Determinar los efectos de un programa basado en ejercicio muscular de piso pélvico y educación sobre el equilibrio estático y la calidad de vida en mujeres con IUE. Materiales y métodos: Participaron 18 mujeres con IUE durante 12 semanas en 10 sesiones de ejercicio muscular de piso pélvico y educación (hábitos de higiene, micción, ingesta de líquidos). Pre y post-intervención se evaluó equilibrio estático mediante oscilografía postural y calidad de vida mediante el International Consultation on Incontinence Questionnaire Short-Form (ICQ-SF). Los datos fueron analizados con la prueba no paramétrica de Wilcoxon. Resultados: Se encontró una disminución significativa en el área de desplazamiento del centro de presión en el subtest ojos abiertos (p=0,027) y en el Subtest ojos cerrados (p=0,006). Disminuyó la sintomatología asociada a IUE (p=0,0001). Conclusiones: Pos-intervención mejora equilibrio estático y calidad de vida, confirmando los efectos positivos de este programa que pueden servir de orientación a profesionales de la salud que trabajan con mujeres con IUE.

Introduction: Stress urinary incontinence (SUI) has high prevalence in adult women, affecting psychological, social and functional variables, including decreased balance capacity, due to a lack of trunk movements that contribute to postural correction. Objective: To determine how a program based on pelvic floor muscle exercises and education affects static balance and quality of life of women with SUI. Materials and methods: 18 SUI female patients participated in a 12 week/10 sessions program that included pelvic floor muscle exercises and education (hygiene habits, urination, fluid intake). Static balance and quality of life were assessed before and after the intervention using postural oscillography and the International Consultation on Incontinence Questionnaire Short Form(ICQ-SF), respectively. Data were analyzed with the non-parametric Wilcoxon test. Results: The displacement area of the center of pressure in the open (p=0.027) and closed (p=0.006) subtests showed a significant reduction. Likewise, the amount of symptoms associated with SUI decreased (p=0.0001). Conclusions: Intervention improves static balance and quality of life, confirming the positive effects of this program, which can serve as a guide for health professionals who work with women with SUI.

Diagnostic urethrocystoscopy: A five-year review of indications and findings in a tertiary hospital in Nigeria

Background:Urethrocystoscopy is defined as endoscopic visualization of the urethra and the urinary bladder for the purpose of diagnosis or treatment of diseases of the lower urinary tract.Objective: To study the indications, diagnosis and complications of diagnostic urethrocystoscopy in our hospital.Materials and method:It was a retrospective descriptive study of all patients who had diagnostic urethrocystoscopy in our hospital between January 2016 to December 2021. Institutional ethical clearance was obtained. Particulars of the patients were collected from the operating theatre register and their medical case files were retrieved. Information about the patients'bio-data, presentation, clinical/radiologic diagnosis, urethrocystoscopic findings and its complications were extracted. The generated data was analyzed using statistical package for social sciences (SPSS) version 21 and results presented in tables, text and figures.Results:Atotal of 673 patients had urethrocystoscopy/cystoscopy during the period out of which we recovered full medical records of 592 patients whose data were analyzed.The patient's age ranges between 9 to 86years with mean age of 43.7±9.3SD years and M: F = 3.9:1. The indications for diagnostic urethrocystoscopy were lower urinary tract symptoms [LUTS] (48.8%), bladder tumour (29.2%) and haematuria (11.1%) among others. The urethrocystoscopic diagnoses were bladder tumour (37.8%), prostate enlargement (19.1%) and urethral stricture (6.9%) among others. The complications recorded were urethral/bladder bleeding (2.4%), urosepsis (1.4%) and urethral/bladder injury (0.3%).Keywords: Urethrocystoscopy, diagnosis, indicationsConclusion: Urethrocystoscopy is a necessary tool for comprehensive practice of urology owing to its vital role in the diagnosis and treatment of different kinds of lower urinary tract diseases and it is generally a safe procedure

Incidence of Urologic Disease Among 95 Consecutive Filipino Patients Presenting With Asymptomatic Microscopic Hematuria

Objective@#One of the common clinical problems warranting urologic evaluation is asymptomatic microscopic hematuria (AMH). According to some studies, it has prevalence as high as 38% with a possibility of urologic disease or malignancy around 23%. The presence of AMH would be quite a dilemma to a urologist in terms of how aggressive urologic evaluation and follow up is recommended. The present study was to determine the incidence of significant urologic diseases among Filipino patients with AMH on initial evaluation and on follow-up. This study would also determine if there would be a significant difference in terms of incidence of urologic disease among patients less than 35 years old and more than 35 years old with AMH.@*Methods@#A total number of 95 patients (38 male, 57 female) were included in this study. All patients presented with AMH. They were grouped in terms of age, gender, and duration of follow-up. All patients underwent cystoscopy and a diagnostic imaging (ultrasound, CT urogram, or CT stonogram) on initial evaluation. Patients then were followed up. They were divided into two groups, those less than 2 years of follow-up and those more than 2 years of follow-up. Excluded from the study are those patients with gross hematuria, on indwelling catheter, with urinary tract infection, with previous malignancy, history of pelvic irradiation, and those who did not undergo cystoscopy, or any urologic imaging. @*Results@#Out of 95 patients with AMH who underwent urologic evaluation, the incidence of urologic disease was noted to be 12% (11 out of 95). There was no malignancy related cause of AMH discovered. Age and gender failed to show any significant difference in terms of developing urologic disease. Among patients with negative findings on initial urologic evaluation, no urologic disease was noted even on follow-up. Among those with positive findings on initial evaluation, no new urologic disease was discovered on follow-up.@*Conclusion@#AMH has a low incidence of urologic disease or any GUT malignancy. Age and gender alone are not sufficient risk factors warranting an invasive endoscopic procedure. They are recommended only to those patients with high risk of urologic disease and can be avoided in majority of the population. We would recommend a kidney, urinary bladder, and prostate (KUBP) ultrasound as the initial imaging of choice since the only findings noted on evaluation through imaging were just two cases of nephrolithiasis, one via CT stonogram and the other through a CT urogram, which can also be diagnosed with a regular KUBP ultrasound. This would be more cost-effective as well as beneficial in terms of the patient’s risk regarding radiation and contrast-related effects. Clinicians may decrease unnecessary repeated urologic evaluation and follow-ups on patients with AMH, as the results of the study failed to show any significant difference in developing urologic disease for patients with persistent AMH on initial assessment and even on follow-up.

The value of repeat kidney biopsy in lupus nephritis. A systematic review / La utilidad de la biopsia renal repetida en nefritis lúpica. Una revisión sistemática

ABSTRACT A renal biopsy is the 'gold standard' for diagnosis and classification of lupus nephritis (LN). The role of repeat renal biopsy in lupus nephritis (LN) to guide treatment or predict prognosis has been controversial. A systematic literature review was conducted based on retrospective and prospective studies. The studies were identified using English electronic scientific databases, including MEDLINE PUBMED, published between January 1990 and August 2020. The eligibility criteria were studies including adult LN patients with at least one follow-up renal biopsy with appropriate longitudinal information. Case reports, studies with incomplete information or including duplicate patients were excluded. Based on the inclusion and exclusion criteria, a total of 73 publications were identified. This study included a total of 1167 repeat biopsies in LN patients from 15 studies. The primary indication for a repeat biopsy was relapse in 44-78% of the cases, and lack of response in 13-51%. Additionally, several repeat biopsies were done according to the protocol, after induction and maintenance therapy. In terms of histopathological class switches, there was a higher frequency of changes from nonproliferative to proliferative lesions. Only two studies provide a definition of histological response. There were often changes in the therapeutic approach after a repeat biopsy. Repeat kidney biopsies are helpful in patients with LN flare/relapse, and in patients with poor treatment response. Histological transformation was a common finding. The histologic and clinical responses are discordant. A repeat biopsy could be of prognostic value for therapeutic decision-making.

RESUMEN La biopsia renal es el «estándar de oro¼ para el diagnóstico y la clasificación de la nefritis lúpica (NL). El papel de la biopsia renal repetida en nefritis lúpica para orientar el tratamiento o predecir el pronóstico ha sido controversial. Se llevó a cabo una revisión sistemática de la literatura basada en estudios retrospectivos y prospectivos. Los estudios se identificaron a través de bases de datos científicas electrónicas en inglés, incluyendo Medline PubMed, de publicaciones entre enero de 1990 y agosto del 2020. Los criterios de elegibilidad fueron estudios que incluyeran a pacientes adultos con NL, quienes tuvieran al menos una biopsia renal de seguimiento, con información longitudinal apropiada. Se excluyeron informes de casos, estudios con información incompleta o con pacientes duplicados. Basándose en los criterios de inclusión y exclusión, se identificaron 73 publicaciones. En la presente revisión se analizaron un total de 1.167 biopsias repetidas en pacientes con NL en 15 estudios. Las principales indicaciones para la biopsia repetida fueron: recidiva en 44-78% de los casos, y falta de respuesta en 13-51%. Adicionalmente, varias biopsias repetidas se hicieron conforme al protocolo, luego de la terapia de inducción y de mantenimiento. Con respecto a los cambios de clase histopatológica, hubo una mayor frecuencia de cambios de lesiones no proliferativas a lesiones proliferativas. Solamente dos estudios ofrecen una definición de respuesta histológica. Con frecuencia hubo cambios en el abordaje terapéutico después de realizar la biopsia repetida. Las biopsias renales repetidas son útiles en pacientes con exacerbación/recidiva y en pacientes con falta de respuesta a tratamiento. La transformación histológica fue un hallazgo frecuente; las respuestas histológicas y clínicas son discordantes. Una biopsia repetida puede ser de valor pronóstico para la toma de decisiones terapéuticas.

Diagnóstico prenatal de anomalías nefrourológicas en el Centro de Referencia Perinatal Oriente, Santiago, Chile / Prenatal diagnosis of nefrourological anomalies at the Eastern Perinatal Referral Center, Santiago, Chile

INTRODUCCIÓN: Las anomalías congénitas de los riñones y las vías urinarias (CAKUT, Congenital Anomalies of the Kidney and Urinary Tract) representan un 20-30% de las anomalías detectadas en el periodo prenatal. Si bien la mayoría son de buen pronóstico, un 25% se asocian a enfermedad renal crónica en la infancia y en los casos graves a mortalidad perinatal. OBJETIVO: Describir los casos ingresados al Centro de Referencia Perinatal Oriente (CERPO) y determinar los resultados perinatales y la sobrevida al año. MÉTODO: Estudio descriptivo y retrospectivo. Se incluyeron pacientes ingresadas en la base de datos CERPO, entre los años 2003 y 2019, con diagnóstico de anomalía nefrourológica. Se incluyeron antecedentes prenatales, perinatales y de seguimiento posnatal al año. RESULTADOS: Se evaluaron 273 pacientes. La edad gestacional promedio de derivación fue de 29 semanas + 2 días. El diagnóstico más frecuente fueron las anomalías del tracto de salida (69%). Un 40% de los casos se asociaron a otras anomalías congénitas, siendo las cardiopatías las más frecuentes (19%). Aceptaron la realización de estudio genético invasivo 38 pacientes, de las cuales un 34% presentaron aneuploidías, siendo las trisomías 18 y 13 las más frecuentes (17% y 6%, respectivamente). Se instalaron cinco shunts derivativos vesicoamnióticos en fetos diagnosticados con megavejiga. La sobrevida global para la patología nefrourológica fue del 63% al año, y la mortalidad fetal y neonatal fue del 7% y el 16%, respectivamente. La sobrevida al año según el grupo de clasificación CAKUT fue del 22% para las anomalías de número de riñones, del 46% para las anomalías de tamaño y de morfología renal, del 60% para las anomalías de la posición renal y del 72% para las anomalías del tracto de salida. En este último grupo, la sobrevida alcanza el 81% al excluir los pacientes con diagnóstico prenatal de megavejiga, que presentaron una sobrevida al año del 28%. Los casos de patología nefrourológica asociada a oligohidramnios (índice de líquido amniótico < 5 cm) sin evidencias de uropatía obstructiva asociada presentaron una sobrevida al año del 3%. CONCLUSIONES: Las anomalías del sistema nefrourológico son un diagnóstico prenatal frecuente. La sobrevida al año fue del 63%, pero es necesario prolongar el seguimiento a largo plazo para determinar la evolución de la función renal en cada diagnóstico. La asociación de patología nefrourológica y oligohidramnios conlleva una sobrevida menor.

INTRODUCTION: Congenital anomalies of the kidneys and urinary tract (CAKUT) represent 20 to 30% of the anomalies detected prenatally. Although most are of good prognosis, 25% are associated with chronic kidney disease in childhood and severe cases with perinatal mortality. OBJECTIVE: To describe the cases studied in the Eastern Perinatal Referral Center (CERPO) and to determine the perinatal outcome and survival at one year. METHOD: Descriptive and retrospective study. Patients registered on the CERPO database, between 2003 to 2019, with diagnosis of nephrourological anomaly were included. Antenatal, perinatal and postnatal follow-up information was collected. RESULTS: 273 patients were evaluated. The average gestational age at referral was 29 + 2 weeks. The main diagnosis was urinary tract outlet disorders (69%). Thirty nine percent of the cases were associated with other congenital anomalies, with heart disease being the most frequent (19%). Thirty-eight patients accepted an invasive procedure for genetic study, 34% presented aneuploidy, trisomy 18 and 13 were the most frequent (17% and 6% respectively). Five vesico-amniotic derivative shunts were installed in fetuses diagnosed with megabladder. Overall survival at one year was 63% and fetal and neonatal mortality were 7% and 16% respectively. One-year survival per group according to CAKUT classification was 22% in kidney number abnormalities, 46% in kidney size and morphology abnormalities, 60% in renal position abnormalities and 72% in outflow tract abnormalities. In the latter, survival reaches 81% excluding the patients with prenatal diagnosis of megabladder who had a one-year survival of 28%. The cases of nephrourological pathology associated with oligohydramnios (amniotic fluid index < 5 cm) without evidence of associated obstructive uropathy presented a survival of 3% at one year. CONCLUSIONS: The anomalies of the nephrourological system correspond to a frequent prenatal diagnosis. Overall, the one-year survival was 63%; however, follow-up must continue to determine the evolution of renal function in relation to each diagnosis.

Hematúria macroscópica em equinos associada à infecção por Leptospira interrogans / Macroscopic haematuria in horses associated with Leptospira interrogans infection

Hematúria é uma grave manifestação clínica de doença do sistema urinário, ocorrendo sob as formas micro ou macroscópica. Neste artigo relatam-se dois casos de hematúria macroscópica associada à infecção por Leptospira interrogans sorogrupo Canicola. O exame clínico inicial revelou hematúria macroscópica, taquicardia, taquipneia, febre, elevação do tempo de perfusão capilar, hipomotilidade intestinal, além de icterícia da mucosa oral. Leucocitose, proteinúria, glicosúria, piúria e azotemia foram achados comuns aos dois casos. Teste de Soroaglutinação Microscópica foi realizado para titulação de anticorpos contra Leptospira interrogans. Tratamento incluiu medidas terapêuticas de suporte (fluidoterapia), controle da hematúria e antibioticoterapia. Sete dias após manifestação dos sinais clínicos iniciais, ambos animais receberam alta hospitalar após remissão dos sinais clínicos.

Haematuria is a serious clinical manifestation of urinary system disease, occurring in micro or macroscopic forms. In this article two cases of macroscopic haematuria associated with Leptospira interrogans serogroup Canicolainfection are related. The initial clinical examination revealed macroscopic haematuria, tachycardia, tachypnea, fever, increased capillary perfusion time, intestinal hypomotility, in addition to jaundice of the oral mucosa. Leukocytosis, proteinuria, glycosuria, pyuria and azotemia were common findings in both cases. Microscopic serum agglutination test was performed for titration of antibodies against Leptospira interrogans. Treatment included supportive therapeutic measures (fluid therapy), hematuria control and antibiotic therapy. Seven days after the manifestation of the initial clinical signs, both animals were discharged from the hospital without complications.

Características clínico-patológicas de las lesiones malignas del tracto urinario inferior / Clinicopathological features of malignant lesions of the lower urinary tract / Características clínico-patológicas de lesões malignas do trato urinário inferior

RESUMEN Introducción: El cáncer de vejiga es un tumor mucho más frecuente de lo que a veces nos transmiten las estadísticas o los medios de comunicación. Ocupa el noveno lugar en cuanto al número de diagnósticos de cáncer a nivel mundial y se reporta aproximadamente cinco veces más frecuente en varones que en mujeres. Objetivo: Describir las características clínico-patológicas de los tumores malignos del tracto urinario inferior. Método: Se realizó un estudio descriptivo y transversal de 186 pacientes con tumores malignas del tracto urinario inferior diagnosticados anatomo-patológicamente en el Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres", de Santiago de Cuba, entre los años 2017 al 2020. Una vez recopilados los datos se procesaron mediante el sistema estadístico SPSS, en su versión 21.0. Resultados: En la serie la mayoría de los afectados fueron hombres entre los 60 y 79 años de edad, siendo más frecuente en el sexo masculino. Predominaron los carcinomas uroteliales con el 96,4 % del total en su variedad papilar y de alto grado de malignidad. Conclusiones: Los tumores malignos del tracto urinario inferior son un problema de salud de baja frecuencia cuya trascendencia es la afectación individual a quien lo padece, y su comportamiento clínico patológico, en sentido general, fue similar a lo reportado por la literatura nacional e internacional, salvo pequeñas y puntuales diferencias relativo a los síntomas, el diagnóstico histológico, en parte, y el grado de malignidad de las lesiones.

ABSTRACT Introduction: Bladder cancer is a more common tumor that sometimes the statistics database or media conveyed to us. It ranks ninth concerning cancer diagnoses worldwide and it is reported to be approximately five times more frequent in males than in females. Objective: To describe the clinicopathologic features of malignant lower urinary tract tumors. Method: A descriptive and cross-sectional study involving a total of 186 patients was conducted. Anatomical and pathological diagnoses were carried out to all patients with malignant lower urinary tract tumor at the Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" in Santiago de Cuba, from 2017 throughout 2020. Once the data were collected, they were processed using the SPSS statistical system, version 21.0. Results: Most affected patients with lower urinary tract tumor had an average age of 60 to 70, arising most frequently in males. The 96.4 % of the total of the patients were diagnosed with urothelial carcinomas (predominant), described in its papillary variety and the high degree of malignant transformation. Conclusions: Malignant lower urinary tract tumors are health problems labeled as the low frequency which differ in their transformation according to the patient. The clinical pathological behavior of the tumor, in a general sense, was similar to that reported in the national and international literature, except for small and pointed differences regarding symptoms, histological diagnosis, and the degree of the lesions´ malignant transformation.

RESUMO Introdução: O câncer de bexiga é um tumor mais comum do que às vezes o banco de dados de estatísticas ou a mídia veiculada por nós. Ele ocupa o nono lugar em diagnósticos de câncer em todo o mundo e é relatado ser aproximadamente cinco vezes mais frequente em homens do que em mulheres. Objetivo: Descrever as características clínico-patológicas dos tumores malignos do trato urinário inferior. Método: Foi realizado um estudo descritivo e transversal envolvendo um total de 186 pacientes. Os diagnósticos anatômicos e patológicos foram realizados a todos os pacientes com tumor maligno do trato urinário inferior no Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" em Santiago de Cuba, de 2017 a 2020. Uma vez coletados os dados, eles foram processados ​​no SPSS sistema estatístico, versão 21.0. Resultados: A maioria dos pacientes afetados com tumor do trato urinário inferior tinha uma idade média de 60 a 70 anos, surgindo mais frequentemente no sexo masculino. 96,4% do total dos pacientes foram diagnosticados com carcinomas uroteliais (predominantes), descritos em sua variedade papilar e alto grau de transformação maligna. Conclusões: Os tumores malignos do trato urinário inferior são problemas de saúde rotulados como de baixa frequência e que diferem em sua transformação de acordo com o paciente. O comportamento clínico-patológico do tumor, de um modo geral, foi semelhante ao relatado na literatura nacional e internacional, exceto por pequenas e pontuadas diferenças quanto à sintomatologia, ao diagnóstico histológico e ao grau de transformação maligna das lesões.

Prevalencia de infección del tracto urinario y factores asociados en pacientes de 0 a 5 años hospitalizados / Prevalence of urinary tract infection and associated factors in hospitalized patients aged 0 to 5 years

Introducción: La infección del tracto urinario es una afectación frecuente en niños, y su recurrencia predispone a patologías crónicas que disminuyen la sobrevida de pacientes hospitalizados. El objetivo del presente estudio fue determinar la prevalencia de infección del tracto urinario y factores asociados en niños hospitalizados de 0 a 5 años. Métodos: El presente estudio es transversal analítico, el universo lo constituyó los niños hospitalizados en pediatría de 0 -5 años del Hospital ¨José Carrasco Arteaga¨ de Cuenca-Ecuador, la muestra fue probabilística 147 casos, el muestreo fue aleatorio simple. Las variables fueron presencia de ITU, edad, sexo, nivel socio-económico, balanitis, estreñimiento, antecedentes de ITU. En el análisis bivariado se determinó asociación mediante chi cuadrado y se midió la intensidad de asociación por Razón de prevalencia (RP) con un Intervalo de confianza del 95% y un valor significativo de P< 0.05. Resultados: Fueron 147 casos. La prevalencia de ITU fue 10.6%, se presentaron como factores protectores: edad < 1 año RP 0.21 (IC 95% 0.16-0.42, P<0.001) y el sexo masculino RP 0.28 (IC 0.18-0.471, P<0.001). Los factores de riesgo fueron: el nivel socioeconómico medio-bajo RP 1.70 (IC 1.01-2.86, P=0.04), balanitis RP 3.23 (IC 2.48-4.21, P=0.012), fimosis RP 29.37 (IC 6.34-136.3., P<0.001), sinequias RP 1.43 (IC 1.14-1.79, P=0.02), el antecedente de infección del tracto urinario RP 78.91 (IC 10.72-580.7, P<0.001) y estreñimiento RP 4.51 (IC 2.16-9.50, P<0.001). La hidronefrosis fue el hallazgo ecográfico más frecuente RP 78.9 (IC 10.7-580.7, P<0.001). Conclusiones: El sexo masculino fue un factor protector, y alteraciones anatómicas del tracto urinario fueron los mayores factores de riesgo.

Introduction: Urinary tract infection is a frequent affliction in children, and its recurrence predisposes the patient to chronic pathologies that decrease the survival of hospitalized patients. The objective of the present study was to determine the prevalence of urinary tract infection and associated factors in hospitalized children aged 0 to 5 years. Methods: The present study is cross-sectional analytical. The universe was made up of children hospitalized in pediatrics, aged 0-5 years, at "José Carrasco Arteaga" Hospital in Cuenca-Ecuador. The sample was probabilistic, with 147 cases, while the sampling was simple random. The variables were the presence of UTI, age, sex, socioeconomic status, balanitis, constipation, and history of UTI. In the bivariate analysis, the association was determined using chi-square, and the intensity of the association was measured by prevalence ratio (PR) with a 95% confidence interval and a significant value of P <0.05. Results: There were 147 cases. The prevalence of UTI was 10.6%. The following were presented as protective factors: age <1 year PR 0.21 (95% CI 0.16-0.42, P <0.001) and male sex PR 0.28 (CI 0.18-0.471, P <0.001). The risk factors were: low-middle socioeconomic level PR 1.70 (CI 1.01-2.86, P = 0.04), balanitis PR 3.23 (CI 2.48-4.21, P = 0.012), phimosis PR 29.37 (CI 6.34-136.3., P <0.001), synechiae PR 1.43 (CI 1.14-1.79, P= 0.02), history of urinary tract infection PR 78.91 (CI 10.72-580.7, P <0.001), and constipation PR 4.51 (CI 2.16-9.50, P <0.001 ). Hydronephrosis was the most frequent ultrasound finding PR 78.9 (CI 10.7-580.7, P <0.001). Conclusions: Male sex was a protective factor, and anatomical alterations of the urinary tract were the major risk factors.

The impact of COVID-19 in medical practice. A review focused on Urology

ABSTRACT COVID-19 pandemic is a rapidly spreading virus that is changing the World and the way doctors are practicing medicine. The huge number of patients searching for medical care and needing intensive care beds led the health care system to a burnout status especially in places where the care system was already overloaded. In this setting, and also due to the absence of a specific treatment for the disease, health authorities had to opt for recommending or imposing social distancing to relieve the health system and reduce deaths. All other medical specialties nondirectly related to the treatment of COVID-19 had to interrupt or strongly reduce their activities in order to give room to seriously ill patients, since no one knows so far the real extent of the virus damage on human body and the consequences of doing non deferrable procedures in this pandemic era. Despite not been a urological disease, the urologist needs to be updated on how to deal with these patients and how to take care of himself and of the medical team he works with. The aim of this article is to review briefly some practical aspects of COVID-19 and its implications in the urological practice in our country.

Comportamiento de las infecciones del sistema genitourinario en el Hospital Universitario "Comandante Faustino Pérez Hernández". Matanzas. 2014-2019 / Behavior of the genitourinary system infections in the University Hospital "Comandante Faustino Perez Hernandez". 2014-2019

RESUMEN Introducción: durante mucho tiempo los términos infección y sepsis han sido utilizados en forma alternativa, la tendencia actual es referirse al término infección como proceso bacteriano dependiente del germen. Objetivo: caracterizar el comportamiento de las infecciones urológicas en el servicio de urología del Hospital Universitario Comandante "Faustino Pérez Hernández", Matanzas. Materiales y métodos: se realizó un estudio observacional, descriptivo y transversal, a los pacientes atendidos en el servicio de urología del hospital Faustino Pérez, mediante el método de pesquisaje activo en el periodo comprendido desde enero de 2014 hasta diciembre de 2019. Resultados: se comprobó que la mayor parte de la población sometida a estudio es adulta mayor, predominando el sexo masculino. Entre las patologías crónicas asociadas a infecciones se encuentran la diabetes mellitus, la insuficiencia renal crónica, las inmunodeficiencias. El uso de catéteres se presentó en más de un 64% de los pacientes con infecciones. La echerichia coli fue el germen de mayor incidencia seguido de la klepsiella, pseudomonas. Conclusiones: la hiperplasia benigna de próstata, las litiasis, estenosis uretrales y los tumores uroteliales y prostático, son las principales causas obstructivas asociadas a infecciones. Un grupo importante de los pacientes operados presentaron infección del sitio quirúrgico. La sensibilidad bacteriana ante los antibióticos mostró mayor sensibilidad a meropenem, aztreonam y amikacina (AU).

Summary Introduction: the terms infection and sepsis have being alternatively used during many years; the current tendency is referring to the term infection as a germ- dependent bacterial process. Objective: to characterize the behavior of urologic infections in urological service of the University Hospital "Comandante Faustino Perez Hernandez". Materials and methods: an observational, descriptive, cross-sectional research has been made to the patients who have attended the urology service of the University Hospital "Comandante Faustino Perez Hernandez", using the method of active screening in the period from January 2014 until December 2019. Results: it was proved that the biggest part of the studied population is elder adult people, predominating the male sex. Diabetes mellitus, chronic renal failure, immunodeficiency were found among the chronic diseases associated to infections. The use of catheters was present in more than 64% of patients. Echerichia coli was the germ with highest incidence, followed by Klepsiella, andPseudomonas. Conclusions: benign prostatic hyperplasia, lithiasis, urethral stenosis, prostatic and urothelial tumors are the main obstructive causes associated to infections. An important group of patients who underwent surgery presented infections at the surgical site. Bacteria showed higher sensitivity to antibiotics like meropenem, aztreonam and amikacin (AU).

Caracterización microbiológica y molecular de la resistencia antimicrobiana de Escherichia coli uropatógenas de hospitales públicos peruanos / Microbiological and molecular characterization of antimicrobial resistance in uropathogenic Escherichia coli from peruvian public hospitals

RESUMEN Se caracterizó la resistencia antimicrobiana de 70 aislados de Escherichia coli obtenidos de pacientes con infección del tracto urinario (ITU) provenientes de ocho hospitales públicos en el Perú. Los perfiles de resistencia fueron identificados mediante el uso del sistema automatizado MicroScan®. Se utilizó una reacción en cadena de la polimerasa convencional para la detección de los genes bla TEM, bla CTX-M, bla SHV y bla PER. El 65,7% (46/70) de los aislados presentó un fenotipo multidrogorresistente y el 55,7% (39/70) fue identificado como productores de betalactamasas de espectro extendido. Se detectaron altos niveles de resistencia para ampicilina (77,1%), ciprofloxacina (74,3%), trimetoprim/sulfametoxazol (62,9%), cefepime (57,1%) y cefuroxima (57,1%). El gen bla TEM fue el más frecuente con un 31,4%, seguido por bla CTX-M (18,6%) y bla SHV (2,9%). Los resultados evidencian altos niveles de resistencia a antimicrobianos de importancia clínica en aislados de E. coli de pacientes con ITU en el Perú.

ABSTRACT We characterized the antimicrobial resistance of 70 Escherichia coli isolates obtained from patients with a urinary tract infection (UTI) from 8 public hospitals in Peru. Resistance profiles were identified using the automated MicroScan® system. A standard polymerase chain reaction was used for the detection of the bla TEM, bla CTX-M, bla SHV and bla PER genes. The 65.7% (46/70) of the isolates presented a multidrug-resistant phenotype and 55.7% (39/70) were extended-spectrum beta-lactamases producers. High levels of resistance were detected for ampicillin (77,1%), ciprofloxacin (74,3%), trimethoprim/sulfamethoxazole (62,9%), cefepime (57,1%), and cefuroxime (57,1%). The bla TEM gene was the most frequent (31,4%), followed by bla CTX-M (18,6%) and bla SHV (2,9%) genes. These results show high resistance levels to antimicrobials of clinical use in E. coli isolates from hospital UTI patients in Peru.

Caracterización microbiológica y molecular de la resistencia antimicrobiana de Escherichia coli uropatógenas de hospitales públicos peruanos / Microbiological and molecular characterization of antimicrobial resistance in uropathogenic Escherichia coli from peruvian public hospitals

RESUMEN Se caracterizó la resistencia antimicrobiana de 70 aislados de Escherichia coli obtenidos de pacientes con infección del tracto urinario (ITU) provenientes de ocho hospitales públicos en el Perú. Los perfiles de resistencia fueron identificados mediante el uso del sistema automatizado MicroScan®. Se utilizó una reacción en cadena de la polimerasa convencional para la detección de los genes bla TEM, bla CTX-M, bla SHV y bla PER. El 65,7% (46/70) de los aislados presentó un fenotipo multidrogorresistente y el 55,7% (39/70) fue identificado como productores de betalactamasas de espectro extendido. Se detectaron altos niveles de resistencia para ampicilina (77,1%), ciprofloxacina (74,3%), trimetoprim/sulfametoxazol (62,9%), cefepime (57,1%) y cefuroxima (57,1%). El gen bla TEM fue el más frecuente con un 31,4%, seguido por bla CTX-M (18,6%) y bla SHV (2,9%). Los resultados evidencian altos niveles de resistencia a antimicrobianos de importancia clínica en aislados de E. coli de pacientes con ITU en el Perú.

ABSTRACT We characterized the antimicrobial resistance of 70 Escherichia coli isolates obtained from patients with a urinary tract infection (UTI) from 8 public hospitals in Peru. Resistance profiles were identified using the automated MicroScan® system. A standard polymerase chain reaction was used for the detection of the bla TEM, bla CTX-M, bla SHV and bla PER genes. The 65.7% (46/70) of the isolates presented a multidrug-resistant phenotype and 55.7% (39/70) were extended-spectrum beta-lactamases producers. High levels of resistance were detected for ampicillin (77,1%), ciprofloxacin (74,3%), trimethoprim/sulfamethoxazole (62,9%), cefepime (57,1%), and cefuroxime (57,1%). The bla TEM gene was the most frequent (31,4%), followed by bla CTX-M (18,6%) and bla SHV (2,9%) genes. These results show high resistance levels to antimicrobials of clinical use in E. coli isolates from hospital UTI patients in Peru.

Disfunción eréctil, prevalencia y factores asociados, en hombres con diabetes tipo 2, en el Eje Cafetero, Colombia, 2016-2019 / Erectile Dysfunction, Prevalence and Associated Factors, in Men with Type 2 Diabetes, in the Coffee Region, Colombia, 2016-2019

Objetivo determinar la prevalencia de la disfunción eréctil y los factores de riesgo entre los hombres con diabetes tipo 2, en el Eje Cafetero. Métodos estudio observacional. Se realizó muestreo no probabilístico por conveniencia incorporando a 372 participantes. Se incluyeron hombres mayores de 18 años, más de un año de diagnóstico de Diabetes tipo 2 y en tratamiento periódico de su enfermedad, pertenecientes al programa de enfermedades crónicas en la consulta externa; entre 2016 y 2019, en tres instituciones universitarias de referencia ubicadas en el Eje Cafetero, Colombia. Se excluyeron analfabetos, enfermedades urológicas y los que no desearon participar. La evaluación de la salud sexual se hizo con el índice internacional de la función eréctil abreviado (IIFE-5). Variables medidas: socio-demográficas, clínicas y bioquímicas. Se aplicó estadística descriptiva. Resultados La edad media fue de 57,59 ± 8,73 años. La prevalencia de disfunción eréctil fue del 85,48% (n = 318/372). Predominando la forma leve a moderada y severa, en un 27,33% y 26,69%, respectivamente. La prevalencia de disfunción eréctil fue mayor entre los fumadores (OR = 10,14; IC95%: 3,36-31,56), hipotiroideos (OR = 5,55; IC95%: 2,76-8,19), (p = 0,001) y diagnóstico de la diabetes 3 15 años (OR = 3,27; IC95%: 1,77-5,82). Conclusiones la disfunción eréctil representa una complicación común, con una alta prevalencia entre los hombres con diabetes tipo 2; la cual es superior entre los fumadores, hipotiroideos y mayor tiempo de padecer la diabetes, donde se observa la más alta severidad.

Objective to determine the prevalence of erectile dysfunction and the risk factors among men with type 2 diabetes, in the Coffee Region. Methods observational study. Non-probability convenience sampling was carried out, incorporating 372 participants. Men older than 18 years, more than a year of diagnosis of type 2 diabetes and in periodic treatment of their disease, belonging to the chronic diseases program in the outpatient clinic were included; between 2016 and 2019, in three leading university institutions located in the Coffee Region, Colombia. Illiterate women, urological diseases and those who did not want to participate were excluded. The evaluation of sexual health was made with the abbreviated international index of erectile function (IIFE-5). Variables measured: socio-demographic, clinical and biochemical. Descriptive statistics were applied. Results The mean age was 57.59 ± 8.73 years. The prevalence of erectile dysfunction was 85.48% (n = 318/372). The mild to moderate and severe forms predominate, in 27.33% and 26.69%, respectively. The prevalence of erectile dysfunction was higher among smokers (OR = 10.14; 95% CI: 3.36-31.56), hypothyroid (OR = 5.55; 95% CI: 2.76-8.19), (p = 0.001) and diagnosis of diabetes ≥ 15 years (OR = 3.27; 95% CI: 1.77-5.82). Conclusions erectile dysfunction represents a common complication, with a high prevalence among men with type 2 diabetes; which is higher among smokers, hypothyroid and longer suffering from diabetes, where the highest severity is observed.

Effects of Fluorodeoxyglucose Conjugated and Unconjugated Iron Oxide Magnetic Nanoparticles on Macrophages: a Pilot Study

Abstract The effects of fluorodeoxyglucose conjugated iron oxide magnetic nanoparticles (FDGMNP) on macrophages are presented using a yeast substrate. Iron oxide magnetic nanoparticles (MNP) were synthesized by partially reducing FeCl3, then conjugated with (3-aminopropyl) triethoxysilane (APTES) after silication with tetraethyl orthosilicate. Silanated MMP nanoparticles were combined with fluorodeoxyglucose (FDG). Fluorodeoxyglucose iron oxide magnetic nanoparticles (FDGMNP) and its unconjugated control (MNP) were added (1mL) to the cells from the murine macrophage-like, Abelson murine leukemia virus transformed cell line RAW 264.7 (American Type Culture Collection number TIB-71) cell culture wells at different concentrations from 90-3.6 μg/mL. Cells were placed on the magnet plate for 30 min before incubating at 37°C, 5% CO2 overnight. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide tetrazolium) assay was performed to measure cell viability. Our results demonstrate that iron based nanoparticles can be linked to macrophages (elements of the immune system that attack bacteria) without the function of the macrophages being affected, ie no detrimental effects to the macrophages were evident in these experiments. We conclude that neither FDGMNP nor MNP had a detrimental effect on macrophage function.

Perfil epidemiológico de agravos urológicos em homens cisgêneros em município da Bahia, Brasil / Epidemiological profile of urological disorders in cisgendered men in the municipality of Bahia, Brazil / Perfil epidemiológico de los trastornos urológicos en hombres cisgénero en el municipio de Bahía, Brasil

Objetivo: caracterizar o perfil epidemiológico de agravos urológicos em homens cisgêneros em uma unidade de urologia, nefrologia e transplante na Bahia, Brasil. Método: Estudo descritivo, quantitativo, transversal, realizado a partir da base de dados oriundos de 160 prontuários de atendimento em um hospital público, filantrópico, especializado, localizado em um município da Bahia, Brasil no ano de 2016. Os dados foram analisados no software Statistic Package Science for Social (SPSS). Resultados: Dos 160 homens atendidos na unidade de referência, na faixa etária ≥ 60 anos, casados, raçacor parda, escolaridade não informada, zona urbana e aposentados. Dos agravos urológicos identificados, 12 tipos de agravos foram identificados sendo os mais frequentes: câncer de próstata e hiperplasia prostática. As características clínicas foram: os hábitos de vida tiveram quantitativo expressivo de informações não fornecidas. Entretanto, daqueles informados, destacaram: ser tabagista e etilista. As doenças de base não foram informadas. Daquelas apontadas, destacaram a Hipertensão. O modo de identificação da doença, a maioria não informou, mas destacou-se a apresentação de sintomas. Os exames realizados foram os laboratoriais e o PSA. Sobre os tratamentos, o medicamentoso e cirúrgico foram os mais frequentes. Quatro usuários foram a óbito. Conclusão: O perfil de atendimentos de homens com agravos urológicos no serviço de referência, predominou os idosos, da raça negra (pretos e pardos) e o câncer de próstata como principal agravo urológico.

Objective: to characterize the epidemiological profile of urological disorders in cisgendered men in a urology, nephrology and transplant unit in Bahia, Brazil. Method: Descriptive, quantitative, crosssectional study, carried out from a database of 160 medical records in a public, philanthropic, specialized hospital, located in a municipality in Bahia, Brazil in 2016. The data were analyzed using the software Statistic Package Science for Social (SPSS). Results: Of the 160 men seen at the referral unit, aged ≥ 60 years, married, mixed race, uneducated schooling, urban area and retirees. Of the urological disorders identified, 12 types of disorders were identified, the most frequent being: prostate cancer and prostatic hyperplasia. The clinical characteristics were: life habits had a significant amount of information not provided. However, of those informed, they highlighted: being a smoker and alcoholic. The underlying diseases were not reported. Of those pointed out, they highlighted Hypertension. The mode of identification of the disease, most did not report, but the presentation of symptoms stood out. The tests performed were laboratory tests and PSA. Regarding treatments, medication and surgery were the most frequent. Four users died. Conclusion: The profile of visits by men with urological disorders at the reference service, predominated the elderly, blacks (blacks and browns) and prostate cancer as the main urological condition.

Objetivo: Objetivo: caracterizar el perfil epidemiológico de los trastornos urológicos en hombres cisgénero en una unidad de urología, nefrología y trasplante de Bahía, Brasil. Método: Estudio descriptivo, cuantitativo, transversal, realizado a partir de una base de datos de 160 historias clínicas de un hospital público, filantrópico, especializado, ubicado en un municipio de Bahía, Brasil en 2016. Los datos fueron analizados mediante el software Ciencia del paquete estadístico para las redes sociales (SPSS). Resultados: De los 160 hombres atendidos en la unidad de derivación, de ≥ 60 años, casados, mestizos, sin educación, zona urbana y jubilados. De los trastornos urológicos identificados, se identificaron 12 tipos de trastornos, siendo los más frecuentes: cáncer de próstata e hiperplasia prostática. Las características clínicas fueron: los hábitos de vida tenían una cantidad significativa de información no aportada. Sin embargo, de los informados destacaron: ser fumador y alcohólico. No se informaron las enfermedades subyacentes. De los señalados, destacaron Hipertensión. El modo de identificación de la enfermedad, la mayoría no informó, pero se destacó la presentación de los síntomas. Las pruebas realizadas fueron pruebas de laboratorio y PSA. En cuanto a los tratamientos, la medicación y la cirugía fueron las más frecuentes. Murieron cuatro usuarios. Conclusión: En el perfil de visitas de hombres con alteraciones urológicas al servicio de referencia, predominó el anciano, la raza negra (negros y pardos) y el cáncer de próstata como principal afección urológica.

Association between Neospora caninum seropositivity and reproductive disorders in girolando cows / [Associação entre a soropositividade para Neospora caninum e distúrbios reprodutivos em vacas girolando]

The aim of this study was to investigate the presence of anti-Neospora caninum antibodies in Girolando cows, in order to evaluate the association between seropositivity and reproductive disorders. Blood samples were collected from 40 dairy cows in their reproductive phase from the cranial superficial epigastric vein. The blood samples were tested using the Indirect Fluorescence Antibody Test (IFAT) to detect anti-N.caninum antibodies. The serological results were used to verify whether there was any association with the manifestation of reproductive disorders based on data from the records of reproductive history from 2017 to 2018 as well as the clinical observations of the herd throughout this study. The Fisher exact test was used to verify the existence of an association between the serology and reproductive disorders, adopting a 95% confidence level. The serological results showed a 27.5% seroprevalence in the herd for N. caninum, however, after statistical analysis, no association between seropositivity and reproductive disorders was found in the evaluated herd. Although the studied population is infected with Neospora caninum, we can infer that anti-Neospora caninum antibodies present in Girolando dairy cows at the UFRRJ Dairy Cattle Facility are not associated with the occurrence of reproductive disorders.(AU)

O objetivo deste estudo foi investigar a presença de anticorpos anti-Neospora caninum em vacas Girolando, avaliando-se a associação entre a soropositividade e os distúrbios reprodutivos. Foram coletadas amostras de sangue da veia epigástrica superficial cranial de 40 vacas leiteiras em fase reprodutiva, sendo as amostras testadas pela reação de imunofluorescência indireta (RIFI) para detecção de anticorpos anti-N. caninum. A partir dos resultados sorológicos, foi realizada a verificação de associação, ou não, com a manifestação de distúrbios reprodutivos, coletados nos registros de histórico reprodutivo entre 2017 e 2018 e observações do rebanho no transcorrer do estudo. O teste exato de Fisher foi utilizado para verificar a existência de associação entre a sorologia e os distúrbios reprodutivos, adotando-se nível de confiança de 95%. O resultado do estudo demonstrou uma soroprevalência no rebanho de 27,5% para N. caninum, contudo, após análise estatística, não foi confirmada a associação entre soropositividade e distúrbios reprodutivos no rebanho avaliado. Apesar de a população estudada estar infectada com o Neospora caninum, pode-se inferir que anticorpos anti-Neospora caninum presentes em vacas leiteiras Girolando do Setor de Bovinocultura de Leite da UFRRJ não estão associados à ocorrência de distúrbios reprodutivos.(AU)

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists

ABSTRACT Objectives To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. Materials and Methods A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. Results Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). Conclusions COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.