Enterococcal urinary tract infections in a university hospital: clinical studies

Although urinary tract infections (UTI) represent the most common infection caused by enterococci, some aspects remain to be fully clarified. The aim of this study was to determine the clinical characteristics present in UTI caused by Enterococcus spp. in patients followed up at the Prof. Edgard Santos Teaching Hospital of the Federal University of Bahia. All patients consecutively examined between 1997 and 2005, who received a diagnosis of UTI caused by Enterococcus spp. were included in the study. UTI was defined as the presence of 10(5) colony-forming units per mL of urine. Standard microbiological techniques were used. During the study period, 6.2 percent of the urine cultures were positive for Enterococcus spp. The mean age of the patients was 48.9 years and 57 percent were male. At initial evaluation, 13 percent of the patients had complaints suggestive of UTI. Nineteen patients had a history consistent with obstructive uropathy and 26 with neurogenic bladder. At final evaluation, UTI was the diagnosis in 48 patients. In 36 patients (29 percent), the primary diagnosis was related to urogenital diseases, consisting of obstructive uropathy in 23 of these cases, while in 32 patients (25.8 percent) primary diagnosis was related to neurologic diseases, frequently neurogenic bladder. UTI caused by Enterococcus spp. is not infrequent, is usually associated with few or no symptoms and occurs in sick patients who have anatomical or functional obstructive uropathy associated or not with urinary tract catheterization or instrumentation. The diagnosis of enterococcal UTI may indicate a urinary tract abnormality yet to be diagnosed.

Experimental supratrigonal cystectomy: evaluation of long-term complications

OBJECTIVE: The present study aims at assessing the occurrence of pyelonephritis and long-term complications in rats submitted to surgical reduction of bladder capacity. MATERIALS AND METHODS: Sprague-Dawley rats were submitted to supratrigonal cystectomy (29 animals) or sham operation (15 animals) and sacrificed 2, 4 and 6 months after the surgical procedure. The arterial blood pressure and serum creatinine levels were assessed before the surgery and at the time of the sacrifice. After the sacrifice a careful inspection of the urinary apparatus was performed to the characterization of the hydronephrosis and for the detection of the presence of calculi. With sterile technique, the urine was aspirated from the bladder and the kidneys removed and sent to a microbiologic study. RESULTS: Pyelonephritis was frequent in animals submitted to supratrigonal cystectomy. The most frequent and isolated microorganisms were Staphylococcus sp. and E. coli. The presence of urinary calculi was correlated significantly to the presence of urinary tract infection (p < 0.003). Arterial hypertension was frequent amongst animals submitted to supratrigonal cystectomy. Serum creatinine was high in 72.4 percent of the animals in the group submitted to supratrigonal cystectomy. The presence of calculi and pyelonephritis were frequent in rats presenting renal insufficiency and in hypertensive rats. CONCLUSIONS: The long-term course of urinary infection in rats submitted to supratrigonal cystectomy was characterized by a high incidence of renal insufficiency and arterial hypertension that seem to be related to dysfunction and bladder obstruction induced by an extensive surgical procedure and the presence of urolithiasis and pyelonephritis.

Simplified upper pole nephrectomy: initial experience

OBJECTIVE: To assess the results of an upper pole nephrectomy technique on 5 children. MATERIALS AND METHODS: Upper pole nephrectomy was performed on 5 children, including 4 females and 1 male. Age ranged from 3 to 6 years old. The technique was performed without initial dissection of the renal pedicle. The upper pole is incised and removed. Upon its complete dissection, the segment that drains the upper pole is easily identified, clamped and sectioned. RESULTS: Three children with ureterocele and 2 with ectopic ureter underwent this procedure. There was no intra- or postoperative complication with this technique. DSMA scintigraphy showed no decrease in renal function in the remaining kidney following the procedure. CONCLUSION: The polar nephrectomy technique is simple, and has the advantage of not approaching the renal hilum, which makes surgery less laborious and prevents risk of renal damage, hemorrhage and decreased function in the remaining renal portion.

Findings in cystourethrography that suggest lower urinary tract dysfunction in children with vesicoureteral reflux

PURPOSE: Children with lower urinary tract dysfunction and vesicoureteral reflux, at cystography assessment, frequently present alterations in the lower urinary tract anatomy such as dilated posterior urethra, irregularity of the bladder wall and diverticula. However, the significance of these findings is unknown. The objective of this study is to evaluate the incidence of these findings, their time of disappearance and their correlation with the severity of the reflux. MATERIALS AND METHODS: 193 children with vesicoureteral reflux, considered simple, in the age group above 5 years at the moment of diagnosis, were analyzed. The recommendation for follow-up of these patients was one voiding cystoureterography (VCUG) each year. Only patients with a minimum of 2 VCUGs performed in a period of at least 6 months were considered. The VCUGs were classified as positive and negative in relation to findings that were characteristic of lower urinary tract dysfunction (LUTD). RESULTS: From the 193 children analyzed, 50 (26 percent) presented positive VCUG and 143 negative VCUG. From the patients without symptoms of lower urinary tract dysfunction (n = 135), 12 (9 percent) presented positive VCUG and 123 (91 percent) a negative VCUG. From the patients with negative VCUG, 68 (48 percent) presented unilateral reflux and 75 (52 percent) presented bilateral reflux. From those with positive VCUG, 26 (52 percent) had unilateral reflux and 24 bilateral reflux (48 percent). This difference was not statistically significant. A higher incidence of grade II reflux was more evident in patients with negative VCUG and degree III in patients with positive VCUG (p < 0.05). CONCLUSIONS: Our study demonstrated that 64 percent of the patients with LUTD and reflux presented findings in the VCUG that suggest dysfunction.

Prevalence of prostate adenocarcinoma according to race in an university hospital

OBJECTIVES: To determine the prevalence of prostate cancer and to assess potential associations between race and prostate adenocarcinoma according to age in patients followed in an outpatient service of general urology in an university hospital. MATERIALS AND METHODS: Retrospective study of men aged from 40 to 79 years, followed during the period from 1999 to 2001. Patients were classified according to race in White, Mulatto and Black. Those with abnormal digital rectal examination and/or serum level of prostate specific antigen (PSA) > 4.0 ng/ml, underwent a transrectal prostate biopsy. RESULTS: 580 patients with mean age of 60.7 ± 10.0 years were studied, with 116 Whites (20.0 percent), 276 Mulattos (47.6 percent) and 188 Blacks (32.4 percent). There was no significant difference regarding the mean age (p = 0.62), serum level of PSA (p = 0.65) and prevalence of prostate adenocarcinoma between Whites, Mulattos and Blacks (p = 0.36). While studying the association between race classified in 2 groups (Whites versus Mulattos and Blacks) and prostate adenocarcinoma according to age, no association was found when the total group was assessed, neither among those with age above 60 years old. In the group between 40 and 60 years, even though without statistical significance, the estimate of prevalence ratio was 2.2 (CI 95 percent: 0.52 to 9.0; p = 0.38). CONCLUSION: Prostate adenocarcinoma was found in 16.6 percent of the patients aged between 40 and 79 years. We did not find a racial influence in our population.

Infecçäo do trato urinário pós-prostatectomia-tratamento com lomefloxacina / Treatment with lomefloxacin of post-prostatectomy urinary tract infection

Estudamos a eficácia de lomefloxacina em 20 pacientes portadores de infecçäo urinária pós-prostatectomia. Após a remoçäo da sonda uretral foram tratados com 400mg de lomefloxacina por via oral, dose única diária, durante dez dias. A eficácia da medicaçäo foi avaliada clínica e bacteriologicamente. Das 22 racas bacterianas isoladas do trato urinário, 90,1 por cento foram sensiveis in vitro a lomefloxacina. Clinicamente houve cura dos 20,100 por cento dos pacientes, sendo que três semanas após a retirada da lomefloxacina reapareceu infefcçäo urinária em três, ocorrendo reinfecçäo. A tolerabilidade ao produto foi excelente. Houve elevado indice de cura, apesar das alteraçöes do trato urinário existentes na fase inicial da pós-prostatectomia, dificultando a erradicaçäo do germe infectante

Tratamento da infecçao urinaria nao complicada: uso de uma quinolona difluorada: lomefloxacina / Treatment of uncomplicated urenary tract infection with lomefloxicin, a difluorinated quinolone

Este e um estudo prospectivo, aberto, nao comparativo envolvendo 10 centros de pesquisa, que avaliou a segurança e a eficacia da lomefloxacina (quinolona difluorada) no tratamento da infecçao nao complicada do Trato Urinario (ITU). oram incluidos 88 pacientes de ambos os sexos (68 mulheres) com idade media de 41 anos. Os pacientes deviam apresentar 2 ou mais sinais e sintomas de infecçao do trato urinario e urocultura com presença de mais de 100.000 colonias por milimetro. Cada paciente recebeu um comprimido de 400 mg de lomefloxacina uma vez ao dia por sete dias. A avaliaçao

Tratamento de uretrite gonocócica por norfloxacin / Treatment of gonoccocal urethritis by norfloxacin

Norfloxacin, quinolônico utilizado por via oral, relacionado ao ácido nalidíxico, tem atividade "in vitro" contra N. gonorrhoaea. Trinta homens com uretrite gonocócica resistente à penicilina, foram dividios em dois grupos e tratados com 1200mg de Norfloxacin (divididos em duas aplicaçöes, a primeira de 800mg, seguida 4 horas após de 400mg) e outro grupo recebendo 800mg do produto em dose única. Todos os pacientes tratados com 1200mg do produto foram curados. Na dose única de 800mg, houve 1 caso näo curado de uretrite. A eficácia do produto nos dois grupos, portanto foi excelente. Deste modo, acreditamos que o Norfloxacin pode ser utilizado para o tratamento de uretrite gonocócica, e provavelmente seu uso deva ser cada vez mais indicado nos casos com elevada prevalência de N. gonorrhoaea resistente à penicilina

Tratamento da infecçäo do trato urinário pós-prostatectomia com cefotaxima / Treatment of post-prostatectomy urinary tract infection with cefotaxime

Estudou-se a eficácia da cefotaxima em 29 pacientes portadores de infecçäo urinária pós-prostatectomia. Todos os pacientes foram tratados, após a remoçäo da sonda uretral colocada no pós-operatório, com lg de cefotaxima por via intramuscular, a cada 12 horas, durante 7 dias. A eficácia da medicaçäo foi avaliada clínica e bacteriologicamente. Das raças bacterianas isoladas do trato urinário destes pacientes, 96,7% foram sensíveis "in vitro" à cefotaxima. Houve cura clínica em 22 (75,9%) dos casos, sendo que 4 destes pacientes tiveram reinfecçäo no acompanhamento tardio. Houve persistência da infecçäo em 7 (24,1%) pacientes. A tolerância ao produto foi considerada excelente. Comenta-se o habitualmente elevado índice de persistência de infecçäo como, talvez, devido às alteraçöes do trato urinário na fase imediata pós-prostatectomia, dificultando a erradicaçäo do agente infectante. Apesar disso, para a situaçäo clínica tratada, a eficácia de cefotaxima foi considerada muito boa

Duplicidade da bexiga / Double bladder

Os autores apresentam um caso de duplicidade de bexiga e analisam os aspectos embriológicos, diagnósticos, terapêuticos e fazem revisäo da literatura

Peculiaridades da bacteriologia urinária em pacientes com estreitamento inflamatório da uretra submetidos a sucessivas dilataçöes / Peculiarity from urinary bacteriology in patients with urethra inflammatory striation submited to successives dilatations

Foi realizado estudo prospectivo de 40 pacientes do sexo masculino, portadores de estreitamento inflamatório da uretra, procurando-se verificar o bacteriológico da flora infectante do trato urinário face às repetidas manobras de dilataçäo. Além disto, estudou-se a capacidade antibacteriana da urina de estreitados crônicos frente a uma raça de E. coli e outra de Staph. aureus. Após sucessivas sessöes de dilataçäo, a flora infectante se manteve a mesma em 10(25%) casos; em 9(22,5%) casos, houve mudança da flora infectante durante os cateterismos repetidos; em igual número (22,5), uroculturas inicialmente negativas tornou-sea positivas, no decorrer do processo de dilataçäo, e somente em 1 caso a urocultura inicialmente positiva tornou-se negativa, no decorrer da dilataçäo. Vale salientar que 11 (27,5%) tiveram uroculturas sempre negativas, a despeito do estreitamento uretral, particularmente daqueles com uroculturas repetidamente negativas. Em 9 de 15 casos, houve inibiçäo do crescimento de Staph. aureus e em 6 de 15 a E. coli foi inibida, sendo que em 4 casos este poder inibitório se fez para ambas as bactérias. Cumpre destacar que o poder inibitório é filtrável no filtro de Seitz, necessitando maiores investigaçöes