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.

Special strategies and management of urological diseases during the COVID-19 pandemic: initial experiences from a Medical Center of China

ABSTRACT Although urological diseases are not directly related to coronavirus disease 2019 (COVID-19), urologists need to make comprehensive plans for this disease. Urological conditions such as benign prostatic hyperplasia and tumors are very common in elderly patients. This group of patients is often accompanied by underlying comorbidities or immune dysfunction. They are at higher risk of COVID-19 infection and they tend to have severe manifestations. Although fever can occur along with urological infections, it is actually one of the commonest symptoms of COVID-19; urologists must always maintain a high index of suspicion in their clinical practices. As a urological surgeon, how we can protect medical staff during surgery is a major concern. Our hospital had early adoption of a series of strict protective and control measures, and was able to avoid cross-infection and outbreak of COVID-19. This paper discusses the effective measures that can be useful when dealing with urological patients with COVID-19.

Hipercalciuria hidiopática como factor predisponente de infección urinaria / Idiopathic hypercalciuria as predisposing factor of urinary infection

Introducción: La hipercalciuria idiopática es una alteración metabólica relativamente frecuente y existen escasas publicaciones de su relación con la infección del tracto urinario. Objetivos: Precisar si existe asociación entre la infección urinaria e hipercalciuria idiopática para determinar si esta alteración metabólica constituye un factor de riesgo de infección urinaria. Métodos: Estudio descriptivo longitudinal prospectivo en pacientes de edad pediátrica con diagnóstico de infección urinaria atendidos en el Hospital Pediátrico Universitario William Soler entre 1ro. enero de 2016 y 31 de diciembre de 2017. Dos semanas después de controlada la infección se recogió muestra de orina de la primera micción del día para determinación de índice calcio/creatinina y precisar la excreción de calcio en 24 horas. Si esta prueba arroja resultados positivos, entre dos y cuatro semanas posteriores, se repite la muestra y si ambas son positivas y el calcio en sangre es normal se diagnostica hipercalciuria idiopática. Resultados: Se incluyeron en el estudio 130 pacientes. En 43,8 por ciento se encontró hipercalciuria idiopática. En su primer episodio infeccioso se estudiaron 52,3 por ciento y los restantes con antecedentes de infección o recurrencia. En 86,2 por ciento la infección fue catalogada como pielonefrítica. La distribución por sexo de la hipercalciuria no mostró diferencia y el síntoma hematuria con dolor abdominal recurrente resultó sugestivo de infección asociada a hipercalciuria (p < 0,05). El germen infectante no contribuye a pensar en hipercalciuria. Conclusión: La hipercalciuria idiopática constituye un factor predisponente de infección del tracto urinario(AU)

Introduction: Idiopathic hypercalciuria is a relatively frequent metabolic alteration and there are scarce publications on its relation with the urinary tract´s infection. Objective: To specify if there is a relation between urinary infection and idiopathic hypercalciuria, in order to determine if this last one constitutes a risk factor of urinary infection. Methods: Prospective, descriptive and longitudinal study in pediatric age's patients with a diagnosis of urinary infection that were attended in William Soler University Pediatric Hospital from January 1st, 2016 to December 31st, 2017. After two weeks of the infection being controlled, a urine sample from the first micturition of the day was collected to determine calcium/creatinine index and to specify calcium excretion in 24 hours. If this test shows positive results, after two to four weeks the sample is repeated, and if both are positive and calcium level in blood is normal, so idiopathic hypercalciuria is diagnosed. Results: 130 patients were included in the study. In 43.8 percent idiopathic hypercalciuria was found. 52.3 percent were studied during the first infectious episode, and there is presented a history of infection or recurrence. In 86.2 percent of the patients, the infection was catalogued as pyelonephritis. Hypercalciuria´s gender distribution didn't show any differences, and the symptom called hematuria with recurrent abdominal pain was suggestive to an infection related to hypercalciuria (p < 0.05). The infectious germ does not induce to think in hypercalciuria. Conclusions: Idiopathic hypercalciuria constitutes a predisposing factor of urinary tract's infection(AU)

The Ochoa urofacial syndrome: recognize the peculiar smile and avoid severe urological and renal complications / Síndrome urofacial de Ochoa: reconheça o sorriso peculiar e evite complicações urológicas e renais graves

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients’ medical records were reviewed and patients’ urological status clinically reassessed. At last evaluation patients’ mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.

A síndrome de Ochoa é rara, e seus principais problemas clínicos são frequentemente não reconhecidos. Descrevem-se aqui características faciais de seis pacientes para auxiliar profissionais de saúde a reconhecer o sorriso invertido que eles apresentam e encaminhá-los para o tratamento adequado. Os prontuários médicos foram revisados e a condição urológica dos pacientes foi reavaliada clinicamente. A média de idade na última avaliação foi de 15,5 anos, variando de 12 a 32 anos. O seguimento médio foi de 35 meses (12 a 60). Os sintomas iniciais foram infecções do trato urinário em quatro pacientes (67%) associadas com enurese e incontinência urinária em três deles (50%). Um paciente apresentou infecções do trato urinário isoladamente e dois apresentaram sintomas do trato urinário inferior, porém sem infecções. O tratamento inicial consistiu em cateterismo intermitente limpo, com anticolinérgicos em todos os pacientes. Reconstrução urinária foi realizada em quatro pacientes (67%) por meio de ampliação vesical. Dois pacientes apresentaram doença renal em estágio terminal no seguimento, um recebeu transplante renal e outro manteve-se em lista de espera para transplante renal. Consanguinidade familiar esteve presente em apenas um caso. Essa condição significativa é rara, porém deve ser reconhecida por pediatras, nefrologistas e urologistas, a fim de instituir tratamento urológico agressivo precoce.

Anomalías del tracto urinario y microorganismos diferentes a Escherichia coli en la infección urinaria neonatal / Anomalies of the urinary tract and microorganism other than Escherichia coli in the neonatal urinary infection

Objetivo: verificar si existe asociación entre tipo de microorganismo aislado en recién nacidos que inician una infección del tracto urinario y la presencia de anomalías del tracto urinario. Métodos: estudio observacional, prospectivo, desde 1992 hasta 2010, de una cohorte de 427 recién nacidos que ingresaron con la primera infección del tracto urinario, de localización alta, por criterios clínicos, y que se realizaron ultrasonido renal y uretrocistografía miccional. Se analizó la asociación entre la presencia de reflujo vésico-ureteral y otras anomalías del tracto urinario, con el tipo de microorganismo causal de la infección del tracto urinario. Resultados: los aislamientos bacterianos en los urocultivos correspondieron en 402 de los pacientes a microorganismos del género Enterobacteriaceae (94,1 por ciento), liderados por la E. coli en 276 (64,6 por ciento). La prevalencia de anomalías del tracto urinario resultó ser de 23,6 x 100. El problema más prevalente fue el reflujo vésico-ureteral, presente en 82 pacientes (19,2 x 100). Se comprobó que la presencia de reflujo vésico-ureteral tuvo asociación de riesgo estadísticamente significativa con el microorganismo causal diferente a E. coli (RR: 1,56; p< 0,05). De igual manera, se relacionó la presencia de reflujo vésico-ureteral o de otro tipo de anomalía del tracto urinario, con el microorganismo causal de la infección del tracto urinario, y los resultados del análisis fueron similares (RR:1,64; p< 0,01). Conclusiones: aunque la E. coli es el microorganismo causal más frecuente de la infección del tracto urinario neonatal, cuando se obtiene un aislamiento diferente a E. coli es muy probable que el paciente sea portador de una anomalía del tracto urinario, dado que la presencia de reflujo vésico-ureteral y otras anomalías del tracto urinario se asocian significativamente a aquellos diferentes a E. coli

Objective: to confirm whether the type of microorganism isolated in newborns with initial urinary tract infection and the anomalies of the urinary tract are associated or not. Methods: prospective and observational study of a cohort of 427 newborns, who were admitted to the hospital with their first urinary infection in the upper tract based on clinical criteria, and they underwent renal ultrasound and urethrocystography. The relationship between the vesicourethral reflux and other anomalies of the urinary tract with the type of causative microorganism of the urinary tract infection was analyzed. Results: bacterial isolates in uricultures were Enterobacteriaceae genus microorganisms in 402 patients (94.1 percent), led by E. coli in 276 (64.6 percent ). The prevalence of anomalies of the urinary tract was 23.6 x 100. The most prevalent problem was vesicourethral reflux found in 82 patients (19.2 x 100). It was confirmed that the presence of vesicourethral reflux had statistically significant association, in terms of risk, with causative microorganism other than E.coli (RR: 1.56; p< 0.05). Similarly, the presence of vesicourethral reflux or of other type of anomalies in the urinary tract was related to the causative microorganism of the urinary tract infection and the results of the analysis were similar (RR:1.64; p< 0.01). Conclusions: although E.coli is the most frequent causative microorganism of the neonatal urinary tract infection, when an isolate different from E. coli is obtained, it is very likely that the patient carries some anomaly of the urinary tract since the presence of the vesicourethral reflux and other anomalies of the urinary tract are significantly associated to microorganisms other than E.coli

Microbiología y resistencia a antimicrobianos de urocultivos: en el Hospital Dr. Gustavo Fricke / Microbiology and antimicrobial resistance in urinary cultures: at Dr. Gustavo Fricke Hospital

Introducción: La terapia antibiótica, muchas veces empírica, es el eje fundamental del tratamiento de las infecciones del tracto urinario. Esto hace necesario conocer la flora bacteriana local y su patrón de resistencia para optimizar el tratamiento. Objetivo: Determinar frecuencia y resistencia de microorganismos en cultivos urinarios de pacientes adultos ambulatorios y pacientes críticos de nuestro medio hospitalario. Materiales y Método: Se realizó un estudio descriptivo retrospectivo de los urocultivos del año 2007 del Hospital Dr. Gustavo Fricke. Se utilizaron frecuencias, porcentajes, y prueba de Ji2 o Fisher para el análisis de los datos. Resultados: Se obtuvo un total de 11185 urocultivos, resultando 3500 positivos (31,29 por ciento), y de éstos 1247 polimicrobianos (39,06 por ciento). Se obtuvo 830 muestras correspondientes a pacientes ambulatorios, siendo el microorganismo más frecuentemente aislado Escherichia coli (Ec) (72,53 por ciento) seguido por Klebsiella pneumonías (Kp) (5,78 por ciento). Ec presenta una resistencia de 20,43 por ciento a ciprofloxacino, 49,5 por ciento a ampicilina, y 29 por ciento a cotrimoxazol. Se obtuvo 129 urocultivos correspondientes a unidades de pacientes críticos, aislándose más frecuentemente Ec (24,03 por ciento), Kp (20,93 por ciento), Candida albicans (16,28 por ciento) y Pseudomonas aeruginosa (13,95 por ciento). Se encontró una diferencia significativa al comparar las frecuencias de cada microorganismo entre pacientes ambulatorios y críticos (p=0,001), y al comparar los patrones de resistencia de Ec para diferentes antibacterianos entre ambos grupos. Conclusiones: La microbiología se ajusta a lo descrito en la literatura, aunque se observa mayor resistencia por parte de Ec a antimicrobianos de uso común en nuestro medio. Se observan además poblaciones microbiológicas diferentes entre el medio ambulatorio y el de pacientes críticos.

The antibiotic therapy, often empirical, is the fundamental axis in treatment of urinary tract infections. This makes necessary to know the local bacterial flora and its pattern of resistance to optimize the treatment. Aim: To determine the frequency and resistance of microorganisms in urinary cultures of adult ambulatory patients and critical units patients of our hospital. Materials and method: We conducted a descriptive retrospective study of the urinary cultures of 2007 at Dr. Gustavo Fricke Hospital. Frequencies, percentages, and 312 or Fisher test the data analysis. Results: A total of 11185 urinary cultures was obtained, with 3500 positives (31,29 per cent), and of these 1247 polymicrobial (39,06 per cent). There were 830 samples corresponding to ambulatory patients, and the most frequently isolated microorganism was Escherichia coli (Ec) (72,53 per cent) followed by klebsiella pneumoniae (Kp) (5,78 per cent). Ec presents a resistance of 20,43 per cent to ciprofloxacine, 49,5 per cent to ampicillin, and 29 per cent to cotrimoxazole. There were 129 urinary cultures from critical care patients, isolating more frequently Ec (24,03 per cent), Kp (20,93 per cent), Candida albicans (16,28 per cent) and Pseudomonas aeruginosa (13,95 per cent). There was a significant diffence when comparing the frequencies of every microorganism among ambulatory and critical units patients (p=0,001), and when comparing the pattern of drug resistence of Ec for different antibacterial agents between both groups. Conclusions: The microbiology of this sample adjusts to that described in the literature, although higher resistance is observed of Ec to antimicrobial agents of common use in our hospital. Microbiological different populations are observed among the ambulatory and critical units patients.

A study of abdominal pain in children.

Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal. Knowledge about its etiology and frequency helps in its evaluation and management. The present study was undertaken to find out the causes and their frequency of pain abdomen in Nepali children. Children with pain abdomen presenting at the emergency room and pediatric outpatient department of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 were clinically evaluated and investigated to find out the causes and frequency of their pain abdomen. The outcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completed investigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only. 91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic (9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related to surgical conditions, which needed operative management. Secondary or extra-abdominal causes were found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic (11) were predominant causes. Our study showed that the causes of pain abdomen in children were predominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, including functional and emotional causes were infrequent. Small percentage needing surgical management formed a diagnostic challenge.

Uropatía obstructiva femenina que se presenta como dolor pélvico / Voiding obstruction in female patients presenting as pelvic pain

El dolor pelviano crónico es una patología de creciente frecuencia y de origen multifactorial. El objetivo de este trabajo es describir el diagnóstico y tratamiento de pacientes con dolor pelviano crónico, cuya etiología es la uropatía obstructiva. Material y método: Se presenta una breve serie, retrospectiva, de 14 pacientes de sexo femenino, que se manifiesta con sintomatología caracterizada fundamentalmente por dolor pélvico, la mayoría de ellas catalogadas como portadora de cistitis intersticial. Todas las pacientes habían sido sometidas a tratamientos múltiples para su dolor pélvico, incluyendo instilaciones intravesicales, analgésicos, antiinflamatorios, opiáceos, manejo por equipos de dolor, etc. Todas estas pacientes fueron sometidas a estudio anatómico con tomografía axial computada de abdomen y pelvis y uretrocistoscopia, además de estudio funcional con evaluación urodinámica multi canal. Resultados: Se trata a un grupo de pacientes largamente estudiadas y sometidas a múltiples tratamientos. Entre ellas, destaca a un grupo de 6 pacientes que habían sido previamente sometidas acirugía para corrección de incontinencia urinaria. Las otras 8 pacientes, eran vírgenes de tratamiento para incontinencia urinaria. En ellas se encontró hipertrofia de cuello vesical primaria. Una paciente presentaba ambos orígenes de obstrucción. En todas ellas se demostró uropatía obstructiva, aun cuando los criterios urodinámicos para la demostración de esta patología fueron variables. Las pacientes fueron sometidas a Uretrolisis y a Resección de Cuello Vesical, dependiendo del origen de la uropatía obstructiva. Una paciente fue sometida a ambos procedimientos simultáneamente. En este grupo de pacientes, de las 6 pacientes sometidas a Uretrolisis, 5 presentaron desaparición de su sintomatología y mejoría de sus parámetros urodinámicos. De este grupo 1 paciente presenta aún sintomatología residual. De las 9 pacientes sometidas a Resección de Cuello...

Chronic pelvic pain is a multifactor entity with an increasing incidence. We describe the diagnosis and management procedures for patients with chronic pelvic pain and voiding obstruction. Material and methods: We report a series of 14 female patients that were retrospectively reviewed. All manifested chronic pelvic pain and most were diagnosed with interstitial cystitis. All patients underwent multiple treatments that included: intravesical instillations, apiaceous analgesics and consultations with pain management experts. Also all patients underwent abdominal and pelvic CT scan along with cystoscopy and complete urodynamic study. Results: Patients were widely studied and underwent multiple treatments. Six patients had been surgically treated for urinary incontinence, the other 8 had never been treated at all; in these patients primary bladder neck hypertrophy was found. One patient presented both causes of obstruction. In all patients voiding obstruction was evidenced, however urodynamics showed a wide variety of results. Patients underwent urethrolysis or bladder neck resection. One patient underwent both procedures in the same anesthesia. Symptoms disappeared and urodynamic results got better in 5 of the 6 patients that underwent urethrolysis All patients that underwent bladder neck resection (including the patient that underwent both procedures) were asymptomatic. Conclusion: Even though this is a small series of patients, we believe it is relevant due to the fact that obstructive pathology was not considered as a cause of chronic pelvic pain. We believe that voiding obstruction should be considered in the setting of chronic pelvic pain.

High-Dose Terazosin Therapy (5mg) in Korean Patients with Lower Urinary Tract Symptoms with or without Concomitant Hypertension: A Prospective, Open-Label Study

PURPOSE: We determined the efficacy and safety of a relatively high dose of terazosin (5mg) in Korean patients with lower urinary tract symptoms (LUTS), with or without concomitant hypertension. MATERIALS AND METHODS: From July to December 2006, 200 men who consecutively presented with LUTS were prospectively studied. Eight weeks after treatment, blood pressure (BP), uroflowmetry, and International Prostate Symptom Score (I-PSS) were assessed. For analysis purposes, patients were stratified according to concomitant hypertension. Of the 200 patients, 173 completed the scheduled eight-week treatment period. RESULTS: At baseline, no differences were evident in the two groups in terms of I-PSS, Qmax, PVR and BP. After eight weeks of treatment-although I-PSS and uroflowmetry parameters were not significantly different in the two groups-systolic and diastolic BP in the non-hypertensive control group were higher than in the hypertensive group (p= 0.001 and p=0.0100, respectively). Changes in I-PSS, uroflowmetry parameters, and BPs measured at week eight post- treatment commencement did not significantly differ between the two groups. Moreover, the addition of 5mg of terazosin to antihypertensives did not cause a significant reduction in either systolic or diastolic BP in either group. CONCLUSION: Adding terazosin to existing antihypertensive regimens did not seem to increase the incidence of adverse events. Our findings suggest that 5mg terazosin is effective and that it has an acceptable safety profile as an add-on therapy for patients with LUTS and concomitant hypertension.

The association between erectile function and severity of lower urinary tract symptoms.

It is unclear whether the erectile dysfunction (ED) that frequently occurs with lower urinary tract symptoms (LUTS) may have a common causative factor: sympathetic overactivity. The aim of this study was to evaluate the association between ED and LUTS. From June 1998 to March 2000, 75 male patients, presenting with LUTS, enrolled into the present study. A total of 63 patients were included into the study, age ranging from 51 - 74 years (mean 61.5). Allpatients completed an American Urological Association (AUA) symptom severity index and IIEF-5 questionnaires. The results from the present study demonstrated that the AUA symptom and IIEF-5 scores do not correlate with increasing age. When the statistical analyses were performed for each age group, there were no significant differences in mean IIEF-5 values between any degree of AUA symptom score in the same age group (p > 0.05). The present results indicate that there is no association between the degree of LUTS and the erectile function. Moreover, the statistical analyses of the association between any degree of erectile function and the mean A UA symptom score either for obstructive or irritative symptoms revealed no significant differences (p > 0.05). The present study demonstrates that there is no association between BPH and erectile function in any age group, inconsistent with the sympathetic overactivity theory.

Significance of recent onset nocturnal enuresis in adult men: a prospective study.

INTRODUCTION: Although literature on childhood nocturnal enuresis and its persistence into adulthood is abundant, recent onset nocturnal enuresis in adults is a poorly studied symptom. OBJECTIVE: To determine the significance of recent onset nocturnal enuresis in adult males in relation to lower urinary tract pathology, and its treatment. METHODS: All men with recent onset nocturnal enuresis attending a urology unit over a period of 12 months were evaluated prospectively. Their treatment and outcome were recorded. RESULTS: There were 30 patients (mean age 64 years). Ultrasonography revealed upper urinary tract dilatation in 22 patients. Another six patients had post-void residual urine volume over 500 mL without upper tract dilatation. Only two patients did not have ultrasonographic evidence of bladder outflow obstruction. Elevated blood urea was noted in 14 patients. Twenty patients underwent transurethral resection of the prostate (TURP) and one patient with balanitis xerotica obliterans had circumcision and meatotomy. Three patients were taught clean intermittent self catheterisation, and three patients preferred indwelling urethral catheters. One patient while awaiting TURP died of a myocardial infarction. Eight patients, who were treated with alpha-adrenergic antagonists initially, required further intervention later as the response to medical therapy was poor. CONCLUSIONS: Recent onset nocturnal enuresis in adult males is a symptom closely associated with significant lower urinary tract pathology requiring early urological intervention. Considering its impact on management it is reasonable to classify recent onset nocturnal enuresis as a lower urinary tract symptom in adult men and including it in symptom scores used to assess bladder outflow obstruction.

Multidetector CT Urography in Imaging of the Urinary Tract in Patients with Hematuria

This review article comprehensively discusses multidetector CT urography protocols and their role in imaging of the urinary tract in patients with hematuria.

Infección recurrente del tracto urinario en niñas y adolescentes y su relación con el estado nutricional / Recurrent urinary tract infection in girls and adolescents and its relationship with the nutritional status

Se realiza un estudio retrospectivo de 240 niñas y adolescentes atendidas por infección del tracto urinario; de éstas se seleccionaron 140 pacientes diagnosticadas de infección recurrente del tracto urinario, en edades comprendidas entre cero y 15 años. Se halló la valoración nutricional al compararlas con los resultados de las tablas cubanas, donde se observó afectación, peso para edad y peso para la talla en el grupo de menores de 9 años. Los gérmenes más frecuentes detectados fueron Escherichia coli 78 (por ciento) y proteus 12,0 (por ciento). Los síntomas que se apreciaron con más frecuencia fueron: fiebre, micción de esfuerzo y ardor miccional. Los hallazgos imagenológicos detectados fueron: duplicidad pieloureteral y reflujo vesicouretral. Se administró tratamiento clásico antimicrobiano y soporte nutricional y se vio una mejoría en los parámetros antropométricos. El tratamiento profiláctico se inició una vez realizado el diagnóstico de infección recurrente del tracto urinario, durante 6 meses. Los fármacos usados fueron: sulfisoxasol, nitrofurantoína, ácido nalidíxico, en una única toma al acostarse. El número de recurrencia disminuyó una vez instaurado el tratamiento profiláctico

Spontaneous bladder rupture secondary to posterior urethral valves in a neonate.

Bladder rupture is a rare cause of ascites in neonates. A review of literature revealed about 32 cases including both iatrogenic and spontaneous rupture. This case report describes a successfully treated case of spontaneous rupture of bladder with ascites in a neonate with posterior urethral valves.

Sustained hypertension in children.

OBJECTIVE: To study the etiology and clinical profile of children with sustained hypertension. DESIGN: Retrospective hospital-based study. SETTING: Tertiary care, referral center. SUBJECTS: 246 children with sustained hypertension presenting between January 1983 and December 1996. RESULTS: The mean age at presentation was 8.2+/-3.9 yr; range 2 months-16 yr. There were 180 boys. An underlying cause for hypertension was identified in 242 (98.4%); 4 patients were considered to have essential hypertension. The chief causes included chronic glomerulonephritis (GN) in 121 (49.2%), obstructive uropathy in 39 (15.8%), reflux nephropathy in 30 (12.2%), thrombotic microangiopathy in 15 (6.1%) and renovascular disease in 14 (5.7%). Takayasu's disease was the most common cause of renovascular hypertension. Coarctation of aorta was the commonest cause of hypertension in infancy, being present in 53.3% of cases. In 198 subjects (80.5%) hypertension was detected as a feature of a known underlying disease. Thirty-five patients however, presented for the first time with complications of severe hypertension, including congestive cardiac failure in 21 and encephalopathy in 23. Thirteen patients presented with nonspecific symptoms and hypertension was detected on clinical examination. CONCLUSIONS: Most patients with sustained hypertension have an underlying etiology. A significant proportion of patients with renovascular and endocrine conditions may present, for the first time, with complications of hypertension.