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.

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.

Protocolos de encaminhamento da atenção básica para a atenção especializada: urologia / Primary care referral protocols for specialized care: urology

Este material tem como objetivo orientar as equipes que atuam na AB, qualificando o processo de referenciamento de usuários para outros serviços especializados. É uma ferramenta, ao mesmo tempo, de gestão e de cuidado, pois tanto guiam as decisões dos profissionais solicitantes quanto se constitui como referência que modula as avaliações apresentadas pelos médicos reguladores.

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.

Current status of stem cell therapy in urology

No abstract available.

Endometriosis tracto urinario: revisión de la literatura / Urinary tract endometriosis: review of the literature

Se define como endometriosis a la presencia de tejido endometrial fuera de la cavidad uterina. La endometriosis del tracto urinario (ETU) se refiere a la presencia de tejido endometrial en o alrededor de la vejiga, uréteres, uretra o riñones, lo que ocurre en alrededor de 1por ciento de los casos. El objetivo de esta revisión es realizar una puesta al día en los conceptos relativos a esta rara enfermedad. Se analiza clínica, fisiopatología y tratamiento.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Urinary tract endometriosis (ETU) refers to the presence of endometrial tissue in or around the bladder, ureters, urethra or kidneys, which occurs in about 1percent of cases. The objective of this review is to update the concepts concerning this rare disease. Clinic, pathophysiology and treatment are discussed.

Anomalías nefrourológicas congénitas en niños hospitalizados / Nephrourological congenital anomalies in children hospitalized

Introducción : las anomalías congénitas nefrourológicas se encuentran en segundo lugar en frecuencia entre las malformaciones detectadas por ecografía prenatal. La importancia del diagnóstico precoz radica en la posibilidad de prevenir infecciones urinarias, corregir la obstrucción urinaria y evitar o enlentecer el deterioro de la función renal. En nuestro país, el 30,4% de los menores de 15 años en diálisis crónica tiene una insuficiencia renal por nefrouropatía malformativa. Los objetivos fueron conocer la tasa de hospitalización, describir las características clínicas y evolutivas de los niños hospitalizados con diagnóstico ecográfico pre y postnatal de malformación nefrourológica. Material y métodos: estudio descriptivo, prospectivo. Se incluyeron los niños con ecografía del aparatourinario patológica hospitalizados en el sector de cuidados moderados del HP-CHPR entre 01/07/2012 y el 30/6/2013, se excluyeron aquellos con disfunción vesical o glomerulopatía crónica. Se valoró: edad, sexo, hallazgo ecográfico, diagnóstico nosológico, manifestaciones clínicas, evolución y tratamiento. Resultados: se incluyeron 44 niños, la tasa de hospitalización fue 3.9‰, relación masculino/femenino 1,9/1; la mediana de edad 23 meses (percentil 75: 91 meses). Se realizó ecografía prenatal en 36/44, de las cuales 18 fueron patológicas. Se controlaron ecográficamente luego del nacimiento 11/18. En los 26 pacientes restantes, el diagnóstico ecográfico se realizó en la etapa postnatal previo a la internación en 15 y durante la hospitalización en 11. El número de malformaciones halladas fue 66; 22 fueron bilaterales. Predominaron el reflujo vésicoureteral(n=19), las obstrucciones (n=15), y la agenesia/displasia renal (n=18). Requirieron tratamiento quirúrgico 21, endoscópico seis.(...)

Introduction: congenital abnormalities of urinary tract andkidneys rank second in frequency of structuralabnormalities on antenatal ultrasound. Early diagnosisallows to prevent urinary tract infections, to treat urinarytract obstruction and to avoid or slow the decline in renalfunction. In our country 30,4% of patients younger than 15years old on chronic dialysis have a kidney failurebecause of a congenital abnormality.The aims of this study were to know the hospitalizationrate and to describe clinic and evolutionary characteristicsof hospitalized children with a congenital abnormality ofurinary tract and kidneys diagnosed by antenatal/postnatal ultrasound.Patients and methods: a descriptive and prospectivestudy was performed. Hospitalized children in HP-CHPR,between 01/07/2012 and 30/06/2013, with pathologicultrasound of kidneys or urinary tract, were included.Children with bladder dysfunction or glomerulopathy wereexcluded. We considered age, gender, ultrasoundfindings, definitive diagnosis, clinic manifestations,treatment and outcome.Results: we included 44 children. Hospitalization rate was3.9 0/00, the relation male/female was 1.9/1 and themedian age 23 months (75th percentile: 91 months).Antenatal ultrasound was performed in 36/44 patients; 18of them were pathologic; among these last ones, 11/18underwent postnatal ultrasound to control findings. In theother 26 patients, the diagnosis of pathologic ultrasoundwas made after birth: in 15 of them before thehospitalization and in 11 during the hospitalization. Wefound 66 affected kidneys; 22 were bilateral. The mostfrequent diagnosis were: vesicoureteric reflux (n=19),obstruction (n=15) and renal dysplasia/ agenesis (n=18).Twenty one patients underwent surgical treatment and 6underwent endoscopic treatment; 8 patients receivedmore than one invasive treatment...

Inmunoterapia para las infecciones recurrentes del tracto urinario: efectos de un extracto de escherichia coli: [revisión] / Immunotherapy for recurrent urinary tract infections: effects of an escherichia coli extract: [review]

La carga de las infecciones del tracto urinario (ITU) es alta en el mundo entero. Debido a que los tratamientos causales de estas infecciones frecuentemente recurrentes tienen límites sustanciales, las medidas preventivas merecen la prioridad. Entre ellas, la inmunoestimulación con extractos bacterianos ha demostrado que previene las ITUs y que es muy segura. Esta revisión enfoca el inmunoestimulante OM-89, un extracto liofilizado de Escherichia coli producido mediante biotecnología, formulado para la administración por vía oral a partir de este germen frecuentemente responsable de las ITU, y cubrirá sus efectos farmacológicos y clínicos con respecto a eficacia y seguridad. Se pondrá énfasis especial en los estudios clínicos realizados en niños, adultos y pacientes especiales así como en un estudio que evaluó el efecto de OM-89 sobre la calidad de vida de los pacientes.

Neuromodulación en patologías de piso pélvico / Neuromodulation in pelvic floor dysfunctions

Através de la historia la neuromodulación ha demostrado ser una alternativa de tratamiento eficaz en el manejo de diversas disfunciones del piso pélvico. Distintas técnicas intentan conseguir un objetivo común, sin embargo, el éxito terapéutico es disímil dependiendo de la severidad y tipo de patología. Describimos los aspectos clínicos y operacionales relacionados con las diversas técnicas, así como los mecanismos de acción propuestos para la neuromodulación.

Through hystory, neuromodulation have proved to be an effective alternative of management of pelvic floor dysfunctions. Several technical alternatives try to reach a same therapeutic objetive, however, depending on the severity and type of symptom their succes differ. We describe the clinical and technical aspects related to those different technics so as the mechanisms of action that are propose for the neuromodulation.

Diagnóstico y evolución de las malformaciones congénitas del riñón y vías urinarias: 1999-2005: Holguín 2007 / Diagnosis and evolution of congenital malformations of the kidney and urinary tract

Con el objetivo de evaluar la experiencia clínica en los Servicios de Nefrología y Urología del Hospital Pediátrico Provincial Docente Octavio de Concepción y de la Pedraja de Holguín se realizó un estudio descriptivo de 351 pacientes atendidos entre enero 1999 y diciembre 2005. En esta serie de 351 pacientes fueron diagnosticadas 535 malformaciones congénitas del riñón y vías urinarias de 19 tipos. El reflujo vesico ureteral primario, la estenosis de la unión ureteropiélica y el doble sistema excretor fueron en ese orden, las malformaciones más frecuentes, siendo la edad más común de diagnóstico durante el primer año de vida. La mayoría de los pacientes se presentaron con infección del tracto urinario y un número importante fueron asintomáticos. La ultrasonografía y la uretrocistografía miccional convencional resultaron una combinación efectiva para el diagnóstico de estas. La mayoría de los pacientes a los que se les realizó diagnóstico prenatal tenían una Hidronefrosis Congénita. La valva de uretra posterior fue la principal causa de insuficiencia renal crónica. Los grados I, II y III de reflujo vesico ureteral primario casi siempre desaparecen espontáneamente, siendo el tratamiento médico o conservador la piedra angular en el manejo de estos pacientes. Apreciamos una relación directa entre la nefropatía de reflujo y el grado de esta entidad.

Etiologia e perfil de resistência das bactérias isoladas a partir de uroculturas oriundas de mulheres acima dos 18 anos / Etiology and bacterial resistance profile of urinary tract infection in women older than 18 in Recife, Brazil

A infecção do trato urinário (ITU) é uma síndrome clínica de alta incidência, predominantemente em mulheres, sendo tratada, muitas vezes, de forma empírica, isto é, sem uma confirmação microbiológica. Devido à carência de pesquisas sobre infecção urinária no Nordeste do Brasil, o presente estudo se propôs a identificar o perfil etiológico dessa infecção e a suscetibilidade dos microrganismos isolados diante dos antimicrobianos em mulheres maiores de 18 anos, aproveitando-se a demanda espontânea de um laboratório privado, situado na cidade de Recife - Pernambuco. O período da pesquisa foi o compreendido entre novembro de 2006 e maio de 2007. Analisou-se um total de 1.550 amostras de urina oriundas de pacientes com queixas urinárias que incluíam: disúria, polaciúria, dor em baixo ventre, através da cultura em meios de Ágar sangue e Teague. As 502 culturas positivas foram submetidas a uma bateria de testes bioquímicos para identificação bacteriana, através da inoculação das colônias em meios de tríplice açúcar ferro (TSI), lisina, indol e ornitina. Empregou-se ainda o método da difusão em Ágar para avaliar-se o perfil de sensibilidade dos patógenos aos antimicrobianos. As bactérias mais frequentemente isoladas foram: Escherichia coli (61,16%), Klebsiella pneumoniae (12,75%) e Proteus mirabilis (7,37%). Curiosamente, o Staphylococcus saprophyticus foi o quinto isolado em ordem de frequência (2,79%). Verificou-se uma resistência importante dos três microrganismos frequentemente isolados a sulfametoxazol-trimetoprima (SMZ-TMP) (em, respectivamente, 46,58%, 29,69% e 18,92% dos casos), o que desaconselha o seu uso como droga de primeira escolha para tratamento de ITU. O perfil de resistência bacteriana às duas quinolonas testadas, ciprofloxacina e norfloxacina, foi semelhante nas uroculturas estudadas, tendo a E. coli demonstrado uma resistência significativa a esses dois antimicrobianos (20,85%).Ademais, a resistência aos antimicrobianos beta-lactâmicos...

Fluoroscopy guided instillation therapy in chyluria using combination of povidone iodine with contrast agent: is a single instillation sufficient?

PURPOSE: To evaluate the safety and efficacy of a single instillation in a combination of povidone iodine with contrast agent under fluoroscopy guidance for the treatment of chyluria. MATERIALS AND METHODS: From December 1999 to July 2006 a total of 40 patients with chyluria were treated by renal pelvic instillation therapy (RPIS). The sclerosing solution was prepared using povidone iodine with contrast agent diluted with sterile water in a ratio of 1:1:3. It was instilled on the side having chylous efflux using a bulb tip ureteric catheter. Unilateral instillation was done in 26 cases, 10 on the right side and 16 on left. Fourteen patients had bilateral chylous efflux and RPIS was performed on both sides in the same session. Fluoroscopy was used to evaluate the complete filling of the pelvic calyceal system. The sclerosing solution was kept in the system for 5 minutes and the ureteric catheter was then withdrawn. RESULTS: Immediate clearance was observed in 39 patients. Recurrence occurred in five patients. They were treated again using the same procedure with satisfactory results. The longest follow-up was five years and the shortest five months. CONCLUSION: RPIS of chyluria using a single instillation a combination of povidone iodine with contrast agent is safe and effective. Use of fluoroscopy helps to determine the exact amount of sclerosing solution required to completely fill the system and therefore overfilling is avoided. Moreover, the complications, which arise due to pyelointerstitial backflow, are prevented.

Urgencias urológicas / urological emergency

Esta obra tiene vasrios objetivos como son, en primer lugar, el intentar reunir o consolidar en un texto los estados urológicos urgentes de tratamiento médico y quirúrgico, aclarando definiciones, cuadros clínicos y exámenes complementarios para llegar al diagnóstico y el tratamiento; segundo, incluir el texto como material docente complementario en el libro de la asignatura Urología que utilizan los alumnos de pregrado de la carrera de Medicina y, tercero, exponer mis experiencias en el tema obtenidas durante más de 30 años de trabajo docente asistencial como unsencillo aporte a la educación médica de posgrado.

Procedimientos mínimamente invasivos en nefrourología y patología pelviana / Minimally invasive procedures in nephrourology and pelvic pathology

Future medicine tendency is executing minimum invasive procedures in areas such as diagnostic and therapeutic. Nephrourology is not the exception. Simple and complex techniques are analyzed and described at the Interventional Unit of Imaging Center, Hospital Clínico Universidad de Chile, with theoretic and practical basis approved by several national and international institutions.

Determinación de la susceptibilidad de Escherichia coli en aislamientos del tracto urinario por el sistema DIRAMIC / Antimicrobial susceptibility of Escherichia coli urinary tract isolates by the DIRAMIC system

Las infecciones del tracto urinario (ITU) constituyen una de las más frecuentes en el hospital y la comunidad siendo Escherichia coli el microorganismo principalmente involucrado en estos procesos. El presente trabajo tuvo como objetivo principal evaluar la susceptibilidad de este patógeno frente a un grupo de antimicrobianos comúnmente empleados en el tratamiento de estas infecciones, a partir de un análisis retrospectivo de los datos acumulados y procesados durante el periodo Enero 2001 a Diciembre 2004 por el sistema DIRAMIC desde 11 hospitales pediátricos ubicados en diferentes regiones del país. Se procesaron 3.300 cepas, 2.401 de la comunidad y 899 hospitalarias. Se encontraron porcentajes de resistencia superiores en los aislados de la comunidad siendo significativos (p = 0,00) para kanamicina (37,7% contra 26,0%) cefazolina, (44,7% contra 28,1%) ácido nalidíxico (34,6% contra 24,7%), sulfametoxazol/trimetoprim (84,5% contra 68,8%) y ciprofloxacina (29,2% contra 15,1%), aunque no se observó incremento en el periodo. Para los aislamientos hospitalarios se encontró una tendencia de incremento significativo en el periodo para kanamicina, gentamicina, amicacina, cefazolina y ciprofloxacina (p = 0,00). Los antibióticos menos efectivos in vitro fueron sulfametoxazol/trimetoprim, ampicilina, tetraciclina y cefazolina y los más efectivos quinolonas, nitrofurantoína, gentamicina y amicacina.

Infecções do trato urinário / Urinary tract infections

As infecções do trato urinário representam problema de grande relevância clínica, não só pela elevada frequência com que acometem mulheres e homens vivendo na comunidade, mas também por representar a primeira causa de infecção em pacientes hospitalizados. Na presente revisão, o autor apresenta os conceitos atuais sobre a epidemiologia, os fatores etiopatogênicos, as manifestações clínicas e os métodos de diagnóstico / Urinary tract infections have an extremely high clinical prevalence in both the community as well as in nosocomial patients. This behavior justifies the efforts that habe been made to disseminate the present knowledge on urinary tract infections to the members of most clinical specialities. In the present review the authors discuss and treatment of urinary tract infections, with emphasis on the practical clinical approach to such cases...