Urological complications of COVID-19: a systematic review

ABSTRACT Purpose: COVID-19 continues to be an urgent World issue. Receptors of angiotensin converting enzyme 2 (ACE2), gateway of SARS-CoV-2, are present in the lungs, bladder, prostate, and testicles. Therefore, these organs face high risk of damage caused by the virus and this mechanism may explain non-respiratory symptoms of the disease. Materials and Methods: This systematic review, guided by the PRIMSA statement, was proposed to elucidate possible urological complications of COVID-19. Searches were carried out in Medline (PubMed), Cochrane (CENTRAL), Embase, MedRxiv and LILACS. Bias analysis was made using the specific Newcastle-Ottawa Scale for each study design. Results: Search was carried out until April 2022, and 8,477 articles were identified. Forty-nine of them were included in this systematic review. There is evidence that lower urinary tract symptoms and acute scrotum may be signs of COVID-19 in men, although in a small proportion. Also, the disease may have a transitory impact on male fertility, evidenced by several alterations in sperm counts. However, it must be clarified whether this impact is transitory, or may last for longer periods. Several patients showed reduction of total value of testosterone. Two authors linked low levels of testosterone with worse outcomes of COVID-19, suggesting that the hormone may be used as an early biomarker of the severity of the disease. Moreover, it is extremely unlikely that SARS-CoV-2 is transmitted by semen. Conclusion: This systematic review identified possible repercussions of COVID-19 in the urinary as well as in the male reproductive system.

Impact of COVID-19 on education, health and lifestyle behaviour of Brazilian urology residents

ABSTRACT Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents' concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 - 7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents' concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents´ training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents' losses.

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.

Renal hemangiopericytoma: case report and literature review / Hemangiopericitoma renal: relato de caso e revisão de literatura

Hemangioperycytoma is a rare perivascular tumor that seldom involves the urogenital system. This tumor often appears with an unspecific clinical picture, and sometimes is associated with hematuria or hypertension. Diagnosis is based on a combination of histological and immunohistological findings. We report a case of a 52-year-old patient with renal hemangiopericytoma who underwent surgical treatment at our service. This report also includes a literature review on the subject.

Hemangiopericitoma é um raro tumor perivascular que raramente envolve o sistema urogenital. Esses tumores geralmente se manifestam com quadro clínico inespecífico, por vezes associado a hematúria ou hipertensão. O diagnóstico baseia-se numa combinação de alterações histológicas e imuno-histológica. Este artigo relatou o caso de uma paciente de 52 anos de idade com um hemangiopericitoma renal submetida a tratamento cirúrgico em nosso serviço e incluiu uma revisão de literatura sobre o assunto.

Small cell carcinoma of the bladder / Carcinoma de células pequenas de bexiga

Small cell carcinoma of the urinary bladder is an extremely aggressive and rare tumor. Even though small cell carcinoma most commonly arises from the lungs there are several reports of small cell carcinoma in extrapulmonary sites. Due to its low frequency there is no well-established management for this disease. We report the case of a 61 year-old man with small cell carcinoma of the bladder who underwent radical cystectomy following neoadjuvant chemotherapy. We also reviewed the literature for the optimal treatment strategy.

O carcinoma de células pequenas da bexiga urinária é um tumor extremamente agressivo e raro. Apesar desses tumores terem como sítio principal o pulmão, existem diversos relatos de carcinoma de pequenas células extrapulmonares. Pela baixa frequência, ainda não existe um tratamento bem estabelecido para essa neoplasia. Relatamos o caso de um homem de 61 anos de idade com carcinoma de células pequenas da bexiga urinária que foi submetido à quimioterapia neoadjuvante seguida de cistectomia radical. Fazemos ainda revisão na literatura em busca dos métodos de maior sucesso para o tratamento.

Cistectomia com reconstrução de neobexiga ortotópica ileal para tratamento de bexiga contraída após aplicação de bacilo de Calmette-Guérin intravesical / Cystectomy with orthotopic ileal neobladder reconstruction for treatment of bladder contracture after intravesical bacillus Calmette-Guerin therapy

O câncer de bexiga é um importante problema de saúde mundial, tanto pelas elevadas taxas de prevalência, quanto pelos custos relacionados ao tratamento. Desde a introdução da imunoterapia intravesical adjuvante com bacilo Calmette-Guérin, vem sendo observada diminuição na taxa de recorrência. As principais complicações são de pequeno porte e simples resolução a partir de medidas locais e orientações. A bexiga contraída, uma complicação local rara e grave, mas incapacitante em alguns casos, é observada principalmente em doentes com um programa de manutenção. Relatamos aqui o caso de um paciente masculino submetido a ressecção transuretral da bexiga por um carcinoma urotelial T1 de alto grau, que desenvolveu tal complicação durante tratamento com bacilo Calmette-Guérin, sendo portanto submetido à cistoprostatectomia com realização de neobexiga ortotópica ileal.

Bladder cancer is an important health problem worldwide due to high prevalence rates and costs related to treatment. A reduction in recurrence rates has been observed since the introduction of adjuvant intravesical immunotherapy with bacillus Calmette-Guerin. There are mild complications that are easily solved by local measures and orientations. Bladder contracture, a rare and severe local complication, in some cases leading to disability, is observed primarily in patients in a maintenance program. In this article we reported the case of a male patient who underwent transurethral resection of the bladder because of a high-grade T1 urothelial carcinoma and developed this complication during treatment with bacillus Calmette-Guerin. For this reason he was submitted to cystoprostatectomy with orthotopic ileal neobladder reconstruction.

Macroscopic alteretions in kidneys retrieved for transplant / Alteraciones macroscópicas en riñones recibidos para trasplante

El análisis de alteraciones macroscópicas en riñones recibidos para trasplante es de gran importancia debido a que estas anomalías pueden impedir usar el órgano Ciento cincuenta y cinco (1 55) descripciones de riñones recibidos para trasplante en el hospital de Santa Casa de Sao Paulo fueron realizadas entre enero y diciembre 2009. De los 155 riñones recibidos desde donantes cadáveres durante el periodo, 22 (1 5 por ciento) presentaron alteraciones macroscópicas. La alteración más frecuente fue la presencia de quistes renales. Encontrados en 12 (7,7 por ciento). Se reportaron otras alteraciones menos frecuentes, incluyendo hidroureteronefrosis en 4 (2,55 por ciento) casos, agenesia renal en 2 (1 ,3 por ciento), hematoma renal en 3 (1 .93 por ciento) y un caso de trauma sólido (0,64 por ciento). De tos riñones que presentaron alteración 15 (68 por ciento) fueron usados para trasplante y 7 (32 por ciento) se descañaron. Conclusión: La alteración macroscópica más común identificada en los riñones recibidos fue el quiste renal en 1 2 (7,7por ciento) de los casos, un hallazgo que está en la línea de lo reportado en la literatura para el hallazgo de quistes renales en la población. La mayoría de los riñones con alteraciones (1 5/68 por ciento) fueron usados para el trasplante. demostrando que la mayor parte de las alteraciones no comprometen la viabilidad del Órgano...

The analysis of macroscopic alterations in kidneys for transplants is of great importance since such anomalies can preclude organ use. One hundred and fifty-five (1 55) surgical descriptions of kidneys retrieved for transplant at the Santa Casa de Sao Paulo hospital were carried out between January and December 2009. Of the 155 kidneys retrieved from deceased donors during this analysis period, 22 (1 5 percent) showed macroscopic alterations. The most frequent isolated alteration was the presence of renal cysts. found ¡n 12 (7.7 percent) cases. Other less frequent alterations were reported including ureterohydronephrosis in 4 (2 .58 percent) cases. renal agenesis 2 (1 .3 percent) cases, hematoma in 3 (1.93 percent) cases, and 1 (0.64 percent) case of sold injury Of all kidneys that presented alterations, 15 (68 percent) were still used for transplants and 7 (32 percent) were discarded. The most common macroscopic alteration identified in retrieved kidneys was renal cyst. occurring in12 (7.7 percent) cases, a finding in line with incidence of renal cysts reported in the literature. The majority of the kidneys with alterations (1 5 - 68 percent) were still used for transplants. demonstrating that most alterations do not compromise organ viability...

Sterilization of single-use helical stone baskets: an experimental study / Esterilização de cestas helicoidais descartáveis extratoras de cálculo: um estudo experimental

Objectives: To experimentally evaluate the efficacy of a standard sterilization protocol employed during reuse of disposable helical stone baskets. Methods: Study performed on 20 helical stone baskets: 10 were used in the initial validation process, contaminated with Escherichia coli ATCC 25922 and imprinted on Müeller-Hinton media; 10 catheters were contaminated with Geobacillus stearothermophilus ATCC 7953, processed, inoculated in TSB and incubated in a water bath at a temperature of 55ºC. Bacterial growth was evaluated after 1, 3, 5 and 7 days. After sterilization, stone baskets were also opened and closed 40 times to check for functional problems. All plastic and basket parts were carefully checked for damages. Results: After the 72-hour incubation period, there was growth of E. coli ATCC 25922 in 100% of imprints. After the sterilization process and up to 7 days incubation period on a blood agar plate, there was no growth of G. stearothermophilus ATCC 7953 or any other bacteria. There were no functional problems or damage to baskets after the sterilization process. Conclusion: The ethylene oxide system is efficacious and safe for sterilization of disposable helical stone baskets. However, further clinical studies are required and should provide more safety information.

Objetivo: Avaliar experimentalmente a eficácia de um protocolo padrão de esterilização de cestas helicoidais descartáveis extratoras de cálculo. Métodos: Estudo realizado com 20 cestas helicoidais descartáveis extratoras de cálculo: 10 foram utilizadas no processo inicial de validação do método, contaminadas com Escherichia coli ATCC 25922 e semeadas em meio de Müeller-Hinton; 10 foram contaminadas com Geobacillus stearothermophilus ATCC 7953, processadas, inoculadas em TSB e incubadas em banho maria, a 55 ºC. O crescimento bacteriano foi avaliado depois de 1, 3, 5 e 7 dias. Após a esterilização, as cestas helicoidais descartáveis extratoras de cálculo foram abertas e fechadas 40 vezes para avaliar problemas funcionais. Todas as partes plásticas foram avaliadas quanto a danos. Resultados: Após as 72 horas de incubação, observou-se crescimento de E. coli ATCC 25922 em todos os meios. Após a esterilização e até 7 dias de incubação, não houve crescimento de G. stearothermophilus ATCC 7953 ou de qualquer outra bactéria. Não foram observados problemas funcionais ou danos nas cestas após a esterilização. Conclusão: O processo de esterilização com óxido de etileno é seguro e eficaz para re-esterilizar cestas helicoidais descartáveis extratoras de cálculo descartáveis. Contudo, são necessários mais estudos clínicos para fornecer mais informações sobre segurança.

Is there an association between urolithiasis and roux-en-y gastric bypass surgery?

Purpose: Several studies have documented high incidence of urinary lithiasis after jejunoileal by-pass. Roux-en-y gastric bypass surgery (RYGB) is currently the most common bariatric procedure. Because of its difficult for absorption, RYGB has a potential risk to increase the incidence of lithiasis. This study was conducted in order to test the hypothesis that RYGB increases the incidence urolithiasis after 50 percent of excessive weight loss. Materials and Methods: We performed a retrospective cohort study to evaluate 58 patients who underwent RYGB at the Obesity Service at Santa Casa de Misericordia de Sao Paulo, between 2000 and 2005, with minimum follow-up of 10 and maximum of 72 months, after the procedure. Results: Forty-five (77.6 percent) patients had ¡Ý 50 percent loss of weight excess. There was no difference between the frequency of urolithiasis before and after the procedure, and nephrolithiasis was observed after surgery in only one patient, however this had been detected before the procedure. Conclusion: In the period studied, RYGB does not seem to affect the incidence of urolithiasis after weight reduction. This may be due to its smaller malabsorptive component as compared with jejunoileal ¡°by-pass¡±, thereby possibly not significantly influencing the oxalate metabolism.

Carcinoma of the renal pelvis and ureter

OBJECTIVE: To assess the occurrence of upper urinary tract urothelial tumors (UUTT) in Brazil. MATERIALS AND METHODS: We performed a clinical and histopathologic study of 33 patients who were diagnosed with a malignant neoplasm in the renal pelvis or ureter in the period of 1994 to 2004, in a single institution. RESULTS: Among the patients with upper urinary tract carcinoma, 70 percent were males and 30 percent females, with mean age of 65 ± 16 years (ranging from 31 to 91 years). Nineteen patients presented renal pelvis tumor (58 percent), 9 ureteral tumor (27 percent) and 5 synchronic pelvic and ureteral tumors (15 percent). Renal pelvis tumors represented 2.8 percent of all the urothelial neoplasms, and 11.4 percent of all renal neoplasms treated in the same period. Ureteral tumors represented 1.6 percent of all the urothelial malignancies surgically managed in these 11 years. Tobacco smoking was the most common risk factor, and analgesic abuse was not reported by those patients. Most carcinomas were high-grade and muscle-invasive. Mean time to diagnosis was 7 months, being hematuria the most common symptom. CONCLUSIONS: A high association was also found between UUTT and bladder urothelial carcinoma. UUTT were mostly seen in men in their seventies and related to a high overall and cancer-related mortality rate. The overall disease-specific survival was 40 percent, much lower than found in most of the reported series.

Coexistence of prostate neoplasia in patients undergoing radical cystoprostatectomy due to vesical neoplasia

OBJECTIVE: To assess the incidence of bladder carcinoma infiltrating the prostate and prostate adenocarcinoma in patients undergoing radical cystoprostatectomy due to bladder cancer, as well as to assess if the characteristics of the bladder neoplasia influence the prostatic involvement by this neoplasia. MATERIALS AND METHODS: We retrospectively assessed 60 male patients, who underwent radical cystoprostatectomy between July 1997 and December 2003. Mean age was 66.7 years (40 and 93 years). The product of radical cystoprostatectomies was checked for involvement of urethra and prostate parenchyma by the primary neoplasia, and for the presence of associated prostate adenocarcinoma. Bladder neoplasia characteristics, such as localization, size, multifocality, association with in situ carcinoma and histological grade, were studied in order to assess the possibility of using such characteristics as predictive factors of prostate infiltration by bladder urothelial carcinoma. RESULTS: We observed the presence of 20 percent of patients with bladder carcinoma infiltrating the prostatic urethra, 23.3 percent of patients with infiltration of the prostate parenchyma and 28.3 percent of patients with associate prostate adenocarcinoma, resulting in a total of 55 percent of patients with prostatic involvement (infiltrative bladder carcinoma and/or adenocarcinoma). We also observed a statistically significant correlation between tumor location in the trigone, the presence of in situ carcinoma and the histological grade of the bladder tumor with prostatic infiltration by the vesical neoplasia. CONCLUSION: The coexistence of prostatic neoplasia in patients operated for bladder neoplasia was frequent in our sample (55 percent). We observed that the prostatic infiltration by bladder tumors occurs more frequently with tumors located in the trigone, with associated in situ carcinoma and with high histological grade. There was no correlation between neoplastic infiltration of prostate and multifocality or size of the bladder tumor in the studied sample.

Trauma abdominal: analise dos aspectos epidemiologicos e clinicos em cidade de medio porte do estado de Sao Paulo / Abdominal trauma: analysis of epidemiological and clinical aspects in a country town in the state of Sao Paulo

Foram analisados os aspectos epidemiologicos e clinicos observados em 200 pacientes com trauma abdominal a atendidos no Hospital das Clinicas de Botucatu(SP). O grupo mais acometido e constituido de jovens do sexomasculino. Os ferimentos ocorreram em 109 pacientes (54,5%) e as contusoes em91 (45,5%). Contrariamente ao observado nas grandes cidades, em Botucatu a causamais importante do ferimento abdominal foi a arma branca (35%), seguida das lesoes determinadas por projeteis de arma de fogo (18,5). No trauma abdominal fechado o acidente por veiculo a motor apresentou o maior numero de vitimas. A mortalidade operatoria foi mais elevada na contusao (11%) do que no ferimento (37%)As causas determinantes desta diferença sao as associaçoes com lesoes extra-abdominais (cranio, torax e esqueleto ) e a demora na indicaçao cirurgica, fatos observados no trauma fechado. A mortalidade operatoria globas foi de 7%