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.

Analysis of lower urinary tract disease of dogs / Análise de doenças do trato urinário inferior em cães

Lower urinary tract diseases (LUTD) include different conditions that affect the urinary bladder, urethra and prostate. The objective of this study was to determine the frequency of different related diseases, to characterize the population affected, and to determine risk factors in dogs. The clinical cases were diagnosed with LUTD through physical examination, and clinical laboratory and imaging studies. Male dogs had a greater predisposition to present a LUTD. Dogs from 3 months to 18 years with a median of 8 years were affected, and the most affected breeds were Poodle, Labrador, German shepherd, Schnauzer, Cocker Spaniel and Chihuahua. The LUTD presented with the following frequencies: bacterial urinary tract infection 34.02%; micturition disorders 22.68%; urolithiasis 20.61%; prostatic disease 14.43%; traumatic problems 8.24%. Sixty-seven per cent of the cases were specific diseases, such as uncomplicated and complicated bacterial urinary tract infections, urinary retention of neurologic origin and silica urolithiasis.(AU)

Doenças do trato urinário inferior (DTUI) incluem várias condições clínicas que afetam a bexiga, próstata e uretra. O objetivo deste estudo foi determinar a frequência de diferentes doenças relacionadas, caracterizar a população afetada, e determinar os fatores de risco em cães. Os casos clínicos com DTUI foram diagnosticados através de exame físico, estudos laboratoriais e de imagem. Os cães machos apresentam uma maior predisposição para DTUI. Foram afectados cães com idades compreendidas entre os 3 meses a 18 anos, com uma mediana de oito anos, sendo as raças mais predispostas os Poodle, Labrador, Pastor Alemão, Schnauzer, Cocker Spaniel e Chihuahua. A etiologia DTUI apresentou as seguintes frequências: 34,02% foram originadas em infecção do trato urinário inferior; 22,68% em distúrbios miccionais; 20,61% em urolitíase; 14,43% em doença prostática; 8,24% em problemas traumáticos. Sessenta e sete por cento dos casos de DTUI estavam associados a doenças específicas, tais como infecções bacterianas do trato urinário não complicadas e complicadas, retenção urinária neurogénica e urolitíase por sílica.(AU)

Infección del tracto urinario y resistencia antimicrobiana en la comunidad / Urinary tract infection and antimicrobial resistance in the community

Introducción: las infecciones del tracto urinario constituyen un problema frecuente en la atención primaria de salud. Objetivo: actualizar la prevalencia y susceptibilidad a los antibióticos disponibles en nuestro medio. Métodos: se realizó un estudio retrospectivo sobre el aislamiento de gérmenes uropatógenos y la susceptibilidad antibiótica del microorganismo más frecuente en 2 912 pacientes ambulatorios que presentaron clínica sugerente de infección urinaria. Se tomó como muestra 484 pacientes con urocultivos positivos que tenían antibiograma realizado, en el municipio Banes, Holguín, desde noviembre del 2012 a octubre del 2013. Se utilizó el método de difusión de Kirby y Bauer. Resultados: la Escherichia coli resultó el germen más frecuente, afectando de igual manera al sexo femenino y mostró mayor resistencia al Ampicillín (83,7 %), Cefazolina (74,5 %), Ácido nalidíxixco (72,1 %), Co-trimoxazol (57,3 %), alrededor del (50,0 %) de resistencia a la Ciprofloxacina, Kanamicina y Ceftaxidima; mejor sensibilidad ante la Gentamicina, Cefotaxima y Ceftriaxona. Conclusiones: la Gentamicina, Cefotaxima y Ceftriaxona las opciones terapéuticas de primera línea en el tratamiento empírico de las infecciones del tracto urinario constituyen en nuestro medio.

Introduction: urinary tract infections are a common problem in primary health care. Objective: update the prevalence and susceptibility to available antibiotics in our environment. Method: a retrospective study was carried out on the isolation of uropathogenic bacteria and antibiotic susceptibility of the most common organism in 2912 ambulatory patients with symptoms suggesting urinary tract infection. The sample was 484 patients with positive urine cultures and susceptibility study performed in Banes municipality, Holguin, from November 2012 to October 2013. Kirby and Bauer diffusion method was used. Results: escherichia coli were the most common pathogen, affecting females. This pathogen showed higher resistance to Ampicillin (83.7%), Cefazolin (74.5%), nalidixic acid (72.1%), Co- trimoxazole (57.3%), about (50.0%) of ciprofloxacin resistance, kanamycin and Ceftaxidima; and better sensitivity to gentamicin, cefotaxime, and ceftriaxone. Conclusions: treatment options for first-line empiric treatment of urinary tract infections are gentamicin, cefotaxime, and ceftriaxone.

Importancia epidemiológica, asistencial y económica del cultivo de orina, en pacientes hospitalizados y de la comunidad / Epidemiological, economical and assistance importance of urine culture on in-patients and out-patients. Hermanos Ameijeira Hospital

Introducción: una de las infecciones más comunes que afectan al ser humano a lo largo de su vida y una de las más frecuentes tanto en el ámbito comunitario como en el nosocomial, son las infecciones del tracto urinario (ITU). Es conocido que los agentes etiológicos se relacionan fundamentalmente con bacilos gramnegativos, pero en la mayoría de los casos, sobre todo en los ambulatorios, no se realiza el cultivo de las muestras de orina antes de iniciar del tratamiento antibacteriano. Al mismo tiempo, una terapia inicial correctamente indicada, tomando como base los datos aportados por el Laboratorio de Microbiología, puede significar evolución favorable y menores costos en sentido general. Objetivos: determinar los principales agentes etiológicos con sus patrones de sensibilidad antimicrobiana, en ITU hospitalarias y de la comunidad, asi como evaluar los costos relacionados con los cultivos microbiológicos, según el tipo de resultado alcanzado. ..

Introduction: the high incidence and prevalence of urinary tract infections in both hospital patients and outpatients determine that the exact knowledge of the major etiologic agents with antimicrobial susceptibility patterns gain immeasurable epidemiological and economic assistance values. Objective: to do Microbial map for hospital patients, and outpatients suffering from UTIs. Methods: a retrospective and cross study was conducted in 13,939 urine cultures from inpatient and outpatients received in the Microbiology Laboratory at Hermanos Ameijeiras hospital from September 2009 to August 2010. Results: 62 percent of the samples were negative, 22 percent positive, and 16 percent were reported as the contaminated samples representing a cost of 86 100, 61 980, and 22 300 CUC, respectively, with an overall total of 170 380 CUC. The microorganism most frequently isolated was Escherichia coli in both groups (76.4 percent and 54.0 percent respectively), which were higher than 55 percent to trimethoprim/sulfamethoxazole and ciprofloxacin. Ampicillin resistance was close to 90 percent for almost all microorganisms. Nitrofurantoin for Escherichia coli presented the lowest percentages of resistance. Antimicrobial resistance was higher in hospital patients. Conclusions: the monetary cost per patient for a second or third course of antibiotics, in an initial incorrect therapy, may imply spending approximately 100 times more than a correct initial therapy based on scientific evidence

Cirugía urológica en pacientes de 80 años y más: ¿es la edad un factor de riesgo para el desarrollo de complicaciones postoperatorias? / Urological surgery in patients 80 years and older: is age a risk factor for the development of postoperative complications?

La expectativa de vida ha ido aumentando en Chile y en el mundo, lo que ha causado un gran impacto a nivel del número de cirugías que se realiza en la población añosa. El objetivo de este trabajo es describir la experiencia de nuestro centro en cirugías urológicas en pacientes mayores de 80 años y analizar que factores aumentan el riesgo de complicaciones postquirúrgicas.Materiales y método: Análisis retrospectivo de 138 cirugías urológicas realizadas en 120 pacientes mayores de 80 años, durante los años 2000 a 2012. Se obtuvo información sociodemográfica, riesgo quirúrgico (ASA), tipo y duración de cirugía realizada, complicaciones post-operatorias (escala de Clavien) y tiempo de hospitalización. Los datos obtenidos fueron analizados mediante el programa SPSS v17. Se realizó análisis multivariado y se estableció el riesgo relativo para el desarrollo de complicaciones. Se consideró signi ficativo p<0,05. Resultado: La edad promedio de los pacientes fue de 84+/-3.7 años, 86.2 por ciento fueron hombres. El 96.7 por ciento presentaba algún tipo de comorbilidad, con predominio de hipertensión arterial (60,84 por ciento) y diabetes mellitus tipo 2 (24,16 por ciento). La mayoría de las intervenciones fue de complejidad intermedia (77.27 por ciento), donde la anestesia regional (56,8 por ciento) y la vía endo urológica (84,78 por ciento) fueron las más utilizadas, con un tiempo operatorio promedio de 62+/-52.4 minutos. El riesgo quirúrgico prevalente fue ASA2 (62.7 por ciento). El promedio de hospitalización fue de 2,8+/-2.7 días. El 15.21 por ciento de los pacientes presentó algún tipo de complicación, con predominio de clasifi cación tipo 1 de Clavien (38 por ciento). En el análisis multivariado se evidenció como factores de riesgo signi ficativos para complicaciones, edad mayor a 90 años (p=0.03), presencia de insu ciencia renal (p=0.01), portar 4 o más comorbilidades (p=0.04), cirugía mayor a 3 horas (p=0.03) y tener riesgo quirúrgico ASA3 (p=0.04)...

Life expectancy has been increasing in Chile and in the World. This has caused a great impact over the number of surgeries being performed in the elderly population. The aim of this paper is to describe the experience of our center in urological surgery in patients older than 80 years and analyze which factors increase the risk of postoperative complications.Materials and methods: Retrospective analysis of 138 urological surgeries performed in 120 patients older than 80 years, during the years 2000-2012. Sociodemographic information, surgical risk (ASA), type and duration of surgery, postoperative complications (Clavien scale) and length of hospitalization was obtained. The data were analyzed using SPSS v17. Multivariate analysis was performed and the relative risk for developing complications was established. Signi cance was p <0.05. Average age of the patients was 84 +/- 3.7 years, 86.2percentwere men. The 96.7 percenct had some kind of comorbidity, with prevalence of hypertension (60.84 percent) and diabetes mellitus type 2 (24.16 percent). Most of the interventions was of intermediate complexity (77.27percent), where regional anesthesia (56.8 percent) and endourological aproach (84.78 percent) were the most used, with average operative time of 62 +/- 52.4 minutes. Most common Surgical risk was ASA2 (62.7 percent). Average hospital stay was 2.8 +/- 2.7 days. 15.21 percent of patients had some type of complication, with a predominance of type 1 Clavien classication (38 percent). The multivariate analysis showed signi cant risk factors for complications: age greater than 90 years (p = 0.03), renal failure (p = 0.01), carrying 4 or more comorbidities (p = 0.04), surgery Langer than 3 hours (p = 0.03) and ASA3 surgical risk (p =.04). No mortality was reported in our series. In this study, although most of our patients underwent endourological procedures, we evidence that surgery in patients older than 80 years is feasible...

Malformaciones urinarias del recién nacido: estudio ECLAMC 1998-2010 / Urinary malformations among newborns: ECLAMC registry, 1998-2010

Introduction: Congenital abnormalities of the Urinary Tract are frequent and prevalence has increased since the introduction of routine prenatal sonogram. Objectives: To determine the prevalence rate of congenital urinary malformations at birth at Hospital Clínico de la Universidad de Chile. These data will be compared to other Chilean hospitals participating in ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas - Latin American Collaborative Study of Congenital Malformations). A longitudinal study will serve to evaluate if significant variation has occurred, and risk factors will be investigated. Patients and Methods: All births occurring between January, 1998 and December, 2010 were included. Prevalence rate of urinary malformations were calculated, and compared to those obtained in previous years. Statistical analysis of proportions was calculated through mean and average comparison was made through Student t test. Results: Urinary anomalies appeared at a rate of 64.5 per 10.000 births. This represents a significant increase from previous studies. Highest risk factor seemed to be "other family members with disease". Most frequent anomaly was Hydroureteronphrosis (24,2 percent) followed by Hypospadias (17 percent). The rate of these malformations in ECLAMC participating Chilean hospitales was 23.37/10.000 births. Conclusion: A significant increase in the diagnosis of these anomalies was shown, being the most important risk factor the presence of family members with similar congenital disorders.

Introducción: Las anomalías congénitas del Aparato Urinario son frecuentes y ha aumentado su prevalencia al nacimiento con la introducción rutinaria del estudio prenatal por ultrasonografía. Objetivos: Determinar la Tasa de prevalencia al nacimiento de las malformaciones urinarias en el Hospital Clínico de la Universidad de Chile. Compararlas con las del resto de los hospitales chilenos que participan en el ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas). Estudiarlas a lo largo del tiempo para ver si han tenido variaciones significativas. Investigar factores de riesgo que pueden influir en la aparición de ellas. Pacientes y Método: Se estudió todos los nacimientos ocurridos entre Enero de 1998 y Diciembre de 2010 en el Hospital Clínico de la Universidad de Chile. Se calculó las tasas de prevalencia al nacimiento de las malformaciones urinarias y se las comparó con las obtenidas en períodos anteriores. El análisis estadístico de comparación de proporciones se realizó mediante la prueba de c² y las comparaciones entre promedios se hicieron mediante prueba t de Student. Resultados: La tasa de Anomalías urinarias fue 64,5 por 10 000 nacimientos. Ellas aumentaron significativamente al compararlas con los períodos estudiados anteriormente. El factor de riesgo más influyente fue "otros malformados en la familia". La anomalía más frecuente fue Hidroureteronefrosis (24,2 por ciento) seguida por Hipospadias (17 por ciento). La tasa de estas malformaciones en los hospitales chilenos participantes del ECLAMC fue 23,37/10 000 nacimientos. Conclusión: Se demuestra un incremento significativo del diagnóstico de estas anomalías, siendo el factor de riesgo más importante el antecedente de otros malformados en la familia.

Egresos hospitalarios por patología genitourinaria en Chile: tercera parte / Hospital discharges because of genitourinary diseases: third part

El objetivo del presente trabajo fue actualizar el análisis de los egresos hospitalarios (EH) de patologías del sistema genitourinario (PGU) en nuestro país. Para estos efectos se obtuvieron los datos del boletín de egresos hospitalarios del Ministerio de Salud (MINSAL) del año 2005, utilizándose los códigos de la clasificación internacional de enfermedades de la OMS (CIE-10). Los distintos diagnósticos fueron caracterizados según su composición geográfica y demográfica, comparándose con la información publicada en los reportes anteriores. Los egresos por PGU disminuyeron de un 4,13 por ciento a un 3,78 por ciento del total. De esta manera, la patología genitourinaria continúa siendo una contribución menor al total de egresos hospitalarios en el país. Las infecciones del tracto urinario, la hiperplasia prostática benigna, la urolitiasis y la fimosis se mantuvieron como las patologías más frecuentes. Los EH por patología oncológica es el único subgrupo que ha mostrado un alza sostenida durante los 12 años analizados. El presente reporte constituye una aproximación a nuestro quehacer como urólogos en nuestro país, y al mismo tiempo grafica la necesidad de crear herramientas de registro epidemiológico más efectivas.

The aim of the study was to update the analysis of hospital discharges because of genitourinary diseases in our country. For these purposes, data were obtained from the registers of the Chilean Ministry of Health. Diseases were codified according to the WHICD-10 classification. Hospital discharges because of genitourinary diseases showed a slight decrease in 2005 when compared to 2001, from 4.13 percent to 3.78 percent. Consequently, genitourinary diseases are still a minor fraction of the national hospital discharges. The most relevant diseases were urinary tract infections, benign prostate hyperplasia, urolithiasis and phimosis. Hospital discharges because of genitourinary cancer has been the only subgroup showing a steady increase since 1993. The present analysis is a rough estimation of our work as urologists in our country. However, more accurate epidemiological tools are needed.

Urological complications in ureteric stenting live related renal transplantation

To determine the frequency and types of post-transplant urological complications in live-related kidney transplantation with reference to the impact of JJ ureteric stent. Case series. Shaikh Zayed Postgraduate Medical Institute and National Institute of Kidney Diseases, Lahore, from June 2006 to July 2010. Consecutive renal transplantations, donors being alive were relatives, reterospectively reviewed. All patients underwent extravesical ureteroneocystostomy and all, except one were stented. From the retrieved clinical records, the frequency and types of various minor and major urological complications and their management was studied. All the complications were managed according to standard guidelines. The overall incidence of urological complications among transplant recipients was 11.9%, observed in 12 patients. The complications were urinary leakage in 2 [2%] and clot retention, ureterovesical junction obstruction and wound infection in one [1%] patient each. Urinary tract infection was observed in 7 [6.9%] patients. Urinary tract infection was the most common urologic complication in the studied cases. The technique of stented extravesical ureteronecystostomy had a low rate of urological complications in this series. Other factors which may reduce the urological complications are preserving adventitia, fat and blood supply of ureter by delicate dissection during donor nephrectomy and prevent kinking and twisting of ureter are important factors in reducing the post-transplant urological complications

Infección humana por Trichomonas vaginalis y su relación con otros agentes patógenos / Human infection from Trichomonas vaginalis and its relation to other pathogen agent

Trichomonas vaginalis es un protozooo flagelado causante de la trichomonosis urogenital en humanos. La asociación y coexistencia de T. vaginalis con otros agentes patógenos causantes de infecciones de transmisión sexual es bastante común. Se realizó una revisión de la literatura, incluyendo las últimas publicaciones sobre las principales manifestaciones clínicas de T. vaginalis y su relación con otros agentes de transmisión sexual

Trichomonas vaginalis is a flagellate protozoon causing urogenital trichomoniasis in humans. Association and co-existence of T. vaginalis with other pathogen agents causing of sexually transmitted infections is fairly common. A bibliographic review was carried out including the last publications on the main clinical manifestations from T. vaginalis, and its relation to other sexual transmission agents

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...

Complicaciones urológicas postrasplante renal con técnica de Lich-Gregoir: experiencia de cuatro años / Urological complications following kidney transplantation using Lich-Gregoir technique: a 4-year experience in Mexico

Objetivo: Revisión de las complicaciones urológicas posteriores al trasplante renal en dos centros hospitalarios utilizando la técnica de ureteroneocistostomía extravesical de Lich-Gregoir en un periodo de cuatro años. Material y métodos: Se revisaron los expedientes de 242 pacientes en quienes se llevó a cabo trasplante renal de enero de 2003 a noviembre de 2007. En todos los pacientes se realizó ureteroneocistostomía extravesical. Se informaron todas las complicaciones urológicas y su manejo. Resultados: Se registraron 19 complicaciones en 18 pacientes, con una incidencia de 7.8 %; 16 riñones se obtuvieron de donadores vivos. Las complicaciones más comunes fueron fuga de orina (4.5 %), estenosis urinaria (1.6 %), reflujo vesicoureteral (1.2 %) y necrosis ureteral (0.4 %). La mayoría de los pacientes fueron tratados con sonda de Foley (42 %), colgajo de Boary (26 %) y nefrostomía (15 %). La pérdida del injerto renal se asoció a complicaciones urológicas en 1.23 % Conclusiones: El trasplante renal debe incurrir en pocas complicaciones urológicas, por lo que debe cuidarse los detalles técnicos. La evaluación temprana para corregir las complicaciones reduce la sepsis, morbilidad y el riesgo de pérdida del injerto.

OBJECTIVE: We present a retrospective review of urological complications following kidney transplantation in two medical centers in the Mexican state of Veracruz using Lich-Gregoir extravesical ureteroneocystostomy during a 4-year period. METHODS: Records from 242 patients from January 2003 to November 2007 were reviewed. Standard technique for organ procurement, open nephrectomy and kidney transplant was performed. EVU was used in all patients. Urological complications and management are reported. RESULTS: There were 19 complications recorded in 18 patients (7.8%). Sixteen kidneys were obtained from living donors. Urinary leak was the most common complication (4.5%) followed by ureteral stenosis (1.6%), vesicoureteral reflux (1.2%) and ureteral necrosis (0.4%) Most patients were treated with Foley catheter (42%), Boary flap (26%) and nephrostomy (15%); 1.23% grafts were lost associated with urological complications. CONCLUSIONS: Renal transplantation should incur few urological complications. Attention to technical details should be paid to avoid major complications. Early evaluation to correct complications reduces sepsis, morbidity and the risk of losing graft function.

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.

Infección urinaria en pediatría: relación entre clínica, paraclínica y gamagrafía renal / Urinary tract infection in children: relation between symptoms, lab work-up and renal scan

Objetivo: describir la relación entre hallazgos clínicos, laboratorio y gamagrafía renal estática (GR-DMSA) en pacientes pediátricos hospitalizados por infección del tracto urinario (ITU) en el Hospital de San José. Materiales y métodos: estudio descriptivo, de corte transversal. Se incluyeron 130 pacientes entre tres meses y 14 años de edad. Se tomó información de las historias clínicas revisando las variables: edad, género, fiebre, estado general, leucocitosis en hemograma, velocidad de sedimentación globular (VSG), proteína C reactiva, hipostenuria, nitritos y estearasas leucocitarias (EL) en uroanálisis, comparando cada una de ellas con el resultado de la GR-DMSA. Resultados: el 76% de los pacientes mostró pielonefritis con GR-DMSA. El 87,7% de éstos eran lactantes y preescolares y el 72% niñas. Se realizaron análisis bivariados utilizando como medida de asociación el riesgo relativo (RR) y como medida de la precisión el intervalo de confianza (IC) del 95%. Se encontró que los pacientes que presentan leucocitosis, aumento de la VSG y EL positivas tienen probabilidad 1,81 veces mayor de presentar pielonefritis. Conclusiones: si un paciente presenta leucocitosis, VSG elevada y EL positiva, no se recomienda realizar GR-DMSA, dado que la probabilidad que curse con pielonefritis es 81%. La sensibilidad de estos laboratorios es del 76% y la especificidad del 58%, comparada con la GR-DMSA.

Objective: to describe the relation between clinical symptoms, lab work-up and static renal scan (DMSA) in pediatric in-patients with urinary tract infection (UTI) at the San José Hospital. Materials and methods: a descriptive, cross-sectional study was undertaken. A total of 130 children aged 0.3 months to 14 years were enrolled in the study. Their clinical histories were reviewed considering the following variables: age, gender, fever, general status, leukocytosis (on CBC), erythrocyte sedimentation rate (ESR), C-reactive protein level, hypostenuria, nitrates and leukocyte stearates (LS) in urinalysis, comparing each of them with the DMSA renal scan results. Results: the DMSA revealed pyelonephritis in 76%. Infants and pre-school children accounted for 87.7% of the latter and 72% were females. A bivariable analysis was performed using relative risk (RR) as the measure of association and a confidence interval (CI) of 95% as the accuracy measure. It was found that patients with leukocytosis, increased ESR and positive LS had 1.81-fold greater odds of pyelonephritis. Conclusions: DMSA is not recommended in patients with leukocytosis, increased ESR and positive LS, for the odds of being associated with pyelonephritis is 81%. The sensitivity of lab work-ups was 76% and specificity was 58%, compared to the DMSA renal scan.

Complicaciones urológicas postrasplante renal / Urological complications after kidney transplantation

BACKGROUND: Urological complications represent a common problem in kidney transplant surgery. The estimated incidence of these complications occurs in 3-30% of renal transplants. Solving these complications may improve renal graft survival and, consequently, patient outcome. The objective is to establish the prevalence of urological complications after renal transplantation. METHODS: We retrospectively reviewed 338 patients with kidney transplantations performed at the Transplant Unit of the Specialties Hospital of the Western Medical Center over a 6-year period. Data were obtained from the patients' clinical files about the prevalence of urological complications and their management. Renal graft loss prevalence and mortality were reported. RESULTS: Overall prevalence of urological complications was 5.92%. Onset time of all complications occurred between 1 and 210 days. Diagnosis was established using clinical, laboratory and imaging methods. Endourological management with double-J catheter through cystoscopy was used as the first option of treatment in the majority of patients, having complete resolution in all cases. There was no graft loss or mortality in our patients. CONCLUSIONS: The most common urological complication was the urinary fistulae located at the ureterovesical anastomosis. In comparison with other transplant centers worldwide, our prevalence of urological complications was similar.

¿Se justifica el uso rutinario de catéter ureteral post trasplante renal? / Is routinary ureteral stenting indicated in kidney transplant?

Introducción: El uso rutinario de de stent ureterales en trasplante renal (TR) es controvertido. Nosotros evaluamos la experiencia del stent selectivo basado en la decisión del cirujano comparando las tasas de complicaciones ureterales (filtración y/o obstrucción) en el grupo que recibió o (SU+) o no un stent (SU-). El objetivo del estudio es identificar factores de riesgo para filtración y/o obstrucción. Materiales y Métodos: Entre septiembre de 1994 y octubre de 2005, 160pacientes consecutivos se sometieron a un trasplante renal en nuestro centro. El uso de SU estuvo basado en la decisión del cirujano y fue insertado después de que un lado de la anastomosis estuvo completada. Se identificaron las complicaciones urológicas dentro de los primeros 90 días después del TR. Las complicaciones ureterales fueron definidas como: filtración, obstrucción, Infección del tracto urinario, lesión arterial y necrosis tubular aguda. Los datos demográficos fueron recolectados desde la revisión de fichas clínicas y base de datos computarizada de TR. Resultados: Se evaluaron 113 pacientes del grupo total. La incidencia global de complicaciones urológicas en este estudio fue de 8 por ciento (9), filtración fue vista en 5 por ciento (6), obstrucción en 3 por ciento (3) y 28 por ciento de TU entre los primeros 90 días después de un IR. Cuarenta y un pacientes (36 por ciento) recibieron un stent (SU+) y setenta y dos (64 por ciento) no (SU-). Los grupos fueron comparables. La frecuencia complicaciones ureterales (obstrucción, filtración y obstrucción más filtración) y de TU entre los grupos no mostró diferencia estadística. En el análisis univariado se demostró que la edad y sexo del receptor, edad del donante, la fuente del donante (cadáver o vivo), tiempo de isquemia (caliente y fría), presencia de NTA y lesiones arteriales no fueron asociadas con la presencia de obstrucción, filtración o ambas...

Introduction: Routine use of ureteral stent (US) after transplanstation remains controversial. We evaluate the experience of selective stent use based on surgeon decision comparing the ureteral complicationrates (leaking and / or obstruction) between the group receiving (US+) or another group without not astent (SU-). The aim of the study was to identify risk factors for leaking and / or obstruction in patients receiving ureteral stent after transplantation. Materials and Methods: Between September 1994 and October 2005, 160 consecutive patients underwent a renal transplant in our center. The use of US was based on the decision of the surgical team. Urological complications were identified within the first 90 days after RT. The ureteral complications were defined as: leaking, obstruction, urinary tract infection, arterial injury and acute tubular necrosis (ATN). Demographic data were collected prospectively and retrospectively analized from the review of clinical data base. Results: We evaluated 113 patients of the total group. The overall incidence of urological complications in this study was 8 percent (9), leaking was seen in 5 percent (6), obstruction in 3 percent (3) and 28 percent of the TU first 90days after an IR. Forty-one patients (36 percent ) received a stent (SU +) and seventy and two (64 percent) no(SU-). The groups were comparable. The frequency of ureteral complications (obstruction, leaking and obstruction-filtration) and TU between groups showed no statistical difference. In the Univariate analysis showed age, sex of recipient, donor´s age, the source of graft (living of dead), ischemia time(hot and cold), presence of ATN and arterial lesions were not associated with the presence of obstruction, leaking or both. However, among patients with obstruction leaking a higher probability of developing TU was verified. Conclusions: Our experience shows that routine stent use has no clear benefit in transplantation´s outcomes...

Lower urinary tract symptoms; an undetected cause for morbidity in adults.

INTRODUCTION: Lower urinary tract symptoms (LUTS) have been recognised as a cause of distress among adult men and women. In view of the increasing elderly population in Sri Lanka, the number of individuals with LUTS is likely to increase. OBJECTIVES: To determine the prevalence and severity of LUTS in a community sample of older men and women residing in an urban area. DESIGN: Cross-sectional descriptive study. SETTING: Field practice area of National Institute of Health Sciences, Kalutara. METHODS: Households were selected using probability proportionate to the size (PPS) method. 985 adult men and women (above 40 years of age) were interviewed by Public Health Midwives regarding LUTS using an interviewer-administered questionnaire. The questions were adapted from ICSmale questionnaire and the Bristol Female Lower Urinary Tract questionnaire. RESULTS: 209 (47%) men and 338 (62.6%) women reported at least one urinary symptom. In men, urgency, nocturia, dysuria and frequency were the most prevalent symptoms with stress incontinence being the least prevalent. Majority of the symptoms showed an increase in prevalence with age. In women, dysuria, stress incontinence, urgency and frequency were the most prevalent symptoms. Hesitancy, intermittency, and stress and urge incontinence were the most bothersome symptoms among men, and urge and stress incontinence among women. CONCLUSIONS: Prevalence of LUTS was high in our study population.

Transabdominal ultrasound in the assessment of postvoid residual urine volume in patients after hysterectomy.

OBJECTIVE: To evaluate the correlation between assessment of postvoid residual urine by transabdominal ultrasound and catheterization in patients after radical or transvaginal hysterectomy. MATERIAL AND METHOD: A cross-sectional study was conducted and 46 patients were enrolled after they had radical and transvaginal hysterectomy. After surgery, urinary catheter was indwelled. After catheter removal and the 3rd private voiding, the patients were sent for transabdominal ultrasound assessment of PVR at the Division of Maternal-Fetal Medicine. Complete drainage of bladder with standard catheterization was then performed and catheterized urine volume was recorded. PVR was calculated from previously published equation and compared with actual PVR from catheterization. RESULTS: Mean age of the patients was 55.9 years. The most common diagnoses were procidentia uteri (23.9%), Carcinoma of cervix stage 1b1 (23.9%), and prolapsed uteri grade 2 (21.7%). Radical hysterectomy with pelvic node dissection and vaginal hysterectomy with anterior colporhaphy and posterior colpoperiniorhaphy was performed each in 50% of cases. Mean duration of urinary catheter indwelling was 7.17 days for those underwent radical hysterectomy and 5 days for vaginal hysterectomy. The calculated PVR was significantly correlated with catheterized urine volume with correlation coefficient 0.93 (p < 0.001). If the usual cutoff of PVR > 100 ml was used to determine the necessity of re-indwelling catheter, among those with calculated PVR from ultrasound measurement < 100 ml, still 30% actually had actual PVR of > 100 ml. Among those with calculated PVR from ultrasound measurement >100 ml, all actually had actual PVR of > 100 ml. CONCLUSION: PVR estimation by ultrasound significantly correlated with actual PVR. This could reduce the process of repeat catheterization and give more comfort to the patients when the PVR is > 100 ml.

Doentes atendidos no ambulatório de urologia do Sistema Único de Saúde: Departamento Municipal de Assistência à Saúde Pública (SUS – DEMASP) Barbacena – Minas Gerais / Outpatients assisted by the Unifield Health Sistem: Municipal Public Health Department (SUS – DEMASP) Barbacena – Minas Gerais

Este trabalho mostra a prevalência de doenças urológicas que levaram uma população de 4.007 pacientes a ser atendida no ambulatório de urologia do Sistema Único de Saúde – Departamento Municipal de Assistência à Saúde Pública (SUS – DEMASP) e avaliar a importância desse órgão na solução dessa demanda no período de março de 2002 a março de 2006. Foi feita a análise no prontuário de cada paciente a partir de sua e anotadas as queixas que motivaram a procurar o serviço de urologia da rede pública de assistência médica. Dos 4.007 atendidos, 2.299 (57,3%) apresentaram alguma doença relacionada ao trato geniturinário e 1.708 (42,6%) tiveram avaliação urológica normal. Os resultados mostraram ser relevante o percentual de pacientes com doenças geniturinárias atendidos no ambulatório de urologia da rede pública (SUS – DEMASP), em Barbacena, Minas Gerais, e que o serviço de saúde prestado pelo ambulatório de urologia desse órgão foi eficaz.

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...