Antibiotic prophylaxis in flexible ureterorenoscopy with negative urine culture.

Objective: To improve susceptibility profiles of nosocomial bacteria, identifying the difference between infectious complications in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) that received extended antibiotic prophylaxis (EP) compared with standard antibiotic prophylaxis (SP). Methodology: This is a retrospective, observational, analytical cohort study, comparing infectious complications between patients undergoing fURS with negative UC who received EP versus SP. We include patients with susccessfull fURS, <20-mm stones and complete information. Results: Overall, 10.3% of patients had complications, 7.2% of patients had postoperative urinary infection, 1.8% had upper urinary tract infection (UTI) and 1.4% had urinary sepsis. Lower UTI were significantly more likely in the extended prophylaxis group with 6.8% versus 2.7% (RR = 2.8; 95% CI: 1.10-7.37, p = 0.030). The risk of upper UTI and sepsis did not show significant differences. A total of 69% patients with postoperative infection had isolated multidrug-resistant bacteria (MDRB) in the UC, with a higher risk in patients with extended prophylaxis (RR = 3.1; 95% CI: 1.33-7.59, p = 0.009). Conclusions: Patients with negative UC who underwent fURS using extended prophylaxis have two times higher risk of low UTI than patients with standard prophylaxis, without differences in the incidence of upper UTI or urinary sepsis. The risk of MDRB isolation in the postoperative UC is higher in the extended prophylaxis group, therefore we recommend the standard 60-min preoperative prophylaxis.

Successful laparoscopic approach to intraperitoneal bladder injury caused during gynecologic surgery. a case report

ABSTRACT Introduction: Urinary tract injuries are common in the context of pelvic surgery; however, there is little information in the medical literature on the management of these injuries using a laparoscopic approach. The following is the clinical case of a patient with intraperitoneal bladder injury secondary to gynecological pelvic surgery that was successfully treated using a laparoscopic approach. Moreover, a management algorithm is proposed based on the scientific data available. Case report. A 39-year-old female patient was admitted to the hospital with generalized abdominal pain and anuria three days after undergoing a left laparoscopic salpingectomy and resection of a migrated intrauterine device. Laboratory tests showed microhematuria, serum creatinine of 4.35mg/dL, and urea nitrogen of 35.2mg/dL. Computed tomography cystography showed a solution of continuity on the left posterolateral intraperitoneal bladder. The patient underwent successful laparoscopic treatment for the bladder injury, and two weeks later, retrograde cystography confirmed its adequate resolution. Conclusions. Based on the benefits of the laparoscopic approach and after extrapolating the outcomes of the laparoscopic management of bladder trauma, it can be concluded that the laparoscopic approach to surgical injuries of the bladder is a feasible therapeutic option.

RESUMEN Introducción. Las lesiones del tracto urinario son frecuentes en el contexto de la cirugía pélvica; sin embargo, existe poca información sobre su manejo por vía laparoscópica. Se presenta el caso de una paciente con una lesión vesical intraperitoneal secundaria a cirugía pélvica ginecológica, quien recibió manejo por abordaje laparoscópico, y se propone un algoritmo de tratamiento. Presentación del caso. Mujer de 39 años quién, luego de tres días de practicársele una salpingectomía izquierda y una resección del dispositivo intrauterino migrado mediante abordaje laparoscópico, consultó al servicio de urgencias por dolor abdominal generalizado y oligoanuria. Los exámenes de laboratorio evidenciaron microhematuria, creatinina sérica de 4.35mg/dl y nitrógeno ureico de 35,2mg/dl. En cistografía por tomografía computarizada (cisto-TC) se observó una solución de continuidad de la pared vesical posterolateral izquierda intraperitoneal. A la paciente se le trató la lesión vesical de forma exitosa por vía laparoscópica, y dos semanas después, también mediante cistografía retrógrada se confirmó una adecuada resolución de la misma. Conclusión. Dados los resultados satisfactorios del manejo laparoscópico en la paciente y los beneficios de esta técnica, se puede concluir que el abordaje laparoscópico de las lesiones quirúrgicas de la vejiga es una opción terapéutica factible.