A novel mortality risk score for emphysematous pyelonephritis: A multicenter study of the Global Research in the Emphysematous Pyelonephritis group.

Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality. We aimed to formulate a score that classifies the risk of mortality in patients with EPN at hospital admission. Materials and methods: Patients diagnosed with EPN between 2013 and 2020 were retrospectively included. Data from 15 centers (70%) were used to develop the scoring system, and data from 7 centers (30%) were used to validate it. Univariable and multivariable logistic regression analyses were performed to identify independent factors related to mortality. Receiver operating characteristic curve analysis was performed to construct the scoring system and calculate the risk of mortality. A standardized regression coefficient was used to quantify the discriminating power of each factor to convert the individual coefficients into points. The area under the curve was used to quantify the scoring system performance. An 8-point scoring system for the mortality risk was created (range, 0-7). Results: In total, 570 patients were included (400 in the test group and 170 in the validation group). Independent predictors of mortality in the multivariable logistic regression were included in the scoring system: quick Sepsis-related Organ Failure Assessment score ≥2 (2 points), anemia, paranephric gas extension, leukocyte count >22,000/µL, thrombocytopenia, and hyperglycemia (1 point each). The mortality rate was <5% for scores ≤3, 83.3% for scores 6, and 100% for scores 7. The area under the curve was 0.90 (95% confidence interval, 0.84-0.95) for test and 0.91 (95% confidence interval, 0.84-0.97) for the validation group. Conclusions: Our score predicts the risk of mortality in patients with EPN at presentation and may help clinicians identify patients at a higher risk of death.

Prognosis of Extended-Spectrum-Beta-Lactamase-Producing Agents in Emphysematous Pyelonephritis-Results from a Large, Multicenter Series.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and surrounding tissues with significant mortality. We aimed to assess the clinical factors and their influence on prognosis in patients being managed for EPN with and without ESBL-producing bacteria and to identify if those with EPN due to ESBL infections fared any different. METHODS: A retrospective analysis was performed on patients with EPN diagnosis from 22 centers across 11 countries (between 2013 and 2020). Demographics, clinical presentation, biochemical parameters, radiological features, microbiological characteristics, and therapeutic management were assessed. Univariable and multivariable analyses were performed to determine the independent variables associated with ESBL pathogens. A comparison of ESBL and non-ESBL mortality was performed evaluating treatment modality. RESULTS: A total of 570 patients were included. Median (IQR) age was 57 (47-65) years. Among urine cultures, the most common isolated pathogen was Escherichia coli (62.2%). ESBL-producing agents were present in 291/556 urine cultures (52.3%). In multivariable analysis, thrombocytopenia (OR 1.616 95% CI 1.081-2.413, p = 0.019), and Huang-Tseng type 4 (OR 1.948 95% CI 1.005-3.778, p= 0.048) were independent predictors of ESBL pathogens. Patients with Huang-Tseng Scale type 1 had 55% less chance of having ESBL-producing pathogens (OR 1.616 95% CI 1.081-2.413, p = 0.019). Early nephrectomy (OR 2.3, p = 0.029) and delayed nephrectomy (OR 2.4, p = 0.015) were associated with increased mortality in patients with ESBL infections. Conservative/minimally invasive management reported an inverse association with mortality (OR 0.314, p = 0.001). CONCLUSIONS: ESBL bacteria in EPN were not significantly associated with mortality in EPN. However, ESBL infections were associated with poor prognosis when patients underwent nephrectomy compared conservative/minimally invasive management.

Advantages and Short-Term Outcomes of Laparoscopic-Assisted Renal Surgery in Elderly Patients.

OBJECTIVE: To compare the perioperative results of adult and elderly patients undergoing laparoscopic renal surgery. METHODOLOGY: Retrospective, analytical study. 448 who underwent kidney surgery for benign or malignant pathologies between 2011-2019 were included in the General Hospital of Mexico "Dr. Eduardo Liceaga". They were categorized into two groups: Group 1 <60 years and Group 2 >60 years. Descriptive statistics and bivariate analysis were performed, the calculations were performed with 95% reliability and a value of p (<0.05). RESULTS: In the group over 60 years of age, the following was found: Age: 67.1 years (60-83). IMC 28.3 kg/m2 (19-48.7). Intra and postsurgical outcomes: intraoperative bleeding = 184.4cc (5-1700). Surgical Time = 112.6min (30-240). Days of hospital stay = 2 (1-7). Complications in 2.6% (Clavien-Dindo: I = 2; II = 1), no conversion was required in any patient. There were no statistically significant differences with group 1, an exception for intraoperative bleeding. CONCLUSIONS: Our study is a pioneer in Latin America in the evaluation of the geriatric population and outcomes with laparoscopic surgery and we recommend that renal procedures with a laparoscopic approach should be considered as the best strategy in the management of benign or malignant renal pathology in geriatric patients.

[Treatment of prostate cancer using high-intensity focused ultrasound, literature review.] / Tratamiento del cáncer de próstata con ultrasonido focalizado de alta intensidad, revisión de la literatura.

INTRODUCTION: The treatment of prostatecancer has recently been questioned because ofthe adverse effects it causes may out weigh the benefitsin many patients, so, it has increased interest in active surveillance for low-risk diseases and tissue preservation with focal therapy, thereby reducing the burden on medical care and side effects that may occur after radical prostatectomy and radiation therapy. OBJECTIVE: provide updated information on the treatment of prostate cancer with high intensity focused ultrasound therapy. MATERIALS AND METHODS: Bibliographic reviewstudy and systematic analysis of 27 scientific articlesfound in the Medline, Scielo and PubMed databases, whose publication dates correspond to the last 5 years.The search criteria used consisted of terms: prostatic neoplasms, ablation techniques, high-intensity focused ultrasound ablation. RESULTS: Focal therapy is a therapeutic option forlow-risk prostate cancer, clinical studies report a 75% cancer-free survival, 99% cancer-specific survival and 96% metastasis-free survival, the prostate antigen is maintained at values lower than 0.1 ng/ml in long-term controls, while the adverse effects of surgery such as incontinence and sexual impotence are rare. CONCLUSIONS: HIFU is a less invasive option for the treatment of low-risk prostate cancer, with oncological results similar to radiotherapy and radical prostatectomy.

INTRODUCCIÓN: El tratamiento del cáncerde próstata ha sido recientemente cuestionado debido a que los efectos adversos que causa pueden superara los beneficios en muchos pacientes; por lo que ha aumentado el interés en la vigilancia activa de enfermedades de bajo riesgo y la conservación de tejidos conterapia focal reduciendo de esta manera la carga en la atención médica y los efectos adversos secundarios a laprostatectomía radical y a la radioterapia.OBJETIVO: Proporcionar información actualizada sobre el tratamiento del cáncer de próstata con ultrasonido focalizado de alta intensidad.MATERIALES Y MÉTODOS: Estudio de revisión bibliográfica y análisis sistemático de 27 artículos científicos encontrados en las bases de datos Medline, Scielo y PubMed, cuyas fechas de publicación corresponden a los últimos 5 años. El criterio de búsqueda empleado consistió en los siguientes términos Mesh: neoplasias prostáticas, terapia de ablación, ablación con ultrasonido focalizado de alta intensidad.RESULTADOS: La terapia focal es una opción terapéutica para el cáncer de próstata de riesgo bajo, estudios clínicos reportan una sobrevida libre de cáncer del 75%, sobrevida específica de cáncer del 99% y sobrevida libre de metástasis del 96%, el antígeno prostático se mantiene en valores menores de 0,1 ng/ml en controles a largo plazo mientras que los efectos adversos de la cirugía como incontinencia, e impotencia sexual son poco frecuentes. CONCLUSIONES: El HIFU es una opción menos agresiva para el tratamiento del cáncer de próstata de riesgo bajo, con resultados oncológicos similares a la radioterapia y a la prostatectomía radical.

Tratamiento del cáncer de próstata con ultrasonido focalizado de alta intensidad, revisión de la literatura / Treatment of prostate cancer with high-intensity focused ultrasound, a review of the literature

Introducción: El tratamiento del cáncer de próstata ha sido recientemente cuestionado debido a que los efectos adversos que causa pueden superar a los beneficios en muchos pacientes; por lo que haaumentado el interés en la vigilancia activa de enfermedades de bajo riesgo y la conservación de tejidos conterapia focal reduciendo de esta manera la carga en laatención médica y los efectos adversos secundarios a laprostatectomía radical y a la radioterapia.Objetivo: Proporcionar información actualizada sobreel tratamiento del cáncer de próstata con ultrasonidofocalizado de alta intensidadMateriales and métodos: Estudio de revisión bibliográfica y análisis sistemático de 27 artículos científicosencontrados en las bases de datos Medline, Scielo yPubMed, cuyas fechas de publicación corresponden alos últimos 5 años. El criterio de búsqueda empleadoconsistió en los siguientes términos Mesh: neoplasiasprostáticas, terapia de ablación, ablación con ultrasonido focalizado de alta intensidad. Resultados: La terapia focal es una opción terapéutica para el cáncer de próstata de riesgo bajo, estudios clínicos reportan una sobrevida libre de cáncer del75%, sobrevida específica de cáncer del 99% y sobrevida libre de metástasis del 96%, el antígeno prostáticose mantiene en valores menores de 0,1 ng/ml en controles a largo plazo mientras que los efectos adversosde la cirugía como incontinencia, e impotencia sexualson poco frecuentesConclusiones: El HIFU es una opción menos agresiva para el tratamiento del cáncer de próstata de riesgo bajo, con resultados oncológicos similares a la radioterapia y a la prostatectomía radical.(AU)

Introduction: The treatment of prostate cancer has recently been questioned because ofthe adverse effects it causes may outweigh the benefitsin many patients, so, it has increased interest in activesurveillance for low-risk diseases and tissue preservationwith focal therapy, thereby reducing the burden on medical care and side effects that may occur after radicalprostatectomy and radiation therapy.Objetive: provide updated information on the treatment of prostate cancer with high intensity focused ultrasound therapy.Material and methods: Bibliographic reviewstudy and systematic analysis of 27 scientific articlesfound in the Medline, Scielo and PubMed databases,whose publication dates correspond to the last 5 years. The search criteria used consisted of terms: prostaticneoplasms, ablation techniques, high-intensity focusedultrasound ablation.Results: Focal therapy is a therapeutic option forlow-risk prostate cancer, clinical studies report a 75%cancer-free survival, 99% cancer-specific survival and96% metastasis-free survival, the prostate antigen ismaintained at values lower than 0.1 ng/ml in long-termcontrols, while the adverse effects of surgery such asincontinence and sexual impotence are rare.Conclusions: HIFU is a less invasive option for thetreatment of low-risk prostate cancer, with oncologicalresults similar to radiotherapy and radical prostatectomy.(AU)