Machine learning accurately predicts food exchange list and the exchangeable portion.

Introduction: Food Exchange Lists (FELs) are a user-friendly tool developed to help individuals aid healthy eating habits and follow a specific diet plan. Given the rapidly increasing number of new products or access to new foods, one of the biggest challenges for FELs is being outdated. Supervised machine learning algorithms could be a tool that facilitates this process and allows for updated FELs-the present study aimed to generate an algorithm to predict food classification and calculate the equivalent portion. Methods: Data mining techniques were used to generate the algorithm, which consists of processing and analyzing the information to find patterns, trends, or repetitive rules that explain the behavior of the data in a food database after performing this task. It was decided to approach the problem from a vector formulation (through 9 nutrient dimensions) that led to proposals for classifiers such as Spherical K-Means (SKM), and by developing this idea, it was possible to smooth the limits of the classifier with the help of a Multilayer Perceptron (MLP) which were compared with two other algorithms of machine learning, these being Random Forest and XGBoost. Results: The algorithm proposed in this study could classify and calculate the equivalent portion of a single or a list of foods. The algorithm allows the categorization of more than one thousand foods with a confidence level of 97% at the first three places. Also, the algorithm indicates which foods exceed the limits established in sodium, sugar, and/or fat content and show their equivalents. Discussion: Accurate and robust FELs could improve implementation and adherence to the recommended diet. Compared with manual categorization and calculation, machine learning approaches have several advantages. Machine learning reduces the time needed for manual food categorization and equivalent portion calculation of many food products. Since it is possible to access food composition databases of various populations, our algorithm could be adapted and applied in other databases, offering an even greater diversity of regional products and foods. In conclusion, machine learning is a promising method for automation in generating FELs. This study provides evidence of a large-scale, accurate real-time processing algorithm that can be useful for designing meal plans tailored to the foods consumed by the population. Our model allowed us not only to distinguish and classify foods within a group or subgroup but also to perform the calculation of an equivalent food. As a neural network, this model could be trained with other food bases and thus improve its predictive capacity. Although the performance of the SKM model was lower compared to other types of classifiers, our model allows selecting an equivalent food not from a group previously classified by machine learning but with a fully interpretable algorithm such as cosine similarity for comparing food.

Long-Term Functional Outcomes and Quality of Life after Male Transobturator-Retrourethral Sling Surgery.

INTRODUCTION: Post-prostatectomy urinary incontinence (PPUI) has an enormous impact in quality of life (QoL). Transobturator-rethrourethral sling (AdVanceTMXP sling) is a well-established treatment option although there is paucity of data on long-term outcomes. Our objective was to assess the long-term functional outcomes and QoL in a cohort of men undergoing AdVanceTMXP sling surgery. METHODS: Retrospective observational study of men undergoing AdVanceTMXP sling in a tertiary referral institution from August 2013 to July 2020. 55 patients met the inclusion criteria, with a minimum follow-up of 12 months. Main outcomes were pre- and post-operative daily pad use and scoring in the ICIQ-SF questionnaire. Post-operative complications were assessed following the Clavien-Dindo classification system. QoL and satisfaction with the procedure were assessed through direct interview. RESULTS: Mean number of pads prior to surgery was 3.1, and mean ICIQ-SF score was 13.5. After surgery, mean daily pads use went to 1.2, and mean ICIQ-SF dropped to 5. With a mean follow-up of 42.36 months, 21.8% patients did not use any pads/day and 76.4% achieved social continence (0-1 pad/day). We found no statistically significant differences in outcomes of patients with follow-up of <36 months, 36-48 months, and >48 months (p = 0.067). CONCLUSIONS: AdVanceTMXP sling implantation in men with PPUI improves urinary incontinence and QoL, and their results are sustained over time.

Management of Acute Cystitis in the Era of COVID-19.

Purpose of Review: No specific guidelines have been developed for acute cystitis management during the COVID-19 pandemic. This review aims to provide up-to-date information about treatment and follow-up in patients with symptoms suggesting lower urinary tract infection. Recent Findings: Uncomplicated cystitis does not need microbiological confirmation; thus, clinical diagnosis via telephone interview or questionnaires may be done. When complicated infections are suspected, in-person evaluation or close follow-up is mandatory. Antibiotic treatment is still the gold standard for treatment, although non-pharmacological strategies have also been suggested and further investigations are warranted. Summary: Urinary tract infections are still a frequent reason for consultation that needs to be addressed in both primary care and specialized levels. Their management during the pandemic is similar than in precedent years, but telehealth options have emerged which can facilitate diagnosis and treatment.

Artificial Urinary Sphincter in a High-Risk Urethra: Transcorporal Gullwing Modification Description of the Technique.

BACKGROUND: In this report, we describe a modification of transcorporal artificial urinary sphincter place ment known as Gullwing modification. DESCRIPTION OF TECHNIQUE: Using a penoscrotal approach, bilateral corpora cavernosa flaps are harvested and sutured in the midline covering the lateral and ventral surfaces of the urethra. Transcorporal cuff placement provides dorsal reinforcement, thus having extra tissue buttressing all the circumference in cases of a fragile urethra due to previous urethral cuff erosion, urethroplasty, or pelvic radiotherapy. PATIENT AND METHODS: After previous urethral cuff erosion, radiotherapy, and urethral reconstruction, our patient complained of severe stress urinary incontinence. Due to the high risk of urethral complications, we proceed to a transcorporal artificial sphincter placement with urethral reinforcement through a bilateral cavernosal flap. RESULTS: The surgery was successfully completed, and after 6 weeks, sphincter was activated with satisfac tory results. Two years after surgery, his continence status is stable without complications. CONCLUSION: Urethral complications associated with artificial urinary sphincter surgery remain a challenge for the reconstructive surgeon. Reinforcement of the ventral aspect of the urethra through corpora cavernosal flaps may reduce the likelihood of urethral erosion in high-risk cases.

Current role of neuromodulation in bladder pain syndrome/interstitial cystitis.

Neuromodulation is recommended by major international guidelines as a fourth-line treatment in bladder pain syndrome/interstitial cystitis (BPS/IC) patients after failure of behavioural, oral and intravesical pharmacological treatments, including hydrodistension. A non-systematic review of studies identified by electronic search of MEDLINE was performed with no time limitation. A narrative synthesis of the existing evidence regarding the results of sacral, tibial and pudendal nerve stimulation in the management of BPS/IC was developed. Neuromodulation in pelvic chronic pain disorders, including BPS/IC, is a useful tool for refractory patients to conventional treatments. Sacral neuromodulation may be effective in patients with BPS without Hunner's lesions, and the effect seems to be maintained in the mid- and long-term. Posterior tibial nerve stimulation can be offered to patients with BPS/IC in the context of a multidisciplinary approach. When pudendal neuralgia is suspected, selective pudendal nerve stimulation has a high response rate. The aetiology of the pain can influence the outcomes in the mid- and long-term of the different neuromodulation approaches, thus careful diagnosis is recommended.

Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults.

Purpose of review: Our goal was to summarize recent evidence regarding recurrent urinary tract infections and asymptomatic bacteriuria in different adult populations. Recent findings: Several research groups are focused on the description of resident bacterial flora in the bladder and urinary dysbiosis in the microbiome era. Even the definitions might change in light of these discoveries. However, the role of urinary microbiome and bacterial interference has still to be determined. Summary: Systematic treatment of asymptomatic bacteriuria is not recommended and even classic indications such as asymptomatic bacteriuria in pregnant women are controversial. In fact, its treatment is associated with a higher probability of symptomatic UTI and a higher prevalence of antibiotic-resistant bacteria. Improving the diagnosis of asymptomatic bacteriuria and optimizing the management of recurrent urinary tract infections, especially through non-antibiotics measures, are needed in order to minimise antimicrobial resistance.

Female Urethroplasty: Anterior Vaginal Wall Flap (Blandy Flap) - Simpler Tends to Be Better.

Urethral stricture is a rare condition in women, representing a diagnostic challenge for the urologist. Its main etiology is traumatic or due to labor. Definitive treatment can be by means of dilations or urethroplasty using both local flaps and free grafts. In this study, we report the case of a patient with voiding symptoms during a period of 9 years after childbirth, despite an attempt of urethral dilation and chronic self-catheterization. The patient was finally diagnosed of a long distal urethral stricture, and she underwent urethroplasty with an anterior vaginal wall flap with satisfactory results. We take the opportunity to briefly review the diagnostic pathway in women with obstructive symptoms and the main female urethroplasty techniques.

Same problem, different approaches: transvesical and extravesical laparoscopic vesicovaginal fistula repair-case report.

Vesicovaginal fistulas (VVaFs) are relatively uncommon in developed countries but with devastating consequences for the women suffering them. Conservative management has a low response rate. The surgical repair is a technically demanding procedure. Transvaginal, open transabdominal or laparoscopic (pure or robot-assisted) approaches have been described with similar post-operative results. We report two real-life cases of VVaF after surgery of benign gynaecological conditions, both presenting with continuous urinary incontinence and repaired with laparoscopic surgery. The first case had a simple tract above the trigone and was managed with an extravesical approach. The second is a complex case with multiple fistulous tracts that required a transabdominal-transvesical approach (modified O'Connor technique). Both patients have their fistula closed and are continent after surgery with a mean follow-up of 9 months. Given the lack on evidence for the selection of the best approach, it is important to report the outcomes with the different surgical techniques in both simple and complex fistulae. A pre-operative exhaustive study of the location and number of fistulous tracts is essential, as well as selecting the technique which best allows tissue dissection and tension-free suture to get a successful closure. Therefore, knowledge of several procedures and approaches is mandatory when dealing with this disorder.

Long-term Outcomes of Sacral Nerve Stimulation in Pelvic Floor Dysfunctions.

PURPOSE: The aim of this study was to analyze the long-term outcomes of sacral nerve stimulation (SNS) in both idiopathic and neurogenic pelvic floor disorders in patients treated at a referral center. METHODS: This retrospective observational study analyzed the records of 106 patients tested at our department from December 1999 to January 2017. The efficacy variables evaluated were the Global Response Assessment (range, 0%-100%) and, according to the clinical indication, other specific variables such International Consultation on Incontinence QuestionnaireShort Form, number of catheterizations or pads/day, and the numerical pain scale. The safety variables analyzed were complications (pain, migration, infection), reinterventions and explants. Patients' quality of life (QoL) and satisfaction with the procedure were evaluated through telephone interviews. RESULTS: The clinical indications were overactive bladder (OAB) (n=36), urinary retention (UR) (n=37), bladder pain syndrome/interstitial cystitis (BPS/IC) (n=19), fecal incontinence (FI) (n=8), and double incontinence (DI) (n=6). The implant rates according to the clinical indication were as follows: OAB, 55.6%; UR, 56.8%; BPS/IC, 63.15%; FI, 87.5%; and DI, 66.7%. Clinical and/or statistically significant improvements in all efficacy variables were observed. Loss of therapeutic effect at 75 months of follow-up was observed in 34% of patients. Device-related pain appeared in 25 patients (39%); in 20 patients, it was resolved by reprogramming and 5 patients required device removal. An overall improvement in QoL and high levels of satisfaction with the procedure were observed. More than 90% of patients would recommend SNS to a friend or relative. CONCLUSION: SNS is a minimally invasive procedure that offers a real alternative to patients with refractory pelvic floor dysfunction. Its safety profile is very favorable and it provides a long-lasting improvement in symptoms and QoL.

[Management of neurourological patients during the COVID-19 pandemic.] / Manejo del paciente neurourológico durante la pandemia COVID-19.

OBJECTIVES:  To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing the recommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgentor delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment inspecific scenarios.

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19.MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales  para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios.

Manejo de la hiperplasia benigna de próstata durante la pandemia COVID-19 / Benign prostatic hyperplasia management during COVID-19 pandemia

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19. MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios

OBJECTIVES: To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing the recommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgent or delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment in specific scenarios

Manejo del paciente neurourológico durante la pandemia COVID-19 / Management of neurourological patients during the COVID-19 pandemic

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19. MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios

OBJECTIVES: To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing ther ecommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgent or delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment in specific scenarios

Urodynamics Before Stress Urinary Incontinence Surgery in Modern Functional Urology.

There is an ongoing debate in functional urology forums about the role and utility of urodynamics as a diagnostic and prognostic tool for patients with urinary incontinence. Current evidence suggests that in a limited number of patients with pure stress urinary incontinence (those without relevant urogynaecological comorbidities and a low postvoid residual volume of urine), urodynamic studies can be avoided, although this opinion remains controversial. PATIENT SUMMARY: Stress urinary incontinence is highly prevalent and surgical treatment is frequently needed. There is a debate about the need to perform invasive tests to assess the function of the lower urinary tract to predict the outcome of any surgery. We describe the pros and cons for this situation.

Urinary retention.

Urinary retention, defined as the inability to void, is a common medical problem. If unidentified and/or untreated, it may become a serious condition that can lead to kidney damage or urosepsis, compromising the patient's life.
Acute urinary retention (AUR) is usually easy to identify and to treat as patients usually complain of hypogastric pain and anuria. Proper bladder drainage with urethral or suprapubic catheter is the first line of treatment, with posterior studies to determine the cause of retention.
Chronic urinary retention (CUR) is often much more difficult to identify. It is invariably linked to increased post-void residual urine (PVR), but its asymptomatic nature makes it often a hidden condition.
There is a wide range of intrinsic and extrinsic, obstructive and non-obstructive causes affecting the lower urinary tract, which can lead to urinary retention. Due to the differences in urinary physiology and in order to simplify diagnosis and management, these are usually studied separately in men and in women. Management consists of a variety of options depending on the cause of retention, including conservative treatment, drug therapy and several forms of surgery. 
In this review, we make an overview of the main causes of acute and chronic urinary retention in men and women, focusing on the main aspects of diagnosis and management.


Conocimiento, riesgo y condiciones de trabajo en trabajadores de la atención primaria de salud en el municipio Playa / Knowledge, risk and working conditions in workers of the first health care in Playa municipality

Introducción: La calidad en los servicios de salud no pasa solamente por el desarrollo tecnológico y el conocimiento especializado de nuestros trabajadores del sector. Existen factores que influyen notablemente en el alcance de la excelencia en estos centros. Uno de estos aspectos es la educación sanitaria y el conocimiento que tengan los colectivos laborales sobre los riesgos y las causas que pueden producir la transmisión de enfermedades y su relación con las malas prácticas que se pueden generar durante esta tarea. Material y método: Se encuesta el universo de trabajadores de 3 policlínicos del municipio Playa (‘Manuel Fajardo', ‘28 de Enero' y ‘5 de Septiembre'), a partir de un instrumento breve de fácil aplicación que explora la percepción que los trabajadores tienen sobre su actividad. El instrumento fue aplicado por un equipo de trabajo a 304 trabajadores, de ellos 240 mujeres y 65 hombres, que se encontraban en activo en el momento de la encuesta. Resultados: El universo de trabajadores resultó un grupo joven con alta experiencia en el sector y un bajo reconocimiento sobre los riesgos que representan potencialmente algunas condiciones de trabajo. Se asoció al nivel de capacitación declarado y el reconocimiento de los riesgos solo en el policlínico Manuel Fajardo. Un alto porcentaje de los trabajadores en los tres policlínicos declara no haber recibido nunca capacitación sobre el tema. Se calcularon dos ecuaciones discriminantes que nos hablan de diferencias entre los que recibieron y los que no recibieron capacitación, con buen poder discriminativo. Conclusiones: No hay un buen conocimiento y es necesaria la capacitación sobre los riesgos del trabajo en la población estudiada(AU)