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  • Article
    Cristóbal Ramírez Sevilla, Esther Gómez Lanza, Juan Llopis Manzanera, Alfredo Cetina Herrando, Josep Miquel Puyol Pallàs
    Archivos Españoles de Urología. 2022, 75(9): 753-757. https://doi.org/10.56434/j.arch.esp.urol.20227509.110
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    Background: The objective of this article was to assess the long-term efficacy and safety of the MV140 vaccine to prevent recurrent urinary tract infections (UTIs).

    Methods: This is a prospective, descriptive, comparative and multicenter study of 1003 patients with 3 or more urinary infections for 12 months, treated with the MV140 vaccine from 2011 to 2021. Variables: Age, gender, urinary infections at 3, 6 and 12 months, distribution according to age and months of the year, smoking, use of MV140 vaccines and autovaccines.

    Results: Mean age was 78 and 82.7% were women. At baseline, 84.1% had 3 to 5 infections. According to age, 68.6% had >70 years. There were more consultations in March (12.3%) and fewer in August (4.4%). Smokers represented 24.6% and 21.8% follow autovaccines. Results at 3 months: 0 UTI 45%, 1 UTI 31.3%, 2 UTI 19.2%. 6 months: 0 UTI 29.3%, 1 UTI 33.2%, 2 UTI 24.3%. 12 months: 0 UTI 9%, 1 UTI 28.2%, 2 UTI 17.5%. Smokers: 0–1 UTI 80.2% (3 months), 65.5% (6 months), 53.9% (12 months). Non-smokers: 0–1 UTI 85.8% (3 months), 66.8% (6 months), 20% (12 months). p = 0.41, 0.27 and 0.21 respectively. Vaccines: 0–1 UTI 74.5% (3 months), 61% (6 months), 38.8% (12 months). Autovaccines: 0–1 UTI 82.7% (3 months), 68 % (6 months), 28.2% (12 months). p = 0.04, 0.25 and 0.63 respectively.

    Conclusions: MV140 reduced the number of UTI to 0–2 in 95.5% at 3 months, 86.8% at 6 months and 54.7% at 12 months. Smoking did not worsen the response of MV140. Autovaccines achieved better results than vaccines only at 3 months. Adverse effects represented 1.49%, but no patient had to abandon treatment.

  • Article
    María Romo Rosado, Adoración Granados Molina, Almudena Lagares Velasco, Gloria Caro Chinchilla, Paula Vidal Lana, Enrique La Orden Izquierdo, Llanos Salar Vidal
    Archivos Españoles de Urología. 2022, 75(9): 791-797. https://doi.org/10.56434/j.arch.esp.urol.20227509.115
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    Introduction: Resistance to antibiotics is a growing problem with repercussions on the choice of first-line treatment in urinary tract infection (UTI) in childhood.

    Objectives: To know the current pattern of antibiotic susceptibility/resistance of the most frequent germs that cause UTI in our healthcare area. Secondary objective is to know the evolution of these patterns over time.

    Patients and Methods: A cross-sectional retrospective study of UTI episodes in a first-level hospital in two periods: 1st January 2008-31th December 2010 and 1st January 2017-31th December 2019 through a review of medical records, recording the following variables: Age, sex, fever, hospital admission, uropathy/bladder dysfunction, antibiotic prophylaxis.

    Results: First period: 174 UTI episodes (156 patients); Second period: 266 UTI episodes (218 patients). The most frequently isolated germ was E. coli, but in patients with uropathy or bladder dysfunction, the percentage of different germs is greater. A significant increase in resistance to amoxicillin/clavulanate (from 12.2 to 24%) is observed between both periods, it remains stable and in an acceptable range for gentamicin, cotrimoxazole and slightly increases to first-generation cephalosporins. In patients with uropathy/bladder dysfunction, resistance to all these antibiotics is significantly increased.

    Conclusions: The increased resistance of the most frequent uropathogens in the UTI of the pediatric population of our healthcare area to amoxicillin/clavulanate makes it unsuitable as empirical therapy. First-generation cephalosporins are an adequate alternative in patients without risk factors.

  • Article
    Irene Diéguez, José Antonio March, Adrià Costa-Roig, Ignacio Miró, Cinta Sangüesa, Lucía Rodríguez, Alba Polo, María Ángeles Conca, Carsten Driller, Agustín Serrano
    Archivos Españoles de Urología. 2022, 75(8): 693-699. https://doi.org/10.56434/j.arch.esp.urol.20227508.100
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    Introduction: Voiding urosonography (VUS) is a dynamic imaging technique which evaluates the lower urinary tract by introducing sonographic contrast into the bladder, preferably used in the diagnosis of vesicoureteral reflux (VUR). Our goals were to describe the clinical indications for performing a VUS for VUR’s diagnosis and analyse its diagnostic reliability.

    Material and Methods: Cross-sectional study carried on patients under 15 years old with a VUS taken between November 2013-2020. Sex, age, indications (lower urinary tract infection—LUTI; dilatated lower urinary tract—DLUT; duplex collecting system—DCS), results (presence/absence of VUR, score and side) and complications were analysed. U Mann-Whitney and Chi-squared tests were used and 2 predictive capacity models for the indications used to detect VUR were employed (logistic binomial regression and multilayer perceptron neural network). Statistical significance p < 0.05.

    Results: 415 VUS were completed correctly (male 51.8%, median age 7.3 (3.1-15.3) months). Indications were: LUTI (67.5%), DLUT (33.5%) and DCS (10.2%); presenting 1, 2 and 3 indications in 86.5%, 12.8% and 0.7% respectively. VUR was diagnosed in 34.7% cases. A tendency towards statistically significance was showed related to male sex (p = 0.052) and the only significative clinical indication for VUR was DCS (p = 0.007). Patients with 2 simultaneous indications had higher probability of VUR (p = 0.012). DCS presence or male sex were the only predictive variables of VUR: DCS = OR 1.89 (1.54-6.52) (p = 0.006) and male sex = OR 1.56 (1.03-2.35) (p = 0.035).

    Conclusions: VUS is a thriving technique, radiation free and with a low complications rate. Presence of DCS, male sex or 2 simultaneous indications for VUS increase the probability of presenting VUR.

  • Article
    Iris Coello, Ana Isabel Martínez, Maria Peraire, Laura Aizpiri, Camila Andrea Vega, Miquel Amer, Ricardo José Guldris, Jose Luis Bauza, Enrique C. Pieras
    Archivos Españoles de Urología. 2022, 75(8): 720-728. https://doi.org/10.56434/j.arch.esp.urol.20227508.104
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    Objective: Complications in donation after circulatory death (DCD) kidney transplants (KT) are barely described, while in some urological complications the cause is unknown. The aim of this study is to describe surgical and urological complications and analyze what donation features could be involved.

    Methods: A prospective, single center study was performed from 2016 to 2019 including all KT from controlled cardiac death donors (cDCD).

    Results: A total of 86 cDCD KT were included in the study. Recipient BMI, residual urine output (RUO) <500 mL/day, delayed graft function (DGF), and wound complication were related to UTI (p = 0.020, p = 0.008, p = 0.016, and p = 0.004, respectively). Features related to early graft nephrectomy were recipient BMI and recipients with diabetes mellitus (DM) (p = 0.025 and p = 0.036, respectively). DM in recipients was significantly associated with hematuria (p = 0.046). Urinary leak (UL) was associated to vascular complication and ureteral stricture (US) (p = 0.029 both). UL and lymphocele were associated to US (p = 0.029 both). Features related to lymphocele were recipient BMI and US (p = 0.028 and p = 0.029, respectively). History of previous transplant, time from cardiac arrest (CA) to cold flush, and DGF, were associated to wound complication (p = 0.040, p = 0.011 and p = 0.016, respectively).

    Conclusions: Surgical and urological complications after KT are an important issue to resolve. Our data revealed an association between RUO <500 mL/day, DGF, and wound complication with urinary infection, as well as between recipient DM and hematuria. Recipient BMI and DM were related to early graft nephrectomy. Vascular complications were associated with urinary leak, and lymphocele with US. Finally, wound complication was related to previous transplant, DGF, and time from CA to cold flush. This data revealed interesting associations between donor and recipient features and cDCD KT complications, providing more information to improve prevention and management.

  • Article
    García-González Francisco José, Flores-Soler Jesús, Salinas-Casado Jesús, Moreno Sierra Jesús
    Archivos Españoles de Urología. 2022, 75(3): 215-218.
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  • Article
    Cambronero Javier, Osca-García Jose Manuel, Merino-Salas Sergio, Miguel Juan Manuel, Borralleras Cristina, López-Alcina Emilio
    Archivos Españoles de Urología. 2022, 75(3): 219-227.
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    Objectives: To assess the effectivenessand tolerability of treatment with P africanum(P. africanum) in patients with lower urinary tractsymptoms (LUTS) associated with benign prostatichyperplasia (BPH) in routine clinical practice. Material and methods: Cross-sectional observationalstudy in which 115 patients with LUTS/BPHtreated for 6 months with P. africanum (Tebetane® compuesto)in real-world clinical practice conditions wereincluded. The primary objective was to assess thequality of life (QoL) according to changes in the scoresof item 8 of the International Prostate Symptom Score(IPSS) questionnaire (a score ≥ 4 indicates a significantimpairment of QoL). Secondary objectives includedimprovement of urinary symptoms, urinary flow, satisfactionand compliance with treatment as well astolerability. Data were collected in a single scheduledvisit at 6 months of treatment with P. africanum andwere compared with data registered in the medicalrecords at the beginning of treatment. Results: After 6 months of treatment withP. africanum, the percentage of patient with significantimpairment of QoL was 22.6% as compared with45.2% at the initiation of treatment (P 0,-001). Theoverall IPSS score showed a mean decreas of -4,-5points (median -4,0, interquartile range [IQR] -7,-0 to-2,0) and 69 patients (60%) showed a clinically significantimprovement (reduction of ≥ 4 points). Therewere significant decreases in IPSS subscales of storage(mean -1,-8; median -2,-0, IQR -3,-0 to 0 (P 0,-001)and voiding (mean -1,-9; median -2,-0, IQR -3,-0 to 0)(P 0,-001) symptoms. The degree of satisfaction and compliance with treatment was high with mean scores(median) of 6,9 (7,0) and 9,2 (10), respectively in the1-10 visual analogue scale. Treatment-related adverseeffects did not occur. Conclusions: Treatment with P. africanum during6 months improved significantly QoL and LUTS inpatients with BPH, with a high level of satisfaction andcompliance with treatment, without adverse events.