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Nutrition is tightly associated with the risk of stone events. Apart from genetic predisposition, a correct and balanced diet might prevent incident kidney stones.Several studies analyzed each dietary component and different diets to better understand their impact on stone recurrence.Fluids: High fluids intake is the most important factor for preventing kidney stones disease and for every 200 mL of fluid, the risk of stones is reduced by 13%. Soft drinks seems to be associated to a greater risk of stone events, whereas caffeine and citrus fruits juice are not.Calcium: Normally calcium intake with diet does not exceed 1.2 g/day. A balanced consumption of dairy products is capable of reducing oxalate intestinal absorption and urinary excretion compared to low calcium diet, being protective for stone disease.Oxalate: The exact amount of oxalate contained in different foods is difficult to estimate for its variability, even in the same aliment. In addition, the amount of oxalate consumed was shown to be only a minor risk factor for stone disease, whereas its intestinal absorption is strongly influenced by external factors, such as calcium intake. Dietary oxalate restriction is advisable only in patients with known elevated consumption. Sodium: High sodium intake is both associated with hypertension, heart disease and stone risk. Increased sodium consumption is directly associated to hypercalciuria in both calcium stone formers and healthy subjects. Although dietary sodium restriction to recommended values is always desirable in stone formers, it is difficult to achieve for its broad use in food preparation.Proteins: Animal proteins are associated to increased risk for stone formation, whereas vegetable and dairy proteins are not. Increased meat intake was associated to acidic urine pH, negative calcium balance and reduced anti-lithogenic urinary solutes excretion.Fruits and vegetables: Alkalizing foods are one of the most important factors for stone protection. Their consumption increases anti-lithogenic solutes as citrate, potassium and magnesium. A diet rich in fruits and vegetables is strongly recommended for stone formers.Uric acid: Elevated meat consumption is either associated to increased purine metabolism and acid load, favoring uric acid nephrolithiasis by reducing urine pH and increasing urinary excretion of uric acid, especially in patients affected by metabolic syndrome and diabetes.In conclusion, the most effective diet for stone protection is rich in fruits and vegetables, low in animal proteins and salt, with balanced dairy product consumption and obviously, with elevated fluid intake. These characteristics make vegetarian and Mediterranean diets protective and useful for stone formers, whereas western diet is at risk for stone formation.
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INTRODUCTION AND OBJECTIVES: Multiple chemical sensitivity (MCS) is a multi-symptomatic systemic disease whose genitourinary symptoms are poorly known. The aim of this article is to study these symptoms in Spanish publications.MATERIALS AND METHODS: A retrospective study of descriptive type on the genitourinary symptoms of MCS is carried out in the Spanish publications between the years 2000 and 2019. The search in Medline was performed with MeSH terms “multiple chemical sensitivity Spanish” and in Google with free terms “sensibilidad química multiple España”. In the publications found, only those referring to genitourinary symptoms were selected, in which year, authors, type of article (clinical case, review, casuistry), genital symptoms, urinary symptoms, specialty, hospital or centre and city were studied. The results of these variables have been analyzed with descriptive statistics.RESULTS: We found 45 Spanish publications on MCS of which 20 (44,4%) mentioned genitourinary symptoms. The 20 articles corresponded to 7 clinical cases, 6 reviews, 2 case series, 2 updates, 1 book chapter, 1 special article and 1 consensus document. We found 12 publications on female genital symptoms (60%), 12 on urinary symptoms (60%) and 4 on male genital symptoms (20%). The specialties with the highest number of publications were Family Medicine and Psychiatry with 3 (15%) and Neumology, Toxicology and Anesthesia and Resuscitation with 2 (10%). There are publications from 13 hospitals and 7 national centers, health agencies or foundations. The publications corresponded to 10 cities, the 2 with the most publications being Madrid with 6 (30%) and Barcelona with 6 (30%).CONCLUSIONS: The genitourinary symptoms of MCS are mentioned in about half of the Spanish publications. There is a clear predominance of these symptoms in women. This “genitourinary syndrome” should be taken into account in urological and gynecological patients with MCS.
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INTRODUCTION: The use of a temporary or permanent catheter is very common in clinical practice. Between 15.0% and 25.0% of hospitalized patients have in-dwelling bladder catheters, the majority of which are short-term. Bladder catheter clamping before catheter removal was generally regarded as useful in the past. Today, its utility is questionable. OBJECTIVE: To determine the association between bladder catheter clamping and spontaneous micturition or acute urinary retention (AUR) in postoperative patients with short-term indwelling bladder catheter. MATERIALS AND METHODS: A descriptive, comparative, longitudinal study was conducted at a secondary care hospital center in a western Mexican state. AUR was the outcome variable. Two study groups were formed: patients with bladder catheter clamping (n=43) and the control patients with no bladder catheter clamping (n=41). Descriptive statistical analyses were performed, and percentage comparisons were made with the chi-square test. Significant predictors were subsequently added to the multivariate model. RESULTS: Fourteen percent (n=12) of all the study patients, with and without bladder catheter clamping, presented with AUR and 86% (n=72) did not. In the association analysis, there was no statistically significant difference between presenting with AUR and having or not having bladder catheter clamping (p=0.59). The associations of AUR with bladder re-catheterization (p= 0.001), age (p=0.01), and the presence of lower urinary symptoms (p= 0.005) were statistically significant. CONCLUSION: Postoperative bladder catheter clamping was not associated with the presence of AUR.
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OBJECTIVE: Determining the complications rate and the risk factors associated with early operative and postoperative complications with a bipolar transurethral resection of the prostate at a complex care institution in Colombia. MATERIALS AND METHODS: A mixed cohort study was conducted involving 340 patients diagnosed with benign prostatic hyperplasia who were taken to bipolar transurethral resection of the prostate between 2012 and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate of. complications determined up to 30 postoperative days. RESULTS: A total of 67 patients (19.45%) presented perioperative complications of which 17 (25.37%) were previously hospitalized. According to the Clavien Dindo classification, 14.79% were grade I – II: secondary hematuria was the most reported complication and was present in 18 patients (5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). The risk factors found were surgery during hospitalization (RR: 2.23, 95% CI: 1.14 – 4.39), INR (RR: 7.59, IC95%: 4.63 – 12.44), duration in days of cysto/irrigation (RR: 1.32, CI95%: 1.22 – 1.42) and urethral catheter use (RR: 1.04, CI95%: 1.02 – 1.05). CONCLUSIONS: In this study, the complication rate after bipolar transurethral resection of the prostate was less than 20%. The most frequent complications were grade I and II according to the Clavien Dindo classification. The risk factors that were found are modifiable, which could reduce postoperative morbidity
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INTRODUCTION: Prostate cancer is the second most common neoplasm in men. The prostate biopsy is the fundamental support for the therapeutic decision, the histopathological results of the surgical piece differ from those obtained in the diagnostic prostate biopsy generating under-staging or over-staging in patients.MATERIALS AND METHODS: This study collects data from a total of 147 patients who underwent radical robot-assisted prostatectomy at the Carlos Andrade Marín Hospital in the period January 2016 to December 2018, a statistical analysis is performed by the Chisquared test with a significance level of 5%.RESULTS: The percentage agreement of prostate biopsy with the histopathological result of the surgical piece was 49%, over-staging was 14% and under-staging was 35%. The Gleason score most commonly found in this study was 6 (3 + 3) both in prostate biopsy and in the radical prostatectomy surgical piece. There were 3 patients with vanishing prostate cancer in this study group.CONCLUSIONS: The agreement of the prostate biopsy in relation to the surgical piece of radical prostatectomy is in the context of that reported in international studies, over staging does not represent a major health problem since patients could benefit from the radical prostatectomy but under-Staging could lead to the decision not to provide the patient a curative treatment of his disease to be referred to an active surveillance protocol.Vanishing prostate cancer in this study group is explained by the use of hormonal blockade with leuprolide acetate prior to surgical treatment in two patients and a low tumor invasion in the histopathology sample of the third patient.
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OBJECTIVE: Pneumatic lithotripsy (PL) and Ho: YAG laser lithotripsy (LL) are the most widely accepted methods in the endoscopic treatment of ureteral lithiasis. The objective is to compare efficacy and safety of pneumatic lithotripsy vs. Ho: YAG laser lithotripsy in the treatment of ureteral lithiasis. MATERIAL AND METHODS: Prospective, single-blind, multicenter study. Adult patients were recruited from August 2017 to March 2019, in 23 institutions throughout Argentina. Patient demographics, stone characteristics, presence of double J stent prior to the intervention, stonefree rate (SF) and postoperative complications were evaluated and analyzed.RESULTS: A total of 366 patients with ureteral lithiasis were included, 204 in the PL group and 162 in the LL group. The SF rate was significantly higher in the LL group (77% vs. 92%), OR 3 .43 (1.76 to 6.70). The complication rate was significantly lower in the LL group (9.8% vs. 2.5%), OR 0.23 (0.07 to 0.71). In the multivariate analysis, the use of Ho: YAG energy, the location of the lithiasis in the distal ureter, and the preoperative placement of double J stent, were found to be predictors of SF status.CONCLUSIONS: Ho: YAG laser lithotripsy has a higher stone-free rate and a lower complication rate compared to pneumatic lithotripsy.
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OBJECTIVE: This study aims to compare infectious complications after a prostate biopsy in patients with or without chronic idiopathic constipation (CIC). METHODS: Six hundred and sixty-three patients who underwent a transrectal ultrasound-guided biopsy (TRUSBx) of the prostate between 2012 and 2018 were evaluated prospectively. Patients were divided into two groups according to their CIC status and monitored for complications. CIC was defined by the Rome III criteria. Multivariate analysis was performed to assess the risk factors. RESULTS: Thirty-five patients (5.8%) developed a urinary tract infection (UTI) while sepsis occurred in only three cases (0.5%). CIC was found as a risk factor for infection. Infection occurred in 18.1% of the men with CIC compared to 2.3% of those without CIC (p=0.001). Sepsis occurred in 1.4% of the men with CIC compared to vs 0.2% of those without CIC (p=0.68). In multivariate analysis, CIC (OR of 9.27 and 95% CI 4.40-19.54, p<0.05) and Diabetes Mellitus (OR of 3.11 and 95% CI 1.52-6.36, p=0.002) were associated with an increased risk factor of UTI and sepsis. CONCLUSIONS: We demonstrated that CIC is an important risk factor of infection after a prostate biopsy. Prevention is important to minimize complications after this very common worldwide procedure.
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OBJECTIVE: Adrenocortical carcinoma (ACC) is a rare and heterogeneous disease, with challenging management and poor prognosis. Surgery with curative intent is the preferred treatment option for localized disease, with a reported 5-year survival rate of 55% for complete resections. However, owing to the high risk of recurrence there is a need for adjuvant therapies, such as mitotane, an adrenolytic drug, or irradiation, while in advanced disease the standard of care is a combined chemotherapy scheme. The aim of this study was to report our experience in the surgical management and outcomes of ACC patients. MATERIALS AND METHODS: A retrospective observational study was performed in a cohort of ACC patients who had undergone surgical resection (open or laparoscopic approach) and were followed up at our tertiary hospital. Patients with localized or locally advanced disease were included in the analysis. All medical records, including clinical, surgical, pathologic, and follow-up data, were collected and analyzed. RESULTS: A total of 19 ACC patients were managed at our center between August 1990 and August 2013. The median age at diagnosis was 50.5 years (range 19–72), and most patients were males. Abdominal pain was the most common clinical presentation (n=9, 47.4%). Abdominal contrast-enhanced computed tomography (CT) was performed in all cases. Only 3 tumors (15.8%) were functional and most were stage II at diagnosis (n=9, 47.4%). No patient presented metastasis. Of the 19 patients, 18 (94.7%) underwent surgery with curative intent, while one (5.3%) received adjuvant radiotherapy (ART). The open approach was used in 17 patients (89.5%), while the remaining 2 (10.5%) underwent laparoscopy. Postoperative complications occurred in 8 patients (42.1%); none were of grade IV or V. Median follow-up was 66 months (range 3–312). The majority of patients (n=15, 78.9%) were disease free with surgery alone. None received adjuvant mitotane therapy (AMT). Four patients (21%) experienced metachronous metastases and 3 (15.8%) local recurrence after a median time of 10.5 months (range 2-60) and 9.3 months (range 1.5-30), respectively. The 5-year overall survival rate was 47.4%. CONCLUSIONS: Our findings confirm both the unpredictable nature of ACC and the accepted primary role of surgery. The use of adjuvant therapy was less frequent in this series than is supported currently. However, a multidiscipinary approach should be the initial step in the management of this rare malignancy.
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OBJECTIVE: To compare systematic biopsy with MRI-TRUS fusion prostate biopsy in terms of cancer detection rates. PATIENTS AND METHODS: The data of the patients who had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or more lesions on mpMRI and underwent MRI-TRUS fusion biopsy with simultaneous 12-core standard systematic biopsy from June 2016 to June 2019 in our tertiary center were retrospectively reviewed. Clinical, radiological and pathological data were recorded. Statistical difference among the groups was determined by using McNemar tests. RESULTS: A total of 344 patients were included in the study. As a result of transrectal targeted and systematic combined biopsy, 117 patients were diagnosed with prostate cancer. Benign pathology rates in patients with PI-RADS 3, PI-RADS 4, and PI-RADS 5 lesions were 93.8%, 68.5%, and 46.4%, respectively. Patients were divided into two groups as ISUP grade 1 and ISUP grade ≥2 and cancer detection rates (CDRs) were found significantly higher in transrectal targeted biopsy compared with the systematic biopsy (12.5% vs. %6.4, p=0.007 and 17.4% vs. 8.7%, p<0.001, respectively). Targeted biopsy CDRs were found significantly higher in the high PSA density group (24.5% vs. 41.4%, p=0.001) unlike the systematic biopsy. CONCLUSION: Transrectal targeted biopsy was superior to systematic biopsy in the diagnosis of prostate cancer. Clinicians should be more selective when making a biopsy decision for patients with PI-RADS 3 lesions. PSA density can be used as a criterion for patient selection for targeted biopsy.
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OBJECTIVE: Parastomal hernia in patients with ileal urinary diversion is insufficiently described in the literature, and among its complications, the presence of urinary obstruction is not usually reported.METHODS: We present a 74-year-old male with a Bricker type urinary diversion. He presented urinary infections with CT scan showing hydronephrosis with obstruction of the ileal conduit probably related to a parastomal hernia. The hernia growth runs in parallel to the ureterohydronephrosis, so we performed a hernioplasty to solve the obstruction. CT at 6 months shows no urinary obstruction and no hernia recurrence. No hydronephrosis in the follow-up at 14 months.RESULTS: We reviewed the literature and we only found three articles that related parastomal hernia in Bricker to ureterohydronephrosis, although none of them proved this relationship with the correction of the urinary obstruction after hernia surgery.CONCLUSIONS: Parastomal hernia should be considered in the differential diagnosis of obstructive uropathy in patients with ileal urinary diversion.
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INTRODUCTION: Prostatic carcinoma with signet ring cells is a very rare histopathological entity, with few infected cases in the literature, for which there is no management protocol.DESCRIPTION OF CASES: Two patients are presented, one 46 years old and the other 76 years old, the first debuts with a decompensated picture of urinary and intestinal obstruction, and the second presents a torpid evolution of his disease with progression from stage I to III in three months.DISCUSSION: Mucosacretory prostate tumors have their own morphohistological and immunohistochemical characteristics, which differentiate them from classic adenocarcinomas.CONCLUSIONS: Prostatic carcinoma with signet ring cells is an entity that must be borne in mind, especially in patients with rapid progression of their disease.
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OBJECTIVE: To assess the metastasic prostate cancer in the differenctial diagnosis of mediastinal masses.METHODS: To report a case. RESULTS: We present the case of a 78-year-old male patient with a diagnosis of prostate cancer with a mediastinal mass compatible with prostate metastasis.CONCLUSION: Mediastinum is a very rare site for prostate cancer metastasis, but it must be considered in the differential diagnosis of mediastinal masses. Treatment is the usual for metastatic prostate cancer.
