INTRODUCTION: Chronic bladder disorders are a common condition. Endovesical hyaluronic acid is one of the therapeutic options for these patients. It is intended to verify the effectiveness and safety of treatment with intravesical instillations of hyaluronic acid in patients with bladder symptoms. MATERIAL AND METHODS: We present a series of 32 patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance, and complications were analyzed, and symptoms before and after treatment were compared. Symptomatic relief achieved with treatment was assessed using the Patient Global Improvement Impression Scale (PGI-I).RESULTS: The median age was 74 years (IQR 60-78) and 65.6% were women. Median follow-up was 10 months (IQR 7-14). Eleven patients were diagnosed with radiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrent cystitis. After treatment, symptoms improved in 81.8% of patients with radical cystitis, 82.3% of patients with BPS/IC, and 75% of the patients with recurrent cystitis. The incidence of hematuria was reduced from 46.9% to 9.4% (p<0.001), filling symptoms from 62.5% to 12.5% (p<0.001), and pain from 40.6% to 12.5% (p=0.004). 100% of the patients tolerated the treatment well and only 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6% showed total control of symptoms and 15.6% partial control, achieving a greater response in the group of patients with hematuria (73.3%). 61.3% of the patients perceived relief of symptoms after treatment according to the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up.CONCLUSION: Intravesical hyaluronic acid is a safe and effective treatment for filling symptoms, hematuria, and pain in patients with chronic cystopathies. Patients with radiotherapy-induced cystitis seem to especially benefit from treatment.
INTRODUCTION: Urinary tract infections (Uti) are one of the most common infections that affect humans throughout their lives and are a common health problem both at the community and at the nosocomial level. Knowing microbiological characteristics, sensitivity profile and risk factors allow to optimize the management of Utis minimizing the increase of antibiotic resistance (AR) and establishing early treatments to reduce the morbidity and severity of infection. This study aims to establish which microorganisms are responsible for urinary tract infections in our community and determine their AR.PATIENTS AND METHODS: An observational, descriptive, cross-sectional, retrospective study of all patients with the first episode of UTI recorded at the Sanatorio Allende in the city of Cordoba, Argentina, who were requested to undergo urine culture (URC), from January 2016 to December 2017.RESULTS: 3636 positive URC were analyzed, of which 1740 met the inclusion criteria. Of the total analyzed 90.2 % (n=1570) were female. The average age was 37.8 years (SD=15.2). Escherichia coli was the microorganism most frequently isolated in 80.3% followed by S. saprophyticus in 8.0%. The age group of 18-30 years (40.1%) showed the highest proportion of microorganisms, where we observed the highest prevalence of E. coli and S. saprophyticus. The following acquired resistances were obtained from the total isolations: 47.6% of the microorganisms were resistant to ampicillin, 29.6% to cotrimoxazole, 15.2% to ciprofloxacin, 4.6% to first generation of cephalosporins, 3.4% to cefixime, 2.3% to amoxicillin-clavulanic, 1, 2% to gentamicin and 1% to nitrofurantoin.CONCLUSION: E. Coli was the most prevalent pathogen in our environment, with high rates of resistance to ampicillin, fluoroquinolones and trimethoprim-sulfamethoxazole, confirming the need for periodic studies to determine the most optimal empirical antibiotic treatment.
INTRODUCTION: In Argentina, our institution has a urology resident on call who handles requests to the single radio during nighttime. Few studies address this important issue that provides useful information to promote education and optimize hospital dynamics. OBJECTIVE: To describe the characteristics of the calls received in the urology radio during night shifts. MATERIALS AND METHODS: During the night shifts, all calls to the radio were recorded during the period between June and July 2019. We determined: time, source, sex, and age of the patient, reason for the call and classified the calls according to: calls for immediate resolution (which required urological instrumental intervention, bladder catheterization or lavage, etc.), unnecessary calls (wrong number), and the number of emergencies that require calling a superior for immediate surgical resolution. RESULTS: We registered a total of 325 calls, most of them male patients. The main reason for calling was for placement, replacement, or washing of the urinary catheter or suprapubic catheter. We obtained 139 calls that required urological intervention. The highest number of calls was from the emergency department (119), followed by the Internal Medicine staff (47). Most of them (242) did not require patient admission. The total of unnecessary calls was three, corresponding to wrong number. CONCLUSION: This study helped us to characterize the calls to the Urology radio from other services and emergency department, allowing us to identify the most common problems and educate based on this.
OBJECTIVE: To determine predictors of BCR in patients with localized PCa undergoing RP at an oncology reference center in Colombia.MATERIALS AND METHODS: A retrospective analytical study was conducted on patients with localized PCa undergoing RP and who at least had one adverse pathological factor for BCR. We consider BCR as two consecutive elevations of PSA after RP, greater than 0.2 ng/ml. For the bivariate analysis we used Kaplan-Meier, and Cox proportional risk analysis to estimate the hazard ratio as well as to determine variables independently associated with the outcome. RESULTS: 280 patients were included. The median age was 65.3 years, with a median follow up of 52.2 months. BCR occurred in 39% of patients, with a median BCR time of 24.8 months. In the multivariate analysis, high risk [HR 2.07 (95% CI 1.11 – 3.86)], positive surgical margins [HR 2.79 (95% CI 1.66 – 4.69)] and tertiary Gleason pattern [HR 2.16 (95% CI 1.16 – 4.01)] were identified as independent variables associated significantly with BCR. Limitations include retrospective design and sample size. CONCLUSIONS: High risk, positive surgical margins and the presence of tertiary Gleason pattern are the predictive factors of BCR after RP in the Colombian population.
OBJECTIVES: Describe the technique, indications and the correct interpretation given the findings in different clinical entities, and to serve as a guide for urologists, urology residents and even medical students.MATERIAL AND METHODS: A literature search was performed using Pubmed, Cochrane and Scopus database for articles and guidelines published between January 1970 and June 2020. RESULTS: Videourodynamics is a diagnostic procedure that combines the urodynamic study with simultaneous images of the lower urinary tract to assess the anatomy and function during the different phases of micturition.This study provides important information that can modify therapeutic behavior and therefore clinical outcomes of patients.CONCLUSION: The role of videourodynamics becomes more relevant nowadays in the assessment of the pathophysiology of voiding dysfunction, being the gold standard for the workup of neurogenic bladder and voiding dysfunction in young people and women and, possibly in persistent/recurrent incontinence in both men and women.
INTRODUCTION AND OBJECTIVES: The ureteral catheter is used to provide adequate drainage of the upper urinary tract. They have been used to prevent or relieve ureteral obstruction due to multiple causes. The literature mentions the standard placement of double J catheter guided by fluoroscopy, reporting the use of ultrasound exclusively in cases of pregnant patients in order to avoid ionizing radiation. Based on the aforementioned, the primary objective was to evaluate the placement of double J catheter guided by ultrasound, as an alternative technique to the use of the fluoroscope in ureteral obstructions, as secondary objectives the intensity of the pain and the complications of the procedure.MATERIALS AND METHODS: An observational, descriptive and prospective study was carried out with 41 patients who attended the lithiasis consultation Results: A total of 41 patients who underwent double J catheter guided by ultrasound were evaluated, achieving it successfully in 35 of the cases, resulting in bad position in 2 patients and being impossible to insert it in 4. average age was 41 years, size of the lithium 10.41mm. The complications presented were 17% with the use of the scale of Clavien modified these complications were represented as follows: 4.9% grade I back pain, 7.2% grade II lower urinary tract symptoms, lower tract infections , and 4.9% grade IIIa malposition. CONCLUSIONS: The placement of ureteral catheters guided by ultrasound, represent a useful tool, safe, with manageable complications, taking place in times adjusted to the procedure.
OBJECTIVES: Most patients at first diagnosis of bladder cancer (BC) present with nonmuscle invasive disease (NMIBC). BCG intravesical therapy after transurethral resection of the bladder tumor is the gold standard in intermediate and high risk NMIBC patients. However, it is estimated that approximately 50% of these patients will present with BCG failure which increases their risk for progression to muscle invasive disease. Currently, the best option for these patients is radical cystectomy. Thus, it is of great interest to pursue new, therapeutic options for BCG failure patients to avoid the necessity of radical cystectomy. We hereby review novel treatment modalities for BCG failure patients. METHODS: This is a narrative review. Keywords for the search were BCG failure, BCG unresponsive, BCG refractory, BCG relapsing and BCG intolerance. Evidence was identified through a search for publications with a ‘’BCG unresponsive’’ tag through 2020. Studies were selected if they contained clinical data on BCG unresponsive therapeutics with near-term availability. Clinical trial landscape evaluation for emerging therapies was performed by searching ClinicalTrials.gov for recruiting/ open interventional trials in 2020. RESULTS: Novel treatment modalities for BCG failure include intravesical chemotherapy, BCG re-challenge or combination of BCG with IFN-α2β, valrubicin, radiotherapy, electromotive drug administration, vicinium, chemohyperthermia, photodynamic therapy, gene therapy, vaccine therapy and immunotherapy. For patients in whom BCG has once failed a repeat course of BCG or BCG plus interferon appears to be a reasonable practice. Likewise, single agent gemcitabine may be considered a treatment modality. However, after 2 or more BCG failures, especially in patients with earlier relapses or cancer persistence, single agent intravesical chemotherapy with valrubicin, gemcitabine or docetaxel appears to be less active than doublet/triplet intravesical chemotherapy or mitomycin chemothermotherapy. Gene therapy or conjugated antibodies may play a role upon further relapse. Single agent pembrolizumab is unlikely to be used as first line, but may be useful, along with multiple new immunotherapeutics, as part of a multimodal approach towards BCG unresponsive disease. CONCLUSIONS: Results from ongoing trials will provide us useful information about many of the existing regimens and probably new drugs will soon be available for this group of patients.
OBJECTIVES: Portable pH meters are robust and reliable tools for measuring urinary pH by patients at home. This study evaluated the usability of a prototype smart Lit-Control® pH Meter and an associated mobile medical app, with the aim of identifying possible design and functionality issues along with usability problems among non-expert voluntary users.MATHERIALS AND METHODS: Twenty-one individuals of both sexes, between 25 and 65 years old, tested the dyad pH meter/app for 14 days (three readings per day). The participants were asked to carry out a sequence of use of the system equivalent to what an intended user would do for urinary pH self-monitoring. At the end of the trial period, each participant filled out study questionnaires regarding the learning times, i.e. the time used by a new user to perform a task with the technology, usability, errors detected, and suggestions for improvement. RESULTS: The mean age of participants was 35.4 (range, 26 to 61) years. The readings from the pH meter yielded average values of 5.72 (SD = 0.26), 6.13 (SD = 0.43), and 5.47 (SD = 1.27) for the morning, evening, and night urines, respectively. The time of the day with greater adherence was the morning (49.7% of all readings). The learning times were in general short as reported by the participants: 73.7% were able to register in the App, rated as the least easy 12task, in less than two and a half minutes. The task of uploading the pH readings, both manually and automatically, was mostly performed in less than 35 seconds.CONCLUSION: This pilot study of real-world usage pattern shows that the dyad smart LitControl pH meter/App was perceived as fit for purpose by non-expert volunteers and had no relevant functionality or usability issues that would pose a significant barrier to the intended users. New studies are ongoing in order to test the usability by patients with lithiasis history.
OBJECTIVES: Sacral electrical stimulation has been used for more than a century as an alternative therapy for adult urinary syndromes. In the literature, several studies have validated the efficacy of this technique based on clinical and urodynamic criteria. Nevertheless, few studies have shown beneficial results in children with overactive bladder. MATERIAL AND METHODS: We performed a systematic review of studies assessing the impact of sacral electroestimulation treatment on overactive bladder in children. The search identified 389 potentially eligible items. Of them, 14 studies published between 2001 and 2019 met the study criteria and were selected for systematic review. RESULTS: All of papers included in this review individually demonstrated a high efficiency rate with good shortterm results, as well as safety in its use due to its minimal rate of adverse effects. However, the comparison of the results obtained in all of them was not possible because the high variety and heterogeneity in the different studies. The main limitation is that there is still no standard protocol for the application of this therapy in the pediatric population. CONCLUSION: This review revealed the promising benefits of sacral electroneuromodulation in pediatric patients with overactive bladder. However, more studies with strictly meet pediatric overactive bladder diagnosis and management criteria should be done to protocolize and clarify the effectiveness of this therapeutic approach.
OBJECTIVE: Report a case of a scrotum-perineal Granular Cell Tumor (GCT) in pediatric age. METHODS: To report a case. RESULTS: A 12 years old men with a multiple GCT history, located in both extremities, abdomen and scrotumperineal region. Surgical excision of all lesions and a genetic study are performed to rule out Noonan syndrome. CONCLUSION: GCT or Abrikossoff tumor is a tumor with a very low incidence, especially in pediatric age. The most frequent form of presentation a solitary nodule and the most common behavior is in the form of a benign tumor. Immunohistochemistry is crucial for its diagnosis, the main characteristic is positivity for the S100 protein. Although scrotal location is very rare, it must be considered in the differential diagnosis of scrotal mass. Surgical excision is the treatment of choice.
OBJECTIVES: Patients with viral infection are at risk for secondary infections and/or co-infections. Our study aims to describe coronavirus-disease-19 (COVID-19) associated with acute renal failure (ARF) secondary to fungal bezoar in urinary tract in two patients. METHODS: A chart review of two patients with COVID-19 associated pneumonia admitted to an education and training hospital Istanbul, Turkey were evaluated. RESULTS: On the first day of hospitalization, ARF was developed in both of them. Ultrasonography and computed tomography scan revealed image of urolithiasis and hydronephrosis. However, in their cystoscopies, there were dense debris materials leading to obstruction in calyceal system. Antifungal medication was added to the COVID-19 treatment due to the macroscopic aspect during the cystoscopy. Renal functions of the children were improved following the treatment. CONCLUSIONS: Clinicians caring for patients with COVID-19 should perform a comprehensive analysis to detect co-infections.
We present two different cases of involvement of the nervous system due to prostate cancer. We know that atypical metastases can also affect supraclavicular lymphatics, adrenal gland and testicles. In these cases we present atypical places in the nervous system. We must take into account that sometimes the shape the presentation of symptoms can be confused with other pathologies. In some cases, this type of patient has never had a urological check-up and in our sagacity as doctors we come to find the origin of the problem: the prostate.