OBJECTIVES: Emerging urinary infections by rare germs are a public health problem. The objectives of this article are to review urinary tract infections caused by an emerging genus of bacteria called Raoultella and to report a case of asymptomatic urinary tract infection by Raoultella ornithinolytica. MATERIALS AND METHODS: A review of publications on urinary tract infections caused by the genus Raoultella between 2009 and 2018 is carried out and a case of asymptomatic urinary tract infection by Raoultella ornithinolytica is reported. The search of articles in Medline/Pubmed and Google was performed with the keywords: Raoultella, Raoultella ornithinolytica, urinary tract infection. Twelve variables were studied: year of publication, authors, specialty, type of infection, number of cases, sex, age, immunosuppression, oncological patient, urological instrumentation, urological surgery and neurogenic bladder. Results were analyzed using descriptive statistics. A new case is described. RESULTS: 24 publications were found with 120 cases of urinary infections of the genus Raoultella between 2009 and 2018, corresponding to Raoultella ornithinolytica 40.8%, Raoultella planticola 28.3%, Raoultella terrigena 30.8% and Raoultella electrica 0%. The series included 43 men (35.8%), 53 women (44.1%) and 24 patients with this data not provided (20%). %). The minimum age was 14 days, the maximum was 97 years and the average age was 56.6. The types of infection detected were: uncomplicated UTI 94.1%, UTI in newborn 1.6%, acute prostatitis 0.8%, chronic prostatitis 0.8%, giant kidney cyst infection 0.8%, calculous pyelonephritis 0.8% and recurrent cystitis 0.8%. CONCLUSIONS: Urinary tract infections by species of the genus Raoultella occur in immunocompromised, oncological, instrumented or basic urological patients. The species Raoultella ornithinolytica described in 2011 is an emerging germ in urinary infections. This contribution is the second Spanish publication and twelfth worldwide of urinary infection by Raoultella ornithinolytica.
Kidney transplantation (KTx) is the best therapeutic modality for end stage renal disease. Currently in Colombia there are approximately 2800 patients waiting for KTx. Historically, urologists have been in close contact with KTx, however in Colombia the interaction between urology and KT is scarce.OBJECTIVES: To determine the perceptions and KTx training level into colombian urology residents.MATERIAL AND METHODS: We conducted a retrospective and descriptive study through 14 items survey applied to colombian urology residents. Data are summarized as means and Pearson Chi2 test was used to evaluate differences between qualitative variables.RESULTS: The study included 76 participants. More than half of the programs of urology residency in Colombia includes KTx training into their academic programs, 36.84% of participants have received formal training (lectures, rounds, clinical rotation, seminars) on KTx, 28.95% have participated into KTx procedure, 97.37% considered the KTx as a urological field, KTx is the urological area with least academic interest for the residents, 76.32% consider their training in KTx as insufficient. The main barrier identified to increase training in KTx during urology residency is the non-availability of a formal rotation.CONCLUSIONS: KTx is not an area of primary interest for the colombian urology residents. Although most residents identify the KTx as an area related to urology and that exposure to some phases of the KTx is acceptable, 76% of residents consider their transplant training as insufficient. The main barriers identified for the urology resident’s approach to KTx are modifiable.
OBJECTIVE: Kidney transplant is the treatment of election of end-stage chronic renal disease, usually being heterotopic extraperitoneal in the iliac fossae, with successful results. This technique can be challenging or even not feasible, usually in cases of severe vasculopathy or previous grafts, so urologists should consider alternatives such as orthotopic transplant.MATERIAL AND METHODS: We present three cases of orthotopic kidney transplant (OKT) made in Cruces University Hospital from 2001 to 2019, out of 2580 cases. We review recipients’ medical history, indication, surgical technique and postsurgical evolution.RESULTS: The average age of the patients was 51.6 years. The indication was severe vasculopathy of iliac vessels. We made left nephrectomy, followed by venous renal end-to-end anastomosis, arterial end-to-side anastomosis to aorta and pyelo-pyelic anastomosis with catheter, with immediate function of the graft. The patients’ evolution was favourable, without significant complications and no differences with heterotopic transplant. CONCLUSION: OKT is a good alternative when heterotopic is not feasible, with an acceptable number of complications and similar survival.
OBJECTIVE: To describe urinary symptoms and urodynamic findings in patients with advanced pelvic organ prolapse.MATERIAL AND METHODS: A descriptive and retrospective evaluation with advanced POP referred for urodynamic test before surgical repair between 2015 and 2017 were included. All patients underwent a urogyn exam, physical examination, uroflow and urodynamics exam. Clinical features (filling and emptying symptoms, stress incontinence questionnaire (ISIQ-SF) and urodynamics (sensitivity, capacity and hyperactive detrusor, internal sphincter deficiency and voiding symptoms).RESULTS: A total of 170 patients with advanced PRP were evaluated. The most prevalent symptoms were urgency (63%), urinary stream disturbance (64%), incomplete voiding (63%). Mixt urinary incontinence was the most commonly reported (30%). Only 11% had a normal urodynamics exam. 36% had a hidden stress incontinence. 47% had voiding symptoms related to infravesical obstruction (30%).CONCLUSIONS: Patients with advanced POP have a wide variety of urinary symptoms such as urgency, voiding dysfunction and mixt urinary incontinence. Urodynamics studies provide relevant information regarding at the bladder dysfunction that may decrease surgical outcomes.
Pelvic organ prolapse (POP) has a general incidence of > 10% in the female population of the Western world. The pessary is a silicone device, inserted into the vagina to provide support to the pelvic organs. It is used as a conservative treatment to improve prolapse symptoms.OBJECTIVES: To evaluate the effectiveness of pessary treatment in pelvic organ prolapse through a systematic review of the current literature.MATERIAL AND METHODS: A Scoping Review was carried out based on the PRISMA guidelines for the development of systematic reviews. The PICO research question was asked, the sources of information were selected, and the eligibility criteria were established. Subsequently, the descriptors in health sciences and keywords, combined with Boolean operators, were applied in each of the search engines.RESULTS: A total of 19 references were included in the analysis of this work. To delimit the data extraction, the information was divided into four dimensions: improvements in symptoms related to POP and quality of life, sexual function; discontinuation, justification for discontinuation and complications.CONCLUSIONS: The pessary produces positive effects on the quality of life of women with POP, with good satisfaction rates. The main reasons for the interruption include: inability to retain the pessary, discomfort, and the desire for surgery.
OBJECTIVES: Our aim was to compare nephrectomies with kidney resections in terms of their influence on renal function and blood loss. We compared laparoscopic nephrectomies with open nephrectomies in terms of the length of the procedure and the hospital stay.METHODS: We retrospectively included patients who were operated for renal tumors (n=148) between January 2016 to July 2018 in a single secondary center. We considered the type of operation (nephrectomies versus kidney resections), the approach to the kidney (open or laparoscopic) and compared the following outcomes: the length of the operation, perioperative blood loss, the changes in hemoglobin concentrations, in creatinine levels and in the estimated glomerular filtration rate (eGFR). RESULTS: Kidney resections when compared to nephrectomies resulted in a significantly smaller decline in the estimated glomerular filtration rates (β=38.78 ml/min; p<0.001). When compared to baseline values, there was a significant drop in the eGFR on both day 1 and 3-6 months after the operation in the nephrectomy group (p<0.001 for both intervals); this drop was not present in the resection group. The decline in hemoglobin levels was bigger in the resection than in the nephrectomy group. However, during a follow up evaluation 3-6 months after the procedures, the values did not differ between the groups.We then compared open nephrectomies with laparoscopic nephrectomies. Laparoscopy involved more time (β=38.6 minutes; p<0.001), was used for early stage tumors and involved a shorter hospital stay (β=3 days; p<0.001) in comparison to open surgeries. CONCLUSIONS: Data from our center confirmed the findings from other literature that nephron-sparing surgeries lead to a lower decline in kidney function than with nephrectomies. This benefit for kidney function also remained during the follow-up. When performing a nephrectomy, the laparoscopic approach offers a shorter hospital stay for the patient than with an open surgery.
OBJECTIVE: To investigate the diagnostic value of testicular fatty acid-binding protein (T-FABP) in acute testicular ischemia and prolonged ischemia.METHODS: The study included a total of 28 prepubertal male Wistar-Hannover rats. The animals were randomly divided into 4 groups as torsion groups (group I; min 30; 7 rats, group II; min 120; 7 rats, group III; min 240; 7 rats) and control group (group IV; 7 rats). In each group, the left testis was separated from the gubernaculum by blunt dissection together with the tunica vaginalis and spermatic cord, and then exposed. In the control group, the blood samples and left testicular tissues were collected at min 240 after extraction. In torsion groups, the left testis was rotated together with its cord elements, 720° in a clockwise direction for the induction of an extravaginal TT model. The blood samples were obtained at min 30, 120, and 240 in the torsion groups. Bilateral testicular tissues were collected via orchiectomy for histopathological examination in all groups. RESULTS: The mean plasma T-FABP level in group III (torsion, min 240) was significantly higher than those of other groups. The T-FABP level at min 240 had a sensitivity and specificity of 100% and 85%, respectively, at a cut-off value of 1.059. A significant difference was found between the torsion groups and the control group with regard to histopathological scores. CONCLUSIONS: The increased T-FABP levels in testicular ischemia seem to be correlated with testicular necrosis rather than acute ischemia.
OBJECTIVE: In this study, we aimed to determine the factors predicting the duration and success of semirigid ureteroscopy performed for the treatment of ureteral stones in different localizations. MATERIALS AND METHODS: Medical records of the patients whom underwent semirigid ureteroscopy for urolithiasis in our centre between January 2015 and December 2019 were retrospectively reviewed. The study group composed of 170 patients and divided into three subgroups; of which 54 in proximal ureter (31.8%), 51 in the mid (30 %) and 65 (38.2%) in the distal ureter. Predictive factors of semirigid ureteroscopy duration and success were determined by performance of correlation analysis and multivariate analysis. RESULTS: Overall stone-free rate was calculated as 78.8%. Success rates for proximal, mid and distal ureteral stones were 72.2% (39/54 patients), 74.5% (38/51 patients) and 87.7% (57/65 patients), respectively. Complications were present in 19 patients (11.2%). Multivariate analysis indicated that stone diameter and stone burden independently affected the stone-free rate. Statistically significant negative correlation was determined between success of the procedure and stone diameter, stone burden, impaction and more proximal stone localization. While there was a statistically significant positive correlation between duration of procedure and stone burden, diameter, impaction, history of ipsilateral ureteroscopy and more proximal stone localization, there was negative correlation between duration of procedure and stone-free status. CONCLUSION: We conclude that stone diameter, stone burden, impaction and more proximal stone localization are common factors affecting both duration and success of semirigid ureteroscopy. In addition, stone size and stone burden were determined as independent markers of stone-free status.
OBJECTIVES: With the spread of more powerful lasers and the advent of new technologies, endoscopic interventions for urolithiasis are continuously evolving. The aim of this study is to present our experience and technique regarding Low Energy (LE)/High Frequency (HF) lithotripsy by using a 120-W Holmium laser (Lumenis®). METHODS: We retrospectively analysed our prospectively maintained Retrograde Intra Renal Surgery (RIRS) database. Lithotripsy was performed using LE/HF settings with a Long Pulse Width (LPW) and consisted of the following steps: 1) contact Laser lithotripsy (LE/HF/LPW dusting – 0,5 J/50 Hz or 02 J/70 Hz); 2) extraction of main fragments; 3) non-contact Laser lithotripsy (LE/HF/Short Pulse Width Pop Dusting - 0,5 J /80Hz). Pre-operative and peri-operative outcomes were collected. Post-operative complications were recorded according to Clavien-Dindo Grading System. Finally, all patients underwent a CT scan at three months after RIRS to assess the success of procedure, defined as stone-free or presence of ≤4 mm fragments (Clinical Insignificant Residual Fragments – CIRF). RESULTS: Overall, 104 LE/HF/LPW RIRS from December 2017 to January 2019 were performed. Mean operative time was 59 (SD ±23) minutes, median post-operative stay was two days (IQR 2-3). The post-operative complication rate was 4,8%: one patient had nausea and vomiting (Clavien-Dindo I) and four patients developed urosepsis (Clavien-Dindo II). The success rate was 88,5% (71,2% stone-free and 17,3% CIRF).CONCLUSIONS: LE/HF/LPW RIRS seems to be safe and effective in terms of positive success rate, safety and standard operative time. However, randomized clinical trials are needed to compare this technique to standard RIRS.
OBJECTIVE: Bacterial presence, anatomic anomalies and metabolic alterations increase the risk of stone formation in patients with neobladders. These patients sometimes require medical or surgical procedures. The aim of the current work is to analyze those alterations and medical treatment associated to it.METHODS: A case of a 66 yo male who had undergone a cystectomy with neobladder 3 years ago. Currently present with a staghorn stone on the right kidney. Past medical history of stone formation as well as double J calcification.RESULTS: The combination of medical and surgical treatment for stone was performed. Medical therapy will allow prevention of new stones.CONCLUSIONS: Metabolic and chronic infections in patients with neobladders treated should decreased the new stone formation in patients with neobladders.
We present a clinical case of an asymptomatic 61-year-old man was found to have a left kidney mass. Ultrasound and CT showed a 6 x 5 cms mass with calcifications. Histologic examination of the radical nephrectomy specimen revealed a chromophobe renal cell carcinoma. The unique feature of this case is the type of calcifications present in a tumor of this category. To our knowledge, we report the first case of chromophobe renal cell carcinoma with peripheral linear calcifications. A literature review on chromophobe renal cell carcinoma with calcifications is performed.
OBJECTIVES: We present a unique case with a ureteral fibroepithelial tumor originating from the ureter, which could be confused with a bladder tumor on ultrasound examination due to its movement in and out of the bladder.METHODS: In cystoscopy, a papillary tumor lesion emerging from the right ureteral orifice was seen. After scanning the other quadrants, however, the tumor was not observed at the right ureteral orifice. It was then protruded back into the bladder. The tumor was seen several times to protrude into the bladder and return to the ureter, possibly due to ureteral peristalsis. Then, a semi-rigid ureteroscope was introduced through the right ureteric orifice, and the tumor was excised in one piece using Holmium laser fiber with 365μm of diameter. The size of the removed tumor was approximately 8 cm long. A double-j stent of 4.8 Fr was placed in the ureter.RESULTS: The patient was discharged on the first day without complications. The fibroepithelial polyps of the ureter, which consist of the stroma of mesoderm origin, covered with histologically normal or hyperplastic urothelial epithelial cells, are extremely rare tumors. It is important to distinguish these polyps from urothelial cancers, since these two entities are different in treatment and prognosis, although similar in symptoms and imaging procedures.CONCLUSIONS: Minimally invasive treatment techniques can be safely applied in the treatment of such exceedingly rare tumors.