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OBJECTIVE: In the last few years, numer-ous studies have focused on the genetics of the renal system. Betchel et al in 2010 demonstrated that methyl-ation, as a epigenetic phenomenon, would be involved in the perpetuation of fibrosis. In our study, we want to demonstrate whether epigenetics is related to pyelouret-eral stenosis and, if that is the case, if it could be used as prognostic and diagnostic biomarker.METHODS: This is a descriptive observational and cross-sectional study that analyzed the methylation in DNA extracted from pyeloureteral junction samples ob-tained from surgery in pediatric patients in the period from 1999 to 2015, resulting in a total of 20 patients. Clinical data were analyzed using correlation tests and they were grouped with a free access software statisti-cal phylogenetic package called PHYLIP. The selected genes for methylation-specific PCR (MSP) were the fol-lowing: p16, RASSF1A, MGMT, Cyclin D-2, HIN-1, E-Cadherin and RASAL-1.RESULTS: The clinical-radiological data analyzed phylo-genetically by the PHYLIP program established 7 groups of patients. The results of methylation showed a con-siderable proportion of aberrant methylation in the pro-motor region of the genes p16 (25%), MGMT (15%), E-Cadherin (25%), HIN-1 (25%) and RASAL-1 (35%). The association of the clinical-radiological groups with methylation/non-methylation states of each gene was also analyzed.CONCLUSIONS: This study demonstrates that methyl-ation does have a role in fibrosis developed in pyelo-ureteral stenosis. Two clinical patterns of poor prognosis associated with two epigenetic methylation cluster. RAS-AL-1, E-Cadherin, HIN-1 and p16 would be candidates for future studies on their prognostic implications in py-eloureteral stenosis.
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INTRODUCTION AND OBJECTIVES: To evaluate the efficacy of antibiotic prophylaxis as well as the cleaning/disinfection procedures to prevent urinary tract infection in patients undergoing office flexible cystoscopy.METHODS: A prospective, randomized study was performed between June 2015 to May 2016 including every patient who underwent flexible cystoscopy at the Urology outpatient unit. Patients with temporary or permanent urinary stents were excluded from the study as well as procedures that involved bladder biopsies. A total of 251 patients were recruited. Urinary culture was collected in all of the patients before and after the procedure. Patients were randomized in two groups: Antibiotic prophylaxis versus no prophylaxis. Antibiotic prophylaxis consisted in 4 doses of Norfloxacin (400mg): twice a day during two days. Three different cleaning/disinfection methods were used: manual adasport (5% peracetic acid), manual oxide (instrunet sporicidal; Inibsa) and washing machine (Olympus, mini ETD 2). Demographic characteristics such as gender and age were collected during the study. Relationship between antibiotic prophylaxis, type of cleaning/disinfection procedure, demographic characteristics and positive urinary culture after procedure were analysed. Measures to avoid bias: Randomization.RESULTS: Urinary culture before cystoscopy was negative in 231 patients (92.4%), positive in 19 (7.6%) and not valid in 1. After randomization, 129 patients were included in Group 1(no prophylaxis) and 117 in Group 2 (antibiotic prophylaxis), 5 patients dropped from the study. After-procedure culture was negative in 224 patients (91.1%) and positive in 22 (8.9%). There was no statistical significance between urine culture results before and after cystoscopy and the demographic characteristics collected. Furthermore, no statistical differences were seen between urine culture after cystoscopy and cystoscope cleaning method (p=0.7), or between urine culture and type of cleaning with or without antibiotic prophylaxis (p=0.5, p=0.9).CONCLUSIONS: None of the analyzed variables influenced the positivity of urine culture after flexible cystoscopy. Routine antibiotic prophylaxis should not be further recommended.
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OBJECTIVE: The increase of isolation of beta-lactamase resistant Escherichia coli (BREC) strains makes treatment difficult. The objective of this study is to evaluate the situation in our environment. METHODS: Retrospective study including patients who presented positive urine cultures for E. coli in the Department of Health of Castellon between January 2012 and December 2015. We analyzed variables such as age, gender, patient`s origin (outpatient or hospital) and other risk factors. We performed a descriptive analysis to study the prevalence of BREC. RESULTS: 9113 cultures were positive for E Coli, 273(2.9%) of them were BREC. The annual percentage of BREC ranged from 1.7% to 3,4% with no increase over the last years. Mean age was 70 years, without gender differences. 247 cultures came from outpatient patients (90%), being 96% of them women. The factors most frequently associated with BREC were to present UTI over the last year and have received antibiotic treatment the previous 3 months; 50% of these received a beta lactam.CONCLUSIONS: In our environment, the isolation of BREC is similar to other series. Most patients come from the outpatient environment, were previously treated with antibiotics and had recurrent UTIs.
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OBJECTIVES: To investigate urodynamic changes during the voiding phase in males with detrusor underactivity (DU) undergoing bladder catheterization for urinary retention.METHODS: From a total of 64 patients with urinary retention, a follow-up study was performed in 17 males with a mean age of 77 years. Patients received a urody.namic diagnosis of DU based on a Bladder Contractility Index (BCI) score of <100 and underwent permanent bladder catheterization (16 cases) or clean intermittent catheterization (1 case) for acute urinary retention (14 cases), or post void residual urine (3 cases). Patients underwent a second urodynamic study after a mean 13 months of follow-up. Fisher’s exact test was used with categorical variables and Student’s t test with parametric variables. The level of significance was set at p<0.05 for a two-sided test.RESULTS: The second urodynamic study showed a significant increase in maximal detrusor pressure, pressure at maximum flow rate, BCI score, Bladder Outlet Obstruction Index (BOOI) score, and number of patients who urinated during the pressure-flow study.CONCLUSIONS: Bladder catheterization in men with DU significantly improves bladder contractility and revealed obstructions of the lower urinary tract that were masked by insufficient detrusor pressure in relation to the DU of these patients. These findings could have diagnostic as well as prognostic and therapeutic applications.
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We report the case of a 16 year old female who underwent left radical nephrectomy for a 13,2 cm neuroectodermic renal tumor and posterior chemo and radiotherapy in the Quiron Hospitals in Madrid and Complejo Hospitalario de Toledo, with a current survival of 14 months. Medical literature was reviewed for the historical, clinical, etiopathogenic, diagnostic, prognostic, therapeutic and survival features. We estimate the number of published cases to date. We also address the treatment performed and its results under a critical view.
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Objectives: Partial nephrectomy was historically used in urology for the treatment of benign kidney processes. In the last 20 years, its greater use was focused on localized tumors being an alternative to radical nephrectomy. Initially, absolute indications included patients with a single kidney or bilateral tumors. Over time indications were expanded based on the risk of developing kidney disease, and became elective surgery in patients with tumors of less than 4 cm, and even tumors larger than 4 cm. We present a survey of the Venezuelan urological population, regarding partial nephrectomy, as part of treatment for renal masses.Methods: Based on a 21-question survey, by Lopera Toro Adrián et al. Partial nephrectomy in Colombia: current situation, with their previous authorization and adding some questions, the survey was given to urologists and residents of the XXVII National Congress of Urology.Results: 71 people answered, mostly from Caracas and the Metropolitan District (53.5%), 57 were urologists (80.2%) and 14 (19.71%) third year residents. The majority of urologists who answered the survey had a majority of 1 to 3 years of schooling (29.82%). 45.07% (n: 32/71) of the respondents practiced in most Level IV hospitals. 46.4% of these were university hospitals. 38.02% (n: 27/71) respondents did 4 or fewer radical nephrectomies per year. In the case of having a patient candidate for partial nephrectomy, 73.23% of the respondents performed it. Most of the respondents performed partial nephrectomies as part of the treatment of renal masses (84.5%).Conclusions: In the first place, it was very supportive to have a survey designed by Lopera Toro Adrian et al. It allowed us to carry out a survey in our urological population and to see the current state of partial nephrectomy in our environment, considering that a large part of the urological population performs this surgery in order to preserve nephrons even if laparoscopy is not the most used technique. Nevertheless, clear indications are kept.
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OBJECTIVE: To evaluate incidence, clinical, radiological and laboratory features of spontaneous upper urinary tract rupture (s-UUTR) due to ureteric stones and discuss their management.METHODS: Out of 1629 patients admitted to the Emergency Department (ED) for renal colic from January 2015 to December 2016 and studied by kidney US and contrast enhanced CT (CECT), 31 patients had a s-UUTR categorized in 3 stages: a) local spread, b) free fluid, c) urinoma. Presentation, therapeutic procedures and outcomes were registered. RESULTS: S-UUTR is reported in 1.9% of renal colic. The stone was most commonly identified at the vesicoureteric junction (VUJ) (61.3%) and mean (standard deviation, SD) stone size was 5.71 mm (2.31). S-UUTR was most frequently located in a calyx (54.84%). 26 patients (83.87%) had a clinical presentation of a renal colic, 3 cases (9.68%) had an atypical presentation and 2 (6.45%) presented an acute abdomen. In 26 cases a J-J stent (83,87%) was placed, 3 patients underwent primary ureteroscopic lithotripsy (9.67%); in 1 patient (3.23%) a nephrostomy was inserted and in 1 case (3.23%) active surveillance was adopted. Cases who underwent sole urinary derivation were revaluated after 30 days: ureteroscopic lithotripsy was performed in 48.15% of the cases; extracorporeal shock wave lithotripsy in 3.7%; in 22.2% of cases a CT demonstrated the spontaneous expulsion of the stone. 7 patients were lost at follow-up. The patient undergoing an active surveillance spontaneously expelled the stone.CONCLUSIONS: S-UUTR is a rare radiological sign of a renal colic most commonly located in a calyceal fornix. A high incidence of s-UUTR is caused by small distal ureteral stones in which a spontaneous passage is reasonable. Clinical presentation usually does not arise the suspicion of s-UUTR. In our experience, most patients were actively treated with good results but a conservative approach can be offered in selected cases.
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OBJECTIVES: We researched to detect the optimal method for evaluating stone volume, by comparing the ellipsoid formula and 3D reconstructed volume to gold standard of water displacement volume using 3D printed models. METHODS: We retrospectively analyzed out patient database and evaluated 27 patients who had percutaneous nephrolithotripsy. From the DICOM data of patient’s preoperative CT images, stone structures were obtained using an image identification system. All DICOM files were saved in the stereolithography file format and a 3D printed model was created. True stone volume was found by water displacement method using this model and this volume compared with ellipsoid formula and 3D-reconstructed volume. RESULTS: Stone volume on water displacement ranged from 0.38-29.8cm3 with a median of 17.5cm3, stone volume on ellipsoid formula ranged from 0.46-34.7cm3with a median of 19.6cm3 and stone volume on CT based 3D-reconstructed ranged from 0.48-31.8cm3 with a median of 18.9cm3. There was a significant difference between ellipsoid formula and water displacement (p<0.0001); however, there was no difference between 3D-reconstructed volume and water displacement (p=0.051). CONCLUSION: Stone volume calculation using CT based 3D-reconstructed algorithm improves the accuracy of stone volume estimation and this measurement is superior to ellipsoid formula.
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OBJECTIVE: The first choice treatment in stress urinary incontinence (SUI) is rehabilitation of the pelvic floor in order to improve muscle strength. However, no entirely reliable instruments for quantifying pelvic floor muscle (PFM) strength are currently available. Our aim was to test the inter-rater reliability of the Modified Oxford Scale (MOS) used as the gold standard for measuring PFM strength.METHODS: Test-retest reliability study. One hundred and twenty-two women with SUI and thirty continent women were recruited. Patients were excluded if they had a history consistent with pelvic organ prolapse, pregnancy, previous urogynaecological surgery, or neurological conditions. Bidigital palpation quantified by the MOS was carried out by three independent examiners.Each subject answered a two-part questionnaire: demographic and clinical characteristics and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The Cohen’s Kappa index with quadratic (Kw) weighting was used to assess the inter-rater agreement.RESULTS: 122 incontinent and 30 continent women were included. MOS ranged between 0 and 2 in 72.2% incontinent and 19.5% of continent women.The degree of agreement was substantial in the group of incontinent women (Kw between 0.73 and 0.81) and moderate in the group of continent women (Kw between 0.55 and 0.72).CONCLUSIONS: Our results suggest that the inter-observer reliability of MOS is improbable, especially in continent women.
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OBJECTIVE: To report two Zinner`s syndrome cases, a rare anatomical variant with risk of complications.METHODS: Analysis of two Zinner syndrome cases, detected during acute recurrent epididimytis and after a grade IV renal trauma. Review of the literature focusing on its diagnosis and possible complications.RESULTS: The conservative management of the polytrauma patient allowed to preserve the kidney, while maintaining normal renal function. It is the first Zinner`s syndrome diagnosed in this clinical context.CONCLUSIONS: Zinner`s syndrome is a rare entity and often goes unnoticed because of the few symptoms it produces.
Case Report
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Bladder leiomyomas are rare benign tumors; their common presentation are irritative and obstructive urinary symptoms. The treatment is complete surgical resection.OBJECTIVE: To present our experience in the diagnosis and the treatment of bladder leiomyoma.METHODS: A series of three clinical cases.RESULTS: In our series, two patients were women and one was man. The mean age was 33 years. Two women presented with irritative urinary symptoms and palpation of a pelvic mass, and the man was asymptomatic. Ultrasound showed the presence of an adnexal mass with left hydronephrosis in a female patient, bladder tumor in another female patient and pelvic mass of unknown etiology in the male patient. CT scan and MRI demonstrated the bladder origin of the lesion. A biopsy confirmed a bladder leiomyoma. Surgical treatment was partial cystectomy in all patients, and in one of them, nephrectomy was performed. During follow-up, all patients were asymptomatic and without recurrence.CONCLUSIONS: Imaging studies guide to diagnosis. Transurethral resection is recommended in lesions smaller than 3 cm. and enucleation or partial cystectomy in larger lesions. Prognosis is good.
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OBJECTIVE: To present a case of poliorchidism because despite being known, its incidence is very low. METHOD: A review of the medical records of a patient with the diagnosis of polyorchidism identified during a surgical intervention for inguinoscrotal hernia. RESULTS: A 32-year-old male patient with past medical history referred with inguinal pain. An increase in volume was identified in the right inguinoscrotal region that protruded with Valsalva maneuver and another lump in the right scrotal region. During the operation, a right supernumerary testis was identified in the intrascrotal region with an independent epididymis and sharing a common vas deferens. Lichtenstein hernioplasty was performed and the third testis was placed in the scrotal sac. Doppler ultrasound confirmed the diagnosis.CONCLUSIONS: Due to the normality during the operation and the absence of anomalies in the supernumerary testis by Doppler ultrasound, conservative treatment was decided.
