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Objective: Contrast enhanced ultrasound(CE) consists of the intravenous injection of gasmicrobubbles and their detection within the kidney in differentphases. CE is more accurate than contrast enhancedtomography for detection of septa and wall thicknessvascularization in cystic renal lesions. The purposes ofthis study are to confirm the usefulness of this tool in thecharacterization of complex cystic renal masses and toassess its histological correlation. MATERIALS AND METHODS: Retrospective observationalstudy of 78 patients with complex or indeterminatecystic renal masses who underwent a CE betweenJanuary 2015 - January 2020. RESULTS: Lesions with high suspicion of malignancy(Bosniak III and IV) were identified in 35 patients(45%). A surgical approach was taken in 23 (30%): 18patients with histology of renal cell carcinoma, and onlyin 4 the histology was benign. CE involved a change intherapeutic management due to better definition of thelesion in 48 patients (61.5%). CE has a sensitivity 100%,specificity 91.5%, PPV 81.8%, NPV 100%, and CE hadan important confidence level showed by the area underthe ROC curve (AUC = 0.968). Conclusions: CE is a useful tool in the characterizationof complex cystic renal lesions. It allows abetter definition of the Bosniak classification for thoseindeterminate or doubtful cases on CT that couldgenerate a change in the therapeutic attitude in manycases. It has a good image - histology relation.
Case Report
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INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 coronavirus infection has been associated with the development of the novo genitourinary symptoms and neurological symptoms secondary to peripheral nervous system damage. One of the neurological pathologies described as- sociated with the infection has been Guillain-Barré syndrome (GBS). We conducted a review of the lite- rature on SARS-CoV-2 infection and its relationship with lower urinary tract symptoms (LUTS), such as urinary retention (AUR). Bladder alterations derived from neurological involvement by SARS-CoV-2, such as GBS, were also analyzed. An own case is presented. MATERIAL AND METHODS: A literature search was performed using a combination of keywords (MeSH terms): “COVID”, “COVID-19”, “SARS-CoV-2”, “Urinary retention” and “Guillain-Barre Syndrome and Urodynamics”. We searched for articles published up to March 2021. All articles identified from the bibliographic search were analyzed, using the PICOS criteria (participants, intervention, comparisons, results, type of study) to assess the eligibility of the articles. Both prospective and retrospective studies, clinical cases and published systematic reviews were included. RESULTS: Findings in the academic literature about the associations between COVID-19 and RAO, LUTS and Guillain-Barré Syndrome are discussed, as well as their possible pathogenic mechanisms, A summary of relevant studies on urodynamic findings in GBS patients is also provided. The results are summarized in attached tables. A case of AUR associated with COVID-19 and Guillain-Barré Syndrome is provided, with its urodynamic findings. CONCLUSION: Although the association between urinary symptoms and SARS-CoV-2 is not well described, there seems to be evidence of a possible association, at least temporary, between the presentation of SARS-Cov-2 infection and the development of GBS with secondary LUT neurophysiology alterations.
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Mucinous tubularand spindle cell carcinomas (MTSC) are a relativelyrare subtype of renal cell carcinoma (RCC). Thesetumors are composed by tubular and spindle cellareas within a mucinous stroma. They are generallylow-grade nuclei tumors and limited to the kidney, sothey usually have a favorable prognosis. We report twonew cases of MTSC treated at our institution. MATERIALS AND METHODS: We reviewed therenal tumors surgery database of our hospital from2008 to 2019, selecting patients diagnosed with CMTF.We evaluated clinicopathological data and evolution ofthe patients. We also reviewed the published literatureto compare it with our findings. RESULTS: Two patients were included in the study,a 50-year-old male (case 1) and a 55-year-old female(case 2). The diagnosis was made by ultrasound asan incidental fi nding in case 1 and during the studyof fl ank pain in case 2. Treatment was surgical withpartial and radical nephrectomy respectively. After amean follow-up of 70 months, both patients are aliveand disease-free. CONCLUSION: Mucinous tubular and spindle cellcarcinomas (MTSC) is a rare renal tumor, approximatelytwo hundred cases have been published. Thereare questions yet to be answered about their diagnosisand behaviour so it is of utmost importance to reportnew cases in order to increase our knowledge and improvepatient care.
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Objective: To analyze the presenceof human papillomavirus in prostate and its associationwith prostate cancer. METHODS: A case-control study was conducted.Tissue samples with benign hyperplasia and prostatecancer were collected. Risk factors related to prostatecancer and human papillomavirus were assessedby a medical interview. Prostate tissue was obtainedby transrectal biopsy or transurethral resection. Theidentification of viral genome was assessed by the amplificationof 450 pb., from L1 gene. Real time PCR wasused to identified HPV genotypes 16 and 18. For dataanalysis, the χ2 test, Student's T test or Mann-WhitneyU test and OR were computed. RESULTS: Thirty and 99 with benign prostatehyperplasia were included in a 1:3 ratio, with a meanage of 69.44±9.22 years. The global prevalence of humanpapillomavirus was 15.2% being similar in bothcases (15.6%) and controls (15.1%) with no significantdifference (p = 0.572). Forty percent of the infectionswere persistent. From all positive samples, only in the40% were identified some of the genotypes analyzed(16 and 18). The group of patients with Gleason scorede > 7 had a virus prevalence of 16%. Conclusions: The results show the presence ofthe human papillomavirus genome in prostate tissuewith and without neoplasia; no association was foundbetween infection and prostate cancer.
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Symptoms related toureteral double-J stent are the most common complaintamong patients. Back pain during micturition isone of the most frequent but intensity and durationmay vary between them. This study aimed to assessthe relationship between hydronephrosis grade beforeureteral double-j stent insertion and back pain duringmicturition. PATIENTS AND METHODS: All consecutive patientsundergoing a ureteral double-j insertion secondaryto urolithiasis between 2017 and 2019 were prospectivelyenrolled. Hydronephrosis was assessed using aCT scan and was categorized according to renal pelvismeasure as 0-10 mm (low group), and ≥10 mm(moderate group). At one week postoperative, patientsymptoms were evaluated using the Spanish validatedversion of the Ureteral Stent Symptom Questionnaire(USSQ) and 10 cm visual analog scale (VAS). Meanscores for USSQ domains and mean VAS scores werecompared. RESULTS: 149 patients were included and evaluated.The mean age was 48.2±15.1 years. We found no significantdifferences in mean scores for each main domainin the USSQ or VAS. The presence of flank painduring micturition was present in 73.5% and 52.5 %for the low vs moderate hydronephrosis group respectively(p=0.01). Sub-analysis by gender was 78.7 % vs44.0 % (p=0.00) and 58.6% vs 66.6% (p=0.6) of low andmoderate group in men and women respectively.Analysis of the USSQ item score revealed thatthe moderate hydronephrosis group presented less''pain or discomfort when urinating,'' less ''presenceof back pain when urinating,'' less ''admission orprocedure because of discomfort,'' and less ''feelingabout reinsertion''. CONCLUSION: Patients in the moderate hydronephrosisgroup did not have significant advantagesin terms of voiding symptoms, pain, general health,sexual matters, or additional problems determined bythe USSQ or in VAS. However, sub-analysis reportedadvantages concerning pain and additional questions.Men with moderate hydronephrosis presented statisticallysignificantly less pain during micturition.
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To evaluate the impacton sexuality of the mandatory social isolation linked tothe pandemic by SARS-CoV-2 in an open population ofadults in ArgentinaMATERIAL AND METHOD: An anonymous andvoluntary self-response online questionnaire wasdistributed to an open population of adults who werein mandatory social isolation as consequence of theSARS-CoV-2 Pandemic, between March 31 and June1, 2020. A total of 2214 surveys were collected. At the time the survey was answered, 54.2% had been in isolationfor 6 weeks. RESULTS: We observed that the frequency ofintercourse had an impact in 62.7% of partners livingtogether, increasing by 27.8% and decreasingby 34.9%. Many couples decreased the frequencyof oral sex, anal sex, and mutual and simultaneousmasturbation. On the other hand, hugs, caresses andkisses increased. The presence of children at homeand the longest time in quarantine were closely relatedto the decrease in sexual intercourse frequency.In 50.3% of people who had no cohabitant partner,the frequency of weekly masturbation increased,while 23.7% increased the use of virtual sex. Transgenderpopulation showed that in those with a stablepartner, 68.7% experienced changes in their frequencyof intercourse, similarly to that observed incis population. We also found a higher frequency ofself-stimulation practices in this population. CONCLUSION: In most of the cohabiting couplesof the studied population, the frequency of sexualintercourse and the ways of interaction were affected,without relation to gender identity. An increasein masturbation and virtual sex was observed inpeople who had no cohabitant partner, in addition toa higher frequency of self-stimulation practices intrans individuals. More research and follow-up arerequired to understand the real impact of isolationon sexual health.
Meta-Analysis
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Objective: CrossFit is a popular sportamong women. It has numerous benefits, but it is unclearwhat effects it has on the pelvic floor, since physicalexercise may be a risk factor for urinary incontinence.The aim of this study was to determine theoverall prevalence of urinary incontinence in femaleCrossFit practitioners. METHODS: A systematic review and meta-analysiswere conducted (PROSPERO, 2020: CRD42020199479).We searched cross-sectional studies in databases (Pub-Med, CINAHL, WOS, Scopus, ProQuest) and search engines,from inception to 17 June, 2020. The AdaptedNewcastle-Ottawa Scale for Cross-Sectional Studies wasused to assess the risk of bias. Pooled prevalence wascalculated using random-effects models. Heterogeneitywas investigated by meta-regression and subgroupanalysis. Results: A total of 282 records were identified, ofwhich 13 were included in the qualitative and quantitativesynthesises. The prevalence of urinary incontinenceamong female CrossFit practitioners was 32.1%(95% CI = 22.2-43.8%, n = 2187) and of stress urinaryincontinence was 35.8% (95% CI = 19.4-56.4%, n =1323). The prevalence of urinary incontinence was higher among women over 35 years old, with previouspregnancies and vaginal deliveries (P = 0.004). TheCrossFit exercises associated with higher stress urinaryincontinence were rope jumping, double under,weightlifting, and box jumps. Some preventive strategieswere pelvic floor training, using pads, emptyingthe bladder before workouts, and wearing dark pants. CONCLUSIONS: These results show that the prevalenceof urinary incontinence in female CrossFit practitionerswas similar to that found among women whopractice sport.
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Original article: Usefulness and Acceptability of a Smart pH Meter and Mobile Medical App as a Monitoring Tool in Patients with Urolithiasis: Short-term Prospective Study. Objective: An accurate strategy for regularly measuring urine pH is the use of portable electronic pH meters. This study evaluated the usefulness and acceptability of the smart Lit-Control® pH Meter connected with a companion mobile medical application (myLit-Control(R) App) used by patients with urolithiasis for home monitoring of urine pH. We also examined adherence and compliance rates, and users´ satisfaction levels. MATERIALS AND METHODS: This was a multicenter, prospective study conducted in 10 centers from Spain. Adult patients with a history of urolithiasis were recruited and instructed to carry out a pH measurement with the pH meter three times per day for two weeks. User tasks included turning on the device, registration and on boarding processes in the App, sync the device and the App, and data dumping. At the end of the trial, we evaluated the level of adherence and usage compliance. Participants' perceptions about the usefulness, acceptability, and satisfaction with the device/App were collected through the Computer System Usability Questionnaire (CSUQ) and subjective surveys. RESULTS: Participants were 27 men and 10 women. The mean age of participants was 48.7 (SD = 10.4) years, ranging from 25 to 66. The predominant type of stone was calcium oxalate. The mean pH of all readings was 5.83 (SD = 0.41). Seventy-three (73%) patients met the "good adherence" criterion (not being more than 2 days without recording any pH value). The compliance (actual vs. theoretical readings) was 87.6%. Participants rated the usability of the App 5.4 and above (on a 7-point scale) in all the items of CSUQ. Satisfaction was high, as indicated by the mean score of 6.0 in item 16. In the subjective questionnaire (0 to 3 scale), nearly all mean values were above 2. Patients scored their probability to recommend the App with an average of 8.2 on a 0 to 10 scale. Conclusion: The new smart Lit-Control® pH Meter and the accompanying medical App were deemed useful and acceptable by urolithiasis patients as a portable tool for urine pH monitoring at home. The usage compliance rates were high and the satisfaction with the products was good.
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INTRODUCTION AND OBJECTIVE: The aim of this study was to determine the effect formed by pelvic diameters preoperatively measured through multiparametric magnetic resonance imaging (mp-MRI) and different surgical positions on anesthesia parameters used during perineal robot-assisted radical prostatectomy (p-RARP). MATERIALS AND METHODS: Six different pelvimetric dimensions were determined preoperatively. Respiratory and hemodynamic variables of the patients were measured separately and repeatedly in the supine position, exaggerated lithotomy position at the beginning of the 15° Trendelenburg position and the 60th minute of insufflation. RESULTS: There was a significant increase in the partial pressure of oxygen (PaO2) in the exaggerated lithotomy position compared to the supine position. There was no significant change in the partial pressure of carbon dioxide (PCO2) in the exaggerated lithotomy position compared to the supine position. In the 60th minute of insufflation, there was a significant increase in the PCO2 compared to the supine and exaggerated lithotomy positions. There was no statistically significant change in the end-tidal carbon dioxide tension (EtCO2), with surgical position or insufflation time. A significant negative correlation was observed between the distance of the ischial spines (ISD) and PCO2 change, and a significant positive correlation was observed between the angle of the symphysis pubis-seminal vesicles (ASS) and PCO2 change. A significant positive correlation was observed between the ASS value and EtCO2 change between the 60th minute of insufflation and exaggerated lithotomy position. CONCLUSION: In our study, the effect caused by differing pelvimetric diameters, surgical positions, and duration of anesthesia during p-RARP on anesthesia parameters were shown.
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There are many causesof ureteral injury being the main one iatrogenic.The reconstruction depends on the injury´s locationand length. In some complex cases, we must do ureteralreconstructions using bowel segments. Thesetechniques are a challenge for the surgeon and arenot exempt of short and long-term complications.Our purpose is to present three complex ureteralinjury cases, and to analyze the main technical variants. PATIENTS AND METHODS: We present threeclinical cases with long length ureteral injuries treatedin our hospital. RESULTS: None of the cases presented had complicationsin the immediate postoperative period. Inlong term, all of them had mechanical complications, needing urinary diversion and reintervention in twocases. However, no metabolic disturbances or kidneyfunction deterioration have been reported. At presentthe three patients have a good clinical condition. CONCLUSION: The repairment of complex ureteralinjuries is a safe and effective procedure, but itneeds a great knowledge of the anatomy, the differenttechniques described and the patient´s characteristics.It is recommended to be performed in experiencedcenters.
Case Report
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The objective of thisstudy is to review three cases using urokinase in patientswith urinary catheter obstructed by clots, aswell to carry out a review of the published literature. METHODS: It was done a review of three casesfrom 2019 to 2020 who required urokinase due tourinary catheters obstructed by clots in our department.In addition, a reference search was performedin Pubmed. RESULTS: The first case was a woman with metastaticbreast carcinoma who required nephrostomyplacement. The second case was a renal trauma thatrequired bladder catheterization. The third case wasa male with a benign ureteric obstruction who requirednephrostomy placement due to sepsis. After instillationswith urokinase, the first two cases respondedadequately, while the third was unsuccessful. CONCLUSIONS: Urokinase may be an effectiveand well-tolerated therapy in the treatment of coagulatedurinary catheters that does not respond toother measures.
