RESUMO
INTRODUCTION: Acute urinary tract infections (UTIs) in adult are now a major public health issue in terms of morbidity, mortality and in terms of costs for society. The latest French guidelines and the European Association of Urology guidelines differ in some points. The aim of this article is to compare the guidelines of these two societies in order to highlight their differences but also their common points in the management of UTIs. METHODS: A comparative analysis of the latest French and European guidelines was carried out. The authors defined the following sub-sections: terminology, pyelonephritis, male UTIs, pregnancy urinary tract infections and cystitis. RESULTS AND CONCLUSION: The guidelines of these two societies are not very different in terms of diagnostic and therapeutic management. The major differences are in the duration of antibiotic therapies, where French guidelines continue to recommend long term treatments where EAU sometimes recommends only 5 days of antibiotics, as in the case of simple acute pyelonephritis. LEVEL OF EVIDENCE: 3.
Assuntos
Guias de Prática Clínica como Assunto , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapia , Europa (Continente) , Feminino , França , Humanos , MasculinoRESUMO
INTRODUCTION: The aim was to assess the risk of postoperative infections in patients with preoperative polymicrobial urine culture and to provide the urologist with practices to minimise the risk of infection in these clinical situations. METHODS: A systematic literature review was carried. All national and international recommendations have been reviewed. Data collection has been performed from the Cochrane, LILACS and the Medline database. 31 publications were selected for inclusion. RESULTS: Risk of infection in patients without ureteral stents or urinary catheters with previous polymicrobial urine culture is low. In the absence of leukocyturia, the urine sample can be considered as sterile. With ureteral stents or urinary catheters, the colonisation by biofilm ranges from 4 to 100% depending on the duration and ureteral stents or urinary catheters type. Urine culture is positive 24 to 45% of the time when ureteral stents or urinary catheters are known to be colonised. The post-operative risk of infection in endo-urological surgery in a patient with ureteral stents or urinary catheters is estimated around 8 to 11% depending on the type of surgery. A retrospective study reports a postoperative infections rate of 18.5% in photo selective vaporization of the prostate with preoperative polymicrobial urine culture. CONCLUSIONS: Scientific data are limited but for patients without ureteral stents or urinary catheters, in the absence of leukocyturia, the polymicrobial urine culture can be considered as negative. Considering a preoperative polymicrobial urine culture as sterile in patients with colonised ureteral stents or urinary catheters is at risk of neglecting a high risk of postoperative infections or sepsis even in case of perioperative antibiotic prophylaxis. It should not always be considered sterile and therefore, a perioperative antibiotic therapy could be an acceptable option.
Assuntos
Bacteriúria/terapia , Complicações Pós-Operatórias , Guias de Prática Clínica como Assunto/normas , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Antibioticoprofilaxia , Técnicas Bacteriológicas , Bacteriúria/epidemiologia , Bacteriúria/urina , Feminino , França/epidemiologia , Humanos , Masculino , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/urina , Fatores de Risco , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Urinálise , Procedimentos Cirúrgicos Urológicos/normas , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/métodos , Urologia/normasAssuntos
Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Bacteriúria/diagnóstico , Infecções Comunitárias Adquiridas/diagnóstico , Diagnóstico Diferencial , Gerenciamento Clínico , Resistência Microbiana a Medicamentos , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Masculino , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Fitas Reagentes , Recidiva , Infecções Urinárias/diagnóstico , Urina/microbiologiaRESUMO
PURPOSE: The use of the dipstick urinalysis has been validated for the diagnosis of symptomatic urinary infections, cystitis and pyelonephritis thanks to an excellent negative predictive value. For prostatitis, it is rather its positive predictive value that is interesting. The aim of this study is to validate its use in the screening of urinary colonizations in the preoperative assessment in urology. METHODS: A monocentric prospective study was carried out for one year in 2011 comparing the data from the urine dipstick test with a fresh-voided midstream urinary examination and culture performed on the day of admission with the same urine sample in 598 asymptomatic patients programmed for a urological procedure. The gold standard to diagnose a microbiological-confirmed urinary tract infection or colonization was uropathogen growth of ≥10(3) colony-forming units per ml (cfu/mL) with or without leucocyturia. RESULTS: The study disclosed 5% of colonized patients. The urine dipstick test had a 65% sensitivity and a 97% negative predictive value. However, the low sensitivity of the urine dipstick test entailed 34% of false negatives. CONCLUSION: In spite of a good negative predictive value linked to a low prevalence of colonized patients (5%), the low sensitivity of the urine dipstick test entails a non-negligible number of false negatives. Its use as a single test of preoperative screening would expose colonized patients to the prospect of an operation, which seems to be unacceptable for some of them, notably endoscopic ones. LEVEL OF EVIDENCE: 4.
Assuntos
Cuidados Pré-Operatórios , Fitas Reagentes , Urinálise , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Urinálise/métodos , Infecções Urinárias/epidemiologiaRESUMO
INTRODUCTION: In urology, antibiotic prophylaxis is advised by the French Association of anesthesiology (SFAR) and the Infectious Disease Committee of the French Association of urology guidelines published in 2010. No guideline exists concerning the implantation of neuromodulation implants. MATERIAL AND METHOD: A literature analysis was performed on sacral modulation and antibiotic prophylaxis. Then guidelines were discussed by reviewers. Items that showed no consensus were then discussed again to arrive at recommendations. RESULTS: Antibiotic prophylaxis is recommended during the test phase as well as in the case of installation of sacral neuromodulation (Grade C). Antibiotic recommended (Grade B) are: cefotetan or cefoxitin, 2g dose by slow intravenous injection or amoxicillin-clavulanic acid at a dose of 2 g, intravenously or, in the case of allergy vancomycin at a dose of 15 mg/kg or the clindamycin has 600 mg intravenously. CONCLUSIONS: Despite the lack of high level of evidence, antibiotic prophylaxis seems necessary when setting up of electrode case of sacral neuromodulation.
Assuntos
Antibioticoprofilaxia/normas , Terapia por Estimulação Elétrica , Eletrodos Implantados , Infecções Relacionadas à Prótese/prevenção & controle , Humanos , Incontinência Urinária/terapia , Retenção Urinária/terapiaRESUMO
The candiduria are frequently encountered in urology. We present the recommendations of the Infectious Diseases Committee of the French Association of Urology for diagnosis, treatment and monitoring of urinary tract infections. C. albicans is the most frequently isolated species, representing 60% of the isolates. Immunosuppression, diabetes mellitus, age extremes of life, the presence of catheters or procedures on the urinary tract are risk factors for Candida urinary tract infection. The candiduria is usually asymptomatic and does not need treatment. Only 4-14% of patients with candiduria have symptoms of urinary infection. It is necessary before choosing candiduria isolated on a first urinalysis to eliminate contamination by conducting a second harvest. In patients surveyed, the removal of the material allows the resolution of the candiduria nearly half the time and represents the first step of management. Oral fluconazole is the recommended treatment for cystitis (400 mg on day 1 and 200 mg daily for 7 to 14 days). In cases of pyelonephritis without associated candidemia, the first-line therapy is fluconazole (3-6 mg/kg/day) for 14 days or amphotericin B at a dose of 0.5 to 0.7 mg/kg/day with or not associated to flucytosine when potentially resistant strain (C. glabrata).
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Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Algoritmos , Candidíase/urina , Humanos , Infecções Urinárias/urinaRESUMO
Resistance progression of the Neisseria gonorrhoeae to quinolones and the decreasing sensitivity to cephalosporin implicate to actualise the guidelines for managing urethritis. We present the guidelines from the committee of infectious diseases of the French Association of Urology to manage acute urethritis.
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Uretrite/diagnóstico , Uretrite/tratamento farmacológico , Humanos , Masculino , Uretrite/microbiologiaRESUMO
The French Association of anesthesiology (SFAR) has published in 1999 the Antibiotic prophylaxis guidelines. Antibiotic resistance has increased and new procedures appeared so new recommendations were needed. We present the antibiotic prophylaxis guidelines from the committee of infectious diseases of the French Association of Urology.
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Antibioticoprofilaxia/normas , Doenças Urológicas/tratamento farmacológico , Anestesiologia , França , Humanos , Guias de Prática Clínica como Assunto , Sociedades Médicas , Doenças Urológicas/economia , Doenças Urológicas/cirurgia , UrologiaAssuntos
Projetos de Pesquisa , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Livros de Texto como Assunto , Doenças Urológicas/diagnóstico , Doenças Urológicas/terapiaRESUMO
Urinary tract infections are frequent. The aim of these guidelines is to improve the management of urionary tract infections. Increasing antibiotic prescriptions may increase bacterial drug resistance. Asymptomatic bacteriuria, bacterial count, pyuria are defined and the clinical value of the bacterial culture and urinary dipstick test are discussed. The good antibiotic use depends on bacteriological, pharmaceutical, patient characteristics and economic findings which are precised in these guidelines.
Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Doenças Urológicas/diagnóstico , Doenças Urológicas/tratamento farmacológico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriúria/diagnóstico , Contagem de Colônia Microbiana , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Farmacorresistência Bacteriana , Feminino , Humanos , Contagem de Leucócitos , MasculinoRESUMO
The management of uncomplicated lower urinary tract infections (UTI) implicate to look for risk factors and complications. Bacterial or radiological exams are not recommanded and short course of antibiotic is effective for treating uncomplicated UTI. Complicated UTI needs clinical, bacteriological and radiological exams, longer treatments are recommanded. Recurrent UTI definition is precised in these guidelines.
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Cistite/diagnóstico , Cistite/tratamento farmacológico , Doença Aguda , Antibacterianos/uso terapêutico , Cistite/etiologia , Feminino , Humanos , Masculino , Pós-Menopausa , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/etiologia , Recidiva , Fatores de Risco , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológicoRESUMO
The initial management of pyelonephritis needs to look for complicating factors. Ultrasound and X ray of the abdomen are able to rule out a urinary dilatation or a stone. The treatment is then surgical with renal drainage. Additional investigations such as a CT scan should be performed in patients with complicating factors or recurrence. In uncomplicated pyelonephritis a ambulatory treatment with 2 weeks of fluoroquinolones or cephalosporine Gr3 is sufficient. More severe cases should be admitted to a hospital and treated with initial cephalosporin Gr 3 plus aminoside for 3 to 6 weeks.
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Pielonefrite/diagnóstico , Pielonefrite/terapia , Doença Aguda , Antibacterianos/uso terapêutico , Drenagem , Feminino , Humanos , Masculino , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Ultrassonografia , Sistema Urinário/diagnóstico por imagem , UrografiaRESUMO
A urinary infection in a febrile man is classiquely defined as a prostatitis. Investigation exams look for complicating factors or post voiding residual which should be drained. Antibiotic treatment should begin with a fluroquinolone or cephalosporin gr 3 for 3 to 6 weeks.
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Prostatite/diagnóstico , Prostatite/tratamento farmacológico , Doença Aguda , Antibacterianos/uso terapêutico , Humanos , Masculino , Prostatite/classificaçãoRESUMO
The ideal solution first recommended is the use of Abbé-Mustardé's flap with lower lid transposition to rebuild the total loss of the upper eyelid. Every step of the surgical technique has been detailed to improve the result and keep the drawbacks under control. After having read articles on this subject, we describe three clinical cases, which enable us to compare with others surgical techniques that cannot rebuild all the levels of the eyelids and the edge of the eyelashes.
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Traumatismos Oculares/cirurgia , Neoplasias Palpebrais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Carcinoma Basocelular/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Reflux into vagina during micturition is a rare phenomenon in adults. We report a case of a 22-old-year woman who presented with intravaginal influx of urine. This case illustrates the anatomic basis, diagnostic examinations and clinical and bacteriological implications of this phenomenon.
Assuntos
Doenças Urológicas/diagnóstico , Vagina , Adulto , Feminino , Humanos , Radiografia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Transtornos Urinários/diagnóstico por imagemRESUMO
OBJECTIVE: To present results of a retrospective analysis of eighty cases of ethmoid adenocarcinoma. Carcinologic and surgical results of anterior skull base resection via the transfacial approach are presented. METHODS: Tumors were classified as 5% T1, 23% T2, 31% T3, 21% T4a and 20% T4b. Thirty-four patients were treated via a paralateronasal approach without skull base resection. Anterior skull bas resections were performed via the transfacial approach for 26 patients and by combined neurosurgical approach for 21. RESULTS: Mean follow-up was 4.8 years. Survival rate was 63.4% at 5 years and 57.9% at 8 years. Forty-two patients were alive and disease-free at last follow-up. Three patients were alive with recurrence. The rate of local recurrence was 38.8%. Complications occurred in 20% of the patients who had a transfacial approach. Complications appeared to be less frequent than with the combined approach. CONCLUSION: Prognosis is related to local control and could be improved by using skull base resection more systematically. In our experience this can be managed by a transfacial approach with similar carcinological results and less complications than the combined approach.
Assuntos
Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Osso Etmoide/patologia , Osso Etmoide/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/cirurgia , Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Face , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias dos Seios Paranasais/mortalidade , Taxa de SobrevidaRESUMO
Intratesticular location of leiomyoma is unusual. A single case has been published in the literature. We report a case of what we consider to be an intratesticular leiomyoma, with a description of its pathology, a discussion of its differential diagnosis and histogenesis.
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Leiomioma/patologia , Neoplasias Testiculares/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Squamous carcinoma of the bladder is a rare tumour, little known in Western countries in contrast with the high incidence in the Middle East and East Africa. It has a sex-ratio of 1 and black populations appear to be preferentially affected. Several recent theories of carcinogenesis elucidate the pathophysiology of this tumour. Its risk factors essentially consist of urinary schistosomiasis and mechanical and chemical vesical irritant factors. The diagnosis of this cancer is often delayed, but can be facilitated by strict follow-up of high-risk patients. Prevention appears possible in these patients. Its prognosis, traditionally poor, essentially depends on tumour stage and grade. Treatment is surgical, essentially radical cystectomy, which has a real therapeutic efficacy. The respective roles of chemotherapy and radiotherapy are currently under evaluation.
Assuntos
Carcinoma de Células Escamosas , Neoplasias da Bexiga Urinária , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Cistectomia , Feminino , Humanos , Masculino , Prognóstico , Fatores de Risco , Esquistossomose Urinária/complicações , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia , Bexiga Urinaria Neurogênica/complicaçõesRESUMO
Clinical stage T3 prostate cancer is ambiguous both in terms of its definition and its place in the natural history of the disease, and there is no consensus concerning its treatment. In a review of the literature, 148 articles were selected and analysed from the Medline database over a 14-year period (1983-1997). Single-agent therapy: Radiotherapy and radical prostatectomy: it is unlikely that these treatments can cure clinical stage T3 prostatic cancer, except perhaps for a small minority of patients actually presenting with overstaged pT2 disease or certain forms of low-grade pT3. Neither treatment appears to have any advantage over the other-Endocrine therapy: it has been proposed as exclusive treatment at this stage. Few studies have been reported. However, many authors consider this choice to be legitimate, because one-half of patients already have lymph node involvement. Combination therapy: Radiotherapy and endocrine therapy: recent studies comparing exclusive external beram radiotherapy with endocrine therapy show an advantage in favour of combination therapy. Total prostatectomy and endocrine therapy: neoadjuvant endocrine therapy does not provide any advantage. Adjuvant endocrine therapy improves local control and progression-free survival. Adjuvant radiotherapy and radical prostatectomy provides no advantage for T3. The choice of treatment for stage T3, N0, M0 obviously depends on the patient's general state and life expectancy. If the option of a curative treatment in a young subject can be reasonably considered, combination therapy should be preferred.