Tratamiento antibiótico de elección en sepsis urinaria asociada a litiasis ureteral en Chile. Estudio multicéntrico

Introducción: El uso de un esquema antibiótico inadecuado en sepsis aumenta significativamente la morbimortalidad. Este estudio presenta un reporte multicéntrico de susceptibilidad antibiótica en urosepsis asociada a ureterolitiasis, buscando proponer un esquema empírico óptimo para el medio nacional. Métodos: Se realizó un estudio observacional prospectivo en 7 hospitales de 4 regiones del país. Se incluyeron pacientes con criterios de sepsis asociada a ureterolitiasis confirmada radiológicamente. Se registraron sus datos demográficos, signos vitales y laboratorio de ingreso, así como sus estudios microbiológicos y radiológicos, realizándose estadísticas descriptivas de los datos obtenidos. Resultados: Se ingresaron 119 pacientes, de los cuales 52 cumplieron criterios de inclusión. 77% eran mujeres, con una edad promedio de 52 años. Se tomaron hemocultivos en el 48,7% de los casos y urocultivos en el 100%. El microorganismo más común fue Escherichia coli (73%), seguido por Proteus mirabilis (9,6%) y Klebsiella pneumoniae (3,9%). Hubo dos casos de bacterias gram positivas. El 100% de las bacterias gram negativas fueron sensibles a amikacina. Conclusión: Los microorganismos encontrados en nuestra cohorte fueron similares a los de los estudios internacionales. Dado que el mayor nivel de susceptibilidad fue para amikacina, proponemos su uso como terapia empírica para la urosepsis asociada a ureterolitiasis en Chile. Siempre es necesario considerar los posibles efectos ne-frotóxicos de la amikacina. Se debe considerar una asociación de betalactámicos y glicopéptidos en pacientes con factores de riesgo de infecciones enterocócicas.

Background: Inadequate antibiotic coverage in septic patients is associated with higher morbidity and mortality. This multicentric study reports antibiotic susceptibility in patients with ureterolithiasis-associated urosepsis, aiming to propose an optimal empirical therapy for this disease in the Chilean population. Methods: The prospective cohort study included patients from 7 Chilean hospitals who presented with ureterolithiasis and met sepsis criteria. We analyzed demographic data, vital signs at admission, and microbiological and radiological exams. We used descriptive statistics for the analysis of collected data. Results: Initially, the study included 119 patients; 52 met the inclusion criteria. 77% were female, with a mean age of 52. 100% of the cohort had a urine culture taken at admission, whereas 48,7% had blood cultures. Escherichia Coli was the most common microorganism (73%), followed by Proteus Mirabilis (9.6%) and Klebsiella Pneumoniae (3.9%). Only two patients presented gram-positive pathogens. 100% of gram-negative bacteria were sensible to amikacin. Conclusion: The microorganisms found in our cohort were similar to those in international reports. Since the highest level of susceptibility was for amikacin, we propose its use as empirical therapy for urosepsis associated with ureterolithiasis in Chile. It is always necessary to consider the potential nephrotoxic effects of amikacin. An association of beta-lactams and glycopeptides should be considered in patients with risk factors for enterococcal infections.

[Antibiotic treatment of choice for urinary sepsis associated with ureteral lithiasis in Chile. Multicenter study]. / Tratamiento antibiótico de elección en sepsis urinaria asociada a litiasis ureteral en Chile. Estudio multicéntrico.

BACKGROUND: Inadequate antibiotic coverage in septic patients is associated with higher morbidity and mortality. This multicentric study reports antibiotic susceptibility in patients with ureterolithiasis-associated urosepsis, aiming to propose an optimal empirical therapy for this disease in the Chilean population. METHODS: The prospective cohort study included patients from 7 Chilean hospitals who presented with ureterolithiasis and met sepsis criteria. We analyzed demographic data, vital signs at admission, and microbiological and radiological exams. We used descriptive statistics for the analysis of collected data. RESULTS: Initially, the study included 119 patients; 52 met the inclusion criteria. 77% were female, with a mean age of 52. 100% of the cohort had a urine culture taken at admission, whereas 48,7% had blood cultures. Escherichia Coli was the most common microorganism (73%), followed by Proteus Mirabilis (9.6%) and Klebsiella Pneumoniae (3.9%). Only two patients presented gram-positive pathogens. 100% of gram-negative bacteria were sensible to amikacin. CONCLUSION: The microorganisms found in our cohort were similar to those in international reports. Since the highest level of susceptibility was for amikacin, we propose its use as empirical therapy for urosepsis associated with ureterolithiasis in Chile. It is always necessary to consider the potential nephrotoxic effects of amikacin. An association of beta-lactams and glycopeptides should be considered in patients with risk factors for enterococcal infections.

Comparison of pre- and post-surgical images of reusable and single use flexible ureteroscopes: a qualitative analysis.

INTRODUCTION: Given the fragility of reusable ureterorenoscopes, many single use instruments have appeared on the market. Unfortunately, reuse of these scopes occurs in undeveloped countries in order to cut costs. This raises safety concerns for the patient.The aim of this article was to macroscopically evaluate the changes that single use flexible ureterorenoscopes (su-fURS) suffer after a retrograde intrarenal surgery (RIRS), and to compare them to reusable fURS. MATERIAL AND METHODS: Pre and post-operative images of the instruments used in 23 RIRS were obtained. All the cases had renal calculi of the inferior calix between 10-15 mm, and all of them were treated with Holmium laser. The ureterorenoscopes used were: Storz® Flex X2, Storz® Flex XC, Pusen® 3022, OTU® Wiscope, AnQIng® Innovex and Boston Scientific® LithoVue. Qualitative comparisons of these were made. RESULTS: After su-fURS usage, significant damage was observed, especially on the distal tip. Deflection was not compromised. Reusable fURS did not sustain any damage after their use. CONCLUSIONS: fURS are delicate equipment, especially if they are of single use. The considerable damage sustained by single use scopes could mean that reuse of these instruments is dangerous and should be avoided.

Vasectomía sin bisturí - sin aguja con dispositivo madajet: Introducción de la técnica en Chile / No-scalpel needle-less vasectomy with madajet device: Itroduction of the tecnique in Chile

La vasectomía es un método simple, seguroy efectivo de control de fertilidad que tiene múltiples ventajas comparativas respecto a la ligadura tubaria. A pesar de esto, continúa representando sólo un pequeño porcentaje de las esterilizaciones efectuadas en nuestro país.El costo del procedimiento y el temor a la cirugía siguen siendo algunas de las barreras que impiden una mayor realización y aceptación del procedimiento. Estas aprehensiones podrían ser evitadas a través del uso de la técnica de vasectomía sin bisturí - sin aguja con el uso del dispositivo Madajet. El equipo Madajet es un aparato mecánico que permite inyectar un volumen fijo de 0,1 cc de anestésico local, con una penetración del liquido a 4-5 mm de la superficie epitelial, generando una pápula de 5-6 mm de diámetro que evita la distensión tisular producida por la inyección del anestésico con aguja.AU

Vasectomy is a simple, safe and effective fertility control method that has multiple comparative advantages over tubal ligation. Despite this, it continues to represent only a small percentage of the sterilizations carried out in our country. The cost of the procedure and the fear of surgery continue to be some of the barriers that prevent further implementation and acceptance of the procedure. These shortcomings could be avoided by using the no-scalpel needle-less technique incorporating the Madajet device. The Madajet device is a mechanical device that allows the injection of a fixed volume of 0.1 cc of local anesthetic, with a penetration of the fluid to 4-5 mm of the epithelial surface, generating a papule 5-6 mm in diameter that avoids the Tissue distention produced by injection of anesthetic with needle.AU

[Metanephric adenoma of the kidney associated with polycythemia and erythromelalgia: report of one case]. / Adenoma metanéfrico del riñon asociado a policitemia y eritromelalgia: caso clínico.

BACKGROUND: We report a 21-year-old male, presenting with erythromelalgia and polycythemia. A solid renal mass of the lower pole of the right kidney was discovered. The patient was subjected to a right open partial nephrectomy. The pathological study of the surgical specimen showed a metanephric adenoma of the kidney. The patient had an uneventful postoperative evolution. Currently the patient is in good health without evidence of recurrence of the tumor and normal hematological parameters.

Adenoma metanéfrico del riñon asociado a policitemia y eritromelalgia: caso clínico / Metanephric adenoma of the kidney associated with polycythemia and erythromelalgia: Report of one case

Background: We report a 21-year-old male, presenting with erythromelalgia and polycythe-mia. A solid renal mass of the lower pole of the right kidney was discovered. The patient was subjected to a right open partial nephrectomy. The pathological study of the surgical specimen showed a metanephric adenoma of the kidney. The patient had an uneventful postoperative evolution. Currently the patient is in good health without evidence of recurrence of the tumor and normal hematological parameters.

Long-term impact of arsenic in drinking water on bladder cancer health care and mortality rates 20 years after end of exposure.

PURPOSE: In this study we assessed bladder cancer health care and mortality trends in recent decades in a well studied arsenic exposed area in Northern Chile. MATERIALS AND METHODS: Arsenic levels in the affected region were obtained for the last 60 years, and correlated with bladder cancer hospital discharge and mortality rates in recent decades. RESULTS: Bladder cancer hospital discharge rates were significantly higher in the affected region (peak RR 3.6, 95% CI 3.0-4.7). Mortality rates for bladder cancer showed a trend of increase during the period analyzed, reaching peak mortality rates of 28.4 per 100,000 for men and 18.7 per 100,000 for women in the last 10 years. Poisson regression models showed an increased mortality risk in the studied region compared to the rest of the country until the present for men (IRR 5.3, 95% CI 4.8-5.8) and women (IRR 7.8, 95% CI 7.0-8.7). Mean age at cancer specific death was significantly lower in the exposed region (69.6 years, 95% CI 68.4-70.7 vs 73.7 years, 95% CI 73.3-74.2, p <0.01). CONCLUSIONS: Exposure to arsenic is related to a significant need for bladder cancer health care and to high mortality rates even 20 years after having controlled arsenic levels in drinking water. Affected individuals should be aware of the significant impact of this ecological factor. Further research is required to identify strategies for the management of bladder cancer in arsenic exposed populations.

Egresos hospitalarios por cáncer genitourinario en Chile: tercera parte / Hospital discharges because of genitourinary cancer: third part

El objetivo del presente trabajo fue actualizar el análisis de los egresos hospitalarios (EH) de cáncer genitourinario (CGU), específicamente cáncer de próstata, testículo, vejiga y riñón, en nuestro país. Para estos efectos se obtuvieron los datos del boletín de egresos hospitalarios del Ministerio de Salud (MINSAL) del año 2005, utilizándose los códigos de la clasificación internacional de enfermedades de la OMS (CIE-10). Los distintos diagnósticos fueron caracterizados según su composición geográfica y demográfica, comparándose con la información publicada en los reportes anteriores. La proporción de patología oncológica genitourinaria dentro de los egresos hospitalarios por patología genitourinaria ha experimentado un alza sostenida, correspondiendo 10,9 por ciento a cáncer de próstata, 4,28 por ciento a cáncer de testículo, 3,92 por ciento a cáncer de vejiga, y 2,2 por ciento a cáncer renal. El presente reporte constituye una aproximación a nuestro quehacer como urólogos en nuestro país, y al mismo tiempo grafica la necesidad de crear herramientas de registro epidemiológico más efectivas.

The aim of the study was to update the analysis of hospital discharges because of genitourinary cancer in our country. For these purposes, data were obtained from the registers of the Chilean Ministry of Health. Diseases were codified according to the WHO ICD-10 classification. Hospital discharges because of genitourinary cancer has shown a steady increase since 1993.According to the last register (2005), 10.9 percent corresponds to prostate cancer, 4.28 percent to testicular cancer,3.92 percent to bladder cancer and 2.2 percent to renal cell cancer. The present analysis is a rough estimation of our activity in urological oncology. However, more accurate epidemiological tools are needed.

Egresos hospitalarios por patología genitourinaria en Chile: tercera parte / Hospital discharges because of genitourinary diseases: third part

El objetivo del presente trabajo fue actualizar el análisis de los egresos hospitalarios (EH) de patologías del sistema genitourinario (PGU) en nuestro país. Para estos efectos se obtuvieron los datos del boletín de egresos hospitalarios del Ministerio de Salud (MINSAL) del año 2005, utilizándose los códigos de la clasificación internacional de enfermedades de la OMS (CIE-10). Los distintos diagnósticos fueron caracterizados según su composición geográfica y demográfica, comparándose con la información publicada en los reportes anteriores. Los egresos por PGU disminuyeron de un 4,13 por ciento a un 3,78 por ciento del total. De esta manera, la patología genitourinaria continúa siendo una contribución menor al total de egresos hospitalarios en el país. Las infecciones del tracto urinario, la hiperplasia prostática benigna, la urolitiasis y la fimosis se mantuvieron como las patologías más frecuentes. Los EH por patología oncológica es el único subgrupo que ha mostrado un alza sostenida durante los 12 años analizados. El presente reporte constituye una aproximación a nuestro quehacer como urólogos en nuestro país, y al mismo tiempo grafica la necesidad de crear herramientas de registro epidemiológico más efectivas.

The aim of the study was to update the analysis of hospital discharges because of genitourinary diseases in our country. For these purposes, data were obtained from the registers of the Chilean Ministry of Health. Diseases were codified according to the WHICD-10 classification. Hospital discharges because of genitourinary diseases showed a slight decrease in 2005 when compared to 2001, from 4.13 percent to 3.78 percent. Consequently, genitourinary diseases are still a minor fraction of the national hospital discharges. The most relevant diseases were urinary tract infections, benign prostate hyperplasia, urolithiasis and phimosis. Hospital discharges because of genitourinary cancer has been the only subgroup showing a steady increase since 1993. The present analysis is a rough estimation of our work as urologists in our country. However, more accurate epidemiological tools are needed.

Requerimientos de analgesia para litotricia extracorpórea de cálculos urinarios, según su ubicación: 20 años de experiencia clínica / Analgesic requirements for extracorporeal shock wave lithotripsy of urolithiasis, according to their location. 20 years of clinical experience

Objetivo: Determinar los requerimientos de analgesia y anestesia para litotricia extracorpórea (LEC) de cálculos urinarios según la localización del cálculo en la vía urinaria. Material y Métodos: Se analizan 3.905 pacientes tratados en el Hospital Militar de Santiago con litotritores electromagnéticos tipo Modulith entre 1990 y 2010,consignando la ubicación del cálculo, la analgesia y sedación utilizada. Las modalidades de analgesia, sedación y anestesia se dividen en 3 grupos: 1-. Sin analgesia. 2-.Analgosedación superficial: aquella en la cual el urólogo determina y administra los fármacos requeridos. 3-. Analgosedación profunda: se requieren técnicas y fármacos de manejo del anestesista. Resultados: 349 pacientes (8,9 por ciento) no requirieron ningún analgésico o sedante. Tres mil doscientos once pacientes (82,2 por ciento) fueron manejados con analgesia superficial y en 345 casos (8,8 por ciento), se requirió sedación profunda o anestesia para su tratamiento. Aquellos pacientes con cálculos localizados en el cáliz superior registran los mayores requerimientos de analgesia profunda. Conclusión: En la mayor parte de los casos, la analgesia superficial administrada por el urólogo es suficiente para el manejo del dolor en LEC. Las LEC con litotritores Modulith, requieren la asistencia de anestesista en menos del 10 por ciento de los casos. La posición del cálculo en la vía urinaria tiene impacto en los requerimientos de analgosedación y anestesia.

Objective: To determine the requirements of analgesia and anesthesia for extracorporeal shock wave lithotripsy (ECL) for kidney stones according to the location of the calculus in the urinary tract. Material and methods: We analyzed 3,905 patients treated at the Military Hospital of Santiago with MODULITH electromagnetic type lithotripters, between 1990 and 2010, stating the location of calculi, analgesia and sedation used. Types of analgesia, sedation and anesthesia were divided into 3 groups: 1-. No analgesia. 2-.Superficial sedation/analgesia: in which the urologist determines and administers the drugs required. 3-. Deep sedation/analgesia: It requires anesthesiologist management. Results: 349 patients (8.9 percent) did not require any analgesic or sedative agent. 3,211patients (82.2 percent) were managed with superficial analgesia. 345 patients (8.8 percent) required deep sedation or anesthesia for treatment. Patients with calculi located in the upper calyx had the highest requirements of deep anesthesia. Conclusion: In most cases, the superficial analgesia administered by a urologist is enough for pain management. MODULITH electromagnetic type lithotripters ECL, required the assistance of an anesthesiologist in less than 10 percent of the cases. The position of calculi in the urinary tract has an impact on the requirements of analgesic/sedation and anesthesia.