Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC).

Most urinary tract infections (UTI) are uncomplicated infections occurring in young women. An extensive evaluation is not required in the majority of cases, and they can be safely managed as outpatients with oral antibiotics. Escherichia coli is by far the most common uropathogen, accounting for >80% of all cases. Other major clinical problems associated with UTI include asymptomatic bacteriuria, and patients with complicated UTI. Complicated UTIs are a heterogeneous group associated with conditions that increase the risk of acquiring infection or treatment failure. Distinguishing between complicated and uncomplicated UTI is important, as it influences the initial evaluation, choice, and duration of antimicrobial therapy. Diagnosis is especially challenging in the elderly and in patients with in-dwelling catheters. The increasing prevalence of resistant uropathogens, including extended-spectrum ß-lactamases and carbapenemase-producing Enterobacteriaceae, and other multidrug-resistant Gram-negative organisms further compromises treatment of both complicated and uncomplicated UTIs. The aim of these Clinical Guidelines is to provide a set of recommendations for improving the diagnosis and treatment of UTI.

Update of the Spanish clinical practice guideline for urinary tract infection in infants and children. Summary of recommendations for diagnosis, treatment and follow-up.

The management of urinary tract infection (UTI) in infants and children has changed significantly over the past few decades based on scientific evidence that questioned the efficacy of strategies used to prevent kidney injury and subsequent progression to chronic kidney disease, which is very unlikely in most paediatric cases. However, there is still substantial heterogeneity in its management and uncertainty regarding the diagnosis, indication of imaging tests, treatment or follow-up in these patients. The Spanish clinical practice guideline has been updated through the review of the literature published since 2009 and a rigorous evaluation of current clinical practice aspects, taking into account the evidence on the benefits of each intervention in addition to its risks and drawbacks to attempt to provide more precise recommendations.

Effect of intravesical mitomycin compared with gemcitabine on the treatment non-muscle invasive bladder cancer: A meta-analysis.

INTRODUCTION: We performed a meta-analysis to evaluate the effect of intravesical mitomycin compared with gemcitabine on the treatment of non-muscle invasive bladder cancer. METHODS: A systematic literature search up to November 2021 was done and 6 studies included 389 subjects with non-muscle invasive bladder cancer at the start of the study; 197 of them were provided with intravesical-mitomycin and 192 with intravesical gemcitabine. The studies reported the relationships about the effect of intravesical mitomycin compared with gemcitabine on the treatment of non-muscle invasive bladder cancer. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effect of intravesical mitomycin compared with gemcitabine on the treatment of non-muscle invasive bladder cancer using the dichotomous method with a random or fixed-effect model. RESULTS: Intravesical mitomycin had significantly higher recurrence rates (OR, 2.41; 95% CI, 1.43-4.08, p=0.001) and chemical cystitis (OR, 4.39; 95% CI, 2.27-8.51, p<0.001) compared to intravesical gemcitabine in subjects with non-muscle invasive bladder cancer. However, intravesical mitomycin had no significant difference in its effect on hematuria (OR, 1.71; 95% CI, 0.68-4.33, p=0.26), skin reaction (OR, 2.04; 95% CI, 0.59-7.07, p=0.26), and liver and kidney functions damage (OR, 1.96; 95% CI, 0.35-10.96, p=0.44) compared to intravesical gemcitabine in subjects with non-muscle invasive bladder cancer. CONCLUSIONS: Intravesical mitomycin had significantly higher recurrence rates and chemical cystitis and no significant difference in its effect on hematuria, skin reaction, and liver and kidney functions damage compared to intravesical gemcitabine in subjects with non-muscle invasive bladder cancer. Further studies are required to validate these findings.

Recommendations on the use of intravesical hyaluronic acid instillations in bladder pain syndrome.

INTRODUCTION: Bladder pain syndrome (BPS) is a complex syndrome, without a clearly defined etiology that encompasses different entities, such as interstitial cystitis. This leads to difficulties in establishing a precise definition, obtaining accurate prevalence data, and defining diagnostic criteria and standardized assessment methods. Moreover, there is no consensus regarding the treatment of BPS. Intravesical instillations with hyaluronic acid (HA) are an option, although no specific recommendations have been made yet. OBJECTIVE: To synthesize the scientific evidence on the therapeutic options available for BPS and to establish a work plan and recommendations for the use of intravesical instillations with HA. The Spanish Association of Urology, through the Functional, Female, and Urodynamic Urology Group, created a commission of experts. This commission was in charge of reviewing literature (evidence), agreeing on the work plan, and proposing recommendations. RESULTS: There is great variability in literature on the treatment of BPS, without a standard regimen of intravesical instillation with HA (frequency and duration of initial and maintenance treatment). CONCLUSIONS: Intravesical HA instillations (usual dose of 40 mg) are effective and safe. They can be combined with other options, with efficacy still to be determined in some cases. Treatment is divided into several initial weekly sessions, followed by maintenance treatment, usually monthly (unestablished duration of cycles). Recommendations on the management of BPS were agreed, with diagnostic criteria and guidelines for treatment with intravesical HA (initiation, reassessment, and follow-up).

[Emphysematous cystitis and emphysematous pyelonephritis]. / Cistitis y pielonefritis enfisematosa.

Emphysematous cystitis and emphysematous pyelonephritis are rare entities, difficult to diagnose and with high morbidity and mortality. The non-specificity of the medical history and the little usefulness of laboratory tests contribute to diagnostic delay, which increases the possibility of therapeutic failure. We present 2 cases, one of cystitis and another of emphysematous pyelonephritis, who attended the emergency room due to severe urinary sepsis. Despite severity of the symptoms, conservative management was performed with bladder drainage and antibiotic treatment, without interventions or surgeries, presenting a favorable evolution and resolution of the infectious process. Each case must be individualized to offer the best possible therapeutic alternative.

[Effectiveness and safety of intravesical hyaluronic acid for symptom control in chronic bladder diseases.] / Efectividad y seguridad del ácido hialurónico intravesical para el control de los síntomas en cistopatías crónicas.

INTRODUCTION: Chronic bladder disorders are a common condition. Endovesical hyaluronic acid is one of the therapeutic options for these patients. It is intended to verify the effectiveness and safety of treatment with intravesical instillations of hyaluronic acidin patients with bladder symptoms. MATERIAL AND METHODS: We present a series of 32 patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance, and complications were analyzed, and symptoms before and after treatment were compared. Symptomatic relief achieved with treatment was assessed using the Patient Global Improvement Impression Scale (PGI-I). RESULTS: The median age was 74 years (IQR 60-78) and 65.6% were women. Median follow-up was 10 months (IQR 7-14). Eleven patients were diagnosed with radiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrent cystitis. After treatment, symptoms improved in 81.8% of patients with radical cystitis, 82.3% of patients with BPS/IC, and 75% of the patients with recurrent cystitis. The incidence of hematuria was reduced from 46.9% to 9.4% (p<0.001), filing symptoms from 62.5% to 12.5% (p<0.001) and pain from 40.6% to 12.5% (p= 0.004). 100% of the patients tolerated the treatment well and only 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6% showed total control of symptoms and 15.6% partial control, achieving a greater response in the group of patients with hematuria (73.3%). 61.3% of the patients perceived relief of symptoms after treatment according to the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up. CONCLUSION: Intravesical hyaluronic acid is a safe and effective treatment for filling symptoms, hematuria, and pain in patients with chronic cystopathies. Patients with radiotherapy-induced cystitis seem to especially benefit from treatment.

INTRODUCCIÓN: Las cistopatías crónicas son una patología frecuente. El ácido hialurónico endovesical es una de las opciones terapéuticas para estos pacientes. Se pretende verificar la efectividad y seguridad del tratamiento con instilaciones intravesicales de ácido hialurónico en pacientes con síntomas vesicales.MATERIAL Y MÉTODOS: Se presenta una serie de 32 pacientes que recibieron instilaciones intravesicales de ácido hialurónico. Se analizaron las características demográficas, tolerancia y complicaciones, y se compararon los síntomas antes y después del tratamiento. El alivio sintomático conseguido con el tratamiento se evaluó mediante la escala de impresión de mejoría global del paciente (PGI-I).RESULTADOS: La mediana de edad fue de 74 años (IQR60-78), siendo el 65,6% mujeres. La mediana de seguimiento fue 10 meses (IQR 7-14). Once pacientes fueron diagnosticados de cistitis rádica, 17 de síndrome de dolor vesical/cistitis intersticial (SDV/CI) y 4 de cistitis de repetición. Tras el tratamiento mejoraron los síntomas el 81,8% de los pacientes con cistitis rádica, el 82,3% de los pacientes con SDV/CI y el 75% de los pacientes con cistitis recurrentes. La incidencia de hematuria se redujo del 46,9% al 9,4% (p<0,001), los síntomas de llenado del 62,5% al 12,5% (p<0,001) y el dolor de un 40,6% al 12,5% (p=0,004). El 100% de los pacientes toleró bien el tratamiento y sólo se registraron 2 efectos adversos (infección del tracto urinario y retención agudade orina). Durante el seguimiento un 65,6% mostró un control total de los síntomas y un 15,6% un control parcial, consiguiendo una respuesta mayor en el grupo de pacientes con hematuria (73,3%). El 61,3% de los pacientes percibió alivio de los síntomas tras el tratamiento según la escala PGI-I. El 88,9% mantiene la mejoría de los síntomas al finalizar el seguimiento.CONCLUSIÓN: El ácido hialurónico intravesical es un tratamiento seguro y efectivo para los síntomas de llenado, hematuria y dolor en pacientes con cistopatías crónicas. Los pacientes con cistitis rádica parecen beneficiarse especialmente del tratamiento.

[Hyperbaric oxygen therapy efficacy in the treatment of hematuria due to radiation cystitis. Experience in a reference center.] / Eficacia de la oxigenoterapia hiperbárica en el tratamiento de la hematuria por cistitis rádica. Experiencia en un centro de referencia.

OBJECTIVE: To evaluate the efficacy of hyperbaric oxygen therapy (HBOT) in the treatment of hemorrhagic radiation cystitis (HRC). MATERIAL AND METHOD: Retrospective study of patients diagnosed with hematuria secondary to HRC after pelvic radiation from January 2005 to January 2017 who were treated with HBOT. Demographic and clinical variables were collected. A descriptive univariate and multivariate statistical analysis using Cox regression was carried out. The treatment was considered effective when there was a total or partial remission of the hematuria based on the Radiation Therapy Oncology Group (RTOG) scoring schema. Partial remission was defined as the presence of hematuria grade 2 or less. RESULTS: A total of 67 patients with a mean age of 68,6 years (39-87) were included. 65,7% men and 34,3% women. The RT was administered in 64,2% of the cases by urological cause, prostate cancer. The av-erage dose of RT was 75,24 Gy (45-180). The mean from the RT to the HBOT treatment was 55,97 months (4-300) and from the beginning of the hematuria until the treatment was 11,3 months (1-48). Response was observed in 51 (76,1%) patients, total in 50,7% and partial in 25,4% of cases. Patients with a degree of hematuria less than 3, those who were administered more than 30 sessions and those who did not require transfusion or hospital admission, responded significantly bet-ter to treatment with HBOT (p<0.05) according to the univariate and multivariate analysis. No adverse effects related to treatment were reported, only one patient was excluded due to claustrophobia. CONCLUSIONS: Hyperbaric oxygen therapy is an effective and safe treatment for the management of hematuria due to radiological cystitis secondary to radiotherapy. A better response was observed in patients with a lower degree of hematuria and those who could be administered a greater number of sessions.

OBJETIVO: Evaluación la eficacia de la oxigenoterapia hiperbárica (OHB) en el tratamiento de la cistitis rádica hemorrágica (CRH) postradioterapia.MATERIAL Y MÉTODO: Estudio retrospectivo que incluyó a los pacientes diagnosticados de hematuria secundaria a CRH postradioterapia pélvica desde enero de 2005 hasta enero del 2017 tratados con OHB. Se recogieron variables demográficas y clínicas. Se efec-tuó un análisis estadístico descriptivo, univariante y multivariante mediante regresión de Cox. El tratamiento se consideró eficaz cuando se produjo una remisión total o parcial de la hematuria en base a la escala del Grupo Oncológico de Radioterapia (RTOG). La respuesta parcial se definió como la presencia de hematuria grado 2 o menor tras el tratamiento. RESULTADOS: Se recogieron un total de 67 pacientes con una edad media de 68,6 años (39-87). Un 65,7% hombres y 34,3% mujeres. La RT fue administrada en el 64,2% de los casos por causa urológica, la más frecuente fue el cáncer de próstata. La dosis media de RT fue 75,24 Gy (45- 180). La media desde la RT hasta el tratamiento con OHB fue de 55,97 meses (4-300) y desde el inicio de la hematuria hasta el tratamiento de 11,3 meses (1-48). Se observó algún tipo de respuesta en 51 (76,1%) pacientes, siendo una respuesta total en el 50,7% y parcial en el 25,4% de los casos. Los pacientes con un grado de hematuria menor a 3, aquellos que recibieron más de 30 sesiones, y aquellos que no precisaron transfusión ni ingreso hospitalario, respondieron significativamente mejor al tratamiento (p<0,05), según el análisis univariante y multivariante. No fueron reportados efectos adversos relacionados con el tratamiento, solo un paciente fue excluido por claustrofobia. CONCLUSIONES: La terapia con OHB es una tratamiento efectivo y seguro para el manejo de la hematuria por CRH secundaria a radioterapia. Se observó una mejor respuesta en los pacientes con un menor grado de hematuria, en aquellos que recibieron mayor número de sesiones y que no precisaron transfusión ni ingreso hospitalario.

Hyperbaric oxygen for radiation-induced cystitis: A long-term follow-up. / Oxígeno hiperbárico para la cistitis inducida por radioterapia: un seguimiento a largo plazo.

INTRODUCTION AND OBJECTIVES: Bladder complications may be seen in up to 12% of patients treated with pelvic irradiation. Hyperbaric oxygen therapy (HBOT) is an option for the management of radiation-induced hemorrhagic cystitis (RIHC). The aim of this study was to evaluate the efficacy of HBOT in radiation cystitis and to identify the predictive factors for a successful outcome. MATERIAL AND METHODS: We retrospectively reviewed 105 patients diagnosed with RIHC which were treated with HBOT between 2007 and 2016 in our institution. Patients received 100% oxygen in a multiplace hyperbaric chamber at 2.4atm for 80minutes. All patients fulfilled a questionnaire documenting symptom severity pre-HBOT and at the end of the follow-up period. RESULTS: After a median of 40 HBOT sessions, there was success rate of 92,4% in the control of hematuria. During our follow-up period (median of 63 months) 24,7% patients presented with recurrence of hematuria. The mean score of the questionnaire-assessed variables: dysuria, urinary frequency and hematuria, was significantly lower after the follow-up period (P<.05). Our data shows that the sooner HBOT is delivered after the first episode of hematuria, better response rates are achieved and lower recurrences concerning hematuria were registered (P<.05). No serious complications were observed. CONCLUSIONS: Our results support the safety and long-term benefits of HBOT on RIHC and other distressful bladder symptoms, which represents an expected improvement of quality of life in our patients.

Cistitis enfisematosa: una causa poco frecuente de dolor abdominal / Emphysematous cystitis: An uncommon cause of ab dominal pain

Resumen Una mujer de 82 años con antecedentes de hiperten sión arterial e hipotiroidismo acudió al servicio de urgencias por dolor abdominal, diarrea, confusión y deterioro de su estado general de varios días de evolu ción. A su admisión, la paciente se encontraba febril y la analítica mostró una elevación de la proteína C reac tiva sin leucocitosis (8.9 × 10[PRESERVECIRC]9/L). En ese contexto se realizó exudado nasofaríngeo para SARS-CoV-2 que fue negativo. Con estos resultados, la sospecha inicial era la de un cuadro infeccioso de origen digestivo. La muestra de orina era maloliente con presencia de leucocitos y nitritos enviándose a cultivo microbiológico. Se inició tratamiento antibiótico empírico con una cefalosporina de tercera generación ante la sospecha de une posible infección urinaria. Se decidió la realización de una tomografía tóraco-abdomino-pélvica con el objetivo de evaluar la presencia de otros focos infecciosos en una paciente de edad avanzada. Este estudio mostró una cistitis enfisematosa, una enfermedad poco fre cuente en una paciente sin ninguno de los factores de riesgo clásicos para esta entidad. Los cultivos de orina y sangre fueron positivos para Escherichia coli sensible al antibiótico empírico por lo que se continuó para completar 7 días de tratamiento. La evolución clínica fue favorable.

Abstract An 82-year-old woman with a previous medical his tory of hypertension and hypothyroidism was admitted to the emergency department for abdominal pain, dia rrhea, confusion and changes in her overall condition over several days. At the emergency department, the patient was febrile and her blood tests showed elevated C-reactive protein without leukocytosis (8.9 × 10[PRESERVECIRC]9/L). In the current context, a nasopharyngeal swab for SARS was performed and was negative. With these results, the initial suspicion was that of an infectious condi tion of gastrointestinal origin. The urine sample was foul-smelling with presence of leukocytes and nitrites and was sent out for culture. In the setting of probable urinary tract infection, empirical antibiotic treatment was started with a third generation cephalosporin. It was decided to perform a total body scanner in order to evaluate the presence of other infectious foci. The study described the presence of emphysematous cystitis, a rare pathology in a patient without any of the classic risk factors for this entity. Urine and blood cultures were positive for Escherichia coli sensitive to the empiric antibiotic which was continued to complete 7 days. The clinical course was favorable.

Cistitis eosinofílica en mujer con enfermedad renal crónica

Se presenta caso de una mujer de 70 años, con antecedentes de enfermedad renal crónica sin requerimiento dialítico que ingresa con descompensación aguda y que mejora con sesiones de hemodiálisis. Al examen físico llama la atención hematuria franca por lo que se solicita ecografía de pelvis donde aprecia vejiga distendida con coágulo en su interior de 7,2 cm. La tomografía muestra aparente tumor de pared de vejiga. La uretrocistografía confirma una cistitis crónica eosinofílica. Es manejada con hidroxicina teniendo respuesta favorable cediendo episodios de hematuria. La cistitis eosinofílica es una condición médica rara que se presenta con síntomas urinarios tales como disuria y hematuria. Es más común en niños que en adultos. El método diagnóstico es a través de una biopsia de pared vesical por cistoscopía. El manejo está dirigido a aliviar los síntomas. El interés por el caso se debe a la rareza de esta patología.

We present the case of a 70-year-old woman with a history of chronic kidney disease without dialysis who was admitted with acute decompensation and improved with hemodialysis sessions. On physical examination, frank hematuria was noticeable, therefore a pelvic ultrasound was requested, where a distended bladder with a 7.2 cm clot inside was observed. The tomography showed an apparent bladder wall tumor. Cyst urethrography confirmed chronic eosinophilic cystitis. It was managed with hydroxyzine, having a favorable response, reducing episodes of hematuria. Eosinophilic cystitis is a rare medical condition that presents with urinary symptoms such as dysuria and hematuria. It is more common in children than in adults. The diagnostic method is through a bladder wall biopsy by cystoscopy. Management is aimed at relieving symptoms. The interest in the case is due to the rarity of this pathology.

Apoptotic effect as biomarker of disease, severity and follow-up in interstitial cystitis. / Efecto apoptótico como biomarcador de enfermedad, severidad y seguimiento en la cistitis intersticial.

OBJECTIVE: To determine whether the apoptotic effect test could serve as a biomarker of severity in bladder pain syndrome/interstitial cystitis. MATERIAL AND METHODS: A prospective study was conducted between January 2010 and January 2015, which included 57 patients diagnosed with interstitial cystitis and 49 diagnosed with chronic pelvic pain of gynaecological origin. The urine was exposed to cell cultures, and the urine's capacity for inducing apoptosis in the cultures was analysed. A statistical analysis was then conducted to assess whether the apoptotic effect was associated with the symptoms. RESULTS: After performing an analysis of the association between the degree of apoptotic effect and the symptoms of patients with interstitial cystitis, we observed a significant increase in the mean percentages of apoptosis as the degree of symptom severity increased. After analysing the association between the apoptotic effect and symptoms, we obtained a positive correlation in the patients with interstitial cystitis and a lack of correlation in the patients with chronic pelvic pain of gynaecological origin. The rates of apoptosis increased progressively in the patients with interstitial cystitis as the symptoms increased, while the patients with chronic pelvic pain of gynaecological origin remained stable. CONCLUSIONS: The apoptotic effect of the urine of patients with interstitial cystitis could be a marker of disease, thus differentiating patients with interstitial cystitis from patients with chronic pelvic pain. The effect could also provide an objective measure of symptom severity.

La esquistosomiasis como factor de riesgo del cáncer de vejiga. Hospital Central de Nampula, Mozambique

Introducción: la esquistosomiasis es la infección por trematodos más importante a nivel global. El carcinoma de células escamosas constituye el 2 % de todos los tipos histológicos de cáncer vesical; sin embargo, la incidencia de esta variedad en países endémicos de esquistosomiasis es mayor. Objetivo: evaluar la relación entre la esquistosomiasis y el cáncer de vejiga en pacientes del Hospital Central de Nampula. Materiales y métodos: se realizó un estudio observacional, descriptivo y transversal en el período comprendido entre enero de 2014 y diciembre de 2020. Los pacientes se dividieron en grupos etarios, por intervalos de 10 años. Se tomaron muestras de biopsias de tumores de vejiga, clasificándose por tipo histológico, además de los hallazgos relacionados con infestación por esquistosomiasis y formas de presentación del cáncer de vejiga. El universo estuvo constituido por 184 pacientes, y la muestra se conformó por 135 casos. Resultados: se comprobó que el mayor número de pacientes con cáncer de vejiga es del sexo masculino; el tipo histológico más frecuente fue el carcinoma de células escamosas, representando un 84,3 % del total. La cistitis, la presencia de esquistosomas, y sus huevos estuvieron presentes en casi todas las biopsias realizadas. Sus formas de presentación más frecuente fueron la cistitis, la hematúrica y la dolorosa. Conclusiones: el cáncer de vejiga mostró una mayor incidencia en las edades comprendidas entre 30 y 69 años. El carcinoma de células escamosas fue el más frecuente, y su relación con la cistitis y la infección por esquistosomas estuvo presente en más del 90 % de las biopsias.

Introduction: schistosomiasis is the most important trematode infection globally. Squamous cell carcinoma constitutes 2% of all the histological types of bladder cancer; however, the incidence of this variety of cancer in squistosomiasis-endemic countries is higher. Objective: to evaluate the relationship between squistosomiasis and bladder cancer in patients from the Central Hospital of Nampula. Materials and methods: a cross-sectional descriptive observational study was carried in the period between January 2014 and December 2020. Patients were divided into age-groups, by 10-year intervals. Biopsy samples of bladder tumors were taken, classified by histological type, in addition to findings related to squistosomiasis infestations and bladder cancer presentation forms. The universe consisted of 184 patients and the sample of 135 cases. Results: it was found that the largest number of patients with bladder cancer is male; squamous cell carcinoma is the most frequent histological type, representing 84.3% of the total. Cystitis, schistosome and their eggs were present in almost all the biopsies performed. Its most frequent presentation forms were hematuric and painful cystitis. Conclusions: bladder cancer showed higher incidence at the ages between 30 and 69 years. The squamous cell carcinoma was the most frequent, and its relationship with cystitis and schistosome infection was present in more than 90% of biopsies.

Eosinophilic cystitis treated with hydrodistention and complementary methods: Case report. / Cistitis eosinofílica tratada con hidrodistensión y métodos complementarios: comunicación de un caso.

OBJECTIVE: Even though there is no established standard therapy for Eosinophilic cystitis (EC), the series of cases guide us in the treatment of patients. We report our therapeutic experience with hydrodistention and complementary methods. In order to establish a standard treatment in patients with EC. METHODS: Retrospective review of the clinical history of a patient diagnosed with eosinophilic cystitis. RESULTS: A 66-year-old woman presented female urethral syndrome 1 year before and was initially treated as a chronic cystitis. After further investigations including cystoscopy and bladder biopsy, she was diagnosed with EC.Urothelial mucosa bleeding was evidenced and cauterization and hydrodistention were performed. After the surgical treatment, corticosteroids and antibiotics were initiated.The maintenance treatment was continued with Vitamin C, Maurita flexuosa and Peumus boldus. The patient's condition has been improving and she is still asymptomatic one year later. CONCLUSION: The efficacy of treatment with hydrodistention, corticosteroids and antibiotics showed positive results in short and long term in this patient. Vitamin C, Maurita flexuosa and Peumus boldus showed favorable results in EC maintenance treatment.

OBJETIVO: A pesar de que no existe una terapia estándar establecida para la cistitis eosinofílica (CE), la serie de casos nos guía en el tratamiento de los pacientes. Presentamos nuestra experiencia terapéutica con hidrodistensión y métodos complementarios. Con el fin de establecer un tratamiento estándar en pacientes con CE.MÉTODOS: Revisión retrospectiva de la historia clínica de un paciente con diagnóstico de cistitis eosinofílica. RESULTADOS: Una mujer de 66 años presentó síndrome uretral femenino hace un año y fue tratada inicialmente como una cistitis crónica. Después de más investigaciones incluyendo una cistoscopia y una biopsia de la vejiga, se le diagnosticó CE. Se evidenció sangrado de la mucosa urotelial y se realizaron cauterización e hidrodistensión. Después del tratamiento quirúrgico, se iniciaron corticosteroides y antibióticos. El tratamiento de mantenimiento se continuó con Vitamina C, Maurita flexuosa y Peumus boldus. La condición del paciente ha mejorado y sigue estando asintomática un año después.CONCLUSIÓN: La eficacia del tratamiento con hidrodistención, corticosteroides y antibióticos mostró resultados positivos a corto y largo plazo en este paciente. La vitamina C, Maurita flexuosa y Peumus boldus mostraron resultados favorables en el tratamiento de mantenimiento de CE.

Cistitis hemorrágica tras trasplante alogénico de progenitores hematopoyéticos: experiencia en un centro oncológico pediátrico / Hemorrhagic cystitis following allogeneic hematopoietic stem cell transplantation: experience in a pediatric oncological institution

Objetivos: Analizar factores de riesgo asociados a la gravedad de lacistitis hemorrágica (CH) y estrategias de tratamiento en pacientes conCH tras trasplante alogénico de progenitores hematopoyéticos (TAPH).Material y métodos: Estudio retrospectivo de historias clínicas. Lospacientes con CH tras TAPH tratados entre 2017 y 2021 se dividieronen dos grupos según la gravedad del cuadro (leve y grave). Se compararon datos demográficos, características específicas de la enfermedad,secuelas urológicas y mortalidad global entre ambos grupos. Se utilizóel protocolo del hospital para el manejo de los pacientes. Resultados: Se recogieron 33 episodios de CH en 27 pacientes, delos cuales el 72,7% fueron varones. La incidencia de CH tras TAPH fuedel 23,4% (33/141). El 51,5% de las CH fueron graves (grados III-IV).La enfermedad de injerto contra huésped (EICH) grave (grados III-IV) yla trombopenia al inicio se asociaron a CH grave (p= 0,043 y p= 0,039,respectivamente). Este grupo tuvo mayor tiempo de hematuria (p<0,001)y necesitó más transfusiones de plaquetas (p= 0,003). Además, el 70,6%precisó sondaje vesical, pero solo un caso cistostomía percutánea. Ningún paciente con CH leve precisó sondaje. No hubo diferencias en lassecuelas urológicas ni en la mortalidad global. Conclusiones: Una CH más grave podría predecirse por la presenciade EICH grave o trombopenia al inicio del cuadro. La CH grave puedemanejarse con sondaje vesical en la mayoría de estos pacientes. Seguirun protocolo estandarizado puede reducir la necesidad de procedimientosinvasivos en pacientes con CH leve.(AU)

Objective: To analyze the risk factors associated with hemorrhagiccystitis (HC) severity and the treatment strategies available in HC patientsfollowing allogeneic hematopoietic stem cell transplantation (AHSCT). Materials and methods: A retrospective study of medical recordswas carried out. Patients with HC following AHSCT treated from 2017to 2021 were divided into two groups according to severity –mild andsevere. Demographic data, disease-specific characteristics, urologicalsequelae, and overall mortality were compared between both groups.The hospital’s protocol was used for patient management. Results: 33 episodes of HC were collected in 27 patients, 72.7% ofwhom were male. HC incidence following AHSCT was 23.4% (33/141).51.5% of HCs were severe (grades III-IV). Severe graft host disease(GHD) (grades III-IV) and thrombopenia at HC onset were associatedwith severe HC (p= 0.043 and p= 0.039, respectively). This group hadlonger hematuria times (p< 0.001) and required more platelet transfusions (p= 0.003). In addition, 70.6% required bladder catheterization,but only 1 case needed percutaneous cystostomy. None of the patientswith mild HC required catheterization. No differences were found interms of urological sequelae or overall mortality. Conclusions: Severe HC could be predicted thanks to the presenceof severe GHD or thrombopenia at HC onset. Severe HC can be managedwith bladder catheterization in most of these patients. A standardizedprotocol may help reduce the need for invasive procedures in patientswith mild HC.(AU)

Cumulative incidence and predictive factors of radiation cystitis in patients with localized prostate cancer. / La incidencia acumulada y los factores predictivos de la cistitis rádica en pacientes con cáncer de próstata localizado.

PURPOSE: To determine the cumulative incidence of overall and severe radiation cystitis in a high volume cohort of patients and to investigate its potential predictive factors. METHODS: We have performed a retrospective analysis of clinical data from patients diagnosed with localized prostate cancer and treated with radiotherapy at our institution (June 2005-January 2013), and quantified the cumulative incidence of radiation cystitis. Cox regression analysis and Kaplan-Meier curves were computed to evaluate the determinants of radiation cystitis. RESULTS: Data from 783 patients was retrieved (557 treated with primary radiotherapy, 188 with adjuvant and 38 with salvage). Median follow-up time was 49 months (P25-P75: 31.8-69.3). At 5 years of follow-up, cumulative incidence of overall and severe radiation cystitis was 9.1 and 1.6%, respectively. No association was found between the incidence of radiation cystitis and age, tumor T stage, baseline PSA level, Gleason score, D'Amico risk classification, radiotherapy setting (primary versus adjuvant versus salvage) or radiation dose applied. CONCLUSIONS: Within our cohort, radiation cystitis is an uncommon complication of prostatic radiotherapy treatment, and severe cases requiring hospitalization are even more infrequent. We found no association between tumor characteristics, radiotherapy setting or radiation dose and the cumulative incidence of radiation cystitis.

Efficacy of Botulinum toxin A for the treatment of Bladder pain syndrome: A systematic review. / Eficacia de la toxina botulínica A para el tratamiento del síndrome de dolor vesical: una revisión sistemática.

OBJECTIVES: To determine the efficacy and safety of BTX-A, compared with other interventions for the treatment of BPS to improve quality of life. METHODS: This systematic review fulfils all the requirements of the Cochrane manual and PRISMA reporting guidelines. The PROSPERO registration number is: CRD42016039480.Clinical trials without language discrimination were included. BPS patients over 18 y/o that were treated with BTX-A were included. Studies were searched in published databases and no published literature from inception to the present day. Risk of bias analysis was done using the Cochrane risk of bias tool. RESULTS: 88 articles were found with the designed search strategies. After exclusions, four studies were included in the qualitative analyses. Kasyan et al., 2012 compared BTX-A with hydrodistention. Manning et al., 2014 compared the injection of BTX-A with the injection of normal saline in previously hydrodistended bladders. In both cases, primary end point was measured by the O'Leary-Sant questionnaire score. El-Bahnasy et al., 2009 compared BTX-A with BCG administration, through Global Response Assessment. Kuo et al., 2015 compared hydrodistention plus suburothelial injections of BTX-A with hydrodistension plus normal saline injections. Reduction in pain was estimated by VAS bladder pain score. A similar efficacy to their controls had been found in Kasyan and Manning studies. El-Bahnasy had found improvement in BTX-A in all parameters. Kuo el al. 2015, found a significantly reduction in pain in the BTX-A group. Regarding the risk of bias, three studies did not have adequate descriptions of selection, performance and detection bias. The study of Manning had low risk of selection, attrition and reporting bias. CONCLUSION: There is not enough evidence to conclude the efficacy of BTX-A for the treatment of interstitial cystitis to improve quality of life.

Infección de vías urinarias por Pantoea Agglomerans / Urinary tract infection by Pantoea agglomerans

La infección del tracto urinario es especialmente frecuente en mujeres, las bacterias aerobias gram negativas son las responsables del mayor número de casos. Pantoea agglomerans denominado previamente Enterobacter agglomerans es un bacilo anaerobio Gram negativo que pocas veces se ha descrito como patógeno en el ser humano; se han reportado casos de infecciones cutáneas, osteomielitis y sinovitis posterior a trauma con plantas; e infecciones nosocomiales especialmente en pacientes inmunodeprimidos que se han asociado a material médico contaminado, siendo la mayor parte de los casos resistentes a betalactámicos. Se presenta un insólito caso clínico de cistitis por Pantoea agglomerans en una mujer de 30 años, inmunocompetente, sin antecedentes de hospitalización ni instrumentación o sondaje de vía urinaria; fue manejada con esquema alargado de betalactámicos, con respuesta favorable a la antibiótico terapia. El diagnóstico de infección urinaria por P. agglomerans en pacientes inmunocompetentes es inusual, su escaso aislamiento podría relacionarse a la dificultad de identificar esta bacteria en muestras biológicas y la resistencia a antibioticoterapia podría asociarse en los pacientes hospitalizados a la amplia y prolongada administración de antibióticos en su estancia hospitalaria. Por ello se recomienda solicitar urocultivo y su respectivo antibiograma en pacientes con infección sintomática del tracto urinario para disponer de información del patógeno aislado y dar un adecuado manejo antimicrobiano contemplando el esquema más adecuado...(AU)

[Antimicrobial susceptibility profile in urinary pathogens causing community-acquired infections in diabetic patients in Colombia].

INTRODUCTION: Urinary tract infection is the most common pathology in diabetic patients, and an important determinant of morbidity and mortality among them. The increasing resistance of uropathogens acquired in the community to commonly used antibiotics is alarming. OBJECTIVE: To identify the profile of antibiotic susceptibility of uropathogens responsible for communityacquired infections among diabetic patients in hospitals in Colombia. MATERIALS AND METHODS: We conducted a descriptive study in a subgroup of diabetic patients in the framework of a larger study in adults with urinary tract infection acquired in the community. Over one year, we collected Escherichia coli, Klebsiella spp. and Proteus mirabilis isolates from nine hospitals in Colombia. Their susceptibility profile was determined using microbiological and molecular methods to establish the presence of extended-spectrum AmpC betalactamases and KPC carbapenemases. RESULTS: We collected 68 isolates (58 E. coli, nine Klebsiella spp. and one Proteus mirabilis). Four (6.9%) of the E. coli isolates expressed extended spectrum betalactamases, two (3.4%) of them belonged to the phylogenetic group B2 and to ST131 clone and expressed the TEM-1 and CTM-X-15 betalactamases. The AmpC phenotype was found in four (6.9%) of the E. coli isolates, three of which produced TEM-1 and CMY-2 betalactamases. One K. pneumoniae isolate expressed the KPC-3 carbapenemase. CONCLUSION: The presence of extended spectrum betalactamases and carbapenemases in uropathogens responsible for community-acquired infection was confirmed in diabetic patients.

Red propolis reduces inflammation in cyclophosphamide-induced hemorrhagic cystitis in rats / El propóleos rojo reduce la inflamación en la cistitis hemorrágica inducida por ciclofosfamida en ratas

Introduction. Cyclophosphamide (CP) is used to treat malignant neoplasias and control autoimmune diseases. Still, one of its metabolites, acrolein, is toxic to the urothelium and can lead to hemorrhagic cystitis and severe discomfort. Objective.To evaluate the ability of red propolis to prevent and treat CP-induced hemorrhagic cystitis in rats. Materials and methods. Red propolis was extracted in 1% gum arabic and administered subcutaneously (sc). In the first experiment, groups IA, IIA, and IIIA and groups IB, IIB, and IIIB received water, gum arabic (GA), or propolis, respectively, for 30 days. Then water (controls) or CP (treatment) was administered i.p. In the second experiment, groups IVA, VA, and VIA received water i.p. while groups IVB, VB, and VIB received CP i.p. This was followed by 5 injections at 2-hour intervals with either water, GA, or propolis. Bladder tissue was examined according to Gray's criteria. Results. The total inflammatory histology score was significantly smaller in group VIB (11.33 ± 2.07). Mild inflammation predominated in group VIB while most of the animals in group IVB had severe inflammation (p=0.0375). Ulcers were predominantly multiple in Groups IVA and VB but rare or absent in Group VIB (p=0.0118). Urothelial cells were mostly absent in groups IVB and VB and present/normal in group VIB (p=0.0052). Fibrin was abundant in groups IVB and VA but mostly absent in group VIB (p=0.0273). Conclusions. Red propolis can reduce inflammation in CP-induced hemorrhagic cystitis in rats.

Introducción. La ciclofosfamida se usa para tratar neoplasias malignas y controlar enfermedades autoinmunitarias, pero uno de sus metabolitos, la acroleína, es tóxico para el urotelio y puede provocar cistitis hemorrágica y malestar grave. Objetivo. Evaluar la capacidad del propóleos rojo para prevenir y tratar la cistitis hemorrágica inducida por ciclofosfamida en ratas. Materiales y métodos. Se extrajo propóleos rojo en goma arábiga al 1 % y se administró por vía subcutánea. En el primer experimento, los grupos IA, IIA, IIIA, IB, IIB y IIIB recibieron agua, goma arábiga y propóleos, respectivamente, durante 30 días. Luego se les administró agua (controles) o el tratamiento (ciclofosfamida) por inyección intraperitoneal. En el segundo experimento, los grupos IVA, VA, VIA recibieron agua por vía intraperitoneal, y los grupos IVB, VB, VIB recibieron el tratamiento por la misma vía, a lo que le siguieron cinco inyecciones con intervalos de dos horas entre ellas, con agua, goma arábiga o propóleos. El tejido de la vejiga se examinó de acuerdo con los criterios de Gray. Resultados. La puntuación total de la inflamación según la histología fue significativamente menor en el grupo VIB (11,33 ± 2,07). La inflamación leve predominó en este grupo, en tanto que la mayoría de los animales del IVB presentó inflamación grave (p=0,0375). Predominaron las úlceras múltiples en los grupos IVA y VB, pero fueron raras o estuvieron ausentes en el VIB (p=0,0118). En general, no se observaron células uroteliales en los grupos IVB y VB, pero sí en el VIB (p=0,0052). La fibrina fue abundante en los grupos IVB y VA, pero predominantemente ausente en el VIB (p=0,0273). Conclusiones. El propóleos rojo puede reducir la inflamación en la cistitis hemorrágica inducida por ciclofosfamida en ratas.

Predictors of urinary and rectal toxicity after external conformed radiation therapy in prostate cancer: Correlation between clinical, tumour and dosimetric parameters and radical and postoperative radiation therapy. / Factores predictivos de toxicidad urinaria y rectal tras radioterapia externa conformada en el cáncer de próstata: correlación de parámetros clínicos, tumorales y dosimétricos con radioterapia radical y postoperatoria.

OBJECTIVE: To determine rectal and urinary toxicity after external beam radiation therapy (EBRT), assessing the results of patients who undergo radical or postoperative therapy for prostate cancer (pancreatic cancer) and their correlation with potential risk factors. METHOD: A total of 333 patients were treated with EBRT. Of these, 285 underwent radical therapy and 48 underwent postoperative therapy (39 cases of rescue and 9 of adjuvant therapy). We collected clinical, tumour and dosimetric variable to correlate with toxicity parameters. We developed decision trees based on the degree of statistical significance. RESULTS: The rate of severe acute toxicity, both urinary and rectal, was 5.4% and 1.5%, respectively. The rate of chronic toxicity was 4.5% and 2.7%, respectively. Twenty-seven patients presented haematuria, and 9 presented haemorrhagic rectitis. Twenty-five patients (7.5%) presented permanent limiting sequela. The patients with lower urinary tract symptoms prior to the radiation therapy presented poorer tolerance, with greater acute bladder toxicity (P=0.041). In terms of acute rectal toxicity, 63% of the patients with mean rectal doses >45Gy and anticoagulant/antiplatelet therapy developed mild toxicity compared with 37% of the patients with mean rectal doses <45 Gy and without anticoagulant therapy. We were unable to establish predictors of chronic toxicity in the multivariate analysis. The long-term sequelae were greater in the patients who underwent urological operations prior to the radiation therapy and who were undergoing anticoagulant therapy. CONCLUSIONS: The tolerance to EBRT was good, and severe toxicity was uncommon. Baseline urinary symptoms constitute the predictor that most influenced the acute urinary toxicity. Rectal toxicity is related to the mean rectal dose and with anticoagulant/antiplatelet therapy. There were no significant differences in severe toxicity between radical versus postoperative radiation therapy.