Application of controllable negative pressure suction sheath in flexible ureteroscopic lithotripsy in the treatment of renal calculi / 现代泌尿外科杂志

【Objective】 To compare the clinical application value of controllable negative pressure suction outer sheath and ordinary flexible endoscope outer sheath in flexible ureteroscopic lithotripsy with holmium laser in the treatment of renal calculi less than or equal to 2 cm in diameter. 【Methods】 A total of 85 patients with renal calculi were selected and randomly divided into negative pressure group (n=45) and ordinary group (n=40). The operation time, complications, infection indexes 2 h after operation, adverse reactions, treatment efficacy and stone-clearance rate were compared between the two groups. 【Results】 The sheath was successfully implanted and holmium laser lithotripsy was performed in both groups. The negative pressure group had significantly shorter operation time than the ordinary group [(43.3±4.9) min vs. (66.2±5.8) min, P0.05). The increase of infection indexes (procalcitonin and leukocyte) 2 h after operation were significantly lower in the negative pressure group than in the ordinary group (P<0.05). The efficacy in the negative pressure group was 91.11% (41/45) and the stone-clearance rate was 95.56% (43/45), which were significantly better than those in the ordinary group (72.50% (29/40) and 80% (32/40), respectively. The total incidence of adverse reactions such as renal colic, gross hematuria and ureteral stone street was higher in the ordinary group than in the negative pressure group (P<0.05). 【Conclusions】 Controllable negative pressure suction sheath in flexible ureteroscopic lithotripsy is more effective, as the circulation perfusion keeps the operation field clear, reduces the operation time and improves the stone-clearance rate, while the negative pressure suction lowers the pelvis pressure to prevent infectious urine from entering the blood.

A single-center clinical study of 61 children with ammonium urate stones / 现代泌尿外科杂志

【Objective】 To analyze the clinical characteristics of children with ammonium urate stones in Xinjiang, so as to provide reference for the prevention and treatment of this disease. 【Methods】 The clinical data of all children with ammonium urate stones admitted to the People’s Hospital of Xinjiang Uygur Autonomous Region from 2016 to 2021 were retrospectively analyzed, including age, sex, body mass index, stone site, stone size, stone component, urine pH, urine culture and biochemical examination results. The serum total protein, albumin, sodium, potassium, calcium, magnesium, uric acid and urine pH were compared between the pure and mixed groups. 【Results】 A total of 61 children (31.6%) had ammonium urate stones, their average age was (4.05±3.37) years, and the male to female ratio was 2.21∶1. Among them, there were 37 cases (60.7%) of renal calculi and 50 cases (82.0%) of upper urinary calculi. The most common component of mixed ammonium urate stones was calcium oxalate, including calcium oxalate monohydrate, calcium oxalate monohydrate and calcium oxalate dihydrate. Compared with mixed type, children with pure stone type had a younger age (P=0.001) and a smaller stone size (P=0.003). Positive urine culture was detected in 14 cases (23.0%), 7 of which (50% were infected with Escherichia coli, and 11 (78.6%) with non-urease bacteria. 【Conclusion】 Non-urease bacteria are the main pathogens of urinary tract infection in children with ammonium urate stones. The incidence is higher in boys, and the most common stone location is upper urinary tract. Calcium oxalate is the most common mixed component. Pure type is more common in young children and the stones are relatively small.

Famous traditional Mongolian medicine Xieriga-4 (Turmeric-4) decoction: A review / 中草药·英文版

Xieriga-4 Decoction, composed of dried rhizomes of Curcumae longae, barks of Phellodendron chinense or Phellodendron amurense, fruits of Cardenia jasminoides, and fruits of Tribulus terrestris, is a famous prescription of traditional Mongolian medicine for the treatment of urinary system diseases such as frequent urination, urgent urination, urine occlusion, hematuria, bladder irritation and pain. This paper reviewed Xieriga-4 Decoction from the aspects of historical description, prescription principle, chemical components, pharmacology, clinical application and quality control.

Research status and prospect of artificial intelligence technology in the diagnosis of urinary system tumors / 生物医学工程学杂志

With the rapid development of artificial intelligence technology, researchers have applied it to the diagnosis of various tumors in the urinary system in recent years, and have obtained many valuable research results. The article sorted the research status of artificial intelligence technology in the fields of renal tumors, bladder tumors and prostate tumors from three aspects: the number of papers, image data, and clinical tasks. The purpose is to summarize and analyze the research status and find new valuable research ideas in the future. The results show that the artificial intelligence model based on medical data such as digital imaging and pathological images is effective in completing basic diagnosis of urinary system tumors, image segmentation of tumor infiltration areas or specific organs, gene mutation prediction and prognostic effect prediction, but most of the models for the requirement of clinical application still need to be improved. On the one hand, it is necessary to further improve the detection, classification, segmentation and other performance of the core algorithm. On the other hand, it is necessary to integrate more standardized medical databases to effectively improve the diagnostic accuracy of artificial intelligence models and make it play greater clinical value.

Individual control of urine volume to improve stability of bladder volume in radiotherapy of urinary tumor / 北京大学学报(医学版)

OBJECTIVE@#To explore the training mode of individual urine volume control, to take indi-vidual expected urine volume as the goal of bladder control in patients with urinary system tumors, and to improve the accuracy of bladder control during radiotherapy by active training of bladder receptivity.@*METHODS@#Twenty-five patients of urinary system tumors were enrolled from May 2019 to September 2019, of whom, 21 patients had prostate cancer, and 4 had bladder cancer. Training of bladder filling started before CT simulation. The patients were required to take the individual bladder filling as the training goal, and the optimal bladder volume range was suggested to be 200－400 mL. After 2－4 weeks of training, the prescribed volume of the bladder was determined according to the patient's bladder receptivity. The volume of the bladder was measured by images of plain CT and images 8-minutes after intravenous contrast injection. The patient's bladder volume was measured using BladderScan before treatment. CBCT (Cone-beam CT) was performed, and bladder volume was measured before treatment. The bladder volume was measured again using BladderScan after treatment.@*RESULTS@#The mean bladder volume of simulation (VCT01) was (262±130) mL, ranging from 78 mL to 505 mL. The mean self-evaluation bladder volume before radiotherapy (VEVA01) was (238±107) mL, ranging from 100 mL to 400 mL. The mean BladderScan measured volume before radiotherapy (VBVI01) was (253±123) mL, ranging from 60 mL to 476 mL. The mean cone-beam CT measured volume before radiotherapy (VCBCT) was (270±120) mL, ranging from 104 mL to 513 mL. There was a correlation between VEVA01 and VBVI01, VCT01 and VBVI01, VCT01, and VBVI01, and there was no significant difference in paired t-test. There was a correlation between differences of self-evaluation bladder volume before radiotherapy(VEVA01) and simulation CT (VCT01) and differences of self-evaluation bladder volume before radiotherapy (VEVA01) and cone-beam CT (VCBCT), and there was no significant difference in paired samples by t-test.@*CONCLUSION@#During radiotherapy for urinary system tumors, such as prostate cancer and bladder cancer, with the assistance of BladderScan, the patients could try to hold their urine moderately according to their conditions, and individualized bladder prescription may be beneficial to achieve stable bladder volume during radiotherapy.

Study of the relationship between vitamin D deficiency, sunlight incidence and skeletal/extra skeletaldiseases

It is estimated that more than 1 billion people worldwide have vitamin D insufficiency or deficiency. Vitamin D participates in bone mineralization, and is therefore important in osteoporosis, osteomalacia and rickets prevention. However, vitamin D deficiency could also be associated with several other pathologies. The present study aimed to investigate the relationships between vitamin D deficiency and vitamin D deficiency-related disorders in patients. In addition, this study aims to verify if countries with low solar incidence have higher extraskeletal disease death rates when compared to countries with high solar incidence. The vitamin D concentrations were obtained from the Heart Hospital database (Natal/Brazil). The relationship between solar incidenceand death rate for vitamin D deficiency-related disorders was verified. Death rate data were extracted from the 'World Life Expectancy' repository and data about solar incidence were obtained from NASA's Surface Meteorology and Solar Energy project. Thesedata were statistically processed with IBM SPSS v23.0 software and R programming language. Our results showed that patients with vitamin D insufficiency/deficiency showed significantly more bone diseases, thyroid diseases, hypercholesterolemy, hypertriglyceridemia, cancers, diabetes, hepatobiliary diseases, and urinary system diseases. Moreover, countries with high solar incidence have low cancer and multiple sclerosis death rates. This work suggests the participation of vitamin D and sunlight incidence inseveral diseases.

Radiation dose control for CT urography based on different body mass index / 中华放射医学与防护杂志

Objective To explore the optimization of CT urography imaging parameters and the control measures of radiation dose to patients with different body mass index.Methods A total of 133 patients who were required to undergo CT urography were prospectively selected in terms of three different types of CT urography scan;firstly,conventional parameter scan (120 kV,CARE Dose4D);secondly,low kV scan (BMI ≤ 22.9 ∶ 80 kV,22.9 ＜ BMI ＜ 30 ∶ 100 kV,BMI ≥ 30 ∶ 120 kV,CARE Dose4D)and thirdly,low mAs scan (120 kV,40％ reduction in mAs on CARE Dose4D).Noise,signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of all images were measured as objective evaluation indicators of image quality.The subjective evaluation of the images was performed by two radiologists who had been working for more than five years using a double-blind method and a 5-score system evaluation.The effective dose values (CTDIvol,DLP,E) in each group were measured.Results Patients' effective dose was decreased by 77.7％ in 80 kV group and 38.3％ in 100 kV group,with a statistical difference between the two groups (Z =-3.330,-5.559,P＜0.05).There was a statistically significant difference in renal cortex noise,SNR,CNR and ureteral noise between the 80 kV scan and the routine scan (Z =-3.705-2.392,P＜0.05),but no significant difference in ureteral SNR,CNR and renal pelvis noise,SNR,CNR (P＞ 0.05).There was a statistically significant difference in renal cortex noise and SNR between the 100 kV scan group and the routine scan group (Z =-5.096,-3.566,P＜ 0.05),but no statistical difference in renal cortex CNR,renal pelvis and ureteral noise,SNR,CNR (Z =-5.086,-5.912,-2.842,P＞0.05).The effective dose from low mAs scan in the three types of patients was decreased by 38.3％,32.0％,and 34.7％,respectively,with a statistical difference between them (P ＜0.05).There was no significant difference in noise,SNR,and CNR between renal cortex,renal pelvis and ureter (P＞0.05) besides ureteral CNR in the 22.9 ＜ BMI ＜ 30 group (Z =-2.587,P＜0.05).The subjective evaluation scores of all images were greater than 3 points.Conclusions In this study,the scan method for low kV and low mAs used for patients with different body mass index can effectively reduce the radiation dose to patients and meet the requirements of clinical diagnosis.

The application and prospects of three dimensional bioprinting in urinary system reconstruction / 生物医学工程学杂志

Three dimensional (3D) bioprinting is a new biological tissue engineering technology in recent years. The development of 3D bioprinting is conducive to solving the current problems of clinical tissue and organ repairing. This article provides a review about the clinical and research status of 3D bioprinting and urinary system reconstruction. Furthermore, the feasibility and clinical value of 3D bioprinting in urinary system reconstruction will be also discussed.

Radiation dose control for CT urography based on different body mass index / 中华放射医学与防护杂志

Objective@#To explore the optimization of CT urography imaging parameters and the control measures of radiation dose to patients with different body mass index.@*Methods@#A total of 133 patients who were required to undergo CT urography were prospectively selected in terms of three different types of CT urography scan; firstly, conventional parameter scan (120 kV, CARE Dose4D); secondly, low kV scan (BMI ≤ 22.9∶80 kV, 22.9 < BMI < 30∶100 kV, BMI ≥ 30∶120 kV, CARE Dose4D) and thirdly, low mAs scan (120 kV, 40% reduction in mAs on CARE Dose4D). Noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of all images were measured as objective evaluation indicators of image quality. The subjective evaluation of the images was performed by two radiologists who had been working for more than five years using a double-blind method and a 5-score system evaluation. The effective dose values (CTDIvol, DLP, E) in each group were measured.@*Results@#Patients′ effective dose was decreased by 77.7% in 80 kV group and 38.3% in 100 kV group, with a statistical difference between the two groups (Z=-3.330, -5.559, P<0.05). There was a statistically significant difference in renal cortex noise, SNR, CNR and ureteral noise between the 80 kV scan and the routine scan (Z=-3.705-2.392, P<0.05), but no significant difference in ureteral SNR, CNR and renal pelvis noise, SNR, CNR (P>0.05). There was a statistically significant difference in renal cortex noise and SNR between the 100 kV scan group and the routine scan group (Z=-5.096, -3.566, P<0.05), but no statistical difference in renal cortex CNR, renal pelvis and ureteral noise, SNR, CNR(Z=-5.086, -5.912, -2.842, P>0.05). The effective dose from low mAs scan in the three types of patients was decreased by 38.3%, 32.0%, and 34.7%, respectively, with a statistical difference between them (P <0.05). There was no significant difference in noise, SNR, and CNR between renal cortex, renal pelvis and ureter (P>0.05) besides ureteral CNR in the 22.9 < BMI < 30 group (Z=-2.587, P<0.05). The subjective evaluation scores of all images were greater than 3 points.@*Conclusions@#In this study, the scan method for low kV and low mAs used for patients with different body mass index can effectively reduce the radiation dose to patients and meet the requirements of clinical diagnosis.

Infecções do trato urinário: uma revisão sobre as evidências científicas das principais plantas medicinais utilizadas na prática clínica / Urinary tract infections: a review on the scientific evidence of main medicinal plants used in clinical practice

As infecções do trato urinário (ITUs) afetam cerca de 150 milhões de pessoas por ano e caracterizam-se pela resposta do organismo a uma invasão e multiplicação bacteriana. O tratamento é realizado com antibióticos, mas, devido ao uso indiscriminado, tem-se observado o aumento de resistência bacteriana. Nesse contexto, as plantas medicinais são promissoras, pois possuem baixo custo e fácil acesso, e muitas possuem atividade antimicrobiana. Objetivou-se revisar as principais espécies utilizadas na prática clínica na prevenção e tratamento de ITUs. A utilização da fitoterapia para aliviar sintomas e diminuir a recorrência sintomática das ITUs é uma alternativa válida e promissora, destacando-se a espécie Vaccinium macrocarpon L. (cranberry). Porém, apesar dos avanços e do potencial dessas espécies, há ainda a necessidade de estudos sobre seus respectivos mecanismos de ação. Além disso, a capacitação dos profissionais de saúde para realizar uma prescrição correta, assertiva e segura é essencial.(AU)

Urinary tract infections (ITUs) affect about 150 million people each year and are characterized by the body's response to invasion and bacterial multiplication. Antibiotics are the main therapy used, but due to indiscriminate use, increased bacterial resistance has been observed. In this context, medicinal plants are a promising, low cost and easy access alternative. The aim of this study was to review the main species used in clinical practice in the prevention and treatment of UTIs. The use of herbal medicine to relieve symptoms and reduce symptomatic recurrence of UTIs is a valid and promising alternative, especially Vaccinium macrocarpon L. (cranberry) specie. However, despite the advances and potential of these species, it is necessary to establish their mechanisms of action. Still, the primary training of health professionals to make a correct, assertive and safe prescription is fundamental.(AU)

Development of the urinary system in guinea pig females (Cavia porcellus) / Desenvolvimento do sistema urinário em fêmeas de porquinhos-da-índia (Cavia porcellus)

Guinea pigs are animal models widely used in research related to developmental biology. The objective of this work was to demonstrate the process of formation and differentiation of urinary organs in females of the species in the prenatal period. Four females were used at 25, 30, 45 and >65 DG (days of gestation). The animals were dissected, and then macroscopic and microscopic descriptions of the urinary organs were performed. At 25 DG metanephros were present in the urogenital crest into the abdominal cavity. Collecting ducts and glomerular precursor cells could be visualized. After this period, metanephros underwent microstructural modifications to form the kidneys at the end of the prenatal period. After 30 DG, the renal parenchyma already had a cortex, where the glomerulus and proximal convoluted tubules were present; and the medulla, where distal convoluted tubules, collecting ducts, and pelvis were present. The pelvis of each kidney was drained by the ureters. The ureters also underwent tissue differentiation to be differentiated (mucosa with transitional epithelium and lamina propria of connective tissue, muscular, and adventitia) at the end of the prenatal period. The urinary vesicle also underwent tissue changes to form the tunics similar to those found in the ureters, with emphasis on the greater volume of the muscular tunica and the lamina propria that constituted the submucosa in this organ. The pelvic urethra was evidenced by a mucosa lined by transitional epithelium, submucosa, muscular and adventitia. Finally, a partial clitoral urethra and a urethral meatus in the prepuce of the clitoris were also evidenced. The urethral channel began to form with the emergence of the urethral plate and the urethral groove at 30 DG and thereafter with the fusion of the urethral folds to form a partially channeled urethra in the clitoris. A urethral meatus was observed in the most distal portion of the clitoral tissue, formed by the fusion of the prepuce. It is concluded that the urinary organs of guinea pig have similar development to that described in domestic animals, except for the partial clitoral urethra and evident urethral meatus.(AU)

Os porquinhos-da-índia são modelos animais amplamente utilizados em pesquisas relacionadas a biologia do desenvolvimento. O objetivo deste trabalho foi demonstrar o processo de formação e diferenciação dos órgãos urinários em fêmeas da espécie no período pré-natal. Foram utilizadas quatro fêmeas aos 25, 30, 45 e >65 DG (dias de gestação). Os animais foram dissecados e então, realizaram-se descrições macroscópicas e microscópicas dos órgãos urinários. Aos 25 DG os metanefros estavam presentes na crista urogenital da cavidade abdominal. Podiam ser visualizados ductos coletores e células precursoras glomerulares. Após este período, os metanefros sofreram modificações microestruturais para formar os rins ao final do período pré-natal. Após os 30 DG, o parênquima renal já apresentava um córtex, onde estavam presentes os glomérulos e túbulos convolutos proximais, e a medula onde estavam presentes túbulos convolutos distais, ductos coletores e a pelve. A pelve de cada rim era drenada pelos ureteres. Os ureteres também sofreram diferenciação tecidual para estarem com suas túnicas diferenciadas (mucosa com epitélio de transição e lâmina própria de tecido conjuntivo; muscular; e, adventícia) ao final do período pré-natal. A vesícula urinária também passou por modificações teciduais para formar as túnicas semelhantes as dos ureteres, com destaque para o maior volume da túnica muscular e a lâmina própria que constituiu a submucosa neste órgão. Uma uretra pélvica foi evidenciada por uma mucosa revestida por epitélio de transição, submucosa, muscular e adventícia. Por último, uma uretra parcialmente clitoriana e um meato uretral no prepúcio do clitóris também foi evidenciado. O canal uretral começou a se formar com o aparecimento da placa uretral e do sulco uretral aos 30 DG e posteriormente com a fusão das pregas uretrais para formar uma uretra parcialmente canalizada no clitóris. Observou-se um meato uretral na porção mais distal do tecido clitoriano, formado pela fusão do prepúcio. Conclui-se que os órgãos urinários do porquinho-da-índia possuem desenvolvimento semelhante ao descrito em animais domésticos, com exceção da uretra parcialmente clitoriana e do meato uretral evidente.(AU)

Obstructive urolithiasis in growing-finishing pigs / Urolitíase obstrutiva em suínos de crescimento e terminação

Obstructive urolithiasis is a disease characterized by the presence of uroliths in the urinary tract, with consequent obstruction of excretion pathways. This paper described the epidemiological and clinical-pathological findings of 22 outbreaks of urolithiasis in growing-finishing pigs in Southern Brazil. All affected pigs were male and clinical presentation consisted of lethargy, dysuria, rectal prolapse, abdominal distention, peripheral cyanosis and reluctance to move. Clinical progression course ranged from 12 hours to one week, and the lethality rate was 100%. Gross changes were characterized by urinary bladder rupture associated with marked amount of yellowish liquid with ammoniacal odor (urine) in the abdominal cavity (uroperitoneum), as well as mild fibrin deposition on the surface of abdominal organs and hydronephrosis. Urinary uroliths ranging from 0.3 to 1cm in diameter were often observed obstructing the lumen of the penile urethra and sometimes those were free in the abdominal cavity. Histopathological findings included diffuse and marked urinary bladder edema and hemorrhage associated with inflammatory infiltrate of lymphocytes, plasma cells, and macrophages. Diffuse and marked necrosis of the mucosal epithelium was observed in the penile urethra. Intense fibrin deposition and inflammatory infiltrate of neutrophils were noted in the peritoneum, as well as in the serosa of the organs in the abdominal cavity. Uroliths were submitted to the method of qualitative determination of the mineral components, and were compatible with calcium carbonate and magnesium ammonium phosphate. Growing pigs ration analysis revealed low levels of calcium in relation to phosphorus, resulting in a Ca:P ratio of approximately 0.35:1. Histological findings and mineral analysis suggest that outbreaks of urolithiasis were related to a nutritional imbalance in the proportions of dietary calcium and phosphorus. The main cause of mortality was related to dehydration and uroperitoneum.(AU)

Urolitíase obstrutiva é uma enfermidade caracterizada pela presença de urólitos no trato urinário, com consequente obstrução das vias de excreção. Este artigo descreve os achados epidemiológicos e clínico-patológicos de 22 surtos de urolitíase em suínos de crescimento e terminação no Sul do Brasil. Os suínos afetados eram machos e clinicamente apresentavam letargia, disúria, prolapso retal, abaulamento do abdômen, extremidades cianóticas e relutância em movimentar-se. A duração dos sinais clínicos variou de 12 horas a uma semana, e a letalidade foi de 100%. As alterações macroscópicas caracterizaram-se por ruptura da bexiga com acentuada quantidade de líquido de coloração amarelada e odor amoniacal (urina) livre na cavidade abdominal (uroperitônio), além de discreta deposição de fibrina sobre os órgãos e hidronefrose. Frequentemente obstruindo o lúmen da uretra peniana e por vezes livre na cavidade abdominal, era possível observar urólitos urinários que variavam de 0,3 a 1cm de diâmetro. Os achados histopatológicos incluíram edema e hemorragia difusos e acentuados na bexiga, associado a infiltrado inflamatório predominante de linfócitos, plasmócitos e macrófagos. Na uretra peniana havia necrose difusa e acentuada do epitélio da mucosa. No peritônio e nas serosas dos órgãos da cavidade abdominal havia intensa deposição de fibrina e infiltrado neutrofílico. Os urólitos foram submetidos ao método de determinação qualitativa dos componentes minerais, os quais foram compatíveis com carbonato de cálcio e fosfato de amônio magnesiano. A análise da ração de crescimento revelou baixos níveis de cálcio, em relação ao fósforo, perfazendo uma relação Ca:P de aproximadamente 0,35:1. Os achados histológicos e as dosagens minerais sugerem que os surtos de urolitíase foram relacionados a um desequilíbrio nutricional nas proporções de cálcio e fósforo dietético. A principal causa da morte dos suínos foi relacionada à desidratação e ao uroperitônio.(AU)

Bactérias causadoras de infecções urinárias e seu perfil de resistência aos antimicrobianos / Bacteria who causes urinary tract infection and their antimicrobial resistance profile

Objetivo ­ Identificar quais os microrganismos responsáveis por esta infecção e seu perfil de resistência aos antimicrobianos. Metódos ­ A pesquisa foi realizada no Laboratório CDAC-Centro de Diagnósticos de Análises Clínicas, situado no município de Nova Granada - SP. Foram analisadas amostras de uroculturas positivas e seus respectivos antibiogramas, cujos resultados foram obtidos através de laudos laboratoriais digitais no período de janeiro de 2017 a janeiro de 2018 e à partir da realização dessa coleta de dados, foi feito um levantamento dos principais agentes patológicos causadores das infecções do trato urinário que atingem a população do município, assim como foi verificado o perfil de suscetibilidade aos antibioticos testados. Resultados ­ O uropatógeno mais frequente foi Escherichia coli (N = 58/136; 43%), seguido por Enterobacter sp. (N = 30/136; 22%), Klebsiella sp. (N = 15/136; 11%), Shigella sp. (N = 10/136; 7%), Proteus vulgaris. (N = 6/136; 4,5%), Citrobacter sp. (N = 5/136; 3,5%), Providencia sp. (N = 4/136; 3%), Proteus mirabilis. (N = 4/136; 3%), Edwardsiella sp. (N = 2/136; 1,5%) e Proteus sp. (N = 2/136; 1,5%). Oxacilina e ácido nalidixico apresentaram menor poder inibitório contra os uropatógenos encontrados. Conclusão ­ O uropatógeno mais frequente foi Escherichia coli,seguido por Enterobacter sp., Klebsiella sp. e Shigella sp. Os dados aqui relatados demonstram que a etiologia das infecções urinárias é semelhante à encontrada em outros municípios. Porém, o padrão de resistência desses uropatógenos pode possuir características diferenciadas de acordo com o histórico de consumo de antimicrobianos em cada comunidade. Assim, é importante que dados epidemiológicos sejam periodicamente divulgados com a intenção de auxiliar a comunidade médica

Objective ­ To identify the responsible microorganisms for the urine infection and their antimicrobial resistance profile. Methods ­ We carried out the research at the Laboratory-Diagnostic Center for Clinical Analysis (CDAC), located at the Nova Granada city. We analyzed samples of positive urocultures and their respective antibiograms, whose results were taken through laboratory reports from January 2017 to January 2018 and from the data gathering. We performed a data survey of the main pathological agents who causes infections in the urinary tract affecting the city's population, as well as the susceptibility profile of the antibiotics tested. Results ­ Escherichia coli (N = 58/136, 43%) was the most frequent uropathogen identified, followed by Enterobacter sp. (N = 30/136, 22%), Klebsiella sp. (N = 15/136, 11%), Shigella sp. (N = 10/136, 7%), Proteus vulgaris (N = 6/136, 4,5%), Citrobacter sp. (N = 5/136; 3,5%), Providencia sp. (N = 4/136, 3%), Proteus mirabilis (N = 4/136, 3%), Edwardsiella sp. (N = 2/136, 1.5%), and Proteus sp. = 2/136, 1.5%). Oxacillin and nalidixic acid showed lower inhibitory power against the found uropathogens. Conclusion ­ Escherichia coli was the most frequent uropathogen found, followed by Enterobacter sp, Klebsiella sp and Shigella sp. We demonstrate with the data reported here that the etiology of urinary infections of our research is similar to the found in other cities. However, the antimicrobial resistance profile of these uropathogens may have different characteristics according to the history of antibiotics use in each community. It is therefore important that epidemiological data be periodically disclosed with the intention of assisting the medical community

Etiología y perfil de resistencia antimicrobiana en pacientes con infección urinaria / Etiology and antimicrobial resistance profile in patients with urinary infection

Introducción: La infección de vías urinarias (IVU) es una de las enfermedades más prevalentes en la práctica clínica Objetivo: Identificar los principales agentes etiológicos y la frecuencia de resistencia a antibióticos por parte de microorganismos aislados por urocultivos en pa cientes con IVU en un hospital de primer nivel de atención. Materiales y Métodos: Estudio descriptivo de corte transversal, a partir de una muestra aleatoria de pacientes con IVU en La Virginia, Risaralda, entre el 1 de abril de 2014 a 31 de marzo de 2015. Se evaluaron las bacterias aisladas en la totalidad de urocultivos procesados y los resultados de los antibiogramas. Se establecieron frecuencias y proporciones. Para el análisis de datos, se utilizó SPSS Statistics 22. Se hizo análisis multivariado. Resultados: Se realizaron 1563 urocultivos en el periodo de estudio, de los cuales 329 (21,0%) mostraron crecimiento mayor a 100.000 UFC. Las frecuencias más altas de resistencia para E. coli se observaron para cefalotina (75,8%), ampicilina (72,6%) y trimetoprim/sulfametoxazol (55,3%). De 296 pacientes seleccionados aleatoriamente se halló que la cistitis era la IVU más frecuente (70,3%) y al 50,7% no se les prescribió ningún antimicrobiano. El uso de antiulcerosos se asoció con mayor probabilidad de uso inadecuado del antibiótico (OR:4,28; IC95%:1,070-17,153; p=0,04). Conclusiones: Existe una elevada resistencia bacteriana a los antibióticos de primera línea para el tratamiento de las IVUs, lo que sugiere la importancia de identi ficar los microorganismos y sus perfiles de sensibilidad a antimicrobianos para seleccionar con mejor criterio cual emplear.

Introduction: Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice. Objective: To identify the main etiologic agents and the frequency of antibiotic resistance by microorganisms isolated from urine culture and sensitivity in patients with IVU in a hospital primary care. Materials and Methods. Descriptive cross-sectional study, from a random sample of patients with UTI in La Virginia, Risaralda, from April 1, 2014 to March 31, 2015. Bacteria isolated from all processed urine cultures and the results of susceptibility were evaluated. Frequencies and proportions were established. For data analysis was used SPSS Statistics 22. Results: A total of 1563 urine cultures were performed in the study period, of which 329 (21.0%) showed further growth to 100,000 UFC. Higher frequencies of resis tance were observed for E. coli to cephalothin (75.8%), ampicillin (72.6%) and trimethoprim/sulfamethoxazole (55.3%). In the 296 randomized patients it was found that the most common UTI was cystitis (70.3%) and 50.7% were not prescribed any antimicrobial. The use of anti-ulcer is associated with increased probability of inappropriate use of antibiotics (OR:4.28; 95% CI:1.070-17.153; p=0.04). Conclusions: There is a high bacterial resistance to first-line antibiotics for treatment of UTIs, suggesting the importance of identifying microorganisms and their antimicrobial susceptibility profiles to select which use better approach.

Sintomas Urinários em Primíparas de Parto Normal e Cesárea / Urinary Symptoms in Primiparous women of Normal and Cesarean Delivery

Objetivo: comparar os sintomas urinários de primíparas de parto normal e cesárea. Métodos: foi realizado um estudo observacional analítico do tipo transversal realizado com 98 primíparas O estudo ocorreu no Centro de Saúde Escola do Marco, da Universidade do Estado do Pará, na Cidade de Belém do Pará, com mulheres que fizeram o acompanhamento do pré-natal nos anos de 2012 e 2013. A amostra foi definida por conveniência. Os critérios de inclusão para a participação da pesquisa foram: mulheres com idade entre 18 e 35 anos, primíparas de parto normal ou cesárea no período de dois meses a dois anos do pós-parto e que tenham assinado o TCLE. Os critérios de exclusão foram: mulheres multíparas, que tiveram histórico de gravidez de risco, diabéticas, hipertensas, que estivessem em novo período gestacional ou tiveram período gestacional menor que 37 semanas e que apresentaram algum sintoma urinário prévio à gravidez. A análise estatística foi feita com aplicação do Teste Exato de Fisher com índice de significância de 5%. Resultados: Participaram do estudo 98 mulheres primíparas, sendo que 41 primíparas de parto normal e 57 de parto cesárea. Quanto à prevalência dos sintomas urinários relacionados ao tipo de parto, observou-se que a noctúria foi citada por 13 (22,8%), seguida da polaciúria 8 (14%) das mulheres que realizaram parto cesárea, enquanto que a urge-incontinência e a polaciúria ocorreram em 13 (31,71%) e 6 (14,6%), respectivamente, mulheres que tiveram parto normal. Conclusão: O surgimento dos sintomas urinários independe da via de parto. (AU)

Objective: to compare urinary symptoms in primiparous women with normal and cesarean delivery. Methods: An observational, analytical cross-sectional, study was performed with 98 primiparous women. The study was carried out at the Center of Health School of Marco, of the State University of Pará, in the city of Belém do Pará, Brazil, with women who underwent antenatal care between the years of 2012 and 2013. Sampling was defined for convenience. The inclusion criteria for the participation of the research were: women aged between 18 and 35 years, primiparous women of normal birth or cesarean section in the period of two months to two years postpartum and who signed the ICF. The exclusion criteria were: multiparous women, who had a history of risky pregnancies, diabetic, hypertensive, who were in a new gestational period or had a gestational period of less than 37 weeks, and who presented some urinary symptom prior to the pregnancy. Statistical analysis was performed using Fisher's Exact Test with a significance level of 5%. Results: 98 primiparous women participated in the study, 41 of whom were primiparous women of normal birth and 57 of cesarean birth. Regarding the prevalence of urinary symptoms related to the type of delivery, nocturia was cited by 13 (22.8%), followed by polaciuria 8 (14%) of the women who underwent cesarean delivery, whereas urge-incontinence and polaciuria occurred in 13 (31.71%) and 6 (14.6%), respectively, women who had normal delivery. Conclusion: The appearance of urinary symptoms does not depend on the route of bith delivery. (AU)

Secondary Tumors of the Urinary System: An Imaging Conundrum

Imaging features of metastases to the urinary system may closely mimic primary urinary tract tumors, and differential diagnosis by imaging alone may be problematic or even impossible in some cases. The main purpose of this article was to familiarize radiologists with imaging findings of metastasis to the urinary system on cross-sectional imaging, with an emphasis on abdominal and pelvic computed tomography and magnetic resonance imaging. In addition, we review the clinical importance and implications of metastases to the urinary tract and provide information on diagnostic work-ups.

Application of MRI in abnormal urinary system of fetus / 中国医师进修杂志

Objective To investigate the clinical value of MRI in the diagnosis of fetal urinary system diseases.Methods The MRI images of 20 cases of genitourinary system diseases were analyzed retrospectively. Results In 20 cases, MRI showed 10 cases with urinary tract dilatation, 3 cases with ectopic kidney,1 case with renal cystic disease, and 6 cases with renal agenesis and/or renal dysplasia. Among them, MRI showed 4 cases with less/no amniotic fluid volume and 3 cases with pulmonary hypoplasia. Conclusions Prenatal MRI is an important examination method to evaluate fetal urinary system diseases.

Research progress in epigenetics of the development of urinary system / 国际儿科学杂志

With the reciprocal inductive interactions between metanephric mesenchyme and ureteric bud,embryonic kidney cells gradually grow,proliferate,and differentiate,contribute to the formation of nephron and urinary collecting duct systems,and eventually develop into a mature urinary system. In this process,epigenetic modifier genes regulate the development of the urinary system;aberrant epigenetic modifications,however, will lead to congenital anomalies of kidney and urinary tract. Epigenetic factors,including histone modification, DNA methylation,and non-coding RNA,affect the development of the urinary system through the regulation of Wnt,GDNF / Ret,and p53 signaling pathways. This article combines with the latest research progress,reviews the role of epigenetic modifications in the development of the urinary system and during the formation of congenital anomalies of kidney and urinary tract;besides,the specific regulation mechanisms are explained.

Clinical analysis of de novo malignancies in recipients after renal transplantation / 器官移植

Objective To summarize the characteristics and treatment methods of de novo malignancies in recipients after renal transplantation. Methods Clinical data of 43 patients with de novo malignancies after renal transplantation among 759 recipients were analyzed retrospectively. Characteristics, treatment methods and prognosis of the de novo malignancies after renal transplantation were summarized. Results The incidence of de novo malignancies in recipients after renal transplantation was 5.7％. The age of onset was (52±11) years old, and the de novo malignancies was diagnosed in 13-193 months with the median of 60 months after renal transplantation. The 43 patients with de novo malignancies included 9 cases of primary renal carcinoma, 7 cases of bladder carcinoma, 6 cases of lung carcinoma, 5 cases of lymphoma, 4 cases of colorectal carcinoma, 4 cases of mammary carcinoma, 2 cases of skin carcinoma, 1 case of adrenal carcinoma, 1 case of gastric carcinoma, 1 case of primary carcinoma of liver, 1 case of pancreatic carcinoma, 1 case of scalp angiosarcoma and 1 case of meningioma, and they were treated by surgical procedure, adjusting immunosuppressive therapy, radiotherapy or chemotherapy after diagnosed. The postoperative 1- and 5-year survival rates were 81％ and 63％, respectively. Conclusions The incidence of de novo malignancies in recipients after renal transplantation is higher than that in healthy subjects, and urological neoplasm is most common. Radical resection should be considered first, and antineoplastic combined therapy can be performed for the patients who cannot undergo surgery. Meanwhile, dosage of immunosuppressive agents can be reduced and medication regimens can be adjusted, thus effectively prolonging the survival time of patients.

Duplicidad no ectópica del uréter: implicancias clínicas / Non-ectopic duplicity of the ureter: clinical implications

La duplicación del sistema colector renal es la variación más frecuente del sistema urinário y se puede presentar como duplicación completa o incompleta, así como la inserción ectópica en todas las partes del sistema urinario a partir de la parte distal hacia la vejiga. Este artículo presenta uma duplicación completa no ectópica del ureter en el riñón izquierdo de un cadáver de un individuo brasileño, de sexo masculino. Ambos uréteres tenían origen en el hilio renal y continuaban hasta la vejiga urinaria separadamente, desembocando en ostios diferentes, en el área del trígono vesical, donde el ostio perteneciente al uréter que drenaba el polo superior presentó posición distal y lateral en relación al ostio del uréter que drenaba el polo inferior. Esta disposición es uma excepción a la regla de Weigert-Meyer, que indica que el uréter del polo superior, por el hecho de permanecer fijo por más tiempo al conducto mesonéfrico, presenta mayor migración, terminando medial e inferiormente al uréter que drena el polo inferior en 97 % de los casos.

Duplication of the urinary tract is the most frequent variation of this system and may present as complete or incomplete duplication, as well as ectopic insertion throughout all parts of the urinary system from distal to the bladder. This article presents a complete non-ectopic duplication of the ureter in the left kidney of a cadaver of one Brazilian individual of male sex. In this study, both ureters originated in the renal hilum and continued to the urinary bladder separately, opening into different ostia, in the area of the bladder trigone, where the ostium belonging to the ureter that draining the upper pole presented a distal and lateral position in relation to the ostium of the ureter draining the lower pole. This arrangement is an exception to the Weigert-Meyer rule, which indicates that the ureter of the upper pole, due to its longer fixation to the mesonephric duct, presents a greater migration, ending medial and inferior to the ureter draining the inferior pole in 97 % of cases.