URINARY DYSFUNCTION AFTER SURGICAL TREATMENT FOR RECTAL CANCER / Disfunção urinária após tratamento cirúrgico do câncer de reto

BackgroundThe impact on quality of life attributed to treatment for rectal cancer remains high. Deterioration of the urinary function is a relevant complication within that context.ObjectiveTo detect the presence of urinary dysfunction and its risk factors among individuals underwent surgical treatment for rectal cancer.MethodsThe present prospective study analyzed 42 patients from both genders underwent surgical treatment for rectal adenocarcinoma with curative intent. The version of the International Prostatic Symptom Score (IPSS) questionnaire validated for the Portuguese language was applied at two time-points: immediately before and 6 months after surgery. Risk factors for urinary dysfunction were analysed by means of logistic regression and Student’s t-test.ResultsEight (19%) participants exhibited moderate-to-severe urinary dysfunction 6 months after surgery; the average IPSS increased from 1.43 at baseline to 4.62 six months after surgery (P<0.001). None of the variables assessed as potential risk factors exhibited statistical significance, i.e., age, gender, distance from tumour to anal margin, neoadjuvant therapy, adjuvant therapy, type of surgery, surgical approach (laparoscopy or laparotomy), and duration of surgery.ConclusionThis study identified an incidence of 19% of moderate to severe urinary dysfuction after 6 months surveillance. No risk factor for urinary dysfunction was identified in this population.

ContextoA perda de qualidade de vida atribuída ao tratamento do câncer retal continua elevada. Neste contexto, a deterioração da função urinária é complicação relevante.ObjetivoIdentificar disfunção urinária e seus fatores de risco em doentes submetidos ao tratamento cirúrgico do câncer de reto.MétodosRealizou-se estudo prospectivo com 42 doentes de ambos os sexos submetidos a tratamento cirúrgico com intenção curativa para adenocarcinoma de reto. Foi utilizado o questionário International Prostatic Symptom Score, validado na língua portuguesa, em dois períodos: imediatamente antes e após 6 meses do procedimento cirúrgico. Os fatores de risco para disfunção urinária foram analisados por regressão logística e teste t de Student.ResultadosApós 6 meses do procedimento cirúrgico, oito (19%) doentes apresentaram disfunção urinária moderada a grave e aumento na média do escore utilizado de 1,43 pontos no pré-operatório para 4,62 pontos no pós-operatório (P<0,001). A análise de fatores de risco para disfunção urinária não mostrou significância para as variáveis estudadas, idade, gênero, distância tumoral da margem anal, neoadjuvância, adjuvância, procedimento cirúrgico realizado, via de acesso cirúrgico (laparoscópica ou laparotômica) e tempo operatório.ConclusãoNos doentes com carcinoma retal operados com intenção curativa, a incidência de disfunção urinária moderada a grave após 6 meses da operação foi de 19%. Não foram identificados fatores de risco para disfunção urinária nesses doentes.

Epididymitis in Patients with Anorectal Malformations: A Cause for Urologic Concern

Introduction Epididymitis in patients with anorectal malformation (ARM) represents a unique problem because unlike the general population, an underlying urinary tract problem is frequently identified. We review our experience with epididymitis in ARM population with an emphasis on examining urologic outcomes. Materials and Methods We performed a retrospective review of male patients with ARM cared for from 1980 to 2010. Clinical and pathologic variables recorded included age at presentation, recurrence, associated urologic anomalies, incidence of ureteral fusion with mesonephric ductal structures, glomerular filtration rate and urodynamic parameters. Results Twenty-six patients were identified with documented episodes of epididymitis. Renal injury was noted in five patients (19%), all of whom were diagnosed with neurogenic bladder (NGB) several years after anorectoplasty. NGB was found in ten patients (38%) in our series. Ectopic insertion of ureter into a mesonephric ductal structure was discovered in five patients (19%). Twelve patients (46%) had recurrent episodes of epididymitis, with seven of these patients (58%) being diagnosed with NGB. Two patients in the pubertal group presented with a history of epididymitis and complained of ejaculatory pain. Conclusion Epididymitis in a patient with ARM warrants a comprehensive urologic investigation, particularly in recurrent episodes. Attempts at surgical intervention (e.g. vasectomy) should be avoided until functional assessment of the urinary tract has occurred. Failure to recognize this association may lead to potentially avoidable complications and morbidity. Long term urological follow up of these patients is warranted to identify at risk patients and minimize renal deterioration .

Importancia epidemiológica, asistencial y económica del cultivo de orina, en pacientes hospitalizados y de la comunidad / Epidemiological, economical and assistance importance of urine culture on in-patients and out-patients. Hermanos Ameijeira Hospital

Introducción: una de las infecciones más comunes que afectan al ser humano a lo largo de su vida y una de las más frecuentes tanto en el ámbito comunitario como en el nosocomial, son las infecciones del tracto urinario (ITU). Es conocido que los agentes etiológicos se relacionan fundamentalmente con bacilos gramnegativos, pero en la mayoría de los casos, sobre todo en los ambulatorios, no se realiza el cultivo de las muestras de orina antes de iniciar del tratamiento antibacteriano. Al mismo tiempo, una terapia inicial correctamente indicada, tomando como base los datos aportados por el Laboratorio de Microbiología, puede significar evolución favorable y menores costos en sentido general. Objetivos: determinar los principales agentes etiológicos con sus patrones de sensibilidad antimicrobiana, en ITU hospitalarias y de la comunidad, asi como evaluar los costos relacionados con los cultivos microbiológicos, según el tipo de resultado alcanzado. ..

Introduction: the high incidence and prevalence of urinary tract infections in both hospital patients and outpatients determine that the exact knowledge of the major etiologic agents with antimicrobial susceptibility patterns gain immeasurable epidemiological and economic assistance values. Objective: to do Microbial map for hospital patients, and outpatients suffering from UTIs. Methods: a retrospective and cross study was conducted in 13,939 urine cultures from inpatient and outpatients received in the Microbiology Laboratory at Hermanos Ameijeiras hospital from September 2009 to August 2010. Results: 62 percent of the samples were negative, 22 percent positive, and 16 percent were reported as the contaminated samples representing a cost of 86 100, 61 980, and 22 300 CUC, respectively, with an overall total of 170 380 CUC. The microorganism most frequently isolated was Escherichia coli in both groups (76.4 percent and 54.0 percent respectively), which were higher than 55 percent to trimethoprim/sulfamethoxazole and ciprofloxacin. Ampicillin resistance was close to 90 percent for almost all microorganisms. Nitrofurantoin for Escherichia coli presented the lowest percentages of resistance. Antimicrobial resistance was higher in hospital patients. Conclusions: the monetary cost per patient for a second or third course of antibiotics, in an initial incorrect therapy, may imply spending approximately 100 times more than a correct initial therapy based on scientific evidence

Infección humana por Trichomonas vaginalis y su relación con otros agentes patógenos / Human infection from Trichomonas vaginalis and its relation to other pathogen agent

Trichomonas vaginalis es un protozooo flagelado causante de la trichomonosis urogenital en humanos. La asociación y coexistencia de T. vaginalis con otros agentes patógenos causantes de infecciones de transmisión sexual es bastante común. Se realizó una revisión de la literatura, incluyendo las últimas publicaciones sobre las principales manifestaciones clínicas de T. vaginalis y su relación con otros agentes de transmisión sexual

Trichomonas vaginalis is a flagellate protozoon causing urogenital trichomoniasis in humans. Association and co-existence of T. vaginalis with other pathogen agents causing of sexually transmitted infections is fairly common. A bibliographic review was carried out including the last publications on the main clinical manifestations from T. vaginalis, and its relation to other sexual transmission agents

Diverticulitis aguda perforada simulando prostatitis aguda / Perforated acute diverticulitis mimicking acute prostatitis

We present an unfrequent case of acute diverticulitis mimmicking acute prostatitis. Case report: A 72-year-old man suffering from hypogastric and genital pain, fever and dysuria, with an edematous and tender prostate at physical examination, was initially diagnosed of acute prostatitis. 24 hours later the patient developed left lower quadrant pain and abdominal distension. A CT scan was performed, showing pneumoperitoneum and acute sigmoid diverticulitis signs. The patient underwent a Hartmann's procedure.

Presentamos un caso infrecuente de diverticulitis aguda con manifestaciones clínicas sugerentes de prostatitis aguda. Caso clínico: Varón de 72 años, presenta dolor hipogástrico y en región genital, fiebre y disuria, palpándose una próstata edematosa y dolorosa al tacto rectal, por lo que es inicialmente diagnosticado de prostatitis aguda. A las 24 horas el paciente desarrolla un cuadro de distensión abdominal y dolor en fosa ilíaca izquierda. Una TC abdominal mostró neumoperitoneo y signos de diverticulitis aguda. Se intervino al paciente realizando una intervención de Hartmann.

Complicaciones urológicas postrasplante renal con técnica de Lich-Gregoir: experiencia de cuatro años / Urological complications following kidney transplantation using Lich-Gregoir technique: a 4-year experience in Mexico

Objetivo: Revisión de las complicaciones urológicas posteriores al trasplante renal en dos centros hospitalarios utilizando la técnica de ureteroneocistostomía extravesical de Lich-Gregoir en un periodo de cuatro años. Material y métodos: Se revisaron los expedientes de 242 pacientes en quienes se llevó a cabo trasplante renal de enero de 2003 a noviembre de 2007. En todos los pacientes se realizó ureteroneocistostomía extravesical. Se informaron todas las complicaciones urológicas y su manejo. Resultados: Se registraron 19 complicaciones en 18 pacientes, con una incidencia de 7.8 %; 16 riñones se obtuvieron de donadores vivos. Las complicaciones más comunes fueron fuga de orina (4.5 %), estenosis urinaria (1.6 %), reflujo vesicoureteral (1.2 %) y necrosis ureteral (0.4 %). La mayoría de los pacientes fueron tratados con sonda de Foley (42 %), colgajo de Boary (26 %) y nefrostomía (15 %). La pérdida del injerto renal se asoció a complicaciones urológicas en 1.23 % Conclusiones: El trasplante renal debe incurrir en pocas complicaciones urológicas, por lo que debe cuidarse los detalles técnicos. La evaluación temprana para corregir las complicaciones reduce la sepsis, morbilidad y el riesgo de pérdida del injerto.

OBJECTIVE: We present a retrospective review of urological complications following kidney transplantation in two medical centers in the Mexican state of Veracruz using Lich-Gregoir extravesical ureteroneocystostomy during a 4-year period. METHODS: Records from 242 patients from January 2003 to November 2007 were reviewed. Standard technique for organ procurement, open nephrectomy and kidney transplant was performed. EVU was used in all patients. Urological complications and management are reported. RESULTS: There were 19 complications recorded in 18 patients (7.8%). Sixteen kidneys were obtained from living donors. Urinary leak was the most common complication (4.5%) followed by ureteral stenosis (1.6%), vesicoureteral reflux (1.2%) and ureteral necrosis (0.4%) Most patients were treated with Foley catheter (42%), Boary flap (26%) and nephrostomy (15%); 1.23% grafts were lost associated with urological complications. CONCLUSIONS: Renal transplantation should incur few urological complications. Attention to technical details should be paid to avoid major complications. Early evaluation to correct complications reduces sepsis, morbidity and the risk of losing graft function.

Complicaciones urológicas postrasplante renal / Urological complications after kidney transplantation

BACKGROUND: Urological complications represent a common problem in kidney transplant surgery. The estimated incidence of these complications occurs in 3-30% of renal transplants. Solving these complications may improve renal graft survival and, consequently, patient outcome. The objective is to establish the prevalence of urological complications after renal transplantation. METHODS: We retrospectively reviewed 338 patients with kidney transplantations performed at the Transplant Unit of the Specialties Hospital of the Western Medical Center over a 6-year period. Data were obtained from the patients' clinical files about the prevalence of urological complications and their management. Renal graft loss prevalence and mortality were reported. RESULTS: Overall prevalence of urological complications was 5.92%. Onset time of all complications occurred between 1 and 210 days. Diagnosis was established using clinical, laboratory and imaging methods. Endourological management with double-J catheter through cystoscopy was used as the first option of treatment in the majority of patients, having complete resolution in all cases. There was no graft loss or mortality in our patients. CONCLUSIONS: The most common urological complication was the urinary fistulae located at the ureterovesical anastomosis. In comparison with other transplant centers worldwide, our prevalence of urological complications was similar.

¿Se justifica el uso rutinario de catéter ureteral post trasplante renal? / Is routinary ureteral stenting indicated in kidney transplant?

Introducción: El uso rutinario de de stent ureterales en trasplante renal (TR) es controvertido. Nosotros evaluamos la experiencia del stent selectivo basado en la decisión del cirujano comparando las tasas de complicaciones ureterales (filtración y/o obstrucción) en el grupo que recibió o (SU+) o no un stent (SU-). El objetivo del estudio es identificar factores de riesgo para filtración y/o obstrucción. Materiales y Métodos: Entre septiembre de 1994 y octubre de 2005, 160pacientes consecutivos se sometieron a un trasplante renal en nuestro centro. El uso de SU estuvo basado en la decisión del cirujano y fue insertado después de que un lado de la anastomosis estuvo completada. Se identificaron las complicaciones urológicas dentro de los primeros 90 días después del TR. Las complicaciones ureterales fueron definidas como: filtración, obstrucción, Infección del tracto urinario, lesión arterial y necrosis tubular aguda. Los datos demográficos fueron recolectados desde la revisión de fichas clínicas y base de datos computarizada de TR. Resultados: Se evaluaron 113 pacientes del grupo total. La incidencia global de complicaciones urológicas en este estudio fue de 8 por ciento (9), filtración fue vista en 5 por ciento (6), obstrucción en 3 por ciento (3) y 28 por ciento de TU entre los primeros 90 días después de un IR. Cuarenta y un pacientes (36 por ciento) recibieron un stent (SU+) y setenta y dos (64 por ciento) no (SU-). Los grupos fueron comparables. La frecuencia complicaciones ureterales (obstrucción, filtración y obstrucción más filtración) y de TU entre los grupos no mostró diferencia estadística. En el análisis univariado se demostró que la edad y sexo del receptor, edad del donante, la fuente del donante (cadáver o vivo), tiempo de isquemia (caliente y fría), presencia de NTA y lesiones arteriales no fueron asociadas con la presencia de obstrucción, filtración o ambas...

Introduction: Routine use of ureteral stent (US) after transplanstation remains controversial. We evaluate the experience of selective stent use based on surgeon decision comparing the ureteral complicationrates (leaking and / or obstruction) between the group receiving (US+) or another group without not astent (SU-). The aim of the study was to identify risk factors for leaking and / or obstruction in patients receiving ureteral stent after transplantation. Materials and Methods: Between September 1994 and October 2005, 160 consecutive patients underwent a renal transplant in our center. The use of US was based on the decision of the surgical team. Urological complications were identified within the first 90 days after RT. The ureteral complications were defined as: leaking, obstruction, urinary tract infection, arterial injury and acute tubular necrosis (ATN). Demographic data were collected prospectively and retrospectively analized from the review of clinical data base. Results: We evaluated 113 patients of the total group. The overall incidence of urological complications in this study was 8 percent (9), leaking was seen in 5 percent (6), obstruction in 3 percent (3) and 28 percent of the TU first 90days after an IR. Forty-one patients (36 percent ) received a stent (SU +) and seventy and two (64 percent) no(SU-). The groups were comparable. The frequency of ureteral complications (obstruction, leaking and obstruction-filtration) and TU between groups showed no statistical difference. In the Univariate analysis showed age, sex of recipient, donor´s age, the source of graft (living of dead), ischemia time(hot and cold), presence of ATN and arterial lesions were not associated with the presence of obstruction, leaking or both. However, among patients with obstruction leaking a higher probability of developing TU was verified. Conclusions: Our experience shows that routine stent use has no clear benefit in transplantation´s outcomes...

Protocolo de estudio en el niño con infección urinaria: Hospital Padre Justo Rubio: Estado Táchira año 1998-2002 / Protocolo of study in children with urinary infections: Hospital Padre Justo Rubio, state Tachira: years 1998-2002

La infección urinaria es una de las afecciones más importantes dentro de la urología pediátrica debido a su elevada frecuencia, dificultad diagnóstica, gran tendencia a recurrencias y posibilidad de generar insuficiencia renal. La relación varón/mujer aumenta con la edad y es mayor después de los 4 años 10:1. El 5-15 por ciento de los niños en edad escolar con una infección urinaria presentan anomalías renales que requieren intervención quirúrgica. Se revisaron 50 historias clínicas de niños hospitalizados con el diagnósticos de infección urinaria en el Hospital Tipo II, Padre Justo de Rubio, Estado Táchira, para el periodo 1998-2002. Se realizó un estudio retrospectivo incluyendo niños que presentaron clínica presuntiva de infección urinaria, con uroanálisis patológico y urocultivo positivo; para determinar a que porcentaje de niños se les cumplió el protocolo de estudio de infección urinaria encontrando: solo el 26 por ciento de los pacientes fueron estudiados, donde el sexo más afectado correspondio al femenino (53.84 por ciento), representado por el grupo etáreo de los preescolares., se les realizó Ultrasonografía renal y uretrocistografía miccional revelando anormalidades en el 15.4 por ciento y en el 54 por ciento respectivamente. El 15 por ciento ameritó urografía de eliminación y un 8 por ciento gammagrafía renal. Y solo el 46 por ciento ameritó tratamiento quirúrgico.

Approach to a case of autonomic peripheral neuropathy.

Autonomic neuropathy is the term used to describe autonomic disturbances resulting from diseases of the peripheral autonomic nervous system. This is a group of disorders in which the small, lightly myelinated and unmyelinated autonomic nerve fibers are selectively targeted. Most often, autonomic neuropathies occur in conjunction with a somatic neuropathy (i.e. with motor weakness and/or sensory loss), but they can occur in isolation. Causes of autonomic neuropathies are immune-mediated, paraneoplastic, infectious, toxic and drug-induced, hereditary, nutritional and idiopathic. Amongst all, diabetes mellitus is the most common cause. Autonomic features, which involve the cardiovascular, gastrointestinal, urogenital, sudomotor, and pupillomotor systems, occur in varying combination in these disorders. Orthostatic hypotension is often the first recognized and most disabling symptom. Noninvasive, well-validated clinical tests of autonomic functions along with a host of laboratory tests are of immense value to diagnose the presence and to demonstrate the distribution of autonomic failure. Treatment aims to treat specific cause of the autonomic neuropathy (if possible) and to control symptoms of autonomic dysfunction. Present review attempts to outline clinical approach to a case of autonomic peripheral neuropathy.

Experimental supratrigonal cystectomy: evaluation of long-term complications

OBJECTIVE: The present study aims at assessing the occurrence of pyelonephritis and long-term complications in rats submitted to surgical reduction of bladder capacity. MATERIALS AND METHODS: Sprague-Dawley rats were submitted to supratrigonal cystectomy (29 animals) or sham operation (15 animals) and sacrificed 2, 4 and 6 months after the surgical procedure. The arterial blood pressure and serum creatinine levels were assessed before the surgery and at the time of the sacrifice. After the sacrifice a careful inspection of the urinary apparatus was performed to the characterization of the hydronephrosis and for the detection of the presence of calculi. With sterile technique, the urine was aspirated from the bladder and the kidneys removed and sent to a microbiologic study. RESULTS: Pyelonephritis was frequent in animals submitted to supratrigonal cystectomy. The most frequent and isolated microorganisms were Staphylococcus sp. and E. coli. The presence of urinary calculi was correlated significantly to the presence of urinary tract infection (p < 0.003). Arterial hypertension was frequent amongst animals submitted to supratrigonal cystectomy. Serum creatinine was high in 72.4 percent of the animals in the group submitted to supratrigonal cystectomy. The presence of calculi and pyelonephritis were frequent in rats presenting renal insufficiency and in hypertensive rats. CONCLUSIONS: The long-term course of urinary infection in rats submitted to supratrigonal cystectomy was characterized by a high incidence of renal insufficiency and arterial hypertension that seem to be related to dysfunction and bladder obstruction induced by an extensive surgical procedure and the presence of urolithiasis and pyelonephritis.

Infecções do trato urinário / Urinary tract infections

As infecções do trato urinário representam problema de grande relevância clínica, não só pela elevada frequência com que acometem mulheres e homens vivendo na comunidade, mas também por representar a primeira causa de infecção em pacientes hospitalizados. Na presente revisão, o autor apresenta os conceitos atuais sobre a epidemiologia, os fatores etiopatogênicos, as manifestações clínicas e os métodos de diagnóstico / Urinary tract infections have an extremely high clinical prevalence in both the community as well as in nosocomial patients. This behavior justifies the efforts that habe been made to disseminate the present knowledge on urinary tract infections to the members of most clinical specialities. In the present review the authors discuss and treatment of urinary tract infections, with emphasis on the practical clinical approach to such cases...

Pseudo-obstrucción intestinal por miopatía visceral esporádica / Intestinal pseudo-obstruction due to sporadic visceral myopathy

We report an unusual case of a patient with sporadic visceral myopathy and involvement of the entire gastrointestinal and urinary tract. Visceral myopathy is a form of chronic idiophatic intestinal pseudo-obstruction characterized by vacuolar degeneration, atrophy and fibrosis of the intestinal propia muscle layer without inflammatory cells. It can be found in childhood and adolescence affecting the gastrointestinal and urinary visceral muscle. The familial occurrence can be found in about 30% of cases and the mode of transmission is autosomal recessive in most families. It is crucial to exclude secondary forms of chronic intestinal pseudo-obstruction and to obtain full thickness intestinal biopsy for the diagnosis. Surgical treatment is only beneficial in cases with isolated segmental involvement of the gastrointestinal tract.

Se presenta el caso infrecuente de un paciente con miopatía visceral esporádica y afectación de la totalidad del tracto gastrointestinal y de la vía urinaria. La miopatía visceral es una forma de pseudo-obstrucción intestinal crónica idiopática caracterizada por degeneración vacuolar, atrofia y fibrosis de la capa muscular propia de la pared intestinal, sin células inflamatorias. Se puede presentar en niños y adolescentesafectando la musculatura visceral digestiva y urinaria. La manifestación familiar se encuentra en aproximadamente el 30% de los casos y se transmite de forma autosómica recesiva en la mayoría de las familias. Esfundamental descartar causas secundarias de pseudo-obstrucción intestinal crónica y la realización de biopsia de todo el espesor de la pared gastrointestinal para poder arribar al diagnóstico. El tratamiento quirúrgico sólo es eficaz en los que tienen afectación de porciones aisladas del tubo digestivo.

Placenta percreta con invasión vesical: reporte de 2 casos / Placenta percreta with urinary bladder involvement: report of two cases

Se presentan dos casos clínicos de placenta percreta. Uno como hallazgo intraoperatorio y otro con diagnóstico antenatal. Se describen los procedimientos diagnósticos, el manejo quirúrgico intra y post operatorio y el seguimiento, así como el enfrentamiento y la reparación de las complicaciones encontradas. Se hace énfasis en la importancia del trabajo en equipo multidisciplinario en estos casos extremadamente graves. Se revisa la literatura y se sugieren algunas recomendaciones para su mejor manejo.

Infecciones del tracto urinario: microbiología y resistencia antibiótica / Urinary tract infections: microbiology and antibiotic resistance

Las infecciones del tracto urinario son la principal causa de morbilidad actualmente, por lo cual a su vez implican el mayor gasto en salud en personas de todas las edades. Nuestro estudio comprendió urocultilvos realizados en la clínica de Atenas del 5-8-02 al 17-12-03, de los cuales; un 78.43 por ciento fueron positivos para E. coli relegando a los demás agentes a una minoría, además la mayoría de las cepas de E. coli son resistentes al Trimetoprim sulfametoxazole (TMP SMX) que es actualmente el medicamento más utilizado. Como segundo agente causal más frecuente encontramos a Kliebsiella sp.