Reproducibility of the Rocabado pain map.

OBJECTIVE: This study aimed to demonstrate the reproducibility of the Rocabado pain map (RPM) through its application by different evaluators. METHODS: Forty participants (18-45 years old) were evaluated. The examiners applied RPM by searching for painful areas, and their intensities were measured through the visual analog scale (VAS). In addition, presence and degree of joint laxity were estimated. RESULTS: Reproducibility values for antero-inferior synovial (zone 1), lateral ligament (zone 3), temporomandibular ligament (zone 4), posterior-inferior synovial (zone 5), and posterior ligament (zone 7) showed high intraclass correlation (ICC) values (above 0.7). Anterior-superior synovial (zone 2) and posterior-superior synovial (zone 6) showed ICC values above 0.4. DISCUSSION: RPM is reproducible. A "fair" concordance according to Fleiss's criteria in zone 2 (ICC 0.42) and zone 6 (ICC 0.64) might be explained by the difficulties involved in moving the condyle from the upper synovial (zones 1,5) to the lower synovial (zones 2,6).

Performance of the artificial urinary sphincter implantation in men with urinary incontinence: Results from a contemporary long-term real-world nationwide analysis.

PURPOSE: The artificial urinary sphincter (AUS) is one of the most effective surgical treatments for male urinary incontinence regardless of its severity. Current knowledge comes from high-volume centers, but little is known about the performance of this surgery from community practices. This study aims to report contemporary AUS performance in a nationwide observational study in Colombia. METHODS: Male patients who underwent AUS surgery with AMS 800™ between 2000 and 2020 in more than 17 centers and four cities were identified. Pre, intra, and postoperative characteristics were evaluated, mainly addressing patient reported outcomes measurements in the postoperative period. Retrospective and prospective data collection and descriptive analysis were completed. Kaplan-Meier analysis was used to determine AUS survival rate. RESULTS: Out of an initial 667 cases, a total of 215 patients met inclusion and exclusion criteria and were included. Mean age was 67 ± 9.4 years, and mean follow-up was 6.0 ± 4.4 years with maximum range of 14 years. The etiology of urinary incontinence was prostate cancer surgery in 141 (81%) of the cases. The rest of the cases were related to benign prostatic disease or spinal cord injury. It is noteworthy that out of 115 patients, only 59 (51.3%) reported previous formal pelvic floor rehabilitation. Subjective severity of urinary incontinence determined by a visual analog scale showed a decrease in 4.5 points after sphincter implantation. Sphincter removal was required in 50 (23.2%) cases. The main reasons for implant removal were urethral erosion and infection. The sphincter survival rate at 2, 5, 8, 10, and 14 years was 76%, 70%, 60%, 57%, and 17%, respectively. Of the subjects at the last follow-up with the device still in place, 80.7% defined their urinary condition as "does not cause or causes minor discomfort," and 99% would recommend the device to a friend or relative in the same condition. CONCLUSIONS: This series from a community-based practice shows the lack of adherence to clinical practice guidelines and the lack of standardized data collection. In contrast, this study provides real-world data on explantation and revision rates, allows physicians to inform patients and to have clear metrics for a shared decision-making process before the procedure.

Creation of a Pilot Surgical Program for the Comprehensive Management of Patients with Congenital Urological Malformations / Creación de un programa quirúrgico piloto para el manejo integral de pacientes con malformaciones urológicas congénitas

Objectives Congenital malformations constitute the first cause of morbidity and mortality in childhood in Latin America. That is why, since 2001, a surveillance system for congenital malformations has been implemented in Bogota - Colombia. However, despite the increase in detection, an impact on treatment has not been achieved. The present study describes our experience with a novel social program focused on congenital urologic disorders. Methods The present manuscript is a retrospective observational study. We reviewed two national databases containing patients with congenital malformations. Patients were actively contacted to verify the status of the malformations. Children in whom the malformation was confirmed were offered a free consultation with a multidisciplinary group. After screening for surgical indications, patients were scheduled for surgery. Results Between November 2018 and December 2019, 60 patients were identified. In total 44, attended the consultation; the remaining did not attend due to financial or travel limitations. The most common condition assessed was hypospadias. In total, 29 patients underwent surgery. The total cost of care was of US$ 5,800. Conclusions Active search improves attention times and reduces the burden of disease. The limitations to be resolved include optimizing the transportation of patients and their families, which is a frequent limitation to access health care.

Objetivos Las malformaciones congénitas corresponden a la principal causa de morbimortalidad en la infancia en América Latina, motivo por el cual desde el 2001 se viene implementando un sistema de vigilancia epidemiológica de malformaciones congénitas en Bogotá, Colombia. Sin embargo, a pesar del aumento en la cobertura del reporte obligatorio, no se ha logrado un impacto sobre su tratamiento. Este estudio busca mostrar nuestra experiencia con un programa integral de pacientes con malformaciones urológicas congénitas. Métodos El presente es un estudio observacional retrospectivo. Los menores con malformaciones congénitas fueron identificados en dos bases de datos nacionales que incluyen pacientes con malformaciones congénitas. Los pacientes reportados fueron contactados telefónicamente para verificar el estado actual de la malformación. A aquellos niños en quienes se les confirmó la malformación, se les ofreció de manera gratuita una consulta con un grupo multidisciplinario. Una vez confirmadas las indicaciones quirúrgicas, fueron llevados a cirugía. Resultados Se identificaron 60 pacientes entre noviembre del 2018 y diciembre de 2019. De los pacientes identificados, 44 acudieron a consulta. Los demás no asistieron por limitaciones económicas. La principal condición valorada fue hipospadias. En total, 29 pacientes fueron llevados a cirugía. El costo total de la atención de estos pacientes fue de 22 millones de pesos colombianos. Conclusiones La búsqueda activa mejora los tiempos de atención y reduce la carga de la enfermedad. Una de las limitaciones aun por resolver es optimizar el transporte de los pacientes y sus familias, que resulta una limitación frecuente para el acceso a la salud.

Publication Trends in Pediatric Stone Disease: A Bibliometric Analysis / Tendencias de publicación en la litiasis pediátrica: Un análisis bibliométrico

Introduction In the pediatric population, the prevalence of stone disease has increased in recent years. We aim to analyze the bibliometric characteristic of available literature on the management of stones in this population. Methods We performed a search for articles published until December 2019 on the Scopus, Google Scholar, PubMed, Embase, and Web of Science databases using the keywords children, lithiasis, and stones. We excluded articles involving patients older than 18 years of age and those with non-urological lithiasis. Then, we performed a bibliometric analysis using the original language, year of publication, impact factor (yearly number of citations), and absolute citation count as variables to calculate the impact index (number of sources adjusted for the time since publication). Results We included 291 articles published between 1940 and December 2019 for analysis. The average number of citations per manuscript was of 15.3 (± 21.9), and the average impact index was of 502 (± 976.4). A total of 4 articles were published before 1970. The evaluation of historical landmarks that could affect citation counts, such as the launch of a journal specialized in pediatric urology (Journal of Pediatric Urology), showed a mean citation count of 23.29 before the first edition, and of 14.96 after (p = 0.0006). The variation on the impact index with the same criteria was of 539.6 before the first edition of the Journal of Pediatric Urology, and of 316.32 after (p = 0.001). The average number of citations before internet access was of 17.9, and, after the internet, of 15.1 (p = 0.17). We also observed a difference in counts regarding languages of publication. Conclusions The proportional academic productivity on pediatric stone disease demonstrates that citation counts do not reflect the true academic impact of subspecialized topics.

Introducción La prevalencia de la urolitiasis en la población pediátrica ha venido aumentando en los últimos años. Este manuscrito busca analizar las características bibliométricas de la literatura disponible sobre el manejo de la urolitiasis pediátrica. Métodos Realizamos una búsqueda por artículos publicados hasta diciembre de 2019 en las bases de datos Scopus, Google Scholar, PubMed, Embase y Web of Science con las palabras children, lithiasis, y stones. Excluimos artículos con pacientes mayores de 18 años y litiasis no urológica. Posteriormente, realizamos un análisis bibliométrico utilizando el idioma original, el año de publicación, el factor de impacto (número de citas anuales), y el recuento absoluto de citas para calcular el índice de impacto (número de fuentes ajustadas por el tiempo desde la publicación). Resultados Analizamos 291 artículos publicados desde 1940 hasta diciembre de 2019. El promedio de citas por artículo fue de 15,3 (± 21,9), y el índice de impacto fue de 502 (± 976,4). Un total de 4 artículos fueron publicados antes de 1970. La evaluación de hitos históricos que pudieran afectar el recuento de citas, como el lanzamiento de una revista de urología pediátrica (Journal of Pediatric Urology), mostró un recuento medio de citas de 23,29 antes de la primera edición, y de 14,96 después (p = 0,0006). La variación del índice de impacto con los mismos criterios fue de 539,6 antes de la primera edición de esta revista, y de 316,32 después (p = 0,001). El promedio de citas antes del acceso a la internet fue de 17,9, y después, de 15,1 (p = 0,17). Observamos también una diferencia en los recuentos respecto a los idiomas de publicación. Conclusiones La productividad académica sobre la litiasis pediátrica demuestra que los recuentos de citas no reflejan el verdadero impacto académico de los temas subespecializados.

Association between Genitourinary and Congenital Heart Defects: A 52-year Case-Control Study of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) / Asociación entre cardiopatías congénitas y malformaciones congénitas urinarias: Un estudio de casos y controles de 52 años del Estudio Colaborativo Latino Americano de Malformaciones Congénit

Background Congenital urological anomalies are present in 4.3/10 thousand newborns, and their association with other anomalies may increase the overall mortality and disability. The present study establishes the risk of having congenital urological anomalies presenting associated cardiopathies. Methods We conducted a retrospective case-control study using the Latin American Collaborative Study of Congenital Malformations (Estudio Colaborativo Latino Americano de Malformaciones Congénitas, ECLAMC, in Spanish). The analysis included all registered cases of congenital urological malformation from 1967 to 2019. Patients with or without associated heart defects were included for the statistical analysis. Odds ratios (ORs) were calculated using a 95% confidence interval (95% CI). We compared the variables with the Chi-squared test and analysis of variance (ANOVA). The statistical analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, United States) software, version 27.0. Values of p < 0.05 were considered statistically significant. Results A total of 7,767,161 newborns were evaluated, and 17,834 genital and upper urinary tract malformations were identified. Of these, 64.2% were genital anomalies, and 35.8% were abnormalities of the upper urinary tract. Genitourinary malformations and concomitant congenital heart defects (GU + C) were observed in 3.5% of the cases. Subjects with GU + C had a higher number of malformations (4.59 ± 2.3) than patients without heart defects (1.53 ± 1.58) (p < 0.000). The OR was of 3.61 (range: 1.86­7.00) for cloacal exstrophy, of 4.01 (range: 3.14­5.12) for imperforate anus, of 5.52 (range: 3.92­7.78) for horseshoe kidney, and of 13.7 (range: 6.65­28.22) for trisomy 21 (Down syndrome) with malformations of the upper urinary tract. Conclusion The association of congenital heart defects with urological anomalies is higher for complex congenital anomalies such as imperforate anus, cloacal exstrophy, and ho

Introducción Las malformaciones congénitas urológicas están presentes en 4,3/10 mil, y su asociación con otros defectos puede aumentar la mortalidad global y la discapacidad. Este estudio analiza la presentación de las malformaciones congénitas urológicas asociadas a las cardiopatías congénitas. Métodos Este es un estudio retrospectivo de casos y controles que usa el Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC). Se incluyeron todos los casos registrados de malformaciones congénitas urológicas de 1967 a 2019, y todos los casos con y sin defectos cardiacos. Se calculó la razón de disparidad (RD) usando un intervalo de confianza del 95% (IC 95%). Se probó la hipótesis con el Chi-cuadrado y análisis de la varianza (analysis of variance, ANOVA, en inglés). Se realizó el análisis estadístico por medio del programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, Estados Unidos), versión 27.0. Se consideró la significancia estadística con valores de p < 0,05. Resultados Se evaluaron 7.767.161 recién nacidos, y se identificaron 17.834 malformaciones genitales y del tracto urinario superior. De estas, 64,2% fueron genitales, y 35,8%, de vías urinarias superiores. El 3,5% de los casos tenían malformaciones genitourinarias y defectos cardiacos congénitos concomitantes (GU + C). Aquellos con GU + C tenían mayor número de malformaciones (4,59 ± 2,3) que los pacientes sin defectos cardiacos (1,53 ± 1,58) (p < 0,000). La RD fue de 3.61 (rango: 1,86­700) para la extrofia cloacal, de 4,01 (3,14­5,12) para el ano imperforado, de 5,52 (3,92­7,78) para el riñón en herradura, y de 13,7 (6,65­28,22) para la trisomía 21 (síndrome de Down) con malformaciones del tracto urinario superior. Conclusión La asociación entre defectos cardiacos congénitos y anomalías urológicas es significativa en malformaciones congénitas complejas como el ano imperforado, la extrofia cloacal, y el riñón en herradura. Los pacientes con síndrome de Down y malformaciones urológicas tienen la mayor probabilidad.

Neuropsychiatric Aspects in a Patient Diagnosed with Corticobasal Degeneration: Clinical Case of Low Incidence and Prevalence in Colombia.

Corticobasal degeneration (CBD) is a pathology of low incidence and prevalence worldwide; it is accompanied by symptoms such as dystonia, rigid akinetic syndrome (bradykinesia), gait disturbances, neurological deterioration associated with severe cortical subcortical atrophy, and progressive to moderate to severe neurocognitive deficits, especially in immediate verbal memory and dorsolateral or dysexecutive syndrome. We identified neurocognitive impairment and neuropsychiatric symptoms in a patient diagnosed with CBD. Participant was a 70-year-old female patient, single; she presented progressive memory loss of an immediate verbal nature. Initially, she was diagnosed with Alzheimer's disease and Lewy body dementia, finding that she had no characteristic signs and symptoms of these pathologies. The patient presented conciliation insomnia, gait disturbances, and severe neurocognitive deficit, especially in executive functions, immediate verbal memory, and visuospatial functioning. It was found that the patient presented neurocognitive alterations of the executive type (frontal lobe) such as decision making, planning, inhibition and operative memory, correlated with a severe alteration in her basic, instrumental and advanced activities of daily life, with a high risk factor for developing dementia. It is necessary to diagnose in an assertive and timely manner in order to generate functional neurorehabilitation plans in people diagnosed with CBD, with the main objective of positively impacting quality of life, at the individual, family, and social level.