Infección urinaria en pacientes con vejiga neurógena: patrones de resistencias de los uropatógenos más frecuentes / Urinary Infection in Patients With Neurogenic Bladder: Patterns of Resistance to the Most Frequent Uropathogens

Objetivos: Analizar la etiología y resistencias de los uropatógenos más frecuentes en una población con vejiga neurógena. Material y métodos: Se incluyeron 284 pacientes a los que se practicaron un total de 284 urocultivos. De estos, 106 procedían de pacientes con lesión neurológica, 28 de grupo control no neurógeno, 75 de pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) y 75 de pacientes que acudieron a Urgencias por sintomatología de infección aguda del tracto urinario. Se realizó urocultivo cuantitativo en medio cromogénico, así como identificación y estudio de resistencias de todos los urocultivos positivos para uno o dos microorganismos. Resultados: El 67% de los pacientes neurológicos presentaron urocultivos positivos, frente al25% de los pacientes control. Los urocultivos de pacientes ingresados en UCI y los del grupo Urgencias fueron positivos al 100%, ya que se seleccionaron los primeros 75 urocultivos positivos. E. coli fue el microorganismo más frecuentemente aislado en el grupo de neurológicos, al igual que en enfermos procedentes de Urgencias y del grupo control. En UCI fue Enterococcus spp. (19,4%), seguido de P. aeruginosa (16,5%). En el estudio de resistencias E. coli presentó altas tasas de resistencia a ampicilina y cotrimoxazol y, aunque en menor grado, a ciprofloxacino. Conclusiones: E. coli es el microorganismo más frecuentemente aislado entre todos los grupos, excepto en UCI, en el que es superado por Enterococcus spp. y P. aeruginosa. Las resistencias entre los 4 grupos de población estudiada tienen características diferentes, mostrando globalmente un bajo índice de resistencias a nitrofurantoína y especialmente a fosfomicina, observado en pacientes que provienen de Urgencias o ingresados en UCI y neurológicos (AU)

Purpose: To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder. Material and methods: A total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied. Results: A total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcusspp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin. Conclusions: E. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients (AU)

[Urinary infection in patients with neurogenic bladder: patterns of resistance to the most frequent uropathogens]. / Infección urinaria en pacientes con vejiga neurógena: patrones de resistencias de los uropatógenos más frecuentes.

PURPOSE: To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder. MATERIAL AND METHODS: A total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied. RESULTS: A total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcus spp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin. CONCLUSIONS: E. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients.

[Quality of life evaluation in spinal cord injured patients comparing different bladder management techniques]. / Evaluación de la calidad de vida en pacientes con lesión medular comparando diferentes métodos de vaciado vesical.

OBJECTIVES: This study examines quality of life among patients with spinal cord injury requiring bladder management techniques, according to the validated King s Health Questionnaire (KHQ). MATERIAL AND METHODS: Prospective and observational study of 91 spinal cord-injured patients (21 women 23% and 70 men 77%). Mean age was 40 years (SD 13.4) and average time since spinal injury was 11.4 (SD 10.4) years. Patients completed the KHQ quality of life instrument and 10 additional questions related to urinary disturbance developed for the study, and filled in a form to subjectively rank their main concerns related to spinal injury. Patients were divided according to the bladder management techniques they regularly used: intermittent catheterization, condom catheter or indwelling catheter, and differences between the mean groups were assessed with de SPSS 13.0 statistic package. RESULTS: The overall KHQ score for the sample was 39.9 (SD 54.4) with higher scores (poorer QoL) in patients using an indwelling catheter. A thorough analysis of the test showed no significant differences between the groups other than in the physical role limitation item (p

Evaluación de la calidad de vida en pacientes con lesión medular comparando diferentes métodos de vaciado vesical / Quality of life evaluation in spinal cord injured patients comparing different bladder management techniques

Material y métodos: Estudio observacional y prospectivo con 91 pacientes (21 mujeres 23%, 70 hombres 77%) afectos de lesión medular que acudieron a la consulta durante marzo 2004 y diciembre del 2005, con media de edad 40 años (DS 13,4) y tiempo medio de evolución de la lesión 11,4 (DS 10,4) años. Los pacientes completaron el KHQ, así como una valoración subjetiva de los principales problemas relacionados con la lesión medular. Se clasificaron los pacientes en función del sistema de evacuación urinaria habitual en: Cateterismos Intermitentes (CI), Sondaje Vesical Permanente (SVP) y Colector Permanente (CP). Analizamos con el paquete estadístico SPSS 12.0 las diferencias entre las medias de las dimensiones del KHQ de los tres grupos. Resultados: La media de la puntuación total del KHQ fue de 39,9 puntos (DT 54,4), con mejor puntuación en el grupo portador de CP. Encontramos que no hay diferencias significativas, excepto en la dimensión de la limitación de los roles, donde obtienen mejor puntuación el grupo portador de CP que los de SVP y los CI (p=0,025).La sexualidad se presenta en primer lugar en la lista de problemas que más preocupa a los pacientes, seguidos de los trastornos de defecación y urinarios. Conclusión: El grupo con mejor puntuación global en el KHQ es el portador de CP, aunque no hay diferencias significativas entre los 3 grupos. Lo que más preocupa a nuestros pacientes son los problemas sexuales (AU)

Material and methods: Prospective and observational study of 91 spinal cord-injured patients (21 women 23% and 70 men 77%). Mean age was 40 years (SD 13.4) and average time since spinal injury was 11.4 (SD 10.4) years. Patients completed the KHQ quality of life instrument and 10 additional questions related to urinary disturbance developed for the study, and filled in a form to subjectively rank their main concerns related to spinal injury. Patients were divided according to the bladder management techniques they regularly used: intermittent catheterization, condom catheter or indwelling catheter, and differences between the mean groups were assessed with de SPSS 13.0 stadistic pakagge. Results: The overall KHQ score for the sample was 39.9 (SD 54.4) with higher scores (poorer QoL) in patients using an indwelling catheter. A thorough analysis of the test showed no significant differences between the groups other than in the physical role limitation item (p=0.025). Patients using a condom catheter reported lower physical limitation scores (better QoL) than patients using an indwelling catheter or intermittent catheterization. Sexuality was the main concern of most patients, followed by bowel dysfunction, urinary incontinence and ambulation or gait problems. Conclusion: Patients treated with condom catheters reported the best quality of life according to KHQ scores, although there were no significant differences versus the other urinary management techniques. The patients’ main concern was related to sexuality (AU)

Características de las infecciones urinarias en pacientes con vejiga neurógena según el sistema de vaciado vesical utilizado en comparación con pacientes sin vejiga neurógena / Characteristics of urinary tract infections in different patient subpopulations and depending on the bladder emptying system

Introducción: La infección urinaria es una patología muy frecuente en las disfunciones miccionales neurógenas. Existen pocos trabajos sobre dicha problemática y menos respecto al sistema de vaciado vesical empleado en estos casos (sonda vesical permanente, colector permanente, cateterismos intermitentes). El objetivo de este estudio fue analizar la prevalencia y la etiología de la infección urinaria en pacientes afectados de vejiga neurógena según su sistema de vaciado vesical en comparación con una población no neurógena, así como valorar la percepción de la infección urinaria en los pacientes afectados de vejiga neurógena. Material y métodos: Se realizó un estudio epidemiológico y prospectivo consecutivo en el que se incluyó a 283 pacientes a los que se les practicó un total de 283 urocultivos. De éstos, 106 procedían de pacientes con lesión neurológica, 28 de un grupo control no neurógeno, 74 de pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) de nuestro hospital y 75 de pacientes que acudieron a urgencias por sintomatología de infección aguda del tracto urinario. Se analizó la sensibilidad y la especificidad que tiene la percepción del propio paciente como indicativo de infección urinaria mediante las curvas ROC. Resultados: El 66% de los pacientes con lesión neurológica presentó urocultivos positivos respecto al 25% de los controles. Dentro del grupo neurológico, el colectivo con más urocultivos positivos fueron pacientes con mielomeningocele (81,5%) y con lesión medular (71,7%), con una significación estadística (p=0,01). El microorganismo más frecuente en todos los subgrupos fue Escherichia coli en primer lugar, seguido de Enterococcus faecalis y Pseudomonas aeruginosa en el subgrupo neurológico, de E. faecalis y Proteus mirabillis en el subgrupo control y de Klebsiella pneumoniae y Streptococcus agalactiae en el subgrupo de urgencias. En el subgrupo de la UCI, el microorganismo más frecuente en primer lugar fue E. faecalis, seguido de E. coli y P. aeruginosa. La sensibilidad para la percepción del paciente neurológico como indicativa de tener una infección urinaria fue del 97,2 respecto al 80% en el grupo control. Las especificidades fueron bajas en ambos grupos. Conclusiones: El microorganismo hallado en los urocultivos positivos en todos los subgrupos fue E. coli, excepto en los de la UCI. Los colectivos con más infecciones urinarias fueron mielomeningocele y lesión medular. La sensibilidad y la especificidad (medidas con la curva ROC) para la percepción del paciente neurológico como indicativas de tener una infección urinaria fueron más altas en los pacientes neurológicos respecto al grupo control no neurológico (p=0,0004; área: 0,643) (AU)

Introduction: To analyze the prevalence and etiology of urinary tract infection in patients with neurogenic bladder depending on the bladder emptying system used as compared to a population with no neurological impairment. To assess perception of urinary tract infection by patients with neurogenic bladder. Materials and methods: An epidemiological and prospective study was conducted on 283 patients, in whom a total of 283 urethral cultures were performed. Of these, 106 came from patients with neurological damage, 28 from a control group with no neurological impairment, 74 from patients admitted to the intensive care unit (ICU) of our hospital, and 75 from patients who attended the emergency room for symptoms of acute urinary tract infection. The sensitivity and specificity of patient perception as indicative of urinary tract infection was analyzed using ROC curves. Results: Positive urethral cultures were found in 66% of patients with neurological damage and 25% of control patients. Within the neurological group, patients with the highest rates of positive urethral cultures were those with myelomeningocele (MMC) (81.5%) and spinal cord injuries (71.7%), with a statistically significant difference (p=0.01). The microorganism most commonly found in all subgroups was Escherichia coli, followed by Enterococcus faecalis and Pseudomonas aeruginosa in the neurological subgroup, Enterococcus faecalis and Proteus mirabilis in the control subgroup, and Klebsiella pneumoniae and Staphylococcus agalactiae in the emergency room subgroup. In the ICU subgroup, the most commonly found microorganism was Enterococcus faecalis, followed by Escherichia coli and Pseudomonas aeruginosa. Sensitivity for perception by neurological patients as an indication of the presence of urinary tract infection was 97.2%, as compared to 80% in the control group. Specificity was low in both groups. Conclusions: E. coli was the microorganism found in positive urethral cultures from all subgroups, except in the ICU group. The groups with the highest urinary tract infection rates were patients with MMC and spinal cord injuries. Sensitivity and specificity (as measured using ROC curves) for perception by neurological patients as an indication of the presence of urinary tract infection was higher in neurological patients than in the non-neurological control group (p=0.0004, area: 0.643) (AU)

[Validity of the King's Health questionnaire in the assessment of quality of life of patients with urinary incontinence. The King's Group]. / Validez del cuestionario King's Health para la evaluación de la calidad de vida en pacientes con incontinencia urinaria. Grupo King's.

BACKGROUND: To assess the validity of the Spanish version of the King's Health Questionnaire (KHQ) for measuring the quality of life of women with different types of urinary incontinence. PATIENTS AND METHODS: 77 women with urinary stress incontinence (USI), 51 with urge incontinence (UUI) and 34 with mixed urinary incontinence (MUI) were consecutively recruited. Subjects were diagnosed using urodynamic tests. Patients completed the KHQ and SF-36 questionnaires on inclusion in the study, after 15 days, and again after one month. RESULTS: There were no significant differences in socio-demographic and QOL characteristics between different UI groups. UUI and MUI patients had greater urinary frequency and urge than USI patients, and USI and MUI patients had a greater number of leakage episodes than UUI patients. Correlations between dimensions on the KHQ and the SF-36 were moderate to strong. Women with greater urinary frequency, greater urgency, more incontinence episodes during the week and who used pads and nappies perceived a worse quality of life. Changes in these variables correlated with changes in HRQOL. The internal consistency of dimensions was good (0.65-0.92) as was test-retest reliability (0.68-0.88). Dimensions most sensitive to change after one month of treatment were impact of UI, seriousness of UI, and the symptoms scale (effect size greater than 0.6). CONCLUSION: The KHQ is a valid instrument for measuring the quality of life of patients with different types of UI. Improvements in urinary frequency, urinary urgency, number of leakage episodes, and changes in the type of protective material produces an increase in HRQOL.

[Comparative population-based survey as evaluation method of prostate disease changes]. / Estudio poblacional comparativo mediante encuesta como método de evaluación de las modificaciones sobre la patología prostática.

A survey-based comparative study was conducted to evaluate the changes on the prostate pathology in two male populations separated by a time interval of two years (1st and 3rd Week of Prostate Health). A total of 2056 respondents in the 1st Week, and 2126 in the 3rd Week were evaluated. The questionnaire included questions relative to prostate awareness, impact of urinary complaints on daily like activities, Spanish validated IPSS and selective questions for prostate patients. The comparison between both surveys disclosed visits to the urologist at earlier age and longer-standing symptoms. The most prevalent symptoms continue to be decreased calibre of the urinary stream, pollakiuria and urgency. IPSS/L and IPSS/age ratios remained unchanged. There was increased number of visits by mildly symptomatic patients (IPSS < 8), increased periodical revisions, and in the number of patients seen and treated by the urologist. A significant approximation to the diagnostic testing criteria established by the WHO for BPH was demonstrated. The number of patients who received treatment raised and there was also a significant improvement in the outcome. Comparative populational studies could allow to assess changes in the awareness status of the prostate, changes in symptomatic levels and quality of life of the population requesting health care, as well as changes in the diagnostic and therapeutical schemes in patients suspected of having BPH.

[The development and preliminary validation of the IU-4 questionnaire for the clinical classification of urinary incontinence]. / Elaboración y validación preliminar del cuestionario para la clasificación clínica de la incontinencia urinaria IU-4.

RATIONALE: To prepare and validate a simple and self-administered questionnaire for the clinical rating of patients with urinary incontinence (UI) for use in the clinical practice. METHODS: The questionnaire was prepared based on a review of the literature on urinary incontinence and the views of 7 urodynamic urologists. The initial questionnaire UI-5 included 5 items related to UI symptoms that divided patients into three categories: stress incontinence (UEI), urge incontinence (UUI) or mixed urinary incontinence (MUI). An additional question evaluates the impact of UI type on the quality of life. The of construct validity was analyzed correlating the responses to UI-5 items and the question on quality of life. The area under the ROC curve was calculated for each UI type correlating the UI-5 scores and the results of the urodynamic test. The cut-off values for each scale were determined based on sensitivity (SE) and specificity (SP). RESULTS: The study included 188 females with UI (73.4% with UEI, 13.3% with UUI and 13.3% with MUI; based on the urodynamics). Only 4.3% patients did not answer some UI-5 items. One item related to the protective material used was excluded as it was not related to UI types, and so the final questionnaire included only 4 items (UI-4). The results show that UI-4 discriminates the different types of incontinence: UEI (SE: 0.69/SP: 0.76; 1 item), UUI (SE: 0.83/SP: 0.65; 2 items), MUI (SE: 0.72/SP: 0.65; 1 item). 100% patients with MUI, 84% with UUI and 59.9% with UEI report some impact on their quality of life. CONCLUSIONS: UI-4 is simple, valid and easy to administer, and can be particularly valuable in the clinical rating of UI in settings where urodynamic testing is not easily available such is primary health care.

[Acquired urethral diverticulum in males with spinal cord injury]. / Divertículo uretral adquirido en varones con lesión medular.

OBJECTIVES: To study the clinical features, etiology, diagnostic methods and therapeutic possibilities in male patients with medullary lesion presenting with acquired urethral diverticulum. METHODS: A retrospective study was conducted on patients seen in our department over the past twenty years (June, 1974 to June, 1994) for acquired urethral diverticulum. Ten patients have been treated for the foregoing condition. RESULTS: The etiology of the medullary lesion was traumatic injury in 7 cases and spina bifida in 3 cases. The most frequent cause of the acquired urethral diverticulum was a condom-like urinary collecting device associated with a septic factor. Three patients presented intradiverticular lithiasis. These 3 patients had previous or current lithiasis at other sites of the urinary tract and all of them had a condom-like collecting device. All patients underwent surgery consisting in diverticulectomy and lithectomy, when required. One patient had a recurrence 6 years later because the underlying factors causing the diverticulum were still present. CONCLUSIONS: Personal care and hygiene of patients with medullary lesion is one of the most important factors in preventing urethral injuries. In our view, patient follow-up should include regular radiologic assessment and correct training in the use of condom-like urinary collecting devices and urinary catheters. We advocate one-stage surgical repair with temporary cystostomy, preoperative antibiotic therapy according to the antibiotic profile and culture of symptomatic and asymptomatic urinary infections and the use of methylene blue to ensure the suture is watertight.

[Trigonocervicoprostatotomy]. / Trigonocervicoprostatotomía.

Endoscopic trigonocervicoprostatotomy incision has become a minimally aggressive alternative to surgical treatment of early benign prostatic hypertrophy (BPH). The present article analyzes its indications, advantages and disadvantages. We describe the technique utilized and report on the results achieved in 146 patients (mean age 62.7 years, mean follow-up 15.7 months). Clinically, the results were completely satisfactory in 78.1% of the cases, symptomatology improved in 15.7%, and 4.8% warranted a second procedure. The incidence of retrograde ejaculation was observed to be only 20.5%. With regard to the urodynamics, the preoperative mean maximum flow rate of 9 ml/sec. increased to almost 20 ml/sec. postoperatively. The results of urethral evaluation support the hypothesis of Turner-Warwick which ascribes the obstructive symptomatology in these patients to cervical dysfunction.

[Closed renal trauma: 287 cases. Evaluation of treatment and long-term follow-up]. / Traumatismos renales cerrados: 287 casos. Valoración del tratamiento y seguimiento a largo plazo.

We evaluated 287 cases of blunt renal trauma that had been treated at the Urology Department of the Valle de Hebrón Hospital from 1974 to 1987. Data gleaned from patient work up, diagnosis and treatment during the acute phase are presented, highlighting the early and long-term results. Patient follow-up ranging from 1 to 10 years and data from statistical analyses show that conservative treatment achieved better early and late results than surgical treatment of the compromised renal unit. Hypertension was an uncommon secuela in our series (1% incidence). Evaluation with radioisotopes has proved to be the most reliable diagnostic method in the long-term assessment of secuelae in the renal unit.

[Modification of the simplified Cobb-Radge and Raz techniques in the treatment of stress urinary incontinence. Description and results]. / Modificación de las técnicas simplificadas de Cobb-Radge y Raz en el tratamiento de la incontinencia urinaria de esfuerzo. Descripción y resultados.

Various surgical procedures have been described for correction of stress urinary incontinence (SUI) which have afforded different results. Modifications to these procedures have been made in an attempt to reduce morbidity and the operating time without detriment to the efficacy of the procedures. Herein we describe two procedures, the modified Cobb-Radge and Raz techniques, and report on the results achieved. In patients with no cystocele that had been submitted to the modified Cobb-Radge technique, we achieved 80.4% good results. In patients with significant cystocele, our modified Cobb-Radge technique and anterior colporrhaphy achieved a success rate of 80%, and we achieved good results in 88.3% of these cases with our modified Raz procedure.

[Non-acquired renal arteriovenous fistulas. Apropos of 2 cases]. / Fístulas arteriovenosas renales no adquiridas. A propósito de dos casos.

Herein we describe two additional cases of non-acquired arteriovenous renal fistula, one was congenital or cirsoid and the other was idiopathic or aneurysmal. Patient clinical work up prompted us to suspect this condition which was confirmed by renal arteriography. The usefulness of the diagnostic tests are highlighted and the incidence and management of this type of vascular malformation are discussed.

[Trigono-cervico-prostatomy. Technic, clinical and urodynamic results]. / Trigonocervicoprostatotomía (TCP). Técnica, resultados clínicos y urodinámicos.

Trigono-cervico-prostatotomy (TCP) incision was performed endoscopically in 102 patients, 99 for benign hypertrophy of the prostate (BHP) less than 35 g., and 3 for bladder neck obstruction. Good results were achieved in 81.4%, symptom relief was achieved in 12.7%, and 5.8% required reoperation. The incidence of retrograde ejaculation was only 20.6%. Patient follow-up was one year. Our findings show the usefulness of ultrasound, urethroscopy and urodynamics in determining the size of the adenoma and in assessing the results achieved by the surgical technique.

[Post-traumatic renal hypertension]. / HTA renal postraumática.

Post-traumatic renal hypertension is an uncommon sequela of renal trauma that may appear late making long follow-up advisable. The pathophysiology of this condition, the diagnostic methods, its different modes of presentation including transient and reversible or irreversible permanent hypertension are discussed. The usefulness of renal function tests in its diagnosis and the criteria for reversibility with surgical treatment are analyzed. Three cases of hypertension that presented late (2, 12, and 20 years after renal trauma) are described and the literature reviewed.

[Urethral diverticulum. Complication in males with spinal cord lesions]. / Divertículo uretral. Complicación en varones con lesión medular.

We report on 4 spinal cord injury patients with urethral diverticulum from urethral lesions caused by urine collecting systems. We advocate one-stage surgical repair with the following precautions: treatment of the septic condition prior to surgery, puncture cystostomy, and closure of the surgical wound using methylene blue.