Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.749
Filtrar
1.
Niger Postgrad Med J ; 27(1): 37-41, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32003360

RESUMEN

Background: Urinary tract infection (UTI), especially pyelonephritis when inadequately treated may culminate in end-stage renal disease. The study aims to evaluate the risk factors for and clinico-pathologic features of chronic pyelonephritis (CPN) among patients in Aminu Kano Teaching Hospital, Kano, in North-Western Nigeria. Materials and Methods: Data on cases diagnosed as CPN between 2010 and 2017 in the study centre were retrieved from archives and analysed for risk factors and clinic-pathologic features. Results: Forty-three cases of CPN were diagnosed in the study period and comprised 24 males and 19 females, with a male: female ratio of 1.3:1. The ages ranged from 3 to 80 years with a mean age of 37.0 ± 19.6 years. Urinary tract obstruction, poorly treated UTI, HIV infection and polycystic kidney disease were the risk factors in 21 (49%), 15 (35%), 6 (14%) and 1 (2%) cases, respectively. Proteinuria was seen in 10 (23.3%) of the patients, hypertension in 7 (16.3%) and haematuria in 3 (7.0%) of cases. Nephrectomy was done in 17 (39.5%) of the 43 CPN cases, indications for surgery were pus-filled, non-functioning kidneys. The diameters of the removed kidneys ranged from 10 to 28 cm and they weighed between 140 g and 2500 g. Scarring, reported in 79.0% of patients, was the most common pathological finding, followed by pus casts in 48.8% and focal segmental glomerulosclerosis in 27.9%. No statistically significant difference was found between age or gender and aetiology or risk factors of the disease (P > 0.05). Conclusion: CPN with pus-filled and non-functioning kidneys is a common indication for nephrectomy. Urinary tract obstruction, poorly treated UTI, and HIV infection were major risk factors seen in this environment. To prevent this complication there is a need for better training of clinicians in the diagnosis and adequate treatment of UTI.


Asunto(s)
Infecciones por VIH , Pielonefritis , Infecciones Urinarias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Nefrectomía , Nigeria , Pielonefritis/diagnóstico , Pielonefritis/tratamiento farmacológico , Pielonefritis/etiología , Estudios Retrospectivos , Factores de Riesgo , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología , Adulto Joven
2.
Medicine (Baltimore) ; 99(1): e18519, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895786

RESUMEN

Urinary obstruction may be a complicating factor in critically ill patients with urinary tract infections (UTIs) and requires efforts for identifying and controlling the infection source. However, its significance in clinical practice is uncertain. This retrospective study investigated the overall hospital courses of patients in the intensive care unit (ICU) with UTIs from the emergency department.Baseline severity was assessed by the sequential organ failure assessment (SOFA) score; outcomes included probability and inotropic-, ventilator-, renal replacement therapy (RRT)-, and ICU-free days and 28-day mortality.Of 122 patients with UTIs, 99 had abdominal computed tomography scans. Patients without computed tomography scans more frequently had quadriplegia and a urinary catheter than those without scans (P = .001 and .01). Urinary obstruction was identified in 40 patients who had higher SOFA scores and lactate levels (P = .01 and P < .001). The use and free days of inotropic drugs and ventilator did not differ between the groups. However, patients with obstruction were more likely to require RRT and had shorter durations of RRT-free days (odds ratio 3.8; P = .06 and estimate -3.0; P = .04). Durations of ICU-free days were shorter, but it disappeared after adjustment for initial SOFA scores (estimate -2.3; P = .15). Impact of the timing of urinary drainage on outcomes was evaluated, demonstrating that an intervention within 72 hours lengthened the duration of RRT-free days compared with that after 72 hours (estimate -6.0 days; P = .03). On the other hand, the study did not find the association between other outcomes including 28-day mortality and the timing of urinary drainage.Urinary obstruction can be a complicating factor, resulting in a higher probability of RRT implementation and shorter durations of RRT- and ICU-free days in critically ill patients with UTIs. Furthermore, delayed intervention for urinary drainage may result in longer durations of RRT. Efforts should be warranted to find the presence of urinary obstruction and to control infection source in critically ill patients with UTIs.


Asunto(s)
Enfermedad Crítica/mortalidad , Terapia de Reemplazo Renal/mortalidad , Infecciones Urinarias/mortalidad , Enfermedades Urológicas/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Oportunidad Relativa , Puntuaciones en la Disfunción de Órganos , Estudios Retrospectivos , Factores de Tiempo , Infecciones Urinarias/etiología , Infecciones Urinarias/terapia , Enfermedades Urológicas/complicaciones , Enfermedades Urológicas/terapia
3.
Medicine (Baltimore) ; 99(2): e18707, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914077

RESUMEN

Aim to illuminate the correlation between fetal hydronephrosis and postnatal urological abnormalities by a new classification system-"urinary tract dilation (UTD)" grade.Of 659 pregnancies screened by ultrasound, 34 cases were found with isolated fetal hydronephrosis, and enrolled in our study from 2017 to 2019. These 34 infants had been prospectively followed up to 6 months after birth by 3 times of urinary tract ultrasound. Hydronephrosis was graded in accordance with the UTD classification system.Among 34 infants with isolated fetal hydronephrosis. Twenty-four (70.6%) were classified as UTD A1 grade (mild hydronephrosis), and the other 10 (29.4%) were UTD A2-3 grade (moderate to severe hydronephrosis) by antenatal evaluation. After birth, all of the 24 infants (70.6%) with UTD A1 grade had normal ultrasonic findings of urinary tract; while the other 10 cases with UTD A2-3 grade had persistent abnormalities of urinary tract by postnatal assessment, sorted as UTD P1 grade (mild hydronephrosis) in 6 cases (17.6%), UTD P2 grade (moderate hydronephrosis) in 2 cases (5.9%) and UTD P3 grade (severe hydronephrosis) in 2 cases (5.9%). The most common postnatal urological abnormality of isolated fetal hydronephrosis was vesicoureteral reflux. During the follow-up period, 7 infants (20.6%) had urinary tract infection episodes and very few obtained positive cultures of the urine. Only 2 infants (5.9%) with the diagnosis of ureterovesical junction obstruction required surgery intervention, who were both classified as UTD P3 grade. None of the children with UTD P1 and P2 grades needed operation.The UTD classification system described the urinary tract both antenatally and postnatally, which could point out the correlation between fetal hydronephrosis and postnatal urological abnormalities. This new classification system is expected to be a good prognostic marker for fetal hydronephrosis.


Asunto(s)
Hidronefrosis/clasificación , Hidronefrosis/patología , Enfermedades Urológicas/etiología , Dilatación Patológica , Femenino , Edad Gestacional , Humanos , Hidronefrosis/complicaciones , Hidronefrosis/diagnóstico por imagen , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Ultrasonografía Prenatal , Sistema Urinario/diagnóstico por imagen , Infecciones Urinarias/etiología , Reflujo Vesicoureteral/etiología
4.
Medicine (Baltimore) ; 99(2): e18710, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914080

RESUMEN

The present study aimed to assess the effect of removing an indwelling urinary catheter at different times on urinary retention and urinary infection in patients undergoing gynecologic surgery.Electronic databases including PubMed, EMbase, the Cochrane Central Register of Controlled Trials, and Ovid from inception to June 2018 were searched. Relevant randomized controlled trials (RCTs) of removal the indwelling urinary catheter in different time were included.Eight RCTs were included. Data were analyzed by RevMan 5.3 version. There was significant difference in urinary retention (relative risk [RR] 2.46, 95% confidence intervals [CIs] 1.10-5.53), P = .03) between the ≤6 hours and >6 hours indwelling urinary catheter removal groups, while no significant differences were found in the gynecologic surgery excluded the vaginal surgery group and vaginal surgery group. When compared with >6 hours indwelling urinary catheter removal group, the incidence of urinary infection was significantly reduced at the ≤6 hours removal group (RR = 0.66, 95% CI 0.48-0.89, P = .007). The urinary catheter removal time at ≤6 hours also significantly reduced the incidence of urinary retention (RR = 5.06, 95%CI 1.74-14.69, P = .003), and did not statistically increase the incidence of urinary infection (RR = 0.30, 95%CI 0.08 to 1.20, P = .09), compared with immediate urinary catheter removal after surgery.Removal time of the urinary catheter at ≤6 hours postoperatively seems to be more beneficial than immediate or >6 hours for patients undergoing gynecologic surgery which excluded the vaginal surgery.


Asunto(s)
Remoción de Dispositivos/métodos , Procedimientos Quirúrgicos Ginecológicos/métodos , Cuidados Posoperatorios/métodos , Catéteres Urinarios , Remoción de Dispositivos/efectos adversos , Humanos , Cuidados Posoperatorios/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Retención Urinaria/etiología , Infecciones Urinarias/etiología
5.
Urology ; 135: 38-43, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31600558

RESUMEN

OBJECTIVE: To evaluate differences in adverse events (AE) in asymptomatic patients with a positive urine dip (UD) at time of intradetrusor onabotulinumtoxinA (BTX-A) injection vsthose with a defined negative UD. MATERIALS AND METHODS: All intradetrusor BTX-A injections were retrospectively reviewed at a single institution between 2016 and 2018. Exclusion criteria included an indwelling catheter, recent positive urine culture, recent antibiotic course, or absence of UD on the day of injection. A positive UD was defined using 7 different definitions with varying combinations of any level of positive blood, leukocyte esterase, or nitrite. Negative UDs were defined those excluded from the positive UD group. We compared multiple positive UD-defined groups to their respective negative UD cohorts with regards to outcomes and demographics. RESULTS: A total of 212 patients underwent 335 cycles of BTX-A injections over a 2-year period. The average age was 65 years (range: 21-90). The majority received 100 units (73%) of BTX-A for a non-neurogenic diagnosis (73%). The overall rate of AEs, urinary tract infection, and urinary retention was 14.6%, 9%, and 3%, respectively. In all groups, the most common AE was urinary tract infection followed by urinary retention. There were no major Clavien-Dindo-defined complications. There was no statistically significant difference in the total or categorical AE rates between positive and negative UD groups using all 7 definitions of a positive UD (P = .05-1.0). CONCLUSION: These data do not support the practice of obtaining a preprocedure UD in asymptomatic patients undergoing intradetrusor BTX-A injection for any indication; test results are unable to predict outcomes or AEs.


Asunto(s)
Toxinas Botulínicas Tipo A/efectos adversos , Fármacos Neuromusculares/efectos adversos , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Retención Urinaria/epidemiología , Infecciones Urinarias/epidemiología , Administración Intravesical , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Asintomáticas/terapia , Toxinas Botulínicas Tipo A/administración & dosificación , Femenino , Humanos , Inyecciones Intramusculares/efectos adversos , Inyecciones Intramusculares/métodos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares/administración & dosificación , Estudios Retrospectivos , Vejiga Urinaria/efectos de los fármacos , Vejiga Urinaria/fisiopatología , Vejiga Urinaria Hiperactiva/fisiopatología , Retención Urinaria/etiología , Infecciones Urinarias/etiología , Infecciones Urinarias/orina , Urodinámica/efectos de los fármacos , Adulto Joven
6.
Urology ; 135: 32-37, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31626856

RESUMEN

OBJECTIVE: To ascertain whether a poor response and adverse events (voiding dysfunction and urinary tract infection) were predictable for first time botulinum toxin-A (BTX-A) injections in a patient cohort of refractory idiopathic overactive bladder with detrusor overactivity. METHODS: Patients who received BTX-A injections for the first time between the dates of March 2004-August 2017 were analyzed in this single center study. Urogenital Distress Inventory short form (UDI-6) questionnaires were collected both preinjection and postinjection prospectively. A poor response was defined as a decrease of less than 16.7 on the UDI-6 questionnaire. Additional information was gathered from patient records in a retrospective fashion. Predictors of poor response, voiding dysfunction, and UTI were analyzed with multivariate logistic regression analysis. RESULTS: Seventy-four patients were analyzed. The only predictor of poor response was male gender (OR, 5.45; 95% CI 1.83-16.47; P = .002). Lower maximum urinary flow rates (OR, 0.91; 95% CI, 0.83-0.99; P = .023), male gender (OR, 5.14; 95% CI 1.41-18.72; P = .013), and hysterectomy in females (OR, 4.55; 95% CI, 1.09-18.87; P = .038) were predictors of clean intermittent self catheterisation (CISC). There was an increased risk of UTIs in patients who performed CISC (OR, 5.26; 95% CI 1.38-20.0; P = .015). CONCLUSION: Male gender was associated with a poor response to BTX-A injections and increased risk of CISC. Lower maximum urinary flow rates and women with hysterectomies were at increased risk of requiring CISC postinjection. Performing CISC was associated with increased risk of UTI. These factors could be helpful when counselling or selecting patients.


Asunto(s)
Toxinas Botulínicas Tipo A/administración & dosificación , Fármacos Neuromusculares/administración & dosificación , Vejiga Urinaria Hiperactiva/terapia , Administración Intravesical , Toxinas Botulínicas Tipo A/efectos adversos , Femenino , Humanos , Inyecciones Intramusculares/métodos , Cateterismo Uretral Intermitente/efectos adversos , Cateterismo Uretral Intermitente/métodos , Cateterismo Uretral Intermitente/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares/efectos adversos , Pronóstico , Estudios Retrospectivos , Autocuidado/métodos , Autocuidado/estadística & datos numéricos , Factores Sexuales , Encuestas y Cuestionarios , Resultado del Tratamiento , Vejiga Urinaria/efectos de los fármacos , Vejiga Urinaria/fisiopatología , Vejiga Urinaria Hiperactiva/diagnóstico , Vejiga Urinaria Hiperactiva/fisiopatología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Trastornos Urinarios/diagnóstico , Trastornos Urinarios/epidemiología , Trastornos Urinarios/etiología
7.
Urology ; 136: 225-230, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31758980

RESUMEN

OBJECTIVE: To determine pediatric urologists' antibiotic prophylaxis prescribing practices for children with vesicoureteral reflux (VUR) and other congenital anomalies of the kidney and urinary tract (CAKUT). METHODS: Web-based survey of pediatric urologists about their practice of antibiotic prophylaxis in children with CAKUT. RESULTS: We had a response rate of 17.8% (n = 73). The majority of respondents always or often prescribe prophylactic antibiotics for grade IV or V VUR, while greater variability was seen for lower grades of VUR. 47.9% of respondents report that they often or always prescribe antibiotics for patients with grade 4 hydronephrosis, and most respondents report that they never or rarely prescribe antibiotics for grade 1 or 2 hydronephrosis. The majority of respondents never or rarely prescribe antibiotics for horseshoe or solitary kidney (88% and 86%, respectively), but frequently prescribed antibiotic for ureterocele. For ectopic ureter, almost half of respondents prescribe prophylactic antibiotics always or often, whereas only 18% prescribe antibiotics always or often for duplication anomalies. Only 11% reported prescribing antibiotics for prophylaxis always or often for children with myelomeningocele. CONCLUSION: We report notable variability in antibiotic prescribing patterns for children with CAKUT. Given the lack of guidelines around the use of prophylaxis in the majority of these conditions, standardization of care may be warranted to decrease this variability.


Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Prescripciones de Medicamentos/estadística & datos numéricos , Pediatría , Pautas de la Práctica en Medicina , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & control , Anomalías Urogenitales/complicaciones , Urología , Reflujo Vesicoureteral/complicaciones , Niño , Encuestas de Atención de la Salud , Humanos
8.
Int J Gynaecol Obstet ; 148(1): 87-95, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31560131

RESUMEN

OBJECTIVE: To determine the rates of urinary tract infection (UTI) in adolescent users of menstrual pads versus non-users in a rural area of Rwanda. METHODS: An interventional prospective cohort study was conducted at four secondary schools in the Western Province of Rwanda from May 12, 2017 to October 20, 2017. Inclusion criteria were female students aged 18-24 who were menstruating and volunteered to participate in the study. In total, 240 adolescent participants were assigned to two cohorts; 120 received menstrual pads for 6 months and the other 120 did not use pads. Baseline symptoms and urine cultures were obtained. Symptoms and methods of menstrual hygiene management were assessed and urine cultures were obtained every 2 months. The primary outcome was the presence of UTI diagnosed by positive urine culture. Secondary outcomes were symptoms of UTI, vulvovaginal symptoms, sexual activity, dyspareunia, and self-reported sexually transmitted infection. Generalized estimating equations with nesting were used to assess associations of pad use with study outcomes. RESULTS: A total of 209 participants completed the study. There was no difference in rates of positive urine culture. A decreased odds of vulvovaginal symptoms was found in self-reported "always" versus "never" pad users (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.43-0.96; P=0.031). CONCLUSIONS: Despite not finding any difference in rates of UTI, the present study showed a decreased rate of vulvovaginal symptoms in users of menstrual pads. Further research investigating rates of genital infections in this population is thus necessary.


Asunto(s)
Productos para la Higiene Menstrual/efectos adversos , Infecciones Urinarias/etiología , Adolescente , Salud del Adolescente , Estudios de Casos y Controles , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Higiene , Menstruación/fisiología , Estudios Prospectivos , Rwanda , Autoinforme , Adulto Joven
9.
World Neurosurg ; 135: e307-e320, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31841719

RESUMEN

OBJECTIVE: To investigate preoperative baseline anemia, stratified by severity as a function of hematocrit level, as a risk factor for perioperative complications in geriatric patients undergoing spinal procedures. BACKGROUND: Previous literature has examined the impact of anemia on risk for complications and adverse outcomes in patients undergoing elective spinal procedures. However, there is a paucity of literature analyzing the impact of anemia in the geriatric population, specifically. METHODS: The American College of Surgeons-National Surgical Quality Improvement Database was used to identify patients older than 65 years who had undergone elective spinal procedures and were subsequently stratified into 3 separate cohorts based on hematocrit levels: severe/moderate (hematocrit level <30%), mild (30%-37%), and no anemia (>38%). These patient samples were then analyzed using multivariate analyses to assess severity of anemia as a risk factor for complications in elderly patients undergoing spinal procedures. RESULTS: When anemia classes were analyzed as separate independent risk factors for complications, mild anemia (class II) was a significant risk factor for the same complications as moderate/severe anemia (class III/IV), with the exception of 2 complications, compared with nonanemic patients. Mild anemia was independently associated with wound dehiscence (odds ratio, 1.521; 95% confidence interval, 1.126-2.054; P = 0.006), whereas moderate/severe anemia did not show an increased risk for wound dehiscence. However, moderate/severe anemia independently increased the risk for deep venous thromboembolism (odds ratio, 1.437; 95% confidence interval, 1.028-2.011; P = 0.034), compared with mild anemia. Both categories of anemia independently increased the risk for additional complications such as deep incisional surgical site infection, organ/space surgical site infection, pneumonia, unplanned intubation, ventilator dependence, progressive renal insufficiency, acute renal failure, urinary tract infections, cardiac arrest, myocardial infarctions, blood transfusions, systemic sepsis, reoperation, extended length of stay of ≥5 days, unplanned readmission, and mortality. CONCLUSIONS: This study indicated that patients with preoperative baseline anemia were at risk for requiring transfusions, renal failure, and infectious complications. Physicians should be cognizant of anemia as a risk factor affecting numerous perioperative complications and adverse outcomes to work toward improving health-related quality of life.


Asunto(s)
Anemia/complicaciones , Complicaciones Posoperatorias/epidemiología , Columna Vertebral/cirugía , Anciano , Anemia/sangre , Procedimientos Quirúrgicos Electivos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Perioperatorio , Complicaciones Posoperatorias/cirugía , Calidad de Vida , Reoperación/efectos adversos , Factores de Riesgo , Infecciones Urinarias/etiología
10.
Int J Cancer ; 146(7): 1930-1936, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-31863454

RESUMEN

Schistosoma haematobium infection can lead to squamous cell carcinomas (SCC) of the bladder. Whether this also applies to more common urinary tract infections (UTIs) is unclear. We therefore aimed to investigate the association between UTIs, reflected by the use of specific antibiotics and risk of SCC of the bladder. We conducted a Danish nationwide case-control study and identified histologically verified bladder cancer cases (2000-2015; n = 12,271) and age- and sex-matched cancer-free controls. We computed odds ratios (ORs) with 95% confidence intervals (CI) associating the use of UTI-specific antibiotics with SCC bladder cancer, using conditional logistic regression. We applied a 2-year lag-time to minimize reverse causation. To aid interpretation, similar analyses were performed for other bladder cancer types and other antibiotics. We identified 333 SCC cases (2.7% of all bladder cancers). Compared to no use (0-1 prescription), high-use (≥10 prescriptions) of UTI-specific antibiotics was associated with SCC with an OR of 11.4 (CI 7.6-17.2) and a clear dose-response pattern (ptrend < 0.001). Use of phenoxymethylpenicillin, an antibiotic not used against UTIs, was not associated with SCC after adjustment for use of UTI-specific antibiotics (OR 0.5). Furthermore, UTI-specific antibiotic use was not associated with urothelial carcinomas (n = 11,029; OR 1.13; CI 0.97-1.32). Excluding patients with known urogenital disease did not influence the SCC estimates (overall OR 10.8; CI 6.2-18.9). Data on smoking were lacking, however, a quantitative bias analysis suggested this to be of limited importance. In conclusion, common UTIs are strong, dose-dependent and specifically associated with risk of SCC of the bladder.


Asunto(s)
Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/epidemiología , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Dinamarca/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Vigilancia en Salud Pública , Medición de Riesgo , Factores de Riesgo , Flujo de Trabajo
11.
Pan Afr Med J ; 33: 304, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692745

RESUMEN

Vesicoureteral reflux is very common in children, requiring a long follow-up period to reduce its progression toward chronic renal failure. This study aims to analyze the epidemiological diagnostic features, the management of vesicoureteral reflux and long term course of patients with this disease. We conducted a retrospective study of 42 patients with suspected vesicoureteral reflux hospitalized in the Department of Visceral Paediatric Surgery at the Hassan II University Hospital of Fez over a period of 6 years from January 2010 to December 2015. Mean age of patients at diagnosis was 3 years and 2 months. The boy is to girl sex ratio was 1.8. Vesicoureteral reflux was isolated in 81% of patients and secondary or associated in 19% of patients. The most common initial manifestation was urinary tract infection (90.4%). Renal function was impaired in 54.8% of children. The treatment was based on antibiotics against diagnosed UTI (90.4%), antibiotic prophylaxis in the case of recurrence and Cohen reimplantation (97.62%). Surgical indication readily concerned all patients with grades IV and V vesicoureteral reflux (73.9%) as well as patients with impaired kidneys and 26.1% of patients after medical treatment. Early and late postoperative course was in general satisfactory: disappearance of vesicoureteral reflux in 92.68% of cases. Upper urinary tract regressed except for 9.52% of patients; 95.23% of patients had complete recovery of renal function. There was a reduction in UTI recurrence (in 19.04% of cases after surgery). The majority of parents judged positively the clinical course of their children (54.76%) after surgery.


Asunto(s)
Antibacterianos/administración & dosificación , Infecciones Urinarias/etiología , Reflujo Vesicoureteral/diagnóstico , Adolescente , Profilaxis Antibiótica/métodos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Recurrencia , Estudios Retrospectivos , Infecciones Urinarias/epidemiología , Infecciones Urinarias/terapia , Reflujo Vesicoureteral/fisiopatología , Reflujo Vesicoureteral/cirugía
12.
Pan Afr Med J ; 33: 328, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692786

RESUMEN

Urethral stricture is a disease whose cause and management vary according to the context. This study aims to analyze the epidemiological etiological and therapeutic features of urethral stricture in our department. We conducted a longitudinal cross-sectional study of patients with acquired urethral stricture admitted to our department between March 2014 and February 2016. The average age of our patients was 24.5 years (10 and 81years). The diagnosis was confirmed by retrograde and voiding Urethro-Cystography (UCG). The average stricture length was 2.28cm (0.5-5cm). The therapeutic approaches included: resection with termino-terminal anastomosis; retrograde dilatation etc. Outcome assessment performed 6-15 months after surgery was satisfactory with absence of recidivism, PMR ≤30cc and strong urine flow and weak in the case of recurrence of dysuria or PMR ≥100cc. Urethral stricture accounted for 7.14% of our urologic treatments. Most of our patients were farmers from the rural area. A history of recurrent urethritis was most often reported by our patients and 78,57% of them were married men, among whom 91% were polygamous). The main reason for consultation was dysuria (50% of the study population) and 50.01% of our patients had secondary urinary tract infection, most commonly caused by Escherichia coli. The main cause of urethral stricture was an infection (56.52%). The most affected area was the bulbar urethra (45.60% of cases). UCG was the most used technique (39.13%). Overall outcomes were good (85,65%) and failure rate reached 13.04%; the highest success rate was achieved with resection with anastomosis (94.44% respectively). Urethral stricture is common among young people. Infection is the main cause in our department. Prevention is essential as well as an efficient and effective management of sexually transmitted infections.


Asunto(s)
Anastomosis Quirúrgica/métodos , Disuria/etiología , Estrechez Uretral/cirugía , Uretritis/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios Transversales , Cistografía/métodos , Disuria/epidemiología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estrechez Uretral/diagnóstico , Uretritis/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Adulto Joven
14.
Am Surg ; 85(10): 1099-1103, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657302

RESUMEN

Foley catheters (FCs) are often used during inguinal hernia operations; however, the impact of intraoperative FC use on postoperative urinary retention (POUR) is not well understood. We reviewed unplanned returns to the urgent care or ED for 27,012 inguinal hernia operations across 15 Southern California Kaiser Permanente medical centers over 6.5 years. In total, 239 (0.88%) patients returned to urgent care/ED with POUR [235 (98%) men versus 4 (2%) women]. Overall, POUR increased with age (P < 0.00001). POUR was higher in open repairs using general anesthesia versus local with monitored anesthesia care (0.7% vs 0.3%, P < 0.0001). Of 5,017 laparoscopic operations, 28 per cent had FC use. Although POUR was greater for laparoscopic versus open operations (2.21 vs 0.58%, P < 0.00001), there was no difference in POUR for intraoperative FC versus no FC use in the laparoscopic approach (2.36% vs 2.15%, P = 0.33). For all laparoscopic operations, there was no difference in urinary tract infection within 7 or 30 days when comparing intraoperative FC versus no FC use (P = 0.28). POUR can be minimized by avoiding general anesthesia for open inguinal hernia repairs, but intraoperative FC use does not affect POUR or urinary tract infection rates for laparoscopic inguinal hernia repair.


Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/efectos adversos , Complicaciones Posoperatorias/etiología , Catéteres Urinarios/efectos adversos , Retención Urinaria/etiología , Distribución por Edad , Factores de Edad , Anciano , Anestesia General/efectos adversos , Anestesia General/estadística & datos numéricos , California/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Herniorrafia/métodos , Herniorrafia/estadística & datos numéricos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Catéteres Urinarios/estadística & datos numéricos , Retención Urinaria/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología
15.
Medicine (Baltimore) ; 98(38): e17312, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31568017

RESUMEN

Kidney transplantation (KT) is the best therapy available for patients with end-stage renal disease, but postoperative infections are a significant cause of mortality.In this retrospective study the frequency, risk factors, causative pathogens, and clinical manifestations of infection in KT recipients from Beijing Chao-Yang Hospital, Capital Medical University were investigated. Ninety-seven KT recipients who were hospitalized with infection between January 2010 and December 2016 were included. Clinical characteristics, surgery details, laboratory results, and etiology were compared in patients who developed single infection and patients who developed repeated infection (2 or more) after KT.A total of 161 infections were adequately documented in a total of 97 patients, of which 57 patients (58.8%) had 1 infection, 24 (24.7%) had 2, 11 (11.3%) had 3; 3 (3.1%) had 4, and 2 (2.1%) had 5 or more. The most common infection site was the urinary tract (90 infections; 56%), both overall and in the repeated infection group. The most frequently isolated pathogen was Pseudomonas aeruginosa. In the repeated infection patients, in most cases of P. aeruginosa infection (54%) it was cultured from urine. For first infections, a time between KT and infection of ≤ 21 days (area under receiver operating characteristic curve [AUC] 0.636) and a tacrolimus level ≥ 8 ng/mL (AUC 0.663) independently predicted repeat infection. The combination of these two predictive factors yielded an AUC of 0.716, which did not differ statistically significantly from either predictor alone.With regard to first infections after KT, a time between KT and infection of ≤ 21 days, and a tacrolimus level ≥ 8 ng/mL each independently predicted repeated infection in KT recipients.


Asunto(s)
Trasplante de Riñón/efectos adversos , Infección de la Herida Quirúrgica/etiología , Adulto , Femenino , Humanos , Masculino , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/microbiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Infecciones Urinarias/microbiología
16.
Urology ; 134: 199-202, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31563537

RESUMEN

OBJECTIVE: To report long-term safety and efficacy data on middle lobe only-transurethral resection of the prostate (TURP) (MLO-TURP). MATERIALS AND METHODS: We evaluated: (1) efficacy: International Prostate Symptom Score, Quality of Life, peak flow rate (Qmax), postvoid residual urine, International Index of Erectile Function and ejaculatory function, which was assessed by the Male Sexual Health Questionnaire. Men were evaluated at 1 month, 6 months, and yearly thereafter. RESULTS: A total 312 men (mean age 61.3 ± 8.6) with significant lower urinary tract symptoms (n = 147) or urinary retention (n = 175 were treated with MLO-TURP from 2005 to 2017. Mean baseline prostate volume was 79.8 g (30-178 g); mean baseline intravesical-prostatic protrusion was 13.6. Improvements in International Prostate Symptom Score, Quality of Life, Qmax and postvoid residual urine were durable throughout the study period. There was no difference in outcomes between monopolar and bipolar MLO-TURPs. Postoperatively, the incidence of ejaculatory dysfunction was 2.6% (N = 8) and there was 1 case of new onset ED (0.3%). There were modest improvement in bother due to ejaculatory function (baseline: 2.4 and at 5 years: 1.27). CONCLUSION: MLO-TURP is a safe and effective treatment for men with lower urinary tract symptoms. Patients experience long-term improvement of symptoms and preserve antegrade ejaculation. In select men with prominent middle lobes, MLO-- should be considered a therapeutic, ejaculation-sparing option.


Asunto(s)
Eyaculación , Terapia por Láser , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Anciano , Anciano de 80 o más Años , Disuria/etiología , Estudios de Seguimiento , Humanos , Terapia por Láser/efectos adversos , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Próstata/cirugía , Calidad de Vida , Resección Transuretral de la Próstata/efectos adversos , Cateterismo Urinario , Retención Urinaria/cirugía , Infecciones Urinarias/etiología
17.
Transplant Proc ; 51(7): 2501-2502, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31405733

RESUMEN

OBJECTIVE: Urologic complications are among the most common complications after kidney transplantation. These complications are urinary retention, hematuria, hemorrhage, urinary leakage, vesicoureteral reflux, pyelonephritis, and nephrolithiasis. Although neurogenic bladder is one of the indications for kidney transplantation, it is not considered in the literature to be an expected complication after transplantation. In this case, we discuss the nursing care of a patient who underwent kidney transplantation from a living donor and developed neurogenic bladder. CASE REPORT: A 60-year-old woman underwent kidney transplantation from a living donor, and neurogenic bladder developed in the patient 1 year after kidney transplantation. Clear intermittent catheterization treatment was administered for the kidney transplant recipient with neurogenic bladder. Clear intermittent catheterization treatment was stopped in the patient who had frequent urinary tract infections and, alternatively, sacral neuromodulation treatment was administered to the patient. CONCLUSIONS: The nursing care of a patient with neurogenic bladder after kidney transplantation aims to prevent excessive bladder distension, infection, stone formation, vesicoureteral reflux, renal failure, urinary tract damage, and incontinence, and to ensure regular and complete discharge of the bladder. The most common treatment modalities for these objectives are permanent or intermittent catheterization, sacral neuromodulation, and medical therapy. In the care of the patient with neurogenic bladder after kidney transplantation, nurses should provide appropriate care related to treatment options and bladder training, plan urination schedules of the patient, and monitor for possible complications.


Asunto(s)
Trasplante de Riñón/efectos adversos , Vejiga Urinaria Neurogénica/etiología , Vejiga Urinaria Neurogénica/enfermería , Vejiga Urinaria Neurogénica/terapia , Femenino , Humanos , Cateterismo Uretral Intermitente/efectos adversos , Persona de Mediana Edad , Estimulación Eléctrica Transcutánea del Nervio/métodos , Infecciones Urinarias/etiología , Infecciones Urinarias/terapia
18.
Int J Clin Oncol ; 24(12): 1558-1564, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31332612

RESUMEN

BACKGROUND: The effectiveness of perioperative oral management in gastrointestinal surgery remains unclear. To elucidate the clinical significance of oral care, we investigated the relationship between the oral environment and postoperative infectious complications (POICs) in patients undergoing gastrointestinal surgery. METHODS: This was a single-institute and historical cohort study of 341 patients. The participants were isolated from consecutive patients undergoing planned radical resection for gastrointestinal carcinoma from January 2016 to June 2017. Dentists assessed the oral environment for periodontal disease, hygiene status, dry mouth, fur on tongue, and tooth stumps. All patients received scaling and tooth brushing instructions. A stepwise logistic regression analysis was conducted to identify risk factors for POICs among the different oral statuses. RESULTS: The surgical procedures performed were gastrectomy in 123 (36.1%), colorectal resection in 185 (54.2%), and pancreatoduodenectomy or others in 38 (11.1%). POICs occurred in 48 patients (14.1%), including deep organ space infection in 20, surgical site infection in 11, anastomotic leakage in 5, urinary tract infection in 4, pneumonia in 2, and others in 6. After adjusting for confounding factors, periodontal disease was isolated as an independent risk factor for POICs (odds ratio 2.091, p = 0.037, 95% confidence interval 1.045-4.183). Other variables of oral environment such as hygiene status, dry mouth, fur on tongue, and tooth stumps did not have a significant impact on POICs. CONCLUSIONS: Periodontal disease is a risk factor for infectious complications after gastrointestinal surgery.


Asunto(s)
Gastrectomía/efectos adversos , Neoplasias Gastrointestinales/cirugía , Enfermedades Periodontales/complicaciones , Complicaciones Posoperatorias/etiología , Anciano , Profilaxis Antibiótica , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Periodontales/terapia , Neumonía/etiología , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Resultado del Tratamiento , Infecciones Urinarias/etiología
19.
BMJ Case Rep ; 12(7)2019 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-31315842

RESUMEN

Pelvic organ prolapse (POP), the transvaginal descent of pelvic organs, can cause mild hydronephrosis but rarely leads to a deterioration in kidney function. We present a case of severe uterovaginal prolapse that caused bilateral ureteral obstruction and led to renal failure and urinary tract infection. During outpatient follow-up, kidney function had already been deteriorating, but POP was not recognised as a causal factor. A longer duration of ureteral obstruction can lead to irreversible kidney damage, and therefore, timely recognition and intervention is of essence. Even in complex cases with various causative factors for kidney injury, the presence of severe POP and kidney injury should prompt the clinician to exclude this cause.


Asunto(s)
Prolapso de Órgano Pélvico/patología , Prolapso Uterino/complicaciones , Prolapso Uterino/patología , Diagnóstico Diferencial , Femenino , Humanos , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/etiología , Hidronefrosis/cirugía , Persona de Mediana Edad , Prolapso de Órgano Pélvico/cirugía , Insuficiencia Renal/etiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Obstrucción Ureteral/etiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología , Prolapso Uterino/clasificación , Prolapso Uterino/cirugía
20.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-31340946

RESUMEN

We present a rare case of association of anterior rectal duplication and posterior urethral valve (PUV). A term neonate with no antenatal concerns was admitted with urosepsis and acute renal injury at 18 days of age. History revealed a poor urinary stream and dribbling. After resuscitation and stabilisation, renal tract ultrasound and micturating cysto-urethrogram were performed. Cystourethroscopy showed PUV and a mass indenting the bladder posteriorly. MRI confirmed the presence of a cystic lesion anterior to the rectum suspicious of rectal duplication. Laparoscopic-assisted excision of the anterior rectal duplication cyst was then performed. The infant recovered uneventfully. Creatinine normalised postoperatively and has been stable at follow-up.


Asunto(s)
Anomalías Múltiples/diagnóstico por imagen , Malformaciones Anorrectales/diagnóstico por imagen , Laparoscopía/métodos , Recto/anomalías , Uretra/anomalías , Obstrucción Uretral/diagnóstico por imagen , Anomalías Múltiples/cirugía , Malformaciones Anorrectales/cirugía , Cistoscopía/métodos , Estudios de Seguimiento , Humanos , Recién Nacido , Imagen por Resonancia Magnética/métodos , Masculino , Enfermedades Raras , Recto/cirugía , Medición de Riesgo , Resultado del Tratamiento , Uretra/cirugía , Obstrucción Uretral/etiología , Obstrucción Uretral/cirugía , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/etiología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA