Ureteral Stenosis and Fistula after Kidney Transplantation.

INTRODUCTION: Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center. METHODS: Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas. RESULTS: Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948). CONCLUSION: Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival.

[Late kidney transplant complications treatment.] / Tratamiento de las complicaciones tardías del trasplante renal.

OBJECTIVES: Late kidney transplant complication might compromise graft durability, thus the need for early detection and treatment. MATERIAL AND METHODS: A PubMed review including the following MeSH terms was included: kidney transplant¨, ¨complications¨, ¨vascular complications¨,¨transplant renal artery stenosis¨, ¨ureteral obstruction¨,¨urologic complications¨, ¨forgotten stent¨, ¨vesicoureteralreflux¨, ¨urinary lithiasis¨ e ¨incisional hernia¨. Metanalysis and systematic review in spanish and English were included from January 2015 till February 2021, as well as relevant selected manuscripts. RESULTS: We defined as late complications those appearing at 3 months from kidney transplant. Those include vascular complications (renal artery stricture), urinary tract (ureteral stricture, permanent double Js, pyelonephritis due to reflux, urinary stones) and abdominal wall (incisional hernia). CONCLUSIONS: Late kidney transplant complications remain high still with advancement on surgical technique and immunotherapy. Those complication might compromise the graft durability and so early detection is or primary importance.

OBJETIVO: Las complicaciones tardías del trasplante renal pueden comprometer de manera importante la viabilidad del injerto, por lo que debemos detectarlas y tratarlas de manera precoz.MATERIAL Y MÉTODOS: Realizamos una revisión bibliográfica en PubMed utilizando los términos MeSH ¨kidney transplant¨, ¨complications¨, ¨vascular complications¨, ¨transplant renal artery stenosis¨, ¨ureteralobstruction¨, ¨urologic complications¨, ¨forgotten stent¨,¨vesicoureteral reflux¨, ¨urinary lithiasis¨ e ¨incisionalhernia¨. Se incluyeron metaanálisis, revisiones y revisiones sistemáticas en inglés y español, desde enero de2015 hasta febrero de 2021, así como las referencias más relevantes incluidas en los artículos seleccionados. RESULTADOS: Definimos como complicaciones tardías aquellas que suelen aparecer a partir del tercer mes trasla realización del trasplante. Dentro de ellas se incluyen complicaciones vasculares (estenosis de la arteria renal), de la vía urinaria (estenosis ureteral, catéteres ureterales no retirados, pielonefritis secundarias a reflujovesico-ureteral y litiasis urinaria) y de pared (hernia incisional). CONCLUSIONES: A pesar de los avances, tanto médicos (inmunosupresión) como en la técnica quirúrgica, en el trasplante renal, todavía son frecuentes las complicaciones a largo plazo. Estas complicaciones pueden comprometer la viabilidad del injerto renal, lo que hace necesario que sean detectadas lo antes posible, y no demorar su tratamiento.

Tratamiento de las complicaciones tardías del trasplante renal / Treatment of late complications of renal transplantation

Objetivo: Las complicaciones tardíasdel trasplante renal pueden comprometer de maneraimportante la viabilidad del injerto, por lo que debemosdetectarlas y tratarlas de manera precoz.Materiales y métodos: Realizamos una revisión bibliográfica en PubMed utilizando los términos MeSH ̈kidney transplant ̈, ̈complications ̈, ̈vascular complications ̈, ̈transplant renal artery stenosis ̈, ̈ureteralobstruction ̈, ̈urologic complications ̈, ̈forgotten stent ̈, ̈vesicoureteral reflux ̈, ̈urinary lithiasis ̈ e ̈incisionalhernia ̈. Se incluyeron metaanálisis, revisiones y revisiones sistemáticas en inglés y español, desde enero de2015 hasta febrero de 2021, así como las referenciasmás relevantes incluidas en los artículos seleccionados. Resultados: Definimos como complicaciones tardíasaquellas que suelen aparecer a partir del tercer mes trasla realización del trasplante. Dentro de ellas se incluyen complicaciones vasculares (estenosis de la arteriarenal), de la vía urinaria (estenosis ureteral, catéteresureterales no retirados, pielonefritis secundarias a reflujo vesico-ureteral y litiasis urinaria) y de pared (herniaincisional).Conclusiones: A pesar de los avances, tanto médicos (inmunosupresión) como en la técnica quirúrgica,en el trasplante renal, todavía son frecuentes las complicaciones a largo plazo. Estas complicaciones puedencomprometer la viabilidad del injerto renal, lo que hacenecesario que sean detectadas lo antes posible, y nodemorar su tratamiento.(AU)

Objetives: Late kidney transplant complication might compromise graft durability, thus theneed for early detection and treatment.Material and methods: A PubMed review including the following MeSH terms was included: kidneytransplant ̈, ̈complications ̈, ̈vascular complications ̈, ̈transplant renal artery stenosis ̈, ̈ureteral obstruction ̈, ̈urologic complications ̈, ̈forgotten stent ̈, ̈vesicoureteral reflux ̈, ̈urinary lithiasis ̈ e ̈incisional hernia ̈. Metanalysis and systematic review in spanish and Englishwere included from January 2015 till February 2021,as well as relevant selected manuscripts. Results: We defined as late complications those ap-pearing at 3 months from kidney transplant. Those include vascular complications (renal artery stricture),urinary tract (ureteral stricture, permanent double Js, pyelonephritis due to reflux, urinary stones) and abdominalwall (incisional hernia).Conclusions: Late kidney transplant complicationsremain high still with advancement on surgical techniqueand immunotherapy. Those complication might compromise the graft durability and so early detection is or primary importance.(AU)

Iterative renal transplantation: our experience on third transplants.

PURPOSE: To report our experience on third kidney transplantation, analyzing the complications and graft survival rates as compared to previous transplants. METHODS: Retrospective study of third renal transplants performed at our center. Outcomes were compared with a cohort of first and second transplants. RESULTS: Of a total of 4143, we performed 72 third transplants in 46 men and 26 women with an average age of 46 years and mean time on dialysis of 70 months. Thirty-seven patients were hypersensitized [panel-reactive antibody (PRA) > 50%]. They were all from deceased donors, with a mean cold ischemia time of 19.2 h. The extraperitoneal heterotopic approach was used in 88.8%, transplantectomy was performed in 80.6% and vascular anastomoses were realized mostly to external iliac vessels, using the common iliac artery in 15 cases, and the inferior vena cava in 16. The main ureteral reimplantation technique was the Politano-Leadbetter (76.4%). Third transplantation reported a significantly higher incidence of lymphocele (13.9% vs. 3.2% in first and 4.5% in second transplants; p < 0.001), rejection (34.7% vs. 14.9% and 20.5%, p < 0.001) and urinary obstruction (11.1% vs. 3.6% and 6.3%, p 0.002). Graft survival rates for first, second and third transplants were 87%, 86% and 78% at 1 year, 83%, 82% and 74% at 3 years and 80%, 79% and 65% at 5 years, respectively. CONCLUSION: Iterative transplantation constitutes a valid therapeutic option with adequate surgical and survival results compared to previous transplants. It is a challenging procedure which must be performed by experienced surgeons.

Seizures and Neuropsychiatric Toxicity in Patients with Non-Metastatic CRPC Treated with New Antiandrogens: Systematic Review and Meta-Analysis.

INTRODUCTION: Recently, enzalutamide, apalutamide, and darolutamide have shown benefits in metastasis-free survival in non-metastatic castration-resistant prostate cancer (nmCRPC) patients compared to placebo. Previous evidence about the safety profile of these new androgens is limited. This meta-analysis studies seizure and neuropsychiatric effects of new anti-androgens compared to placebo in nmCRPC patients. METHODS: PubMed and Cochrane databases were systematically reviewed until 1 March 2020 by 2 independent researchers using a pre-specified search strategy. Placebo-compared randomized controlled trials (RCTs) of nmCRPC patients treated with new anti-androgens providing data on neuropsychiatric events and seizures were included. Variables were seizure, headache, mental impairment, and dizziness. Pooled risk ratios (RR) were calculated using the Mantel-Hansel random effects model and Review Manager v5.3 software. RESULTS: After systematic review, 3 eligible RCTs were selected that included 4,104 patients; 2,687 comprised the treatment group and 1,417 the control group. No significant increase in RR for seizures was registered with the new anti-androgens compared to placebo (RR 1.96; 95% confidence interval [CI] 0.40-9.61). However, 2 trials excluded patients with risk factors or a history of seizures. There was also no significant increase RR for grade ≥3 seizures (RR 2.50; 95% CI 0.12-52.02). RR for suffering dizziness (any grade) was 1.57 (95% CI 1.07-2.32) with the new anti-androgens, but no significant differences were found in the other study regarding neuropsychiatric events or grade ≥3 events. CONCLUSIONS: New anti-androgens (i.e., enzalutamide, apalutamide, and darolutamide) are acceptably safe in terms of seizures and neuropsychiatric toxicity compared to placebo in patients with nmCRPC.

Critical analysis of a multicentric experience with holmium laser enucleation of the prostate for benign prostatic hyperplasia: outcomes and complications of 10 years of routine clinical practice.

OBJECTIVE: To assess the perioperative outcomes of holmium laser enucleation of the prostate (HoLEP) in real-life practice and investigate the factors influencing the safety and effectiveness of the technique. PATIENTS AND METHODS: Critical analysis of patients with benign prostate hyperplasia (BPH) treated with HoLEP over 10 years of routine practice in three hospitals. Analysed variables included: preoperative characteristics (prostate size, active antiplatelet/anticoagulant therapy, blood parameters. prostate-specific antigen (PSA) level, maximum urinary flow rate [Qmax ], and International Prostate Symptom Score [IPSS]), intraoperative variables (operation time, concomitant removal of bladder calculi, and complications), early postoperative outcomes (change in blood parameters, catheterisation time, and hospital stay), and 12-month follow-up outcomes (change in IPSS, PSA level, and Qmax ). RESULTS: The analysis included 963 patients, aged 48-91 years, with a mean (range) prostate size of 91 (35-247) mL. The mean (sd) operation time was 77 (29) min, and the hospital stay and catheterisation time were 4 (2) and 1.3 (2) days, respectively. In all, 56 patients (5.6%) required concomitant removal of bladder calculi and 36 (3.7%) were converted to open prostatectomy or transurethral resection of the prostate due to intraoperative complications. Patients had a significant decrease in haemoglobin and haematocrit, but no differences were seen between patients with and without anticoagulant/antiplatelet therapy and those with prostates ≥ and <100 mL. The concomitant removal of bladder calculi and having a prostate ≥100 mL resulted in a longer operation time, but did not influence the safety and effectiveness outcomes. CONCLUSIONS: HoLEP is suitable for real-life patients with BPH, irrespective of the presence of active treatment with anticoagulant/antiplatelet, bladder lithiasis or a prostate ≥100 mL.

Assessment of the influence of transrectal and transperineal prostate biopsies on erectile function: A prospective observational single-center study.

OBJECTIVES: To assess the impact of transrectal versus transperineal prostate biopsy on erectile function. METHODS: This was a single-center, observational, prospective study of consecutive patients who underwent a prostate biopsy (transrectal or transperineal/fusion biopsy). Study participants completed the International Index of Erectile Function-5 questionnaire before the procedure, and 3 and 6 months after. Prostatic biopsies were carried out following the standard procedure for both techniques. RESULTS: The study included 135 male patients with a mean age of 63.5 years. At baseline, 28 patients (21%) presented normal erectile function, whereas 107 patients (82%) presented erectile dysfunction, which was severe in four (3%), moderate in 49 (36%) and mild in 54 (40%), with an overall mean International Index of Erectile Function-5 score of 17.70. After 3 months, the rates were 29%, 3%, 27% and 38%, respectively (mean International Index of Erectile Function-5 score 17.95). At 6 months, the rates were 30%, 6%, 28% and 34%, respectively (mean International Index of Erectile Function-5 score of 17.77). No significant differences between pre- and post-biopsy International Index of Erectile Function-5 scores at 3 and 6 months were observed, even when analyzing transrectal and transperineal separately. The number of biopsy cores and number of previous biopsies did not influence the International Index of Erectile Function-5 scores. CONCLUSIONS: Our findings suggest that prostate biopsy technique, number of biopsy cores and history of previous biopsy do not significantly impact erectile function in the medium term up to 6 months.

Factors Influencing Intraoperative Blood Loss in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Large Multicenter Analysis.

OBJECTIVE: To assess blood loss during holmium laser enucleation of the prostate (HoLEP) and investigate the factors influencing it. PATIENTS AND METHODS: Analysis of patients with benign prostatic hyperplasia (BPH) treated with HoLEP at 3 centers. Hemoglobin and hematocrit were measured before surgery and hospital discharge. All blood transfusions performed during and after HoLEP were recorded. Blood loss outcomes were analyzed regarding antithrombotic (antiplatelet/anticoagulant) therapies and drug treatments for BPH and other conditions. RESULTS: The analysis included 963 patients with a mean age of 72 years. Mean (range) prostate size was 102 (40-316) g; 28% of patients were receiving antiplatelets and 11% anticoagulants. Mean (range) prostate-specific antigen was 6.0 (0.3-43.5) ng/dL. Mean (range) operation time was 77 (28-178) minutes. Bladder calculi were found in 54 (5.6%) patients; all of them were successfully treated with cystolitholapaxy. Forty-eight (5%) patients required blood transfusion during or immediately after the HoLEP procedure. Overall, mean (SD) hemoglobin decreased from 14.6 (1.5) g/dL to 12.3 (2.1) g/dL (P <.001), and mean (SD) hematocrit decreased from 44.3% (4.7) to 37.7% (6.5) (P <.001). Neither hemoglobin nor hematocrit decreases were significantly different between patients receiving and not receiving antithrombotic therapy or BPH therapy. CONCLUSION: HoLEP is safe and has no remarkable impact on blood loss. Patients at high risk, such as those receiving antithrombotic therapy, had the same outcome than the rest regarding blood loss, although showed a higher transfusion rate. Operating time may influence hemoglobin decrease; therefore, it should be considered in patients with higher risk of bleeding.

Analysis of Holmium Laser Enucleation of the Prostate in a High-Volume Center: The Impact of Concomitant Holmium Laser Cystolitholapaxy.

Purpose: To assess the influence of holmium laser cystolitholapaxy (HLC) concomitantly with holmium laser prostate enucleation (HoLEP) on patients with benign prostatic hyperplasia (BPH) presenting bladder calculi. Materials and Methods: We present a retrospective analysis of patients with BPH (with or without concomitant HLC) at three Spanish centers. Intraoperative variables (e.g., time and resected tissue), changes in functional parameters of the prostate, and frequency of complications (intraoperative, early postoperative, and at 12 months) in patients with and without HLC were compared. Results: The analysis included 963 patients aged 48 to 91 years, of which 54 (5.6%) underwent HLC to treat vesical lithiasis. Mean (range) prostate size (measured by transrectal ultrasound) was 79 (43-173) g and 91 (35-247) g for patients with and without concomitant HLC, respectively (p = 0.080). All bladder calculi were effectively removed. No significant differences were found regarding enucleation and morcellation times, but total operation time was significantly higher in patients with HLC: mean (standard deviation [SD]) of 78 (27) minutes vs 95 (41) minutes (p < 0.001). Three patients underwent conversion to open surgery because of bladder perforation, all of them from the group without HLC. Rates of intraoperative, early, and 12-month complications were similar in both groups. No significant differences in International Prostate Symptom Scale, maximum flow rate (Qmax), and mean flow were observed between groups 12 months after surgery. Conclusions: Simultaneous HoLEP and HLC increases the total operation time, but does not influence the risk of clinically relevant perioperative and postoperative complications.

Healthcare-Associated Infections after Lower Urinary Tract Endoscopic Surgery: Analysis of Risk Factors, Associated Microorganisms and Patterns of Antibiotic Resistance.

OBJECTIVES: To review the incidence of healthcare-associated infections/urinary tract infection (UTI), risk factors, microorganisms isolated and antibiotic resistances in patients who underwent lower urinary tract endoscopic surgery (LUTES) in a tertiary care hospital. METHODS: A prospective observational study was carried out including 1,498 patients who undergo LUTES. Patients with and without UTI after surgery were compared. We analysed infection incidence, risk factors, microorganisms isolated and antibiotic resistances. RESULTS: Postoperative UTI incidence was 4.7%. Risk factors found: higher American Society of Anesthesiologists classification (OR 2.82; 95% CI 1.8-4.5; p < 0.00), immunosuppression (OR 2.89; 95% CI 1.2-7.2; p = 0.01), indwelling urinary catheter prior admission (OR 2.6; 95% CI 1.6-4.2; p < 0.00) and postoperative catheterization longer than 2 days (OR 1.74; 95% CI 1.7-4.3; p < 0.00). Transurethral resection of the bladder (TURB) had the highest infection rates (5.5%). Microorganisms isolated were Pseudomonas aeruginosa (23.5%), Escherichia coli (17.6%), Klebsiella pneumoniae and Enterococcus spp (11.8%). Resistance rates for flourquinolones varied between 28 and 80%, and Carbapenem-resistant Enterobacteriaceae rose up 20%. CONCLUSIONS: Low percentage of UTI after endoscopic surgery was registered. TURB was the procedure with highest infection rate. Pseudomonas aeruginosa stands out as the most frequently isolated microorganism. Patient comorbidities, previous urinary catheter and postoperative catheter were identified as risk factors.

[Maximal androgen deprivation with abiraterone acetate in hormone sensitive prostate cancer.] / Supresión androgénica máxima con acetato de abiraterona en cáncer de próstata hormonosensible.

OBJECTIVES: The treatment of metastatic prostate cancer has remained unchanged for more than 70 years, based on androgen deprivation therapy (ADT). In 2015, following the CHAARTED and STAMPEDE trials, it was established that the addition of 6 cycles of docetaxel to ADT was associated with significantly increased survival. In June 2017, the LATITUDE trial and the G arm of the STAMPEDE trial showed that the addition of Abiraterone with Prednisone (5 mg/day) to ADT was also associated with a significant increase in survival in metastatic patients. The present study analyzes these two trials. RESULTS: LATITUDE demonstrated a 38% reduction in the risk of death (HR=0.62, 95% CI, 0.61-0.76) in almost all sub-groups. Risk reduction for radiological progression was 53% (HR=0.47, 95% CI 0.39-0.55). Secondary objectives such as prostate specific antigen progression, time to chemotherapy or a new skeletal event are also significantly delayed. STAMPEDE also showed that the combination of Abiraterone and Prednisone is associated with a 37% increase in survival (HR=0.63, 95% CI, 0.52- 0.76, p<0.001) in metastatic patients, but not in nonmetastatic patients. Progression-free survival was greatly improved in this arm (HR=0.29, 95% CI 0.25-0.34, p<0.001). The side effects reported show the known pattern of mineral corticosteroid excess with increased blood pressure, hypokalemia, and of liver enzymes elevation. CONCLUSIONS: The indirect comparison of docetaxel and abiraterone studies confirms that both populations and results are comparable. Two comparative indirect metanalysis (>6000 patients) gave marginal superiority to abiraterone. In favor of abiraterone we have that it is an oral, comfortable medication with a good tolerance profile and side effects that are easy to manage, useful in patients who are old and fragile, in whom chemotherapy may not be indicated; the downsides are prolonged exposure to the drug and its current price. Future trials, currently in progress, will determine the ideal patient profile, or a potential association of both therapies.

Supresión androgénica máxima con acetato de abiraterona en cáncer de próstata hormonosensible / Maximal androgen deprivation with abiraterone acetate in hormone sensitive prostate cancer

OBJETIVO: El tratamiento del cáncer de próstata (CP) metastático ha permanecido inalterado durante más de 70 años fundamentado en la deprivación androgénica (DA). En 2015, a raíz de los estudios CHAARTED y STAMPEDE se estableció que la adición de 6 ciclos de docetaxel a la DA se asociaba significativamente con incremento de la supervivencia. En junio de 2017 los estudios LATITUDE y el brazo G del STAMPEDE demuestran que la adición de Abiraterona junto con Prednisona (5 mg/día) a DA se asocia también a un incremento significativo de supervivencia en los pacientes metastáticos. El presente trabajo analiza estos dos estudios. RESULTADOS: LATITUDE demostró una reducción relativa del riesgo de muerte del 38% (HR=0,62, 95% IC, 0,61-0,76) patente en la práctica totalidad de subgrupos. La reducción del riesgo relativo de progresión radiológica fue del 53 % (HR=0,47,IC 95% 0,39-0,55). Los objetivos secundarios como progresión de PSA, tiempo a quimioterapia o a nuevo evento esquelético también son significativamente retrasados. STAMPEDE también demuestra que la combinación con Abiraterona+prednisolona se asocia a un incremento relativo de SV del 37% (HR=0,63;95% IC, 0,52-0,76; p < 0,001) en pacientes M1, no así en los M0. La supervivencia libre de progresión fue muy mejorada en este brazo (HR=0,29;95% IC 0,25-0,34, p < 0,001). Los efectos secundarios referidos muestran el patrón conocido de exceso mineralcorticoide con incremento de HTA, hipokaliemia y elevación de enzimas hepáticas. CONCLUSIONES: La comparación indirecta de los trabajos de docetaxel y abiraterona confirma que tanto poblaciones, como resultados, son superponibles. Dos meta-análisis indirectos comparativos (>6000 pacientes) otorgan beneficio marginal a abiraterona. A favor de Abiraterona juega el ser una medicación oral, cómoda, con buen perfil de tolerancia y efectos secundarios de fácil manejo, útil en pacientes con frecuencia añosos y frágiles en los que la QT pudiera no estar indicada, aún a costa de una exposición al fármaco es más prolongada y de su actual precio. Futuros ensayos, en curso, determinará el perfil de pacientes idóneo, su posicionamiento en el tiempo o una potencial asociación de ambos

OBJECTIVES: Prostate cancer is linked to bone disease by two different entities. On one hand, androgen deprivation therapy (ADT) usually causes osteoporosis, on the other a great number of patients with advanced prostate cancer will present bone bicametastases, that condition not only their vital prognosis but also an important quality of life deterioration. METHODS: We performed a bibliographic review on both the physiology and therapy of osteoporosis secondary to ADT and bone metastasis in prostatic neoplasias. RESULTS: Osteoporosis: Long term ADT is associated with osteopenia/osteoporosis in 80% of the patients, with a 5-20% incidence of osteoporotic fractures. We should monitor bone mineral density before starting ADT therapy and during treatment. Treatment is based on risk factors reduction, regular physical exercise, calcium and vitamin D supplements, and drugs such as biphosphonates or denosumab. Bone metastasis: Currently, both zolendronic acid and denosumab have approval for the prevention of skeletal events in patients with castration resistant prostate cancer (CPRC). Although the last one seems to be more effective, it is associated with a higher risk of hypocalcemia and jaw osteonecrosis so that the choice of drug must be individualized in every patient. The duration of treatment is not clear. Currently, the indication for the use of this drugs in earlier phases of advanced disease is not approved. CONCLUSIONS: Comprehensive management of the patient with advanced prostate cancer should include the study and treatment of osteoporosis and bone metastases. Currently, very effective therapies are available for both entities

Infecciones del tracto urinario de origen hospitalario en pacientes portadores de catéter urinario: factores de riesgo, características microbiológicas y resistencias a antibióticos / Healthcare-associated urinary tract infections in patients with a urinary catheter: Risk factors, microbiological characteristics and patterns of antibiotic resistance

OBJETIVO: Las infecciones del tracto urinario asociadas a catéteres urinarios (ITU-AC) son la causa más frecuente de infección nosocomial, presentando altas tasas de resistencias. Están asociadas a complicaciones potencialmente severas, implicando mayor coste económico. Nuestro objetivo fue analizar las características de las ITU nosocomiales asociadas a catéter urinario en un Servicio de Urología. MÉTODOS: Llevamos a cabo un estudio prospectivo desde Noviembre de 2011 hasta Octubre de 2013, evaluando la incidencia de infecciones nosocomiales asociadas a los catéter de derivación urinaria en una planta de hospitalización urológica. Además evaluamos los factores de riesgo como comorbilidades, sondaje previo al ingreso y cirugía durante la hospitalización. Se presentan los patrones microbiológicos y tasas de resistencia de los gérmenes aislados. RESULTADOS: La incidencia de ITU-AC nosocomial fue de 8,2% (189/2283 pacientes portadores d e catéteres urinarios). La edad media fue de 67,4 ± 14,26 años, el 90,2% fueron sometidos a un procedimiento quirúrgico (p< 0,001), 14,8% tenían litiasis urinaria (p = 0,058) y el 46% portaban cateterismo urinario previo al ingreso (p < 0,001). Los microorganismos más frecuentemente aislados fueron Escherichia coli (22,6%), Enterococcus (21,9%) y Pseudomonas aeruginosa (13,9%). E.coli mostró una resistencia de 41,9% para quinolonas y un 33,3% fueron productores de β-lactamasas de espectro extendido (ESBL). P.aeruginosa presentaba 42,1% de resistencias a quinolonas y hasta un 21,1% a carbapenems. CONCLUSIONES: Portar un catéter urinario previo al ingreso y la realización de un procedimiento quirúrgico urológico durante el ingreso son factores de riesgo de ITU nosocomial en pacientes ingresados en el Servicio de Urología. Existe una elevada incidencia de gérmenes resistentes y de patógenos no clásicos como Enterococcus spp

OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial acquired infections, with high resistance rates. CAUTIs are a potentially severe complication in hospitalized patients and imply higher costs. Our aim was to analyze the characteristics of CAUTIs in our Urology department. METHODS: Between November 2011 and October 2013, a prospective observational study was carried out analyzing the incidence of healthcare-associated urinary tract infections in patients admitted to the urology ward with an indwelling urinary catheter. Furthermore, we evaluated associated risks factors and comorbidities such as urinary catheter at the time of admission or urological surgery during the hospitalization. We also presented our results regarding the microbiological characteristics and patterns of resistance to antibiotics in patients with CAUTI admitted in our service. RESULTS: The incidence of CAUTI was 8.2% (189/2283 patients who had urinary catheter). Mean age was 67.4 ± 14.26 years, 90.2% underwent a surgical procedure (p < 0.001), 14.8% had a urinary stone (p = 0.058) and 46% had a urinary catheter before admission (p < 0.001). The most commonly isolated pathogens were Escherichia coli (22.6%), Enterococcus (21.9%) and Pseudomonas aeruginosa (13.9%). E.coli showed resistance rates of 41.9% for quinolones, 33.3% of them produced extended spectrum βeta-lactamase (ESBL). P.aeruginosa showed resistance rates of 42.1% for quinolones and 21.1% for carbapenems. CONCLUSIONS: Healthcare-associated CAUTI in patients hospitalized in a urology ward are related to risks factors such as having a urinary catheter before admission and undergoing a surgical procedure. Moreover, CAUTIs have higher incidence of pathogens with antibiotic resistances and non-common pathogens such as Enterococcus spp

[Healthcare-associated urinary tract infections in patients with a urinary catheter: Risk factors, microbiological characteristics and patterns of antibiotic resistance]. / INFECCIONES DEL TRACTO URINARIO DE ORIGEN HOSPITALARIO EN PACIENTES PORTADORES DE CATÉTER URINARIO: FACTORES DE RIESGO, CARACTERÍSTICAS MICROBIOLÓGICAS Y RESISTENCIAS A ANTIBIÓTICOS.

OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial acquired infections, with high resistance rates. CAUTIs are a potentially severe complication in hospitalized patients and imply higher costs. Our aim was to analyze the characteristics of CAUTIs in our Urology department. METHODS: Between November 2011 and October 2013, a prospective observational study was carried out analyzing the incidence of healthcare-associated urinary tract infections in patients admitted to the urology ward with an indwelling urinary catheter. Furthermore, we evaluated associated risks factors and comorbidities such as urinary catheter at the time of admission or urological surgery during the hospitalization. We also presented our results regarding the microbiological characteristics and patterns of resistance to antibiotics in patients with CAUTI admitted in our service. RESULTS: The incidence of CAUTI was 8.2% (189/2283 patients who had urinary catheter). Mean age was 67.4±14.26 years, 90.2% underwent a surgical procedure (p<0.001), 14.8% had a urinary stone (p=0.058) and 46% had a urinary catheter before admission (p<0.001). The most commonly isolated pathogens were Escherichia coli (22.6%), Enterococcus (21.9%) and Pseudomonas aeruginosa (13.9%). E.coli showed resistance rates of 41.9% for quinolones, 33.3% of them produced extended spectrum Β-lactamase (ESBL). P.aeruginosa showed resistance rates of 42.1% for quinolones and 21.1% for carbapenems. CONCLUSIONS: Healthcare-associated CAUTI in patients hospitalized in a urology ward are related to risks factors such as having a urinary catheter before admission and undergoing a surgical procedure. Moreover, CAUTIs have higher incidence of pathogens with antibiotic resistances and non-common pathogens such as Enterococcus spp.

Semen Quality Assessment in Fertile Men in Madrid During the Last 3 Decades.

OBJECTIVE: To evaluate semen quality of men with proven fertility in Spain over the last 3 decades. METHODS: We conduct a retrospective analysis of ejaculate samples of 992 men between 1985 and 2009. All patients had proven fertility as demonstrated by fathering at least 2 children and a semen analysis performed before they underwent vasectomy. A standardized procedure was used for the semen analysis. Semen volume, total sperm count, sperm concentration, motility, and percentage of morphologically normal spermatozoa were assessed. Mean values were calculated by examining microscopic fields of 100 spermatozoa. RESULTS: Statistically significant differences were found in all semen parameters analyzed. For the periods 1985-1990, 1990-2000, and 2000-2009, the mean (standard deviation [SD]) sperm concentration was 27.7 (22.97), 20.73 (14.79), and 20.18 (20.79) × 10(6) (P <.0001). The mean (SD) progressive motility for each period was 53.19 (20.35), 47.22 (15.84), and 40.57 (15.15; P <.0001). The mean (SD) normal-shaped spermatozoa for each period was 67.69 (10.24), 58.87 (14.67), and 51.02 (15.76; P <.0001). Multivariate analysis using a logistic regression model showed that age had no significant effect in the variation of semen parameters at the cut-points analyzed, except for normal forms at percentile 25 (P = .001). Multivariate analysis revealed a trend for decline of semen in sperm concentration, progressive and nonprogressive motility, and the percentage of morphologically normal spermatozoa (P = .001-.002). CONCLUSION: Over the last 3 decades, a decline in semen quality was found in all the parameters analyzed in Spanish men with proven fertility.

Healthcare-associated infections in a department of urology: incidence and patterns of antibiotic resistance.

OBJECTIVE: Healthcare-associated infections (HAIs) constitute a potentially severe complication which implies higher costs. A full knowledge of their microbiological characteristics and risk factors is of paramount importance for adequate management. The purpose of this study was to carry out an analysis of HAIs in patients admitted to a department of urology. MATERIAL AND METHODS: Between November 2011 and October 2012, a prospective observational study was carried out analysing HAIs in patients admitted to the urology department of a tertiary care university hospital in Spain, reviewing the incidence and types of HAIs, the microorganisms isolated and patterns of resistance to antibiotics. Risk factors for HAIs were also evaluated. RESULTS: HAIs were seen in 110 (6.5%) out of 1701 patients. Hypertension, a higher American Society of Anesthesiologists (ASA) score and surgery showed a statistical association with a higher risk of HAIs, and patients who underwent radical cystectomy had a high incidence of HAIs (10 out of 14). The most common HAIs were urinary tract infections (66.1%), followed by surgical site infections (16.5%), intra-abdominal abscesses (10.4%) and venous catheter-associated bacteraemia (6.1%). The most frequently isolated microorganisms were Escherichia coli (31.8%), then Enterococcus (17.6%) and Pseudomonas (12.9%). Escherichia coli showed resistance rates of 48.1% for ampicillin/amoxicillin plus ß-lactamase inhibitor, 51.9% for fluoroquinolones, and 33.3% were extended-spectrum ß-lactamase-producing E. coli. Pseudomonas aeruginosa showed a resistance rate of 36.4% for fluoroquinolones and carbapenems. CONCLUSIONS: HAIs usually occur in patients with risk factors. Radical cystectomy is associated with a high incidence of HAIs. Microorganisms associated with HAIs show high rates of resistance, which must be taken into account when selecting appropriate antibiotic therapy.