New Perspectives on the Role of Liquid Biopsy in Bladder Cancer: Applicability to Precision Medicine.

Bladder cancer (BC) is one of the most common tumors in the world. Cystoscopy and tissue biopsy are the standard methods in screening and early diagnosis of suspicious bladder lesions. However, they are invasive procedures that may cause pain and infectious complications. Considering the limitations of both procedures, and the recurrence and resistance to BC treatment, it is necessary to develop a new non-invasive methodology for early diagnosis and multiple evaluations in patients under follow-up for bladder cancer. In recent years, liquid biopsy has proven to be a very useful diagnostic tool for the detection of tumor biomarkers. This non-invasive technique makes it possible to analyze single tumor components released into the peripheral circulation and to monitor tumor progression. Numerous biomarkers are being studied and interesting clinical applications for these in BC are being presented, with promising results in early diagnosis, detection of microscopic disease, and prediction of recurrence and response to treatment.

Evaluation of Quality of Life and Self-reported Complications in Patients With Clean Intermittent Catheterization: An Observational Study.

PURPOSE: This study sought to determine health-related quality of life and self-reported complications associated with clean intermittent catheterization (CIC). DESIGN: Observational, cross-sectional study. SUBJECTS AND SETTING: The target population was patients cared for by the urology department at Hospital 12 de Octubre in Madrid, Spain, undergoing CIC for chronic urinary retention of any etiology (neurogenic bladder dysfunction, neobladder, and other). The sample comprised 50 respondents with a mean age of 49 years; a majority (66%, n = 33) were female. Participants performed an average of 4 CICs. METHODS: All participants completed the ISC-Q (Intermittent Self-Catheterization Questionnaire) and a questionnaire about CIC-associated complications. Data were collected in February 2019. RESULTS: A vast majority of respondents (98%, n = 49) indicated preparation for catheterization was simple, and 76% (n = 38) indicated the catheter was easy to insert. One in 5 (20%, n = 10) considered carrying catheters and supplies inconvenient, though 58% (n = 29) indicated it was easy to dispose of the catheters outside the home. Most respondents (98%, n = 49) indicated they felt self-conscious about their need to self-catheterize, and 16% (n = 8) felt that CIC created limitations when visiting friends and family. The most frequent complication was symptomatic urinary tract infections (UTIs); participants reported an average of 1.7 UTIs in the last year. Additional complications, such as epididymo-orchitis, urethral stenosis, and urethral bleeding, were reported by less than 5% (n = 2) of participants. CONCLUSIONS: Participants managed by CIC for chronic urinary retention of any cause reported acceptable levels of satisfaction with the procedure. The reported incidence of complications was low, except for UTIs.

Extrauterine Retroperitoneal Leiomyomas: 3 Case Reports and Review of the Literature.

Leiomyomas are benign mesenchymal tumors which originate from smooth muscle cells. Extrauterine leiomyomas are rare and they may arise where smooth muscle cells are found. Their diagnosis is challenging due to their heterogeneous ways of presentation. Histological analysis may reveal areas of sarcomatous differentiation; therefore, complete resection of the entire tumor is the only curative treatment. There is no adjuvant therapy proved to increase overall survival. It is essential to develop a standardized protocol, detailing how to follow up these patients since it is not reported in the literature to date; however, it is advisable to follow them because the local recurrence rate is high if small implants remain. In this review, we present 3 cases of extrauterine leiomyomas diagnosed and treated in our hospital. The management was different in each case, highlighting the heterogeneity of this condition. According to the literature, there are no solid guidelines on their management. We compare our experience with the data available to date in order to support the existing knowledge and provide our expertise for future studies.

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.

Observational study over 8-year period evaluating microbiological characteristics and risk factor for isolation of multidrug-resistant organisms (MDRO) in patients with healthcare-associated infections (HAIs) hospitalized in a urology ward.

Objective: To analyze, in a urology ward, the prevalence and characteristics of healthcare-associated infections (HAIs) due to multidrug-resistant organisms (MDRO). Methods: We carried out an observational study from 2012 to 2019, evaluating MDRO among patients with HAIs, who were hospitalized in the urology ward. MDRO include Pseudomonas spp., resistant to at least three antibiotic groups, extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae or those resistant to carbapenems, and Enterococcus spp. resistant to vancomycin. Results: Among patients with HAIs, MDRO were isolated in 100 out of 438 (22.8%) positive cultures. Univariate and multivariate analyses reported that prior urinary tract infection (UTI) [OR 2.45; 95% CI 1.14-5.36; p=0.021] and immunosuppression [OR 2.13; 95% CI 1.11-4.10; p=0.023] were risk factors for MDRO. A high prevalence of MRDO was found in patients with a catheter in the upper urinary tract; 27.6% for double J stent, 29.6% in those with a nephrostomy tube, and 50% in those with a percutaneous internal/external nephroureteral (PCNU) stent. MDRO were isolated in 28.4% of cultures with Enterobacteriaceae (23.8% and 44.7% in those with E. coli and Klebsiella spp.); 7% of Enterobacteriaceae showed resistance to carbapenems (1.3% and 10% for E. coli and Klebsiella spp., respectively). Three out of 80 Enterococcus spp. were vancomycin-resistant. The rate of Pseudomonas aeruginosa resistant to at least three antibiotic groups was 36.3%. Conclusions: The isolation of MDRO, in up to 25% of positive cultures in a urology ward, constitutes a challenge for the selection of antibiotics. MDRO are more common in immunosuppressed patients, those with previous UTIs, and those with a catheter in the upper urinary tract.

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.

Analgesic refractory colic pain: Is prolonged conservative management appropriate?

OBJECTIVES: To propose a clear definition and management pathway of patients with analgesic refractory colic pain (ARCP). PATIENTS AND METHODS: Prospective cohort study from February 2018 to February 2019 including patients with ARCP defined as ongoing renal colic pain after one dose of IV NSAID, IV paracetamol, and a parenteral opioid, given sequentially in that order. Patients were observed in-hospital under full parenteral analgesic management for 8-12 h, whenever patients had minimal or absent pain after conservative management (CM) they were discharged, and followed-up with new imaging within four weeks. If the pain was not controlled after CM, surgical management (double-J stent or ureteroscopy) was performed. We excluded patients with any other indication for urgent intervention or in cases where CM was deemed inappropriate (sepsis, acute renal failure, stones >10 mm in size, suspected concomitant urinary tract infection, bilateral ureteral stones, pregnancy, patients with a single kidney, kidney transplant recipients, difficult access to medical care or refusal to undergo CM). RESULTS: Data from 60 patients was collected. The only variable associated with an increased risk of failed CM was a history of previous renal colic (OR 3.98 [95% CI 1.14-13.84], p = 0.02). Neither gender, age, stone size, location, or hydronephrosis grade were able to predict CM failure. 41.6% of patients were successfully managed conservatively and only 8% of them required scheduled surgical management at follow-up. CONCLUSION: Our results show that a high proportion of patients with ARCP may be successfully managed conservatively with an extended observation period without complications at follow-up. These results should be replicated in a randomized controlled trial to confirm them.

Diagnóstico por imagen de la litiasis urinaria / Urinary stone imaging tests

El diagnóstico por imagen de la urolitiasis comprende un amplio grupo de técnicas, con diferentes características, limitaciones e indicaciones, que en su conjunto permiten el manejo de esta patología tan prevalente. La radiografía simple de abdomen y la ecografía son técnicas muy accesibles y económicas que combinadas presentan una aceptable sensibilidad y especificidad. Siendo ampliamente utilizadas para el seguimiento de la evolución de la enfermedad litiásica y para la valoración tras tratamientos (cirugía o LEOC). La ecografía es la técnica de elección en la población pediátrica y en gestantes. El TC se ha impuesto sobre la UIV en la valoración anatómica de la vía urinaria y la descripción de las características de la litiasis, aunque presenta una mayor exposición a radiaciones ionizantes, por lo que se está extendiendo el uso del TC de baja y ultrabaja dosis. Tratamos también en este artículo otras técnicas como la Tomosíntesis digital, la Fluoroscopia y la Gammagrafía DMSA

Imaging in urolithiasis has a wide group of techniques, with different characteristics, limitations, and indications, which together allow the management of this prevalent pathology. Plain abdominal radiography and ultrasound are very accessible and inexpensive techniques that combined present an acceptable sensitivity and specificity. They are widely used for monitoring the evolution of stone disease and for evaluation after treatments (surgery or SWL). Ultrasound is the primary radiological diagnostic tool in the pediatric population and in pregnant women. CT has prevailed over IVP in the anatomical assessment of the urinary tract and the description of the characteristics of the lithiasis, although it shows a greater exposure to ionizing radiation, so the use of low and ultra-low dose CT is spreading. In this article we also discuss other imaging techniques such as Digital tomosynthesis, Fluoroscopy and DMSA Scintigraphy

[Urinary stone imaging tests.] / Diagnóstico por imagen de la litiasis urinaria.

Imaging in urolithiasis has a wide group of techniques, with different characteristics, limitations, and indications, which together allow the management of this prevalent pathology. Plain abdominal radiography and ultrasound are very accessible and in expensive techniques that combined present an acceptable sensitivity and specificity. They are widely used for monitoring the evolution of stone disease and for evaluation after treatments (surgery or SWL). Ultrasound is the primary radiological diagnostic tool in the pediatric population and in pregnant women. CT has prevailed over IVP in the anatomical assessment of the urinary tract and the description of the characteristics of the lithiasis, although it shows a greater exposure to ionizing radiation, so the use of low and ultra-low dose CT is spreading. In this article we also discuss other imaging techniques suchas Digital to mosynthesis, Fluoroscopy and DMSA Scintigraphy.

El diagnóstico por imagen de la urolitiasis comprende un amplio grupo de técnicas, con diferentes características, limitaciones e indicaciones, que en su conjunto permiten el manejo de esta patología tan prevalente. La radiografía simple de abdomen y la ecografía son técnicas muy accesibles y económicasque combinadas presentan una aceptable sensibilidad y especificidad. Siendo ampliamente utilizadas para el seguimiento de la evolución de la enfermedad litiásica y para la valoración tras tratamientos (cirugía o LEOC). La ecografía es la técnica de elección en la población pediátrica y en gestantes. El TC se ha impuesto sobre la UIV en la valoración anatómica de la vía urinaria y la descripción de las características de la litiasis,  aunque presenta una mayor exposición a radiaciones ionizantes, por lo que se está extendiendo el uso del TC de baja y ultrabaja dosis. Tratamos también en este artículo otras técnicas como la Tomosíntesis digital, la Fluoroscopiay la Gammagrafía DMSA.

Analysis of the relationship between sexual satisfaction, erectile dysfunction, and penile vascular parameters in a cohort of patients.

BACKGROUND: Erectile dysfunction (ED) is the second sexual dysfunction affecting men. Penile duplex ultrasound (PDU) with intracavernous injection of a vasoactive agent as alprostadil or papaverine, may play an important role in differentiating psychogenic from vasculogenic ED (arterial or venooclusive) and may also have an important role in the secondary prevention of cardiovascular events. The aim of this study is to investigate the relationship between the vascular parameters and sexual satisfaction as established by a questionnaire. METHODS: Prospective, multicenter analysis of all patients who underwent a PDU between September 2018 and April 2021 in four centers, including patients who were >18 years old and underwent a PDU for ED, Peyronie's disease (PD) or other reasons, signed informed consent and completed an adapted version of the Brief Sexual Symptom Checklist (BSSC). All the patients underwent a standard technique, and from a total of 325 patients, 16 were excluded because of low testosterone levels, and 15 due to missing data. RESULTS: A total of 294 patients were included for the analysis. Significant differences were found between patients with and without ED defined by their score in the Sexual Health Inventory for Men (SHIM) questionnaire in the PSV at 10', adjusted for age (38.07 vs. 44.95 cm/s; P=0.016), and in the PSV and the EHS at 10' for sexually satisfied and non-satisfied patients, and a significant correlation with those parameters and the probability of being sexually satisfied (r=0.147, P=0.011; r=0.132, P=0.023; respectively). CONCLUSIONS: In our clinical practice we used the cut-off of >35 cm/s, that seems to be quite low looking at our results. The 10' measurement may be more sensitive in order to establish a diagnosis. BSSC questionnaire is a simple, easy-to perform tool to screen those patients at risk of developing sexual dysfunctions.

Treatment of peyronie's disease with combination of clostridium histolyticum collagenase and penile traction therapy: a prospective, multicenter, single-arm study.

The aim of this paper is to analyze our experience with intraplaque administration of collagenase from Clostridium Histolyticum (CCH) together with penile modeling for selected patients with Peyronie's disease (PD). We conducted a prospective, multicenter, single-arm study. Patients were included from October 2015 to August 2019. We carried out the I + E PROTOCOL (IMPRESS + extender). Each cycle involved administration of two injections of CCH separated 24-72 h, up to a maximum of four cycles. 24-48 h after injection patients underwent penile modeling maneuvers with the use of a PTD at home for at least 4 h a day. After each cycle, penile curvature was evaluated by the Kelami test. Mean pretreatment curvature was 57° (30-100). Eighty-seven patients underwent at least a single cycle and were eligible for analysis. Mean number of cycles administered was 2. Final average curvature after treatment, regardless of the number of cycles was 34°, with a mean reduction in curvature of -23.29° (-41%). Across the first three cycles we found statistically significant differences in the means in terms of the degrees of curvature after each cycle (p < 0.05), however this was not maintained in the fourth cycle. Statistical significance was also found when comparing the initial and final curvature after the complete treatment. We can conclude that treatment with CCH for PD is safe and effective. The concomitant use of CCH and PTT may limit the number of treatment cycles necessary to optimize outcomes when compared with CCH alone.

Role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in Peyronie's disease: a new diagnostic approach to predict the stage of the disease?

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been associated with multiple entities and several types of cancers. They can be assumed as markers of inflammatory imbalance. The objective of this study is to evaluate the NLR and PLR in Peyronie's disease (PD) and to establish a comparison of its values in the acute and chronic stages. We recruited patients with PD from March 2018 to March 2019. The patients enrolled underwent medical and sexual history as well as a physical examination. The values of blood count of each patient were collected both in the acute and chronic stages. Wilcoxon test was used to compare the acute and chronic stage ratios. Kruskal-Wallis test was carried out to evaluate the impact of treatments on the ratios. To identify cutoff values, we used sensibility and specificity tables and receiver operating characteristic (ROC) curves. A total of 120 patients were enrolled. Their mean age was 55.85 (range: 18-77) years and the mean penile curvature was 48.43° (range: 10°-100°). In the acute stage, the mean NLR was 2.35 and the mean PLR was 111.22. These ratios, in the chronic stage, were 1.57 and 100.00, respectively. Statistically significant differences between acute and stable stages for both indices were found (NLR: P< 0.0001; PLR: P= 0.0202). The optimal cutoff for classification in acute or stable stage was 2 for NLR and 102 for PLR. According to our results, with an ordinary blood count, we could have important indications regarding the disease stage of the patient, and consequently on the most appropriate type of therapy to choose.

The challenge of pseudomonas aeruginosa related infections in a Urology Ward: Epidemiology, risk factors and patterns of antibiotic resistance. / El reto de las infecciones por pseudomonas aeruginosa en un Servicio de Urología: epidemiología, factores de riesgo y patrones de resistencia a antibióticos.

OBJECTIVES: Urological patients usually come up with risk factors for developing infections. Some of these are caused by multidrug-resistant microorganisms like Pseudomonas aeruginosa, whose notable resistance rates to antibiotics and aggressiveness make its treatment a challenge in clinical practice. Our objective was to analyze Pseudomonas aeruginosa infections incidence, risk factors and features in patients admitted to a Urology Ward in a tertiary care university hospital in Spain. MATERIAL AND METHODS: We carried out a prospective observational study from 2012 to 2017, to review all infections in our Ward with a special focus on those caused by Pseudomonas aeruginosa, performing a descriptive analysis and a comparison with other causative agents. RESULTS: 78 Infections with Pseudomonas aeruginosa isolation were registered during this period. Having a catheter of the upper urinary tract (CUUT) or comorbidities and undergoing surgery, were frequently observed among these patients although the results did not reach statistically significant differences for more frequent isolation compared to other pathogens. Antibiotic resistance rates were high for cephalosporins (33.3%) and quinolones (50%), while carbapenems (24.4%), aztreonam (10.3%) and amikacin (23.1%) exhibited the best activity. No deaths related to the infection were registered. CONCLUSIONS: Pseudomonas aeruginosa is commonly isolated in patients carrying a CUUT. An early suspicion of Pseudomonas aeruginosa infection and knowledge of local antibiotic resistance pattern are of paramount importance for improving the outcomes and handling this worldwide problem.

OBJETIVOS: Los pacientes urológicos se acompañan habitualmente de factores de riesgo para el desarrollo de infecciones. Algunas de éstas son causadas por microorganismos multi-resistentes como Pseudomonas aeruginosa, cuyas notables tasas de resistencia a los antibióticos y agresividad hacen de su tratamiento un reto para la práctica clínica. Nuestro objetivo fue analizar la incidencia de infecciones por Pseudomonas aeruginosa, factores de riesgo y características en pacientes ingresados en el Servicio de Urología de un hospital universitario de tercer nivel en España.MATERIALES Y MÉTODOS: Llevamos a cabo un estudio observacional prospectivo desde 2012 hasta 2017, para revisar todas las infecciones en nuestro Servicio, con especial atención en aquellas causadas por Pseudomonas aeruginosa, haciendo un análisis descriptivo y una comparación con otros agentes causales. RESULTADOS: Durante este periodo se registraron 78 infecciones por Pseudomonas aeruginosa. Frecuentemente estos pacientes portaban un catéter del tracto urinario superior, tenían comorbilidades o se habían sometido a una intervención quirúrgica, aunque ningún factor alcanzó la significación estadística para mayor frecuencia de aislamiento de Pseudomonas aeruginosa. Las tasas de resistencia antibiótica fueron altas para cefalosporinas (33,3%) y quinolonas (50%), mientras que los carbapenémicos (24,4%), aztreonam (10,3%) y amikacina (23,1%) mostraron la mejor actividad. No se registraron éxitus relacionados con estas infecciones. CONCLUSIONES: El aislamiento de Pseudomonas aeruginosa es frecuente en portadores de catéteres del tracto urinario superior. La sospecha precoz de estas infecciones y el conocimiento de los patrones locales de resistencia a antibióticos son de vital importancia para mejorar los resultados de este problema a nivel global.

The challenge of pseudomonas aeruginosa related infections. In a urology ward: epidemiology, risk factors and patterns of antibiotic resistance / El reto de las infecciones por pseudomonas aeruginosa en un Servicio de Urología: epidemiología, factores de riesgo y patrones de resistencia a antibióticos

OBJECTIVES: Urological patients usually come up with risk factors for developing infections. Some of these are caused by multidrug-resistant microorganisms like Pseudomonas aeruginosa, whose notable resistance rates to antibiotics and aggressiveness make its treatment a challenge in clinical practice. Our objective was to analyze Pseudomonas aeruginosa infections incidence, risk factors and features in patients admitted to a Urology Ward in a tertiary care university hospital in Spain. MATERIAL AND METHODS: We carried out a prospective observational study from 2012 to 2017, to review all infections in our Ward with a special focus on those caused by Pseudomonas aeruginosa, performing a descriptive analysis and a comparison with other causative agents. RESULTS: 78 Infections with Pseudomonas aeruginosa isolation were registered during this period. Having a catheter of the upper urinary tract (CUUT) or comorbidities and undergoing surgery, were frequently observed among these patients although the results did not reach statistically significant differences for more frequent isolation compared to other pathogens. Antibiotic resistance rates were high for cephalosporins (33.3%) and quinolones (50%), while carbapenems (24.4%), aztreonam (10.3%) and amikacin (23.1%) exhibited the best activity. No deaths related to the infection were registered. CONCLUSIONS: pseudomonas aeruginosa is commonly isolated in patients carrying a CUUT. An early suspicion of Pseudomonas aeruginosa infection and knowledge of local antibiotic resistance pattern are of paramount importance for improving the outcomes and handling this worldwide problema

OBJETIVOS: Los pacientes urológicos se acompañan habitualmente de factores de riesgo para el desarrollo de infecciones. Algunas de éstas son causadas por microorganismos multi-resistentes como Pseudomonas aeruginosa, cuyas notables tasas de resistencia a los antibióticos y agresividad hacen de su tratamiento un reto para la práctica clínica. Nuestro objetivo fue analizar la incidencia de infecciones por Pseudomonas aeruginosa, factores de riesgo y características en pacientes ingresados en el Servicio de Urología de un hospital universitario de tercer nivel en España. MATERIALES Y MÉTODOS: Llevamos a cabo un estudio observacional prospectivo desde 2012 hasta 2017, para revisar todas las infecciones en nuestro Servicio, con especial atención en aquellas causadas por Pseudomonas aeruginosa, haciendo un análisis descriptivo y una comparación con otros agentes causales. RESULTADOS: Durante este periodo se registraron 78 infecciones por Pseudomonas aeruginosa. Frecuentemente estos pacientes portaban un catéter del tracto urinario superior, tenían comorbilidades o se habían sometido a una intervención quirúrgica, aunque ningún factor alcanzó la significación estadística para mayor frecuencia de aislamiento de Pseudomonas aeruginosa. Las tasas de resistencia antibiótica fueron altas para cefalosporinas (33,3%) y quinolonas (50%), mientras que los carbapenémicos (24,4%), aztreonam (10,3%) y amikacina (23,1%) mostraron la mejor actividad. No se registraron éxitus relacionados con estas infecciones. CONCLUSIONES: El aislamiento de Pseudomonas aeruginosa es frecuente en portadores de catéteres del tracto urinario superior. La sospecha precoz de estas infecciones y el conocimiento de los patrones locales de resistencia a antibióticos son de vital importancia para mejorar los resultados de este problema a nivel global

Prevention of healthcare-associated infections (HAIs) in a surgical urology ward: observational study-analysis of the problem and strategies for implementation.

PURPOSE: Our purpose is to present the results of our working group, with a view to reduce the incidence and improve the management of healthcare-associated infections (HAIs) in a urology ward. METHODS: The study consists on an observational database designed with the view to analyse the incidence and characteristics of HAIs in Urology. Based on the results obtained, a critical evaluation was carried out and specific measures put in place to reduce HAIs. Finally, the impact and results of the implemented measures were periodically evaluated. RESULTS: The incidence of HAIs in urology decreased from 6.6 to 7.3% in 2012-2014 to 5.4-5.8% in 2016-2018. In patients with immunosuppression the incidence of HAIs decreased from 12.8 to 18% in 2012-2013 to 8.1-10.2% in 2017-2018, in those with a previous urinary infection fell from 13.6 to 4.8%, in those with a urinary catheter prior to admission from 12.6 to 10.8%, and in patients with a nephrostomy tube from 16 to 10.9%. The effect of the protocol also demonstrated a reduction in the percentage of patients with suspicion of HAIs for whom no culture was taken, from 6% in 2012 to zero in 2017 and 2018. Moreover, the implementation of protocols for empirical treatment has reduced the incidence of patients experiencing inadequate empirical antimicrobial therapy from 20 to 8.1%. CONCLUSION: It is essential to monitor the incidence of HAIs, and preventive measures play a useful role in reducing the rate of infection and in optimising their management.