Visión global de las guías clínicas en cirugía de la disfunción eréctil: EUA-AUA / Clinical guidelines on erectile dysfunction surgery: EAU-AUA perspectives

INTRODUCCIÓN: El implante de una prótesis de pene se considera un tratamiento de tercera línea y está indicada en pacientes que no responden adecuadamente a farmacoterapia o cuando el paciente desea una solución definitiva del problema. Actualmente los dispositivos más empleados son prótesis de 3 componentes, que actualmente suponen más del 90% de los implantes utilizados. MATERIAL Y MÉTODO: El presente estudio realiza una revisión de la evidencia y las recomendaciones de las guías de práctica clínica en pacientes con disfunción eréctil es los que se plantea un tratamiento quirúrgico. RESULTADOS: Las recomendaciones de las guías de práctica clínica sobre cirugía en pacientes con disfunción eréctil se resumen en los siguientes puntos: los varones con disfunción eréctil deben ser informados sobre la opción de tratamiento con implante de prótesis de pene, comentándose los beneficios, los riesgos y las consecuencias; los varones con disfunción eréctil en los que se ha decidido implantar una prótesis de pene deben recibir consejo sobre las expectativas posquirúrgicas; no debe realizarse implante de prótesis peneana en pacientes con enfermedad sistémica, cutánea o infección del tracto urinario; en varones jóvenes con disfunción eréctil y obstrucción arterial peneana o pélvica focal que no presenten enfermedad vascular generalizada o disfunción venooclusiva puede considerarse la reconstrucción arterial peneana; en varones con disfunción eréctil, no se recomienda cirugía venosa del pene. CONCLUSIONES: El empleo de prótesis de pene ofrece altas tasas de satisfacción tanto al paciente como a su pareja. Sin embargo, es necesario informar adecuadamente de las posibles complicaciones y las consecuencias

INTRODUCTION: The implantation of a penile prosthesis is considered a third-line treatment and is indicated in patients who do not respond adequately to pharmacotherapy or require definitive treatment. Currently, the most used devices are 3-component penile prostheses, which presently account for more than 90% of the implants used. MATERIAL AND METHODS: We reviewed the evidence and the recommendations of the clinical practice guidelines regarding surgery in patients with erectile dysfunction. RESULTS: The recommendations of the clinical practice guidelines on surgery in patients with erectile dysfunction are summarized as follows: men with erectile dysfunction should be informed about the option of penile prosthesis implant treatment, commenting on the benefits, risks and consequences; men with erectile dysfunction who have agreed to receive penile prosthesis should be advised on post-surgical expectations; penile prosthesis implants should not be performed in patients with systemic, cutaneous or urinary tract infection; in young men with erectile dysfunction and focal penile or pelvic arterial obstruction who do not have generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction can be considered; in men with erectile dysfunction, penile venous surgery is not recommended. CONCLUSIONS: The use of penile prostheses offers high satisfaction rates to both the patient and his partner. However, it is crucial to adequately inform and warn patients about possible complications and consequences

Clinical guidelines on erectile dysfunction surgery: EAU-AUA perspectives. / Visión global de las guías clínicas en cirugía de la disfunción eréctil: EUA-AUA.

INTRODUCTION: The implantation of a penile prosthesis is considered a third-line treatment and is indicated in patients who do not respond adequately to pharmacotherapy or require definitive treatment. Currently, the most used devices are 3-component penile prostheses, which presently account for more than 90% of the implants used. MATERIAL AND METHODS: We reviewed the evidence and the recommendations of the clinical practice guidelines regarding surgery in patients with erectile dysfunction. RESULTS: The recommendations of the clinical practice guidelines on surgery in patients with erectile dysfunction are summarized as follows: men with erectile dysfunction should be informed about the option of penile prosthesis implant treatment, commenting on the benefits, risks and consequences; men with erectile dysfunction who have agreed to receive penile prosthesis should be advised on post-surgical expectations; penile prosthesis implants should not be performed in patients with systemic, cutaneous or urinary tract infection; in young men with erectile dysfunction and focal penile or pelvic arterial obstruction who do not have generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction can be considered; in men with erectile dysfunction, penile venous surgery is not recommended. CONCLUSIONS: The use of penile prostheses offers high satisfaction rates to both the patient and his partner. However, it is crucial to adequately inform and warn patients about possible complications and consequences.

Infecciones relacionadas con la asistencia sanitaria en pacientes ingresados en un servicio de Urología: patrones de resistencia y adecuación del tratamiento antibiótico empírico como factor pronóstico / Infections related to healthcare in patients hospitalized in a Urology service: Resistance patterns and adequacy of empirical antibiotic treatment as a prognostic factor

Objetivos: Evaluar la idoneidad de la antibioterapia empírica en IRAS y los patrones de resistencia a antibióticos de los microorganismos responsables, así como la incidencia de mortalidad y factores de riesgo en relación con IRAS. Método: Durante un periodo de 4 años se realiza un estudio prospectivo observacional sobre todos los pacientes de ambos sexos y mayores de 16 años ingresados por cualquier proceso urológico. Se evalúan la incidencia y las características de las IRAS y se analiza el microorganismo causante y sus resistencias, la antibioterapia empírica inicial y si esta precisó modificación, y las tasas de mortalidad. Resultados: De un total de 6.546 pacientes, el 6,3% sufrieron IRAS, correspondiendo el 70,5% a infección del tracto urinario y el 22,1% a infección de la herida quirúrgica. E. coli, Enterococcus spp., Klebsiella spp. y P. aeruginosa fueron los más frecuentemente implicados (25,1, 17,5, 13,5 y 12,3%, respectivamente). E. coli y Klebsiella spp. fueron productoras de betalactamasas de espectro extendido (BLEE) en el 24,7 y el 47,8%, respectivamente. El 4,3% de Klebsiella y el 33,3% de Pseudomonas eran resistentes a carbapenemes. La resistencia global a quinolonas fue del 50% aproximadamente. Los antibióticos más frecuentemente usados de forma empírica fueron cefalosporinas de tercera y cuarta generación (33,6%) y carbapenemes (28,2%). Se obtuvo una tasa global de adecuación de antibioterapia empírica del 82,9%. La tasa de mortalidad en los pacientes con IRAS fue del 2,2%, frente al 0,3% en los pacientes sin infección. En un análisis multivariable, las variables que se asociaron a mayor riesgo de mortalidad fueron el aislamiento de enterobacterias productoras de BLEE y el tratamiento antibiótico empírico inadecuado. Conclusiones: La selección de la antibioterapia empírica fue bastante precisa. Se está observando un aumento de IRAS por microorganismos multirresistentes, como enterobacterias BLEE o P.aeruginosa multirresistentes. El riesgo de mortalidad aumenta con una antibioterapia empírica inicial inadecuada o cuando el microorganismo responsable es una enterobacteria BLEE

Objectives: To evaluate the suitability of empirical antibiotic therapy in HAIs and the antibiotic resistance patterns of the responsible microorganisms, as well as the incidence of mortality and risk factors involved. Method: A prospective observational study was carried out on patients of both sexes older than 16 years, admitted by any urological process during a period of 4 years. The incidence and characteristics of HAIs, as well as the causative organism and its resistance, the initial empirical antibiotic therapy and its modification, if required, and mortality rates are analyzed. Results: Out of 6546 patients, 6.3% suffered HAIs, 70.5% corresponding to urinary tract infection and 22.1% to infection of the surgical wound. E.coli, Enterococcus spp., Klebsiella spp. y P. aeruginosa were the most frequently implicated (25.1%, 17.5%, 13.5% and 12.3%, respectively). E. coli and Klebsiella spp. were producers of extended-spectrum beta-lactamases (ESBL) in 24.7% and 47.8%, respectively. 4.3% of Klebsiella and 33.3% of Pseudomonas were carbapenems-resistant. The overall resistance to quinolones was approximately 50%. The most commonly used antibiotics for empirical therapy were cephalosporins of 3rd and 4th generation (33.6%) and carbapenems (28.2%). An overall rate of adequacy of empirical antibiotic therapy of 82.9% was obtained. The mortality rate in patients with HAIs was 2.2%, compared with 0.3% in patients without infection. In a multivariate analysis, the variables associated with the highest mortality risk were the isolation of ESBL-producing enterobacteria and the inadequate empirical antibiotic treatment. Conclusions: The selection of empirical antibiotic therapy was quite accurate. An increase in HAIs by multiresistant microorganisms, such as ESBL Enterobacteria or multiresistant P.aeruginosa is being observed. The mortality risk increases with inadequate initial empirical antibiotic therapy or when the responsible microorganism is an ESBL enterobacteria

Infections related to healthcare in patients hospitalized in a Urology service: resistance patterns and adequacy of empirical antibiotic treatment as a prognostic factor. / Infecciones relacionadas con la asistencia sanitaria en pacientes ingresados en un servicio de Urología: patrones de resistencia y adecuación del tratamiento antibiótico empírico como factor pronóstico.

OBJECTIVES: To evaluate the suitability of empirical antibiotic therapy in HAIs and the antibiotic resistance patterns of the responsible microorganisms, as well as the incidence of mortality and risk factors involved. METHOD: A prospective observational study was carried out on patients of both sexes older than 16years, admitted by any urological process during a period of 4years. The incidence and characteristics of HAIs, as well as the causative organism and its resistance, the initial empirical antibiotic therapy and its modification, if required, and mortality rates are analysed. RESULTS: Out of 6,546 patients, 6.3% suffered HAIs, 70.5% corresponding to urinary tract infection and 22.1% to infection of the surgical wound. E.coli, Enterococcus spp., Klebsiella spp. y P.aeruginosa were the most frequently implicated (25.1%, 17.5%, 13.5% and 12.3%, respectively). E.coli and Klebsiella spp. were producers of extended-spectrum beta-lactamases (ESBL) in 24.7% and 47.8%, respectively. 4.3% of Klebsiella and 33.3% of Pseudomonas were carbapenems-resistant. The overall resistance to quinolones was approximately 50%. The most commonly used antibiotics for empirical therapy were cephalosporins of 3rd and 4th generation (33.6%) and carbapenems (28.2%). An overall rate of adequacy of empirical antibiotic therapy of 82.9% was obtained. The mortality rate in patients with HAIs was 2.2%, compared with 0.3% in patients without infection. In a multivariate analysis, the variables associated with the highest mortality risk were the isolation of ESBL-producing enterobacteria and the inadequate empirical antibiotic treatment. CONCLUSIONS: The selection of empirical antibiotic therapy was quite accurate. An increase in HAIs by multiresistant microorganisms, such as ESBL Enterobacteria or multiresistant P.aeruginosa is being observed. The mortality risk increases with inadequate initial empirical antibiotic therapy or when the responsible microorganism is an ESBL enterobacteria.

Infección de herida quirúrgica en urología. Análisis de factores de riesgo y microorganismos asociados / Surgical wound infection in urology. Analysis of risk factors and associated microorganisms

Objetivos. La cirugía abierta sigue teniendo un papel fundamental en urología, y la infección de la herida quirúrgica es una de sus principales complicaciones. Nuestro objetivo fue analizar la infección de la herida quirúrgica en pacientes intervenidos por nuestro servicio de urología y valorar factores de riesgo, microorganismos y resistencias por tipo de cirugía. Material y métodos. Estudio prospectivo y observacional. Incluyó 940 pacientes: 370 cirugías abdominal/lumbar abierta y 570 genitoperineales. Analizamos edad, sexo, comorbilidades, estancia y tipo de cirugía, así como microorganismos causantes y resistencias a antibióticos. Resultados. En cirugía genitoperineal hallamos 15 casos (2,6%) de infección de la herida quirúrgica, asociándose a cateterismo urinario previo. La mayoría de los microorganismos aislados corresponden a enterobacterias, destacando las resistencias a betalactámicos. En cirugía abdominal/lumbar encontramos 41 casos (11,1%) de infección de la herida quirúrgica. La incidencia fue del 3,3% en cirugía prostática, del 9,8% en cirugía renal y del 45,0% en cistectomía. Padecer cardiopatía se asoció a mayor incidencia de infección de la herida quirúrgica. Los microorganismos más frecuentes fueron Enterococcus spp. (27,1%), E.coli (22,9%) y Staphylococcus aureus (14,6%). Enterococcus es resistente a ampicilina en el 37,5% y E.coli productor de betalactamasas, en el 41,7%. Conclusiones. Encontramos escasa incidencia de infección de la herida quirúrgica en cirugía genitoperineal, comparada con la renal y cistectomía. La presencia de cardiopatía y portar catéter urinario previo son factores asociados a infección de la herida quirúrgica. Enterococcus y E.coli son los patógenos más frecuentes, con altas tasas de resistencia (AU)

Objectives. Open surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. Material and methods. This was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. Results. For genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam. In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. Conclusions. We found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance (AU)

Surgical wound infection in urology. Analysis of risk factors and associated microorganisms. / Infección de herida quirúrgica en urología. Análisis de factores de riesgo y microorganismos asociados.

OBJECTIVES: Open surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. MATERIAL AND METHODS: This was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. RESULTS: For genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam. In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. CONCLUSIONS: We found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance.

Infecciones urinarias adquiridas en la comunidad que requieren hospitalización: factores de riesgo, características microbiológicas y resistencia a antibióticos / Community-associated urinary infections requiring hospitalization: Risk factors, microbiological characteristics and patterns of antibiotic resistance

Objetivo: Las infecciones del tracto urinario (ITU) suelen manejarse ambulatoriamente. Sin embargo, un pequeño porcentaje requiere ingreso hospitalario. Nuestro objetivo fue analizar los factores de riesgo y características microbiológicas de las infecciones urinarias adquiridas en la comunidad (ITU-AC) que requieren hospitalización. Material y métodos: Realizamos un estudio prospectivo desde noviembre de 2011 a diciembre de 2013 evaluando la incidencia, factores de riesgo, patrones microbiológicos y tasas de resistencia en los pacientes con ITU-AC que requieren ingreso. Resultados: Cuatrocientos cincuenta y siete pacientes ingresaron en nuestro servicio con diagnóstico de ITU-AC. La edad media fue 56,2 ± 19,85 años, el 52,1% eran mujeres, el 19,7% portaban catéter urinario y el 11,4% habían presentado ITU en los meses previos. Los microorganismos más frecuentemente aislados fueron Escherichia coli (60,6%), Klebsiella (9,2%), Enterococcus (8,4%) y Pseudomonas (7,2%). Enterobacteriaceae diferentes a E. coli fueron más frecuentes en pacientes de mayor edad. Enterococcus fueron más frecuentemente aislados en pacientes que habían tenido ITU previa y en aquellos portadores de catéter urinario. E. coli mostró unas resistencias del 23,5% para amoxicilina/ácido clavulánico, 16,6% para cefalosporinas de tercera generación, 31,3% para quinolonas y16,7% para aminoglucósidos. Del total de E. coli 11,4% fueron productores de betalactamasas de espectro extendido (BLEE). Los Enterococcus y Pseudomonas mostraron resistencias a quinolonas del 50,0% y 61,5% respectivamente. Conclusiones: ITU-AC que requieren hospitalización se presentan más frecuentemente en varones de mayor edad, portadores de catéter urinario, litiasis urinaria y con episodios previos de ITU. Estos factores también se asocian con infecciones producidas por gérmenes diferentes a E. coli y altas tasas de resistencia

Objective: Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. Material and methods: A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. Results: Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2 ± 19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + βlactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. Conclusions: CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates

Community-associated urinary infections requiring hospitalization: risk factors, microbiological characteristics and patterns of antibiotic resistance.

OBJECTIVE: Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. MATERIAL AND METHODS: A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. RESULTS: Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2±19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + ß lactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. CONCLUSIONS: CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates.