Influencia de la profilaxis antibiótica sistematica y/o el método de limpieza/desinfeccion del cistoscopio en la positivización del cultivo tras cistoscopia flexible ambulatoria / Influence of systematic antibiotic prophylaxis and/or cystoscope cleaning/disinfecting method on urinary culture becoming positive after outpatient flexible cystoscopy

ntroducción y objetivos: El uso indisciminado de antibióticos ha incrementado las resistencias antimicrobianas, constituyendo un problema de salud global. Identificar aquellas situaciones en las que la profilaxis antibiótica es indicada pero podria ser prescindible es fundamental para disminuir dichas resistencias. La cistoscopia flexible es un procedimiento habitual en la práctica clínica, con un uso extensivo de dicha profilaxis. El objetivo del presente trabajo es evaluar la eficacia de la profilaxis antibiótica y el método de limpieza/desinfección para prevenir la positivización del cultivo urinario en pacientes sometidos a cistoscopia flexible. Material y métodos: Se realizó un estudio prospectivo, aleatorizado y randomizado entre junio de 2015 y mayo de 2016 en pacientes sometidos a cistoscopia flexible en la consulta de urología. Los pacientes con catéteres urinarios temporales o permanentes se excluyeron del estudio, así como los procedimientos que requirieron biopsias vesicales. Se reclutaron un total de 251 pacientes. Se recolectó cultivo urinario en todos los pacientes antes y después del procedimiento. Los pacientes se dividieron aleatoriamente en dos grupos: profilaxis antibiótica versus no profilaxis. La profilaxis con antibióticos consiste en 4 dosis de norfloxacina (400 mg) dos veces al día durante dos días. El tipo de limpieza/desinfección incluye: adasport manual(ácido peracético 5%), detergente enzimático(instrunet esporicida; Inibsa), lavadora(Olympus, mini ETD 2). También se recopilaron características demográficas, como el sexo y la edad. Se analizó la relación entre la profilaxis antibiótica, el tipo de procedimiento de limpieza/desinfección, las características demográficas y el cultivo urinario positivo después del procedimiento. Medidas para evitar sesgos: Aleatorización. Resultados: El cultivo urinario previo a la cistoscopia fue: negativo en 231 pacientes (92,4%) y positivo en 19 (7,6%); nulo en 1. Después de la aleatorización, 129 pacientes se incluyeron en el Grupo 1 (sin tratamiento antibiótico) y 117 en el Grupo 2 (profilaxis con antibióticos), autoexcluyéndose 5 pacientes. Después del procedimiento, el cultivo fue negativo en 224 pacientes (91,1%) y positivo en 22 (8,9%). No hubo significados estadísticos entre los resultados del cultivo de orina antes y después de la cistoscopia y las características demográficas. Además, no se observaron diferencias estadísticas entre el cultivo de orina post cistoscopia y el tipo de procedimiento de limpieza empleado (p = 0,7 ), o entre el cultivo de orina y el tipo de limpieza con o sin profilaxis antibiótica ( p = 0,5, p = 0,9 ). Conclusiones: Ninguna de las variables analizadas influye en la positivización del cultivo de orina después de la cistoscopia. La profilaxis antibiótica rutinaria debería ser evitada, ya que no influye en la positivización del cultivo urinario, incrementa las resistencias bacterianas y aumenta el gasto sanitario. El uso de uno u otro método de desinfección del cistoscopio tampoco parece influir en la positivización del cultivo, por lo que no podemos realizar ninguna recomendación, y la elección queda sujeta a criterios de cada departamento de urología

Introduction and objectives: To evaluate the efficacy of antibiotic prophylaxis as well as the cleaning/disinfection procedures to prevent urinary tract infection in patients undergoing office flexible cystoscopy. Methods: A prospective, randomized study was performed between June 2015 to May 2016 including every patient who underwent flexible cystoscopy at the Urology outpatient unit. Patients with temporary or permanent urinary stents were excluded from the study as well as procedures that involved bladder biopsies. A total of 251 patients were recruited. Urinary culture was collected in all of the patients before and after the procedure. Patients were randomized in two groups: Antibiotic prophylaxis versus no prophylaxis. Antibiotic prophylaxis consisted in 4 doses of Norfloxacin (400mg): twice a day during two days. Three different cleaning/ disinfection methods were used: manual adasport (5% peracetic acid), manual oxide (instrunet sporicidal; Inibsa) and washing machine (Olympus, mini ETD 2). Demographic characteristics such as gender and age were collected during the study. Relationship between antibiotic prophylaxis, type of cleaning/disinfection procedure, demographic characteristics and positive urinary culture after procedure were analysed. Measures to avoid bias: Randomization. Results: Urinary culture before cystoscopy was negative in 231 patients (92.4%), positive in 19 (7.6%) and not valid in 1. After randomization, 129 patients were included in Group 1(no prophylaxis) and 117 in Group 2 (antibiotic prophylaxis), 5 patients dropped from the study. After-procedure culture was negative in 224 patients (91.1%) and positive in 22 (8.9%). There was no statistical significance between urine culture results before and after cystoscopy and the demographic characteristics collected. Furthermore, no statistical differences were seen between urine culture after cystoscopy and cystoscope cleaning method (p = 0.7), or between urine culture and type of cleaning with or without antibiotic prophylaxis (p = 0.5, p = 0.9)

[Influence of systematic antibiotic prophylaxis and/or cystoscope cleaning/disinfecting method on urinary culture becoming positive after outpatient flexible cystoscopy.] / Influencia de la profilaxis antibiótica sistematica y/o el método de limpieza/desinfeccion del cistoscopio en la positivización del cultivo tras cistoscopia flexible ambulatoria.

INTRODUCTION AND OBJECTIVES: To evaluate the efficacy of antibiotic prophylaxis as well as the cleaning/disinfection procedures to prevent urinary tract infection in patients undergoing office flexible cystoscopy. METHODS: A prospective, randomized study was performed between June 2015 to May 2016 including every patient who underwent flexible cystoscopy at the Urology outpatient unit. Patients with temporary or permanent urinary stents were excluded from the study as well as procedures that involved bladder biopsies. A total of 251 patients were recruited. Urinary culture was collected in all of the patients before and after the procedure. Patients were randomized in two groups: Antibiotic prophylaxis versus no prophylaxis. Antibiotic prophylaxis consisted in 4 doses of Norfloxacin ( 400mg ): twice a day during two days. Three different cleaning/ disinfection methods were used: manual adasport (5% peracetic acid), manual oxide (instrunet sporicidal; Inibsa) and washing machine (Olympus, mini ETD 2). Demographic characteristics such as gender and age were collected during the study. Relationship between antibiotic prophylaxis, type of cleaning/disinfection procedure, demographic characteristics and positive urinary culture after procedure were analysed. Measures to avoid bias: Randomization. RESULTS: Urinary culture before cystoscopy was negative in 231 patients (92.4%), positive in 19 (7.6%) and not valid in 1. After randomization, 129 patients were included in Group 1(no prophylaxis) and 117 in Group 2 (antibiotic prophylaxis), 5 patients dropped from the study. After-procedure culture was negative in 224 patients (91.1%) and positive in 22 (8.9%). There was no statistical significance between urine culture results before and after cystoscopy and the demographic characteristics collected. Furthermore, no statistical differences were seen between urine culture after cystoscopy and cystoscope cleaning method ( p = 0.7), or between urine culture and type of cleaning with or without antibiotic prophylaxis ( p = 0.5, p = 0.9 ). CONCLUSIONS: None of the analyzed variables influenced the positivity of urine culture after flexible cystoscopy. Routine antibiotic prophylaxis should not be further recommended.

INTRODUCCIÓN Y OBJETIVOS: El uso indisciminado de antibióticos ha incrementado las resistencias antimicrobianas, constituyendo un problema de salud global. Identificar aquellas situaciones en las que la profilaxis antibiótica es indicada pero podria ser prescindible es fundamental para disminuir dichas resistencias. La cistoscopia flexible es un procedimiento habitual en la práctica clínica, con un uso extensivo de dicha profilaxis. El objetivo del presente trabajo es evaluar la eficacia de la profilaxis antibiótica y el método de limpieza/desinfección para prevenir la positivización del cultivo urinario en pacientes sometidos a cistoscopia flexible. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, aleatorizado y randomizado entre junio de 2015 y mayo de 2016 en pacientes sometidos a cistoscopia flexible en la consulta de urología. Los pacientes con catéteres urinarios temporales o permanentes se excluyeron del estudio, así como los procedimientos que requirieron biopsias vesicales. Se reclutaron un total de 251 pacientes. Se recolectó cultivo urinario en todos los pacientes antes y después del procedimiento. Los pacientes se dividieron aleatoriamente en dos grupos: profilaxis antibiótica versus no profilaxis. La profilaxis con antibióticos consiste en 4 dosis de norfloxacina (400 mg) dos veces al día durante dos días. El tipo de limpieza/desinfección incluye: adasport manual(ácido peracético 5%), detergente enzimático(instrunet esporicida; Inibsa), lavadora(Olympus, mini ETD 2). También se recopilaron características demográficas, como el sexo y la edad. Se analizó la relación entre la profilaxis antibiótica, el tipo de procedimiento de limpieza/desinfección, las características demográficas y el cultivo urinario positivo después del procedimiento. Medidas para evitar sesgos: Aleatorización. RESULTADOS: El cultivo urinario previo a la cistoscopia fue: negativo en 231 pacientes (92,4%) y positivo en 19 (7,6%); nulo en 1. Después de la aleatorización, 129 pacientes se incluyeron en el Grupo 1 (sin tratamiento antibiótico) y 117 en el Grupo 2 (profilaxis con antibióticos), autoexcluyéndose 5 pacientes. Después del procedimiento, el cultivo fue negativo en 224 pacientes (91,1%) y positivo en 22 (8,9%). No hubo significados estadísticos entre los resultados del cultivo de orina antes y después de la cistoscopia y las características demográficas. Además, no se observaron diferencias estadísticas entre el cultivo de orina post cistoscopia y el tipo de procedimiento de limpieza empleado ( p = 0,7 ), o entre el cultivo de orina y el tipo de limpieza con o sin profilaxis antibiótica ( p = 0,5, p = 0,9 ). CONCLUSIONES: Ninguna de las variables analizadas influye en la positivización del cultivo de orina después de la cistoscopia. La profilaxis antibiótica rutinaria debería ser evitada, ya que no influye en la positivización del cultivo urinario, incrementa las resistencias bacterianas y aumenta el gasto sanitario. El uso de uno u otro método de desinfección del cistoscopio tampoco parece influir en la positivización del cultivo, por lo que no podemos realizar ninguna recomendación, y la elección queda sujeta a criterios de cada departamento de urología.

Fístula recto vesical tras prostatectomía radical laparoscópica atribuida al uso de hem-o-lock / Rectovesical fistula after laparoscopic radical prostatectomy secondary to the use of hem-o-ock clips

No disponible

Stress-stones-stress-recurrent stones: a self-propagating cycle? Difficulties in solving this dichotomy.

Numerous studies have reported an association between stress and urolithiasis. Although urinary risk factors have been measured in several of these, compelling evidence of a causal relationship has not been established. A shortcoming is that alterations in single urinary parameters rather than ratios and quotients, which provide a more synergistic risk evaluation, have been measured. Recently, we speculated about a possible association between chronic stress and stone recurrence. This presents an intriguing dichotomy of whether stress causes stones or vice versa, or whether they are linked in a self-propagating stress-stones-stress-recurrence cycle. We investigated the latter hypothesis in a retrospective case-control designed study in which we calculated urinary ratios and quotients which are regarded as diagnostic indicators of stone risk. These included Ca/Cr, Ox/Cr, Mg/Cr, Cit/Cr, urate/Cr and citrate-magnesium-calcium ratios, activity product quotient for calcium oxalate (CaOx) and relative supersaturation of CaOx, brushite and uric acid. Overnight urinary data from 128 participants comprising 31 first time (FS), 33 recurrent (RS) CaOx stone formers and 64 controls were used. All subjects had been previously assessed for chronic stress dimensions, as well as for stress caused by their stone episodes per se. Conditional and unconditional logistic regression (with a Bonferroni correction for multiple tests) and simple linear regression were used to analyse various components of the data. Although RS had more stressful life events, with greater intensity of perception than FS, there were no significant differences between the groups regarding any of the urinary risk factors. No significant association between stressful life events and any of the urinary ratios or quotients was observed. A direct causal link between stress and stone recurrence was not indicated. We believe that future studies should shift their focus from traditional urinary risk factors to other stone-forming mechanisms. However, we recognize that there is an inherent problem in attempting to solve the stress-stones dichotomy as it would be impossible to disentangle alterations in risk factors which arise from lifestyle stress and those arising from stone episodes themselves.

[Diet in the lithiasic patient: A practical guide.] / La dieta en el paciente litiásico:una guía práctica.

The incidence and prevalence of lithiasic disease in developed countries has increased over the last years. Being diet one of the risk factors for urolithiasis, and having it evolved in conjunction with lifestyle over the last decades, such changes could explain the increase in lithiasis case-load. In this article, we analyze how the exercise of the urologist has been regarding the preventive role of diet in the lithiasis patient, what are the scientific evidences on the relationship of diet and lithiasis, and, on this base, what general dietetic recommendations we can give currently to our patients.

La dieta en el paciente litiásico: una guía práctica / Diet in the lithiasic patient: A practical guide

La incidencia y prevalencia de la enfermedad litiásica en los países desarrollados ha aumentado en los últimos años. Debido a que la dieta es uno de los factores de riesgo de la urolitiasis, y tanto esta como el estilo de vida han evolucionado en las últimas décadas, dichos cambios podrían explicarnos el aumento en la causística de la litiasis renal. En el presente trabajo analizamos cuál ha sido el proceder del urólogo en cuanto al papel preventivo de la dieta en el paciente litiásico, qué evidencias científicas existen en cuanto a la relación entre dieta y litiasis y, en base a ello, qué recomendaciones generales dietéticas podemos dar actualmente a nuestros pacientes

The incidence and prevalence of lithiasic disease in developed countries has increased over the last years. Being diet one of the risk factors for urolithiasis, and having it evolved in conjunction with lifestyle over the last decades, such changes could explain the increase in lithiasis case-load. In this article, we analyze how the exercise of the urologist has been regarding the preventive role of diet in the lithiasis patient, what are the scientific evidences on the relationship of diet and lithiasis, and, on this base, what general dietetic recommendations we can give currently to our patients

Efectos secundarios de la administración de Mitomicina C intravesical: dermatitis por hipersensibilidad retardada / Dermatological side effects of intravesical Mitomycin C: Delayed hypersensitivity

OBJETIVO: Conocer los efectos secundarios dermatológicos del tratamiento con Mitomicina C endovesical en el cáncer de vejiga no músculo invasivo. MÉTODOS: Se describen dos casos de dermatitis palmo plantar durante dicho tratamiento. RESULTADO: Se describen dos tipos de etiopatogenia en dermatitis durante el tratamiento con Mitomicina C endovesical, dermatitis por contacto y dermatitis por hipersensibilidad retardada. CONCLUSIONES: La dermatitis por contacto de etiología no alérgica es un efecto secundario frecuente, se han descrito muchos casos en la literatura, por otro lado existe la dermatitis por mecanismo de hipersensibilidad retardada tipo IV es mucho menos frecuente y requiere tratamiento con corticoesteroides

OBJECTIVE: To know the dermatologic side effects of intravesical treatment with Mitomycin C in non muscle invasive bladder cancer. METHODS: We describe two cases of palm and plantar dermatitis after such treatment. RESULTS: We describe two types of dermatitis pathogenesis during treatment with intravesical Mitomycin C: contact dermatitis and delayed hypersensitivity dermatitis. CONCLUSIONS: Contact dermatitis of non-allergic origin is a common side effect described in many instances in the literature, on the other hand exists dermatitis secondary to delayed hypersensitivity type IV much less common, requiring treatment with corticosteroids

Neoplasia en el injerto renal. Análisis del origen tumoral y opciones terapéuticas / Neoplasm in kidney graft. Analysis of the cause of the tumour and treatment options

El trasplante renal es el tratamiento de elección de la enfermedad renal crónica. La enfermedad cardiovascular, las infecciones, así como las neoplasiasde novo postrasplante renal son las principales causas de mortalidad de los pacientes trasplantados. Las neoplasias más frecuentes en el postrasplante renal son los procesos linfoproliferativos y las neoplasias cutáneas. Otro tipo de neoplasias, como son los tumores renales, también representan aproximadamente el 3 % de todas las neoplasias de los trasplantados. Se ha realizado una revisión de los trasplantados renales de nuestra unidad entre julio de 1985 y octubre de 2012 que han presentado una masa a nivel del injerto renal, confirmando el diagnóstico por biopsia de la masa. Se ha analizado en todos los casos la patología de base, la función renal y el tratamiento inmunosupresor. Este artículo quiere dar importancia a la monitorización de la aparición de posibles masas tumorales en el injerto renal y su manejo (AU)

Kidney transplant is the treatment of choice for chronic kidney disease. Cardiovascular disease, infections, and postransplant de novo neoplasms are the main causes of death in transplant patients. The most frequent kind of post kidney transplant neoplasms are lymphoproliferative processes and cutaneous neoplasms. Another type of neoplasm, that of kidney tumours, also represents approximately 3% of all neoplasms in transplant patients. A review of the kidney transplants from our unit performed between July 1985 and October 2012 which presented a mass in the kidney graft was carried out, confirming the diagnosis by taking a biopsy of the mass. In all the cases, the underlying pathology, kidney function and immunosuppressive treatment were analysed. This article aims to give importance to monitoring and management of the appearance of possible tumour masses in kidney transplants (AU)

Neoplasm in kidney graft. Analysis of the cause of the tumour and treatment options.

Kidney transplant is the treatment of choice for chronic kidney disease. Cardiovascular disease, infections, and postransplant de novo neoplasms are the main causes of death in transplant patients. The most frequent kind of post kidney transplant neoplasms are lymphoproliferative processes and cutaneous neoplasms. Another type of neoplasm, that of kidney tumours, also represents approximately 3% of all neoplasms in transplant patients. A review of the kidney transplants from our unit performed between July 1985 and October 2012 which presented a mass in the kidney graft was carried out, confirming the diagnosis by taking a biopsy of the mass. In all the cases, the underlying pathology, kidney function and immunosuppressive treatment were analysed. This article aims to give importance to monitoring and management of the appearance of possible tumour masses in kidney transplants.

Tratamiento con ácido hialurónico de la hematuria asociada a cistopatía rádica / Hyaluronic acid instillation as treatment of haematuria due to radiation induced cystitis

No disponible

Chronic stress and calcium oxalate stone disease: influence on blood cortisol and urine composition.

OBJECTIVE: To evaluate the influence of chronic stress (CS) on urine composition of calcium oxalate (CaOx) stone patients and controls. METHODS: This case-control study enrolled 128 patients during a period of 20 months. The cases were CaOx stone formers with a recent stone episode. Controls were matched by sex and age. Dimensions of CS were evaluated in cases and controls by validated self-report questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout, and satisfaction with life. Blood and urine samples were collected to determine cortisol levels and urinary composition. RESULTS: More relations between CS dimensions and blood and urine parameters were observed in cases than in controls. In cases, the blood cortisol level was related positively with the number of stressful life events (P = .03), intensity of these events (P = .04), and anxiety (P = .04). In addition, urinary magnesium (P = .03) and pyrophosphate (P = .05) levels were positively related with satisfaction with life and burnout, respectively. In contrast, urinary magnesium levels were negatively related with perceived stress (P = .01), anxiety (P = .016), and depression (P = .03). In controls, the number of stressful life events and the intensity of stressful life events was related positively with magnesium (P = .06, P = .02) levels and negatively with blood cortisol levels (P = .03, P = .004). CONCLUSION: Based on the variation between cases and controls in relations between CS dimensions and biochemical parameters, we hypothesize that CS may trigger a differential biological response in CaOx stone formers and controls, which in turn may promote or protect against CaOx stone formation.

Chronic stress and calcium oxalate stone disease: is it a potential recurrence risk factor?

Chronic emotional stress is associated with increased cortisol release and metabolism disorders. However, few studies have evaluated the influence of chronic stress on calcium oxalate (CaOx) stone disease and its recurrence. A total of 128 patients were enrolled in this case-control study over a period of 20 months. All patients were CaOx stone formers with a recent stone episode (<3 months); 31 were first-time stone formers (FS) and 33 recurrent stone formers (RS). Dimensions of chronic stress were evaluated with self-reported validated questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout and satisfaction with life. An ad hoc self-reporting questionnaire was designed to evaluate stress-related specifically to stone episodes. Blood and urine samples were collected to determine cortisol levels and urinary composition. In addition, epidemiological data, socioeconomic information, diet and incidences of metabolic syndrome (MS) were reported. Overall, no significant differences were observed in the scores of cases and controls on any of the questionnaires dealing with stress. The number (p < 0.001) and the intensity (p < 0.001) of perceived stressful life events were higher in RS than in FS, but there were no differences between the two groups in other dimensions of stress. RS had higher glucose (p = 0.08), uric acid (p = 0.02), blood cortisol (p = 0.01), and urine calcium levels (p = 0.01) than FS. RS also had lower economic levels (p = 0.02) and more frequent incidences of MS (p = 0.07) than FS. Although no differences were observed in cases and controls among any dimension of chronic stress, the number and intensity of stressful life events were higher in RS than in FS. These differences correlate with variations in blood and urinary levels and with metabolic disorders, indicating an association between chronic stress and risk of recurrent CaOx stone formation.

[Primary lymphoma of penis]. / Linfoma primario de pene.

We describe a case of primary penis lymphoma in a 71 yr old man. We review the bibliography and we emphasize the peculiarity and different sorts of clinical presentation. The initial symptoms were insidious. Physical examination and ultrasound findings made it indistinguishable from other tumors. A MRI confirmed the presence of a tumoral process with a homogeneous density in the distal part of the penis whose biopsy with immune histological processing confirmed us the diagnosis of primary penis lymphoma. The combined treatment with chemotherapy and radiotherapy allowed preserving the sexual organ and being without disease at 48 month of follow up.

Linfoma primario de pene / Primary lymphoma of penis

Se describe un caso de linfoma primario de pene en un paciente de 71 años. Se revisa la bibliografía destacando su extrema rareza y las diferentes formas clínicas de presentación. La clínica fue insidiosa, y los datos de la exploración física y los hallazgos ecográficos la hicieron indistinguible de otras neoplasias. La resonancia magnética confirmó la existencia de un proceso neoformativo de densidad homogénea en la parte distal del pene, cuya toma biópsica junto con las técnicas de inmunohistoquímica confirmó el diagnóstico de linfoma de pene. El tratamiento combinado de quimio y radioterapia permitió conservar el órgano, encontrándose el paciente a los 48 meses libre de enfermedad (AU)

We describe a case of primary penis lymphoma in a 71yr old man. We review the bibliography and we emphasize the peculiarity and different sorts of clinical presentation. The initial symptoms were insidious. Physical examination and ultrasound findings made it indistinguishable from other tumors. A MRI confirmed the presence of a tumoral process with a homogeneous density in the distal part of the penis whose biopsy with immune histological processing confirme us the diagnosis of primary penis lymphoma. The combined treatment with chemotherapy and radiotherapy allowed preserving the sexual organ and being without disease at 48 month of follow up (AU)

[The history of extracorporeal shockwave lithotripsy in Spain]. / Historia de la litotricia por ondas de choque en España.

We give a historical outline of urinary lithiasis with emphasis in the alternative therapeutic options to surgery. We expose the previous steps that led to the birth of extracorporeal shockwave lithotripsy and its implementation in our country.