Diferencias entre el Urocultivo Previo y el cultivo del Catéter doble J. Implicancias clínicas / DIFFERENCES BETWEEN PREVIOUS URINE CULTURE AND DOUBLE J CATHETER CULTURE. CLINICAL IMPLICATIONS

Las infecciones urinarias complicadas, dentro de las cuales se encuentran las asociadas a catéteres, son un hallazgo frecuente de la práctica clínica. Las complicaciones infecciosas después de los procedimientos urológicos son una fuente importante de morbimortalidad y consumen múltiples recursos sanitarios. La colonización bacteriana en el catéter ureteral juega un papel esencial en la patogénesis de la infección, y el uso de profilaxis antimicrobiana en urología es controvertido. El objetivo de nuestro trabajo fue evaluar la utilidad de la profilaxis antibiótica en la extracción del catéter doble J

Complicated urinary infections, among which are those associated with catheters, are a frequent finding in clinical practice. Infectious complications after urological procedures are an important source of morbidity and mortality and consume multiple healthcare resources. Bacterial colonization in the ureteral catheter plays an essential role in the pathogenesis of infection, and the use of antimicrobial prophylaxis in urology is controversial. Te objective of our work was to evaluate the usefulness of antibiotic prophylaxis in the extraction of the double J catheter

[Pneumatic lithotripsy vs Holmium: YAG Laser lithotripsy for the treatment of ureteral stones.] / Litotricia neumática vs. litotricia láser Ho: YAG en el tratamiento de la litiasis ureteral.

OBJECTIVE: Pneumatic lithotripsy (PL) and Ho: YAG laser lithotripsy (LL) are the most widely accepted methods in the endoscopic treatment of ureteral lithiasis. The objective is to compare efficacy and safety of pneumatic lithotripsy vs. Ho: YAG laser lithotripsy in the treatment of ureteral lithiasis. MATERIAL AND METHODS: Prospective, single-blind, multicenter study. Adult patients were recruited from August 2017 to March 2019, in 23 institutions throughout Argentina. Patient demographics, stone characteristics, presence of double J stent prior to the intervention, stonefree rate (SF) and postoperative complications were evaluated and analyzed. RESULTS: A total of 366 patients with ureteral lithiasis were included, 204 in the PL group and 162 in the LL group. The SF rate was significantly higher in the LL group (77% vs. 92%), OR 3 .43 (1.76 to 6.70). The complication rate was significantly lower in the LL group (9.8% vs. 2.5%), OR 0.23 (0.07 to 0.71). In the multivariate analysis, the use of Ho: YAG energy, the location of the lithiasis in the distal ureter, and the preoperative placement of double J stent, were found to be predictors of SF status. CONCLUSIONS: Ho: YAG laser lithotripsy has a higher stone-free rate and a lower complication rate compared to pneumatic lithotripsy.

OBJETIVO: La litotricia neumática (LN) y láser Ho: YAG (LH) son los métodos más aceptados en el tratamiento endoscópico de la litiasis ureteral. El objetivo es comparar eficacia y seguridad de la litotricia neumática vs. litotricia láser Ho: YAG en el tratamiento de la litiasis ureteral.MATERIAL Y MÉTODOS: Estudio prospectivo, simple ciego, multicéntrico. Se incluyeron pacientes adultos que se sometieron a tratamiento de litiasis ureteral, desde agosto de 2017 a marzo de 2019, en 23 instituciones nacionales. Las variables analizadas incluyeron: datos demográficos, tamaño y ubicación del lito, presencia de catéter doble J previo al procedimiento, tasa libre de litiasis (LL) y de complicaciones. RESULTADOS: Se incluyeron un total de 366 pacientes con litiasis ureteral, 204 en el grupo LN y 162 en el grupo LH. La tasa libre de litiasis fue significativamente superior en el grupo LH (77% vs. 92%), OR 3,43 (1,76 a 6,70) y la tasa de complicaciones fue significativamente menor en el grupo LH (9,8% vs. 2,5%), OR 0,23 (0,07 a 0,71). En el análisis multivariado, la utilización de la energía Ho: YAG, la ubicación de la litiasis en uréter distal y la colocación preoperatoria de catéter doble J, resultaron ser factores predictores del estado LL.CONCLUSIÓN: La litotricia láser Ho: YAG presenta una mayor tasa libre de litiasis y una menor tasa de complicaciones, en comparación con la litotricia neumática.

Litotricia neumática vs. Litotricia láser ho: yag en el tratamiento de la litiasis ureteral / Pneumatic lithotripsy vs. Ho: yag laser lithotripsy in the treatment of ureteral lithiasis

Obetivo: La litotricia neumática (LN) yláser Ho: YAG (LH) son los métodos más aceptados enel tratamiento endoscópico de la litiasis ureteral. El objetivo es comparar eficacia y seguridad de la litotricianeumática vs. litotricia láser Ho: YAG en el tratamientode la litiasis ureteral. Material y métodos: Estudio prospectivo, simpleciego, multicéntrico. Se incluyeron pacientes adultosque se sometieron a tratamiento de litiasis ureteral, desde agosto de 2017 a marzo de 2019, en 23 instituciones nacionales. Las variables analizadas incluyeron:datos demográficos, tamaño y ubicación del lito, presencia de catéter doble J previo al procedimiento, tasalibre de litiasis (LL) y de complicaciones. Resultados: Se incluyeron un total de 366 pacientescon litiasis ureteral, 204 en el grupo LN y 162 en elgrupo LH. La tasa libre de litiasis fue significativamentesuperior en el grupo LH (77% vs. 92%), OR 3,43 (1,76a 6,70) y la tasa de complicaciones fue significativamente menor en el grupo LH (9,8% vs. 2,5%), OR 0,23(0,07 a 0,71). En el análisis multivariado, la utilizaciónde la energía Ho: YAG, la ubicación de la litiasis enuréter distal y la colocación preoperatoria de catéterdoble J, resultaron ser factores predictores del estado LL. Conclusión: La litotricia láser Ho: YAG presenta unamayor tasa libre de litiasis y una menor tasa de complicaciones, en comparación con la litotricia neumática.(AU)

Objetive: Pneumatic lithotripsy (PL) andHo: YAG laser lithotripsy (LL) are the most widely accepted methods in the endoscopic treatment of ureterallithiasis. The objective is to compare efficacy and safetyof pneumatic lithotripsy vs. Ho: YAG laser lithotripsy inthe treatment of ureteral lithiasis. Material and methods: Prospective, single-blind,multicenter study. Adult patients were recruited from August 2017 to March 2019, in 23 institutions throughoutArgentina. Patient demographics, stone characteristics,presence of double J stent prior to the intervention, stonefree rate (SF) and postoperative complications wereevaluated and analyzed. Results: A total of 366 patients with ureteral lithiasiswere included, 204 in the PL group and 162 in theLL group. The SF rate was significantly higher in the LLgroup (77% vs. 92%), OR 3 .43 (1.76 to 6.70). Thecomplication rate was significantly lower in the LL group(9.8% vs. 2.5%), OR 0.23 (0.07 to 0.71). In the multivariate analysis, the use of Ho: YAG energy, the locationof the lithiasis in the distal ureter, and the preoperativeplacement of double J stent, were found to be predictorsof SF status. Conclusions: Ho: YAG laser lithotripsy has a higherstone-free rate and a lower complication rate comparedto pneumatic lithotripsy.(AU)

Simultaneous Ureteral and Renal Foreign Bodies.

Clinical presentation of patients with foreign bodies is highly variable. We received a 55-year-old female patient with fever and right flank pain. She was treated previously for kidney stones by percutaneous nephrolithtomy with partial resolution, requiring renal embolization during this procedure because of bleeding. CT evidenced metallic density images localized in kidney and ureter, associated with kidney stones located in lower calix. Semirigid ureteroscopy and retrograde intrarenal surgery were performed, revealing the presence of foreign bodies in both localizations and lower calix stones. Complete removal of foreign bodies and stones was performed. Foreign bodies were found to be embolization coils applied in the previous procedure.

Complex relationship between sex hormones, insulin resistance and leptin in men with and without prostatic disease.

OBJECTIVES: To assess sex hormones, leptin and insulin-resistance in men with prostate cancer (PCa) and benign prostatic hyperplasia (BPH) and to study associations between androgens and histologic score of prostate tissue in PCa. SUBJECTS AND METHODS: Two hundred ten men older than 45 years selected from 2906 participants of a population screening for PCa were studied: 70 with PCa, 70 with BPH and 70 controls (CG), matched by body mass index and age. Insulin, IGF-1, PSA, leptin, total, free (fT) and bioavailable testosterone (bT) and estradiol were measured. Each group was subdivided into two subgroups considering the presence of metabolic syndrome (MS); androgens and leptin levels were analyzed in the subgroups. RESULTS: Prostate cancer and BPH patients presented higher total, fT and bT levels than CG. IGF-1, insulin and HOMA index were higher in BPH than in the other two groups. PCa presented higher leptin [median (range) 6.5 (1.3-28.0) versus 4.8 (1.1-12.3) ng/ml; p < 0.01] and estradiol [median (range) 37.0 (20-90) versus 29.0 (20-118) pg/ml; p = 0.025] levels than CG. After dividing men considering the presence of MS, leptin was higher and total testosterone was lower in MS patients in all the groups. CONCLUSIONS: It was observed a coexistence of an altered hormone profile with increased sex hormones and leptin in PCa patients, in accordance with the new perspective of PCa pathogenesis.