ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 2: Analysis of PFS, reporting, and diagnosis.

AIMS: The Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure-flow studies of 1997. METHODS: Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release. RESULTS: The WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure-flow study (PFS) for patients in part 1. A pressure-flow plot is recommended for the diagnosis of every patient, in addition to time-based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure-flow scatter graph including every patient's pdet at maximum flow (pdetQmax ) with maximum flow rate (Qmax ) point should be included in all scientific reports considering voiding dysfunction. CONCLUSION: PFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females.

Defining bladder outlet obstruction and detrusor underactivity in females with overactive bladder: Are we forgetting about the free uroflowmetry?

INTRODUCTION: Both detrusor underactivity (DU) and bladder outlet obstruction (BOO) can coexist in patients with overactive bladder. Definitions of both DU and BOO are based on pressure-flow study (PFS) data. However, invasive urodynamics study can differ from a natural micturition, in fact, discrepancies between free uroflowmetry (UFM) and PFS have been largely described. Our goal is to assess the correlation of free-flowmetry and PFS among patients with OAB and to evaluate how different definitions of DU/BOO are able to discriminate patients with different free UFMs. METHODS: A retrospective review of urodynamics performed at a single institution was conducted. Females with OAB who voided more than 150 mL in both UFM and PFS were included. Parameters from both voiding episodes were compared with nonparametric test. Two definitions of DU were applied; PIP1: Pdet@Qmax+Qmax < 30 and Gammie: Pdet@Qmax < 20 cmH2 O, Qmax < 15 mL/s, and BVE < 90% (Bladder voiding efficiency). Also, two definitions of obstruction were chosen; Defretias: Pdet@Qmax ≥25 cmH2 O and Qmax ≤ 12 mL/s and Solomon-Greenwell female BOO index ≥ 18. Patients who matched with each definition were compared to those who did not, to assess if any definitions were able to discriminate different noninvasive uroflowmetries. RESULTS: A total of 195 patients were included. Overall, mean age was 55 ± 12 years, 90.8% had mixed urinary incontinence, and 39% complained of at least one voiding symptom. Globally, Qmax and BVE correlated poorly between UFM and PFS, showing that most of the variation corresponded to a systematic error. Twenty-two individuals were found to have DU, they had a difference of 13 mL/s on both maximum flows. Fifty-four patients showed BOO, with a difference between their Qmax of 19 mL/s. Among the four definitions analyzed, only PIP1 and Defreitas were able to discriminate patients with actually a lower Qmax on the free UFM. CONCLUSIONS: Patients with overactive bladder seem to have a systematic discordance between the urine flow of the free and invasive studies. Current definitions of DU and BOO, which are based on the PFS parameters, are not consistently able to discriminate patients who actually void deficiently on the free UFM.

Dropped abdominal pressure at void in women.

INTRODUCTION AND HYPOTHESIS: "Dropped pabd at void" occurs when pabd decreases below the previous resting pressure during voiding time. We sought clinical factors associated with this phenomenon and evaluated whether its correction modifies the urodynamic diagnosis. METHODS: Retrospective cross-sectional study of non-neurological consecutive symptomatic women. The following definitions were used: "dropped pabd at void": decrease in pabd at Qmax ≥ 5 cmH2O; bladder outflow obstruction (BOO) (pdetQmax ≥ 25 cmH2O + Qmax ≤ 12 ml/s and female BOO index (pdetQmax - 2.2*Qmax) > 18; "low detrusor contraction strength": PIP1 (pdetQmax + Qmax) < 30. In patients with "dropped pabd at void", pdetQmax was corrected. RESULTS: A total of 360 women were analyzed. Ninety-five percent of the women had a variation in pabd at Qmax between -13 and 53 cmH2O. "Dropped pabd at void" was found in 100 women (27.8%). History of stress urinary incontinence (SUI) surgery was significantly higher (p = 0.016) and symptoms of mixed urinary incontinence were significantly lower (p = 0.030) in patients with "dropped pabd at void". On multivariate analysis only the history of SUI surgery maintained its significance (OR = 1.787 [95% CI: 1.058, 3.017], p = 0.030). When correcting pdetQmax in women with "dropped pabd at void", 2 or 5 patients lost BOO diagnosis (depending on how it was diagnosed) and 7 patients gained a "low detrusor contraction strength" diagnosis. CONCLUSIONS: Approximately one-quarter of women had "dropped pabd at void", which was associated with a history of SUI surgery. Correction of pdetQmax would lead to a 2.5% to 3.33% diagnostic modification.

Voiding symptoms obtained by open versus directed anamnesis as predictors of voiding dysfunction in women

ABSTRACT Objectives To determine the differences between voiding symptoms obtained by open anamnesis (VS-Open) versus voiding symptoms obtained by directed anamnesis (VS-Directed) to predict voiding dysfunction in women. Materials and Methods Retrospective study of women with prior anti-incontinence surgery evaluated during 5 years. In a standardized clinical history taking, each patient was asked to answer question number five of the UDI-6 questionnaire ("Do you experience any difficulty emptying your bladder?"). If the answer was positive, the following voiding symptoms spontaneously described by the patient were documented: slow urine stream, straining to void, intermittent stream and feeling of incomplete bladder emptying, which were considered VS-Open. If the answer to this question was negative or if the patient had not reported the four voiding symptoms, she was asked in a directed manner about the presence of each o Ninety-one women are analyzed. Eighteen patients presented voiding dysfunction (19.8%), There was a statistical association between voiding dysfunction and the presence of any VS-Open (p = 0.037) and straining to void obtained by open anamnesis (p = 0.013). Sensitivity, specificity, PPV, NPV, positive likelihood ratio and negative likelihood ratio, respectively, were 44.4% and 27.8%, 80.8% and 94.5%, 36.3% and 55.6%, 85.5% and 84.1%, 2.324 and 5.129, and 0.686 and 0.764. There was no statistical association between voiding dysfunction and VS-Directed. Conclusions VS-Open may predict better voiding dysfunction than VS-Directed in women.

Voiding symptoms obtained by open versus directed anamnesis as predictors of voiding dysfunction in women.

OBJECTIVES: To determine the differences between voiding symptoms obtained by open anamnesis (VS-Open) versus voiding symptoms obtained by directed anamnesis (VSDirected) to predict voiding dysfunction in women. MATERIALS AND METHODS: Retrospective study of women with prior anti-incontinence surgery evaluated during 5 years. In a standardized clinical history taking, each patient was asked to answer question number fi ve of the UDI-6 questionnaire ("Do you experience any difficulty emptying your bladder?"). If the answer was positive, the following voiding symptoms spontaneously described by the patient were documented: slow urine stream, straining to void, intermittent stream and feeling of incomplete bladder emptying, which were considered VS-Open. If the answer to this question was negative or if the patient had not reported the four voiding symptoms, she was asked in a directed manner about the presence of each of them, which were considered VS-Directed. Voiding dysfunction was considered the presence of a maximum fl ow ≤ 12 mL/s and/ or a postvoid residual > 100 mL. RESULTS: Ninety-one women are analyzed. Eighteen patients presented voiding dysfunction (19.8%), There was a statistical association between voiding dysfunction and the presence of any VS-Open (p = 0.037) and straining to void obtained by open anamnesis (p = 0.013). Sensitivity, specificity, PPV, NPV, positive likelihood ratio and negative likelihood ratio, respectively, were 44.4% and 27.8%, 80.8% and 94.5%, 36.3% and 55.6%, 85.5% and 84.1%, 2.324 and 5.129, and 0.686 and 0.764. There was no statistical association between voiding dysfunction and VS-Directed. CONCLUSIONS: VS-Open may predict better voiding dysfunction than VS-Directed in women.

Incontinencia urinaria en el adulto mayor / Urinary incontinence in the elderly

RESUMEN Antecedentes: La incontinencia urinaria (IU) corresponde a la pérdida involuntaria de orina. En la medida en que la población envejece, aumenta su prevalencia y severidad. Objetivo: Describir el impacto de la incontinencia de orina en la población adulto mayor, así como conocer su fisiopatología e implicancias en la calidad de vida. Método: Revisión de la literatura disponible en PubMed, Embase y Medline utilizando los términos "urinary incontinence" y "elderly" entre los años 1990 y 2018. Resultados: La IU en el adulto mayor impacta negativamente en la calidad de vida de esta población, teniendo una multiplicidad de causas subyacentes que implican un tratamiento integral y multidisciplinario de esta patología. Conclusión: Dado el incremento de la edad en la población, conocer y manejar esta patología es importante para el clínico y el especialista para que de esta forma mejore la calidad de vida en este grupo etario.

ABSTRACT Background: Urinary incontinence (UI) is the involuntary loss of urine. The prevalence and severity of this condition increase as population ages. Objective: To describe the impact urinary incontinence in the elderly population, as well as to know its pathophysiology and implications in the quality of life. Method: Review of the literature available in PubMed, Embase and Medline using the keywords "urinary incontinence" and "elderly" between 1990 and 2018. Results: UI in the elderly has a negative impact on their quality of life, having a multiplicity of underlying causes that imply a comprehensive and multidisciplinary treatment of this pathology. Conclusion: Given the age increase in general population, knowing and managing this pathology is important for the clinician and the specialist to improve the quality of life in this age group.

Differences in urodynamic voiding variables recorded by conventional cystometry and ambulatory monitoring in symptomatic women.

OBJECTIVES: To determine whether there are differences in pressure and flow measurements between conventional cystometry (CONV) and ambulatory urodynamic monitoring (AMB) in women with overactive bladder syndrome and urinary incontinence. MATERIALS AND METHODS: Retrospective study which included female subjects who underwent both CONV (with saline filling medium) and AMB, separated by less than 24 months, not using medication active on the lower urinary tract and without history of prior pelvic surgery. Both tests were carried out in compliance with the International Continence Society standards. The paired Student's t test was used to compare continuous variables. Bland-Altman statistics were used to assess the agreement of each variable between both studies. RESULTS: Thirty women with a median (range) age of 50 (14 - 73) years met the inclusion criteria. AMB was carried out at a mean (SD) of 11 (6) months after CONV. Measurements of pves and pabd at the end of filling, and Qmax were significantly higher from AMB recordings. There were no differences in pdet at the end of filling, pdetQmax or pdetmax during voiding, nor significant difference in Vvoid. CONCLUSIONS: We provide previously undocumented comparative voiding data between CONV and AMB for patients who most commonly require both investigations. Our findings show higher values of Qmax but similar values of pdetQmax measured by AMB which may partly reflect an overall lower catheter caliber, physiological filling but perhaps also more 'normal' voiding conditions.

Differences in urodynamic voiding variables recorded by conventional cystometry and ambulatory monitoring in symptomatic women

Objectives To determine whether there are differences in pressure and flow measurements between conventional cystometry (CONV) and ambulatory urodynamic monitoring (AMB) in women with overactive bladder syndrome and urinary incontinence. Materials and Methods Retrospective study which included female subjects who underwent both CONV (with saline filling medium) and AMB, separated by less than 24 months, not using medication active on the lower urinary tract and without history of prior pelvic surgery. Both tests were carried out in compliance with the International Continence Society standards. The paired Student’s t test was used to compare continuous variables. Bland-Altman statistics were used to assess the agreement of each variable between both studies. Results Thirty women with a median (range) age of 50 (14 - 73) years met the inclusion criteria. AMB was carried out at a mean (SD) of 11 (6) months after CONV. Measurements of pves and pabd at the end of filling, and Qmax were significantly higher from AMB recordings. There were no differences in pdet at the end of filling, pdetQmax or pdetmax during voiding, nor significant difference in Vvoid. Conclusions We provide previously undocumented comparative voiding data between CONV and AMB for patients who most commonly require both investigations. Our findings show higher values of Qmax but similar values of pdetQmax measured by AMB which may partly reflect an overall lower catheter caliber, physiological filling but perhaps also more ‘normal’ voiding conditions. .

Immunohistochemistry expression of P53, Ki67, CD30, and CD117 and presence of clinical metastasis at diagnosis of testicular seminoma.

INTRODUCTION: We evaluated the immunohistochemical expression of p53, Ki67, CD30, and CD117 and correlated it with histological features and presence of clinical metastasis at diagnosis of testicular seminomas. MATERIALS AND METHODS: A retrospective study of 62 patients was performed in patients with pure seminoma. The retroperitoneum was staged with computed tomography scan and the thorax with simple x-rays and/or computed tomography scan. Pathologists were unaware of the clinical stage of the patients. Manual microarrays were created from a tissue representative of tumor. The expression of p53, Ki67, CD30, and CD117 was evaluated as negative, any degree of expression, and expression in more than 50% of neoplastic cells. Univariate and multivariate analysis were performed. RESULTS: Sixty-two cases were analyzed: 43 cases were in clinical stage I (69.4%), 17 were in clinical stage II (27.4%), and 2 were in clinical stage III (3.2%). Fifty-six cases expressed CD117 (90%), 42 p53 (68%), 8 CD30 (13%), and all cases Ki67. There were no differences in p53, Ki67, CD30, and CD117 expression between testicular seminoma with and without clinical metastasis at diagnosis, regardless of the magnitude of expression. Neither of them found positive association between these marker expressions and morphologic risk factors such as tumor size greater than 6 cm and rete testis invasion. CONCLUSIONS: This study shows that expression of p53, Ki67, and CD30 and loss of CD117 expression fail to predict the presence of clinical metastasis at diagnosis of testicular seminoma and do not correlate with other histopathological risk factors in clinical stage I patients.

Requerimientos de analgesia para litotricia extracorpórea de cálculos urinarios, según su ubicación: 20 años de experiencia clínica / Analgesic requirements for extracorporeal shock wave lithotripsy of urolithiasis, according to their location. 20 years of clinical experience

Objetivo: Determinar los requerimientos de analgesia y anestesia para litotricia extracorpórea (LEC) de cálculos urinarios según la localización del cálculo en la vía urinaria. Material y Métodos: Se analizan 3.905 pacientes tratados en el Hospital Militar de Santiago con litotritores electromagnéticos tipo Modulith entre 1990 y 2010,consignando la ubicación del cálculo, la analgesia y sedación utilizada. Las modalidades de analgesia, sedación y anestesia se dividen en 3 grupos: 1-. Sin analgesia. 2-.Analgosedación superficial: aquella en la cual el urólogo determina y administra los fármacos requeridos. 3-. Analgosedación profunda: se requieren técnicas y fármacos de manejo del anestesista. Resultados: 349 pacientes (8,9 por ciento) no requirieron ningún analgésico o sedante. Tres mil doscientos once pacientes (82,2 por ciento) fueron manejados con analgesia superficial y en 345 casos (8,8 por ciento), se requirió sedación profunda o anestesia para su tratamiento. Aquellos pacientes con cálculos localizados en el cáliz superior registran los mayores requerimientos de analgesia profunda. Conclusión: En la mayor parte de los casos, la analgesia superficial administrada por el urólogo es suficiente para el manejo del dolor en LEC. Las LEC con litotritores Modulith, requieren la asistencia de anestesista en menos del 10 por ciento de los casos. La posición del cálculo en la vía urinaria tiene impacto en los requerimientos de analgosedación y anestesia.

Objective: To determine the requirements of analgesia and anesthesia for extracorporeal shock wave lithotripsy (ECL) for kidney stones according to the location of the calculus in the urinary tract. Material and methods: We analyzed 3,905 patients treated at the Military Hospital of Santiago with MODULITH electromagnetic type lithotripters, between 1990 and 2010, stating the location of calculi, analgesia and sedation used. Types of analgesia, sedation and anesthesia were divided into 3 groups: 1-. No analgesia. 2-.Superficial sedation/analgesia: in which the urologist determines and administers the drugs required. 3-. Deep sedation/analgesia: It requires anesthesiologist management. Results: 349 patients (8.9 percent) did not require any analgesic or sedative agent. 3,211patients (82.2 percent) were managed with superficial analgesia. 345 patients (8.8 percent) required deep sedation or anesthesia for treatment. Patients with calculi located in the upper calyx had the highest requirements of deep anesthesia. Conclusion: In most cases, the superficial analgesia administered by a urologist is enough for pain management. MODULITH electromagnetic type lithotripters ECL, required the assistance of an anesthesiologist in less than 10 percent of the cases. The position of calculi in the urinary tract has an impact on the requirements of analgesic/sedation and anesthesia.

[Discontinuous oral ciprofloxacin for transurethral resection of the prostate. Initial results]. / Ciprofloxacino oral discontinuo en resección transuretral de prostata. Resultados iniciales.

OBJECTIVES: To describe the rate of infectious complications using a discontinuous scheme of oral ciprofloxacin in transurethral resection of the prostate (TUR-P). To try to weigh the influence of clinical background, operative complications and postoperative outcome on the development of such complications. To compare the results to those obtained with equal methodology using antibiotics in a continual scheme until the catheter removal. METHOD: A prospective open study was designed including 53 consecutive patients with sterile urine and without indwelling catheter subjected to TUR-P. Patients received oral ciprofloxacin 500 mg (4 doses) before going to the surgical room, the night of surgery, next morning of surgery and before catheter removal. Three patients were excluded after incorporation (5.6%) and all the remainders completed follow up. RESULTS: Fifty patients are analyzed. Fever was present in 8 patients (16%). Systemic clinical infection was present in 3 patients (6%). No isolated-germ postoperative bacteriuria was present. Previous urinary infection (UTI) was statistically associated to systemic clinical infection (p = 0.007) and to active chronic prostatitis on operative biopsy (p = 0.002). CONCLUSION: Probably previous UTI antecedent made less advisable the discontinuous scheme use in TUR-P, although a greater number of patients is needed to confirm these statement. When these results are compared to those using antibiotics in a continual scheme until catheter removal, a significant higher frequency of fever is seen (p = 0.022).

Ciprofloxacino oral discontinuo en resección transuretral de próstata. Resultados iniciales / Discontinuous oral ciprofloxacin for transurethral resection of the prostate. Initial results

OBJETIVOS: Describir las complicaciones infecciosas con el uso de ciprofloxacino oral discontinuo en resección transuretral de próstata (RTU-P). Ponderar la influencia de los antecedentes clínicos, hallazgos y complicaciones intraoperatorias y evolución postoperatoria en el desarrollo de dichas complicaciones. Comparar los resultados con estudio previo de igual metodología en que se usó esquema antibiótico continuo hasta el retiro de la sonda uretrovesical. MÉTODO: Estudio prospectivo abierto de 53 pacientes consecutivos con orina estéril no usuarios de sonda uretrovesical, sometidos a RTU-P. Los pacientes recibieron ciprofloxacino 500 mg. oral (4 dosis) antes de su traslado a pabellón, la noche de la operación, la mañana siguiente de ésta y antes de retirar la sonda uretrovesical. Se excluyeron 3 pacientes después de su incorporación (5,6%) y no hubo pérdidas en el seguimiento. RESULTADOS: Se analizan 50 pacientes. Se presentó fiebre en 8 pacientes (16%). Se presentó infección clínica sistémica en 3 pacientes (6%). No se presentó bacteriuria postoperatoria aislada. El antecedente de ITU previa presentó asociación estadística con el desarrollo de infección clínica sistémica (p= 0,007) y con el hallazgo de prostatitis crónica activa en la biopsia operatoria (p= 0,002). CONCLUSIÓN: Probablemente el antecedente de ITU previa hace menos aconsejable el uso de esquema antibiótico discontinuo en RTU-P, aunque se requiere de un mayor número de pacientes para confirmar este planteamiento. Al comparar estos resultados con aquellos obtenidos usando un esquema antibiótico continuo, se observa una significativa mayor frecuencia de fiebre durante la evolución (p= 0,022)

OBJECTIVES: To describe the rate of infectious complications using a discontinuous scheme of oral ciprofloxacin in transurethral resection of the prostate (TUR-P). To try to weigh the influence of clinical background, operative complications and postoperative outcome on the development of such complications. To compare the results to those obtained with equal methodology using antibiotics in a continual scheme until the catheter removal. METHOD: A prospective open study was designed including 53 consecutive patients with sterile urine and without indwelling catheter subjected to TUR-P. Patients received oral ciprofloxacin 500 mg (4 doses) before going to the surgical room, the night of surgery, next morning of surgery and before catheter removal. Three patients were excluded after incorporation (5,6%) and all the remainders completed follow up. RESULTS: Fifty patients are analyzed. Fever was present in 8 patients (16%). Systemic clinical infection was present in 3 patients (6%). No isolated-germ postoperative bacteriuria was present. Previous urinary infection (UTI) was statistically associated to systemic clinical infection (p= 0,007) and to active chronic prostatitis on operative biopsy (p= 0,002). CONCLUSION: Probably previous UTI antecedent made less advisable the discontinuous scheme use in TUR-P, although a greater number of patients is needed to confirm these statement. When these results are compared to those using antibiotics in a continual scheme until catheter removal, a significant higher frequency of fever is seen (p= 0,022)

Cirugía de masas retroperitoneales residuales post quimioterapia en cáncer testicular / Surgery of retroperitoneal residual mass post chemotherapy in testicular cancer

Introducción: El avance en el tratamiento del cáncer testicular avanzado se debe a la quimioterapia basada en cisplatino y a la cirugía de las masas retroperitoneales residuales (MRR) posquimioterapia. El objetivo de este estudio es mostrar nuestra experiencia en la cirugía de MRR postquimioterapia en cáncer testicular. Material y método: Estudio restrospectivo de pacientes sometidos a esta cirugía en el Hospital Clínico Universidad de Chile entre enero de 1988 y diciembre de 2000. El objetivo quirúrgico fue la resección completa de la MRR. Resultados: Se analizaron 22 pacientes de edad promedio 26 años. El tamaño de las MRR varió entre 1 y 17 cm. Trece pacientes fueron intervenidos con marcadores tumorales (MT) normales y nueve con MT elevados. Se efectuó resección completa en 18 pacientes (82 por ciento). Siete pacientes presentaron complicaciones intraoperatorias mayores (32 por ciento) y 4 complicaciones postoperatorias precoces (18 por ciento). No hubo reoperaciones ni mortalidad en nuestra serie. En pacientes con MT normales 3 presentaron tumor activo en la MRR (25 por ciento); en pacientes con MT elevados todos presentaron tumor activo. Discusión: Una altaproporción de pacientes fueron intervenidos con MT elevados. Incluyendo 5 en que se planificó precozmente después de 1 ó 2 ciclos de quimioterapia. Corresponde a una cirugía con alto índice de complicaciones. Los hallazgos histopatológicos dependieron de la histología testicular y de los MT preoperatorios.

Estudio comparativo prospectivo aleatorio de antibióticos en resección transuretral de próstata / Comparative prospective randomized study of antibiotics in transurethral resection of the prostate

Comparar las complicaciones infecciosas con el uso de 2 esquemas antibióticos en resección transuretral de próstata (RTU-P) de pacientes con bajo riesgo, de modo de reducir el uso de antibióticos en este tipo de pacientes. Secundariamente, intentar ponderar la influencia de los antecedentes clínicos, hallazgos y complicaciones intraoperatorias y evolución postoperatoria en el desarrollo de dichas complicaciones. Se diseñó un estudio comparativo, prospectivo, aleatorio, abierto de 95 pacientes con orina estéril, no usuarios de sonda uretrovesical, sometidos a RTU-P en el plazo de 1 año. El grupo 1 recibió una modificación del esquema antibiótico mayormente utilizado hasta la fecha, consistente en cefazolina 1 gr IV preoperatorio y cada 8 h durante el primer día (3 dosis), seguido de ciprofloxacino 250 mg VO, cada 12 h, hasta el retiro de la sonda uretrovesical (dosis terapéutica). El grupo 2 recibió cefazolina 1 g IV preoperatorio y a las 8 h postoperatorias (2 dosis), seguido de nitrofurantoína, 100 mg VO en la noche, hasta el retiro de la sonda uretrovesical (dosis profiláctica). Se excluyeron 5 pacientes del análisis después de la distribución aleatoria (5,3'porciento) y no hubo pérdidas en el seguimiento. Se analizan 90 pacientes, 45 en cada grupo, los cuales fueron comparables en sus características clínicas, parámetros quirúrgicos, parámetros postoperatorios y complicaciones. Se presentó fiebre (temperatura axilar igual o mayor a 37,5 °C) en el 2 porciento del grupo 1 y en el 11 porciento del grupo 2 (p=0,091). Se presentó bacteriuria postoperatoria (recuento > 100.000 UFC por mL) precoz o tardía en el 2 porciento del grupo 1 y en el 13 porciento del grupo 2 (p=0,049). Esto, posiblemente, se debió al espectro de acción y dosis de los antimicrobianos utilizados. La fiebre estuvo relacionada estadísticamente con la infección urinaria postoperatoria.

[Cyst of the prostatic utricle: report of a case complicated by giant lithiasis]. / Quiste del utrículo prostático: reporte de un caso complicado de litiasis gigante.

OBJECTIVE: We report a case of prostatic utricle cyst complicated with giant lithiasis. METHOD/RESULTS: A 42 year old man with history of surgery for bilateral cryptorchidism and hypospadias in his infancy, presented with initial and terminal hematuria and a digital rectal examination showing a rocky, smooth enlargement of the anterior rectal wall. Prostatic specific antigen was normal. Transrectal and transabdominal ultrasound showed a large retrovesical calcification and intravenous pyelogram showed normality of the upper urinary tract. The patient underwent a complete resection through a suprapubic extraperitoneal approach without complications. Histopathology revealed a 10 cm long prostatic utricle cyst complicated with lithiasis. CONCLUSIONS: The prostatic utricle cysts are rare in clinical practice and associate with anomalies of testicular descent and hypospadias. They have a difficult differential diagnosis and indication for treatment depends on presenting symptoms, size and complications.

Quiste del utrículo prostático: reporte de un caso complicado de litiasis gigante / Prostatic utricle cyst: report of a case complicated with giant lithiasis

OBJETIVO: Reportar un caso de utrículo prostático complicado de litiasis gigante. MÉTODO/RESULTADOS: Paciente de 42 años de edad con antecedente de criptorquídea e hipospadia operadas en la infancia, quien consultó por hematuria inicial y terminal y cuyo examen físico demostró un aumento de volumen pétreo, liso, en pared rectal anterior. Su antígeno prostático específico fue normal. La ultrasonografía transrectal y transabdominal demostraron una gran calcificación retrovesical y la pielografía endovenosa normalidad del tracto urinario superior. Fue sometido a una resección completa suprapúbica extraperitoneal sin complicaciones. La histopatología reveló un quiste del utrículo prostático complicado de litiasis de 10 cm. CONCLUSIONES: Los quistes del utrículo prostático son infrecuentes en la práctica clínica y se asocian a anomalías del descenso testicular e hipospadia. Su diagnóstico diferencial es difícil y la indicación de cirugía depende de los síntomas de presentación, de su tamaño y de sus complicaciones (AU)

No disponible