Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification.

Detrusor underactivity (DU) could be resulted from many different etiologies. Patients with DU might have reduced bladder sensation, low detrusor contractility, and large post-void residual volume. This study analyzed therapeutic outcome of active management for male DU patients, based on clinical and urodynamic characteristics. Male DU patients aged > 18 years old were retrospectively reviewed from the videourodynamic study (VUDS) records in recent 10 years. The patients' demographics, VUDS results, treatment modalities, and treatment outcome were analyzed. The treatment outcomes were compared among patients with different DU subgroups, clinical diagnosis and treatment modalities. Patients with voiding efficiency of > 66.7% were considered having a successful treatment outcome. For comparison, 30 men with normal VUDS finding served as the control arm. Most of the DU patients had reduced bladder sensation. The reduced bladder sensation is closely associated with low detrusor contractility. After active treatment, a successful outcome was achieved in 68.4% of patients after bladder outlet surgery, 59.1% after urethral botulinum toxin A injection, and 57.6% after medical treatment, but only 18.2% after conservative treatment. A successful treatment outcome was achieved in patients with an intact detrusor contractility, either low (69.2%) or normal voiding pressure (81.8%), and in patients with a normal or increased bladder sensation (78.1%). However, patients with detrusor acontractile (41.3%) or absent bladder sensation (17.9%) had less favorable treatment outcome after any kind of urological management. This study revealed that active management can effectively improve voiding efficiency in patients with DU. The normal bladder sensation, presence of adequate detrusor contractility, and bladder outlet narrowing during VUDS provide effective treatment strategy for DU patients. Among all management, BOO surgery provides the best treatment outcome.

Novel AVPR2 mutations and clinical characteristics in 28 Chinese families with congenital nephrogenic diabetes insipidus.

AIMS: To investigate genotype and phenotype of congenital nephrogenic diabetes insipidus caused by AVPR2 mutations, which is rare and limitedly studied in Chinese population. METHODS: 88 subjects from 28 families with NDI in a department (Beijing, PUMCH) were screened for AVPR2 mutations. Medical records were retrospectively reviewed and characterized. Genotype and phenotype analysis was performed. RESULTS: 23 AVPR2 mutations were identified, including six novel mutations (p.Y117D, p.W208R, p.L313R, p.S127del, p.V162Sfs*30 and p.G251Pfs*96). The onset-age ranged from 1 week to 3 years. Common presentations were polydipsia and polyuria (100%) and intermittent fever (57%). 21% and 14% of patients had short stature and mental impairment. Urine SG and osmolality were decreased, while serum osmolality and sodium were high. Urological ultrasonography results showed hydronephrosis of the kidney (52%), dilation of the ureter (48%), and thickened bladder wall or increased residual urine (32%), led to intermittent urethral catheterization (7%), cystostomy (11%) and binary nephrostomy (4%). Urological defects were developed in older patients. Genotype and phenotype analysis revealed patients with non-missense mutations had higher levels of serum sodium than missense mutations. CONCLUSION: In the first and largest case series of NDI caused by AVPR2 mutations in Chinese population, we established genetic profile and characterized clinical data, reporting six novel mutations. Further, we found genotype was associated with phenotype. This knowledge broadens genotype and phenotype spectrum of rare congenital NDI caused by AVPR2 mutations, and provides basis for studying molecular biology of AVPR2.

Mobile sonouroflowmetry using voiding sound and volume.

Uroflowmetry (UF) is a common clinic-based non-invasive test to diagnose Lower Urinary Tract Dysfunction (LUTD). Accurate home-based uroflowmetry methods are needed to conveniently conduct repeated uroflowmetries when patients are physiologically ready to urinate. To this end, we propose and evaluate a novel mobile sonouroflowmetry (SUF) method that estimates the urinary flow rate from a sound signal recorded using a mobile phone. By linearly mapping the total sound energy to the total voided volume, the sound energy curve is transformed to a flow rate curve allowing the estimation of the flow rate over time. An evaluation using data from 44 healthy young men showed high similarity between the UF and SUF flow rates with a mixed-effects model correlation coefficient of 0.993 and a mean root mean square error of 2.37 ml/s. Maximum flow rates were estimated with an average absolute error of 2.41 ml/s. Future work on mobile uroflowmetry can use these results as an initial benchmark for flow rate estimation accuracy.

Factors contributing to discrepant estimated glomerular filtration values measured by creatinine and cystatin C in patients with rheumatoid arthritis.

This study aimed to clarify the factors underlying the discrepancy that has been noted between estimated glomerular filtration ratio (eGFR) measured using serum creatinine (Cr) and eGFR using serum cystatin C (CysC) in patients with rheumatoid arthritis (RA) and to identify those patients whose renal function should be evaluated using CysC. We retrospectively evaluated clinical features, disease activity, Steinbrocker radiological staging, and co-morbidities (diabetes mellitus, hypertension, dyslipidemia) in 238 RA patients. eGFR using serum creatinine (eGFR-Cr) and eGFR using serum cystatin C (eGFR-CysC) were calculated using the new Japanese coefficient-modified Modification of Diet in Renal Disease study equation. To clarify the cause(s) of differences of 20% or more between the two eGFRs, we divided our RA patients into Group A (eGFR-Cr/eGFR-CysC ≥ 1.2) and Group B (eGFR-Cr/eGFR-CysC < 1.2), and searched for factors independently related to Group A. Forty-five patients (18.9%) were assigned to Group A, and 193 (81.1%) to Group B. BMI (Odds Ratio [OR] 0.820, 95% confidence interval [CI] 0.675-0.996), Hb (OR 0.633, 95% CI 0.433-0.926), CK (OR 0.773 per 10 units, 95% CI 0.644-0.933), NSAID use (OR 0.099, 95% CI 0.020-0.494), diabetes mellitus (OR 6.024, 95% CI 1.508-24.390) and stage 4 Steinbrocker radiological stage (OR 10.309, 95% CI 2.994-35.714) were identified as independent relevant factors for Group A by a multifactorial analysis. Renal function in RA patients with low BMI, diabetes, anemia and low CK may be overestimated using eGFR-Cr alone, and such patients need to be evaluated using eGFR-CysC.

Análisis de la percepción del dolor asociado al estudio urodinámico en niños mayores de tres años / Analysis of pain perception associated with urodynamic testing in children over 3 years old

Objetivo: Medir la tolerancia del estudio urodinámico (EUD) en el paciente pediátrico, mediante una escala visual analógica. Analizar qué variables clínicas y relacionadas con el EUD influyen en la percepción del dolor.Material y métodosEstudio transversal de 139 pacientes pediátricos tras un EUD (entre diciembre del 2013 a mayo del 2018). Criterio de inclusión: entender y expresar su experiencia tras el EUD (edad preescolar y escolar). No se incluyeron adolescentes.La herramienta de evaluación: escala visual analógica del dolor (EVA 0-10). Se obtuvieron otras variables clínicas y asociadas al EUD. Análisis estadístico: U de Mann-Whitney, Kruskal-Wallis. Análisis de correlación de Spearman (rs). Análisis multivariante mediante regresión logística ordinal. Significación p < 0,05.ResultadosMedia de edad 7,7 años (DE 2,4), mediana puntuación EVA, 2 (2-6). En un 41% (n = 57), la puntuación fue ≥ 4 (dolor moderado). Análisis multivariante. Variables explicativas de obtener una puntuación EVA alta: puntuación APEUD alta (identificar en el paciente nerviosismo previo al EUD), alteración sensitivo-motora de MMII, una dificultad en el sondaje vesical y que aparezca dolor durante el llenado. La edad y el tiempo de duración del EUD no han influido en dicha puntuación EVA.ConclusionesAunque el EUD ha generado que un 40% de los pacientes pediátricos de nuestro estudio expresaran molestias o dolor, es una prueba bien tolerada.Las variables que han influido en la percepción del dolor han sido: el nerviosismo del paciente previo al EUD, una alteración sensitivo-motora localizada en metámeras lumbosacras, una dificultad en el sondaje vesical y que aparezca dolor durante el llenado vesical. (AU)

Objective: To measure the tolerance of urodynamic testing (UDT) in the pediatric patient by means of the Visual Analog Scale (VAS). To analyze which clinical and UDT-related variables influence pain perception. Material and methods. Cross-sectional study of 139 pediatric patients undergoing UDT (December 2013 - May 2018). Inclusion criteria: understanding and expressing their experience after UDT (preschool and school age). No adolescents were included.Measurement instrument Visual Analog Scale (0-10). Other clinical and UDT-associated variables were obtained. Statistical analysis: Mann-Whitney U test, Kruskal Wallis test. Spearman's rank correlation analysis (rs). Multivariate analysis through ordinal logistic regression. Significance p < 0.05.ResultsMean age 7.7 years (SD 2.4), median VAS score, 2 (2-6). In 41% (n = 57), the score was ≥ 4 (moderate pain). Multivariate analysis. Explanatory variables for obtaining a high VAS score: high APUDT score (identifying patient anxiety prior to UDT), sensory-motor alteration in the lower limbs, difficult bladder catheterization and the appearance of pain during the filling phase. Age and duration of the UDT have not influenced the VAS score.ConclusionsAlthough the UDT has resulted in 40% of the pediatric patients in our study expressing discomfort or pain, it is a well-tolerated test.The variables that have influenced on pain perception were patient's anxiety prior to UDT, a sensory-motor alteration located in the lumbosacral metameres, difficult bladder catheterization and the appearance of pain during bladder filling. (AU)

Analysis of pain perception associated with urodynamic testing in children over 3 years old. / Análisis de la percepción del dolor asociado al estudio urodinámico en niños mayores de tres años.

OBJECTIVE: To measure the tolerance of urodynamic testing (UDT) in the pediatric patient by means of the Visual Analog Scale (VAS). To analyze which clinical and UDT-related variables influence pain perception. MATERIAL AND METHODS: Cross-sectional study of 139 pediatric patients undergoing UDT (December 2013 - May 2018). INCLUSION CRITERIA: understanding and expressing their experience after UDT (preschool and school age). No adolescents were included. Measurement instrument Visual Analog Scale (0-10). Other clinical and UDT-associated variables were obtained. STATISTICAL ANALYSIS: Mann-Whitney U test, Kruskal Wallis test. Spearman's rank correlation analysis (rs). Multivariate analysis through ordinal logistic regression. Significance p < 0.05. RESULTS: Mean age 7.7 years (SD 2.4), median VAS score, 2 (2-6). In 41% (n = 57), the score was ≥ 4 (moderate pain). Multivariate analysis. Explanatory variables for obtaining a high VAS score: high APUDT score (identifying patient anxiety prior to UDT), sensory-motor alteration in the lower limbs, difficult bladder catheterization and the appearance of pain during the filling phase. Age and duration of the UDT have not influenced the VAS score. CONCLUSIONS: Although the UDT has resulted in 40% of the pediatric patients in our study expressing discomfort or pain, it is a well-tolerated test. The variables that have influenced on pain perception were patient's anxiety prior to UDT, a sensory-motor alteration located in the lumbosacral metameres, difficult bladder catheterization and the appearance of pain during bladder filling.

Evaluation of the Diagnostic Value of Contrast-Enhanced Voiding Urosonography with Regard to the Further Therapy Regime and Patient Outcome-A Single-Center Experience in an Interdisciplinary Uroradiological Setting.

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.

Comparison of Methods to Identify Stress Urinary Incontinence in Women With Pelvic Organ Prolapse.

OBJECTIVE: The aim of the study was to compare which test is most sensitive in identifying stress urinary incontinence (SUI) in women with pelvic organ prolapse using urodynamics (UDS) as the criterion standard: cough stress test (CST) or pyridium pad test. METHODS: This was a prospective study of women with pelvic organ prolapse stage II or greater who desired surgical management for prolapse. Each patient underwent preoperative urinary testing: UDS, CST, and a 24-hour pyridium pad test. RESULTS: A total of 84 patients were analyzed. Using UDS as the criterion standard, both the CST and the pyridium pad test showed a fair agreement with UDS outcomes (κ = 0.27 for both tests). There was no statistically significant difference between the CST and the pyridium pad test, with estimated sensitivities of 34.4% versus 40.6% (P = 0.791), specificities of 90.4% versus 84.6% (P = 0.508). The pyridium pad test was found to have a statistically significant difference in identifying the subjective complaint of SUI (38.6%, P = 0.003) compared with other tests. Patients with occult incontinence were identified 42.5%, 17.5%, and 10% of the time during UDS, CST, and pyridium pad testing, respectively. CONCLUSION: Our data suggest that the sensitivities of the CST and pyridium pad test for stress incontinence and occult stress incontinence in patients with pelvic organ prolapse are low when compared with UDS as the criterion standard. Urodynamics has an important role in preoperative identification of occult SUI.

Streamlining Postoperative Void Trials: A Study Comparing Standard Backfill Versus Backfill in the Operating Room.

OBJECTIVE: The standard backfill void trial (VT) performed after urogynecologic surgery is time-consuming. We adopted a new VT protocol in which the bladder is backfilled in the operating room (OR). We hypothesized that this protocol would result in (1) shorter postoperative care unit (PACU) stay and (2) lower rates of postoperative catheterization compared with standard VT. METHODS: We performed a retrospective cohort study of women who underwent same-day urogynecologic surgery between August 2018 and March 2019. Basic demographic and procedure information was collected. Patients were divided into 2 groups based on VT performed. Continuous and categorical variables were compared using Student t tests and χ2 tests, respectively. A linear regression model for PACU length of stay was used to control for confounders. RESULTS: Two hundred twenty-five women were included. One hundred eleven (49.3%) had the OR backfill VT and 114 (50.7%) had the standard VT. There were no statistically significant between-group differences in demographics or procedures performed. The average time in PACU was 15 minutes shorter in the OR backfill compared with the standard VT group (154.8 ± 60.6 vs 169.8 ± 83.2, P = 0.12). After adjusting for confounders, having the OR backfill VT resulted in a 23-minute reduction in PACU time (ß = -23.7; 95% confidence interval, -41.3 to -6.1; P = 0.009). The overall VT failure rate was 21.3% and was not significantly different between groups (24.3% vs 18.4%, P = 0.28). CONCLUSIONS: The OR backfill VT resulted in a shorter stay in PACU without increasing the incidence of postoperative catheterization. With the transition to enhanced recovery after surgery protocols, streamlining PACU activities is a priority.

Simplified and improved fluid deprivation test for diagnosing diabetes insipidus.

OBJECTIVE: The challenge of finding patients with the rare conditon of diabetes insipidus in need of vasopressin treatment is demanding. The guidelines for performing the fluid deprivation test and interpreting the results are abundant. We evaluated the discriminative capacity of the fluid deprivation test in patients with polyuria to define a cut off for a more effective discrimination between diabetes insipidus and other polyuria syndromes. RESEARCH DESIGN AND METHODS: Retrospective review and data collection of all ambulatory fluid deprivation tests, of patients with mild polyuria and polydipsia (< 3 L/day), performed between 2000 and 2018. Serum osmolality, urine osmolality, urine volumes and clinical information of diagnosis were retrieved from the patient's medical records. RESULTS: The study group consisted of 153 patients, 123 were diagnosed with non-diabetes insipidus and 30 with diabetes insipidus. After 12 h fasting (baseline) median duration of the fluid deprivation test was 5 h (fasting range: 12-21 h). At baseline, there was a significant difference between median serum and urine osmolality between the groups (P < 0.05). The best cut-off for the diagnosis of diabetes insipidus, was the combination of < 400 mosmol/kg in urine and > 302 mosmol/kg in serum. With this cut-off a sensitivity of 90% and specificity of 98% was achieved. CONCLUSION: After 12 h fasting our proposed cut off clearly differentiated between diabetes insipidus, and non-diabetes insipidus suggesting a possibility to considerably reduce the duration of the fluid deprivation test.

Urinary biomarkers in bladder cancer: A review of the current landscape and future directions.

AIM: This narrative review aims to describe established and emerging urinary biomarkers in the diagnosis and surveillance of non-muscle invasive bladder cancer. It provides a comprehensive account of classical, FDA-approved protein biomarkers and discusses their limitations. Further, we discuss the role that epigenetic, genetic, and exosomal markers can play to enhance sensitivity and specificity of the available tests. BACKGROUND: The initial diagnosis and surveillance of bladder cancer involves a combination of cystoscopy, upper urinary tract imaging, and urine cytology. Despite high specificity, cytology is limited by low sensitivity. There are currently 6 urinary assays approved by the FDA to enhance diagnosis and surveillance of bladder cancer. While these have improved diagnosis and surveillance when combined with cytology, these tests are still not sufficiently sensitive and false positives often occur in benign conditions which result in inflammation of the urinary tract. Advancements in laboratory techniques have produced significant advancements in epigenetic and genetic markers, as well as extracellular vesicles, with DNA- and RNA-based markers dominating the research in this area in recent years. METHODS: We identified relevant published data, using the PubMed/ Medline search engines as well as Google Scholar. We performed an online search using the terms "bladder cancer", "non-muscle invasive bladder cancer" in combination with "urine biomarkers" and limited articles in English published up to February 2020. This review consolidated on all available narrative and systematic reviews published in the 5 years in this field, while also reviewing the original data of each clinical trial or observational study which led to the development of the biomarkers. CONCLUSION: The development of laboratory techniques and understanding urine-based biomarkers in BC has fuelled the use of noninvasive liquid-based biomarkers to complement urine cytology. Nonetheless, none are sufficiently effective when used in isolation, and cytology remains the gold standard in many practices. Future efforts will be focused on using these markers in combination as a predictive signature, and moving on to validating them for use in everyday clinical practice.

The impact of COVID-19 pandemic on urological emergencies: a single-center experience.

PURPOSE: COVID-19 pandemic represents a novel challenge for healthcare systems, and it affects even the daily urological practice. Italy was the first country after China to experience a lock-down period. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological emergencies. METHODS: we retrospectively reviewed urgent urological consultations requested by the Emergency Department (ED) of Padua University Hospital in the 36-day period between February 22nd and March 30th, 2020 and compared them to the prior year cases within a similar time frame (February 24th to March 31st, 2019). Pediatric population (age < 15 years); surgical complications and traumas were excluded to avoid confounding from the reduction of activities during the lockdown. The number of daily consultations, the number of invasive procedures performed and admissions were evaluated, together with the predictors of admission were identified through multivariate logistic regression models. RESULTS: The final sample resulted in 107 consultations performed in 2020 and 266 in 2019. A higher number of daily consultations was performed during 2019 (7.33 vs 2.97, p < 0.001). Similarly, the number of daily-invasive procedures was higher in 2019 (p = 0.006), while there was no difference in the number of daily admissions (15 vs 12, p = 0.80). On multivariate analysis, the year (2020 vs 2019, OR 2.714, 95% CI 1.096-6.757, p = 0.0297) was a significant predictor of admission. CONCLUSIONS: Urgent urology practice was affected during COVID-19 pandemic with a remarkable reduction in urgent urological consultations; furthermore, a higher risk of admissions was observed in 2020. The consequences of a potentially delayed diagnosis remain to be determined.

Periurethral Lidocaine Does Not Decrease Pain After Urodynamic Testing in Women: A Double-Blinded Randomized Control Trial.

OBJECTIVE: Urodynamic testing of women is a common procedure to evaluate lower urinary tract symptoms but may cause discomfort. The objective of our study was to determine the effect of externally applied periurethral 2% lidocaine gel on pain scores after complex urodynamic testing in women. METHODS: This prospective, double-blinded, placebo-controlled randomized trial compared 2% lidocaine gel to water-based lubricant applied to the periurethral area before urodynamic testing in women. Discomfort was measured using a visual analog pain scale (VAS) ranging from 0 to 100. The primary outcome was the difference in VAS from baseline to 4 to 6 hours after urodynamic testing. Secondary outcomes included: VAS difference from baseline to immediately postprocedure and 24 hours after urodynamic testing; VAS scores: at baseline, immediately postprocedure, after 4-6 hours, and after 24 hours; urodynamic testing results; and any adverse events. Sixty-four women per group were needed to provide a power of 80% to detect a 10-mm difference on a 100-point VAS. RESULTS: From January 2018 to March 2019, 134 subjects were randomized, 6 subjects were excluded, which resulted in 64 subjects in both the water-based lubricant group and 2% lidocaine gel group. There was no difference in baseline demographics. There was no significant difference in the change in VAS from baseline to 4 to 6 hours after UDT (0, 0 P = 0.88). No difference in secondary outcomes was noted. CONCLUSIONS: Topically applied 2% lidocaine gel does not decrease pain compared with water-based lubricant. For most women, complex urodynamic testing is not associated with any significant pain.Clinical Trial Registration:www.ClinicalTrials.gov,-NCT03390790, "Lidocaine for Pain After Urodynamic Testing".

Qualidade de vida e cateterismo urinário no contexto da enfermagem em reabilitação: uma revisão integrativa / Quality of life and urinary catheterization in the rehabilitation nursing context: an integrative review

Objetivo: identificar as evidências científicas sobre a atuação de enfermagem na qualidade de vida de crianças e adultos em uso do cateterismo urinário e seus cuidadores no contexto de reabilitação. Método: revisão integrativa de literatura, através de questão norteadora "Qual a produção de conhecimento sobre a atuação de enfermagem na Qualidade de Vida de crianças e adultos em uso do cateterismo urinário e seus cuidadores no contexto de reabilitação?", em três bases de dados com os descritores cateterismo urinário, qualidade de vida e enfermagem. Foram incluídos 23 estudos, publicados no período de 2011 a 2020, realizados em mais de um país, em especial na população brasileira. Resultados: as principais atuações da enfermagem foram: educação em saúde, atividades de orientação em grupo, uso de simuladores e teleatendimentos. Conclusão: as contribuições do enfermeiro em reabilitação estão direcionadas ao cuidado integral e eficaz para promoção de melhores terapêuticas e uma maior qualidade de vida.

Objective: to identify the scientific evidence on nursing performance in the quality of life of children and adults undergoing urinary catheterization and their caregivers in the context of rehabilitation. Methods: integrative literature review adopting the guiding question "What is the production of knowledge about the nursing performance in the quality of life of children and adults undergoing urinary catheterization and their caregivers in the context of rehabilitation?" performed in three databases with use of the following descriptors: urinary catheterization, quality of life and nursing. Twenty-three studies published between 2011 and 2020, conducted in more than one country, especially in the Brazilian population, were included. Results: the main actions of nursing were: health education, group orientation activities, use of simulators and telenursing. Conclusion: the contributions of rehabilitation nurses are directed to comprehensive and effective care to promote better therapies and a higher quality of life.

Present value of the Urethral mobility test as a tool to assess Stress urinary incontinence due to Intrinsic sphincteric deficiency.

Q-tip test offers a simple approach for identifying urethral hypermobility. Considering surgical treatment, stress urinary incontinence (SUI) must be classified and the contribution of intrinsic sphincter deficiency (ISD) and/or urethral hypermobility must be determine. We believe there's a correlation between abdominal leak point pressure (ALPP) and urethral mobility degree, and the aim of this study is to explore it using Q-tip. We conducted a prospective study, between years 2014 and 2016. Females over 18 years presenting with signs and symptoms of SUI according to the 2002 ICS Standardization of Terminology were included. Assessment was made with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Q-tip test and invasive urodynamics. Urethral mobility (UM) and ALPP were analyzed. We built two composite variables based on reported risk factors for ISD, defined as composite variable A (equal to a Q-tip test < 30° AND ICIQ-SF ≥ 10 points) and composite variable B (equal to low urethral mobility AND/OR hypoestrogenism AND/OR history of radiotherapy AND/OR previous pelvic surgery). Correlation analyzes were made according to the type of variable. A total of 221 patients were included. Incontinence was rated as moderate and severe by 65.3% and 6.8%, respectively. The analysis showed a 61.75%, 51.61% and 70.6% agreement between ALPP and UM, ALPP and composite variable A and ALPP and composite variable B respectively. Correlation and concordances were low (r = 0.155, r_s = - 0.053 and r_s = - 0.008), (rho_c = 0.036, k = 0.116 and k = 0.016). Neither the degree of UM, nor the composite variables, correlate or agree with urethral function tests in UDS, suggesting that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI.

Caracterización de Candida spp. aisladas a partir de urocultivos en la ciudad de Medellín / Characterization of Candida spp isolated from urine cultures of Medellín

Resumen Candida spp. es un agente etiológico importante en infecciones del tracto urinario, principalmente en población con terapia antimicótica de amplio espectro y con catéteres urinarios. Candida albicans es la especie más frecuente, pero otras especies han surgido como patógenos emergentes. En este trabajo se recolectaron aislamientos de Candida spp. de urocultivos de pacientes que consultaron en Dinamica IPS entre enero 2016 y noviembre 2017. Para estimar la frecuencia de las especies y observar los patrones de sensibilidad, se realizó la identificación fenotípica y su perfil de sensibilidad con el sistema comercial Vitek 2® (BioMérieux, Inc.), adicionalmente se evaluaron mediante análisis de las secuencia y filogenética ITS1-5.8S-ITS2. En el estudio se incluyeron 78 aislamientos de Candida spp. Las frecuencias de especies de Candida identificadas empleando las herramientas moleculares fueron: C. albicans (38,5%), C. tropicalis (23,1%), C. glabrata (21,8%), C. parapsilosis (10,3%), C. metapsilosis y C. krusei (2,5%) y C. guillermondi (1,3%). La identificación por métodos moleculares y por el sistema Vitek 2 fue: C. albicans (93,3%), C. glabrata (94,1%), C. tropicalis (83,3%), C. parapsilosis (75%) C. guilliermondii y C. krusei (100%). La sensibilidad de todos los aislamientos al fluconazol fue 93,6%.

Abstract Candida spp is an important etiologic agent in urinary tract infections, mainly in patients in broad-spectrum antifungal therapy, with urinary catheters. Candida albicans is the most frequent specie; but other species have arised as emerging pathogens. In this study, isolates of Candida spp. of urine cultures from patients who consulted in Dinamica IPS between January 2016 and November 2017 were evaluated. To estimate the frequency of the species and to observe the sensitivity patterns, the phenotypic identification and its sensitivity profile was performed employed the Vitek 2® commercial system. (BioMérieux, Inc) In addition the isolates were evaluated by sequence analysis and phylogenetics ITS1-5.8S-ITS2. This study included 78 isolates of Candida spp. The frequencies of Candida species identified using the molecular tools were: C. albicans (38.5%), C. tropicalis (23.1%), C. glabrata (21.8%), C. parapsilosis (10.3%), C. guillermondi (1.3%) and C. metapsilosis and C. krusei (2.5%). The identification by molecular methods and by Vitek 2 system were: C. albicans (93.3%), for C. glabrata (94.1%), C. tropicalis (83.3%), C. parapsilosis (75%) and 100% for C. guilliermondii and C. krusei.. fluconazole sensitivity of all isolates was 93.6%

Caracterización clínica de las disfunciones de piso pélvico en mujeres chilenas sintomáticas que consultan en un hospital universitario / Clinical characterization of pelvic floor dysfunctions in symptomatic Chilean women who visit an academic hospital

INTRODUCCIÓN: La prevalencia de las disfunciones de piso pélvico (DPP) puede llegar hasta un 25%, y esta incrementando con los años. El objetivo de este estudio es mostrar las características clínicas de pacientes sintomáticas sometidas a cistometría simple en el Hospital La Florida, entre diciembre del 2015 y marzo 2020. MÉTODOS: Es un estudio retrospectivo transversal. Se evaluaron los datos de todos los resultados de cistometrías simples de pacientes derivadas por sintomatología de piso pélvico entre los años 2015 y 2020. RESULTADOS: Se evaluaron 1.211 cistometrías simples. El motivo de derivación más frecuente fue prolapso de órganos pélvicos + incontinencia de orina (IO) (39.6%). 13.5% tuvieron resultado normal. 58% presentó test de esfuerzo positivo. 22.5% tenían prueba de estrés con vejiga vacía positiva. 17.6% presentó IO oculta. 21.9% de IO mixta. De las pacientes derivadas por vejiga hiperactiva o IO mixta, en el 14.2% se constató la presencia de contracciones no inhibidas y en el 34.8% la presencia de urgencia. CONCLUSIONES: Nuestro estudio aporta información sobre las DPP en la mujer chilena en un hospital universitario.

INTRODUCTION: Prevalence of pelvic floor dysfunctions (PFD) can be as high as 25%, and it is increasing over the years. The objective if this study is to show the clinical characteristics of symptomatic patients undergoing simple cystometry at La Florida Hospital, between December 2015 and March 2020. METHODS: This is a cross-sectional study. The data of all simple cystometries of patients derived for pelvic floor symptoms between 2015 and 2020 were evaluated. RESULTS: 1211 simple cystometries were evaluated. The most frequent reason for referral was pelvic organ prolapse + urinary incontinence (UI) (39.6%). 13.% had a normal result. 58% presented positive stress test. 22.% had a positive empty stress test. 17.6% had occult UI. 21.9% mixed UI. Of the patients referred by overactive bladder or mixed UI, 12.2% had detrusor contractions and 34.8% had urgency. CONCLUSIONS: Our study provides information on PFD in Chilean women in a university hospital. .

Tratamiento del cáncer de próstata resistente a la castración y riesgo de interacciones farmacológicas en pacientes polimedicados / Treatment for castration-resistant prostate cancer and drug interaction risk in polymedicated patients

INTRODUCCIÓN: La telemedicina ofrece un soporte clínico remoto utilizando herramientas tecnológicas. Puede facilitar la atención médica al tiempo que reduce las visitas innecesarias a la consulta. La pandemia COVID-19 ha provocado un cambio brusco en nuestra práctica urológica diaria convirtiéndose en algo muy necesario el acto de la teleconsulta. OBJETIVO: Proporcionar recomendaciones prácticas para el uso efectivo de herramientas tecnológicas en telemedicina. MATERIALES Y MÉTODOS: Se realizó una búsqueda en la literatura en la plataforma Medline hasta abril de 2020; seleccionamos los artículos más relevantes relacionados con «telemedicina» y «trabajo inteligente» que podrían proporcionar información útil. RESULTADOS: La telemedicina se refiere al uso de la información electrónica y a las herramientas de telecomunicaciones para proporcionar apoyo clínico remoto a la atención médica. El trabajo inteligente es un modelo de trabajo que utiliza tecnologías nuevas o existentes para mejorar el rendimiento. La telemedicina se está convirtiendo en una herramienta útil y necesaria durante la pandemia COVID-19 e incluso más allá de la misma. Es hora de que formalicemos y demos el lugar que se merece a la telemedicina en nuestra práctica clínica y es nuestra responsabilidad adaptar y conocer todas las herramientas y posibles estrategias para su implementación de una manera óptima, garantizar una atención de calidad a los pacientes y que dicha atención sea percibida por pacientes y familiares como de alto nivel. CONCLUSIONES: La telemedicina facilita la atención clínica urológica especializada a distancia y resuelve problemas como las limitaciones en la movilidad o el traslado de los pacientes, reduce las visitas innecesarias a las clínicas y es útil para reducir el riesgo de transmisión viral de la COVID-19

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine» and «smart working» that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission

[Bonney maneuver and its derivatives: History, technique, significance and prognostic value]. / Manœuvre de Bonney et ses dérivés : histoire, technique, signification et valeur pronostique.

INTRODUCTION: Historically a positive Bonney maneuver indicates the need for surgical management of stress urinary incontinence. This maneuver is regularly used in French daily practice without formal proof of its predictive value. MATERIAL: A Medline search was performed with the terms "Bonney test" and "urinary incontinence" to include 10 relevant articles in this review. RESULTS: Eight articles study the mechanism of the maneuver or its derivatives, evoking a direct pressure on the urethra. Two studies are interested in the real predictivity of the maneuvers on the success of surgical treatment by urethral strip, reporting a positive predictive value of the Bonney maneuver between 96.2 and 100%. CONCLUSION: Further studies are needed to objectify the utility of this maneuver.

Telemedicine and smart working: Spanish adaptation of the European Association of Urology recommendations. / Telemedicina y trabajo inteligente: adaptación al español de las recomendaciones de la Asociación Europea de Urología.

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.