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1.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33435420

RESUMO

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.


Assuntos
Meios de Contraste , Técnicas de Diagnóstico Urológico , Ultrassonografia/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Cistografia , Feminino , Humanos , Lactente , Injeções , Laparoscopia , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Politetrafluoretileno , Exposição à Radiação , Recidiva , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Hexafluoreto de Enxofre , Ureteroscopia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle , Urografia , Refluxo Vesicoureteral/classificação , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/terapia , Adulto Jovem
3.
Bol. méd. postgrado ; 36(2): 59-62, dic.2020. ilus
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1117902

RESUMO

La hidronefrosis gigante se considera una entidad rara, caracterizada por la presencia de al menos 1 litro de líquido dentro del sistema pielocalicial, más frecuente en pacientes masculinos, generalmente asintomático. Se presenta el caso de una paciente femenina de 85 años de edad quien refiere desde hace 6 años dolor lumbar izquierdo y aumento de la circunferencia abdominal; en la TAC abdomino-pélvica contrastada se evidencia bolsa hidronefrótica izquierda gigante con corteza renal adelgazada que no concentra ni elimina el contraste. Se presenta el caso de paciente masculino de 85 años de edad quien refiere desde hace 5 años aumento de la circunferencia abdominal y la TAC abdomino-pélvica contrastada muestra importante dilatación del riñón y sistema colector derecho secundario a litiasis ureteral. A ambos pacientes se les practicó nefrectomía simple. Con respecto a la hidronefrosis gigante, la etiología más frecuente es la estenosis de la unión ureteropélvica seguido por la patología litiásica y tumoral; es importante considerar esta entidad como diagnóstico diferencial en caso de masas quísticas abdominales(AU)


Giant hydronephrosis is considered a rare entity, characterized by the presence of at least 1 liter of fluid within the pielocalicial system; is more frequent in males and often asymptomatic. We present an 85-year-old female patient who has a 6-year complain of left lumbar pain associated with increase in abdominal circumference. On CT scan, a giant left hydronephrotic pouch is evidenced, with a thinned renal wall that does not concentrate or eliminate contrast. We present a 61 year-old male who refers a 5-year asymptomatic increase in abdominal circumference. The CT scan reveals significant dilatation of the kidney and right collecting system secondary to ureteral lithiasis. Both patients undergo simple nephrectomy. The most frequent etiology of giant hydronephrosis is ureteropelvic junction stenosis followed by lithiasic and tumor pathology. It is important to consider this entity as a differential diagnosis in the case of abdominal cystic masses(AU)


Assuntos
Humanos , Masculino , Feminino , Infecções Urinárias/etiologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Pielocistite/fisiopatologia , Hidronefrose/etiologia , Doenças Urológicas , Nefrectomia
4.
PLoS One ; 15(12): e0243741, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315921

RESUMO

Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients' medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863-0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018-1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289-0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234-0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy.


Assuntos
Bactérias/metabolismo , Infecções Urinárias/microbiologia , Infecções Urinárias/urina , beta-Lactamases/metabolismo , Adulto , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Farmacorresistência Bacteriana , Feminino , Hospitalização , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-33339194

RESUMO

We aim to examine the incidences, clinical characteristics, and in-hospital outcomes of type 2 diabetes (T2DM) patients hospitalized with urinary tract infections (UTIs) in Spain and to identify the factors associated with in-hospital mortality (IHM). A retrospective observational study was carried out with a sample that included all adult patients who were hospitalized for UTIs between 2001 and 2018 and collected in the Spanish National Health System Hospital Discharge Database. We identified 850,276 patients with UTIs (25.49% with T2DM). The incidence of UTIs increased in patients with and without diabetes from 290.76 and 74.79 cases per 100,000 inhabitants in the period from year 2001 to year 2003 to 568.45 and 144.0 in the period from 2016 to 2018, respectively (p < 0.001). Adjusted incidence of UTIs was higher in T2DM patients (incidence rate ratio (IRR) 4.36; 95% CI 4.35-4.39). The multivariable analysis showed a significant reduction in the IHM over time for men and women with T2DM. In T2DM, patients' higher IHM was associated with older age, comorbidities, and Staphylococcus aureus isolation. Women with T2DM had a higher risk of dying than men. The risk of IHM with an episode of UTIs was independent of the presence of T2DM (odds ratio (OR) 0.97; 95% CI 0.91-1.01). We conclude that the incidence of UTIs was over four times higher in T2DM than nondiabetic patients and has increased over time.


Assuntos
Diabetes Mellitus Tipo 2 , Hospitalização , Infecções Urinárias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
6.
Arch Esp Urol ; 73(7): 634-642, 2020 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32886078

RESUMO

OBJECTIVE: Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017and April 2019, 546 patients who under went ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p=0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1clevel were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics. CONCLUSIONS: Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully.


Assuntos
Diabetes Mellitus/epidemiologia , Litotripsia/efeitos adversos , Cálculos Ureterais/cirurgia , Infecções Urinárias/etiologia , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia
7.
Arch. esp. urol. (Ed. impr.) ; 73(7): 634-642, sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-195961

RESUMO

OBJECTIVE: Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017 and April 2019, 546 patients who underwent ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p = 0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1c level were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics. CONCLUSIONS: Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully


OBJETIVO: La litotricia ureteroscópica (URS) es la opción estándar actual de tratamiento para cálculos renales tanto ureterales como adecuados. Aunque se sabe que es un procedimiento seguro, la infección urinaria febril posoperatoria (ITU) no es rara. Especialmente en pacientes diabéticos, la tasa de infección del tracto urinario es mayor. Por lo tanto, nuestro objetivo fue describir los factores de riesgo de IU después de la URS en diabéticos. MATERIALES Y MÉTODOS: Entre enero de 2017 y abril de 2019, se incluyeron 546 pacientes que se sometieron a litotricia ureteroscópica por cálculos ureterales y/o renales. Se realizó un análisis de pares emparejados para comparar las tasas de ITU postoperatorias entre diabéticos y no diabéticos. Revisamos retrospectivamente los registros médicos. Se realizó un análisis de regresión logística para determinar los factores de riesgo de infección urinaria postoperatoria en diabéticos. RESULTADOS: En pacientes diabéticos, la tasa de ITU postoperatoria fue del 29% (13/45). Después del análisis de pares emparejados dentro del grupo de no diabéticos, la incidencia fue del 11% (5/44) (p = 0,04). En el análisis univariado, el historial de ITU y el nivel de HbA1c fueron los factores de riesgo de ITU después de la URS en diabéticos. El historial de ITU y el nivel de HbA1c fueron los factores de riesgo independientes para desarrollar ITU postoperatoria en pacientes diabéticos. El umbral de HbA1c del 6,9% proporcionó una sensibilidad del 75% y una especificidad del 67% para predecir la infección urinaria postoperatoria en diabéticos. CONCLUSIONES: Los pacientes diabéticos tienen un mayor riesgo de desarrollar ITU postoperatoria después de la URS. Los pacientes con antecedentes de ITU y un nivel de HbA1c superior al 6,9% deben ser seguidos cuidadosamente


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Infecções Urinárias/etiologia , Febre/etiologia , Litotripsia/efeitos adversos , Complicações do Diabetes/complicações , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Diabetes Mellitus/prevenção & controle , Análise por Pareamento , Estatísticas não Paramétricas , Curva ROC , Análise Multivariada
8.
Med. clín (Ed. impr.) ; 155(4): 171-177, ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195763

RESUMO

Las infecciones urinarias son muy prevalentes entre las mujeres y cuando son recurrentes conllevan malestar a las pacientes, un elevado coste sanitario y representan una de las causas más frecuentes de uso de antibióticos. Para prevenirlas existen varias opciones que incluyen tanto tratamientos antibióticos (profilaxis antibiótica continua o poscoital) como medidas no antibióticas (medidas higiénicas, vitamina D, arándanos, D-manosa, probióticos, estrógenos, vacunas, instilaciones intravesicales), pero con diferente nivel de evidencia y, a veces, de mala calidad, por lo que se necesitan nuevos estudios aleatorizados y comparativos que permitan diseñar la mejor estrategia de prevención


Urinary tract infections are highly prevalent among women and when they are recurrent they can lead to patient discomfort and high healthcare costs, and they represent one of the most frequent causes of antibiotic consumption. There are several options to prevent RUTI which include both antibiotic treatment (continuous or postcoital antibiotic prophylaxis) and non-antibiotic measures (hygienic measures, vitamin D, blueberries, D-mannose, probiotics, oestrogens, vaccines, intravesical instillations), but with different levels of evidence, sometimes of poor quality, and therefore new randomized and comparative studies are needed to choose the best strategy


Assuntos
Humanos , Infecções Urinárias/patologia , Infecções Urinárias/prevenção & controle , Recidiva , Infecções Urinárias/etiologia , Fatores de Risco , Pós-Menopausa , Acidificação , Antibioticoprofilaxia , Infecções Urinárias/tratamento farmacológico , Probióticos/uso terapêutico
9.
J Urol ; 204(6): 1263-1269, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32614256

RESUMO

PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.


Assuntos
Cesárea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Esclerose Múltipla/cirurgia , Complicações Pós-Operatórias/etiologia , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/cirurgia , Nascimento Prematuro/etiologia , Cólica Renal/epidemiologia , Cólica Renal/etiologia , Estudos Retrospectivos , Traumatismos da Medula Espinal/cirurgia , Disrafismo Espinal/cirurgia , Bexiga Urinária/anormalidades , Bexiga Urinária/cirurgia , Derivação Urinária/estatística & dados numéricos , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Esfíncter Urinário Artificial/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
10.
Anticancer Res ; 40(6): 3065-3069, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487600

RESUMO

Endometrial cancer is the most common gynecologic malignancy. The mainstay of treatment for endometrial cancer is total hysterectomy with bilateral salpingo-oophorectomy. Radiation and chemotherapy accompanied with progestins can also play a significant role in treatment. Lower urinary tract symptoms (LUTS) following therapy for endometrial cancer are an extremely difficult and challenging condition that deteriorates patients' quality of life. Current literature remains rather scarce regarding LUTS after therapy for endometrial cancer. This review aimed to investigate the incidence of LUTS in endometrial cancer treatment.


Assuntos
Tratamento Conservador/métodos , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/cirurgia , Infecções Urinárias/etiologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Incidência , Sistema Urinário/patologia
11.
Medicine (Baltimore) ; 99(26): e20852, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590783

RESUMO

RATIONALE: Either malacoplakia or xanthogranulomatous cystitis (XC) is a rare chronic infection disease of urinary bladder, which often mimics bladder masses undifferentiated from malignance and results in severe lower urinary tract symptoms. The malacoplakia combined with XC is even rarer in the literature. PATIENT CONCERNS: A 64-year-old female, who presented with nocturia, frequency of micturition, severe urgency with occasional urinary incontinence, and recurrent hematuria for >2 years, was diagnosed with azotemia and anemia. In addition, two 1.0 × 1.0 cm masses of bladder were detected by computer tomography. DIAGNOSES: Malacoplakia combined with xanthogranulomas cystitis was diagnosed histologically. Video urodynamic test showed poor bladder compliance (9 mL/comH2O), markedly decreased maximum bladder capacity (120 mL), and right vesicoureteral reflux at a low intravesical pressure level (25 cmH2O). INTERVENTIONS: Transurethral resection of bladder masses was carried out after treatment of urinary infection by intravenous piperacillin-tazobactam. Oral Ciprofloxacin and Tolterodine were postoperatively used to prevent recurrent lower urinary tract infections and alleviate detrusor overactivity. OUTCOMES: The treatment did not alleviate azotemia, frequency, urgency with incontinence, and bilateral hydroureteronephrosis, but the patient refused to undergo bladder augmentation on account of her poor economic status. LESSONS: Malacoplakia or/and xanthogranulomas cystitis may lead to poor bladder compliance and video urodynamic study should be considered in patients with refractory chronic lower urinary tract symptoms.


Assuntos
Cistite/complicações , Malacoplasia/complicações , Bexiga Urinária/anormalidades , Cistite/fisiopatologia , Feminino , Humanos , Malacoplasia/fisiopatologia , Pessoa de Meia-Idade , Noctúria/etiologia , Tomografia Computadorizada por Raios X/métodos , Bexiga Urinária/fisiopatologia , Incontinência Urinária/etiologia , Infecções Urinárias/etiologia , Infecções Urinárias/fisiopatologia
12.
Nat Immunol ; 21(6): 671-683, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32424366

RESUMO

Urinary tract infections (UTIs) typically evoke prompt and vigorous innate bladder immune responses, including extensive exfoliation of the epithelium. To explain the basis for the extraordinarily high recurrence rates of UTIs, we examined adaptive immune responses in mouse bladders. We found that, following each bladder infection, a highly T helper type 2 (TH2)-skewed immune response directed at bladder re-epithelialization is observed, with limited capacity to clear infection. This response is initiated by a distinct subset of CD301b+OX40L+ dendritic cells, which migrate into the bladder epithelium after infection before trafficking to lymph nodes to preferentially activate TH2 cells. The bladder epithelial repair response is cumulative and aberrant as, after multiple infections, the epithelium was markedly thickened and bladder capacity was reduced relative to controls. Thus, recurrence of UTIs and associated bladder dysfunction are the outcome of the preferential focus of the adaptive immune response on epithelial repair at the expense of bacterial clearance.


Assuntos
Cistite/etiologia , Cistite/metabolismo , Ativação Linfocitária/imunologia , Membrana Mucosa/imunologia , Membrana Mucosa/metabolismo , Células Th2/imunologia , Células Th2/metabolismo , Animais , Carga Bacteriana , Biomarcadores , Linhagem Celular , Cistite/patologia , Citocinas/metabolismo , Modelos Animais de Doenças , Feminino , Camundongos , Camundongos Knockout , Membrana Mucosa/patologia , Células Th1/imunologia , Células Th1/metabolismo , Células Th1/patologia , Infecções Urinárias/etiologia , Infecções Urinárias/metabolismo , Infecções Urinárias/microbiologia , Cicatrização/genética , Cicatrização/imunologia
13.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32467092

RESUMO

Milk of calcium is a viscous colloidal suspension of calcium salts that forms in dilated cysts or cavities. We present, for the first time in literature, a toddler with isolated milk of calcium and treated with a conservative approach. A boy with a history of one urinary tract infection and recurrent fever without vesicoureteral reflux showed at the age of 14 months a left obstructive staghorn stone. Because of absent function of the left kidney at mercapto acetyl tri glycine scintigraphy, a JJ stent was positioned with a leak of whitish material immediately after the stent positioning. Renal scintigraphy performed 1 month later revealed a partial resumption in renal function (18%). When he was 18 months old, the child suffered episodes of acute pain with inconsolable crying, unresponsive to paracetamol administration. Ultrasound assessment revealed left pelvic dilation (anterior-posterior diameter of 18 mm), suspended echogenic debris in the bladder, and dilated left distal ureter with particulate matter. These episodes of acute pain were followed by expulsion of numerous soft formations and emission of greenish urine. Both urine culture at the admission and culture on the greenish urines were sterile. After the expulsion of the soft formations, pain episodes stopped. The diagnosis of milk of calcium stone was made. With this case, we highlight a condition that can be easily diagnosed (if known) because the morphology of the expelled material is pathognomonic. Diagnosing it could avoid unnecessary treatments (ie, extracorporeal shockwave lithotripsy) and support a conservative approach (ie, stent positioning).


Assuntos
Carbonato de Cálcio/urina , Infecções Urinárias/diagnóstico por imagem , Infecções Urinárias/urina , Urolitíase/diagnóstico por imagem , Urolitíase/urina , Humanos , Lactente , Masculino , Infecções Urinárias/etiologia , Urolitíase/complicações
14.
Crit Care Resusc ; 22(2): 126-132, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32389104

RESUMO

BACKGROUND: To determine the temporal trends of incidence and outcome based on different sources of sepsis using a nationwide administrative database. METHODS: From 2002 to 2012, the entire Taiwan's health insurance claims data of emergency-treated and hospital-treated sepsis were analysed for incidence and mortality trends. The information about patients with sepsis and sources of sepsis was identified using a set of validated International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) codes. The 30-day all-cause mortality was verified by linked death certificate database. RESULTS: A total of 1 259 578 episodes of sepsis were identified during the 11-year study period. Lower respiratory tract infection is the most common source of sepsis in patients, with the highest mortality rate. The incidence of genitourinary tract infection has the fastest growing rate. The sepsis mortality was declining at different rates for each source of sepsis. Co-infections in patients with sepsis are associated with higher mortality rate. CONCLUSION: The temporal trends of sepsis incidence and mortality varied among different sources of sepsis, with lower respiratory tract being the highest burden among patients with sepsis. Furthermore, sources of sepsis and the presence of co-infection are independent predictors of mortality. Our results support source-specific preventive and treatment strategies for future sepsis management.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Sepse/etiologia , Feminino , Doenças Urogenitais Femininas/epidemiologia , Doenças Urogenitais Femininas/etiologia , Humanos , Incidência , Classificação Internacional de Doenças , Masculino , Doenças Urogenitais Masculinas/epidemiologia , Doenças Urogenitais Masculinas/etiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Sepse/epidemiologia , Sepse/mortalidade , Taiwan/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
15.
Medicina (B Aires) ; 80(3): 241-247, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32442938

RESUMO

The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, according to the antibiogram. First generation cephalosporins or aminoglycosides are valid alternatives. The use of antibiotic prophylaxis with first-generation cephalosporins or aminoglycosides before percutaneous nephrolithotomy is recommended. Transrectal prostatic biopsy can be associated with infectious complications, such as UTI or acute prostatitis, mainly due to Escherichia coli or other enterobacteria. In patients without risk factors for multiresistant bacteria and negative urine culture, prophylaxis with intravenous amikacin or ceftriaxone is recommended. In patients with positive urine culture, prophylaxis will be performed according to the antibiogram, from 24 hours before to 24 hours post-procedure. For the targeted treatment of post-transrectal biopsy prostatitis, carbapenems for 3-4 weeks are the treatment of choice.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Consenso , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia , Argentina , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Nefrolitíase/complicações , Nefrolitotomia Percutânea/efeitos adversos , Prostatite/tratamento farmacológico , Prostatite/etiologia , Fatores de Risco , Stents/efeitos adversos , Cateteres Urinários/efeitos adversos
16.
Expert Opin Pharmacother ; 21(12): 1449-1454, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32452702

RESUMO

INTRODUCTION: Multiple Sclerosis (MS) manifests with a plethora of signs and symptoms affecting brain structures and spinal pathways. The multitude of lesions in MS patients makes difficult to establish the relative role of each of them to lower urinary tract symptoms (LUTS). Generally, the subcortical white-matter lesions result in detrusor overactivity, whilst lesions of the spinal cord result in the combined occurrence of detrusor overactivity and detrusor-sphincter dyssynergia (DSD). It has been estimated that 80-90% of patients with MS will suffer from some form of LUTS over the course of the disease. Among LUTS, the most reported is detrusor overactivity which includes urinary urgency, frequent urination, nocturia, and urge urinary incontinence. AREAS COVERED: The authors review the management of lower urinary tract symptoms in MS patients providing their expert opinions on the subject matter. EXPERT OPINION: LUTS affect the quality of life substantially and are associated with a significantly increased mortality. The adequate management is an important challenge for both patients and caregivers with a multidisciplinary approach likely necessary.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Canabinoides/uso terapêutico , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Esclerose Múltipla/tratamento farmacológico , Antagonistas Muscarínicos/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Toxinas Botulínicas Tipo A/administração & dosagem , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Canabinoides/administração & dosagem , Cateteres de Demora , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Esclerose Múltipla/complicações , Esclerose Múltipla/patologia , Antagonistas Muscarínicos/administração & dosagem , Qualidade de Vida , Medula Espinal/efeitos dos fármacos , Medula Espinal/fisiopatologia , Estimulação Elétrica Nervosa Transcutânea , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia , Urodinâmica
17.
J Urol ; 204(3): 572-577, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32243241

RESUMO

PURPOSE: The vesicoureteral reflux index is a simple, validated tool for predicting resolution of reflux. Along with likelihood of spontaneous resolution identification of children at risk for febrile urinary tract infection impacts management. We evaluated the usefulness of the vesicoureteral reflux index as a predictive factor for breakthrough febrile urinary tract infection compared to reflux grade and distal ureteral diameter ratio. MATERIALS AND METHODS: Children with primary vesicoureteral reflux and detailed voiding cystourethrogram data were identified. A 1 to 6-point index was assigned, and ureteral diameter ratio was computed by measuring largest ureteral diameter within the pelvis and dividing by the distance between L1 to L3 vertebral bodies. Random forest modeling and logistic multivariable regression were employed to estimate the predictive ability of grade, ureteral diameter ratio and vesicoureteral reflux index with regard to breakthrough febrile urinary tract infection. RESULTS: We analyzed 94 girls and 45 boys with a mean±SD age of 5.4±4.7 months at diagnosis. Mean±SD length of followup was 32.1±24.5 months. A total of 13 children (9.4%) experienced breakthrough febrile urinary tract infection. On univariate analysis ureteral diameter ratio (p=0.01) and vesicoureteral reflux index (p=0.0005) were associated with breakthrough urinary tract infection, while grade (p=0.09) did not reach significance. Area under the curve was generated as a measure of accuracy for each variable and was 0.77 for the vesicoureteral reflux index, 0.71 for ureteral diameter ratio and 0.68 for grade, indicating superiority of the vesicoureteral reflux index for predicting breakthrough febrile urinary tract infection. CONCLUSIONS: Children with higher vesicoureteral reflux index are at increased risk for breakthrough febrile urinary tract infection independent of reflux grade. The vesicoureteral reflux index provides valuable prognostic information about infection risk, facilitating improved clinical decision making.


Assuntos
Ureter/patologia , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/complicações , Doença Aguda , Pré-Escolar , Feminino , Febre/etiologia , Humanos , Masculino , Valor Preditivo dos Testes , Fatores de Risco
18.
Rev Med Liege ; 75(3): 176-179, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32157843

RESUMO

The goal of this retrospective study is to assess if diabetic patients are more likely to develop urinary tract infection (UTI) within the context of ureteral obstruction. 804 patients that had received an emergency treatment by double J placement for ureteral stone were selected between January 2004 and December 2014 at the Clinique Saint Pierre d'Ottignies, Ottignies-Louvain-La-Neuve,Belgium. They were divided in two groups : patients with UTI associated and the control group with the non infected ones. In the group of infected patients, 82 were diabetic whereas they were 46 in the control group. There was a significant difference regarding the presence of diabetes between the group of patients with UTI and the control group (p inferior to 0.001). This study demonstrates that diabetic patients are at higher risk of urinary tract infection in case of ureteral obstruction, thus an invasive treatment could be considered faster.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Obstrução Ureteral , Infecções Urinárias , Bélgica , Humanos , Estudos Retrospectivos , Fatores de Risco , Obstrução Ureteral/complicações , Infecções Urinárias/etiologia
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(3): 357-361, 2020 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-32174083

RESUMO

Objective: To evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty (TKA) under general anesthesia. Methods: Patients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study. Among them, 205 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, body mass index, preoperative range of motion, Hospital for Special Surgery (HSS) score, American Society of Anesthesiologists (ASA) score, disease type, comorbidity, hemoglobin, hematocrit, blood volume, length of operation and operation time, whether to keep drainage after surgery, intraoperative blood loss, total blood loss, and preoperative, intraoperative, postoperative fluid infusions, and total fluid infusion on the day of surgery, urine volume on the day of surgery. Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter. Length of stay and incidences of complications (intermuscular vein thrombosis, deep vein thrombosis, pulmonary embolism, incision swelling and exudation, electrolyte disorder, nausea and vomiting, and urinary tract infection) were compared between the patients with or without indwelling catheter. Results: Indwelling catheter occurred in 41 (20%) of 205 patients. Single factor analysis showed that the influence factors were age, gender, keeping drainage after surgery, total fluid infusion and urine volume on the day of surgery ( P<0.05). The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA ( P<0.05). In addition, postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group, showing significant differences ( P<0.05). Conclusion: The male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.


Assuntos
Artroplastia do Joelho/efeitos adversos , Cateteres de Demora , Feminino , Humanos , Masculino , Período Pós-Operatório , Amplitude de Movimento Articular , Fatores de Risco , Fatores Sexuais , Infecções Urinárias/etiologia
20.
Transplant Proc ; 52(4): 1173-1177, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32178929

RESUMO

BACKGROUND: Urinary tract infection (UTI) is the most common infectious complication after renal transplantation. It is uncertain whether the development of UTI has an impact on renal graft function. The objective of this study was to evaluate the effects of complicated and recurrent UTI on 2-year renal graft function. METHODS: This was a historical cohort study in renal transplantation patients in a kidney transplant center. All renal transplant recipients from June 2004 to September 2016 were included. A linear regression analysis was performed to study the association between the outcome (variation in estimated glomerular filtration rate [eGFR] by the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation between month 1 and month 24 post-transplant) and the UTI. The approval of the Ethics and Research Committee to carry out this study was obtained. RESULTS: In total, 276 kidney transplants were performed during the observation period. Of the transplant patients, 193 (69.9%) did not develop a UTI and 83 (30.1%) presented at least 1 complicated UTI. Patients who presented at least 1 UTI had a variation in eGFR during the observation period of -12.6 mL/min/1.73 m2 (95% confidence interval [CI] -4.5 to -20.7 mL/min/1.73 m2; P = .02), compared with those without a UTI. Said difference persisted in the adjusted model controlling for variables that have an impact on the eGFR. This difference was -10.7 mL/min/1.73 m2 (95% CI -3.1 to -18.2 mL/min/1.73 m2; P = .006). CONCLUSION: The findings suggest that the occurrence of complicated UTI has a negative impact on graft function and that prevention and monitoring of UTIs should be stepped up to avoid their deleterious effects on graft function.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim/efeitos adversos , Infecções Urinárias , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transplantados , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
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