Voided urine cytology is a useful tool predicting non-muscle-invasive bladder cancer risk before surgery.

OBJECTIVE: To determine the accuracy of voided urinary cytology (VUC) in predicting of non-muscle-invasive bladder cancer (NMIBC) risk stratification before surgery. METHODS: We prospectively collected data from all patients diagnosed with bladder cancer in our institution over 2 years. We have analyzed VUC accuracy of positive and suspicious VUC in the detection of high-risk tumors and negative and atypical VUC in the detection of low-risk tumors. To test this accuracy, we assessed sensitivity, specificity, positive (PPV) and negative predictive values (NPV), diagnostic odds ratio (DOR), and generated ROC curves (receiver operating characteristic curve). RESULTS: With 224 patients included, the positive VUC subcategory showed a specificity of 92.4% (95%CI: 83.2%-97.5%) and a PPV of 91.4 (95%CI: 81%-97.1%). DOR in this subgroup was 6.81. In the suspicious VUC, specificity was 90.9% (95%CI: 81.3%-96.6%), PPV was 88% (95%CI: 75.7%-95.5%) and DOR was 4.23. Combined analysis of positive and suspicious cytologies for detecting high-risk NMIBC showed a sensitivity of 65% (95%CI: 57.3%-73.2%) and a DOR of 9.51. Negative VUC showed high specificity in detecting low-risk (93.2% [95%CI: 87.9%-96.7%]) and a DOR of 6.90 (95%CI: 3.07-15.46). Atypical VUC was the least accurate and had rather low specificity and predictive values. CONCLUSIONS: VUC appears to be a good, inexpensive and easily available method to determine risk stratification before surgery. This can be useful in daily practice to determine which patients should receive a single instillation of MMC and to prioritize patients more likely to have a high- risk tumor.

The challenge of pseudomonas aeruginosa related infections. In a urology ward: epidemiology, risk factors and patterns of antibiotic resistance / El reto de las infecciones por pseudomonas aeruginosa en un Servicio de Urología: epidemiología, factores de riesgo y patrones de resistencia a antibióticos

OBJECTIVES: Urological patients usually come up with risk factors for developing infections. Some of these are caused by multidrug-resistant microorganisms like Pseudomonas aeruginosa, whose notable resistance rates to antibiotics and aggressiveness make its treatment a challenge in clinical practice. Our objective was to analyze Pseudomonas aeruginosa infections incidence, risk factors and features in patients admitted to a Urology Ward in a tertiary care university hospital in Spain. MATERIAL AND METHODS: We carried out a prospective observational study from 2012 to 2017, to review all infections in our Ward with a special focus on those caused by Pseudomonas aeruginosa, performing a descriptive analysis and a comparison with other causative agents. RESULTS: 78 Infections with Pseudomonas aeruginosa isolation were registered during this period. Having a catheter of the upper urinary tract (CUUT) or comorbidities and undergoing surgery, were frequently observed among these patients although the results did not reach statistically significant differences for more frequent isolation compared to other pathogens. Antibiotic resistance rates were high for cephalosporins (33.3%) and quinolones (50%), while carbapenems (24.4%), aztreonam (10.3%) and amikacin (23.1%) exhibited the best activity. No deaths related to the infection were registered. CONCLUSIONS: pseudomonas aeruginosa is commonly isolated in patients carrying a CUUT. An early suspicion of Pseudomonas aeruginosa infection and knowledge of local antibiotic resistance pattern are of paramount importance for improving the outcomes and handling this worldwide problema

OBJETIVOS: Los pacientes urológicos se acompañan habitualmente de factores de riesgo para el desarrollo de infecciones. Algunas de éstas son causadas por microorganismos multi-resistentes como Pseudomonas aeruginosa, cuyas notables tasas de resistencia a los antibióticos y agresividad hacen de su tratamiento un reto para la práctica clínica. Nuestro objetivo fue analizar la incidencia de infecciones por Pseudomonas aeruginosa, factores de riesgo y características en pacientes ingresados en el Servicio de Urología de un hospital universitario de tercer nivel en España. MATERIALES Y MÉTODOS: Llevamos a cabo un estudio observacional prospectivo desde 2012 hasta 2017, para revisar todas las infecciones en nuestro Servicio, con especial atención en aquellas causadas por Pseudomonas aeruginosa, haciendo un análisis descriptivo y una comparación con otros agentes causales. RESULTADOS: Durante este periodo se registraron 78 infecciones por Pseudomonas aeruginosa. Frecuentemente estos pacientes portaban un catéter del tracto urinario superior, tenían comorbilidades o se habían sometido a una intervención quirúrgica, aunque ningún factor alcanzó la significación estadística para mayor frecuencia de aislamiento de Pseudomonas aeruginosa. Las tasas de resistencia antibiótica fueron altas para cefalosporinas (33,3%) y quinolonas (50%), mientras que los carbapenémicos (24,4%), aztreonam (10,3%) y amikacina (23,1%) mostraron la mejor actividad. No se registraron éxitus relacionados con estas infecciones. CONCLUSIONES: El aislamiento de Pseudomonas aeruginosa es frecuente en portadores de catéteres del tracto urinario superior. La sospecha precoz de estas infecciones y el conocimiento de los patrones locales de resistencia a antibióticos son de vital importancia para mejorar los resultados de este problema a nivel global