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Calzas Montalvo C, Medina-Polo J, Miranda Utrera NR, Juste Álvarez S, de la Calle Moreno A, Caro González MP, Santos Perez de la Blanca R, Hernández Arroyo M, Peña Vallejo E, Teigell Tobar J, Duarte Ojeda JM, Pamplona Casamayor M, Tejido Sánchez Á, García González L, Arrébola Pajares A, Sánchez Guerrero Á, Rodríguez de la Calle J, Rodríguez Antolín A. Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes. Actas Urol Esp 2024; 48:177-183. [PMID: 37574014 DOI: 10.1016/j.acuroe.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. METHODS We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. RESULTS Seven hundred twenty-four kidney transplants were included, 12% were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. CONCLUSIONS The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.
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Affiliation(s)
- C Calzas Montalvo
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain.
| | - J Medina-Polo
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - N R Miranda Utrera
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - S Juste Álvarez
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - A de la Calle Moreno
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - M P Caro González
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | | | - M Hernández Arroyo
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - E Peña Vallejo
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - J Teigell Tobar
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - J M Duarte Ojeda
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - M Pamplona Casamayor
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - Á Tejido Sánchez
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - L García González
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - A Arrébola Pajares
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | - Á Sánchez Guerrero
- Servicio de Radiología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
| | | | - A Rodríguez Antolín
- Servicio de Urología, Hospital Universitario 12 de Octubre imas12, Madrid, Spain
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Juste Alvarez S, Medina-Polo J, Arrebola Pajares A, Teigell Tobar J, Peña Vallejo E, Calzas Montalvo C, Caro González P, De La Calle Moreno A, García-Rayo Encina C, González Ginel I, Rodríguez Antolín A. Antibiotic prophylaxis before urodynamic studies: Are antibiotics required to decrease infections and for which patients would be prophylaxis the most beneficial? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Alonso Isa M, García-Gómez B, Celada-Luis G, García-Rojo E, Fiorillo A, Medina-Polo J, Tueti-Silva D, García-Cruz E, Romero-Otero J. A morphometric analysis of the penis before and after prostaglandin injection: Is shower and grower even a thing? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Alidjanov J, Ifland C, Ifland F, Sass G, Medina-Polo J, Magyar A, Perepanova T, Bruyère F, Pilatz A, Cai T, Abdusalamov J, Kulchavenya E, Tandogdu Z, Köves B, Wullt B, Bartoletti R, Bonkat G, Naber K, Wagenlehner F, Bjerklund-Johansen T. Report on microbial and resistance patterns of the causative pathogens of nosocomially-acquired urinary tract infections: Preliminary data analysis of the GPIU-Studies 2015-2020. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Medina-Polo J, Arrébola-Pajares A, Alidjanov J, Lorenzo-Gómez M, Corrales-Riveros J, Tapia-Herrero A, Martínez-Berganza M, Ospina-Galeano I, Padilla-Fernández B, Pilatz A, Naber K, Wagenlehner F. Linguistic and clinical validation of the Spanish Acute Cystitis Symptoms Score (ACSS) questionnaire in females with acute cystitis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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García-Rojo E, Medina-Polo J, Miranda-Utrera N, Abad-López P, Gonzalez-Padilla D, González-Díaz A, Arrébola-Pajares A, Guerrero-Ramos F, Tejido-Sánchez Á, Rodríguez-Antolín A. Evaluation of health care-associated infections following radical cystectomy. Actas Urol Esp 2021; 45:124-131. [PMID: 32948346 DOI: 10.1016/j.acuro.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/27/2020] [Accepted: 06/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE Radical cystectomy is a complex surgery with a high rate of complications including infections, which lead to increased morbidity and mortality, longer hospital stay and higher costs. The aim of this work is to evaluate health care-associated infections (HAIs) in these patients, as well as associated microorganisms, antibiotic resistance profiles and risk factors. MATERIAL AND METHODS Prospective study from 2012 to 2017. Epidemiologic variables, comorbidities and surgical variables are collected. The microorganisms involved and antibiotic susceptibility patterns are analyzed. RESULTS 122 patients. Mean age 67 (SD:18,42). Mean hospital stay 23.5 days (18.42). HAIs rate of 45%, with predominant urinary tract infections (43%) and surgical wound infections (31%). Positive cultures in 78.6% of cases. Increased isolation of Enterococcus (18%) and Escherichia coli (13%). Forty-three percent of microorganisms were resistant to amoxicillin/ampicillin, 23% to beta-lactamases and 36% to quinolones. Empirical treatment was adequate in 87.5%. Hospital stay is increased (17 days, p< 0.05) due to HAIs. Lower rate of infectious complications in the laparoscopic vs. open approach (p< 0.001) and in orthotopic vs. ileal conduit diversion (p = 0.04) CONCLUSIONS: We found a high rate of HAIs in our radical cystectomy series, with predominant urinary tract and surgical wound infections. E.coli and Enterococcus spp. are the most frequently isolated microorganisms, with high rates of resistance to some commonly used antibiotics.
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Medina-Polo J, García-Rojo E, González-Padilla D, Abad-López P, González-Díaz A, Hernández-Arroyo M, Santos Pérez De La Blanca R, Téigell-Tobar J, Peña-Vallejo H. Urologists knowledge and perceptions about management of infections and antibiotic resistance. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Medina-Polo J, González-Padilla D, García-Rojo E, González-Díaz A, Abad-López P, Santos-Pérez De La Blanca R, Hernández-Arroyo M, Peña-Vallejo H, Téigell-Tobar J, Calzas-Montalvo C, Caro-González M, Gil-Moradillo J, Miranda-Utrera N, Rodríguez-Antolín A, Tejido-Sánchez Á. Healthcare-associated infections (HAIs) in patients with urinary catheter hospitalized in urology: Analysis of risk factors, microbiological characteristics and the efficacy of preventive measures. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Medina-Polo J, García-Gómez B, Alonso-Isa M, Romero-Otero J. Clinical guidelines on erectile dysfunction surgery: EAU-AUA perspectives. Actas Urol Esp 2020; 44:289-293. [PMID: 32172988 DOI: 10.1016/j.acuro.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/28/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The implantation of a penile prosthesis is considered a third-line treatment and is indicated in patients who do not respond adequately to pharmacotherapy or require definitive treatment. Currently, the most used devices are 3-component penile prostheses, which presently account for more than 90% of the implants used. MATERIAL AND METHODS We reviewed the evidence and the recommendations of the clinical practice guidelines regarding surgery in patients with erectile dysfunction. RESULTS The recommendations of the clinical practice guidelines on surgery in patients with erectile dysfunction are summarized as follows: men with erectile dysfunction should be informed about the option of penile prosthesis implant treatment, commenting on the benefits, risks and consequences; men with erectile dysfunction who have agreed to receive penile prosthesis should be advised on post-surgical expectations; penile prosthesis implants should not be performed in patients with systemic, cutaneous or urinary tract infection; in young men with erectile dysfunction and focal penile or pelvic arterial obstruction who do not have generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction can be considered; in men with erectile dysfunction, penile venous surgery is not recommended. CONCLUSIONS The use of penile prostheses offers high satisfaction rates to both the patient and his partner. However, it is crucial to adequately inform and warn patients about possible complications and consequences.
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Angulo J, Sevilleja-Ortiz A, García-Rojo E, Fernández A, García-Gómez B, Medina-Polo J, Alonso-Isa M, El Assar M, Rodríguez-Mañas L, Romero-Otero J. PS-3-6 Orai Channel Inhibition Modulates Hypercontractility in Corpus Cavernosum From Diabetic Rats and Diabetic ED Patients where Orai Expression Is Upregulated. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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García-Rojo E, Medina-Polo J, Sopeña-Sutil R, Guerrero-Ramos F, García-Gómez B, Aguilar-Gisbert L, García-Álvarez G, Azcutia-Gómez MR, Gómez-Martín F, Molero-García JM, Pereda-Arregui E, Vargas-Machuca Cabañero MC, Villacampa-Aubá F, Tejido Sánchez Á. Analysis of referrals after a synergic work between Primary Care and Urology. Impact of joint protocol implementation and a continuing education program in our healthcare area. Actas Urol Esp 2019; 43:176-181. [PMID: 30824338 DOI: 10.1016/j.acuro.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/07/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyse the evolution and adequacy of referrals from Primary Care to Urology, after the implementation of referral protocols on the most frequent urological diseases and the establishment of a continuing education program. MATERIAL AND METHODS A Primary Care-Urology work group was created in 2011. Initially, performance and clinical practice protocols in prostatic pathology (BPH and PSA) were established. These were supported by training sessions for primary care physicians. After analysing the effect of the mentioned joint work, 3more (scrotal pathology, urinary tract infections and urinary incontinence) were included. We analysed and compared the referrals and their adequacy before and after the establishment of the protocols. RESULTS The most common referral causes were symptoms of the lower urinary tract due to BPH, which initially represented 22.8% of the total, and decreased to 16.9%. After the introduction of the new algorithms, we observed a decrease in referrals for scrotal pathology (13-14% to 7.8%), an increase in urinary incontinence referrals (3% al 10.3%) and those related to urinary tract infections remained stable. The adequacy to the protocols improved progressively: LUTS from 46% to 65.3%; PSA from 55% to 84.4% and urinary incontinence from 66.2% to 73.1%. Adequacy in scrotal pathology decreased (de 67.1% a 63.3%), while in UTI it stayed much the same (around 76%). CONCLUSIONS The joint work between Urology and Primary Care achieves an improvement in referrals adequacy regarding the most frequent urological pathologies.
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Affiliation(s)
- E García-Rojo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J Medina-Polo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - R Sopeña-Sutil
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Guerrero-Ramos
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - B García-Gómez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - L Aguilar-Gisbert
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - G García-Álvarez
- Dirección Continuidad Asistencial Centro, Hospital Universitario 12 de Octubre, Madrid, España
| | - M R Azcutia-Gómez
- Dirección Continuidad Asistencial Centro, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Gómez-Martín
- Centro de Salud Joaquín Rodrigo, Dirección Asistencial Centro, Madrid, España
| | - J M Molero-García
- Centro de Salud San Andrés, Dirección Asistencial Centro, Madrid, España
| | - E Pereda-Arregui
- Centro de Salud Almendrales, Dirección Asistencial Centro, Madrid, España
| | | | - F Villacampa-Aubá
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Á Tejido Sánchez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
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Garcia Gomez B, Romero-Otero J, Alonso-Isa M, Medina-Polo J, García-Rojo E, González-Padilla D, Rodríguez-Antolín A. HP-09-007 The use of a penile traction device reduces the need of cycles of collagenase in patients with Peyronie's disease. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Benítez-Sala R, Medina-Polo J, Justo-Quintas J, Gil-Moradillo J, Pérez-Cadavid S, Arrébola-Pajares A, Sopeña-Sutil R, Lara-Isla A, Alonso-Isa M, González-Padilla DA, García-Rojo E, Miranda-Utrera N, Aguilar-Gisbert L, Tejido-Sánchez Á. Infections related to healthcare in patients hospitalized in a Urology service: resistance patterns and adequacy of empirical antibiotic treatment as a prognostic factor. Actas Urol Esp 2019; 43:151-157. [PMID: 30470584 DOI: 10.1016/j.acuro.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the suitability of empirical antibiotic therapy in HAIs and the antibiotic resistance patterns of the responsible microorganisms, as well as the incidence of mortality and risk factors involved. METHOD A prospective observational study was carried out on patients of both sexes older than 16years, admitted by any urological process during a period of 4years. The incidence and characteristics of HAIs, as well as the causative organism and its resistance, the initial empirical antibiotic therapy and its modification, if required, and mortality rates are analysed. RESULTS Out of 6,546 patients, 6.3% suffered HAIs, 70.5% corresponding to urinary tract infection and 22.1% to infection of the surgical wound. E.coli, Enterococcus spp., Klebsiella spp. y P.aeruginosa were the most frequently implicated (25.1%, 17.5%, 13.5% and 12.3%, respectively). E.coli and Klebsiella spp. were producers of extended-spectrum beta-lactamases (ESBL) in 24.7% and 47.8%, respectively. 4.3% of Klebsiella and 33.3% of Pseudomonas were carbapenems-resistant. The overall resistance to quinolones was approximately 50%. The most commonly used antibiotics for empirical therapy were cephalosporins of 3rd and 4th generation (33.6%) and carbapenems (28.2%). An overall rate of adequacy of empirical antibiotic therapy of 82.9% was obtained. The mortality rate in patients with HAIs was 2.2%, compared with 0.3% in patients without infection. In a multivariate analysis, the variables associated with the highest mortality risk were the isolation of ESBL-producing enterobacteria and the inadequate empirical antibiotic treatment. CONCLUSIONS The selection of empirical antibiotic therapy was quite accurate. An increase in HAIs by multiresistant microorganisms, such as ESBL Enterobacteria or multiresistant P.aeruginosa is being observed. The mortality risk increases with inadequate initial empirical antibiotic therapy or when the responsible microorganism is an ESBL enterobacteria.
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Affiliation(s)
- R Benítez-Sala
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J Medina-Polo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Justo-Quintas
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Gil-Moradillo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - S Pérez-Cadavid
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Arrébola-Pajares
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - R Sopeña-Sutil
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Lara-Isla
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Alonso-Isa
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - E García-Rojo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - N Miranda-Utrera
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - L Aguilar-Gisbert
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Á Tejido-Sánchez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
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Angulo J, El Assar M, Romero-Otero J, La Fuente J, Fernández A, Sánchez-Ferrer A, Sevilleja-Ortiz A, García-Gómez B, Medina-Polo J, Rodríguez-Mañas L. 018 Antagonizing penile smooth muscle contraction by inhibition of orai calcium channels. A potential therapeutic target in erectile dysfunction. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Justo-Quintas J, Medina-Polo J, Gil-Moradillo J, Jaén-Herreros F, Lara-Isla A, Tejido-Sánchez Á. Infections by carbapenemase-producing enterobacteriaceae in a department of urology. A new challenge. Actas Urol Esp 2018; 42:170-175. [PMID: 29157781 DOI: 10.1016/j.acuro.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To analyse infections by carbapenemase-producing enterobacteriaceae (CPE) and describe the characteristics and potential risk factors associated with patients of a department of urology. MATERIAL AND METHODS Observational and retrospective study. The inclusion criterion was hospitalisation in our department of Urology between August 2013 and December 2016. We analysed those patients who were positive for CPE in at least 1 culture. We reviewed their baseline characteristics, risk factors and variables such as the presence of previous urinary tract infections, subsequent readmissions, the microorganism, type of CPE, treatment, origin (hospital or community) and mortality. RESULTS Of the 5,657 patients who met the inclusion criterion, a CPE was isolated in 12 cases. CPE infections represented 3.6% of all healthcare-associated infections and 9.7% of those caused by enterobacteria. The analysed factors associated with CPE infection in our series were the presence of urinary catheters (100%), undergoing surgery (58.3%), previous ICU admission (8.3%) and immunosuppression (16.6%). In terms of mortality, 8.3% of the patients who presented CPE infection died during hospitalisation. CONCLUSIONS Approximately 10% of enterobacteria present a carbapenemase-resistance pattern in urological patients in our setting. Carrying a urinary catheter and/or undergoing surgery are risk factors associated with the development of these infections in urological patients in our setting. CPE infections increase morbidity and mortality.
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Guerrero-Ramos F, Cavero-Escribano T, De la Rosa-Kehrmann F, Rodríguez-Antolín A, Pamplona-Casamayor M, Duarte-Ojeda J, Tejido-Sánchez Á, Villacampa-Aubá F, Medina-Polo J, Andrés-Belmonte A, Passas-Martínez J. La survie des transplantations rénales des donneurs à cœur non battant incontrôlés sous la protection normothermique : sont-ils aussi bons que les reins des donneurs à cœur battant ? Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alonso-Isa M, Medina-Polo J, Lara-Isla A, Pérez-Cadavid S, Arrébola-Pajares A, Sopeña-Sutil R, Benítez-Sala R, Justo-Quintas J, Gil-Moradillo J, Passas-Martínez JB, Tejido-Sánchez A. Surgical wound infection in urology. Analysis of risk factors and associated microorganisms. Actas Urol Esp 2017; 41:109-116. [PMID: 27567274 DOI: 10.1016/j.acuro.2016.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Open surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. MATERIAL AND METHODS This was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. RESULTS For genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam. In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. CONCLUSIONS We found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance.
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Affiliation(s)
- M Alonso-Isa
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Medina-Polo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - A Lara-Isla
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - S Pérez-Cadavid
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - A Arrébola-Pajares
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - R Sopeña-Sutil
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - R Benítez-Sala
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Justo-Quintas
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Gil-Moradillo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J B Passas-Martínez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - A Tejido-Sánchez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
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Medina-Polo J, Pamplona-Casamayor M, Miranda-Utrera N, González-Monte E, Passas-Martínez JB, Andrés Belmonte A. Dual kidney transplantation involving organs from expanded criteria donors: a review of our series and an update on current indications. Transplant Proc 2015; 46:3412-5. [PMID: 25498062 DOI: 10.1016/j.transproceed.2014.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our purpose was to review our kidney transplantation program based on the use of expanded criteria donors, and to determine current indications for dual kidney transplantation (DKT). In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation. METHODS In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation. DKT were performed with donors >75 and donors between 60 and 74 years of age and glomerulosclerosis of >15%. The kidneys of donors between 60 and 74 years of age and with glomerulosclerosis of <15% were used for single kidney transplantation (SKT). In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics. RESULTS From 1996 to 2004, 222 SKTs and 88 DKTs were performed. Graft survival after 1 and 4 years was, respectively, 91% and 78% for SKT and 95% and 79% for DKT. In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics. From 2005 to 2011, 328 SKT and 32 DKT were performed. During this period most kidneys used for DKT were from female donors >75 years old, weighing <65 kg, with a creatinine of >1 mg/dL and glomerulosclerosis of >15%. The recipients for DKT were mostly male, <70 years old and whose weight was >75 kg. CONCLUSION DKT from expanded criteria donors shows good outcomes. However, in many cases SKT may fulfill the need of the recipient. The archetype for DKT is an older female weighing <65 kg and the most common recipient is an overweight male who is <70 years old.
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Affiliation(s)
- J Medina-Polo
- Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | | | - N Miranda-Utrera
- Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E González-Monte
- Department of Nephrology and Transplant Coordination, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - A Andrés Belmonte
- Department of Nephrology and Transplant Coordination, Hospital Universitario 12 de Octubre, Madrid, Spain
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Miranda-Utrera N, Medina-Polo J, Pamplona-Casamayor M, Passas-Martínez JB, Rodríguez-Antolín A, de la Rosa Kehrmann F, Duarte-Ojeda JM, Tejido-Sánchez A, Villacampa Aubá F, Andrés Belmonte A. Uncontrolled non-heartbeating donors (types i-ii) with normothermic recirculation vs. heartbeating donors: evaluation of functional results and survival. Actas Urol Esp 2015; 39:429-34. [PMID: 25749460 DOI: 10.1016/j.acuro.2015.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Non-heartbeating donors (NHBD) are an alternative to heartbeating donors (HBD). Our objective was to compare functional results and kidney survival from NHBDs and HBDs. MATERIAL AND METHODS A retrospective study comparing the results of 236 normothermically preserved kidneys from type i and ii type NHBDs with the results of 250 from HBDs that were transplanted in our center between 2005 and 2012. Homogeneity between groups was tested and we evaluated the presence of delayed graft function (DGF) associated with pretransplant variables of the donor and recipient. RESULTS Both groups show homogeneity in pretransplant characteristics in terms of: age, HLA incompatibilities, and recipient hemodialysis time. Average follow-up time was 33 months (range 0-87) for NHBDs and 38 months (range 0-90) for HBDs. 5.5% of NHBDs showed primary non-function (PNF) vs. 4% of HBDs (P=.42) and 80.9% of DGF vs. 46.8% of HBDs (P<.001). At the end of the follow-up, there were no statistically significant differences in the survival of grafts (92.8% for NHBD vs. 93.6% for HBD, P=.71) and recipients (99.1% NHBD vs. 98.6% HBD, P=.28). CONCLUSIONS Although the DGF percentage was greater for NHBDs, final creatinine as well as graft and recipient survival were similar for both groups. Therefore, in our experience, kidneys from NHBDs have similar results to those from HBDs and are an excellent source of organs for transplantation.
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Affiliation(s)
- N Miranda-Utrera
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Medina-Polo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
| | | | | | | | | | - J M Duarte-Ojeda
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Tejido-Sánchez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Villacampa Aubá
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Andrés Belmonte
- Servicio de Nefrología y Coordinación de Trasplantes, Hospital Universitario 12 de Octubre, Madrid, España
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Medina-Polo J, Guerrero-Ramos F, Pérez-Cadavid S, Arrébola-Pajares A, Sopeña-Sutil R, Benítez-Sala R, Jiménez-Alcaide E, García-González L, Alonso-Isa M, Lara-Isla A, Passas-Martínez J, Tejido-Sánchez Á. Community-associated urinary infections requiring hospitalization: risk factors, microbiological characteristics and patterns of antibiotic resistance. Actas Urol Esp 2015; 39:104-11. [PMID: 25301702 DOI: 10.1016/j.acuro.2014.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. MATERIAL AND METHODS A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. RESULTS Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2±19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + β lactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. CONCLUSIONS CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates.
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Tejido-Sánchez A, García-González L, Jiménez-Alcaide E, Arrébola-Pajares A, Medina-Polo J, Villacampa-Aubá F, Díaz-González R. Quality of life in patients with ileal conduit cystectomy due to bladder cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.acuroe.2013.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tejido-Sánchez A, García-González L, Jiménez-Alcaide E, Arrébola-Pajares A, Medina-Polo J, Villacampa-Aubá F, Díaz-González R. Quality of life in patients with ileal conduit cystectomy due to bladder cancer. Actas Urol Esp 2014; 38:90-5. [PMID: 23850163 DOI: 10.1016/j.acuro.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/16/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the variables that affect quality of life of patients treated by radical cystectomy with ileal conduit. MATERIAL AND METHOD We analyzed quality of life using the EQ-5D-3L questionnaire. This questionnaire evaluates mobility, personal care, daily activities, pain/discomfort, anxiety/depression and a self-rating scale of the health condition. We compared the result with demographic variables (gender, age, work situation, studies, income, partner) and clinical variables (ASA classification, tumor stage, time since cystectomy was performed, adjuvant chemotherapy, recurrent and complications of the stoma). The statistical analysis included a descriptive study, univariate and multivariate analysis. RESULTS A total of 59 patients were included in the study, with a mean age of 69 years (47-84). Mean time from cystectomy was 43 months (12-83), with 61% complications associated to the stoma. Stoma complications were related with limitations in personal care, pain/discomfort, anxiety, depression and quality of life in general. Female gender was associated with limitations in daily activities and adjuvant chemotherapy with anxiety/depression and quality of life in general. The rest of the variables were not statistically significant in the multivariate analysis. CONCLUSIONS The limitations in quality of life in patients with cystectomy and ileal conduit are associated with the stoma-associated complications. Other related variables are female gender and administration of adjuvant chemotherapy.
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Medina-Polo J, de la Rosa F, Pamplona M, Rodríguez A, Villacampa F, Passas J, Duarte J, Gutiérrez E, Aguirre J, Díaz R. MP-06.13 A Comparison of the Outcomes of Renal Transplantation from Heart-Beating Cadaveric Donors and Non-Heart-Beating Who Present Irreversible Cardiac Arrest Occurring Outside the Hospital. Urology 2011. [DOI: 10.1016/j.urology.2011.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Medina-Polo J, Domínguez-Esteban M, Morales J, Pamplona M, Andrés A, Jiménez C, Manrique A, Moreno E, Díaz R. Cardiovascular Events After Simultaneous Pancreas-Kidney Transplantation. Transplant Proc 2010; 42:2981-3. [DOI: 10.1016/j.transproceed.2010.07.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cabeza M, Antolín A, Duarte J, Romero J, Medina-Polo J, Domínguez M, Pamplona M, De La Rosa F, Castro J, Colmenero M, Lanzós E. UP-2.159: Evaluation of Neoadjuvant Hormonal Treatment as Downsizing Treatment Prior to Brachytherapy. Urology 2009. [DOI: 10.1016/j.urology.2009.07.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cabeza M, Antolín A, Romero J, Duarte J, Duque G, Medina-Polo J, Lanzós E, Domínguez M, De La Rosa F, García M, Villacampa F, Leiva O. UP-2.158: First Year Acute Toxicity Analysis of Low Dose Brachytherapy to Treat Low Risk Prostate Cancer: A Uro-Oncologic Radiotherapeutic Multidisciplinar Unit Experience. Urology 2009. [DOI: 10.1016/j.urology.2009.07.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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