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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 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

Resumen Introduccion y objetivo La cistectomia radical es una cirugia compleja con una alta tasa de complicaciones, entre ellas las infecciones, conllevando un aumento de la morbimortalidad, estancia hospitalaria y costes. El objetivo de este trabajo es estudiar las infecciones relacionadas con la asistencia sanitaria (IRAS) en estos pacientes, asi como de los microorganismos asociados, perfiles de resistencia antibiotica y factores de riesgo. Material y metodos Estudio prospectivo del 2012 al 2017. Se recogen variables epidemiologicas, comorbilidades y variables quirurgicas. Se analizan los microorganismos implicados y patrones de susceptibilidad antibiotica. Resultados Estudio de 122 pacientes. Edad media 67 anos (DE:18,42). Estancia hospitalaria media 23,5 dias (18,42). Tasa de IRAS del 45%, predominando las infecciones del tracto urinario (43%) y de la herida quirurgica (31%). Cultivos positivos en el 78,6% de los casos. Mayor aislamiento de Enterococcus (18%) y Escherichia coli (13%). El 43% de los microorganismos presentaban resistencia a la amoxicilina/ampicilina, 23% a las betalactamasas y 36% a las quinolonas. El tratamiento empirico fue adecuado en el 87,5%. Se observa un aumento en la estancia hospitalaria (17 dias, p Conclusiones Encontramos una elevada tasa de IRAS en nuestra serie de cistectomias radicales, con un predominio de infecciones del tracto urinario y de la herida quirurgica. E. coli y Enterococcus spp. son los microorganismos mas frecuentemente aislados, con altas tasas de resistencia a algunos antibioticos de uso comun.

Nocturia is the interruption of the main sleep, one or more times, due to the need for urination. It is associated with a decrease in the quality of life and an increase in mortality. It is a complex and multifactorial symptom in which two pathophysiological mechanisms are mainly involved. These occur alone or in combination as nocturnal polyuria or decreased bladder capacity. Nocturnal polyuria is the most frequent. The preparation of a bladder diary is the key to diagnosis. Treatment usually combines lifestyle changes and drug therapy. Desmopressin has proven to be an effective and well-tolerated treatment in patients with nocturnal polyuria. The risk of hyponatraemia should be controlled in patients treated with desmopressin.

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 16 years, admitted by any urological process during a period of 4 years. 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 analyzed. Results Out of 6546 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.

α7 nicotinic receptors have been involved in numerous pathologies. A hallmark of these receptors is their extremely fast desensitization, a process not fully understood yet. Here we show that human native α7 and α3β4 nicotinic receptors physically interact in human chromaffin cells of adrenal glands. The full activation of this α7-α3β4 receptor complex avoids subtypes receptor desensitization, leading to gradual increase of currents with successive acetylcholine pulses. Instead, full and partial activation with choline of α7 and α3β4 subtypes, respectively, of this linked receptor leads to α7 receptor desensitization. Therefore choline, a product of the acetylcholine hydrolysis, acts as a brake by limiting the increase of currents by acetylcholine. Very importantly, the efficiency of the α7-α3β4 interaction diminishes in subjets older than 50 years, accordingly increasing receptor desensitization and decreasing nicotinic currents. These results open a new line of research to achieve improved therapeutic treatments for nicotinic receptors related diseases.

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.Prospective study from 2012 to 2017. Epidemiologic variables, comorbidities and surgical variables are collected. The microorganisms involved and antibiotic susceptibility patterns are analyzed.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, p0.05) due to HAIs. Lower rate of infectious complications in the laparoscopic vs. open approach (p0.001) 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.

Nocturia is the interruption of the main sleep, one or more times, due to the need for urination. It is associated with a decrease in the quality of life and an increase in mortality. It is a complex and multifactorial symptom in which two pathophysiological mechanisms are mainly involved. These occur alone or in combination as nocturnal polyuria or decreased bladder capacity. Nocturnal polyuria is the most frequent. The preparation of a bladder diary is the key to diagnosis. Treatment usually combines lifestyle changes and drug therapy. Desmopressin has proven to be an effective and well-tolerated treatment in patients with nocturnal polyuria. The risk of hyponatraemia should be controlled in patients treated with desmopressin.

Resumen Objetivos Analizar las infecciones por enterobacterias productoras de carbapenemasas (EPC) y describir caracteristicas y posibles factores de riesgo asociados con los pacientes de un servicio de urologia. Material y metodos Estudio observacional y retrospectivo. El criterio de inclusion fue haber estado ingresado en nuestro servicio de urologia entre agosto de 2013 y diciembre de 2016. Se analizaron aquellos que presentaron positividad para EPC en al menos un cultivo. Se revisaron caracteristicas basales y factores de riesgo. Asimismo se revisaron variables como presencia de infecciones urinarias previas, reingresos posteriores, el microorganismo, tipo de EPC, tratamiento administrado, un origen hospitalario o comunitario y la mortalidad. Resultados De los 5.657 pacientes que cumplian criterio de inclusion, en 12 casos se aislo una EPC. Las infecciones por EPC representaron un 3,6% del total de infecciones relacionadas con la asistencia sanitaria y un 9,7% de las producidas por enterobacterias. Los factores analizados asociados a infeccion por EPC en nuestra serie son: presencia de cateteres urinarios (100%), haber sido sometido a tratamiento quirurgico (58,3%), ingreso previo en UCI (8,3%) e inmunosupresion (16,6%). Con relacion a la mortalidad, un 8,3% de los pacientes que presentaron infeccion por EPC fallecieron durante el ingreso. Conclusiones Aproximadamente un 10% de las enterobacterias presenta patron de resistencia a carbapenemasas en el paciente urologico de nuestro medio. Ser portador de cateter urinario y/o someterse a una cirugia son factores de riesgo asociados al desarrollo de estas infecciones en el paciente urologico de nuestro medio. La infeccion por una EPC eleva la morbimortalidad.

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.We reviewed the evidence and the recommendations of the clinical practice guidelines regarding surgery in patients with erectile dysfunction.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.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.

Objectifs La troisieme transplantation de rein represente une bonne solution apres la perte des greffons precedents, elle est associee a une meilleure survie des patients par rapport a la dialyse. Cependant, cela implique un plus grand risque chirurgical et immunologique. Nous presentons notre experience sur la troisieme transplantation renale, en analysant les complications et le taux de survie des greffons. Methodes Etude retrospective des troisiemes transplantations renales realisees dans notre hopital entre 1976 et 2019. Des variables concernant le receveur, le donneur, les aspects chirurgicaux, les complications et la survie des greffons ont ete recueillies. Les resultats ont ete compares a une cohorte de premieres et deuxiemes transplantations effectuees dans notre service. Resultats Sur un total de 4143, nous avons effectue 72 troisiemes transplantations avec un âge moyen des receveurs de 46 ans (21–76) et une duree moyenne de dialyse de 70 mois (1–250). Les greffons provenaient tous de donneurs cadaveriques. La troisieme transplantation expose a une augmentation significative de lymphocele (13,9 % contre 3,2 % dans les premieres et 4,5 % dans les deuxiemes ; p Conclusion La transplantation renale iterative constitue un tres bon choix therapeutique avec des resultats chirurgicaux et de survie adequats par rapport aux premieres et deuxiemes transplantations. Il s’agit d’une procedure difficile qui doit etre realisee par des chirurgiens experimentes, en individualisant chaque cas.

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.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.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.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.

Resumen Objetivo El donante en asistolia (DA) es una alternativa al donante en muerte cerebral (DMC). Nuestro objetivo es comparar los resultados funcionales y la supervivencia de rinones procedentes de DA y DMC. Material y metodos Realizamos un estudio retrospectivo comparando los resultados de 236 rinones de DA tipos i y ii preservados en normotermia con 250 procedentes de DMC, trasplantados en nuestro centro entre 2005 y 2012. Se comprueba la homogeneidad entre grupos y evaluamos si la presencia de retraso en la funcion del injerto (RFI) de asocia a las variables pretrasplante de donante y receptor. Resultados Ambos grupos muestran homogeneidad en las caracteristicas pretrasplante en cuanto a: edad, incompatibilidades HLA, tiempo del receptor en hemodialisis. El tiempo medio de seguimiento es de 33 meses (rango 0-87) los DA y 38 meses (rango 0-90) para DMC. Los DA mostraron un 5,5% de no funcion primaria (NFP) frente a un 4% en los DMC (p = 0,42) y un 80,9% de RFI frente a un 46,8% de los DMC (p Conclusiones Aunque el porcentaje de RFI es mayor para los DA, tanto la creatinina final como la supervivencia del injerto y el receptor son similares para ambos grupos. Por tanto, en nuestra experiencia los rinones procedentes de DA tienen resultados similares a aquellos de DMC y constituyen una excelente fuente de organos para trasplante.

To analyse infections by carbapenemase-producing enterobacteriaceae (CPE) and describe the characteristics and potential risk factors associated with patients of a department of urology.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.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.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.

Resumen Objetivo Determinar las variables que influyen en la calidad de vida de pacientes tratados mediante cistectomia radical y conducto ileal. Material y metodo Analizamos la calidad de vida utilizando el cuestionario EQ-5D-3L, que valora movilidad, cuidado personal, actividades cotidianas, dolor/malestar, ansiedad/depresion y una escala de autoevaluacion del estado de salud. Comparamos los resultados con variables demograficas (sexo, edad, situacion laboral, estudios, ingresos, pareja) y clinicas (clasificacion ASA, estadio tumoral, tiempo desde la realizacion de la cistectomia, quimioterapia adyuvante, recidiva y complicaciones del estoma). El analisis estadistico incluyo estudio descriptivo, analisis univariante y multivariante. Resultados Cincuenta y nueve pacientes incluidos, con una media de edad de 69 anos (47-84). El tiempo medio desde la cistectomia es de 43 meses (12-83), con un porcentaje de complicaciones asociadas al estoma del 61%. Las complicaciones del estoma se relacionaron con limitaciones en el cuidado personal, dolor/malestar, ansiedad, depresion y calidad de vida en general. El sexo femenino se asocia con limitaciones en las actividades cotidianas y la quimioterapia adyuvante lo hace con la ansiedad/depresion y con la calidad de vida en general. El resto de variables no alcanzaron significacion estadistica en el analisis multivariante. Conclusiones Las limitaciones en la calidad de vida en pacientes con cistectomia y conducto ileal se asocian con las complicaciones asociadas al estoma. Otras variables relacionadas son el sexo femenino y la administracion de quimioterapia adyuvante.

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.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.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.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.

Objectifs Le don a cœur non battant (DCNB) est apparu au cours des deux dernieres decennies pour augmenter le nombre des donneurs, classiquement compose par la donation a cœur battant (DCB). La DCNB incontrolee n’est pas populaire dans des nombreux pays, en raison de problemes ethiques, entre autres. De plus, ces reins ont un risque ischemique plus eleve en raison d’un temps plus long d’ischemie froide. Nous comparons la survie des transplantations DCNB non controlees liees aux transplantations DCB. Methodes Nous avons effectue une etude retrospective de 300 transplantations de rein (150 DCNB non controlee avec la perfusion normothermique et 150 DCB) realisees dans notre centre entre 2007 et 2012 sur recepteurs de moins de 60 ans . Nous avons recueilli des caracteristiques preoperatoires, de la technique chirurgicale, des caracteristiques de greffe (temps d’ischemie froide.) et des evenements postoperatoires. Nous avons estime la survie brute et la survie censuree par la mort censuree et par la non-fonction primaire avec des courbes de Kaplan–Meier, en utilisant Stata v12,0 pour Windows. Resultats Les deux groupes etaient comparables en ce qui concerne les caracteristiques de reference, avec un suivi median de 53,6 mois (ecart interquartile 35,3–70,5) et un âge median de 43 ans pour les donneurs et 46 pour les recepteurs. La survie brute ( Fig. 1 ) a 1, 5 et 10 ans etait de 93,3 %, 90,9 % et 88,5 % pour les reins DCB, 91,1 %, 83,6 % et 81,6 % pour les greffons DCNB non controles, sans difference statistiquement significative (p = 0,100). La survie censuree par la mort et la non-fonction primaire ( Fig. 2 ) a 1, 5 et 10 ans etait de 95,6 %, 93 % et 88,7 % pour les greffes de DCB et 97 %, 88,9 % et 86,9 % pour les greffes de DCNB. Conclusion Les reins des DCNB sous preservation normothermique ont une survie similaire a celle des greffes de DCB. Par consequent, ils peuvent etre consideres comme une source de valeur pour augmenter le nombre de donneurs afin de minimiser le manque d’organes en cours.