Acta Urológica Portuguesa最新文献

{"title":"Indexed Journal: What Does it Mean and Demand?","authors":"H. Donato","doi":"10.24915/aup.34.3-4.75","DOIUrl":"https://doi.org/10.24915/aup.34.3-4.75","url":null,"abstract":"","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80429297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter-Associated Urinary Tract Infections in a Burn Unit: Epidemiological Study","authors":"L. Sepúlveda, M. Vaz, Í. Brito, C. Chaves, L. Cabral, J. Lima, Filipe Rodrigues","doi":"10.24915/aup.34.1-2.4","DOIUrl":"https://doi.org/10.24915/aup.34.1-2.4","url":null,"abstract":"Introduction: Besides burn wound infections, burned patients are also more susceptible to other types of nosocomial infections. Catheter-associated urinary tract infections (CA-UTI) are one of the most common infections in this context, responsible for high morbidity, increased hospital stay and associated costs. The aim of this study was to characterize catheter-associated urinary tract infections in hospitalized burn patients and evaluate the frequency of microbiologic agents responsible for these infections. \u0000Material and Methods: Retrospective study, performed in a Burn Center (Coimbra Burns Unit) of a University Hospital (Centro Hospitalar e Universitario de Coimbra, Portugal – CHUC), based in the clinical data and urine cultures of burned patients who have performed at least once this exam between 1 January 2010 and 31 December 2014. Different variables such as date of infection, general characteristics of the population and the responsible pathogen were analyzed. Infections were further categorized taking into account the existence of previous episodes of CA-UTI, thereby defining primary infection, re- infection, relapse and over-infection. \u0000Results: Between January 2010 and December 2014, 213 CA-UTI were diagnosed in 143 patients. The most common uropathogens were E. coli (27.2%), Enterococcus faecalis (20.2%), Pseudomonas spp. (13.1%), Candida spp. (12.1%), Klebsiella spp. (10.8%) and Acinetobacter baumannii (9.9%). The most common microorganisms varied significantly depending on the gender of the patient. The CA-UTI analyzed corresponded to 143 primary infections, 44 reinfections, 17 relapses and nine over-infections. Relapse corresponded to 11% of infections in males and 5.7% in females and was significantly more frequent in infections due to Acinetobacter baumannii. \u0000Discussion/Conclusion: Catheter-associated urinary infections are common in intensive care units, particularly at Burn Units. The most common pathogens identified were similar to those reported in the literature. Pathogens responsible for polymicrobial infections were similar to those in monomicrobial infections, probably due to the short-term nature of urinary catheterization. Infections by Acinetobacter baumannii showed high susceptibility to relapse, which is probably related to its multi-drug resistance, common in this pathogen. The high relapse rate detected in males is probably related to the greater frequency of Acinetobacter baumannii infections in this gender. Candiduria was more frequent in the context of reinfection and over-infection, probably due to disruption of bacterial flora secondary to previous systemic antibiotics.","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76813001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dilatação Endoscópica de Balão para Tratamento de Megaureter Obstrutivo Primário: Experiência de um Centro","authors":"Sofia Morão, Vanda Pratas Vital, Dinorah Cardoso, Fátima Alves, F. C. Mota, J. Pascoal","doi":"10.24915/AUP.34.1-2.41","DOIUrl":"https://doi.org/10.24915/AUP.34.1-2.41","url":null,"abstract":"Introduction: Congenital obstructive megaureter may be treated with endoscopic balloon dilatation, particularly in children under one year of age. We report our experience over a six year period. Patients and methods: All patients with diagnosis of primary obstructive megaureter (POM) treated with endoscopic balloon dilatation from 2009 to 2014 (6 years) were included. The diagnosis of POM was based on dilatation of the distal ureter greater than 7 mm, obstructive curve on MAG 3 diuretic renogram and absence of vesicoureteral reflux (VUR). After diagnosis, conservative management was maintained with antibiotic prophylaxis in all patients. The indications for surgery were a combination of clinical, ultrasonographic and renographic findings. Under general anesthesia and after retrograde ureteropielography, high pressure balloon dilation of the ureterovesical junction was performed under direct and fluoroscopic vision until the disappearance of the narrowed ring. A double-J catheter was positioned. Follow-up was performed with ultrasonography and diuretic renogram. The success of the intervention was defined by improvement of HUN (at least 2 grades). Results: A total of nine patients underwent this procedure on a single ureter, two girls and seven boys, with a mean age of 7. 6 months (range 1-14) at the intervention. Five were left sided and four were right sided. All patients had prenatal diagnosis of hydroureteronephrosis (HUN). No patients were lost to follow-up (average 46.7 months). They all had HUN greater than grade 3 and preoperative MAG3 diuretic renogram was obstructive in all cases.  Mean differential function of the affected kidney was 46.2% (range 40-53%). The main indication for surgical treatment was progressive HUN. All patients were treated endoscopically with no intraoperative complications. Ultrasound showed improvement of the HUN in six patients (66.7%). Three patients were reimplanted (33.3%). The mean differential renal function (DRF) after the procedure was 47.4% (range 41-53%). At the latest follow-up assessment, all patients remained asymptomatic. Discussion: Endoscopic balloon dilatation is a useful option in the management of POM requiring surgical intervention and may be considered first line treatment in small children.","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80613784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumores Primários Superficiais de Alto Grau da Bexiga","authors":"D. S. Pereira, F. Botelho, Carlos Silva, J. S. Silva","doi":"10.24915/AUP.34.1-2.30","DOIUrl":"https://doi.org/10.24915/AUP.34.1-2.30","url":null,"abstract":"Purpose: We aimed to characterize the population with primary high-grade non muscle invasive bladder cancer followed in a Portuguese Central Hospital and simultaneously identify recurrence and progression rates and associated risk factors. \u0000Material and Methods: The analysis included 79 patients who were diagnosed with primary high-grade non muscle invasive bladder cancer on first transurethral resection between 2006 and 2010. Several variables were statistically analyzed to evaluate their prognostic importance. \u0000Results: With a median follow-up of 54 months, 19 patients (24.1%) recurred, four (5.1%) progressed to muscle-invasive disease and two (2.5%) underwent radical cystectomy. The most important prognostic factor of recurrence was the duration of intravesical bacillus Calmette-Guerin (BCG) treatment while the presence of carcinoma in situ was the most important prognostic factor of progression. Residual disease on second-look transurethral resection showed to reduce the recurrence-free-survival. \u0000Conclusion: In our population, recurrence and progression rates were much lower than those described in other studies. Residual disease on second-look transurethral resection is associated with decreased recurrence-free-survival while the presence of carcinoma in situ is related with higher risk of progression. The duration of treatment with BCG seems to reduce the risk of recurrence.","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86570475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obras de Santa Engrácia","authors":"Belmiro Parada","doi":"10.24915/aup.34.1-2.56","DOIUrl":"https://doi.org/10.24915/aup.34.1-2.56","url":null,"abstract":"","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77564135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric laparoscopic pieloplasty","authors":"Sofia Morão, Vanda Pratas Vital, A. V. Silva, Dinorah Cardoso, F. Alves, F. Mota, J. Pascoal","doi":"10.24915/aup.34.1-2.3","DOIUrl":"https://doi.org/10.24915/aup.34.1-2.3","url":null,"abstract":"Introduction: Ureteropelvic junction obstruction (UPJO) is the most common congenital cause of upper urinary tract obstruction in children. Our objective is to report our experience concerning the first 20 laparoscopic pyeloplasties. \u0000Material and methods: Retrospective study including twenty children with diagnosis of UPJO that underwent laparoscopic pyeloplasty by a single surgeon, at our Hospital, between November 2010 and December 2014, with at least one year of follow-up. Success was defined as absence of conversion, resolution of symptoms and radiologic criteria improvement. \u0000Results: Median age at surgery was 9.5 years (range between 10 months and 17 years-old). Intrinsic obstruction was found in 7 cases, extrinsic obstruction in 12 cases and one case with both situations. Median operative time was 235 minutes (range between 165-275 minutes), with need for conversion in 2 cases (10%).  Median hospital stay was 2 days (range between 2-5 days. Four patients (20%) had early postoperative complications and two cases (10%) needed surgical revision during follow-up. Median follow-up time was 33 months (range between 12-60 months). In follow-up, all but two patients were asymptomatic. There was radiologic improvement of hydronephrosis in all patients but one, although he had non-obstructive pattern in renographic drainage. \u0000Conclusion: Our results are similar to those found in literature, with success rates comparable to open pyeloplasty with advantages of minimally invasive surgery.","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88995842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tratamento de Fístulas Uro-Rectais Iatrogénicas em Tumores Pélvicos no Homem","authors":"F. Martins, David Martinho, L. C. Pinheiro, N. M. Martins, Luís Ferraz, Luís Xambre, L.O.P. Costa, T. Lopes","doi":"10.24915/aup.34.1-2.7","DOIUrl":"https://doi.org/10.24915/aup.34.1-2.7","url":null,"abstract":"Introduction: Urorectal fistulas (URF) are a devastating complication of pelvic tumor treatment and a significant surgical challenge. Despite its increasing incidence associated with an increasing use of different forms of non-surgical treatment of pelvic tumours, urorectal fistula remains rare. Given the improbability of spontaneous closure, surgical correction becomes necessary in almost all cases. Despite the existence of various surgical techniques, rates of failure / recurrence are usually high, particularly in radiation fistulas. In this study the authors describe their experience in the treatment of URF resulting from pelvic tumor treatment. \u0000Methods: Between October 2008 and February 2015, 12 male patients were identified with URF treated in our institutions. A review of medical records of patients, including age, symptoms, comorbidity, diagnostic approach, type and fistula etiology, type of surgical reconstruction, follow-up and results was performed. Non-neoplastic / inflammatory fistula patients were excluded from the study. \u0000Results: We identified and treated 12 patients. One patient with fistula secondary to anterior resection of the rectum developed lymph node and liver metastases 4 months after the diagnosis of urorectal fistula and was consequently excluded from surgical treatment and study. The mean age of patients was 68 years (53-78). Nine patients developed URF after prostate cancer therapy: Two after low-dose brachytherapy combined with external beam radiation therapy; five after retropubic radical prostatectomy, with adjuvant radiation therapy in one; one after low-dose brachytherapy followed by transurethral resection of prostate; and one after high intensity focal ultrasound and radiation therapy. In two patients, the fistula resulted from surgical treatment of rectal carcinoma, associated with radiation therapy in one of them. In all patients with fecal and urinary diversion was performed by means of colostomy and suprapubic catheterization or urethral catheterization during the waiting period for surgical reconstruction. No spontaneous closure of URF occurred in any patient. Eleven patients underwent surgical reconstruction. Perineal approach was exclusively used in seven patients. In four patients, an abdominoperineal approach was employed. Effective fistula closure was reported in six patients after the first surgical attempt. Two patients required a second surgery, while one patient required three surgical procedures to achieve a successful result. Surgical failure occurred in two patients, which at present do not wish any additional reconstructive attempt. These two patients and one patient, in whom the reconstruction was effective, yet remain with colostomy. The mean follow-up was 25.5 months (3-75). \u0000Conclusion: URF are an uncommon but serious complication of treatment of pelvic tumors, usually associated with debilitating morbidity and loss of quality of life. Although a surgical reconstruction can be extremely di","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88477729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Raro Caso de Leiomioma Paratesticular","authors":"G. Brito, D. Ribeiro, Amanda Vanessa Demarchi, Angelo Maurílio Fosse Júnior, José A. Scheinkman","doi":"10.24915/aup.34.1-2.39","DOIUrl":"https://doi.org/10.24915/aup.34.1-2.39","url":null,"abstract":"Introduction: Paratesticular tumors account for 2% of genitourinary neoplasms. They are benign neoplasms originating from the mesenchymal tissue, of slow and indolent growth, with no definite etiology, and can appear in any tissue composed of smooth muscle. Note the leiomyomas, which are considered a rare neoplasia in this location, so that their diagnosis is often confused with testicular tumors. \u0000Clinical Case: The authors present a case of a 56-year-old male patient admitted to the urology outpatient clinic with a large painless mass in the right testis of slow growth and a 3-year evolution. After further examination, he underwent right inguinal orchiectomy. The histopathological analysis and immunohistochemical profile of the surgical specimen showed a mesenchymal neoplasia compatible with atypical Paratesticular Leiomyoma, with borderline behavior and indolent growth. \u0000Discussion: This is a rare benign pathology whose etiology is frankly unknown and easily diagnosed as testicular origin. Therefore, this report sets out the objective of introducing this entity into medical knowledge in order to collaborate on future approaches.","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80471424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urethroplasty in Phalloplasty: Surgical Outcomes and Complications a Critical Review","authors":"A. Morgado, N. Tomada","doi":"10.24915/AUP.34.1-2.8","DOIUrl":"https://doi.org/10.24915/AUP.34.1-2.8","url":null,"abstract":"Phalloplasty can be either performed as a penile reconstructive or phallic constructive procedure, mainly in penile trauma victims or female-to-male gender reassignment. After the introduction of the radial artery-based forearm free flap and with the further awareness of patient desire to void while standing, urethral reconstruction became a standard procedure and a main goal to attain in phalloplasty. Urethroplasty techniques can be broadly split in two main groups: as part of a tube-within-a-tube skin flap or as an independent other-than-skin graft. Urethral complications, such as fistula, stricture, or stones, are common and often recur after treatment. In this review, the main techniques of urethral reconstruction in phalloplasty are reviewed and compared. Urethral complications are also reviewed as well as their management.","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84646542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice","authors":"L. Vale, F. B. L. Mendes, L. Pacheco-Figueiredo, T. Antunes-Lopes, João S. Silva, Carlos Silva","doi":"10.1016/S1569-9056(17)31926-7","DOIUrl":"https://doi.org/10.1016/S1569-9056(17)31926-7","url":null,"abstract":"","PeriodicalId":100020,"journal":{"name":"Acta Urológica Portuguesa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84725491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}