Secondary bladder amyloidosis is a rare condition with less than 60 cases published in the world. It is usually secondary to chronic inflammatory processes such as rheumatologic diseases. Hematuria ...is its predominant and most important symptom, and usually occurs after a bladder catheterization. The diagnostic confirmation is made through a pathological and immunohistochemical study. The treatment must be staggered from less to more invasive. Our objectives are to present a new case of secondary bladder amyloidosis in a woman with a history of chronic bronchiectasis after tuberculosis and frequent super infections, whose main manifestation was a massive hematuria, and review this rare pathology. We have obtained very good initial results using intravesical instillations with dimethyl sulfoxide (DMSO) with complete resolution of the hematuria, the patient remaining asymptomatic for 6 months. After that, there was a recurrence of the hematuria that was treated with embolization of the hypogastric arteries, with good results. We can conclude that, despite being a rare condition, we must consider secondary bladder amyloidosis in patients who have already been diagnosed with systemic amyloidosis and/or chronic pathologies who develop hematuria after bladder catheterization. Based on our experience, instillations with dimethyl sulfoxide are a safe option and provide a quick and temporary resolution of hematuria symptoms.
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.
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.
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.
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 problem.
Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplantation (KT) at the expense of a higher risk of primary graft nonfunction (PNF). At least half of ...the cases of PNF are secondary to graft venous thrombosis. The potential benefit from prophylactic anticoagulation in this scenario remains unclear.
In this single-center retrospective study we compared 2 consecutive cohorts of KT from uDCD with increased (≥0.8) renal resistive index (RRI) in the Doppler ultrasound examination performed within the first 24-72 h after transplantation: 36 patients did not receive anticoagulation ("nonanticoagulation group") and 71 patients underwent prophylactic anticoagulation until normalization of RRI in follow-up Doppler examinations ("anticoagulation group").
Anticoagulation was initiated at a median of 2 d (interquartile range, 2-3) after transplantation and maintained for a median of 12 d (interquartile range, 7-18). In 4 patients (5.6%), anticoagulation had to be prematurely stopped because of the development of a hemorrhagic complication. In comparison with the nonanticoagulation group, recipients in the anticoagulation group had a lower 2-wk cumulative incidence of graft venous thrombosis (19.4% versus 0.0%;
< 0.001) and PNF (19.4% versus 2.8%;
= 0.006). The competing risk analysis with nonthrombotic causes of PNF as the competitive event confirmed the higher risk of graft thrombosis in the nonanticoagulation group
= 0.0001). The anticoagulation group had a higher incidence of macroscopic hematuria (21.1% versus 5.6%;
= 0.049) and blood transfusion requirements (39.4% versus 19.4%;
= 0.050) compared with the nonanticoagulation group. No graft losses or deaths were attributable to complications potentially associated with anticoagulation.
Early initiation of prophylactic anticoagulation in selected KT recipients from uDCD with an early Doppler ultrasound RRI of ≥0.8 within the first 24-72 h may reduce the incidence of graft venous thrombosis as a cause of PNF.
Purpose
Our purpose is to present the results of our working group, with a view to reduce the incidence and improve the management of healthcare-associated infections (HAIs) in a urology ward.
...Methods
The study consists on an observational database designed with the view to analyse the incidence and characteristics of HAIs in Urology. Based on the results obtained, a critical evaluation was carried out and specific measures put in place to reduce HAIs. Finally, the impact and results of the implemented measures were periodically evaluated.
Results
The incidence of HAIs in urology decreased from 6.6 to 7.3% in 2012–2014 to 5.4–5.8% in 2016–2018. In patients with immunosuppression the incidence of HAIs decreased from 12.8 to 18% in 2012–2013 to 8.1–10.2% in 2017–2018, in those with a previous urinary infection fell from 13.6 to 4.8%, in those with a urinary catheter prior to admission from 12.6 to 10.8%, and in patients with a nephrostomy tube from 16 to 10.9%. The effect of the protocol also demonstrated a reduction in the percentage of patients with suspicion of HAIs for whom no culture was taken, from 6% in 2012 to zero in 2017 and 2018. Moreover, the implementation of protocols for empirical treatment has reduced the incidence of patients experiencing inadequate empirical antimicrobial therapy from 20 to 8.1%.
Conclusion
It is essential to monitor the incidence of HAIs, and preventive measures play a useful role in reducing the rate of infection and in optimising their management.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
INTRODUCTION AND OBJECTIVESKidney transplantation is associated, in all age ranges, with better quality of life and, longer survival in comparison with dialysis. Moreover, there has been an increase ...in the number of donors of over 65 years of age, died due to a cerebrovascular accident. Although, kidney transplantation from elderly donors may show worse outcomes; kidneys from elderly donors may be used for older recipients whose lower life expectancy would compensate for potential the lower survival rate of the grafts. Our purpose was to analyze the outcomes of kidney transplantation comparing donors younger and older than 65 years old and, those extremely old donors (>80 years old).
MATERIAL AND METHODSA retrospective study was carried out evaluating complications and functional outcomes of kidney transplantation from donors younger than 65 years old in comparison with those older than 65 years old. Donors older than 80 years old were analyzed independently as they constitute a group of extremely old donors. Our review included kidney transplants performed in our center between 2006 and 2015.
RESULTS1538 kidney transplantations were evaluated, 69.2% using grafts from donors younger than 65 years old, 26.5% older than 65 years old and, 4,3 grafts were from donors older than 80 years. The cause of death was due to a cerebrovascular accident or heart attack in 60.5% and 76.5% among donors younger and older donors, respectively.The percentage of grafts with primary non-function were 5.1%, 10.6% and 17.7% for donors <65, 65-79 and ≥80 years, respectively (p<0.001). The percentage of grafts with delayed graft function were 51.5% and 54.7% for donors <65 and ≥65 years (p=0.187). The percentage of patients with complications after transplantation were 50.8%, 60.3% and 65.6% among recipients with grafts from donors <65, 65-79 and ≥80 years. Ureteral fistula was reported in 3.3%, 7.3% and 12.9% for each group. The percentage of venous thrombosis was 1.7% for grafts <65, 4.5% for those ≥65 and ≤79 and 9.7% for those >80 years. Arterial thrombosis was reported in 1.1%, 3.3% and 4.8% for each group. The incidence of surgical site infection was 7.8% for grafts <65, 14.9% for those ≥65 and ≤79 and 14.5% for those >80 years.
CONCLUSIONSKidneys from older donors have shown a higher incidence of primary non-function and a higher rate of post-operative complications, such as grafts thrombosis, that may be related to more frequent atherosclerotic changes in renal and iliac arteries.
INTRODUCTION AND OBJECTIVESComplications related to urinary tract anastomosis are reported in up to 10% of cases after renal transplantation. The type of bladder anastomosis and urinary catheters as ...double J stents may influence the development of urological complications and urinary tract infections.Our purpose was to analyze whether the type of urinary anastomosis in kidney transplantation influences the incidence of complications in the urinary tract.
MATERIAL AND METHODSA retrospective study was carried out assessing urinary tract complications after kidney transplantation. The study included 1503 kidney transplantations performed at our center between 2006 and 2015. Urinary tract complications included urinary fistula, obstructive uropathy, and urinary tract infections. The analysis was stratified into two groups according to the type of ureterovesical anastomosis and double J stent placement.
RESULTSUreterovesical anastomosis was conducted using an intravesical technique in 1414 patients (94,0%), extravesical in 75 (5.0%) and ureteral-ureteral anastomosis was required in 14 cases. Double J stent was used in all cases with extravesical technique and 47.6% (673/1414) of cases with intravesical technique.The incidence of urinary fistula was 2.8% in the extravesical anastomosis group and 4.8% if intravesical anastomosis, independently whether double J stent was used. Ureteral dilatation was diagnosed in 4.6% and 2.8% after intra and extravesical techniques, respectively. Hematuria requiring surgery or urinary catheter manipulation was shown in 4.5% with intravesical anastomosis and double J stent placement and 4.8% in those without double J stent. No cases of hematuria requiring treatment were reported among those with extravesical anastomosis.The incidence of urinary infections in the early postoperative period was 12% if extravesical anastomosis. The incidence of UTIs in patients with intravesical anastomosis was 15% and 11.9% in those with and without double J stent, respectively. The mean time with bladder catheter was 12.2 days in patients with UTI in comparison with 11.4 days in those without urinary infections (p=0.005). Statistically differences were not found regarding the mean time with double J stent in patients with or without UTI, 17.6 and 16.8 days, respectively (p=0.495).
CONCLUSIONSAccording to our data, the type of bladder anastomosis using intra or extravesical anastomosis is statistically not associated with the incidence of ureteral fistula or obstructive uropathy. However, hematuria which requires treatment is more frequent in recipients with intravesical anastomosis. Moreover, longer times with urinary catheters are related with a higher incidence of urinary tract infections. Therefore, urinary catheter must be removed as soon as possible in order to prevent the development of infections.
Purpose
To report our experience on third kidney transplantation, analyzing the complications and graft survival rates as compared to previous transplants.
Methods
Retrospective study of third renal ...transplants performed at our center. Outcomes were compared with a cohort of first and second transplants.
Results
Of a total of 4143, we performed 72 third transplants in 46 men and 26 women with an average age of 46 years and mean time on dialysis of 70 months. Thirty-seven patients were hypersensitized panel-reactive antibody (PRA) > 50%. They were all from deceased donors, with a mean cold ischemia time of 19.2 h. The extraperitoneal heterotopic approach was used in 88.8%, transplantectomy was performed in 80.6% and vascular anastomoses were realized mostly to external iliac vessels, using the common iliac artery in 15 cases, and the inferior vena cava in 16. The main ureteral reimplantation technique was the Politano-Leadbetter (76.4%).
Third transplantation reported a significantly higher incidence of lymphocele (13.9% vs. 3.2% in first and 4.5% in second transplants;
p
< 0.001), rejection (34.7% vs. 14.9% and 20.5%,
p
< 0.001) and urinary obstruction (11.1% vs. 3.6% and 6.3%,
p
0.002). Graft survival rates for first, second and third transplants were 87%, 86% and 78% at 1 year, 83%, 82% and 74% at 3 years and 80%, 79% and 65% at 5 years, respectively.
Conclusion
Iterative transplantation constitutes a valid therapeutic option with adequate surgical and survival results compared to previous transplants. It is a challenging procedure which must be performed by experienced surgeons.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
10.
Analysis of adverse events in general surgery. Multicenter study Ruiz-López, Pedro M.; Fuente-Bartolomé, Marta de la; Pérez-Zapata, Ana Isabel ...
Cirugia española (English ed.),
February 2024, 2024-Feb, 2024-02-00, 20240201, Volume:
102, Issue:
2
Journal Article
Peer reviewed
Display omitted
Knowledge of adverse events (AE) in acute care hospitals is a particularly relevant aspect of patient safety. Its incidence ranges from 3% to 17%, and surgery is related to the ...occurrence of 46%–65% of all AE.
An observational, descriptive, retrospective, multicenter study was conducted with the participation of 31 Spanish acute-care hospitals to determine and analyze AE in general surgery services.
The prevalence of AE was 31.53%. The most frequent types of AE were infectious (35%). Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. The majority of patients (58.42%) were attributed a category F event (temporary harm to the patient requiring initial or prolonged hospitalization); 14.69% of AE were considered severe, while 34.22% of AE were considered preventable.
The prevalence of AE in General and GI Surgery (GGIS) patients is high. Most AE were infectious, and the most frequent AE was surgical site infection. Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. Most detected AE resulted in mild or moderate harm to the patients. About one-third of AE were preventable.
El conocimiento de los eventos adversos (EA) en los hospitales de agudos es un aspecto de especial relevancia en la seguridad del paciente. Su incidencia oscila entre un 3%–17% y la cirugía se relaciona con la aparición de entre un 46%–65% de todos los EA.
Se realiza un estudio observacional, descriptivo, retrospectivo y multicéntrico, con la participación de 31 hospitales de agudos españoles, para la determinación y análisis de los EA en los Servicios de cirugía general.
La prevalencia de EA fue del 31,53%. Los tipos de EA más frecuentes fueron de tipo infeccioso (35%). Los pacientes con mayores grados de ASA, mayor complejidad y un tipo de ingreso urgente son factores asociados a la presencia de EA. A la mayoría de los pacientes se les atribuyó una categoría de daño F (daño temporal al paciente que requiera iniciar o prolongar la hospitalización) (58,42%). El 14,69% de los EA se considerados graves. El 34,22% de los EA se consideraron evitables.
La prevalencia de EA en pacientes de CGAD es elevada. La mayor parte de los EA fueron de tipo infeccioso. El EA más frecuente fue la infección de herida o sitio quirúrgico. Los pacientes con mayores grados de ASA, mayor complejidad y un tipo de ingreso urgente son factores asociados a la presencia de EA. La mayoría de los EA detectados han supuesto un daño leve o moderado sobre los pacientes. Alrededor de un tercio de EA fueron evitables.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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