RESUMEN

Introduction: Kidney transplant has improved in the last decades due to new technologies and surgical techniques. However, there are still multiple complications associated with this procedure, which can affect the function and viability of the kidney graft. Our aim was to describe the incidence of urological, vascular, and infectious complications in the 1st month after the procedure. Methods: A cross-sectional and retrospective study was carried out. Records of all patients who underwent kidney transplant from 2007 to 2017 were reviewed and data of demographic and surgical variables as well as information of vascular, urological, and infectious complications during the 1st post-operative month were registered and analyzed. Results: A total of 243 patients that required kidney transplant were assessed. The most common chronic kidney disease etiologies were: idiopathic (25.5%), glomerulopathies (24.7%), and hypertension (23.5%). Seventy patients (28.8%) presented a complication, of which 31 were urological, 27 were infectious, and 12 were vascular. In each category, the most frequent complications were the perirenal hematoma, the urinary tract infection, and renal artery stenosis, respectively. Conclusions: The prevalence of complications found in our center is similar to that reported in the literature and it is significant. It is important for medical personnel to be aware of this data to have a high level of suspicion and make an active search, as an early diagnosis and treatment of these pathologies are crucial to avoid graft loss

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Introducción: El trasplante renal ha mejorado en las últimas décadas gracias a las nuevas tecnologías y técnicas quirúrgicas. Sin embargo, aún existen múltiples complicaciones asociadas a este procedimiento, que pueden afectar la función y viabilidad del injerto renal. Nuestro objetivo fue describir la incidencia de complicaciones urológicas, vasculares e infecciosas en el primer mes tras el procedimiento. Métodos: Se realizó un estudio retrospectivo de corte transversal. Se revisaron los expedientes de todos los pacientes que se sometieron a trasplante renal desde 2007 hasta 2017 y se registraron y analizaron datos de variables demográficas y quirúrgicas, así como información de complicaciones vasculares, urológicas e infecciosas durante el primer mes postoperatorio. Resultados: Se evaluaron un total de 243 pacientes que requirieron trasplante renal. Las etiologías de enfermedad renal crónica (ERC) más frecuentes fueron: idiopática (25,5%), glomerulopatías (24,7%) e hipertensión arterial (23,5%). 70 pacientes (28,8%) presentaron alguna complicación, de los cuales 31 fueron urológicos, 27 infecciosos y 12 vasculares. En cada categoría las complicaciones más frecuentes fueron el hematoma perirrenal, la infección del tracto urinario y la estenosis de la arteria renal respectivamente. Conclusiones: La prevalencia de complicaciones encontrada en nuestro centro es similar a la reportada en la literatura y es significativa. Es importante que el personal médico conozca estos datos para tener un alto nivel de sospecha y realizar una búsqueda activa, ya que el diagnóstico y tratamiento precoz de estas patologías es fundamental para evitar la pérdida del injerto.

Asunto(s)

Humanos , Masculino , Femenino , Trasplante de Riñón/efectos adversos

RESUMEN

Objectives Congenital malformations constitute the first cause of morbidity and mortality in childhood in Latin America. That is why, since 2001, a surveillance system for congenital malformations has been implemented in Bogota - Colombia. However, despite the increase in detection, an impact on treatment has not been achieved. The present study describes our experience with a novel social program focused on congenital urologic disorders. Methods The present manuscript is a retrospective observational study. We reviewed two national databases containing patients with congenital malformations. Patients were actively contacted to verify the status of the malformations. Children in whom the malformation was confirmed were offered a free consultation with a multidisciplinary group. After screening for surgical indications, patients were scheduled for surgery. Results Between November 2018 and December 2019, 60 patients were identified. In total 44, attended the consultation; the remaining did not attend due to financial or travel limitations. The most common condition assessed was hypospadias. In total, 29 patients underwent surgery. The total cost of care was of US$ 5,800. Conclusions Active search improves attention times and reduces the burden of disease. The limitations to be resolved include optimizing the transportation of patients and their families, which is a frequent limitation to access health care.

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Objetivos Las malformaciones congénitas corresponden a la principal causa de morbimortalidad en la infancia en América Latina, motivo por el cual desde el 2001 se viene implementando un sistema de vigilancia epidemiológica de malformaciones congénitas en Bogotá, Colombia. Sin embargo, a pesar del aumento en la cobertura del reporte obligatorio, no se ha logrado un impacto sobre su tratamiento. Este estudio busca mostrar nuestra experiencia con un programa integral de pacientes con malformaciones urológicas congénitas. Métodos El presente es un estudio observacional retrospectivo. Los menores con malformaciones congénitas fueron identificados en dos bases de datos nacionales que incluyen pacientes con malformaciones congénitas. Los pacientes reportados fueron contactados telefónicamente para verificar el estado actual de la malformación. A aquellos niños en quienes se les confirmó la malformación, se les ofreció de manera gratuita una consulta con un grupo multidisciplinario. Una vez confirmadas las indicaciones quirúrgicas, fueron llevados a cirugía. Resultados Se identificaron 60 pacientes entre noviembre del 2018 y diciembre de 2019. De los pacientes identificados, 44 acudieron a consulta. Los demás no asistieron por limitaciones económicas. La principal condición valorada fue hipospadias. En total, 29 pacientes fueron llevados a cirugía. El costo total de la atención de estos pacientes fue de 22 millones de pesos colombianos. Conclusiones La búsqueda activa mejora los tiempos de atención y reduce la carga de la enfermedad. Una de las limitaciones aun por resolver es optimizar el transporte de los pacientes y sus familias, que resulta una limitación frecuente para el acceso a la salud.

Asunto(s)

Humanos , Masculino , Femenino , Anomalías Congénitas , Anomalías Urogenitales , Tamizaje Masivo , Indicadores de Morbimortalidad , Atención a la Salud , Diagnóstico , Monitoreo Epidemiológico , Hipospadias

RESUMEN

Introduction In the pediatric population, the prevalence of stone disease has increased in recent years. We aim to analyze the bibliometric characteristic of available literature on the management of stones in this population. Methods We performed a search for articles published until December 2019 on the Scopus, Google Scholar, PubMed, Embase, and Web of Science databases using the keywords children, lithiasis, and stones. We excluded articles involving patients older than 18 years of age and those with non-urological lithiasis. Then, we performed a bibliometric analysis using the original language, year of publication, impact factor (yearly number of citations), and absolute citation count as variables to calculate the impact index (number of sources adjusted for the time since publication). Results We included 291 articles published between 1940 and December 2019 for analysis. The average number of citations per manuscript was of 15.3 (± 21.9), and the average impact index was of 502 (± 976.4). A total of 4 articles were published before 1970. The evaluation of historical landmarks that could affect citation counts, such as the launch of a journal specialized in pediatric urology (Journal of Pediatric Urology), showed a mean citation count of 23.29 before the first edition, and of 14.96 after (p = 0.0006). The variation on the impact index with the same criteria was of 539.6 before the first edition of the Journal of Pediatric Urology, and of 316.32 after (p = 0.001). The average number of citations before internet access was of 17.9, and, after the internet, of 15.1 (p = 0.17). We also observed a difference in counts regarding languages of publication. Conclusions The proportional academic productivity on pediatric stone disease demonstrates that citation counts do not reflect the true academic impact of subspecialized topics.

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Introducción La prevalencia de la urolitiasis en la población pediátrica ha venido aumentando en los últimos años. Este manuscrito busca analizar las características bibliométricas de la literatura disponible sobre el manejo de la urolitiasis pediátrica. Métodos Realizamos una búsqueda por artículos publicados hasta diciembre de 2019 en las bases de datos Scopus, Google Scholar, PubMed, Embase y Web of Science con las palabras children, lithiasis, y stones. Excluimos artículos con pacientes mayores de 18 años y litiasis no urológica. Posteriormente, realizamos un análisis bibliométrico utilizando el idioma original, el año de publicación, el factor de impacto (número de citas anuales), y el recuento absoluto de citas para calcular el índice de impacto (número de fuentes ajustadas por el tiempo desde la publicación). Resultados Analizamos 291 artículos publicados desde 1940 hasta diciembre de 2019. El promedio de citas por artículo fue de 15,3 (± 21,9), y el índice de impacto fue de 502 (± 976,4). Un total de 4 artículos fueron publicados antes de 1970. La evaluación de hitos históricos que pudieran afectar el recuento de citas, como el lanzamiento de una revista de urología pediátrica (Journal of Pediatric Urology), mostró un recuento medio de citas de 23,29 antes de la primera edición, y de 14,96 después (p = 0,0006). La variación del índice de impacto con los mismos criterios fue de 539,6 antes de la primera edición de esta revista, y de 316,32 después (p = 0,001). El promedio de citas antes del acceso a la internet fue de 17,9, y después, de 15,1 (p = 0,17). Observamos también una diferencia en los recuentos respecto a los idiomas de publicación. Conclusiones La productividad académica sobre la litiasis pediátrica demuestra que los recuentos de citas no reflejan el verdadero impacto académico de los temas subespecializados.

Asunto(s)

Humanos , Niño , Litiasis , Urolitiasis , Literatura , Publicaciones , Descriptores , Bibliometría , Factor de Impacto , Acceso a Internet

RESUMEN

Background Congenital urological anomalies are present in 4.3/10 thousand newborns, and their association with other anomalies may increase the overall mortality and disability. The present study establishes the risk of having congenital urological anomalies presenting associated cardiopathies. Methods We conducted a retrospective case-control study using the Latin American Collaborative Study of Congenital Malformations (Estudio Colaborativo Latino Americano de Malformaciones Congénitas, ECLAMC, in Spanish). The analysis included all registered cases of congenital urological malformation from 1967 to 2019. Patients with or without associated heart defects were included for the statistical analysis. Odds ratios (ORs) were calculated using a 95% confidence interval (95% CI). We compared the variables with the Chi-squared test and analysis of variance (ANOVA). The statistical analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, United States) software, version 27.0. Values of p < 0.05 were considered statistically significant. Results A total of 7,767,161 newborns were evaluated, and 17,834 genital and upper urinary tract malformations were identified. Of these, 64.2% were genital anomalies, and 35.8% were abnormalities of the upper urinary tract. Genitourinary malformations and concomitant congenital heart defects (GU + C) were observed in 3.5% of the cases. Subjects with GU + C had a higher number of malformations (4.59 ± 2.3) than patients without heart defects (1.53 ± 1.58) (p < 0.000). The OR was of 3.61 (range: 1.86­7.00) for cloacal exstrophy, of 4.01 (range: 3.14­5.12) for imperforate anus, of 5.52 (range: 3.92­7.78) for horseshoe kidney, and of 13.7 (range: 6.65­28.22) for trisomy 21 (Down syndrome) with malformations of the upper urinary tract. Conclusion The association of congenital heart defects with urological anomalies is higher for complex congenital anomalies such as imperforate anus, cloacal exstrophy, and ho

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Introducción Las malformaciones congénitas urológicas están presentes en 4,3/10 mil, y su asociación con otros defectos puede aumentar la mortalidad global y la discapacidad. Este estudio analiza la presentación de las malformaciones congénitas urológicas asociadas a las cardiopatías congénitas. Métodos Este es un estudio retrospectivo de casos y controles que usa el Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC). Se incluyeron todos los casos registrados de malformaciones congénitas urológicas de 1967 a 2019, y todos los casos con y sin defectos cardiacos. Se calculó la razón de disparidad (RD) usando un intervalo de confianza del 95% (IC 95%). Se probó la hipótesis con el Chi-cuadrado y análisis de la varianza (analysis of variance, ANOVA, en inglés). Se realizó el análisis estadístico por medio del programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, Estados Unidos), versión 27.0. Se consideró la significancia estadística con valores de p < 0,05. Resultados Se evaluaron 7.767.161 recién nacidos, y se identificaron 17.834 malformaciones genitales y del tracto urinario superior. De estas, 64,2% fueron genitales, y 35,8%, de vías urinarias superiores. El 3,5% de los casos tenían malformaciones genitourinarias y defectos cardiacos congénitos concomitantes (GU + C). Aquellos con GU + C tenían mayor número de malformaciones (4,59 ± 2,3) que los pacientes sin defectos cardiacos (1,53 ± 1,58) (p < 0,000). La RD fue de 3.61 (rango: 1,86­700) para la extrofia cloacal, de 4,01 (3,14­5,12) para el ano imperforado, de 5,52 (3,92­7,78) para el riñón en herradura, y de 13,7 (6,65­28,22) para la trisomía 21 (síndrome de Down) con malformaciones del tracto urinario superior. Conclusión La asociación entre defectos cardiacos congénitos y anomalías urológicas es significativa en malformaciones congénitas complejas como el ano imperforado, la extrofia cloacal, y el riñón en herradura. Los pacientes con síndrome de Down y malformaciones urológicas tienen la mayor probabilidad.

Asunto(s)

Humanos , Masculino , Femenino , Recién Nacido , Anomalías Congénitas , Cardiopatías Congénitas , Ano Imperforado , Estudios de Casos y Controles , Síntomas Concomitantes , Análisis de Varianza , Interpretación Estadística de Datos , Síndrome de Down , Riñón Fusionado

RESUMEN

Objetivo: Analizar la tendencia del indicador "Infección del tracto urinario asociado a instalación de catéter urinario a permanencia" en Chile. Material y Método: Estudio ecológico, de series temporales en el sistema sanitario de Chile, correspondiente a un total de 15 regiones, desde el año 2001 al año 2017 (27.087.087 casos). Se incluyeron datos cuyo egreso hospitalario era infección de tracto urinario asociado a catéter urinario a permanencia, según la Clasificación Internacional de Enfermedades (CIE 10). El análisis descriptivo y correlacional (X2 y T de Student, respectivamente) se realizó en función del sexo, tipo de previsión, condición de egreso y operación quirúrgica. El análisis se realizó con el programa SPSS 24 y el nivel de significación estadística fue p< 0,05. La estimación, basada en análisis lineal, estimó cambios porcentuales anuales (APC: Annual Percentage Change) y sus intervalos de confianza al 95%. Se empleó el método de auto-regresión de Prais Winsten. El resguardo ético siguió lo dispuesto en la Ley N° 20.585. Resultados: Se observó un 2% de crecimiento interanual (APC= 0,00007; IC: 95%= 0,000069-0,000073). En los años 2005, 2008, 2009 y 2011 existió un aumento en el porcentaje de cambio de 2 a 5 puntos. Conclusión: El indicador analizado es un evento que ha presentado una tendencia creciente y significativa en Chile desde el año 2001, lo que resulta paradójico, puesto que el ordenamiento de los procesos hospitalarios, asociado a la Reforma de Salud, debería demostrar una mejora en el comportamiento de este tipo de indicadores.

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Objective: To analyze the trend indicator "Urinary tract infection associated with indwelling urinary catheter insertion" in Chile. Material and Method: Ecological, time series study, carried out in the Chilean health system, corresponding to a total of 15 administrative regions, from 2001 to 2017 (27.087.087 cases). Data included information on patients whose hospital discharge was urinary tract infection associated with indwelling urinary catheter, according to the International Classification of Diseases (ICD-10). Descriptive and correlational analysis (X2 and Student's t-test, respectively) was performed according to sex, type of health insurance, hospital discharge condition and surgical operation. The analysis was performed using SPSS 24 software and the level of statistical significance was p<0.05. The estimation was based on linear analysis, estimating annual percentage changes (APC) and their 95% confidence intervals. The Prais-Winsten autoregression method was used. Ethical considerations followed the provision of Law No. 20.585. Results: A 2% interannual growth rate was observed (APC= 0.00007; CI: 95% = 0.000069-0.000073). In the years 2005, 2008, 2009 and 2011 there was an increase in the percentage change of 2 to 5 points. Conclusion: The analyzed indicator corresponds to an event that has shown a significant and increasing trend in Chile since 2001, which seems paradoxical, since hospital processes management, associated with the health care reform, should show an improvement regarding this type of trend indicator.

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Objetivo: Analisar a tendência do indicador "Infecção do trato urinário associada à instalação de cateter urinário permanente" no Chile. Material e Método: Estudo ecológico, e de series temporais realizado no sistema de saúde chileno, correspondente a um total de 15 regiões administrativas, de 2001 a 2017 (27.087.087 casos). Os dados incluíram informações sobre pacientes cuja alta hospitalar foi infecção do trato urinário associada ao uso do cateter urinário permanente, de acordo com a Classificação Internacional de Doenças (CID-10). A análise descritiva e correlacional (X2 e teste t de Student, respectivamente) foi realizada segundo sexo, tipo de seguro de saúde, condição de alta hospitalar e operação cirúrgica. A estimativa foi baseada na análise linear, estimando as mudanças percentuais anuais (APC) e seus intervalos de confiança de 95%. Foi utilizado o método Prais-Winsten de auto-regressão. As considerações éticas seguiram o disposto na Lei No. 20.585. Resultados: Foi observada uma taxa de crescimento interanual de 2% (APC= 0,00007; IC:95%=0,000069-0,000073). Nos anos 2005, 2008, 2009 e 2011 houve um aumento na variação percentual de 2 a 5 pontos. Conclusão: O indicador analizado corresponde a um evento que tem mostrado uma tendência significativa e ascendente no Chile desde 2001, o que parece paradoxal, dado que a organização dos processos hospitalares associados à reforma do sistema de saúde deveria mostrar uma melhoria no comportamento deste tipo de indicador.

RESUMEN

Introduction: The prevalence of sexually transmitted infections (STI) among indigenous communities is an appalling issue related to Brazilian public health, as there is an increasing underreporting and neglect related to the study and care of these people. Objective: To determine the prevalence of STI in the indigenous population of the Alto Rio Solimões. Methods: STI diagnostic records from the database of the Indigenous Health Care Information System - SIASI, of the indigenous communities of the Alto Rio Solimões, belonging to the Nova Itália base, in Amazonas, were evaluated during the period from January 2010 to August 2020. Sociodemographic data were also evaluated to determine the profile of the diagnosed indigenous population and the geographical and temporal distribution of cases. Results: The overall prevalence rate of STIs was 3.91% (113 notifications of STI in the population of 2890 indigenous people). The largest number of diagnosed cases was in Nova Itália (60.17%). The ethnic group with the highest number of cases was Tikuna (92.03%). Among the STI studied, gonorrhea / chlamydia had the highest prevalence (68.14%), followed by Hepatitis B (13.27%) and Syphilis (10.61%). Most cases were found among women (71.7%), aged 30­34 years. Conclusion: A higher prevalence of STIs was observed in indigenous women, mainly from the Nova Itália town and the Tikuna ethnic group.

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Introdução: A prevalência das infecções sexualmente transmissíveis (IST) entre comunidades indígenas é um tema consternador relacionado à saúde pública brasileira, pois há crescente subnotificação e negligência relacionada ao estudo e ao cuidado desses povos. Objetivo: Determinar a prevalência de IST na população indígena do Alto Rio Solimões. Métodos: Foram avaliados os registros diagnósticos de IST da base de dados do Sistema de Informação da Atenção à Saúde Indígena (SIASI), das comunidades indígenas do Alto Rio Solimões, pertencentes ao polo-base de Nova Itália, no Amazonas, durante o período de janeiro de 2010 a agosto de 2020. Também foram avaliados dados sociodemográficos para determinação do perfil da população indígena diagnosticada e a distribuição geográfica e temporal dos casos. Resultados: A taxa de prevalência geral de IST foi de 3,91% (113 notificações de IST na população de 2.890 indígenas). O maior número de casos diagnosticados foi em Nova Itália (60,17%). A etnia com maiores números de casos foi a Tikuna (92,03%). Entre as IST estudadas, gonorreia/clamídia tiveram a maior prevalência (68,14%), seguidas por hepatite B (13,27%) e sífilis (10,61%). A maioria dos casos ocorreu entre mulheres (71,7%) e na faixa de 30­34 anos. Conclusão: Observou-se maior prevalência de IST em mulheres indígenas, principalmente do município de Nova Itália e da etnia Tikuna

Asunto(s)

Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades de Transmisión Sexual/epidemiología , Salud de Poblaciones Indígenas , Brasil/epidemiología , Indígenas Sudamericanos , Prevalencia , Sistemas de Información en Salud

RESUMEN

Introducción: Las infecciones urinarias nosocomiales constituyen una complicación frecuente e importante problema de salud debido complicaciones y recidivas frecuentes. Se pretende identificar los microorganismos implicados en las infecciones urinarias nosocomiales, su relación con el uso de sonda y estancia hospitalaria. Materiales y métodos: Estudio descriptivo­retrospectivo. Se revisaron bases de vigilancia epidemiológica restringiendo a infección de vías urinarias de origen hospitalario; se describieron las características generales y se exploraron diferencias entre los tiempos de estancia por microorganismo por Kluskal Wallis para un nivel de significancia del 95%. Resultados: Se encontraron 167 de infección de vías urinarias de origen hospitalario, la mediana de edad fue de 75 años; la mayoría de género femenino (58%), 34,1% asociadas al uso de sonda; 10% fallecieron en la hospitalización, la mayoría provenían de la unidad de cuidados intensivos adultos. El microorganismo más frecuentemente aislado fue Escherichia coli (46,1%); los pacientes aportaron una mediana de estancia de 20 días. Se encontraron diferencias significativas en los tiempos de estancia por microorganismo aislado en infección urinaria asociada a sonda, el microorganismo relacionado con los mayores tiempos de estancia fue Proteus mirabillis; el resto de diferencias no fueron significativas. Conclusiones: El microorganismo más frecuentemente aislado fue Escherichia coli, el Proteus mirabillis se encontró fue el más relacionado con uso sonda y tiempo de estancia, se requieren estudios adicionales para determinar asociaciones entre la estancia hospitalaria y fenotipos de resistencia, los protocolos de tratamiento empírico disponibles a la fecha, concuerdan los microorganismos aislados.

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Introduction: The nosocomial urinary tract infections are a common complication and a major health problem due to complications and frequent recurrences. It aims to identify microorganisms involved in nosocomial urinary infections, their relationship with the use of probe and hospital stay. Materials & methods: A descriptive retrospective study. Surveillance bases restricting urinary tract infections hospital origins were reviewed; general characteristics were described and differences between the lengths of time of stay were screened by microorganism Kluskal Wallis for a significance level of 95%. Results: 167 urinary tract infections were found of hospital origin, the median age was found to be of 75; most females (58%), 34.1% associated with the use of probe; 10% died in the hospital, most came from the adult intensive care unit. The most frequently isolated microorganism was Escherichia coli (46.1%); patients contributed a median stay of 20 days. Significant differences in length of stay by microorganism isolated in catheter-associated urinary tract infection was found, the microorganism related to the greatest length of stay was Proteus mirabilis; the remaining differences were not significant. Conclusions: The most frequently isolated microorganism was Escherichia coli, Proteus mirabilis was found to be related to probe the use and length of stay, additional studies are required to determine associations between hospital stay and resistance phenotypes empirical treatment protocols available to the date, consistent microorganisms isolated.

Asunto(s)

Humanos , Enfermedades Urogenitales Masculinas , Sistema de Transporte , Infecciones

RESUMEN

RESUMEN Se caracterizó la resistencia antimicrobiana de 70 aislados de Escherichia coli obtenidos de pacientes con infección del tracto urinario (ITU) provenientes de ocho hospitales públicos en el Perú. Los perfiles de resistencia fueron identificados mediante el uso del sistema automatizado MicroScan®. Se utilizó una reacción en cadena de la polimerasa convencional para la detección de los genes bla TEM, bla CTX-M, bla SHV y bla PER. El 65,7% (46/70) de los aislados presentó un fenotipo multidrogorresistente y el 55,7% (39/70) fue identificado como productores de betalactamasas de espectro extendido. Se detectaron altos niveles de resistencia para ampicilina (77,1%), ciprofloxacina (74,3%), trimetoprim/sulfametoxazol (62,9%), cefepime (57,1%) y cefuroxima (57,1%). El gen bla TEM fue el más frecuente con un 31,4%, seguido por bla CTX-M (18,6%) y bla SHV (2,9%). Los resultados evidencian altos niveles de resistencia a antimicrobianos de importancia clínica en aislados de E. coli de pacientes con ITU en el Perú.

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ABSTRACT We characterized the antimicrobial resistance of 70 Escherichia coli isolates obtained from patients with a urinary tract infection (UTI) from 8 public hospitals in Peru. Resistance profiles were identified using the automated MicroScan® system. A standard polymerase chain reaction was used for the detection of the bla TEM, bla CTX-M, bla SHV and bla PER genes. The 65.7% (46/70) of the isolates presented a multidrug-resistant phenotype and 55.7% (39/70) were extended-spectrum beta-lactamases producers. High levels of resistance were detected for ampicillin (77,1%), ciprofloxacin (74,3%), trimethoprim/sulfamethoxazole (62,9%), cefepime (57,1%), and cefuroxime (57,1%). The bla TEM gene was the most frequent (31,4%), followed by bla CTX-M (18,6%) and bla SHV (2,9%) genes. These results show high resistance levels to antimicrobials of clinical use in E. coli isolates from hospital UTI patients in Peru.

Asunto(s)

Humanos , Masculino , Perú , Infecciones Urinarias , Reacción en Cadena de la Polimerasa , Farmacorresistencia Bacteriana , Escherichia coli , Hospitales Públicos , Pacientes , Enfermedades Urológicas , Resistencia betalactámica , Escherichia coli Uropatógena

RESUMEN

RESUMEN Se caracterizó la resistencia antimicrobiana de 70 aislados de Escherichia coli obtenidos de pacientes con infección del tracto urinario (ITU) provenientes de ocho hospitales públicos en el Perú. Los perfiles de resistencia fueron identificados mediante el uso del sistema automatizado MicroScan®. Se utilizó una reacción en cadena de la polimerasa convencional para la detección de los genes bla TEM, bla CTX-M, bla SHV y bla PER. El 65,7% (46/70) de los aislados presentó un fenotipo multidrogorresistente y el 55,7% (39/70) fue identificado como productores de betalactamasas de espectro extendido. Se detectaron altos niveles de resistencia para ampicilina (77,1%), ciprofloxacina (74,3%), trimetoprim/sulfametoxazol (62,9%), cefepime (57,1%) y cefuroxima (57,1%). El gen bla TEM fue el más frecuente con un 31,4%, seguido por bla CTX-M (18,6%) y bla SHV (2,9%). Los resultados evidencian altos niveles de resistencia a antimicrobianos de importancia clínica en aislados de E. coli de pacientes con ITU en el Perú.

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ABSTRACT We characterized the antimicrobial resistance of 70 Escherichia coli isolates obtained from patients with a urinary tract infection (UTI) from 8 public hospitals in Peru. Resistance profiles were identified using the automated MicroScan® system. A standard polymerase chain reaction was used for the detection of the bla TEM, bla CTX-M, bla SHV and bla PER genes. The 65.7% (46/70) of the isolates presented a multidrug-resistant phenotype and 55.7% (39/70) were extended-spectrum beta-lactamases producers. High levels of resistance were detected for ampicillin (77,1%), ciprofloxacin (74,3%), trimethoprim/sulfamethoxazole (62,9%), cefepime (57,1%), and cefuroxime (57,1%). The bla TEM gene was the most frequent (31,4%), followed by bla CTX-M (18,6%) and bla SHV (2,9%) genes. These results show high resistance levels to antimicrobials of clinical use in E. coli isolates from hospital UTI patients in Peru.

Asunto(s)

Humanos , Masculino , Femenino , Resistencia betalactámica , Escherichia coli , Hospitales Públicos , Infecciones , Pacientes , Perú , Infecciones Urinarias , Enfermedades Urológicas , beta-Lactamasas , Farmacorresistencia Bacteriana

RESUMEN

INTRODUCTION: The treatment of urinary tract infections has become more challenging due to the increasing frequency of multidrug-resistant Escherichia coli in human populations. OBJECTIVE: To characterize multidrug-resistant E. coli isolates causing community-acquired urinary tract infections in Cumaná, Venezuela, and associate possible risk factors for infection by extended-spectrum beta-lactamases (ESBL)-producing isolates. MATERIALS AND METHODS: We included all the patients with urinary tract infections attending the urology outpatient consultation and emergency unit in the Hospital de Cumaná, Estado Sucre, Venezuela, from January through June, 2014. blaTEM, blaSHV and blaCTX-M genes detection was carried out by PCR. RESULTS: We found a high prevalence of multidrug-resistant E. coli (25.2%) with 20.4% of the isolates producing ESBL. The ESBL-producing isolates showed a high frequency (66.7%) of simultaneous resistance to trimethoprim-sulphamethoxazole, fluoroquinolones and aminoglycosides compared to non-producing isolates (2.4%). Of the resistant isolates, 65.4% carried the blaTEM gene, 34.6% the blaCTX-M and 23.1% the blaSHV. The blaCTX-M genes detected belonged to the CTX-M-1 and CTX-M-2 groups. Plasmid transfer was demonstrated by in vitro conjugation in 17 of the 26 ESBL-producing isolates. All three genes detected were transferred to the transconjugants. Age over 60 years, complicated urinary tract infections and previous use of a catheter predisposed patients to infection by ESBL-producing E. coli. CONCLUSIONS: The high frequency of multidrug-resistant ESBL-producing isolates should alert the regional health authorities to take measures to reduce the risk of outbreaks caused by these types of bacteria in the community.

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Introducción. El tratamiento de las infecciones urinarias constituye un reto creciente por el aumento de Escherichia coli proveniente de la comunidad multirresistente a los medicamentos. Objetivo. Caracterizar aislamientos de E. coli multirresistente causantes de infecciones urinarias adquiridas en la comunidad en Cumaná, Venezuela, y detectar los posibles riesgos de infección por aislamientos productores de betalactamasas de espectro extendido (BLEE). Materiales y métodos. Se incluyeron todos los pacientes atendidos en la consulta externa de urología y en urgencias del Hospital de Cumaná entre enero y junio de 2014 y que evidenciaban infecciones urinarias. La detección de los genes blaTEM, blaSHV y blaCTX-M se hizo mediante la reacción en cadena de la polimerasa (PCR). Resultados. Se encontró una alta prevalencia de E. coli multirresistente a los medicamentos (25,2 %), con 20,4 % de aislamientos productores de BLEE y una gran frecuencia de resistencia simultánea a trimetoprim-sulfametoxazol, fluoroquinolonas y aminoglucósidos (66,7 %) comparados con los no productores (2,4 %). En el 65,4 % de los aislamientos resistentes, se encontró el gen blaTEM; en 34,6 %, el blaCTX-M, y en 23,1 %, el blaSHV. Los genes blaCTX-M detectados pertenecían a los grupos CTX-M-1 y CTX-M-2. Se demostró la transferencia in vitro de plásmidos por conjugación en 17 de los 26 aislamientos productores de BLEE. Los tres tipos de genes detectados se transfirieron a los transconjugantes. La edad mayor de 60 años, las infecciones urinarias con complicaciones y el uso previo de catéter, predispusieron a la infección por cepas de E. coli productoras de BLEE. Conclusiones. La gran frecuencia de aislamientos multirresistentes productores de BLEE debería alertar a las autoridades sanitarias para tomar medidas que reduzcan el riesgo de epidemias causadas por este tipo de bacterias en la comunidad.

Asunto(s)

Farmacorresistencia Bacteriana Múltiple , Infecciones por Escherichia coli/epidemiología , Escherichia coli/efectos de los fármacos , Infecciones Urinarias/microbiología , Adolescente , Adulto , Anciano , Niño , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Prevalencia , Estudios Retrospectivos , Riesgo , Factores de Riesgo , Especificidad por Sustrato , Infecciones Urinarias/epidemiología , Venezuela/epidemiología , Adulto Joven , Resistencia betalactámica , beta-Lactamasas/análisis , beta-Lactamasas/genética

RESUMEN

Staghorn, struvite or coral calculus are the ones that completely or partially occupies the renal pelvis and branches to the renal calices. The presence of renal calculi of any kind in the urinary tracts is related to the appearing of malign tumor in the kidneys, especially in the absence or failed treatment. A male patient, 51 years old, native of Manaus, reports about dysuria and polyuria associated with constant fever episodes and urinary tract infections with improvement by using several antibiotics but returning the symptoms after suspending it. The patient return was in a month and no improvement of the pain in the patient's feeling, with the tomography image tests result showing atrophy in the right kidney, which presents dilatation of the collector system, that it's filled with material with density varying between thick liquid and soft parts (average of 45 UH), in addition to calculus in the pelvis and ureteropelvic junction, suggesting a pattern for xanthogranulomatous pyelonephritis and matching previous history of right staghorn calculus. The association between kidney cancer and staghorn calculus should be consider through the treatment. Patients with renal diseases of severe prognosis in both kidneys must be kept under constant surveillance by the urology and nephrology team, the association of both clinics is essential to a fortunate ending like the case reported.

RESUMEN

Case description of a male patient, 27 years old, native Brazilian, indigenous, deaf, with a significant growth of left testicle, painless, with infiltrations, insidious beginning and two years of evolution because of the difficulty of monitoring this type of population. Presented high serum level of lactate dehydrogenase (LDH), up to 20 times higher than the maximum reference value. Ultrasound of the testis showed a complex mass on the left testicle, not being able to give an estimate of the volume. The patient underwent a partial left scrotectomy, associated to radical left orchiectomy, showing an extended invasive testicular tumor and left inguinal lymphadenopathy. Histopathology was compatible with seminoma, weighting 2.600 g, with secondary implants on lungs, retroperitoneum and inguinal region, classified as Stage IIIC. The patient was referred to chemotherapy. Testicular tumor is approached as rare and this is one of the few of its descriptions with such size.

RESUMEN

Abstract Introduction: The treatment of urinary tract infections has become more challenging due to the increasing frequency of multidrug-resistant Escherichia coli in human populations. Objective: To characterize multidrug-resistant E. coli isolates causing community-acquired urinary tract infections in Cumaná, Venezuela, and associate possible risk factors for infection by extended-spectrum beta-lactamases (ESBL)-producing isolates. Materials and methods: We included all the patients with urinary tract infections attending the urology outpatient consultation and emergency unit in the Hospital de Cumaná, Estado Sucre, Venezuela, from January through June, 2014. blaTEM, blaSHV and blaCTX-M genes detection was carried out by PCR. Results: We found a high prevalence of multidrug-resistant E. coli (25.2%) with 20.4% of the isolates producing ESBL. The ESBL-producing isolates showed a high frequency (66.7%) of simultaneous resistance to trimethoprim-sulphamethoxazole, fluoroquinolones and aminoglycosides compared to non-producing isolates (2.4%). Of the resistant isolates, 65.4% carried the blaTEM gene, 34.6% the blaCTX-M and 23.1% the blaSHV. The blaCTX-M genes detected belonged to the CTX-M-1 and CTX-M-2 groups. Plasmid transfer was demonstrated by in vitro conjugation in 17 of the 26 ESBL-producing isolates. All three genes detected were transferred to the transconjugants. Age over 60 years, complicated urinary tract infections and previous use of a catheter predisposed patients to infection by ESBL-producing E. coli. Conclusions: The high frequency of multidrug-resistant ESBL-producing isolates should alert the regional health authorities to take measures to reduce the risk of outbreaks caused by these types of bacteria in the community.

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Resumen Introducción. El tratamiento de las infecciones urinarias constituye un reto creciente por el aumento de Escherichia coli proveniente de la comunidad multirresistente a los medicamentos. Objetivo. Caracterizar aislamientos de E. coli multirresistente causantes de infecciones urinarias adquiridas en la comunidad en Cumaná, Venezuela, y detectar los posibles riesgos de infección por aislamientos productores de betalactamasas de espectro extendido (BLEE). Materiales y métodos. Se incluyeron todos los pacientes atendidos en la consulta externa de urología y en urgencias del Hospital de Cumaná entre enero y junio de 2014 y que evidenciaban infecciones urinarias. La detección de los genes blaTEM, blaSHV y blaCTX-M se hizo mediante la reacción en cadena de la polimerasa (PCR). Resultados. Se encontró una alta prevalencia de E. coli multirresistente a los medicamentos (25,2 %), con 20,4 % de aislamientos productores de BLEE y una gran frecuencia de resistencia simultánea a trimetoprim-sulfametoxazol, fluoroquinolonas y aminoglucósidos (66,7 %) comparados con los no productores (2,4 %). En el 65,4 % de los aislamientos resistentes, se encontró el gen blaTEM; en 34,6 %, el blaCTX-M, y en 23,1 %, el blaSHV. Los genes blaCTX-M detectados pertenecían a los grupos CTX-M-1 y CTX-M-2. Se demostró la transferencia in vitro de plásmidos por conjugación en 17 de los 26 aislamientos productores de BLEE. Los tres tipos de genes detectados se transfirieron a los transconjugantes. La edad mayor de 60 años, las infecciones urinarias con complicaciones y el uso previo de catéter, predispusieron a la infección por cepas de E. coli productoras de BLEE. Conclusiones. La gran frecuencia de aislamientos multirresistentes productores de BLEE debería alertar a las autoridades sanitarias para tomar medidas que reduzcan el riesgo de epidemias causadas por este tipo de bacterias en la comunidad.

Asunto(s)

Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Infecciones Urinarias/microbiología , Farmacorresistencia Bacteriana Múltiple , Escherichia coli/efectos de los fármacos , Infecciones por Escherichia coli/epidemiología , Pacientes Ambulatorios , Especificidad por Sustrato , Infecciones Urinarias/epidemiología , Venezuela/epidemiología , beta-Lactamasas/análisis , beta-Lactamasas/genética , Riesgo , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/epidemiología , Resistencia betalactámica , Escherichia coli/aislamiento & purificación , Escherichia coli/genética

Asunto(s)

Enfermedades Urológicas/enfermería

RESUMEN

Resumen La infección del tracto urinario (ITU) es una patología frecuente en la infancia y una de las causas más comunes de consulta en el servicio de urgencias pediátricas. Las manifestaciones clínicas pueden ser inespecíficas en los lactantes y niños pequeños; sin embargo, en los niños mayores la sintomatología es más específica, con la aparición de fiebre, dolor en flanco, puño percusión renal positiva y signos de irritación vesical como disuria, polaquiuria, tenesmo e incontinencia. El diagnóstico definitivo confirmatorio se realiza mediante cultivo de orina. El conocimiento sobre los factores de riesgo, junto con ciertas consideraciones de valoración clínica y epidemiologia, son esenciales para encaminar las estrategias preventivas de las infecciones urinarias.

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Abstract Urinary tract infection (UTI) is a frequent pathology during childhood and one of the most common causes of consultation in the pediatric emergency service. Clinical manifestations may be nonspecific in infants and young children; however, in older children, the symptoms are more specific, including fever, flank pain, positive CVA tenderness and signs of bladder infection such as dysuria, frequent urination, vesical tenesmus and incontinence. The definitive confirmatory diagnosis is made by urine culture. Knowledge about risk factors, together with certain considerations of clinical assessment and epidemiology, are essential to guide the preventive strategies of urinary tract infections.

RESUMEN

ABSTRACT Introduction: Nephrogenic adenoma (NA) was first described by Davis in 1949 as a "hamartoma" of the bladder. There are many proposed predisposing factors for NA including chronic inflammation, renal transplantation, and bladder cancer. We examined our experience with NA to determine predisposing factors and determine if there was any increased risk for development of subsequent malignancy. Materials and Methods: All patients with a pathologic diagnosis of bladder NA from 2001-2013 were included. Patient history, clinical factors including possible predisposing factors for NA, and follow-up were reviewed. Results: Among 60 patients, 68% were males with an average age of 61, an average BMI of 28.7, and 60% had a smoking history. In evaluating pro-inflammatory factors, 26.7% underwent either Bacillus Calmette-Guerin or mitomycin C, 30% had recurrent urinary tract infections, and 25% had a history of catheterization. Recurrence of NA after initial resection occurred only in 14.7% of patients who underwent follow-up cystoscopy. A history of concurrent bladder cancer was seen in 41.7% of patients, but there were no cases of de novo bladder cancer diagnosed after NA. Conclusion: To the best of our knowledge, this is the largest series of patients with NA of the bladder. NA occurs in a heterogeneous population of patients, but most often with underlying inflammation. NA occurred concurrent with bladder cancer; however there were no cases of de novo bladder cancer after NA, reassuring that NA is likely a benign reactive condition.

Asunto(s)

Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Adulto Joven , Neoplasias de la Vejiga Urinaria/etiología , Neoplasias de la Vejiga Urinaria/patología , Adenoma/etiología , Adenoma/patología , Biopsia , Vejiga Urinaria/patología , Estudios Retrospectivos , Factores de Riesgo , Medición de Riesgo , Cistoscopía , Diagnóstico Diferencial , Hematuria , Persona de Mediana Edad

RESUMEN

INTRODUCTION: Nephrogenic adenoma (NA) was first described by Davis in 1949 as a "hamartoma" of the bladder. There are many proposed predisposing factors for NA including chronic inflammation, renal transplantation, and bladder cancer. We examined our experience with NA to determine predisposing factors and determine if there was any increased risk for development of subsequent malignancy. MATERIALS AND METHODS: All patients with a pathologic diagnosis of bladder NA from 2001-2013 were included. Patient history, clinical factors including possible predisposing factors for NA, and follow-up were reviewed. RESULTS: Among 60 patients, 68% were males with an average age of 61, an average BMI of 28.7, and 60% had a smoking history. In evaluating pro-inflammatory factors, 26.7% underwent either Bacillus Calmette-Guerin or mitomycin C, 30% had recurrent urinary tract infections, and 25% had a history of catheterization. Recurrence of NA after initial resection occurred only in 14.7% of patients who underwent follow-up cystoscopy. A history of concurrent bladder cancer was seen in 41.7% of patients, but there were no cases of de novo bladder cancer diagnosed after NA. CONCLUSION: To the best of our knowledge, this is the largest series of patients with NA of the bladder. NA occurs in a heterogeneous population of patients, but most often with underlying inflammation. NA occurred concurrent with bladder cancer; however there were no cases of de novo bladder cancer after NA, reassuring that NA is likely a benign reactive condition.

Asunto(s)

Adenoma/etiología , Adenoma/patología , Neoplasias de la Vejiga Urinaria/etiología , Neoplasias de la Vejiga Urinaria/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Niño , Cistoscopía , Diagnóstico Diferencial , Femenino , Hematuria , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Vejiga Urinaria/patología , Adulto Joven

RESUMEN

Summary Introduction: Cryptorchidism is a common and prevalent condition in patients with Down syndrome. Environmental factors, such as smoking, can be associated with malformations during fetal development. The study of the prevalence of cryptorchidism and its association with parental tobacco use in Down syndrome can contribute to alert health care professionals, patients and family members regarding the prevention of the harms caused by cryptorchidism and its possible predisposing factors. Objective: To evaluate the prevalence of cryptorchidism in Down syndrome and its association with maternal and paternal smoking. Method: Forty (40) patients of a public clinic specialized in Down syndrome were evaluated, using a semi-structured questionnaire for evaluation of antecedents and sociodemographic characteristics, as well as physical and complementary examinations. Results: Cryptorchidism was observed in 27.5% of the patients (95CI 15.98-42.96). Of these, 55% (5/9) were the children of mothers who smoked during pregnancy, and 19.35% (6/31) were the children of mothers who did not smoke during pregnancy (OR = 5.26 [95CI 1.06-25.41]; p=0.032). Similarly, paternal smoking was also observed in greater frequency among the parents of cryptorchid patients compared with subjects with descended testis, 63.36% (7/11) and 31.03% (9/29), respectively (OR = 3.89 [95CI 0.91-16.73]; p=0.060). Conclusion: The prevalence of cryptorchidism is high in patients with Down syndrome. We can show a strong association between smoking parents and the occurrence of cryptorchidism, especially when it comes to maternal smoking.

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Resumo Introdução: A criptorquidia é uma condição comum e prevalente em pacientes com síndrome de Down. Fatores ambientais, como o tabagismo, estão associados a malformações fetais. A avaliação da prevalência do criptorquidismo e a associação com tabagismo dos pais na síndrome de Down podem contribuir para alertar os profissionais de saúde e familiares sobre a prevenção dos danos causados pelo criptorquidismo e os possíveis fatores predisponentes. Objetivo: Avaliar a prevalência de criptorquidismo na síndrome de Down e a associação com tabagismo materno e paterno. Método: Quarenta (40) pacientes acompanhados em um centro de referência para atendimento da síndrome de Down foram avaliados por meio de questionário semiestruturado para avaliação de antecedentes parentais e características sociodemográficas, bem como de exames físico e laboratoriais complementares. Resultados: Criptorquidia foi observada em 27,5% dos pacientes (IC95% 15,98-42,96). Nesses pacientes, o criptorquidismo foi encontrado em 55% (5/9) das crianças cujas mães fumavam e em 19,35% (6/31) daquelas cujas mães não fumavam (OR = 5,26 [IC95% 1,06-25,41]; p=0,032). Do mesmo modo, o tabagismo paterno foi observado com maior frequência entre crianças com criptorquidia, 63,36% (7/11) e 31,03% (9/29), respectivamente (OR = 3,89 [IC95% 0,91-16,73]; p=0,060). Conclusão: A prevalência de criptorquidismo é alta em pacientes com síndrome de Down. Podemos mostrar uma forte associação entre hábito tabágico dos pais e ocorrência de criptorquidismo, especialmente no caso de tabagismo materno.

Asunto(s)

Humanos , Masculino , Femenino , Embarazo , Padres , Efectos Tardíos de la Exposición Prenatal , Fumar/efectos adversos , Síndrome de Down , Criptorquidismo/etiología , Factores Socioeconómicos , Prevalencia , Factores de Riesgo , Criptorquidismo/epidemiología

RESUMEN

ABSTRACT Objectives We sought to determine whether disease representation in the Cochrane Database of Systematic Reviews (CDSR) reflects disease burden, measured by the Global Burden of Disease (GBD) Study as disability-adjusted life-years (DALYs). Materials and Methods Two investigators performed independent assessment of ten men’s health and urologic diseases (MHUDs) in CDSR for systematic review and protocol representation, which were compared with percentage of total 2010 DALYs for the ten conditions. Data were analyzed for correlation using Spearman rank analysis. Results Nine of ten MHUDs were represented by at least one CDSR review. There was a poor and statistically insignificant positive correlation between CDSR representation and disease burden (rho = 0.42, p = 0.23). CDSR representation was aligned with disease burden for three conditions, greater than disease burden for one condition, and less than disease burden for six conditions. Conclusions These results yield high-quality estimates to inform future research prioritization for MHUDs. While prioritization processes are complex and multi-faceted, disease burden should be strongly considered. Awareness of research priority setting has the potential to minimize research disparities on a global scale.

Asunto(s)

Humanos , Masculino , Enfermedades Urológicas , Literatura de Revisión como Asunto , Investigación Biomédica/tendencias , Investigación Biomédica/estadística & datos numéricos , Salud del Hombre/tendencias , Salud del Hombre/estadística & datos numéricos , Factores de Tiempo , Neoplasias Urológicas , Estadísticas no Paramétricas , Años de Vida Ajustados por Calidad de Vida , Carga Global de Enfermedades , Infertilidad Masculina

RESUMEN

OBJECTIVES: We sought to determine whether disease representation in the Cochrane Database of Systematic Reviews (CDSR) reflects disease burden, measured by the Global Burden of Disease (GBD) Study as disability-adjusted life-years (DALYs). MATERIALS AND METHODS: Two investigators performed independent assessment of ten men's health and urologic diseases (MHUDs) in CDSR for systematic review and protocol representation, which were compared with percentage of total 2010 DALYs for the ten conditions. Data were analyzed for correlation using Spearman rank analysis. RESULTS: Nine of ten MHUDs were represented by at least one CDSR review. There was a poor and statistically insignificant positive correlation between CDSR representation and disease burden (rho = 0.42, p = 0.23). CDSR representation was aligned with disease burden for three conditions, greater than disease burden for one condition, and less than disease burden for six conditions. CONCLUSIONS: These results yield high-quality estimates to inform future research prioritization for MHUDs. While prioritization processes are complex and multi-faceted, disease burden should be strongly considered. Awareness of research priority setting has the potential to minimize research disparities on a global scale.

Asunto(s)

Investigación Biomédica/estadística & datos numéricos , Investigación Biomédica/tendencias , Salud del Hombre/estadística & datos numéricos , Salud del Hombre/tendencias , Literatura de Revisión como Asunto , Enfermedades Urológicas , Carga Global de Enfermedades , Humanos , Infertilidad Masculina , Masculino , Años de Vida Ajustados por Calidad de Vida , Estadísticas no Paramétricas , Factores de Tiempo , Neoplasias Urológicas