Background: Penile necrosis is a rare condition that may present in patients with diabetes mellitus or chronic kidney disease (CKD). The recommended treatment is controversial. We report a case of penile necrosis in a diabetic patient caused by episode of paraphimosis associated with uremic arteriopathy treated with partial amputation. Clinical Case: A 53-year-old male with a background of arterial hypertension, diabetes mellitus and CKD in hemodialysis. The patient presented with paraphimosis and glans necrosis. An emergency circumcision was carried out. A doppler ultrasound found fluid collection in the left corpus cavernosum, parietal vascular calcifications and vascular insufficiency in the corpus cavernosum that suggested necrosis. A partial amputation of the penis was carried out. After three years of follow-up, the outcome has remained favorable. Conclusions: Penile necrosis is a rare but serious complication of terminal CKD. In these patients, systemic calciphylaxis is usually observed. The main take-away lesson is that a multidisciplinary approach is necessary.

Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50–60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important and management guidelines have been published worldwide to assist physicians in selecting the right antibiotic for each patient, taking into account the maternal and fetal safety profile. A review of the literature was carried out and all international guidelines giving recommendations about antibiotic treatments for pregnancy-related UTI were selected. The search came back with 13 guidelines from 4 different continents (8 from Europe, 3 from South America, 1 from North America and 1 from Oceania). Our review demonstrated concordance between guidelines with regard to several aspects in the antibiotic treatment of UTI during pregnancy and in the follow-up after treatment. Nonetheless, there are some areas of discordance, as in the case of antenatal screening for bacteriuria and the use of fluoroquinolones in lower or upper UTI. Given the current evidence that we have from international guidelines, they all agree on several key points about antibiotic use.

RESUMENIntroducción: El mapeo microbiológico es una herramienta y pilar para un buen manejo de antibióticos. Guía los tratamientos empíricos en los servicios hospitalarios así como en la actualización de protocolos de atención. Objetivos: Determinar la situación actual del mapeo microbiológico de uro cultivos en un hospital referencial. Métodos: Se realizó un estudio descriptivo trasversal de uro cultivos de los diferentes servicios del hospital desde el primer semestre del 2013 al 2015. La situación fue definida como la determinación de patógenos más frecuentes y porcentaje de resistencia por Betalactamasa de espectro extendido (BLEE) durante 3 años consecutivos más el perfil microbiológico del Servicio de Urología de la institución. Los datos fueron recolectados y agregados a una base de datos codificada en doble back up. Resultados: Los patógenos aislados con mayor frecuencia fueron E. coli (56,60%), K. pneumoniae (10,12%) y P. mirabilis (4,22%). La frecuencia de E. coli productoras BLEE (+) en los años 2013, 2014, 2015 fue de 37,49%; 47,02% y 50,10% respectivamente. La sensibilidad de E. coli fue para ertapenem, meropenem y imipenem (99%-100%), tigecilina (99%) y el porcentaje de resistencia de E. coli a Ciprofloxacino fue 67%,72% y 82% respectivamente. Conclusión: El agente aislado con mayor frecuencia fue E. coli. La frecuencia de E. coli productoras de BLEE ha sufrido un incremento del 33 % (2013) al 50% para el año 2015 añadiéndose el aumento de la resistencia a ciprofloxacino. Sin embargo, existe una alternativa terapéutica (cefotaxima/ac. clavulánico) cuya sensibilidad es mayor al 90%.Palabras clave: Análisis microbiológico; Escherichia coli, terapia antibiotica. (fuente: DeCS BIREME) ABSTRACTIntroduction: Microbiological mapping is a tool and base for good antibiotic management. It guides the empirical treatments in the hospital services as well as in the updating of care protocols. Objective: To determine the situation of the microbiological mapping of urine cultures in referential hospital. Methods: A cross-sectional descriptive study of urine cultures of the different hospital services from the first semester of 2013 to 2015 was carried out. The situation was defined as the determination of the microbiological profile and the most frequent pathogens isolated. The percentage of resistance by extended-spectrum beta-lactamase (ESBL) for 3 consecutive years was determined. The data were collected and added to a database coded in double back up. Results: The most frequently isolated pathogens were E. coli (56.60%), K. pneumoniae (10.12%) and P. mirabilis (4.22%). The frequency of E. coli ESBL (+) in the years 2013, 2014, 2015 was 37.49%; 47.02% and 50.10% respectively. The sensitivity of E. coli was for ertapenem, meropenem and imipenem (99% -100%), tigecillin (99%) and the percentage of resistance of E. coli to Ciprofloxacin: 67%, 72% and 82% respectively. Conclusion: The most frequently isolated agent was E. coli. The frequency of E. coli ESBL (+) has increased by 33% (2013) to 50% by 2015, with an in...

Urinary incontinence post-radical prostatectomy is a common complication that might negatively impact patients’ quality of life. Treatments include medical and surgical options, being the insertion of an artificial urethral sphincter (AUS) the gold standard. The aim of this narrative review is to evaluate the outcomes of artificial urinary sphincter implantation for urinary incontinence developed post-radical prostatectomy with and without radiation, in terms of urinary continence and complications. The MEDLINE and Scopus search returned 477 articles. A total of eleven articles were included for qualitative analysis. A total of 707 men that met the inclusion criteria were included. The 22.6% of the men (160 patients) received pelvic external beam radiotherapy prior to the implantation of the artificial urinary sphincter. The overall continence success rate was defined by the use of pads. Some authors reported a success rate of 0 pads per day (PPD) or ≤ 1 PPD in the last follow-up. The complications included urethral atrophy, mechanical failure, revision and/or removal of the device, infection and erosion. Further prospective studies should be done to clarify continence concepts after the placement of an AUS and long-term complications.