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INTRODUCTION: Clean intermittent catheterization (CIC) is associated with an increased risk of urinary tract infections (UTI), urethral trauma, urethral stenosis, hematuria, and pain. The first catheters were developed of polyvinyl carbon (PVC). Several types of catheters have been developed to reduce these complications, such as those with hydrophilic coating. OBJECTIVE: To conduct a systematic review and meta-analysis to evaluate the effectiveness of hydrophilic coated catheters compared to uncoated catheters on the rate of UTI in patients using CIC. METHODOLOGY: A systematic literature search was performed in OVID, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials (RCTs) or randomized crossover trials comparing UTI and hematuria rates in patients using hydrophilic vs. non-hydrophilic catheters for CIC were identified. The selected trials were evaluated for risk of bias using the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)." The results were expressed as a risk ratio (RR) with a 95% confidence interval (CI), under a random-effects model. Data were analyzed using Review Manager 5.4 software. RESULTS: Nine studies with a total of 525 patients in CIC were analyzed. Overall, the use of hydrophilic catheters had a lower risk of UTIs compared to uncoated catheters (RR = 0.78; 95% CI 0.62-0.97; I2 = 37%). Five of the studies include patients > 18 years, showing a reduction of UTIs with the use of hydrophilic catheters (RR = 0.83; 95% CI 0.74-0.93; I2 = 0%). There was no difference in UTI development when comparing single-use uncoated vs hydrophilic catheters. However, heterogeneity was high (RR = 0.77; 95% CI 0.59-1.00; I2 = 57%). Regarding hematuria risk reduction, we were unable to identify differences between the use of hydrophilic catheters compared to uncoated catheters (RR = 1.02; 95% CI 0.66-1.60). CONCLUSION: We found a risk reduction of UTIs associated with using hydrophilic catheters in adults, with low heterogeneity. Regarding hematuria, significant differences were not proved. We do not find a significant difference in UTI risk reduction in the pediatric population. Urethral trauma presence could not be meta-analyzed due to a lack of information reported.

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PURPOSE: The artificial urinary sphincter (AUS) is one of the most effective surgical treatments for male urinary incontinence regardless of its severity. Current knowledge comes from high-volume centers, but little is known about the performance of this surgery from community practices. This study aims to report contemporary AUS performance in a nationwide observational study in Colombia. METHODS: Male patients who underwent AUS surgery with AMS 800™ between 2000 and 2020 in more than 17 centers and four cities were identified. Pre, intra, and postoperative characteristics were evaluated, mainly addressing patient reported outcomes measurements in the postoperative period. Retrospective and prospective data collection and descriptive analysis were completed. Kaplan-Meier analysis was used to determine AUS survival rate. RESULTS: Out of an initial 667 cases, a total of 215 patients met inclusion and exclusion criteria and were included. Mean age was 67 ± 9.4 years, and mean follow-up was 6.0 ± 4.4 years with maximum range of 14 years. The etiology of urinary incontinence was prostate cancer surgery in 141 (81%) of the cases. The rest of the cases were related to benign prostatic disease or spinal cord injury. It is noteworthy that out of 115 patients, only 59 (51.3%) reported previous formal pelvic floor rehabilitation. Subjective severity of urinary incontinence determined by a visual analog scale showed a decrease in 4.5 points after sphincter implantation. Sphincter removal was required in 50 (23.2%) cases. The main reasons for implant removal were urethral erosion and infection. The sphincter survival rate at 2, 5, 8, 10, and 14 years was 76%, 70%, 60%, 57%, and 17%, respectively. Of the subjects at the last follow-up with the device still in place, 80.7% defined their urinary condition as "does not cause or causes minor discomfort," and 99% would recommend the device to a friend or relative in the same condition. CONCLUSIONS: This series from a community-based practice shows the lack of adherence to clinical practice guidelines and the lack of standardized data collection. In contrast, this study provides real-world data on explantation and revision rates, allows physicians to inform patients and to have clear metrics for a shared decision-making process before the procedure.

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OBJECTIVE: To describe the prevalence of overactive bladder determining patient-reported outcome measures (PROMS) and potential risk factors. METHODS: A cross-sectional population-based study to estimate lower urinary tract symptoms (LUTS) prevalence in the Colombian population was performed (COBaLT study). Overactive bladder (OAB) was assessed using 2002 International Continence Society definitions and the Report on the Terminology for Female Pelvic Floor Dysfunction. PROMS were included to evaluate participant's perceptions of health-related quality of life (QoL). Spanish validated questionnaires were used, including the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and Patient Perception of Bladder Condition (PPBC) scale. RESULTS: A total of 1060 individuals were assessed. The mean age of participants was 42.2 years, and most participants were Hispanic (93.15%). The overall prevalence of OAB syndrome was 31.70%, and it was more frequently reported in women than in men (39.25% vs. 24.15%). Most participants with OAB did not perceive their symptoms as bothersome. The most bothersome symptom, associated with moderate/severe impact in QoL was urinary urgency. According to the PPBC questionnaire 75.6% of the participants reported that their bladder condition does not cause any problem, while 11.% reported moderate to severe bother. The multivariable model showed high blood pressure and anxiety were associated with OAB in men. In females, depression, obstructive sleep apnea, IBS, and pelvic organ prolapse were associated with OAB syndrome. CONCLUSIONS: Using the symptomatic definition of OAB can overestimate the real impact and burden of the condition, and treatment should be targeted to those symptomatic patients with QoL impairment as they would benefit from further management. The questionnaires seem to overestimate the condition, since we assessed it from a PROMS perspective there is not such a marked QoL impact.

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AIM: To determine the prevalence of nocturia and associated risk factors in the Colombian population aged ≥18 years old. METHODS: This is a cross-sectional population-based study conducted in 1060 participants in Colombia. Nocturia was assessed with the Spanish version of the ICIQ-OAB, using the ICS terminology. Descriptive statistics were used to evaluate nocturia prevalence. Logistic regression analysis was carried out to determine the association of nocturia with predefined variables. RESULTS: The prevalence of nocturia was 55.9% and it was more common in women than men (53.96% vs. 46.04%; p = .004). At least three episodes of nocturia were observed in 20.37% of the participants who had a severe alteration in their quality of life (p < .01). The bivariate model showed an association between nocturia and obesity (odds ratio [OR], 1.69; 90% confidence interval [CI]: 1.22-2.34), diabetes mellitus (OR, 2.99; 90% CI: 1.86-4.83), high blood pressure (OR, 2.04; 90% CI: 1.52-2.72), cardiovascular disease (OR, 1.75; 90% CI: 1.08 - 2.83), depression (OR, 1.89; 90% CI: 1.23-2.89), obstructive sleep apnea (OR, 1.70; 90% CI: 1.17 - 2.46), and childhood enuresis (OR, 1.45; 90% CI: 1.04-2.02). The multivariate model showed an association with obesity (OR, 2.0; 95% CI: 1.14 - 3.51) in women, as well as age ≥ 65 years (OR, 3.18; 95% CI: 1.26 - 8.02) and erectile dysfunction (OR, 3.44; 95% CI: 1.21 - 9.72) in men. Childhood enuresis was significantly associated with nocturia in both genders (OR, 1.61; 95% CI: 1.09 - 2.40 in women and OR, 1.66; 95% CI: 1.09-2.52 in men). CONCLUSION: There is a significant prevalence of nocturia in our population and a clear association with impaired quality of life. We consider important to inquire about history of childhood enuresis to define the risk of presenting nocturia in adulthood. Nocturia was associated with multiple comorbidities. Obesity and erectile dysfunction play an important role as modifiable risk factor.

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La infección de vías urinarias (IVU) es una patología común, que afecta a gran parte de la población y que generalmente se resuelve con manejo antibiótico. Se compone de una amplia variedad de entidades clínicas que pueden variar desde una cistitis no complicada hasta un shock séptico de origen urinario. Los patógenos etiológicos de la IVU no complicada están ampliamente establecidos y se han mantenido de forma consistente a lo largo del tiempo, siendo la Escherichia coli el microorganismo más predominante. En la actualidad, la resistencia bacteriana a los antibióticos es de gran preocupación y por esa razón, se busca optimizar la terapia antimicrobiana con el fin de disminuir la estancia hospitalaria, la severidad clínica de la infección y los costos a los sistemas de salud. La presente revisión, tiene como objetivo servir como guía para la correcta definición, clasificación, diagnóstico, tratamiento y prevención de la IVU no complicada.

A urinary tract infection (UTI) is a common pathology, that affects a large part of the population and generally resolves with antibiotic treatment. It embraces a variety of clinical entities that can vary from uncomplicated cystitis to septic shock. The etiological pathogens of uncomplicated UTI are widely established and have been consistent over time, with Escherichia coli being the most predominant microorganism. Currently, bacterial resistance to antibiotics is of great concern and for this reason we seek to optimize antimicrobial therapy in order to decrease hospital stay, clinical severity of the infection and costs to the health systems. The purpose of this review is to serve as a guide for the correct definition, classification, diagnosis, treatment and prevention of uncomplicated UTI.

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Q-tip test offers a simple approach for identifying urethral hypermobility. Considering surgical treatment, stress urinary incontinence (SUI) must be classified and the contribution of intrinsic sphincter deficiency (ISD) and/or urethral hypermobility must be determine. We believe there's a correlation between abdominal leak point pressure (ALPP) and urethral mobility degree, and the aim of this study is to explore it using Q-tip. We conducted a prospective study, between years 2014 and 2016. Females over 18 years presenting with signs and symptoms of SUI according to the 2002 ICS Standardization of Terminology were included. Assessment was made with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Q-tip test and invasive urodynamics. Urethral mobility (UM) and ALPP were analyzed. We built two composite variables based on reported risk factors for ISD, defined as composite variable A (equal to a Q-tip test < 30° AND ICIQ-SF ≥ 10 points) and composite variable B (equal to low urethral mobility AND/OR hypoestrogenism AND/OR history of radiotherapy AND/OR previous pelvic surgery). Correlation analyzes were made according to the type of variable. A total of 221 patients were included. Incontinence was rated as moderate and severe by 65.3% and 6.8%, respectively. The analysis showed a 61.75%, 51.61% and 70.6% agreement between ALPP and UM, ALPP and composite variable A and ALPP and composite variable B respectively. Correlation and concordances were low (r = 0.155, r_s = - 0.053 and r_s = - 0.008), (rho_c = 0.036, k = 0.116 and k = 0.016). Neither the degree of UM, nor the composite variables, correlate or agree with urethral function tests in UDS, suggesting that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI.

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PURPOSE: Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. MATERIALS AND METHODS: A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. RESULTS: A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m2 ) and nonobese (<30 kg/m2 ). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. CONCLUSIONS: This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.

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AIMS: Photovaporization of the prostate (PVP) with GreenLight Laser is a surgical treatment for lower urinary tract symptoms. It is considered safe in elderly patients with comorbidities, however, the evidence is inconclusive. The objective of this study is to evaluate the efficacy and safety outcomes of PVP according to the American Society of Anesthesiologists Physical Status (ASAPS). METHODS: A cohort of 675 patients who underwent PVP between 2012 and 2018 was evaluated. Patients were classified according to their ASAPS as low (I and II) and high risk (III and IV). Surgical characteristics and improvement of symptoms and Quality of Life (QoL) were evaluated. RESULTS: The median age of high-risk group was higher than low-risk group. The high-risk group had more history of anticoagulation, antiaggregation, urinary catheterization, urinary retention and urethral stricture. Longer times of hospitalization (23.7 [interquartile range {IQR} = 18.9-41.35] vs 21.8 hours [IQR = 18.7-26.6], P = .008) and catheterization (19.55 [IQR = 15.6-35.57] vs 17.67 hours [IQR = 14.76-22.5], P = .004) were found in the high-risk group. Conversion and bleeding control were not different between groups. In the follow-up, improvement of International Prostate Symptoms Score (IPSS) and QoL was significant in all patients when compared before and after surgery scores (P < .001). There were no difference between groups for QoL, however, IPSS was lower for the low-risk group (8 [IQR = 4-14.5] vs 5 [2-12], P = .001). CONCLUSION: PVP with GreenLight Laser is a safe and efficient procedure for all patients despite their comorbidities, with comparable middle-term outcomes which makes it a standard treatment for the entire aging population, improving their QoL.

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