RESUMO
ABSTRACT Objectives To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. Materials and Methods A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. Results Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). Conclusions COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.
Assuntos
Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Doenças Urológicas/terapia , Urologia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Carga de Trabalho , Infecções por Coronavirus , Pandemias , Urologistas/psicologia , Betacoronavirus , Estilo de Vida , Qualidade de Vida , Doenças Urológicas/complicações , Doenças Urológicas/epidemiologia , Padrões de Prática Médica/tendências , Brasil , Inquéritos e Questionários , Telemedicina , Urologistas/estatística & dados numéricos , SARS-CoV-2 , COVID-19RESUMO
OBJECTIVE: to assess the quality of life and body image of men with difficulty urinating and indwelling urinary catheter users, integrating the socio-demographic, economic and morbidity variables. METHOD: a cross-sectional analytical study with 64 male patients with urinary problems. Three questionnaires were used for data collection: one containing sociodemographic, economic and morbid data, the Medical Outcome Study 36-item short-form health survey to analyze quality of life, and the Body Dysmorphic Examination, which assesses body image. T-test, Mann-Whitney, Pearson, Spearman, Linear Regression and Stepwise were used. RESULTS: quality of life and body image were compromised in both groups, affecting emotional aspects, with a high degree of body dissatisfaction and altered physical and social adversity. CONCLUSION: changes in patients' quality of life and body image were observed, confirming the need for improvement in care.
Assuntos
Imagem Corporal/psicologia , Qualidade de Vida/psicologia , Doenças Urológicas/complicações , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários , Doenças Urológicas/psicologiaRESUMO
ABSTRACT Although urological diseases are not directly related to coronavirus disease 2019 (COVID-19), urologists need to make comprehensive plans for this disease. Urological conditions such as benign prostatic hyperplasia and tumors are very common in elderly patients. This group of patients is often accompanied by underlying comorbidities or immune dysfunction. They are at higher risk of COVID-19 infection and they tend to have severe manifestations. Although fever can occur along with urological infections, it is actually one of the commonest symptoms of COVID-19; urologists must always maintain a high index of suspicion in their clinical practices. As a urological surgeon, how we can protect medical staff during surgery is a major concern. Our hospital had early adoption of a series of strict protective and control measures, and was able to avoid cross-infection and outbreak of COVID-19. This paper discusses the effective measures that can be useful when dealing with urological patients with COVID-19.
Assuntos
Humanos , Masculino , Idoso , Pneumonia Viral/epidemiologia , Doenças Urológicas/complicações , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/prevenção & controle , Doenças Urológicas/diagnóstico , Doenças Urológicas/terapia , China , Infecções por Coronavirus/prevenção & controle , Betacoronavirus , SARS-CoV-2 , COVID-19 , COVID-19/prevenção & controleRESUMO
Although urological diseases are not directly related to coronavirus disease 2019 (COVID-19), urologists need to make comprehensive plans for this disease. Urological conditions such as benign prostatic hyperplasia and tumors are very common in elderly patients. This group of patients is often accompanied by underlying comorbidities or immune dysfunction. They are at higher risk of COVID-19 infection and they tend to have severe manifestations. Although fever can occur along with urological infections, it is actually one of the commonest symptoms of COVID-19; urologists must always maintain a high index of suspicion in their clinical practices. As a urological surgeon, how we can protect medical staff during surgery is a major concern. Our hospital had early adoption of a series of strict protective and control measures, and was able to avoid cross-infection and outbreak of COVID-19. This paper discusses the effective measures that can be useful when dealing with urological patients with COVID-19.
Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Doenças Urológicas/complicações , Idoso , Betacoronavirus , COVID-19 , China , Infecções por Coronavirus/prevenção & controle , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , SARS-CoV-2 , Doenças Urológicas/diagnóstico , Doenças Urológicas/terapiaRESUMO
OBJECTIVES: To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. MATERIALS AND METHODS: A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. RESULTS: Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). CONCLUSIONS: COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.
Assuntos
Betacoronavirus , Infecções por Coronavirus , Estilo de Vida , Pandemias , Pneumonia Viral , Padrões de Prática Médica/estatística & dados numéricos , Doenças Urológicas/terapia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologistas/psicologia , Urologia/estatística & dados numéricos , Carga de Trabalho , Brasil , COVID-19 , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/tendências , Qualidade de Vida , SARS-CoV-2 , Inquéritos e Questionários , Telemedicina , Doenças Urológicas/complicações , Doenças Urológicas/epidemiologia , Urologistas/estatística & dados numéricosRESUMO
Introducción: La hipercalciuria idiopática es una alteración metabólica relativamente frecuente y existen escasas publicaciones de su relación con la infección del tracto urinario. Objetivos: Precisar si existe asociación entre la infección urinaria e hipercalciuria idiopática para determinar si esta alteración metabólica constituye un factor de riesgo de infección urinaria. Métodos: Estudio descriptivo longitudinal prospectivo en pacientes de edad pediátrica con diagnóstico de infección urinaria atendidos en el Hospital Pediátrico Universitario William Soler entre 1ro. enero de 2016 y 31 de diciembre de 2017. Dos semanas después de controlada la infección se recogió muestra de orina de la primera micción del día para determinación de índice calcio/creatinina y precisar la excreción de calcio en 24 horas. Si esta prueba arroja resultados positivos, entre dos y cuatro semanas posteriores, se repite la muestra y si ambas son positivas y el calcio en sangre es normal se diagnostica hipercalciuria idiopática. Resultados: Se incluyeron en el estudio 130 pacientes. En 43,8 por ciento se encontró hipercalciuria idiopática. En su primer episodio infeccioso se estudiaron 52,3 por ciento y los restantes con antecedentes de infección o recurrencia. En 86,2 por ciento la infección fue catalogada como pielonefrítica. La distribución por sexo de la hipercalciuria no mostró diferencia y el síntoma hematuria con dolor abdominal recurrente resultó sugestivo de infección asociada a hipercalciuria (p < 0,05). El germen infectante no contribuye a pensar en hipercalciuria. Conclusión: La hipercalciuria idiopática constituye un factor predisponente de infección del tracto urinario(AU)
Introduction: Idiopathic hypercalciuria is a relatively frequent metabolic alteration and there are scarce publications on its relation with the urinary tract´s infection. Objective: To specify if there is a relation between urinary infection and idiopathic hypercalciuria, in order to determine if this last one constitutes a risk factor of urinary infection. Methods: Prospective, descriptive and longitudinal study in pediatric age's patients with a diagnosis of urinary infection that were attended in William Soler University Pediatric Hospital from January 1st, 2016 to December 31st, 2017. After two weeks of the infection being controlled, a urine sample from the first micturition of the day was collected to determine calcium/creatinine index and to specify calcium excretion in 24 hours. If this test shows positive results, after two to four weeks the sample is repeated, and if both are positive and calcium level in blood is normal, so idiopathic hypercalciuria is diagnosed. Results: 130 patients were included in the study. In 43.8 percent idiopathic hypercalciuria was found. 52.3 percent were studied during the first infectious episode, and there is presented a history of infection or recurrence. In 86.2 percent of the patients, the infection was catalogued as pyelonephritis. Hypercalciuria´s gender distribution didn't show any differences, and the symptom called hematuria with recurrent abdominal pain was suggestive to an infection related to hypercalciuria (p < 0.05). The infectious germ does not induce to think in hypercalciuria. Conclusions: Idiopathic hypercalciuria constitutes a predisposing factor of urinary tract's infection(AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Doenças Urológicas/complicações , Hipercalciúria/complicações , Epidemiologia Descritiva , Estudos Prospectivos , Estudos LongitudinaisRESUMO
BACKGROUND: Diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. Use of renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and prevention or minimization of definitive renal damage. METHODS: This longitudinal, prospective study analyzed the first-year profile of two serum renal biomarkers: creatinine (sCr) and cystatin C (sCyC); and six urinary renal biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-ß1), retinol-binding protein (RBP), cystatin C (uCyC), and microalbuminuria (µALB) in a cohort of 37 infants with UTO divided into three subgroups: 14/37 with unilateral hydro(uretero)nephrosis, 13/37 with bilateral hydro(uretero)nephrosis, and 10/37 patients with lower urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. RESULTS: All urine biomarkers showed significantly higher values at the first month of life (p ≤ 0.009), while NGAL (p = 0.005), TGF-ß1 (p < 0.001), and µALB (p < 0.001) were high since birth compared to controls. Best single biomarker performances were RBP in bilateral hydronephrosis and LUTO subgroups and KIM-1 in unilateral hydronephrosis subgroup. Best biomarker combination results for all subgroups were obtained by matching RBP with TGF-ß1 or KIM-1 and NGAL with CyC ([AUC] ≤ 0.934; sensitivity ≤ 92.4%; specificity ≤ 92.8%). CONCLUSIONS: RBP, NGAL, KIM-1, TGF-ß1, and CyC, alone and especially in combination, are relatively efficient in identifying surgically amenable congenital UTO and could be of practical use in indicating on-time surgery.
Assuntos
Biomarcadores/sangue , Insuficiência Renal/sangue , Insuficiência Renal/etiologia , Doenças Urológicas/congênito , Doenças Urológicas/complicações , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Insuficiência Renal/diagnósticoRESUMO
BACKGROUND: Posterior urethral valves (PUVs) constitute the most common infravesical urinary obstruction in boys and are often accompanied by severe consequences to the lower and upper urinary tract. Currently, about two-thirds of diagnosis of PUVs has been suspected by prenatal ultrasonography findings. The aim of this study was to compare long-term clinical outcomes in two groups of patients with PUVs, with antenatal vs. postnatal diagnosis. STUDY DESIGN: This was a retrospective cohort study of 173 patients with PUVs systematically followed up in a tertiary center. Median follow-up time was 66.5 months (interquartile range [IQ], 11.4-147.9 months) for those patients who survived neonatal period. Seventy-nine (45.6%) patients were followed up for more than 5 years and 55 (32%) for more than 10 years. For analysis, the cohort was stratified into two groups according to the clinical presentation (prenatal vs. postnatal). The events of interest were urinary tract infection (UTI), surgical interventions, proteinuria, hypertension, chronic kidney disease (CKD), and death. Survival analyses were performed to evaluate time until occurrence of the events. RESULTS: Sixty-two patients (35.8%) were diagnosed by fetal sonography. Patients of postnatal group presented a higher incidence rate of UTI episodes (6.5, 95% confidence interval [CI], 4.9-8.3) than antenatal group (1.2, 95% CI, 0.4-2.7) (P < 0.001). Thirty-six patients (21%) presented hypertension, and 77 (44.5%) had persistent mild proteinuria. There was no significant difference in the estimated incidence of hypertension (P = 0.28) and proteinuria (P = 0.78) between antenatal and postnatal groups. The cumulative incidence of CKD stage ≥3 was estimated to be about 37% at 10 years of age, and 56% at 18 years of age. By survival analysis, there was no significant difference in the estimated incidence of CKD stage ≥3 (log-rank = 0.32, P = 0.57) and CKD stage 5 (log-rank = 1.08, P = 0.28, Figure) between antenatal and postnatal groups. Of 173 patients included in the analysis, 13 (7.5%) died during follow-up with a median age of 2.6 months (IQ, 15 days-62 months). Survival analyses have not shown any significant difference in the estimated incidence of death between antenatal and postnatal groups (log-rank = 1.38, P = 0.24). CONCLUSION: The study findings did not corroborate the initial hypothesis that the rates of renal function declining in patients with PUVs would be attenuated by an early diagnosis and intervention after antenatal diagnosis.