Bacterial characteristics and clinical significance of ureteral double-J stents in children | Actas Urológicas Españolas (English Edition)

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García-Aparicio, E. Blázquez-Gómez, O. Martin, L. Krauel, I. de Haro, J. Rodó" "autores" => array:6 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "García-Aparicio" "email" => array:1 [ 0 => "lgarcia@hsjdbcn.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Blázquez-Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "Martin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Krauel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "I." "apellidos" => "de Haro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Rodó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Pediátrica, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características bacterianas y significado clínico de catéteres ureterales doble J en niños" ] ] "textoCompleto" => "IntroductionThe double-J ureteral stent is a useful urological device enabling internal diversion after urological procedures. In pediatric urology, double-J stents are used after pyeloplasty, ureteral reimplantation and some endourological procedures such as stone treatment. Ureteral stents allow the passage of urine from the renal pelvis to the bladder and make it possible to maintain the diameter of ureteral anastomosis.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> More recently, double-J stents are being used in the treatment of primary obstructive megaureter as adjuvant therapy after high-pressure balloon dilation of the ureterovesical junction.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Morbidity associated with double-J stents has been reported: lower abdominal pain, dysuria, fever, hematuria, migration, fragmentation, calcification and urinary tract infection (UTI).<a class="elsevierStyleCrossRef" href="#bib0015">3</a> It is well-known that any kind of catheter is an ideal surface for bacterial colonization and plays a major role in the pathogenesis of stent infection.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> However, there are very few reports available in pediatric urology showing the incidence of bacterial colonization and UTI associated with double-J ureteral stents.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>The aim of this study was to determine the incidence of urinary tract infection in those patients where double-J ureteral stents were used for internal diversion after urological procedures.Materials and MethodsWe reviewed all medical records of those patients who had a double-J ureteral stent after a urological procedure from August 2007 to May 2013. We analyzed the following data: age, gender, surgical intervention, previous history of UTI, type of antibiotic prophylaxis, days of internal diversion, incidence of urinary tract infection, bacterial characteristics of urine and double-J stent, bacterial sensitivity and UTI treatment.All patients were under antibiotic prophylaxis with amoxicillin during the surgical procedure and until the ureteral stent was removed. All double-J stents were placed and removed under sterile conditions. A bladder catheter was used 48h after the primary procedure; it was not used in the case of ureteral removal.The double-J ureteral stent was analyzed for bacterial colonization; positive cultures were defined as >105cfu/ml of a single pathogen.UTI was defined as fever >38.5°C and a positive urine culture >105cfu/ml obtained after bladder catheterization. UTI was treated with antibiotics, but in some cases the double-J stent was removed within the same time period.Quantitative data were analyzed using Student's t-test or the Mann–Whitney U test, and qualitative data were analyzed using the chi-square test or Fisher's test; a p value<0.05 was considered statistically significant.ResultsBetween August 2007 and May 2013, we used 73 double-J ureteral stents for internal ureteral diversion in 67 patients (47 boys and 24 girls) with a mean age of 44.73±57.23 months. 3 surgical procedures were reported: 50 laparoscopic pyeloplasties (LP) in 49 patients (one repetition), 20 high-pressure balloon dilations (HPBD) of the ureterovesical junction (UVJ) for treating primary obstructive megaureter in 15 (one bilateral and 4 repetitions) and 3 patients with distal ureteral obstruction after endoscopic treatment of vesicoureteral reflux (VUR). Double-J ureteral catheterization was performed at the same time as the primary procedure, in laparoscopic pyeloplasty using an antegrade technique, and in the HPBD group using a retrograde technique. In patients with distal obstruction of the UVJ after endoscopic treatment of VUR, the double-J stent was used when an obstruction was diagnosed.Only 7 patients were previously circumcised with no significant difference among groups. A history of urinary tract infection was observed in 11 patients; the HPBD group had a more significant past history of UTI rates than the pyeloplasty group. There was no history VUR in the pyeloplasty and HPBD groups.A 4.8-Fr stent of polyether-block amide (PEBA) (Vortex-Coloplast®) was used in all patients for 45.34±16.46 days, with no significant differences among groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>50 double-J ureteral stents were used in the LP group, 20 in the HPBD group and 3 in the case of ureteral obstruction after endoscopic correction of VUR. There were no migrations, but mild discomfort was observed in most patients (dysuria when voiding) during JJ catheterization.Double-J stent culture was positive in 43 (58.9%). The most commonly cultured microorganism was Pseudomonas aeruginosa in 9 (20.9%) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). There were no significant differences neither in mean age, gender, surgical procedure, and days of catheterization nor in their previous history of circumcision, UTI or VUR (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Four patients (5.9%) had 5 UTIs; the most commonly cultured microorganism in urine was P. aeruginosa in 4. All patients were treated with antibiotics for 10 days. Double-J removal was brought forward in 3 patients.If we compare those patients who had urinary infection with those who did not have it, there were no significant differences in gender and days of catheterization, their previous history of circumcision, UTI or VUR. The only significant difference was observed in the mean age, which was lower in those patients with UTI. Despite 3 of the 4 patients with UTI had undergone HPBD of the UVJ, there were no significant differences with other procedures (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThe use of double-J ureteral stents is common in pediatric urology, but there are few reports showing infectious complications in children.<a class="elsevierStyleCrossRefs" href="#bib0005">1,5</a> The urinary tract is the most common nosocomial infection and bacteremia secondary to urological procedures has an incidence of around 30% in adults.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Bacterial colonization of double-J stents is well-known in adult urology, but its association with UTI is not clear. Catheter colonization rates of 44–68%<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> have been reported. This high incidence led us to use antibiotic prophylaxis in these patients.Our series showed a bacterial colonization rate of 58.9%, similar to the series of adults and children.<a class="elsevierStyleCrossRefs" href="#bib0005">1,5,8</a> Bacteriological characteristics were reported in the adult series; the most common pathogens that colonized double-J stents were: Enterococcus, E. coli and Pseudomonas.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> In our series, the most common pathogen was Pseudomonas followed by Proteus mirabillis. These findings are similar to other series.Those patients with positive double-J stent cultures had a lower mean age than those with sterile cultures. The incidence of UTI was 5.4% of patients; this rate was lower in the Ben-Mier series.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Only 12 colonized ureteral stents were sensitive to the antibiotic prophylaxis we used (amoxicillin). The most common pathogen in patients with UTI was Pseudomonas. This condition should change prophylaxis guidelines in patients with double-J ureteral catheterization.ConclusionThere are few articles reporting bacterial characteristics in children with double-J stents placed after a urological procedure. Pseudomonas is the most common pathogen that colonized double-J stents and is the most commonly found microorganism in UTI. In our series, the youngest patients showed a higher rate of double-J bacterial colonization.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres413798" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec389462" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres413799" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec389463" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-04-09" "fechaAceptado" => "2014-04-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec389462" "palabras" => array:5 [ 0 => "Urinary tract infection" 1 => "Ureteral stent" 2 => "Children" 3 => "Pyeloplasty" 4 => "Megaureter" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec389463" "palabras" => array:5 [ 0 => "Infección del tracto urinario" 1 => "Catéter ureteral" 2 => "Niños" 3 => "Pieloplastia" 4 => "Megauréter" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo determine the incidence of urinary tract infection in those patients that we have used an ureteral double-J stent as internal diversion after urological procedures. Materials and methodsWe reviewed all the medical records of patients who had a ureteral double-J stent after a urological procedure from August 2007 to May 2013. We have analyzed the following data: age, gender, type of prophylaxis, incidence of urinary tract infection (UTI), days of internal diversion with double-J stent, surgical procedure, bacterial characteristics, bacterial sensibility to antibiotics and UTI treatment. ResultsWe have used 73 double-J stents as ureteral internal diversion in 67 patients with a mean age of 44.73±57.23. Surgical procedures were 50 laparoscopic Anderson-Hynes pyeloplasties in 49 patients, and 20 high-pressure balloon dilatation of the ureterovesical junction to treat primary obstructive megaureter in 15 patients; and 3 patients with ureterovesical obstruction after endoscopic treatment of vesicoureteral reflux. Forty three stents showed a bacterial colonization in cultures. Pseudomonas aeruginosa was present in 9 (20.9%) stents. Only in 12 stents, bacterial colonization was sensible to antibiotic prophylaxis. Stent colonization was higher in boys and younger patients. Four patients had a febrile UTI. Incidence of UTI in younger patients that underwent HBPD of UVJ is higher. ConclusionBacterial colonization is frequent in double-J stents but the incidence of UTI is low. Double-J colonization is higher in younger patients. Patients that underwent HPBD have a higher risk of UTI related with ureteral double-J stent." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivoDeterminar la incidencia de infección del tracto urinario en los pacientes en los que hemos utilizado un catéter ureteral doble J como desvío interno después de procedimientos urológicos. Material y métodosSe revisaron todas las historias clínicas de los pacientes que tenían un catéter ureteral doble J después de un procedimiento urológico desde agosto de 2007 hasta mayo de 2013. Hemos analizado los siguientes datos: edad, sexo, tipo de profilaxis, incidencia de la infección del tracto urinario (ITU), días de desviación interna con catéter doble J, procedimiento quirúrgico, características bacterianas, sensibilidad de las bacterias a los antibióticos y tratamiento de ITU. ResultadosHemos utilizado 73 catéteres doble J como desvío interno ureteral en 67 pacientes con una edad media de 44,73±57,23. Los procedimientos quirúrgicos fueron 50 pieloplastias laparoscópicas Anderson-Hynes en 49 pacientes y 20 dilataciones con balón de alta presión de la unión ureterovesical para tratar megauréter obstructivo primario en 15 pacientes, y 3 pacientes con obstrucción ureterovesical después del tratamiento endoscópico del reflujo vesicoureteral. Cuarenta y tres catéteres mostraron una colonización bacteriana en los cultivos. Pseudomonas aeruginosa estaba presente en 9 (20,9%) catéteres. Solo en 12 catéteres la colonización bacteriana era sensible a la profilaxis antibiótica. La colonización del catéter era mayor en los niños y los pacientes más jóvenes. Cuatro pacientes tuvieron una ITU febril. La incidencia de ITU en los pacientes más jóvenes que se sometieron a DBAP de UUV es mayor. ConclusiónLa colonización bacteriana es frecuente en los catéteres doble J, pero la incidencia de ITU es baja. La colonización doble J es mayor en los pacientes más jóvenes. Los pacientes que se sometieron a DBAP tienen un mayor riesgo de ITU relacionada con el catéter ureteral doble J." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: García-Aparicio L, Blázquez-Gómez E, Martin O, Krauel L, de Haro I, Rodó J. Características bacterianas y significado clínico de catéteres ureterales doble J en niños. Actas Urol Esp. 2015;39:53–56." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LP group (n=49) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HBPD group (n=15) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Others (n=3) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.20±64.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.15±7.4<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.33±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.05<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex (male/female) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32/17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Circumcised/uncircumcised \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7/25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Past history of UTI (yes/no) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/7<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/1<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.05<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">History of VUR (no/yes) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/3<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.05<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Placement of ureteral JJ (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43.4±17.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.35±13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51±21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab644375.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Mann–Whitney U." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Fisher's test." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the patients." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Number of cases \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">P. aeruginosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Proteus mirabillis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E. coli \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Enterococcus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Klebsiella pneumoniae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Serratia marcencens \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Candida albicans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Morganella morgani \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Enterobacter cloacae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Staphylococcus simulans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Staphylococcus aureus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Acitenobacter lwoffii \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Alcaligenes spp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab644378.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Cultured double-J microorganism." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Double-J culture \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Positive culture (n=43) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Negative culture (n=30) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34.23±57.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59.77±62.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p>0.05<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex (male/female) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31/12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18/12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p>0.05<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Surgical procedure (LP/HBPD/others) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27/13/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23/7/0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p>0.05<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Days of double-J catheterization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.83±15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.09±16.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p>0.05<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Circumcised/uncircumcised \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p>0.05<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Past history of UTI (yes/no) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p>0.05<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Past history of VUR (yes/no) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p>0.05<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab644377.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Student's t test." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "Chi square test." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the patients and surgical procedures." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">UTI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No UTI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11±8.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46.68±58.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex (male/female) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41/23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Surgical procedure (LP/HBPD/others) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/3/0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49/17/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Days of double-J catheterization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55±19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44.78±16.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td 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Bacterial characteristics and clinical significance of ureteral double-J stents in children

Características bacterianas y significado clínico de catéteres ureterales doble J en niños

L. García-Aparicioa,

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lgarcia@hsjdbcn.org

Corresponding author.

, E. Blázquez-Gómezb, O. Martina, L. Krauelc, I. de Haroc, J. Rodóa

a Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain

b Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain

c Servicio de Cirugía Pediátrica, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The double-J ureteral stent is a useful urological device enabling internal diversion after urological procedures. In pediatric urology, double-J stents are used after pyeloplasty, ureteral reimplantation and some endourological procedures such as stone treatment. Ureteral stents allow the passage of urine from the renal pelvis to the bladder and make it possible to maintain the diameter of ureteral anastomosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> More recently, double-J stents are being used in the treatment of primary obstructive megaureter as adjuvant therapy after high-pressure balloon dilation of the ureterovesical junction.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Morbidity associated with double-J stents has been reported: lower abdominal pain, dysuria, fever, hematuria, migration, fragmentation, calcification and urinary tract infection (UTI).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is well-known that any kind of catheter is an ideal surface for bacterial colonization and plays a major role in the pathogenesis of stent infection.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However, there are very few reports available in pediatric urology showing the incidence of bacterial colonization and UTI associated with double-J ureteral stents.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to determine the incidence of urinary tract infection in those patients where double-J ureteral stents were used for internal diversion after urological procedures.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We reviewed all medical records of those patients who had a double-J ureteral stent after a urological procedure from August 2007 to May 2013. We analyzed the following data: age, gender, surgical intervention, previous history of UTI, type of antibiotic prophylaxis, days of internal diversion, incidence of urinary tract infection, bacterial characteristics of urine and double-J stent, bacterial sensitivity and UTI treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">All patients were under antibiotic prophylaxis with amoxicillin during the surgical procedure and until the ureteral stent was removed. All double-J stents were placed and removed under sterile conditions. A bladder catheter was used 48<span class="elsevierStyleHsp" style=""></span>h after the primary procedure; it was not used in the case of ureteral removal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The double-J ureteral stent was analyzed for bacterial colonization; positive cultures were defined as &#62;105<span class="elsevierStyleHsp" style=""></span>cfu/ml of a single pathogen.</p><p id="par0035" class="elsevierStylePara elsevierViewall">UTI was defined as fever &#62;38.5<span class="elsevierStyleHsp" style=""></span>&deg;C and a positive urine culture &#62;105<span class="elsevierStyleHsp" style=""></span>cfu/ml obtained after bladder catheterization. UTI was treated with antibiotics, but in some cases the double-J stent was removed within the same time period.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Quantitative data were analyzed using Student&#39;s <span class="elsevierStyleItalic">t</span>-test or the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test, and qualitative data were analyzed using the chi-square test or Fisher&#39;s test; a <span class="elsevierStyleItalic">p</span> value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0.05 was considered statistically significant.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Between August 2007 and May 2013, we used 73 double-J ureteral stents for internal ureteral diversion in 67 patients (47 boys and 24 girls) with a mean age of 44.73<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>57.23 months. 3 surgical procedures were reported: 50 laparoscopic pyeloplasties (LP) in 49 patients (one repetition), 20 high-pressure balloon dilations (HPBD) of the ureterovesical junction (UVJ) for treating primary obstructive megaureter in 15 (one bilateral and 4 repetitions) and 3 patients with distal ureteral obstruction after endoscopic treatment of vesicoureteral reflux (VUR). Double-J ureteral catheterization was performed at the same time as the primary procedure, in laparoscopic pyeloplasty using an antegrade technique, and in the HPBD group using a retrograde technique. In patients with distal obstruction of the UVJ after endoscopic treatment of VUR, the double-J stent was used when an obstruction was diagnosed.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Only 7 patients were previously circumcised with no significant difference among groups. A history of urinary tract infection was observed in 11 patients; the HPBD group had a more significant past history of UTI rates than the pyeloplasty group. There was no history VUR in the pyeloplasty and HPBD groups.</p><p id="par0055" class="elsevierStylePara elsevierViewall">A 4.8-Fr stent of polyether-block amide (PEBA) (Vortex-Coloplast<span class="elsevierStyleSup">&reg;</span>) was used in all patients for 45.34<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>16.46 days, with no significant differences among groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">50 double-J ureteral stents were used in the LP group, 20 in the HPBD group and 3 in the case of ureteral obstruction after endoscopic correction of VUR. There were no migrations, but mild discomfort was observed in most patients (dysuria when voiding) during JJ catheterization.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Double-J stent culture was positive in 43 (58.9%). The most commonly cultured microorganism was <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> in 9 (20.9%) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). There were no significant differences neither in mean age, gender, surgical procedure, and days of catheterization nor in their previous history of circumcision, UTI or VUR (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Four patients (5.9%) had 5 UTIs; the most commonly cultured microorganism in urine was <span class="elsevierStyleItalic">P. aeruginosa</span> in 4. All patients were treated with antibiotics for 10 days. Double-J removal was brought forward in 3 patients.</p><p id="par0075" class="elsevierStylePara elsevierViewall">If we compare those patients who had urinary infection with those who did not have it, there were no significant differences in gender and days of catheterization, their previous history of circumcision, UTI or VUR. The only significant difference was observed in the mean age, which was lower in those patients with UTI. Despite 3 of the 4 patients with UTI had undergone HPBD of the UVJ, there were no significant differences with other procedures (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The use of double-J ureteral stents is common in pediatric urology, but there are few reports showing infectious complications in children.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a> The urinary tract is the most common nosocomial infection and bacteremia secondary to urological procedures has an incidence of around 30% in adults.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Bacterial colonization of double-J stents is well-known in adult urology, but its association with UTI is not clear. Catheter colonization rates of 44&#8211;68%<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> have been reported. This high incidence led us to use antibiotic prophylaxis in these patients.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Our series showed a bacterial colonization rate of 58.9%, similar to the series of adults and children.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,8</span></a> Bacteriological characteristics were reported in the adult series; the most common pathogens that colonized double-J stents were: <span class="elsevierStyleItalic">Enterococcus</span>, <span class="elsevierStyleItalic">E. coli</span> and <span class="elsevierStyleItalic">Pseudomonas</span>.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> In our series, the most common pathogen was <span class="elsevierStyleItalic">Pseudomonas</span> followed by <span class="elsevierStyleItalic">Proteus mirabillis</span>. These findings are similar to other series.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Those patients with positive double-J stent cultures had a lower mean age than those with sterile cultures. The incidence of UTI was 5.4% of patients; this rate was lower in the Ben-Mier series.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Only 12 colonized ureteral stents were sensitive to the antibiotic prophylaxis we used (amoxicillin). The most common pathogen in patients with UTI was <span class="elsevierStyleItalic">Pseudomonas</span>. This condition should change prophylaxis guidelines in patients with double-J ureteral catheterization.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0095" class="elsevierStylePara elsevierViewall">There are few articles reporting bacterial characteristics in children with double-J stents placed after a urological procedure. <span class="elsevierStyleItalic">Pseudomonas</span> is the most common pathogen that colonized double-J stents and is the most commonly found microorganism in UTI. In our series, the youngest patients showed a higher rate of double-J bacterial colonization.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the incidence of urinary tract infection in those patients that we have used an ureteral double-J stent as internal diversion after urological procedures.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We reviewed all the medical records of patients who had a ureteral double-J stent after a urological procedure from August 2007 to May 2013. We have analyzed the following data: age, gender, type of prophylaxis, incidence of urinary tract infection (UTI), days of internal diversion with double-J stent, surgical procedure, bacterial characteristics, bacterial sensibility to antibiotics and UTI treatment.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We have used 73 double-J stents as ureteral internal diversion in 67 patients with a mean age of 44.73<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>57.23. Surgical procedures were 50 laparoscopic Anderson-Hynes pyeloplasties in 49 patients, and 20 high-pressure balloon dilatation of the ureterovesical junction to treat primary obstructive megaureter in 15 patients; and 3 patients with ureterovesical obstruction after endoscopic treatment of vesicoureteral reflux. Forty three stents showed a bacterial colonization in cultures. <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> was present in 9 (20.9%) stents. Only in 12 stents, bacterial colonization was sensible to antibiotic prophylaxis. Stent colonization was higher in boys and younger patients. Four patients had a febrile UTI. Incidence of UTI in younger patients that underwent HBPD of UVJ is higher.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Bacterial colonization is frequent in double-J stents but the incidence of UTI is low. Double-J colonization is higher in younger patients. Patients that underwent HPBD have a higher risk of UTI related with ureteral double-J stent.</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la incidencia de infecci&oacute;n del tracto urinario en los pacientes en los que hemos utilizado un cat&eacute;ter ureteral doble J como desv&iacute;o interno despu&eacute;s de procedimientos urol&oacute;gicos.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y m&eacute;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se revisaron todas las historias cl&iacute;nicas de los pacientes que ten&iacute;an un cat&eacute;ter ureteral doble J despu&eacute;s de un procedimiento urol&oacute;gico desde agosto de 2007 hasta mayo de 2013. Hemos analizado los siguientes datos: edad, sexo, tipo de profilaxis, incidencia de la infecci&oacute;n del tracto urinario (ITU), d&iacute;as de desviaci&oacute;n interna con cat&eacute;ter doble J, procedimiento quir&uacute;rgico, caracter&iacute;sticas bacterianas, sensibilidad de las bacterias a los antibi&oacute;ticos y tratamiento de ITU.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hemos utilizado 73 cat&eacute;teres doble J como desv&iacute;o interno ureteral en 67 pacientes con una edad media de 44,73<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>57,23. Los procedimientos quir&uacute;rgicos fueron 50 pieloplastias laparosc&oacute;picas Anderson-Hynes en 49 pacientes y 20 dilataciones con bal&oacute;n de alta presi&oacute;n de la uni&oacute;n ureterovesical para tratar megaur&eacute;ter obstructivo primario en 15 pacientes, y 3 pacientes con obstrucci&oacute;n ureterovesical despu&eacute;s del tratamiento endosc&oacute;pico del reflujo vesicoureteral. Cuarenta y tres cat&eacute;teres mostraron una colonizaci&oacute;n bacteriana en los cultivos. Pseudomonas aeruginosa estaba presente en 9 (20,9%) cat&eacute;teres. Solo en 12 cat&eacute;teres la colonizaci&oacute;n bacteriana era sensible a la profilaxis antibi&oacute;tica. La colonizaci&oacute;n del cat&eacute;ter era mayor en los ni&ntilde;os y los pacientes m&aacute;s j&oacute;venes. Cuatro pacientes tuvieron una ITU febril. La incidencia de ITU en los pacientes m&aacute;s j&oacute;venes que se sometieron a DBAP de UUV es mayor.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&oacute;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La colonizaci&oacute;n bacteriana es frecuente en los cat&eacute;teres doble J, pero la incidencia de ITU es baja. La colonizaci&oacute;n doble J es mayor en los pacientes m&aacute;s j&oacute;venes. Los pacientes que se sometieron a DBAP tienen un mayor riesgo de ITU relacionada con el cat&eacute;ter ureteral doble J.</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as: Garc&iacute;a-Aparicio L, Bl&aacute;zquez-G&oacute;mez E, Martin O, Krauel L, de Haro I, Rod&oacute; J. Caracter&iacute;sticas bacterianas y significado cl&iacute;nico de cat&eacute;teres ureterales doble J en ni&ntilde;os. Actas Urol Esp. 2015;39:53&#8211;56.</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LP group (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>49)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HBPD group (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Others (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age (months)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58.20<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>64.1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12.15<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>7.4<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37.33<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>2.3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0.05<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sex (male/female)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32/17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10/5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1/2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Circumcised/uncircumcised&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7/25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0/10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0/1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Past history of UTI (yes/no)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1/48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8/7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2/1<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0.05<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">History of VUR (no/yes)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0/49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0/15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3/3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0.05<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Placement of ureteral JJ (days)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43.4<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>17.2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49.35<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>13.5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab644375.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>.</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Fisher&#39;s test.</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients.</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Number of cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P. aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20.1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Proteus mirabillis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">E. coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterococcus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9.3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Serratia marcencens</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9.3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Candida albicans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4.7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Morganella morgani</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4.7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Enterobacter cloacae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4.7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus simulans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2.3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2.3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Acitenobacter lwoffii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2.3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Alcaligenes</span> spp.&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2.3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab644378.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Cultured double-J microorganism.</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Double-J culture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Positive culture (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>43)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Negative culture (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>30)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age (months)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34.23<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>57.21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59.77<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>62.1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0.05<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sex (male/female)&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0.05<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Days of double-J catheterization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42.83<span class="elsevierStyleHsp" style=""></span>&plusmn;<span class="elsevierStyleHsp" style=""></span>15.8&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 21735786
Original language: English

DOI:10.1016/j.acuroe.2014.11.002

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Year/Month	Html	Pdf	Total

2023 March	1	3	4
2018 February	14	0	14
2018 January	14	2	16
2017 December	18	3	21
2017 November	15	1	16
2017 October	24	1	25
2017 September	17	1	18
2017 August	26	1	27
2017 July	25	5	30
2017 June	33	24	57
2017 May	36	8	44
2017 April	13	16	29
2017 March	16	58	74
2017 February	25	7	32
2017 January	17	2	19
2016 November	0	1	1
2016 September	0	3	3
2016 July	0	1	1
2016 June	0	1	1
2016 May	0	3	3
2016 April	0	11	11
2016 March	0	9	9
2016 February	0	8	8
2016 January	0	8	8
2015 December	0	7	7
2015 November	0	7	7
2015 October	0	9	9
2015 September	0	3	3
2015 August	0	2	2
2015 June	0	1	1
2015 April	0	1	1
2015 March	0	1	1
2015 February	0	1	1

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