Urinary tract infections (UTIs) represent a frequent pathology among the female population that has become more and more difficult to treat in the past decade, considering the increase in antibiotic resistance—a serious global public health problem. A cross-sectional retrospective study was conducted for six months to report an update regarding the rates of resistance and susceptibility of uropathogens necessary for optimal treatment. A total of 5487 patients were screened, of which 524 (9.54%) were female patients who met the criteria for inclusion in the study. Escherichia coli was the most common pathogen, representing 290 cases (55.34%), followed by Enterococcus spp. 82 (15.64%). Escherichia coli presented the highest resistance to amoxicillin-clavulanic acid (R = 33.1%), followed by trimethoprim-sulfamethoxazole (R = 32.41%) and levofloxacin (R = 32.06%). The highest sensitivity rates were observed for fosfomycin (S = 96.55%), followed by imipenem (S = 93.1%). Enterococcus spp. showed the highest resistance to levofloxacin (R = 50.0%), followed by penicillin (R = 39.02%). The highest sensitivity was observed for fosfomycin (S = 90.24%), linezolid (S = 89.02%), and nitrofurantoin (S = 86.58%). The second most frequent Gram-negative uropathogen was represented by Klebsiella spp., which had the highest resistance to amoxicillin-clavulanic acid (R = 35.89%), followed by levofloxacin (R = 25.64) and trimethoprim-suflamethoxazole (R = 24.35%). The most frequently associated pathology was an episode of UTI in the previous year, followed by diabetes and chronic kidney disease. Antibiotic resistance is a serious problem for all clinicians who treat UTIs. An up-to-date knowledge of antibiotic resistance rates is a major necessity to stop its evolution. Overall, the highest resistance rates were observed for aminopenicillins, fluoroquinolones, and trimethoprim-sulfamethoxazole. The best susceptibility rates were observed for fosfomycin, nitrofurantoin, and carbapenems. Our report aims to guide clinicians whenever they are forced to prescribe antibiotics empirically.

The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms ”difficult cholecystectomy”, ”bile duct injuries”, ”safe cholecystectomy”, and ”laparoscopy in acute cholecystitis”. The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies.

Urinary Tract Infections (UTIs) represent a common finding among females and an important basis for antibiotic treatment. Considering the significant increase in antibiotic resistance during the last decades, this study retrospectively follows the incidence of uropathogens and the evolution of resistance rates in the short and medium term. The current study was conducted at the “Prof. Dr. Th. Burghele” Clinical Hospital, including 1124 positive urine cultures, in three periods of four months between 2018 and 2022. Escherichia coli was the most frequent uropathogen (54.53%), followed by Klebsiella spp. (16.54%), and Enterococcus spp. (14.59%). The incidence of UTIs among the female population is directly proportional to age, with few exceptions. The highest overall resistance in Gram-negative uropathogens was observed for levofloxacin 30.69%, followed by ceftazidime 13.77% and amikacin 9.86%. The highest resistance in Gram-positive uropathogens was observed for levofloxacin 2018-R = 34.34%, 2020-R = 50.0%, and 2022-R = 44.92%, and penicillin 2018-R = 36.36%, 2020-R = 41.17%, and 2022-R = 37.68%. In Gram-negative uropathogens, a linear evolution was observed for ceftazidime 2018-R = 11.08%, 2020-R = 13.58%, and 2022-R = 17.33%, and levofloxacin 2018-R = 28.45%, 2020-R = 33.33%, and 2022-R = 35.0%. The current knowledge dictates the need to continuously assess antimicrobial resistance patterns, information that is necessary for treatment recommendations. The present study aims to determine the current situation and the evolution trends according to the current locoregional situation.

(1) Background: Chronic kidney disease (CKD), as well as antimicrobial resistance (AMR) represent major global health problems, with important social and economic implications. It was reported that CKD is a risk factor for antimicrobial resistance, but evidence is scarce. In addition, CKD is recognized to be a risk factor for complicated urinary tract infections (UTIs). (2) Methods: We conducted an observational study on 564 adult in-hospital patients diagnosed with urinary tract infections. The aim of the study was to identify the risk factors for AMR, as well as multiple drug resistance (MDR) and the implicated resistance patterns. (3) Results: The mean age was 68.63 ± 17.2 years. The most frequently isolated uropathogens were Escherichia coli strains (68.3%) followed by Klebsiella species (spp. (11.2%). In 307 cases (54.4%)), the UTIs were determined by antibiotic-resistant bacteria (ARBs) and 169 cases (30%) were UTIs with MDR strains. Increased age (≥65) OR 2.156 (95% CI: 1.404–3.311), upper urinary tract obstruction OR 1.666 (1.083–2.564), indwelling urinary catheters OR 6.066 (3.919–9.390), chronic kidney disease OR 2.696 (1.832–3.969), chronic hemodialysis OR 4.955 (1.828–13.435) and active malignancies OR 1.962 (1.087–3.540) were independent risk factors for MDR UTIs. In a multivariate logistic regression model, only indwelling urinary catheters (OR 5.388, 95% CI: 3.294–8.814, p < 0.001), CKD (OR 1.779, 95% CI: 1.153–2.745, p = 0.009) and chronic hemodialysis (OR 4.068, 95% 1.413–11.715, p = 0.009) were risk factors for UTIs caused by MDR uropathogens. (4) Conclusions: CKD is an important risk factor for overall antimicrobial resistance, but also for multiple-drug resistance.

Purpose: To provide an evidence-based review of the use of ureteral stents in managing reno–ureteral lithiasis during the COVID-19 pandemic. Materials and Methods: A literature search was conducted between 2020 and 2023 using the PubMed and SCOPUS databases. As a part of the search query, we entered “ureteral stents” OR “double J stent” AND “renal colic” OR “ureteral obstruction” OR “reno-ureteral lithiasis” AND “COVID-19 Pandemic” OR “SARS-CoV-2 infection”. Results: Patients with lithiasis should be categorized into low priority, intermediate priority, high priority, and emergency under the COVID-19 pandemic scenario to manage their delay and save resources, including healthcare professionals, beds, and ventilators. However, immediate interventions are necessary for individuals at risk of life-threatening septic complications. During the COVID-19 pandemic, the feasibility of conducting or resuming elective activity depended on local circumstances, the accessibility of beds and ventilators, and the execution of screening protocols. If lithiasis surgery is delayed, consequences and increased effort will be inevitable. It is possible that teleconsultation could help guide these patients and cut down on unnecessary visits and exposure. Conclusions: COVID-19 has shifted treatment options for urinary stones, with ureteral stents being a safe, efficient, and cost-effective option for managing urolithiasis. Decompression is essential in emergency situations, while ureteral stents reduce the risk of infection and hospital visits.

Transurethral enucleation (TUE) has revolutionized the management of benign prostatic obstruction (BPO), offering a minimally invasive solution with superior efficacy across all prostate sizes. This review explores the advancements in TUE techniques, including Holmium Laser Enucleation of the Prostate (HoLEP), Thulium Laser Enucleation of the Prostate (ThuLEP), and bipolar enucleation, highlighting their clinical benefits, safety profiles, and long-term outcomes. Compared to traditional approaches such as transurethral resection of the prostate (TURP) and open prostatectomy, TUE has been associated with reduced complication rates, shorter recovery times, and durable symptom relief. The manuscript also examines patient-centered considerations, such as quality of life improvements and preservation of sexual function, which contribute to high patient satisfaction. Furthermore, the economic advantages of TUE, driven by reduced retreatment rates and healthcare costs, underscore its value for both patients and healthcare systems. Emerging innovations, including artificial intelligence (AI), promise to further enhance procedural planning, surgical precision, and training pathways. Efforts to expand global access through cost-effective adaptations like bipolar enucleation and targeted training initiatives are paving the way for wider adoption of TUE. With its adaptability, technological advancements, and focus on patient outcomes, TUE is poised to become the global standard of care in BPO management.