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Feasibility of Anesthesia-Free Ureteroscopic Lithotripsy in Elderly Patients with Urinary Tract Infections
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Duk Yoon Kim, Hyun Jin Jung, Eun Kyoung Yang, Won Yeol Cho
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Urogenit Tract Infect 2023;18(2):60-63. Published online August 31, 2023
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DOI: https://doi.org/10.14777/uti.2023.18.2.60
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- Purpose: Patients with underlying diseases, particularly in the elderly, urinary tract obstruction with a ureter stone would progress to severe conditions. Some of them have poor general conditions to endure anesthesia. Therefore, this study validated the feasibility of ureteroscopic stone removal without anesthesia for elderly patients with ureter stones who were under impending septic conditions or severe urinary tract infections.
Materials and Methods: Thirty-four patients (16 males and 18 females) were included in this study. All of them had serious problems, making it difficult to endure anesthesia. Most of them were inserted pre-operative percutaneous nephrostomy catheter, and ureteroscopic lithotripsy was performed successfully after intravenous analgesic injection (pethidine 25 mg).
Results: The mean age was 71.8±10.84 years. The locations of the stones were upper ureter in 11, mid-ureter in 6, and lower ureter in 17 cases. Urine and blood cultures identified bacteria from 17/34 patients. Escherichia coli was the most common (10/17), followed in order by Klebsiella pneumoniae and Staphylococcus epidermidis in 5 and 2 cases, respectively. Most patients had an abnormal white blood cell count (19,400±4,233.3/l) and elevated C-reactive protein levels (110.3±83.6 mg/L). No patient had to stop the operation because of intolerable pain. The mean of the visual analog pain scale was 3.2±0.86. The overall success rate was 100%.
Conclusions: The trial of ureteroscopic lithotripsy after administering analgesics could improve the condition of elderly patients whose general condition is too poor to endure anesthesia without serious complications.
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Adherence Assay of Uropathogenic Escherichia coli In Vivo and In Vitro
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Duk Yoon Kim, Je Chul Lee
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Urogenit Tract Infect 2017;12(3):122-129. Published online December 31, 2017
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- Purpose: This study aims to investigate the specific pathogenic properties or virulent determinant characteristics of uropathogenic Escherichia coli (UPEC) as bacterial adherence in tissue culture cells in vitro and the pathogenicity in animal model in vivo.
Materials and Methods: Thirty strains of E. coli were isolated from urine of patients with acute pyelonephritis. Four cell lines—HeLa cells, HEp-2 cells, A-498 cells, and J-82 cells—were used for bacterial adherence assay. Histologic examination and scanning electron microscopy examination of pyelonephritis or cystitis, which was caused by E. coli, in mice was performed.
Results: Sixteen (53.3%) strains of E. coli appeared to adhere to at least one or more kinds of four cell lines, and seven strains were able to adhere to all four cell lines. All of the tested E. coli strains were adhered to the mouse bladder and kidneys. The number of bacteria colonized in the kidney was greater than that of bladders in the following 5 strains of E. coli: TME104, TME107, TME113, TME306, and TME119. There was no difference in the number of bacteria colonized in the bladder and kidneys in the aspects of adherence patterns to tissue culture cells.
Conclusions: Although there was no best choice cell lines in the adherence assay to identify the adherence patterns, combined assays of in vitro cell culture and in vivo model of mouse urinary tract infection appeared to be efficient methods to investigate the role of bacterial adherence in the pathogenesis of UPEC.
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Superficial Angiomyxoma of the Scrotum
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Hyun Jin Jung, Duk Yoon Kim
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Korean J Urogenit Tract Infect Inflamm 2013;8(2):133-135. Published online October 31, 2013
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- Superficial angiomyxoma is a rare benign multilobulated cutaneous tumor, comprised of a prominent myxoid matrix and numerous blood vessels. It usually located on trunk, head and neck or lower extremity. Scrotal superficial angiomyxoma is extremely rare. We report a case of superficial angiomyxoma on the scrotum of a 69-year-old man.
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Urinary Tract Infections and Bacteriuria in the Elderly: Diagnosis and Treatment
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Duk Yoon Kim
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Korean J Urogenit Tract Infect Inflamm 2008;3(2):162-167. Published online October 31, 2008
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- The elderly population is now increasing in the world. A higher incidence of bacteriuria and urinary tract infection (UTI) is observed in the elderly patients, in both long-term care facilities and at home. The management of elderly patients with UTI is increasing in clinical significance. Bacteriuria (≥ 105 CFU/ml) is a very common phenomenon in the elderly people, occurring twice as frequently in women than in men. Almost all of UTI in the elderly is complicated UTI. Control of the underlying diseases in the urinary tract is quite important in the management of UTIs in the elderly patients. For pyelonephritis, switch therapy using aminoglycosides and fluoroquinolones, carbapenems, third-generation cephalosporines, or penicillins are selections of choice. The recommended duration of treatment for patients with pyelonephritis is 14 days. Seven to 10 days of treatment using fluoroquinolones or trimethoprim-sulfamethoxazole is recommended for the treatment of elderly patients with symptomatic cystitis. There are symptomatic and asymptomatic types of bacteriuria. Although asymptomatic bacteriuria is quite common in the elderly population, antibiotic treatment has no benefit for such patients. Intravaginal estrogen replacement is one of choice for the prevention of recurrent UTIs in postmenopausal women.
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Actinomycosis of Urinary Bladder Associated with Intrauterine Contraceptive Device
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Il Kang, Jae Duck Choi, Duk Yoon Kim
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Korean J Urogenit Tract Infect Inflamm 2007;2(2):209-211. Published online October 31, 2007
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- Actinomycosis is a rare opportunistic infection caused by anaerobic bacterium Actinomyces israelii. It usually causes a chronic suppurative infection. Actinomycosis occasionally associated with the use of intrauterine contraceptive devices (IUD). Herein, We report a case of 43-year-old woman, who presented urinary frequency, dysuria, abdominal discomfort and had IUD indwelling for 4 years. With the presumptive diagnosis of bladder tumor, transurethral resection of bladder was performed. Pathological examination revealed a vesical actinomycosis.
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2006 EAU Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Treatment Guidelines
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Duk Yoon Kim
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Korean J Urogenit Tract Infect Inflamm 2006;1(1):45-53. Published online October 31, 2006
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- Advaces in research are changing the concept of the clinical management of chronic prostatitis, interstitial cystitis. As the new millennium begins, urologists and patients diagnosed with prostatits and interstitial cystitis can hope that exciting evolution will improve the dismal record for this disease. However, pain management is a subject afflicted by failure to identify its pathophysiological origins. The problem is most commonly experienced as 'interstitial cystitis (IC)' or 'chronic prostatitis (CP)'. The cause of chronic prostatitis (syndrome category IIIB) is not known, so causal treatment is a problem and many therapeutic options are justified on the basis of anecdote alone.
IC is a disease of the urinary bladder, which was first described by Skene in 1887. The ulcer, which is a typical cystoscopic finding in 10-50% of IC patients, was first described by Guy L. Hunner at the beginning of the last century. In 1949, when John Hand presented a large series of IC patients with varying endoscope and histopathological presentations, he realized that his material on IC did not comprise just one single entity. Cure is not currently a realistic goal so that symptom management is the only route to an improvement in quality of life. . Various medical and intravesical treatments have been proposed and investigated for IC.
When all efforts fail to relieve disabling IC symptoms, surgical removal of the diseased bladder represents an option. Three major techniques of bladder resection are common: supratrigonal (i.e. trigone-sparing) cystectomy, subtrigonal cystectomy, or radical cystectomy including excision of the urethra. All techniques require substitution of the excised bladder tissue, which is mostly performed with bowel segments. (Korean J UTII 2006;1:45-51)
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