Urogenital Tract Infection

In-Chang Cho

14 Articles

Clinical Course of the Benign Prostate Hyplasia Patients during the Intermittent Use of 5-Alpha Reductase Inhibitors: Kwibok Choi, Byounghoon Kim, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2019;14(3):93-98. Published online December 31, 2019; DOI: https://doi.org/10.14777/uti.2019.14.3.93

Abstract PDF: Purpose: 5-Alpha reductase inhibitors (5ARI), inhibit the conversion of testosterone to dihydrotestosterone, which is essential in prostate hyperplasia, and decreases the prostate volume directly. On the other hand, 5ARI have a range of side effects, such as sexual dysfunction. After the discontinuation of 5ARI, prostate regrowth occurs rapidly until it reaches the baseline size. This study examined the effects of 5ARI when used intermittently.
Materials and Methods: Between March 2009 and May 2017, patients who visited one physician’s outpatient clinic and were diagnosed with BPH underwent transrectal ultrasonography. The selected patients began to take 5ARI until the prostate size decreased at least 10% of the baseline (the first medication). After confirming adequate prostate shrinkage, the patients stopped medication until prostate regrowth reached 50% of the decreased size. After regrowth, they restarted medication for one year (second medication). The prostate size, serum prostate specific antigen (PSA) levels, international prostate symptom score (IPSS) scores, and maximum flow rate (Qmax) in uroflowmetry were collected after the first and second medication and compared using paired t-tests.
Results: Sixty patients with a mean age of 65.1 years were included in the study. The prostate size and serum PSA level increased after the second medication compared to the first, and the prostate reduction and Qmax in uroflowmetry decreased significantly. On the other hand, the symptoms felt by the patients surveyed by the IPSS scores showed no significant difference.
Conclusions: 5ARI appear to be less effective in reducing the prostate volume and improving uroflowmetry after discontinuation.

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Changes in Antibiotic Resistance of Acute Bacterial Prostatitis in a Korean Single Center: Byoung Hoon Kim, Kwibok Choi, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2019;14(1):14-19. Published online April 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.1.14

Abstract PDF: Purpose: Acute bacterial prostatitis (ABP) is one of main infective disease in urology with various symptoms. Occurrence of complications can be minimized by appropriate treatment. We studied whether any changes in antimicrobial resistance of hospitalized ABP patients as time passed.
Materials and Methods: The study was based on retrospective study. From 2004 to 2007 as past period and 2014 to 2017 as recent period defined. Patient’s ages, length of admission days, intensive care, urinalysis, strains, and resistance to antibiotics were investigated in hospitalized patients with ABP and compared between the two periods.
Results: Fifty patients of past period and 72 patients of recent period with ABP were admitted. The mean age was increased 55.5±13.2 years to 62.0±15.3 years. The infection route was mostly community-acquired. Prostate biopsy-related was decreased 7 to 1. The mean of hospital days were 7.9±4.2 days to 6.9±3.4 days. Intensive care were 5 to 7. Average length of stay intensive care was 4.2±1.3 days to 4.1±1.4 days. Urine cultures showed no significant difference from the previous studies in strains. Extended spectrum beta-lactamases producing bacteria increased 4.3% to 25.0%, and third generation cephalosporin resistance was increased 13.0% to 40.9%. Fluoroquinolone was no significant change 26.1% to 27.3%. Aminoglycosides were identified in 4.3% to 6.8% and carbapenem in 4.3% to 2.3%.
Conclusions: The mean age of hospitalized patients with ABP increased. Antimicrobial resistance did not change to fluoroquinolone, but extended spectrum beta-lactamases producing bacteria showed increased resistance to third-generation cephalosporin. Therefore, attention should be paid to the use of empirical antibiotics.

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Patient’s Factors Correlated with Prostate Volume Recovery after 5 Alpha Reductase Inhibitor Discontinuation: Kwibok Choi, Byounghoon Kim, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2018;13(3):79-83. Published online December 31, 2018; DOI: https://doi.org/10.14777/uti.2018.13.3.79

Abstract PDF: Purpose: The 5 alpha reductase inhibitor (5ARI) reduces the size of the prostate and alleviates lower urinary tract symptoms. After stopping 5ARI, the prostate quickly recovers to its pre-medication size. The purpose of this study was to investigate the factors affecting the restoration of prostate size after 5ARI discontinuation.
Materials and Methods: Between March 2009 and May 2017, patients who visited an outpatient clinic and were diagnosed with benign prostatic hyperplasia were selected and start 5ARI medication. After 6 months of medication, the patients stopped medication for 1 year. Meanwhile, we measured the prostate volumes of patients 3 times (before and after medication, after discontinuation) and divide the patients into 3 groups (maintained, intermediate, and restored) with recovered prostate volume ratio. After classification, we investigated the relationship between the variable factors (age, serum prostate-specific antigen, initial volume, reduced volume after medication) between groups.
Results: Among the 147 selected patients, the mean age and plasma PSA level were 61.6±7.9 and 0.8±0.6, respectively. The mean initial prostate volume was 32.3±4.2 ml, which reduced to 23.2±3.2 ml after medication. After one year of discontinuation, the mean volume was 31.4±6.4 ml, with restoration to 101.5% of the reduced size. We noticed a tendency that patients with faster prostate volume recovery were generally older than those with slower recovery; however, this was not statistically significant. Other factors showed no relationship with prostate recovery.
Conclusions: When using 5ARI in elderly patients, continuous treatment seems better than intermittent treatment. If discontinuation is needed, short term follow-up is recommended.

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Hyperuricemia and Urologic Disease: In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2017;12(3):103-109. Published online December 31, 2017

Abstract PDF: Gout is a disease that causes painful inflammatory arthritis related to hyperuricemia, due to the incorrect metabolism of uric acid. Decreased renal excretion of urate is thought to be the major hyperuricemic mechanism. Most genes responsible for the serum uric acid (SUA) level encode uric acid transporters or related regulatory proteins. The acquired effects can also modulate SUA level and uric acid excretion, which can result in acute gout. Interestingly, kidney related comorbidities in gout, such as hypertension, chronic kidney disease (CKD), and urolithiasis, all have a fairly high prevalence. Recent advancements in genetics and molecular physiology have greatly improved our understanding of renal reabsorption and secretion of filtered uric acid. Furthermore, the baseline SUA level appears to be established by a net balance between absorption and secretion through the epithelium of the kidneys and intestines. There have also been considerable progress in the management of gout patients with CKD. Increased prevalence of gout with CKD can be balanced by an expanded spectrum of treatment options for this important disease. Another issue is that lowering of the uric acid level can reduce the incidence of cardiovascular disease, renal disease, and urological complications. Basic research and clinical studies on these mechanisms might be helpful in determining the appropriate treatment for hyperuricemic patients. Based on currently existing literature, there have been improvements associated with medications that lower uric acid, particularly xanthine oxidase inhibitors. Here, we review the pathogenesis and epidemiology of hyperuricemia, specific diseases related to uric acid, and up-to-date perspectives on their management.

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Intraurethral Lidocaine Usage in Office-Based Rigid Cystoscopy on Pain Experience: Kwi Bok Choi, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2017;12(3):117-121. Published online December 31, 2017

Abstract PDF: Purpose: Cystoscopy is one of the most reliable urological examinations. However, it also a painful one. Intraurethral lidocaine gel injection is widely used to relieve pain during cystoscopy. The purpose of this study is to compare between the use of lidocaine gel and lidocaine solution as a pretreatment for cystoscopy.
Materials and Methods: Between March 2016 and May 2017, we studied 147 patients who had undergone cystoscopy at our institution. Patients were divided into four groups. Lidocaine gel and solution were administered just 10 minutes before each test. For randomization, the patient groups were divided into either odd or even number for the test day and as the patient number, irrespective of medical condition. The amount of lidocaine gel and solution of 10 ml each was uniformly injected. After the procedure, patients were asked to rate their pain on a 10-point visual analogue scale.
Results: The average degree of pain relief was in the order of solution/10 minutes, gel/immediately, gel/10 minutes, and solution/immediately. The gel was associated with significantly less pain in the immediate group than in 10-minute before group, whereas the solution was associated with significantly better pain relief in the 10-minute before group than in the immediate group. There were no complications to report in all groups.
Conclusions: Lidocaine gel and solution showed different changes of pain relief over time. Further prospective studies with a larger population is necessary to better develop a less painful method of cystoscopy in the future.

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The Effect of Intrarectal Lidocaine Gel Instillation before Transrectal Ultrasound Guided Prostate Biopsy: Yoo Seok Kim, Soon Ki Kim, Kwibok Choi, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2016;11(3):97-102. Published online December 31, 2016

Abstract PDF: Purpose: To compare pain induced by a transrectal ultrasound (TRUS)-guided prostate biopsy in men between using local lidocaine gel or plain lubricant.
Materials and Methods: Between January and October of 2014, a total of 63 consecutive patients undergoing TRUS-guided prostate biopsy for elevated prostate-specific antigen (PSA) levels and/or a suspicious digital rectal examination were randomized to two groups: lidocaine group and control group. In the lidocaine group (n=31), patients received 20 ml of 2% lidocaine gel and betadine solution soaked gauze was administered via a transrectal route 10 minutes before the procedure. In the control group (n=32), 20 ml plain lubricant and betadine solution soaked gauze was administrated under the same condition. After the biopsy procedure, patients were asked to rate their pain perception on a 10-point visual analog scale (VAS) score.
Results: There was no statistically significant difference with the mean patient age, PSA, prostate volume, biopsy duration time between lidocaine group and control group. The mean pain score and number of patients with VAS ≥5 in the lidocaine group (4.14±2.0, 10) were significantly lower than those in the control group (5.78±2.3, 19). In younger men (≤65 years), pain was reported significantly less in the lidocaine group than in the control group. Complication rates were not different between the two groups.
Conclusions: Intrarectal lidocaine gel is a simple, safe, and efficacious for reducing pain and discomfort during the TRUS-guided prostate biopsy procedure. It appears to have an enhanced effect, especially in younger than in older men.

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Proposed New Pathophysiology of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2015;10(2):92-101. Published online October 31, 2015

Abstract PDF: The most common type of prostatitis is category III, also known as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The current National Institutes of Health definition of CP/CPPS includes genitourinary pain with or without voiding symptoms in the absence of uropathogenic bacteria, as detected by standard microbiological methods, or other identifiable causes such as malignancy. Many different etiologies and mechanisms of pathogenesis of CP/CPPS have been proposed with a suggested role for immunological, neurological, endocrine, and psychological factors. We examined the data supporting the role of each of these areas and also examined the possible interrelationship of these factors in producing the symptoms of CP/CPPS. Prostatitis types IIIa and IIIb are classified according to the presence of pain without concurrent presence of bacteria; however, it is becoming more evident that, although levels of bacteria are not directly associated with levels of pain, the presence of bacteria might act as the initiating factor that drives primary activation of mast-cell-mediated inflammation in the prostate. The gate control theory provides a neurologic basis for the influence of both somatic and psychological factors on pain. Acceptance of chronic pain as a diagnosis may be difficult for the clinician and patient, however it is an important concept in the care of CP/CPPS, which enables the use of pain-directed therapies. Management of CP/CPPS will remain challenging; however, this review provides a better understanding of the condition and improved management strategies based on the newest evidence and concepts available.

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Change of Antibiotic Resistance to the Causative Organisms of Pelvic Wound Infection for Recent 5 Years: Yoo Seok Kim, Soon Ki Kim, In-Chang Cho, Jin Soo Ko, Gyeong In Lee, Seung Ki Min; Urogenit Tract Infect 2015;10(2):112-119. Published online October 31, 2015

Abstract PDF: Purpose: We researched microbial profiles and the antimicrobial resistance profile of wound infection of the pelvic area in Korea for the recent 5 years in order to provide useful information on the choice of adequate drugs in the treatment of pelvic wound infection.

Materials and Methods: We retrospectively analyzed 211 pelvic wound culture samples and their antimicrobial resistance in 198 in- or out-patients of the Urology and Plastic surgery department from January 2010 to December 2014.

Results: Of the total samples, Staphylococcus aureus was isolated most frequently (35.3%), followed by Escherichia coli (15.1%), Staphylococcus epidermidis (12.6%), Staphylococcus haemolyticus (12.6%), Staphylococcus lugdunensis (8.4%), Pseudomonas aeruginosa (6.7%), Enterococcus spp. (4.2%), and Streptococcus spp. (3.3%). There were no notable changes of bacterial distribution for 5 years. For Gram-positive isolates, the oxacillin resistance rate for Gram-positive bacteria was 42.6% and showed an increasing tendency for the recent 5 years. Piperacillin, rifampicin, and vancomycin had low resistance for Gram-positive bacteria. Carbapenems, piperacillin/tazobactam had low resistance for Gram-negative bacteria. The Gram-positive organisms were more sensitive to many antibiotics in contrast to the Gram-negative organisms.

Conclusions: Of varied causative organisms and susceptibility of the pelvic wound site, the most frequently infected organisms of the pelvic area were S. aureus, followed by E. coli. The methicillin resistive S. aureus (MRSA) incidence showed a tendency to increase yearly, thus selection or early change of antibiotics considering MRSA is recommended if the antibiotic response is poor. Gram-negative bacteria has a higher resistance rate compared with Gram-positive bacteria and had carbapenems and piperacillin/tazobactam.

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Inflammation of Prostate and Prostate-Specific Antigen: In-Chang Cho, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2015;10(1):7-11. Published online April 30, 2015

Abstract PDF: Noncancerous conditions (e.g., benign prostatic hyperplasia and prostatitis) can elevate serum prostate-specific antigen (PSA) levels, limiting the specificity of PSA screening for prostate cancer. In recent years, several studies have also demonstrated a relationship between chronic prostatitis/chronic pelvic pain syndrome and increased PSA levels. However, in asymptomatic patients, routine screening for this diagnosis is not performed before transrectal biopsy to rule out prostate cancer. These asymptomatic men with elevated PSA levels frequently show evidence of inflammation when their expressed prostatic secretions are examined, or on their prostate biopsy specimens. This raises the problem of appropriate evaluation in the presence of chronic prostatitis and elevated PSA levels not only in prostate cancer screening programs, but also in cancer-negative biopsy findings. Thus, there has been investigation into ways to decrease the confounding from inflammation, including repeat PSA measurements after a period of observation or a course of empiric antibiotics. This article reviews the evidence regarding elevations in PSA due to prostatitis and describes the controversy over the optimal approach to reduce its confounding impact on prostate cancer screening. Nowadays, it appears that in patients with prostatic inflammation and increased PSA, an antimicrobial regimen may provide more acceptable initial treatment than proceeding directly to prostate biopsy. Additional evidence is necessary in the form of a randomized clinical trial in which all patients undergo biopsy, regardless of the PSA response to antibiotic or placebo.

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Evaluation of Clinical Sample for Accupower UU Real-Time PCR Kit: Seung Ki Min, Soon Ki Kim, Yoo Seok Kim, In-Chang Cho, Gyeong In Lee; Korean J Urogenit Tract Infect Inflamm 2014;9(2):99-103. Published online October 31, 2014

Abstract PDF: Purpose
In recent years, various diagnostic methods, including culture, immunological detection, conventional polymerase chain reaction (PCR) based methods, and microarray experiment have been applied for detection of Mycoplasma genitalium and Ureaplasma urealyticum infection. We assayed results of real time PCR and culture of variable clinical samples and evaluated various diagnostic indexes for assessing the clinical usefulness of the Accupower UU Real-Time PCR Kit (Bioneer Corp.) for detection of U. urealyticum/parvum. Materials and Methods: We surveyed 111 results of culture test and antibiotic sensitivity test of Ureaplasma spp. that were requested to the department of laboratory medicine, National Police Hospital from January to April 2011. The specimens of Ureaplasma spp. were collected from 97 uterine cervical swab samples, 13 urine samples, and one expressed prostate secretion sample. Real-time PCR and culture methods were performed using the Accupower UU Real-Time PCR Kit (Bioneer Corp.) and Mycoplasma IST2 Kit (BioMérieux). Results: The real-time PCR results showed that 80 clinical specimens were infected with U. urealyticum/parvum. These results were compared with those confirmed by microbiological culture. Compared with the culture, the diagnostic indexes (sensitivity, specificity, positive predictive value, and negative predictive value) of Accupower UU Real-Time PCR were 88.6%, 38.8%, 48.8%, and 83.9%, and the concordance between the Accupower UU Real-Time PCR Kit and the microbiological culture method was 58.5%. Conclusions: Accupower UU Real-Time PCR is a very valuable technique which can process analysis of a massive number of samples with high speed, high sensitivity and specificity, and a high detection rate, particularly for Ureaplasma spp.

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Recurrent Urinary Tract Infection from Urethral Stricture and Urethral Hair Growing after Hypospadias Repair Surgery: Yoo Seok Kim, Sung Bin Kim, Soon Ki Kim, In-Chang Cho, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2014;9(2):122-125. Published online October 31, 2014

Abstract PDF: Despite successful hypospadias repair surgery, complications may occur. We report on a case of recurrent urinary tract infection from urethral stricture and urethral hair growth after hypospadias repair surgery. A 33-year-old man who first underwent hypospadias repair surgery at the age of seven underwent two more visual internal urethrotomy operations afterward. He was referred to our hospital because of voiding difficulty, dysuria, and residual urine sense. His urethral meatus was located at 1 cm proximal ventral sulcus from the glans. We found the urethral stricture and one hair in the urethra at the 2 cm proximal portion from the urethral meatus by retrograde urethrography and urethroscopy. Bacteriuria was found on urine culture, thus, we resolved the problems with soundation, epilation, and antibiotic therapy. However, the patient kept experiencing these problems recurrently; therefore, we managed his problems by recurrent urethral soundation, hair epilation, and antibiotic treatment with three years of regular follow-up.

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Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasmagenitalium, Ureaplasma urealyticum in Chronic Prostatitis Category IIIa andIIIb Patients Using Polymerase Chain Reaction: In-Chang Cho, Yoo Seok Kim, Sung Bin Kim, Soon Ki Kim, Gyeong In Lee, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2013;8(2):102-108. Published online October 31, 2013

Abstract PDF

Purpose: The aim of this study was to report on the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), and Ureaplasma urealyticum (UU) in patients with chronic prostatitis (CP) IIIa and CP IIIb using PCR and correlations between four microorganisms and other clinical parameters.

Materials and Methods: The medical charts of 206 Patients who visited National Police Hospital and were diagnosed with CP IIIa and CP IIIb between January 2011 and December 2012 were reviewed. We investigated white blood cell (WBC) counts on expressed prostatic secretion (EPS) samples and the frequency of four possible causative microorganisms of prostatitis, CT, NG, MG, and UU, using PCR techniques on first voided urine samples (VB1).

Results: Of 206 patients, 88 patients were CP IIIa and 118 were CP IIIb, with a mean age of 33.8±12.9 and 34.6±11.3, respectively. CT, NG, MG, and UU were detected in 13.6%, 0%, 4.5%, and 14.8% of CP IIIa patients and in 0.8%, 0%, 3.4%, and 11.9% of CP IIIb patients, respectively. Among men aged 19-30, detection of CT was significantly greater in the CP IIIa group than in the CP IIIb group (p=0.002). CT showed a positive association with EPS or the third voided urine (VB3) WBC count grade (p＜0.01), however, MG and UU did not. The relationship between numbers of detected microorganisms and WBC counts was statistically insignificant.

Conclusions: In subgroup analyses, microorganisms were detected in by PCR in 29 CP IIIa patients (32.9%) and 19 CP IIIb patients (16.1%). Young aged men in the CP IIIa group showed high prevalence of CT, and patients in whom CT was detected in urine PCR had high EPS WBC counts.

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Asymptomatic Prostatitis: Clinical Significances and Management: In-Chang Cho, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2013;8(1):13-19. Published online April 30, 2013

Abstract PDF: Asymptomatic inflammatory prostatitis (National Institutes of Health, category IV) has been introduced as a separate clinical entity among other prostatitis syndromes. Asymptomatic inflammatory prostatitis is characterized by the presence of significant amount of leukocytes (white blood cells) in prostate-specific samples (post-prostatic massage urine, expressed prostatic secretion, semen, and prostate biopsy) but no subjective symptoms are found, and is therefore diagnosed solely in the laboratory. There have been many questions regarding the clinical role of asymptomatic inflammatory prostatitis and its impact on the management of prostate disease and sterility. This review presents the current definition of asymptomatic inflammatory prostatitis, summarizes the clinical evidence on the two important issues prostate specific antigen and pyospermia, and discusses the optimal approaches to reduce its confounding impact on prostate cancer screening and indiscriminate use of antibiotics.

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Effect of the Severity of Chronic Prostatitis Symptoms on Premature Ejaculation among Korean Males in Their 40-50s: Sung Bin Kim, Yoo Seok Kim, In-Chang Cho, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2013;8(1):32-37. Published online April 30, 2013

Abstract PDF: Purpose: The purpose of this study was to analyze the effect of the severity of chronic prostatitis symptoms on premature ejaculation among Korean males in their 40-50s.
Materials and Methods: From September 2011 to December 2012, we conducted a survey targeting 319 Koreans who had undergone medical examinations in our institution, using National Institute of Health chronic prostatitis symptom index (NIH-CPSI) and premature ejaculation diagnostic tool (PEDT).
Results: The average age of 319 volunteers was 50.8 years (40-59), the average total NIH-CPSI score was 8.6±6.2. And total PEDT score was 7.7±5.0. Twenty eight persons had chronic prostatitis-like symptoms (8.8%). Statistically significant differences in the prevalence of premature ejaculation were observed between persons with chronic prostatitis-like symptoms (82%) and those without (37.5%). In the same manner, the prevalence of premature ejaculation was higher in the moderate and severe symptom groups than in the mild symptom groups according to the symptom scale score (pain plus voiding score) and total score of NIH-CPSI (mild: 38.2%, moderate/severe: 59.6% by symptom scale score and mild: 36.7%, moderate/severe: 65.4% by total score). In univariate and multivariate analyses, presence or absence of chronic prostatitis-like symptoms and classification according to total NIH-CPSI score were independent predictive factors for the prevalence of premature ejaculation on PEDT.
Conclusions: Significant statistical relationships were observed between NIH-CPSI and PEDT in Korean males in their 40-50s who have chronic prostatitis-like symptoms or were classified into moderate and severe symptom groups according to total NIH-CPSI score.

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