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Host-Pathogen Interactions in Urinary Tract Infections
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Young Hwii Ko, Jae Young Choi, Phil Hyun Song
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Urogenit Tract Infect 2019;14(3):71-79. Published online December 31, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.3.71
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- Urinary tract infections (UTIs) are classified by the host condition. Uncomplicated infections are caused most commonly by uropathogenic Escherichia coli (UPEC) and affect otherwise healthy people, whereas complicated infections are commonly caused by species, such as Proteus mirabilis, and affect patients with underlying difficulties, such as a urinary tract abnormality or catheterization. The outcome of infection caused by these bacteria is dictated by the immune response to the UTI and the host factors that influence the susceptibility to disease. This review focuses on the host pathogen interactions in UTI, including an identification of additional virulence factors and therapeutic or prophylactic targets, particularly by UPEC and P. mirabilis.
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Ureteral Obstruction Caused by Aspergilloma in a Non-Immunosuppressive Patient
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Jun Bo Chang, Phil Hyun Song, Jae Young Choi
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Urogenit Tract Infect 2016;11(3):118-120. Published online December 31, 2016
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- Although rarely, aspergillosis can cause obstructive uropathy. This generally occurs in patients with immunosuppressive conditions. Herein, we report a case of aspergilloma that caused ureteral obstruction in a 79-year-old man with no immunosuppressive conditions. A computed tomography revealed that his left pelvocalyceal system and ureter showed mild dilation, without a definite obstructive lesion. The fungal bezoar was removed using an ureteroscopy. The patient was successfully treated with antifungal medication.
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Recurrent Urinary Tract Infection by Bladder Stone Resulting from Subureteral Injection Polydimethylsiloxane (Macroplastique®) for Treatment of Vesicoureteral Reflux
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Jae Young Choi, Hyun Tae Kim, Young Hwii Ko, Young Hwan Lee, Phil Hyun Song
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Urogenit Tract Infect 2016;11(2):62-65. Published online August 31, 2016
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- While endoscopic subureteral injection of bulking agents has become a first-line therapy for the treatment of vesicoureteral reflux (VUR), mainly due to its high success rates with minimal complications, polydimethylsiloxane (PDS) administration can be associated with bladder calcification in a minority of patients. A 10-year-old girl with prior history of subureteral administration of PDS as a treatment modality for bilateral VUR six years ago showed recurrent lower urinary tract symptoms, including dysuria, frequency, and urgency, for the past 6 months. She was admitted to our institution for right pyelonephritis with hydronephrosis. Radiologic examination had revealed two yellowish impacted stones attached to the previous site of PDS administration without recurrence of VUR. The stones were completely removed by cystolitholapaxy. This study suggests that such a late-complication should be considered in patients with recurrent urinary tract infection or lower urinary tract symptom despite complete disappearance of VUR by prior subureteral administration therapy.
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Clinical Significance of Toll-Like Receptor and Toll-Like Receptor Blocker
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Jae Young Choi, Phil Hyun Song, Young Hwii Ko
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Urogenit Tract Infect 2016;11(1):1-6. Published online April 30, 2016
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- The mammalian Toll-like receptor (TLR) family, consisting of 13 members, plays an important role in innate recognition of specific patterns of microbial products. TLR-dependent recognition subsequently causes an activation of antigen-specific adaptive immunity. TLR-mediated signaling pathways consist of two pathways that induce gene expression: the myeloid differentiation primary response gene 88 (MyD88)-dependent pathway and Toll/interleukin-1 receptor-domain containing adaptor protein-inducing interferon--dependent pathway. Synthetic TLR agonists, as well as TLR antagonists, affect and manipulate the host defense systems, and some of these immunomodulating agents may help to overcome intrinsic disturbances of the TLR system to offer new treatment options in urinary tract infection (UTI). Future studies are necessary to clarify additional associations between TLRs and severity of UTI, which may help in developing new treatment options.
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Analysis of Correlation between The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Index of Erectile Function (IIEF-5) among Korean Males Aged 40-50s
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In Chang Cho, Sung Bin Kim, Yoo Seok Kim, Jae Young Choi, Seung Ki Min
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Korean J Urogenit Tract Infect Inflamm 2012;7(2):164-171. Published online October 31, 2012
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Analyzed the correlation between the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Index of Erectile Function (IIEF-5) from questionnaires among Korean 40-50s male.
Materials and Methods: From September 1, 2011 to December 31 2012, we conducted a survey targeting 1032 Korean males who were had medical examinations in National Police Hospital, Using NIH-CPSI and IIEF-5. After explaining the content of the NIH-CPSI and IIEF-5, the paper was checked by volunteers in person, and the results were then collected. The subjects were limited to Korean males in their 40-50s. We analyzed the collected questionnaires.
Results: The average age of 1032 volunteers was 50 years old (42-59), and the average of NIH-CPSI total scores was 7.1±5.5. The average of IIEF-5 total scores was 17.4±6.5. IIEF-5 category was divided into Normal 385 (37.3%), Mild 296 (38.7%), Mild-Moderate 215 (20.8%), Moderate 98 (9.5%), and Severe 38 persons (3.7%). Among total volunteers, 72 persons were Chronic prostatitis like symptom patients (6.9%), and whose NIH-CPSI average of pain score (total 21), voiding score (total 10), quality of life score (total 12) and total scores were 7.6±3.1, 4.3±2.5, 5.8±2.3, and 17.8±6.7, respectively. There were moderate correlations of pain score, voiding score, quality of life score, but not significant (Pearson's coefficient of correlations <0.501). An average of total IIEF-5 scores in chronic prostatitis - like symptoms in the present group was 14.0±6.8. It was significantly lower than in the in the absent group. Prostatitis-like symptoms in the present group had more severe degrees of erectile dysfunction than absent group (p=0.002). Assessing each NIH-CPSI category score and total score affected to total IIEF-5 score, we analyzed the correlation between NIH-CPSI and IIEF-5 using regression analysis. There were all negative correlations between IIEF-5 and Pain score(t=-6.199, r2=0.036, p=0.000), voiding score (t=-0.157, r2=0.025, p=0.000), QOL score (t=-7.845, r2=0.056,p=0.000), and total score (t=-9.366, r2=0.078, p=0.000). Having analyzed correlations between each score of NIH-CPSI groups and IIEF-5 score by using multiple regression analysis, there were statistically significant difference negative correlations between pain score and IIEF-5 (t=-2.646, p=0.008), QOLscore (t=-4.219, p=0.000), and age (t=-3.135, p=0.002), but not to voiding score (t=0.628, p=0.530).
Conclusions: The higher the NIH-CPSI score, especially for pain and QOL scores play a larger role, and adversely affects erectile function of chronic prostatitis like symptom patients in Korean males aged 40-50s. (Korean J UTII 2012;7:164-171)
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Tuberculosis Infected Multiple Genitourinary System
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Jae Young Choi, Sung Bin Kim, Yu Seok Kim, Ji Yun Pae, Seung Ki Min
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Korean J Urogenit Tract Infect Inflamm 2012;7(1):68-72. Published online April 30, 2012
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- Genitourinary tuberculosis is the most common manifestation of an extrapulmonary tuberculous infection. A 54 year old patient was presented with a painful & swelling right testicular mass and left flank pain. Under the clinical diagnosis of right testicular tuberculosis along with left kidney, ureter, bladder tuberculosis, a right orchiectomy and left double J stenting, as well as endoscopic bladder biopsy were performed. The radiological and pathological diagnosis revealed testicular tuberculosis, with involvement of the left kidney, ureter and bladder.
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Prevalence of Chronic Prostatitis Symptoms in Korean Young Adult Male using the National Institutes of Health Chronic Prostatitis Symptom Index
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Sung Bin Kim, Jae Young Choi, Seung Hoon Cho, Seung Tae Lee, Seung Ki Min
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Korean J Urogenit Tract Infect Inflamm 2011;6(2):192-198. Published online October 31, 2011
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- "Purpose: The National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) was used to determine the prevalence of prostatitis-like symptoms among young adult Korean males. Materials and Methods: From February 1, 2009 to February 1 2011, we conducted a survey targeting 1095 Korean young men who were enrolled at an educational institution. After explaining about NIH-CPSI, subject completed a questionnaire. Respondents were fairly evenly distributed. We analyzed the collected questionnaires, and considered men who reported perineal and/or ejaculatory pain or discomfort and a total NIH-CPSI pain score of ≥4 as having prostatitis-like symptoms. We also analyzed the correlations of pain, urinary symptom and quality of life scores in the prevalence group. Results: The average age of 1095 volunteers was 30.1 years (range 25-35 years). Among these men, 90 (8.2%) indicated feeling pain. Of these men, 27 experienced perineal and/or ejaculatory pain or discomfort, and their total NIH-CPSI pain score exceeded 4. The estimated prevalence of prostatitis-like symptoms was approximately 2.5%. The mean pain score of men who indicated experiencing pain was 7.0, but the mean pain score of all respondents was 0.7; the difference was statistically significant. Positive correlations were evident between pain score and quality of life score (Pearson's correlation coefficient=0.965), and urinary symptom score and quality of life score (Pearson's correlation coefficient=0.891). Also, using mean score of quality of life domain of ≤6 and >6 revealed statistically significant differences of mean score of pain (8.1/5.4) and urinary symptoms (2.6/0.3). Conclusions: The estimated prevalence of prostatitis-like symptom in the examined population of young adult Korean males was 2.5%. And there were closed relationships between pain, urinary symptome, and quality of life score in prevalence group."
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Comparison of Clinical Symptoms Scored According to NIH-CPSI in Patients with Chronic Prostatitis Syndrome Category IIIa and IIIb
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Jae Young Choi, Moung Jin Lee, Seung Hoon Cho, Sung Bin Kim, Seung Tae Lee, Seung Ki Min
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Korean J Urogenit Tract Infect Inflamm 2011;6(1):42-47. Published online April 30, 2011
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- "Purpose: With little evidence, the causes of inflammatory and non-inflammatory chronic pelvic pain syndrome (CPPS), which cover a majority of cases of prostatitis syndromes, have not been fully explicated. The mechanisms of these two CPPS may be different. Although the clinical symptoms are expected to be disparate, we compared the clinical symptoms between the two using National Institutes of Health chronic prostatitis symptoms index (NIH-CPSI) over several parameters. Materials and Methods: The chronic pelvic pain syndrome patients (n=256) at our institution between April 2009 and March 2010 were included. After classifying these patients into two groups, the inflammatory CPPS and the non-inflammatory CPPS groups, we compared the two groups in terms of pain or discomfort, urinary symptom, quality of life, prostate volume measured by transrectal ultrasonography (TRUS), prostate specific antigen (PSA) and maximum flow rate (Qmax) difference. Result: There was no statistically significant difference between the two groups in pain or discomfort, urinary symptom, quality of life, prostate volume measured by TRUS, and Qmax difference. However, inflammatory CPPS patients showed meaningfully higher PSA scores than non-inflammatory CPPS patients. No significant difference was observed between patient age and compared among the age groups. Pain or discomfort, urinary symptom, quality of life, prostate volume measured by TRUS, and Qmax difference within each age group were not significantly different between the inflammatory CPPS & non-inflammatory groups. Conclusions: There was no statistically significant difference between the two groups except PSA. It remains unreliable to distinguish inflammatory CPPS from non-inflammatory CPPS based solely on clinical symptoms."
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Urinary Candidiasis Caused by Fluconazole-Resistant Candida glabrata
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Moung Jin Lee, Seung Hoon Cho, Jae Young Choi, Seung Tae Lee, Seung Ki Min
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):97-101. Published online April 30, 2010
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- Urinary tract infection caused by Candida glabrata is an uncommon fungal infection. Risk factors for candiduria include diabetes mellitus, antimicrobial use, immunosuppressive therapy and urinary tract defect. We recently experienced a case of urinary tract infection caused by fluconazole-resistant Candida glabrata in a 57-year old woman with diabetes. The diagnosis and management are discussed, and the literature is reviewed
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