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Risk Factors for Sepsis after Retrograde Intrarenal Surgery: Single Center Experience
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Jinseok Kang, Koo Han Yoo, Taesoo Choi, Gyeong Eun Min, Dong-Gi Lee, Hyung-Lae Lee, Jeonghyouk Choi
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Urogenit Tract Infect 2023;18(3):93-100. Published online December 31, 2023
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DOI: https://doi.org/10.14777/uti.2023.18.3.93
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- Purpose: To evaluate risk factors for sepsis after retrograde intrarenal surgery for treatment of renal stones.
Materials and Methods: We analyzed the clinical data of 243 patients with kidney stones who visited our institution between April 2017 and April 2023. Age, sex, body mass index, underlying disease, location and size of stones, previous history of stones, previous history of urinary tract infections, duration of surgery, preoperative drainage, application of ureteral balloon dilation, and laboratory test results were included in the analysis.
Results: The mean age of the patients was 58.4 (±15.0) years; there were more men (53.1%) than women (46.9%). Of the 243 patients, the overall rate of sepsis was 5.8% (n=14) and the total mortality rate was 0.4% (n=1). In univariate analysis, history of urinary tract infection (p=0.019), positive preoperative urine culture test (p=0.009), operative duration of more than 90 min (p=0.004), and application of ureter balloon dilation (p=0.016) were statistically significant. In multivariate analysis, positive finding in the urine culture test performed before surgery (p=0.003), operation duration >90 min (p=0.005), and use of balloon dilation during surgery (p=0.011) were statistically significant.
Conclusions: There is a risk of progression to postoperative sepsis if bacteria are detected in the urine culture before surgery, if the operative time exceeds 90 min, or if balloon dilation is performed during surgery. Given that the probability of progression to sepsis is approximately 6%, close observation and active treatment are needed for patients with these risk factors.
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A Case Report of Self-Inflicted Surgical Castration
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Koo Han Yoo, Sung-Goo Chang
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Urogenit Tract Infect 2023;18(3):107-109. Published online December 31, 2023
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DOI: https://doi.org/10.14777/uti.2023.18.3.107
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- Religious beliefs are a very significant part of one’s life. We report the case of a strongly religious man who sought to remove his testicles. After enlisting in the military, the man had a surgical castration performed on him while on vacation from military service. The procedure aimed to rid the man of his libido, which he saw as a hindrance to his religious life. After the removal of the testes, his serum testosterone was 0.25 ng/ml. The luteinizing hormone, 22.1 (1.7-8.6 mIU/ml), and follicle stimulating hormone, 53.5 (1.5-12.4 mIU/ml) were elevated. Testicular scans showed an absence of both testes. This appears to be an unfortunate situation caused by false religious beliefs and the reckless use of internet resources.
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Korean Multicenter Study of Infectious Complications after Transurethral Prostate Surgery in Patients with Preoperative Sterile Urine
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Seong Hyeon Yu, Seung Il Jung, Eu Chang Hwang, Tae-Hyoung Kim, Jae Duck Choi, Koo Han Yoo, Jeong Woo Lee, Dong Hoon Koh, Sangrak Bae, Seung Ok Yang, Joongwon Choi, Seung Ki Min, Hoon Choi
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Urogenit Tract Infect 2022;17(3):81-88. Published online December 31, 2022
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DOI: https://doi.org/10.14777/uti.2022.17.3.81
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- Purpose: To evaluate the efficacy of antibiotic prophylaxis and determine the risk factors of infectious complications after transurethral surgery of the prostate.
Materials and Methods: Seven hundred and seventy-two patients who underwent transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HOLEP) were reviewed. Of these, this study enrolled 643 patients without bacteriuria who had not received antibiotics for urinary tract infections for two weeks before surgery. The patients were divided into two groups according to the duration of the antibiotics (Group 1: less than one day, n=396 vs. Group 2: more than one day, n=247).
Results: The overall incidence of postoperative infectious complications in 643 patients was 5.0% (32/643). When postoperative infectious complications were compared according to the duration of the antibiotics (Group 1 vs. Group 2), the infectious complications rates were 5.6% (22/396) vs. 4.0% (10/247), respectively (p=0.393). When postoperative infectious complications were compared according to the duration of antibiotics (Group 1 vs. Group 2) in the TURP and HOLEP groups, the infectious complications rates were 6.3% (12/192) vs. 1.0% (1/103) (p=0.035) and 4.9% (10/203) vs. 6.0% (8/134) (p=0.677), respectively. The duration of Foley catheterization was independently associated with infectious complications (p=0.003).
Conclusions: The results showed that prolonged postoperative catheterization affects postoperative infectious complications associated with transurethral prostate surgery. Although antibiotics administered for less than one day are effective for antibiotic prophylaxis of transurethral prostate surgery, a longer antibiotic therapy is recommended for TURP.
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Characteristics and Treatment Trends for Emphysematous Pyelonephritis in Korea: A 10-Year Multicenter Retrospective Study
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Seung-Kwon Choi, Koo Han Yoo, Jeong Woo Lee, Seung Il Jung, Eu Chang Hwang, Joongwon Choi, Woong Bin Kim, Jung Sik Huh, Jin Bong Choi, Yeonjoo Kim, Jae Min Chung, Ju-Hyun Shin, Jae Hung Jung, Hong Chung, Sangrak Bae, Tae-Hyoung Kim
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Urogenit Tract Infect 2021;16(2):49-54. Published online August 31, 2021
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DOI: https://doi.org/10.14777/uti.2021.16.2.49
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- Purpose: This study examined the characteristics, current treatment trends, and outcomes of patients with emphysematous pyelonephritis (EPN) in Korea.
Materials andMethods: Two hundred and seventeen patients diagnosed with EPN were evaluated using abdominal computed tomography in 2011-2021 at 15 institutes in Korea. The patients’ demographic and clinical characteristics, treatment modalities, and treatment outcomes were analyzed. The total study period was divided arbitrarily into groups A (2011-2014), B (2015-2017), and C (2018-2021) to analyze the trends in the EPN treatment.
Results: The mean age of the patients was 65.1 years; there were more female patients (74.2%) than male patients. The overall mortality rate was 10.6%. Ninety-five (43.8%), 98 (45.2%), and 24 (11.0%) patients were treated with medical, minimally invasive, and surgical management, respectively; the corresponding mortality rates were 13.7%, 6.1%, and 16.7%. There was no significant change in the proportion of patients treated with medical management over time (group A=46.5%, group B=47.0%, and group C=38.8%). The proportion of patients treated with minimally invasive management gradually increased over time (group A=35.2%; group B=43.9%; group C=55.0%), while those who underwent surgical management decreased gradually over time (group A=18.3%, group B=9.1%, and group C=6.3%). No differences in mortality rates were observed between the groups.
Conclusions: EPN with medical and minimally invasive management had a relatively high treatment success rate, which increased gradually, while surgical management decreased gradually over time in Korea. The mortality rate was relatively lower than that reported in studies published before the 2010s.
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Is Double J Stenting or Percutaneous Nephrostomy More Suitable for Maximizing the Clinical Effects of Temporary Urinary Diversion for Acute Pyelonephritis with a Complicated Ureteral Stone?
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Jeonghyouk Choi, Taesoo Choi, Dong-Gi Lee, Gyeong Eun Min, Hyung Lae Lee, Koo Han Yoo
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Urogenit Tract Infect 2019;14(3):87-92. Published online December 31, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.3.87
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- Purpose: This study compared the clinical benefits of double J (DJ) ureteral stenting with percutaneous nephrostomy (PCN) for the management of acute pyelonephritis (APN) with complicated ureteral stones.
Materials and Methods: The records of 85 patients with complicated APN between December 2006 and July 2017 were reviewed retrospectively. Sixty one patients who underwent DJ or PCN for the management of acute urinary obstruction were enrolled in this study. Some of the participants were excluded for concurrent renal stones, multiple ureteral stones, ureteral stricture, malignancy, and anatomical anomalies. The patient and stone characteristics and peri-procedural laboratory test results of the groups were compared. The success rate, depending on the type of urinary diversion and the presence of immediate complications, were also analyzed.
Results: In this study, 19 patients underwent DJ stenting, and 42 patients underwent PCN as a transient urinary diversion. No failed procedures or immediate complications requiring subsequent intervention were encountered (Clavien–Dindo grade II-V). Urologists preferred PCN to DJ stenting in cases with an elevated serum creatinine level (p=0.001) and higher C-reactive protein (CRP) level (p<0.001). The indicative parameters for renal injury and septic conditions (white blood cell count, segment neutrophil, and creatinine levels) tended to show immediate improvement, whereas CRP did not; however, the differences in markers were not significant (p=0.701, 0.962, 0.288, and 0.360, respectively).
Conclusions: Both DJ stenting and PCN were safe and feasible methods for the management of complicated APN. With experienced urologists or radiologists, there may be little danger of prolonged renal failure or other procedure-related complications.
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Changing Epidemiology of Extended Spectrum Beta-Lactamases Pathogen of Urinary Tract
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Taesoo Choi, Koo Han Yoo, Sun-Ju Lee
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Urogenit Tract Infect 2015;10(2):74-83. Published online October 31, 2015
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- This review covers the recent findings on extended spectrum beta-lactamases (ESBL) pathogens, focusing on the epidemiology of infection due to this pathogen. Use of ESBL is growing rapidly and widely. CTX-M-15 producing ESBL Escherichia coli is the most commonly encountered in clinical practice. In general, ESBL infections are represented by urinary tract infections, but they can also cause fatal infections involving the vascular system and central nervous system. Because E. coli is a common colonizer of normal intestine, increasing prevalence of ESBL-producing pathogens is particularly troublesome. In a situation where ESBLs are disseminated in the community, the ideal control of this multidrug-resistant pathogen will be challenging. Precise data on the prevalence and risk factors of ESBL-producing microorganism are still undetermined. More epidemiological studies are needed for the question to be answered. In order to maximize efficiency of treatment, information on the trend of increasing numbers of ESBLs is also needed on persistence of ESBLs in carriers as well as better understanding of how antibiotic treatment and other risk factors affect their persistence and further dissemination. The global emergence of multidrug-resistant ESBL pathogen has recently led to critical treatment problems. Early detection, adequate antibiotic therapy, and effective prevention are necessary for achievement of a safe community.
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The Development and Limitation of the Animal Cystitis Models
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Koo Han Yoo, Sun-Ju Lee
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Korean J Urogenit Tract Infect Inflamm 2008;3(1):5-9. Published online April 30, 2008
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- Animal model refers to a non-human animal with a disease or injury that is similar to a human condition. Animal model is classified as induced model, naturally occurring model and genetically mutant model using the animal such as rat, mouse, rabbit, cat and so on. In consideration of chemical cystitis related model, methods of development of animal model are noxious intravesical stimuli, noxious systemic stimuli, noxious environmental stimuli and naturally occurring bladder disease in cats. These cystitis models introduced to interstitial cystitis, painful bladder syndrome. And in consideration of bacterial cystitis related model, identification and characterization of uropathogenic E. coli is useful method. On the other hands, innoculation of uropathogenic E. coli into the mouse or rats possible method. But animal models are weak in surrounding environments and stimuli, so the results from those can be changed. There is a wide variation between drug responses in dog and parrots, because of species differences. And in aspect of animal welfare consideration, we must remember that healthy animals used as experimental subjects serve as a means to our study.
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Characterization of Uropathogenic Escherichia coli
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Koo Han Yoo, Jeong-Je Cho1, Sun-Ju Lee
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Korean J Urogenit Tract Infect Inflamm 2007;2(1):61-65. Published online May 31, 2007
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- " Purpose: Infections of the urinary tract are common allover the world and occur in all ages and both sex. The organism most commonly isolated from all types of urinary tract infections is Escherichia coli. Materials and Methods: We analyzed E. coli from a woman with acute cystitis. Among the pathogenic determinants of the uropathogenic E. coli strains, the p-fimbriae have been known to be associated with upper urinary tract infections. Results: Type 1 fimbriae (fimH), P family fimbriae (papA), S family fimbriae (sfa), hemolysin (hylA) and cytotoxic necrotizing factor I (cnfI) contribute to virulence in the urinary tract. So, it is important to characterize E. coli in laboratory study. Conclusions: The authors have used tools to reveal characteristics of E. coli, such as polymerase chain reaction, hemagglutination, hemolysin assay. This study provides how to characterize E. coli strains."
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