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The Feasibility of Radical Prostatectomy for Medication Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome
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Seung Chan Jeong
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Urogenit Tract Infect 2022;17(3):76-80. Published online December 31, 2022
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DOI: https://doi.org/10.14777/uti.2022.17.3.76
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- Purpose: The purpose of this study was to compare the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scores of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) given pharmacological treatment with those who additionally had prostate cancer and underwent surgical treatment.
Materials and Methods: From January 2000 to March 2021, a total of 7,650 patients were diagnosed with chronic prostatitis (N41.1) at our hospital, of which 234 patients were additionally diagnosed with prostate cancer. After excluding patients with severe benign prostatic hyperplasia (＞100 g)-related lower urinary tract symptoms or neurological and psychiatric abnormalities, or advanced prostate cancer, 52 patients undergoing pharmacological treatment with a combination of drugs and 20 patients who underwent radical prostatectomy due to additional prostate cancer were included in the analysis. The NIH-CPSI scores of the two groups were compared at the first outpatient visit, 3 months, and 6 months after the first visit. The p-values were calculated using the Mann-Whitney U test, and the Wilcoxon signed rank test.
Results: Patients who underwent radical prostatectomy for prostate cancer showed significant reductions in the voiding and quality of life scores in the NIH-CPSI, but not the pain score at 3 months. After 6 months, there was a significant decrease in the overall NIH-CPSI. On the other hand, in the group on pharmacological therapy, the decrease was statistically significant only in the voiding score at 6 months. However, in the surgery group, 3 patients were found to be suffering from urinary incontinence, and 7 patients from erectile dysfunction.
Conclusions: Radical prostatectomy, therefore, appears to be a promising treatment that can be carefully considered for patients with refractory CP/CPPS who do not receive adequate treatment and thus have a poor quality of life.
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Risk Factors of Sepsis and Factors Influencing the Decision to Perform Emergency Drainage in Obstructive Acute Pyelonephritis Secondary to Urinary Calculi
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Young Hwan Jung, Seung Chan Jeong, Minki Baek, Dong Soo Ryu
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Urogenit Tract Infect 2017;12(3):110-116. Published online December 31, 2017
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- Purpose: To investigate the risk factors for sepsis and analyze the criteria for emergency drainage in patients with obstructive acute pyelonephritis (APN) secondary to urinary calculi.
Materials and Methods: We included 64 patients with obstructive APN secondary to urinary calculi. Patients were divided into two groups: the sepsis and non-sepsis groups. Independent risk factors for sepsis were also identified. Forty-three patients in the sepsis group were further divided into two subgroups: those who underwent emergency drainage and those who did not. A retrospective analysis was performed.
Results: Of the 64 patients, 43 showed signs of sepsis. There was a lower lymphocyte count and lymphocyte percentage, as well as a higher C-reactive protein level and neutrophil-to-lymphocyte ratio (NLR) in the sepsis group compared with the non-sepsis group. Increased sepsis showed a statistically significant association with increased Charlson comorbidity index (CCI). Four out of 21 patients in the non-sepsis group underwent emergency drainage compared with 26 out of 43 patients in the sepsis group. Independent variables for sepsis in a multivariate logistic regression analysis showed positive blood culture, high NLR, and increased CCI score. Among sepsis patients, the likelihood of performing emergency drainage increased with higher creatinine, positive urine culture, and higher CCI score.
Conclusions: In patients with obstructive APN secondary to urinary calculi, a high CCI score were associated with a higher probability of progression to sepsis. In patients with higher creatinine and higher CCI scores, proactive treatment is usually necessary.
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Characteristics of Patients Who Visited the Emergency Room after Prostate Biopsy: Single Center Retrospective Study
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Seung Chan Jeong, Seungsoo Lee, Jae Min Chung, Sang Don Lee
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Urogenit Tract Infect 2015;10(2):120-125. Published online October 31, 2015
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- Purpose: To educate patients and prevent biopsy-related complications, it is helpful to understand the causes for visiting the emergency room (ER). Therefore, we want to analyze the causes and factors of complications that cause patients to visit the ER after prostate biopsy.
Materials and Methods: We conducted a study of in-patients who visited the ER of Pusan National University Yangsan Hospital after prostate biopsy from December 2008 to July 2015. Age, postoperative interval before visiting the ER, Charlson comorbidity index (CCI) score, symptoms in ER, prostate size, pathologic result, and number of biopsy cores were analyzed retrospectively.
Results: Among all 1,694 cases of patients who had undergone prostate biopsies during a 7-year period, only 37 patients (2.2%) visited the ER. Diabetes mellitus (DM) is the most common underlying disease among patients with accompanying infection-related symptoms compared to patients with accompanying non-infection- related symptoms (p＜0.001). In univariate analysis, DM (p=0.004) and CCI score (p=0.030) were statistically significant risk factors for infection, but only DM was significant in multivariate analysis (p=0.004). Prostate size (p=0.044) was a significant risk factor for acute urinary retention (AUR) in univariate analysis, but not statistically significant in multivariate analysis. CCI score was a statistically significant risk factor for bleeding (p=0.005 [univariate], 0.035 [multivariate]).
Conclusions: AUR after transrectal ultrasound-biopsy is the most common reason for visiting the ER. CCI score showed correlation with bleeding and DM showed correlation with infection. Consideration of risk factors of complications after prostate biopsy will be helpful to the patients in the treatment and prevention of complication.
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Comparative Analysis between Top-Down and Down-Top Approach in Children with Febrile Urinary Tract Infection
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Jae Hyun Ahn, Seung Chan Jeong, Sang Don Le
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Korean J Urogenit Tract Infect Inflamm 2013;8(1):38-42. Published online April 30, 2013
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- Purpose: We performed a comparative analysis of the usefulness of top-down and down-top approach in children with febrile urinary tract infection (UTI).
Materials and Methods: Among 79 children, 42 children had undergone voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scintigraphy. High grade vesicoureteral reflux (VUR) was defined as grade VI and V. We analyzed the detection rate of VUR between down-top (group I) and top-down approach (group II).
Results: The mean age of 42 children (Boys 25, girls 17) was 30.3±33.2 years. Among 42 children, 22 (52.4%) were diagnosed as VUR. Detection rate of VUR in groups I and II was 52.4% and 33.3%, respectively (p=0.078). Detection rate of VUR according to sex and age was 56.0% and 36.0% in boys (p=0.156), 47.1% and 29.4% in girls (p=0.290), and 38.9% and 16.7% in children younger than one year of age (p=0.041), and 62.5% and 45.8% in children older than one year of age (p=0.247), respectively. In high grade VUR, there was a similar detection rate of VUR, regardless of sex or age. Sensitivity, specificity, and positive prediction rate of DMSA scintigraphy in all patients and children with high grade VUR were 63.6%, 80.0%, 77.8%, and 84.6%, 80.0%, 73.3%, respectively.
Conclusions: In children with febrile UTI who were younger one year of age, down-top approach was more useful for diagnosis of VUR. Therefore, VCUG may initially be needed for diagnosis of VUR in children with febrile UTI who were younger than one year of age.
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The Difference of Microorganism and Antibiotics Resistance between Adults and Children with Urinary Tract Infection
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Hyung Jong Nam, Seung Chan Jeong, Jong Youn Yi, Sang Don Lee
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Korean J Urogenit Tract Infect Inflamm 2012;7(2):136-141. Published online October 31, 2012
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- Purpose
Urinary tract infection (UTI) is one of the most common infectious diseases in children and adults. It is widely known that most UTI is caused by E. coli. In most cases for those who underwent UTIs, empirical antibiotics were treatment of choice. But resistance of empirical antibiotics is increasing gradually. The proper use of antibiotics is essential in the clinical field. We evaluated the antibiotic resistance of organisms causing UTIs in children and adults patients to provide the proper use of empirical antibiotics.
Materials and Methods: From January 2011 to December 2011, 749 cases (mean age was 27.9±30.2years) who underwent positive urinary culture tests were evaluated. The age, sex, results of urine dipstick and microscopic tests, urine culture, and antibiotics resistance were reviewed.
Results: 460 men and 289 women were evaluated. Adults were 310 cases (41.4%) and children were 439 cases (58.6%). Pathogens from the results of urine culture were E. coli (35.7%), Enterococcus species(25.8%), Klepsiella (12.9%). Antibiotics resistance rate of all pathogens was 29.8% and Pseudomonas(36.1%), with E. coli (32.8%) having the highest resistance rate of all. Ampicillin (61.8%), trimethoprim/sulfamethoxazole (42.6%), and penicillin (39.4%) showed higher resistance rates than other antibiotics. The multi-drug resistance rate was 17.8% in total, adults were 17.4%, and children were 18.1%. Female urine RBC and urine WBC counts were ssociated with UTIs from a pathogen which has resistance at to at least one of the antibiotics in adults. On the other hand, older age, urine leukocyte esterase and urine RBC count was associated with antibiotics resistance in children.
Conclusions: Gram positive microorganisms including E. coli were the most common pathogen of UTIs both in adults and children. Therefore, quinolones and cephalosporins are widely used in UTIs, however antibiotic sensitivity was reduced in this study and there was no difference in adults and children. The sensitivity and drug resistance were changing steadily, affecting many factors and various pathogens gave rise to UTIs. Therefore considerations of many factors of sensitivity to antibiotics are needed.(Korean J UTII 2012;7:136-141)
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Trial for Clinical Guideline of the Use of Prophylactic Antibiotics in Pediatric Urologic Outpatient Surgery
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Hyung Jong Nam, Seung Chan Jeong, Mi Yeon Kong, Keum Seob Lee, Sang Don Lee
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Korean J Urogenit Tract Infect Inflamm 2012;7(1):50-55. Published online April 30, 2012
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- "Purpose: Proper use of antibiotics is essential in the clinical field. The overuse of antibiotics can be one of the causes for resistance. However, there is a lack of guideline to a valid method of prophylactic antibiotics in surgery. We evaluated the evidence on the suitable prophylactic antibiotics usage to prevent perioperative infection, when performing pediatric urologic outpatient surgery. Materials and Methods: From December 2010 to may 2011, 70 cases (mean age was 3.5±3.23 years) who underwent outpatient operation approached inguinal or scrotal incision were evaluated. In group 1, intravenous antibiotic prophylaxis was done only preoperatively. In group 2, intravenous antibiotics were administrated pre- and post-operative, each. In group 3, beside pre- and post-operative intravenous antibiotic prophylaxis, additional oral antibiotics were medicated for 3 days after discharge from the hospital. Further, in group 4, beside pre- and post-operative intravenous antibiotic prophylaxis, oral medication was administered until 7 days after discharge. Skin redness, pain, wound dehiscence, fever, gastrointestinal disturbance, and etc., were examined postoperatively. Results: Slight skin redness was observed in 4 cases (23.5%), 2 cases (10.5%), 1 case (7.1%), and 0 case (0.0%) in each group, but there is no need to treatment. There is no case who feels pain on the incision site of each group. Wound dehiscence occurred in one case in group 1 (5.9%) and group 3 (7.1%), respectively. There were no association with wound infection between each group, and wound infection was recovered spontaneously. Two cases (11.8%), 1 case (5.3%), 0 case(0.0%), and 3 cases (15.0%) complained with fever in each group. Diarrhea was observed in 2 cases (13.3%) and 4 cases (20.0%) in group 3 and 4, respectively. Conclusions: There were no differences in prophylactic effect to prevent infection in each group. Group 1 showed a lower incidence of diarrhea than group 3 or 4, but other adverse effects were not different among the groups. Therefore, it is sufficient to use antibiotics preoperatively for prophylactic purpose in pediatric urologic outpatient surgery."
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