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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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Association between an Interleukin 4 Gene Polymorphism, rs2243268, and Urogenital Tuberculosis
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Bongsuk Shim, Sang Don Lee, Tae-Hyoung Kim, Seung Il Jung, Won Yeol Cho, Gilho Lee
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Urogenit Tract Infect 2018;13(2):35-39. Published online August 31, 2018
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- Purpose: Urogenital tuberculosis (UGT) is rarely reported in developed countries. This study evaluated the genetic susceptibility of Korean patients to UGT.
Materials and Methods: A total of 35 UGT patients who were confirmed pathologically, 44 intrapulmonary tuberculosis (IPT) patients who were confirmed radiologically, and 102 controls over a 6 year period were enrolled in this study. The region of rs2243268 in interleukin-4 (IL-4) gene was amplified from whole blood samples, and the DNA sequences were read using the Sanger method.
Results: Twenty women and 15 men were diagnosed with UGT. The occurrence of the CC, AC, and AA genotypes of rs2243268 were 26 (74.3%), 8 (22.9%), and 1 (2.9%), respectively, in UGT; 28 (63.6%), 15 (34.1%), and 1 (2.3%), respectively, in IPT; and 51 (50.0%), 45 (44.1%), and 6 (5.9%), respectively, in the control groups (p=0.115). The bivariate data of CC and AC/AA were 74.3% and 25.7% in UGT, 63.6% and 36.4% in IPT, and 50.0% and 50.0% in the control groups, respectively (p=0.029). The UGT was significantly different from the control group among the three genotypes (p=0.038, Fisher’s exact test) and bivariate genotypes (p=0.017, Fisher’s exact test). In addition, people carrying the CC genotype had a higher risk of UGT (odds ratios, 2.889; 95% confidence intervals, 1.233-6.770; p=0.015).
Conclusions: A single nucleotide polymorphism in the IL-4 gene, rs2243268, is associated with the development of clinical tuberculosis. The CC type of rs2243268 increases the risk of UGT significantly compared to the CA/AA type.
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Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study
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Eu Chang Hwang, Ho Song Yu, Seung Il Jung, Dong Deuk Kwon, Sun Ju Lee, Tae-Hyoung Kim, In Ho Chang, Hana Yoon, Bongsuk Shim, Kwang Hyun Kim, Donghyun Lee, Jung-Sik Huh, Dong Hoon Lim, Won Jin Jo, Seung Ki Min, Gilho Lee, Ki Ho Kim, Tae Hwan Kim, Seo Yeon Lee, Seung Ok Yang, Jae Min Chung, Sang Don Lee, Chang Hee Han, Sang Rak Bae, Hyun Sop Choe, Seung-Ju Lee, Hong Chung, Yong Gil Na, Seung Woo Yang, Sung Woon Park, Young Ho Kim, Tae Hyo Kim, Won Yeol Cho, June Hyun Han, Yong-Hyun Cho, U-Syn Ha, Heung Jae Park, The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII)
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Urogenit Tract Infect 2016;11(1):17-24. Published online April 30, 2016
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- Purpose: Recent studies have highlighted an increasing trend of infectious complications due to fluoroquinolone-resistant organisms among men undergoing transrectal prostate biopsy. This study evaluated the current incidence of infective complications after trans-rectal prostate biopsy for identification of risk factors in Korean men who received fluoroquinolone prophylaxis.
Materials and Methods: A prospective, multicenter study was conducted in Korea from January to December 2015. Prostate biopsies performed with fluoroquinolone prophylaxis during 3 months in each center were included. A pre-biopsy questionnaire was used for identification of patient characteristics. Clinical variables including underlying disease, antibiotic prophylaxis, enema, povidoneiodine cleansing of the rectum, and infectious complications were evaluated. The primary outcome was the post-biopsy infection rate after fluoroquinolone prophylaxis. Univariable and multivariable analyses were used for identification of risk factors for infectious complications.
Results: The study included 827 patients, of whom 93 patients (11.2%) reported receiving antibiotics in the previous 6 months and 2.5% had a history of prostatitis. The infectious complication rate was 2.2%. Post-biopsy sepsis was reported in 2 patients (0.2%). In multivariable analysis predictors of post-biopsy sepsis included person performing biopsy (adjusted odds ratio [OR], 4.05; 95% confidence interval [CI], 1.31-12.5; p=0.015) and operation history within 6 months (adjusted OR, 5.65; 95% CI, 1.74-18.2; p=0.004).
Conclusions: The post-prostate biopsy infectious complication rate in this study was 2.2%. Person performing biopsy (non-urologists) and recent operation history were independent risk factors for infectious complications after trans-rectal prostate biopsy.
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Renal Actinomycosis Accompanying Staghorn Calculi
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Ki Soo Lee, Joon Yeop Jee, Young Eun Seo, Jin Sook Jeong, Won Yeol Cho
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Korean J Urogenit Tract Infect Inflamm 2013;8(1):59-61. Published online April 30, 2013
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- Actinomycosis is a chronic infectious disease that is generally caused by Actinomyces israelii. Renal actinomycosis is a very rare disease, especially accompanying staghorn calculi formation. In this article, we present a case of renal actinomycosis with the staghorn calculi formation. A 52-year-old woman presented with a 3-month history of pain in the right upper quadrant. The abdominopelvic computed tomography scan showed staghorn calculi and severe dilatation of the pelvicalyceal system of the right kidney. A right simple nephrectomy and a partial resection of the infrahepatic inferior vena cava were performed. We anticipated that the final diagnosis would be xanthogranulomatous pyelonephritis, however histopathologic tests revealed renal actinomycosis with abscess formation and extensive inflammation, glomerulosclerosis and staghorn calculi.
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Clinical Outcome of Acute Bacterial Prostatitis; A Multicenter Study
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Seong Ju Lee, Jin Mo Koo, Bong Suk Shim, Yong Hyun Cho, Chang Hee Han, Seung Ki Min, Sung Joo Lee, Hwan Cheol Son, Jun Mo Kim, Jong Bo Choi, Tae Hyoung Kim, Sang Kuk Yang, Kil Ho Lee, Yong Kil Na, Sung Ho Lee, Hee Jong Jung, Seung Il Jung, Chul Sung Kim, Jae Min Chung, Young Jin Seo, Won Yeol Cho, Kweon Sik Min, Sang Don Lee
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Korean J Urogenit Tract Infect Inflamm 2011;6(2):165-170. Published online October 31, 2011
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- "Purpose: Proper guidelines concerning antibiotic administration for acute bacterial prostatitis (ABP) are unclear. We retrospectively analyzed treatment status and clinical outcomes to establish a proper treatment guideline. Materials and Methods: The clinical records of 669 patients from 21 hospitals diagnosed with ABP were reviewed. Prior manipulation, antibiotics administration, mean length of treatment, complication and procedure were analyzed. Results: The mean age of 538 patients (80.4%) without manipulation (group 1) and 131 patients (19.6%) with manipulation (group 2) was 58.3 years (range 19-88 years). Transrectal prostate biopsy was the most common cause of acute bacterial prostatitis (n=66; 50.4%). Of the clinical symptoms in the non-manipulation and manipulation groups, fever was most common (88.2% and 86.3%, respectively). Acute urinary retention (14.3% and 28.1%, respectively) was significantly increased in the manipulation group (p<0.05). Escherichia coli was the most frequently isolated bacterium from urine (72.0% and 66.7% of cases, respectively). Mean length of treatment was 6.5days and 7.9days, respectively; the difference was significant (p<0.05). Combination antibiotic therapy with third generation cephalosporin+aminoglycoside was used in 49.3% and 55.5% of cases, respectively. For single antibiotic therapy, second generation quinolones were used the most (35.5% and 34.3%, respectively). Sequale occurred in 29 group 1 patients (5.4%) and 20 group 2 patients (15.3%); the difference was significant (p<0.05). Conclusions: Prior manipulation was associated with 20% of ABP patients. Regardless of manipulation, clinical outcome was similar after treating with appropriate antibiotics."
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The Clinical Significance of Granulomatous Prostatitis after Intravesical BCG Immunotherapy
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Soo Dong Kim, Jung Ho Kim, Jung Min Ha, Won Yeol Cho
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Korean J Urogenit Tract Infect Inflamm 2010;5(2):188-192. Published online October 31, 2010
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- "Purpose: To evaluate the clinical significance of granulomatous prostatitis (GnP) after intravesical bacillus Calmette-Guerin (BCG) therapy (GnP-BCG) for superficial bladder transitional cell carcinoma or carcinoma in situ. Materials and Methods: We reviewed the medical records and transrectal ultrasonography (TRUS) of 193 patients who had undergone transurethral resection of bladder tumor and had received intravesical BCG therapy from January, 2003 through to December, 2009. Among them, 19 patients underwent prostate biopsy due to elevated prostate specific antigen (PSA) or abnormal TRUS finding. Results: Six of 19 patients (31.5%) who had sustained symptom were identified as GnP, of whom one patient had concurrent prostate cancer. The other 5 patients’ symptoms were spontaneously resolved and their PSA normalized by conservative care. Conclusions: Since GnP-BCG has a similar clinical appearance to prostate cancer, we should differentiate GnP-BCG from prostate cancer. However, the natural history of GnP-BCG is that of slow and complete resolution after conservative treatment. We suggest conservative treatment before undergoing prostate biopsy in patients with BCG immunotherapy to reduce unnecessary invasive intervention."
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Recent Trend on the Diagnosis and Management of Urinary Tuberculosis
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Soo Dong Kim, Won Yeol Cho
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Korean J Urogenit Tract Infect Inflamm 2009;4(1):13-19. Published online April 30, 2009
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- "Genitourinary tuberculosis is not very common but it is considered as a severe form of extra-pulmonary tuberculosis. Recently, the prevalence rate of genitourinary tuberculosis is increasing, even in developed countries where the incidence used to be low. The tuberculosis recrudescence was caused by the AIDS pandemic, emergence of resistant bacilli, human migration patterns, and world poverty. The diagnosis of genitourinary tuberculosis is made based on culture studies by isolation of the causative organism; however, biopsy material on conventional solid media may occasionally be required. Modern short-course anti-tuberculous drug regimens are effective in all forms of tuberculosis and is considered the first line therapy in genitourinary tuberculosis. And, radical or reconstructive surgery also necessary to treat of genitourinary tuberculosis. All urologist have to know genitourinary tuberculosis inside out and reduce a complication by early diagnosis and right medical and surgical treatment."
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Analysis of Renal and Perinephric Abscesses: with Treatment as the Center
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Soo Dong Kim, Jae Jin Kwak, Chan Wook Shin, Won Yeol Cho
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Korean J Urogenit Tract Infect Inflamm 2008;3(2):223-227. Published online October 31, 2008
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- "Purpose: The objective was to analyze the renal and perinephric abscesses with treatment as the center. Patients and methods: The medical records of 47 patients with renal and prinephric abscesses treated at our hospital from January 1990 to December 2007 were reviewed. The data collected included underlying conditions, size and multiplicity of abscess, cultured organisms, associated disease and treatment method. Results: The mean age of the patients was 47.7 years old (4~84), and men and women were 12 and 35 cases, respectively. In 24 cases the abscess were happened in right kidney, and bilateral cases were 4 cases. Multiple abscess were 11 cases, and the size of abscess was variable from 1cm to 6cm. Below 4cm size of abscess were 25 cases, and beyond 4cm size of abscess were 22 cases. Diabetes mellitus (31.9%), hypertension (17.0%) and urolithiasis (12.8%) were the most common underlying conditions and 11 cases were multiple. The abscess size of twenty-five cases were less than 4cm. Pyuria were found in 29 (61%) and causative organisms were found in 17 cases. The most common organisms are E. coli. Interventional treatments were performed in 23 cases: surgical drainage (1 case), percutaneous drainage (13 cases), nephrectomy (9 cases). Among the percutaneous drainage, nephrectomy was done in 2 cases. Open surgery was performed in cases that associated urologic disease existed, abscesses were multiple and abscess size was more than 4cm. The interventional treatment was decreased after 2000 year. Conclusions: Renal and perinephric abscesses are successfully managed by medical treatment. But for more good results, we considered underlying conditions, size and multiplicity of abscess."
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Penile Necrosis due to Pseudomonas Sepsis in Alcoholic Liver Cirrhosis Patient
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Seong Ho Cho, Jae Jin Kwak, Chan Wook Shin, Won Yeol Cho
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Korean J Urogenit Tract Infect Inflamm 2007;2(2):230-232. Published online October 31, 2007
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- Penile necrosis in the form of dry gangrene is a rare disease which is most commonly associated with renal failure in conjunction with diabetes Moreover, it is associated with long-term administration of coumadin in patients with heart problems and pseudomonas sepsis. We report a case of penile necrosis due to pseudomonas sepsis in alcoholic liver cirrhosis patient.
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