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The Effect of Intrarectal Lidocaine Gel Instillation before Transrectal Ultrasound Guided Prostate Biopsy
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Yoo Seok Kim, Soon Ki Kim, Kwibok Choi, In-Chang Cho, Seung Ki Min
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Urogenit Tract Infect 2016;11(3):97-102. Published online December 31, 2016
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- 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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Change of Antibiotic Resistance to the Causative Organisms of Pelvic Wound Infection for Recent 5 Years
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Yoo Seok Kim, Soon Ki Kim, In-Chang Cho, Jin Soo Ko, Gyeong In Lee, Seung Ki Min
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Urogenit Tract Infect 2015;10(2):112-119. Published online October 31, 2015
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- 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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Effectiveness of Topical Ofloxacin Ointment for Genitourinary Post-Operative Patients with Urinary Catheterization
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Yoo Seok Kim, Soon Ki Kim, Gyeong In Lee, Seung Ki Min
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Korean J Urogenit Tract Infect Inflamm 2015;10(1):25-30. Published online April 30, 2015
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- Purpose: Catheter associated urinary tract infection and discomfort is common in patients with an indwelling urinary catheter. We investigated the effectiveness of prophylactic topical antibiotic ointment for genitourinary post-operative patients with a urinary catheter. Materials and Methods: We investigated 112 inpatients between March 2013 and October 2013, who had an indwelling urinary catheter ≥24 hours after a genitourinary operation in our institution from medical records. Among 112 patients, 59 patients applied ofloxacin ointment to urethral meatus around the indwelling catheter twice a day (ointment group: 52.7%) and 53 patients did not (non-ointment group: 47.3%). All patients were examined by urine analysis and urine culture before the operation, urethral sweep culture after catheter removal, and severity of pain was recorded as visual analogue scale (VAS) score while having an indwelling urinary catheter. Results: Mean duration of urinary catheter of both groups did not differ statistically (3.08±2.19 day, 2.91±2.25 day). Patients with pyuria detected at pre-operative urinalysis were 22.1% vs. 15.1%, pre-operative urine culture positive were 6.8% vs. 9.4%, urethra meatal culture positive after urethral catheter removal were 16.9% vs. 13.2%, respectively, and all results showed no significant differences between two groups. VAS scores of the ointment group (3.52±1.66) while having an indwelling urinary catheter were significantly lower than those of the non-ointment group (5.61±1.75) (p＜0.001). Conclusions: Application of topical antibiotic ointment for genitourinary post-operative patients with urinary catheter had no benefit in reducing growth of urethral microorganisms, but it may decrease pain from an indwelling urinary catheter.
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Evaluation of Clinical Sample for Accupower UU Real-Time PCR Kit
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Seung Ki Min, Soon Ki Kim, Yoo Seok Kim, In-Chang Cho, Gyeong In Lee
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Korean J Urogenit Tract Infect Inflamm 2014;9(2):99-103. Published online October 31, 2014
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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
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Yoo Seok Kim, Sung Bin Kim, Soon Ki Kim, In-Chang Cho, Seung Ki Min
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Korean J Urogenit Tract Infect Inflamm 2014;9(2):122-125. Published online October 31, 2014
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- 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
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In-Chang Cho, Yoo Seok Kim, Sung Bin Kim, Soon Ki Kim, Gyeong In Lee, Seung Ki Min
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Korean J Urogenit Tract Infect Inflamm 2013;8(2):102-108. Published online October 31, 2013
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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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Effect of the Severity of Chronic Prostatitis Symptoms on Premature Ejaculation among Korean Males in Their 40-50s
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Sung Bin Kim, Yoo Seok Kim, In-Chang Cho, Seung Ki Min
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Korean J Urogenit Tract Infect Inflamm 2013;8(1):32-37. Published online April 30, 2013
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- 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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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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