Urogenital Tract Infection

The Development of Experimental Pyelonephritis Animal Models and The Related Problems: Jae-Shin Park; Korean J Urogenit Tract Infect Inflamm 2008;3(1):1-4. Published online April 30, 2008

Abstract PDF: The rat model of experimental pyelonephritis has been developed assuming that the rat has vesicoureteral reflux natively. It is also believed that injecting the infecting micro-organism through the rat urethra may cause pyelonephritis and renal scarring. But, it has been reported that in some experimental pyelonephritis rat model, pyelonephritis dose not develop because vesicoureteral reflux does not occur constantally. I want to review the whole process of developing experimental pyelonephritis in rat model and find the problems which related to vesicoureteral reflux, developing pyelonephritis and analysing pathologic results.

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The Development and Limitation of the Animal Cystitis Models: Koo Han Yoo, Sun-Ju Lee; Korean J Urogenit Tract Infect Inflamm 2008;3(1):5-9. Published online April 30, 2008

Abstract PDF: 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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Experimental Animal Models of Prostatitis: Limitations and Potential: Yun Seok Jung, Chang Hee Han, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2008;3(1):10-23. Published online April 30, 2008

Abstract PDF: Prostatitis is a polyetiological inflammation of the prostate gland in men characterized by pelvic pain, irritative voiding symptoms, and sexual dysfunction. Histologically prostatitis is characterized by poly- and mononuclear cell infiltrates (neutrophils, lymphocytes, macrophages and plasma cells) in the stromal connective tissue around the acini or ducts. Prostatitis is an important worldwide health problem in men. The pathogenesis and diagnostic criteria for the condition are obscure, with the result that the development of management programs for this condition has been hindered. Animal model(s) might be useful in elucidating mechanisms involved in the molecular pathogenesis of chronic nonbacterial prostatitis and chronic pelvic pain syndrome. Given that prostatitis might have a multifactorial etiology, several animal models with unique features may prove helpful. This review examines a number of experimental animal models of prostatitis and evaluates their advantages and limitations.

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Principles of Antimicrobial Treatment in Urologic Field: Kwang Woo Lee, Min Eui Kim; Korean J Urogenit Tract Infect Inflamm 2008;3(1):24-36. Published online April 30, 2008

Abstract PDF: There are two prominent aims in the antimicrobial treatment: (1) rapid and effective response to therapy and prevention of recurrence of the individual patient treated, and (2) prevention of emergence of resistance to antimicrobial chemotherapy in the microbial environment. The main drawback of current antibiotic therapies is the emergence and rapid increase of antibiotic resistance. To combat this establishment proper guidelines of antimicrobial treatment should be made. This article focuses on the principles of antimicrobial treatment with urinary tract infections, prostatitis, sexually transmitted diseases, and perioperative antibiotic prophylaxis in urologic field.

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The Usefulness and Limitation of Bacterial Genetic Amplification Method for Diagnosis of Chronic Prostatitis: Gilho Lee; Korean J Urogenit Tract Infect Inflamm 2008;3(1):37-42. Published online April 30, 2008

Abstract PDF: Some urologists have insisted that fastidious and nonculturable microorganisms may be important in the etiology of idiopathic chronic prostatitis. The bottom-line is that the diagnosis of infectious causes which only detected by genetic amplification methods have theoretically serious defects and incurs determinant misinterpretations if not used by an appropriated method. In Korea, the amplification method to detect fastidious bacteria has been widely used in out-patient clinics without criticism, which phenomenon is unusual or can not understand in the eyes of foreign scientists. Moreover, many urologists who care the patients, even patients, can not believe the PCR results. Under some situations, because the amplification results from some commercial companies make the situations in a mess or more complicating to understand idiopathic chronic prostatitis, so many people have a question that “Is it a right result or is our approach right?”. Herein, I will discuss what the real problems are, and why the results are contradictious in Korea. Finally I will give a suggestion about “we are on the right way”.

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Innovative Diagnostics for Sexually Transmitted Infections: Seung-Ju Lee; Korean J Urogenit Tract Infect Inflamm 2008;3(1):43-54. Published online April 30, 2008

Abstract PDF: Diagnostics for sexually transmitted infections (STIs) with easy non-invasive sample collection are important to increase testing and hence to reduce the spread of this infection. From this point of view, molecular technologies and rapid point-of-care tests are innovations which have gradually shifted the paradigm in the diagnosis of STIs from biological to molecular amplification and from laboratory to near-patient testing. These powerful diagnostic tools have improved and will continue to have a significant impact on our ability to design strategies and programs for the control and prevention of STIs.

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Surveillance System for Sexually Transmitted Diseases in Korea: Hye Kyung Park, Joo Sun Lee, Soo Jin Baek; Korean J Urogenit Tract Infect Inflamm 2008;3(1):55-62. Published online April 30, 2008

Abstract PDF: Sexually transmitted diseases (STDs) are defined as diseases transmitted through sexual intercourse, and which remain a public health problem of major significance in most parts of the world. Syphilis (including primary, secondary, congenital), Gonorrhea, Chlamydial infection, non-gonococcal urethritis, genital herpes, Condyloma acuminata are included the national notifiable infectious diseases category 3, and data are collected via sentinel surveillance system by law in Korea. Including 251 public health centers, 556 medical institutes (as of March 2008) participate in this surveillance system. Total cases of STDs have been decreased since 2003, but notified cases for Syphillis, genital herpes and Condyloma acuminata have been increased during the same period. The results from prevalence surveys of STDs, Chlamydia in women was 2.9∼4.7%, 2.2∼5.6% in men. In case of Gonorrhea, prevalence in college students and pregnant women was 0.2∼0.4%, and prevalence of sex workers and runaway teenagers was 8.8% and 3.5∼7.6%, respectively.

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A Single Center Study of the Change of Antibiotic Resistance to the Causative Organisms of Urinary Tract Infection for Recent 10 Years: Jung Man Kim, Sang Don Lee, Chul Hun Jang; Korean J Urogenit Tract Infect Inflamm 2008;3(1):63-74. Published online April 30, 2008

Abstract PDF: "Purpose: We studied the changes in the antibiotic resistance to the causative organisms of urinary tract infection (UTI) for recent 10 years in order to give some useful informations on the choice of adequate drugs in the treatment of UTI. Material and Methods: We retrospectively analysed 9,546 uropathogens and their antimicrobial resistance that had more than 105 cfu/ml in urine culture in 5,981 in- or out-patients from January 1996 to September 2005. Results: The incidence of UTI was highest in the 1st decade (20.3%). The common pathogens were E. coli (35.2%), Enterococcus (19.4%), Pseudomonas (10.5%), Staphylococcus (8.0%) and Klebsiella (6.7%) in order. The incidence of E. coli decreased from 38.3% in 1996 to 25.1% in 2005 but the incidence of Enterococcus and Pseudomonas increased from 17.4% to 27.5% and from 7.7% to 14.9%, respectively. For Gram negative isolates, the resistance to ampicillin was very high (81.8%) and the resistance to ciprofloxacin and trimethoprim/sulfamethoxazole (TMP/SMX) were 37.4% and 58.6%, respectively. For E. coli, the resistance of ampicillin, ciprofloxacin and TMP/SMX were 77.4%, 37.2% and 56.0%, respectively. Conclusions: E. coli was the most common organism causing UTI but we should be concerned about the increase of Gram positive organisms, especially Enterococcus. Resistance of ampicillin, TMP/SMX and ciprofloxacin at the empirical therapy for UTI should be reconsidered."

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Effect of Chronic Pelvic Pain Syndrome on Sexual Function and Activity: Keon Cheol Lee, Kyeong Hoon Lee, Hyun Dong Song, In Rae Cho; Korean J Urogenit Tract Infect Inflamm 2008;3(1):75-80. Published online April 30, 2008

Abstract PDF: "Purpose: To evaluate whether patients with chronic pelvic pain syndrome (CPPS) have more sexual dysfunction rate than normal control, and whether the sexual dysfunction rate in CPPS increase with more severe CPPS symptom. Materials and Methods: 638 CPPS patients and 102 healthy controls were enrolled in this study. In all subjects, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), International Index of Erectile Function (IIEF) and the frequency of sexual intercourses per month during the last 3 months (F) were checked. Between CPPS patients and controls, scores of 5 domains of IIEF (erectile function: EF, intercourse satisfaction: IS, orgasmic function: OF, sexual desire: SD, overall satisfaction: OS) and F were compared. Erectile dysfunction (defined as < 26 EF domain score) rate was compared between the 2 groups. The CPPS patients were classified according to symptom severity into 3 groups and compared. Results: 289 CPPS patients and 67 controls were eligible for the analysis. F was 4.9, 6.5 for CPPS and control group, respectively (p=0.006). Total IIEF, IS, OF, SD and OS domain scores were lower in CPPS group (p<0.05) but EF domain scores were not different. Erectile dysfunction rate of CPPS and control group was 61.2% and 47.8%, respectively (p=0.043). CPPS patients were sub-classified as mild, moderate, severe symptom groups. The 3 groups were not different in age. In all domains of IIEF and F, no difference was found among the 3 groups. Conclusions: CPPS patients had higher sexual dysfunction rate and less sexual intercourses than healthy controls. But, CPPS symptom severity didn’t influence sexual frequency and dysfunction rate. It needs more extensive studies."

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The Antimicrobial Effect of Antibiotics to Patients with Chronic Prostatitis of Positive Reaction on Chlamydial Antibody: Sung Dae Kim, Dong Wan Sohn, Sae Woong Kim, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2008;3(1):81-88. Published online April 30, 2008

Abstract PDF: "Purpose: Chronic bacterial prostatitis is the most common urological disease in adult males, with antibiotic therapy being the gold standard for its treatment. Recent studies suggest that Chlamydia may play a role in chronic prostatitis but was difficult to prove the pathogen to the prostate. We evaluated the effect of three antibiotics (azithromycin, doxycycline, levofloxacin) in patients with chronic prostatitis of positive reaction on Chlamydial antibody. Material and Methods: The study included 54 patients who had symptoms of chronic prostatitis and proven presence of Chlamydia. The presence of Chlamydia was confirmed in expressed prostatic secretion (EPS) immediately after prostatic massage by multiplex polymerase chain reaction (PCR). The patients were randomized to receive azithromycin 1.0g (n=16) once, or doxycycline 100mg b.i.d. (n=19) for 21 days or levofloxacin 100mg t.i.d. (n=19) for 21 days. Patients’ sexual partners were treated at the same time. Clinical and bacteriological efficacy (leukocyte count, pathogen eradication rate, NIH-CPSI) was evaluated after the end of therapy. Results: After treatment of antibiotics, the leukocytes counts in the EPS was significantly decreased in all groups (p<0.05), but there was no significant difference in three groups. Also, all of groups was superior to control Chlamydia (azithromycin:doxycycline:levofloxacin=93.75%:78.94%:89.47%) and there was no significant difference of the pathogen eradication rates in three groups. The total NIH-CPSI score was significantly decreased, especially pain domain and quality of life domain (p<0.05), and there was no significant difference in three groups. Conclusions: These data suggest that antibiotics of three groups was effective to the patient with chronic prostatitis of positive reaction on Chlamydia antibody."

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Necessity of Clinical Guideline for Syphilis: Jun Mo Kim, Kwang Woo Lee, Young Ho Kim, Min Eui Kim; Korean J Urogenit Tract Infect Inflamm 2008;3(1):89-94. Published online April 30, 2008

Abstract PDF: "Purpose: To evaluate the practical variations in the diagnosis, treatment, and follow-up in the patients with syphilis. Materials and methods: A total of 659 patients with syphilis between 2002 to 2007 were retrospectively analyzed. Clinical data of gender, nontreponemal/treponemal test (rapid plasma reagin; RPR, Treponema pallidum haemagglutination assay; TPHA, Treponema pallidum latex agglutination; TPLA, fluorescent treponemal antibody absorption; FTA-ABS), presence of HIV, follow-up after treatment were collected. Results: The 107 patients (16.2%) with RPR negative were TPHA positive. The false positive rate of RPR was 7.1%. There was a different result between TPHA/TPLA and FTA-ABS in 7 patients. In the 185 patients who had follow-up RPR test after treatment with Benzathin penicillin RPR was converted into negative in 54 patients (29.1%). AIDS was diagnosed in 4 patients. Conclusions: This results indicate that the clinical practice in management for patients with syphilis is different in each doctors. The development of guideline for syphilis is needed to provide reasonable common management in diagnosis, treatment and follow-up of various patients with syphilis."

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Preliminary Study on Protective Effect of Urovaxom^? in the Longterm Urinary Catheterized Patients: Jae Young Yoo, Bong Suk Shim, Hana Yoon; Korean J Urogenit Tract Infect Inflamm 2008;3(1):95-98. Published online April 30, 2008

Abstract PDF: "Purpose: Catheter associated urinary tract infections are a major health concern in chronic catheterizing patients due to the complications and frequent recurrence. In this study, we aimed to investigate the effect of conventional Urovaxom^? administration in chronic urinary cathterizing patients in respect of prevention of recurrent symptomatic urinary tract infections (UTIs). Materials and Methods: Subjects were adult male and female patients who have been catheterized for urinary drainage with any pathologic reason more than 1 month. Among 15 eligible patients 13 patients (2 males, 11 females) were enrolled to this study. Urovaxom^? was parenterally administered at least for more than 3 months. Before and after three months of drug administration urinalysis and urine culture tests were followed. Results: There were no significant adverse effects with Urovaxom^? administration during the study period. All of the 13 patients showed clearance of bacterial growth after taking Urovaxom^? eventhough some of them showed persistent microscopic hematuria or pyuria. Conclusions: UTIs and their associated complications are one of the bothering problems in chronic catheterizing patients. Urovaxom? showed positive effect in preventing UTIs recurrence in our small group study, eventhough further research will be required. Urovaxom^? administration will give beneficial effect in some selective patients with chronic catheterization."

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The Analysis of Urinary Tract Infection and Voiding Dysfunction of Patients Who Were Consulted from Neurosurgery Department to Urology Department: Hwancheol Son, Minyong Kang, Jungbum Bae, Sang Hyung Lee; Korean J Urogenit Tract Infect Inflamm 2008;3(1):99-103. Published online April 30, 2008

Abstract PDF: "Introduction: In general hospital, a lot of patients are consulted to one department from another. We analysed the patients who consulted from the Neurosurgery (NS) department to Urology department for various reasons. Material and methods: The clinical data of patients who consulted from the NS department to Urology department was analysed. And we analysed the results of urinalysis and urine culture data, and antibiotics resistance data. Results: Only 8.4% of neurosurgical patients were consulted to Urology department. In 40 patients, voiding difficulty was most common in 13 post-operative and 8 peri-operative patients. In nineteen cases who had no urinary tract infection (UTI), 5 showed UTI after neurosurgical procedure. Conclusions: Considering of high prevalence of voiding dysfunction and benign prostatic hyperplasia, very small proportion of neurosurgical patients were consulted to Urology department and the most of them had voiding failure during post-operative care. The education for neurosurgical surgeon about voiding dysfunction is needed for higher quality of patients care."

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Emphysematous Pyelonephritis in a Solitary Kidney Managed Successfully by Percutaneous Drainage: Yong Hwang, U Hyuk Jang, Dong Hun Yu, Kyung Han Kim, Joon Hwa Noh; Korean J Urogenit Tract Infect Inflamm 2008;3(1):104-107. Published online April 30, 2008

Abstract PDF: Emphysematous pyelonephritis is an uncommon serious suppurative infection chracterized by the production of intrarenal and perirenal gas and generally occurs in patient with diabetes mellitus or urinary tract obstruction. We report a case of emphysematous pyelonephritis treated successfully with percutaneous drainage in 67 year old diabetic woman with contralateral atrophic kidney and pneumonia. She has been treated with anticoagulant due to acute cerebral infarction.

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Idiopathic Retroperitoneal Fibrosis: Clinical Role of 18F-Fluorodeoxyglucose Positron Emission Tomography for Differential Diagnosis from Malignancy: Chang Seung Liu, Seung Hun Seol, Jong Wan Im, Moung Jin Lee, Yeon Won Park, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2008;3(1):108-115. Published online April 30, 2008

Abstract PDF: Retroperitoneal fibrosis sometimes causes urological problem involving the ureter, but the mechanism is uncertain. The most common treatment of retroperitoneal fibrosis is often a surgical exploration followed by urologic intervention, but medical therapy has been advocated recently. For medical therapy, there is necessary to exclude malignancy and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan may be an useful alternative tool to avoid invasive procedure including open biopsy. Here we report two patients who were undergone the FDG-PET scan to exclude malignancy and received successful treatment of retroperitoneal fibrosis with prednisolone.

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Bacteremia Caused by Acinetobacter Baumannii during the Treatment of Staghorn Calculi: Seung Il Jung, Kyung-Chul Son, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu; Korean J Urogenit Tract Infect Inflamm 2008;3(1):116-119. Published online April 30, 2008

Abstract PDF: Acinetobacter baumannii, a gram-negative, ubiquitous bacteria present in the soil, water and on the skin surface of human beings and animals, is responsible for bronchopneumonia and bacteremia in immuno- compromised and severely illed people, but rarely represents a problem in healthy individuals. We report a case of bacteremia due to Acinetobacter baumannii in a 45-year-old women who underwent percutaneous nephrolithotomy for staghorn calculi.

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Bilateral Genital Tuberculosis with Unusual Presentation: Donghoon Lim, Chul-Sung Kim; Korean J Urogenit Tract Infect Inflamm 2008;3(1):120-123. Published online April 30, 2008

Abstract PDF: Genital tuberculosis occurs in the epididymis most frequently but rarely involves the testis. Also, bilateral involvement of genital tuberculsis is rare. Diagnosis of tuberculous epididymitis and testicular involvement of tuberculosis can be challenging because they can be misdiagnosed as acute epididymitis and testicular tumor. Herein, we present a case of bilateral genital tuberculosis with unusual presentation which mimicked acute epididymitis and testicular tumor in a 72 year old male.

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Combination Therapy of Corticostreroid and Tamoxifen for Retroperitoneal Fibrosis: Hyoung Chul Park, Eun Suk Kim, Eun Hong Jung, Seok Heun Jang, Joung Hwan Son; Korean J Urogenit Tract Infect Inflamm 2008;3(1):124-128. Published online April 30, 2008

Abstract PDF: Retroperitoneal fibrosis is a rare disease in which dominantly inflammatory mass envelops and potentially obstructs retroperitoneal structures including ureters. The initial management of retroperitoneal fibrosis depends on the patient's clinical status. About an emergent condition of a patient, we must have a initial management like resolution of ureteral obstruction. Recently, after initial management, the medical therapy in patient with retroperitoneal fibrosis is prefered to the surgical therapy. In this case, we report a female patient who underwent successful treatment of a retroperitoneal fibrosis with combined corticosteroid and tamoxifen.

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The Concept of Neurogenic Inflammation: In Rae Cho, Sung Yong Cho; Korean J Urogenit Tract Infect Inflamm 2008;3(1):129-136. Published online April 30, 2008

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European and Asian Guidelines on Management and Prevention of Catheter-associated Urinary Tract Infections: Hana Yoon; Korean J Urogenit Tract Infect Inflamm 2008;3(1):137-147. Published online April 30, 2008

Abstract PDF: The urinary tract is the commonest source of nosocomial infection, particularly when the bladder is catheterised. A systematically reviewed guideline has been published by European association of Urology and Tenke et al. updated the guideline of catheter management. Most catheter-associated urinary tract infections (UTIs) are derived from the patient’s own colonic flora and the catheter predisposes to UTI in several ways. The most important risk factor for the development of catheter-associated UTIs is the duration of catheterization. The clinician should be aware of two priorities: the catheter system should remain closed and the duration of catheterization should be minimal. While the catheter is in place, systemic antimicrobial treatment of asymptomatic catheter-associated bacteriuria is not recommended, except for some special cases. Clinicians should always consider alternatives to indwelling urethral catheters that are less prone to causing symptomatic infection. In appropriate patients, suprapubic catheters, condom drainage systems and intermittent catheterization are each preferable to indwelling urethral catheterization.

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