Urogenital Tract Infection

General Review of UPOINT Concept on Prostatitis: Seung Il Jung; Korean J Urogenit Tract Infect Inflamm 2012;7(1):1-9. Published online April 30, 2012

Abstract PDF: "Traditional approach to manage chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has not been successful for many patients. There is no one unifying etiological mechanism or specific curative therapy for CP/CPPS. However, each of the proposed mechanisms may be important in some patients, and many of the treatments work in subgroups of patients. So, CP/CPPS patients are not a homogenous group, which suffers from a single disease entity, but rather a heterogeneous group of individual patients with widely different clinical phenotypes. Unique individuals with differing clinical phenotypes based on various etiological mechanisms with distinctive symptom complexes. A clinically practical phenotyping classification system for patients diagnosed with CP/CPPS has recently been proposed and validated in a CP/CPPS cohort. UPOINT is a 6-point clinical classification system that categorizes the phenotype of patients with CP/CPPS into one or more of 6 clinically identifiable domains: urinary, psychosocial, organ specific, infection, neurologic/systemic, and tenderness (muscle). It is proposed that patients be classified into one or more of these phenotypic domains, as a way to characterize them and direct specific therapy. There is a suggestion that phenotypically directed therapy will improve our clinical treatment outcomes."

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Functional Foods: Role in Disease Prevention and Health Promotion: Chang Hee Han; Korean J Urogenit Tract Infect Inflamm 2012;7(1):10-19. Published online April 30, 2012

Abstract PDF: The term, functional foods, was first introduced in Japan in the mid-1980s and it refers to processed foods that contain ingredients that aid specific bodily functions in addition to being nutritious. The Institute of Medicine's Food and Nutrition Board (IOM/FNB, 1994) defined functional foods as "any food or food ingredient that may provide a health benefit beyond the traditional nutrients it contains". This article reviews the literature for the primary plant and animal foods that have been linked with physiological benefits. Although a plethora of biologically-active compounds have been identified in this regard, this review focuses on foods, rather than specific compounds isolated from foods.

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The Efficacy of Extracorporeal Shock Wave Therapy in Genitourinary Disease: Present and Future: Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2012;7(1):20-28. Published online April 30, 2012

Abstract PDF: Extracorporeal shock wave therapy (ESWT) is an effective, safe, and non-invasive modality for pain relief and tissue regeneration. Because, ESWT is used on various medical areas and many diseases, but its use is limited on genitourinary disease, except urinary stone. However, many studies about efficacy of ESWT in chronic prostatitis, Peyronie's disease, and erectile dysfunction are published recently. Many people are suffering from these diseases all over the world, but these diseases are difficult to treat effectively by previous therapy, so ESWT will be able to be an alternative treatment for them. Of course, the physiology of ESWT is not confirmed to be a standard treatment scientifically, therefore it is necessary to make a greater effort to investigate it.

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Selection of Antibiotics According to the Costs and Efficacy of Empirical Antibiotics Therapy for Extended Spectrum Beta-Lactamase Producing Uropathogens from Urine Culture Test in Patients with Acute Uncomplicated Cystitis: Se Jun Park, Jae Hyung Ryu, Sang Ho Park, Jung Won Choe, Sang Hyup Lee, Jung Hoon Kim, Kyung Do Kim, Tae Hyoung Kim, Mi-Kyung Lee; Korean J Urogenit Tract Infect Inflamm 2012;7(1):29-35. Published online April 30, 2012

Abstract PDF: "Purpose: The usage of antibiotics on urinary tract infection is high, thus, there is a high chance of acquiring resistance towards antibiotics. Followed by the usage of restricted antibiotics, the emergence of multiple drug resistant pathogens, such as ESBL producing pathogens, is frequently being reported, and the increase of resistant pathogens leads to the increase of medical treatment costs. An effective system of management and observation is needed for this. ESBL is an enzyme produced by gram-negative bacterium, which has beta-lactam rings, that restricts the effectiveness of penicillins and cephalosporins. Such antibiotics have been used as empirical antibiotics for acute cystitis. The effects of ESBL producing pathogens in patients on the curative effectiveness of empirical antibiotics are to be identified and appropriate antibiotics will be selected, according to the results with consideration to the cost. Materials and Methods: From the 4727 patients who have been diagnosed with cystitis between January 2000 and 2011 March, through urine culture test, 81 acute uncomplicated cystitis patients with ESBL producing pathogens were confirmed and their medical records were examined for this study. For 3~7 days empirical antibiotics, such as quinolone (ciprofloxacin / levofloxacin), cephalosporin (1st generation- cefroxadine / 2nd generation- cefprozil / 3rd generation- cefpodoxim, cefdinir), penicillin (amoxicillin-clavulanic acid), trimethoprim-sulfamethoxazole, were used and the curative effects were confirmed through urine culture test, with the improvements on the initial symptoms. For each antibiotic, the average medical insurance cost of domestic market as of May 2011 was applied and calculation was done after averaging for 3 days. Results: In urinalysis of 81 patients (age 44.89±17.42, 17~64), pyuria was confirmed in the urine of 79 patients (97.5%) and microscopic hematuria was confirmed in the urine of 17 patients (21.0%). In urine culture test, Escherichia coli was cultured in the urine of 79 patients (97.5%) and Klebsillea pneumonia was cultured in the urine of 2 patients (2.5%). Thirty three patients (40.7%) complained of suprapubic pain, 55 patients (67.9%) of urodynia, 69 patients (85.2%) of frequent urination and 37 patients (45.7%) of urgent urination. After taking antibiotics, not including 6 patients who have not returned, there were improvements in urine culture test and symptoms in all patients. In the reexamination of urine culture test, no significant pathogens were found. According to the cost, the cost was the cheapest in the order of trimethoprim-sulfamethoxazole (160/800mg, twice a day, 3 day therapy, 378 won), amoxicillin-clavulanic acid (250/125mg, three times a day, 3 day therapy, 3019.5 won), and ciprofloxacin (250mg, once a day, 3 day therapy, 3563.4 won). Conclusions: Even if ESBL producing pathogens were found in urine culture test of acute uncomplicated cystitis patient, curative effectiveness can be expected by just taking empirical antibiotic. In concerning the objective of this study as well as the efficacy and the cost, the most appropriate primary antibiotic is trimethoprim/sulfamethoxazole. The acute uncomplicated cystitis caused by ESBL producing pathogen has the same curative effects of antibiotics of the study, having no relations with the antibiotic sensitiveness. Therefore, the empirical antibiotic with no abnormal reactions, cheap cost and short duration of treatment should be selected for the therapy."

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The Risk Factors of Urinary Tract Infection with Fever after Transrectal Ultrasonography Guided Biopsy of Prostate: Hyeon Ju Kim, Young-Joo Kim, Jung-Sik Huh; Korean J Urogenit Tract Infect Inflamm 2012;7(1):36-42. Published online April 30, 2012

Abstract PDF: "Purpose: Recently, incidence of prostatic cancer has increased due to the development of the prostatic cancer screening test. The common procedure is the transrectal technique, whereby following prophylactic antibiotics, a core biopsy needle is passed through the rectum. Complications of prostate biopsy are perineal tenderness, hematuria, hematospermia, rectal bleeding, fever and sepsis. We estimated the risk factors and pathogens of urinary tract infections after transrectal ultrasound guided biopsy of prostate. Materials and Methods: A retrospective chart review was conducted of patients, who had been treated for urinary tract infection (UTI) after 365 prostatic biopsy between January 2009 and January 2012. We analyzed the parameters including past medical history, kind of antibiotics, number of biopsies, pathology, urine culture and blood culture. Results: Hematuria was most common (5.4%), while UTI occurred in 4.9% of the cases. The symptoms of UTI were dysuria and fever. Average admission day was 6.2 days. E. coli was identified in 7 patients. It was observed that higher numbers of biopsies correlated with UTI. The other conditions investigated didn't correlate with complications after biopsies. Conclusions: We considered that UTI was a rare complication of prostatic biopsy and complications after biopsy were low. A higher number of fragments taken during biopsies showed a correlation with UTI. "

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Can Betadine Gauze Compression Be Decreased Significant Complications after Prostate Needle Biopsy under Transrectal Ultrasound at Outpatient Department?: Single Clinician’s Experience: Hong Chung, Hong Sup Kim, Sang-Kuk Yang; Korean J Urogenit Tract Infect Inflamm 2012;7(1):43-49. Published online April 30, 2012

Abstract PDF: "Purpose: Recently, the number of patients undergoing prostate biopsy has increased due to the development of cancer screening test with prostate specific antigen. Prostate needle biopsy under transrectal ultrasound (Bx-TRUS) is the standard procedure to diagnose prostate cancer. We evaluated the incidence of significant infectious and bleeding complications performed by a single urologist with unique methods of betadine gauze compression after Bx-TRUS. Materials and Methods: We retrospectively evaluated the medical records of 299 patients, who underwent Bx-TRUS, from March 2007 to December 2011. All patients received oral levofloxacin 500mg for 4 days. Significant complications, related to infection with fever and persistent rectal bleeding, were evaluated within 4 weeks after biopsy. Patients who presented infectious complications were treated with intravenous ceftriaxone 2.0gm for 5 or 7 days. Patients who present significant anal bleeding were managed with primary closure by colorectal clinic in the department of surgery. Results: Among 299 patients, 4patients (1.3%) developed post-biopsy infections and hemorrhage. Those major complications were catergorized as acute prostatitis (2 patients, 0.7%) and rectal bleeding (2 patients, 0.7%). Of the 2 cases with post-biopsy infection, 1 case (Escherichia coli) had positive urine and blood culture. E. coli was sensitive to cephalosporine, but was resistant to fluoroquinolone. Conclusions: The results of this study suggest that betadine compression after Bx-TRUS may play the role of decreasing or preventing the significant complications, such as febrile infections and persistent rectal bleeding. Further, well designed study is needed to evaluate the clinical implication of betadine gauze compression after Bx-TRUS."

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Trial for Clinical Guideline of the Use of Prophylactic Antibiotics in Pediatric Urologic Outpatient Surgery: Hyung Jong Nam, Seung Chan Jeong, Mi Yeon Kong, Keum Seob Lee, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2012;7(1):50-55. Published online April 30, 2012

Abstract PDF: "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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Risk Factors for Elevation of Prostate-Specific Antigen in Acute Prostatitis: Jun-Mo Kim, Eui-Sang Lee, Kwang-Woo Lee, Young-Ho Kim, Min-Eui Kim; Korean J Urogenit Tract Infect Inflamm 2012;7(1):56-62. Published online April 30, 2012

Abstract PDF: "Purpose: To evaluate the influence of risk factors for elevation of prostate-specific antigen (PSA) in acute prostatitis. Materials and Methods: This retrospective study examined the records of 93 patients with acute prostatitis from March 2002 to July 2011. These patients were divided into two groups into high PSA group (77 patients, 82.8%) and normal PSA group (16 patients, 17.2%). We evaluated clinical factors, including voiding symptoms, co-morbidity, laboratory test for general and local inflammation, prostate size and result of urine culture. Results: The positive culture rate was 38.7%, and E. coli was the most common organism (66.7%). The only significant risk factor correlated with the elevation of PSA was the size of the prostate (40.0±21.7gm Vs 26.2±7.2gm)(p=0.003). The other clinical factors were not significantly correlated with the elevation of serum PSA. Conclusions: The only clinical factor for elevation of PSA was the prostate size. However, because the prostate size in acute inflammatory period would reflect both the usual prostate size and acute swelling by edema, influence of local inflammation could not be clearly excluded."

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Memokath Stent Insertion for the Management of Bilateral Ureteral Obstructions from Retroperitoneal Fibrosis: Phil Hyun Song, Yoon Seob Ji, Jong Min Kim, Hee Chang Jung; Korean J Urogenit Tract Infect Inflamm 2012;7(1):63-67. Published online April 30, 2012

Abstract PDF: Retroperitoneal fibrosis is a rare disease characterized by the presence of a retroperitoneal tissue, consisting of chronic inflammation and marked fibrosis, which often causes ureteral obstruction. Surgical approach is necessary to preserve the renal function, and this is achieved by ureteral stent. The Memokath stent is a new thermo-expandable shape-memory metallic stent. Herein, we report our recent experience of a patient with retroperitoneal fibrosis, which involves bilateral ureter, who underwent successful bilateral Memokath stent insertion.

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Tuberculosis Infected Multiple Genitourinary System: Jae Young Choi, Sung Bin Kim, Yu Seok Kim, Ji Yun Pae, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2012;7(1):68-72. Published online April 30, 2012

Abstract PDF: Genitourinary tuberculosis is the most common manifestation of an extrapulmonary tuberculous infection. A 54 year old patient was presented with a painful & swelling right testicular mass and left flank pain. Under the clinical diagnosis of right testicular tuberculosis along with left kidney, ureter, bladder tuberculosis, a right orchiectomy and left double J stenting, as well as endoscopic bladder biopsy were performed. The radiological and pathological diagnosis revealed testicular tuberculosis, with involvement of the left kidney, ureter and bladder.

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Ureterosigmoidal Fistula Complicated by Crohn's Disease: Jeong Hyun Oh, Jae Min Chung, Seong Choi; Korean J Urogenit Tract Infect Inflamm 2012;7(1):73-76. Published online April 30, 2012

Abstract PDF: We report a case of ureterosigmoidal fistula in a 38 year-old-man with Crohn's disease, who was presented with pneumaturia and feces in urine. Computed tomography showed a fistula between the right ureter and the sigmoid colon, which was successfully managed with right transureteroureterostomy.

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Essay: Tackling Antibiotic Resistance: Korean J Urogenit Tract Infect Inflamm 2012;7(1):77-80. Published online April 30, 2012

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Compicated Urinary Tract Infection due to Urologic Diseases: European Urology Association Guideline: Seung Bae Lee, Hwancheol Son; Korean J Urogenit Tract Infect Inflamm 2012;7(1):81-87. Published online April 30, 2012

Abstract PDF: A complicated urinary tract infection (UTI) is an infection associated with a condition, such as a structural or functional abnormality of the genitourinary tract, or the presence of an underlying disease that interferes with host defence mechanisms, which increase the risks of acquiring infection or of failing therapy. A broad range of bacteria can cause a complicated UTI. The spectrum is much larger than in uncomplicated UTIs and bacteria are more likely to be resistant to antimicrobials, especially in a treatment related complicated UTI. Enterobacteriaceae are the predominant pathogens, with Escherichia coli being the most common pathogen. However, non-fermenters (e.g. Pseudomonas aeruginosa) and Gram-positive cocci (e.g. Staphylococci and Enterococci) may also play an important role, depending on the underlying conditions. Treatment strategy depends on the severity of the illness. Treatment encompasses three goals: management of the urological abnormality, antimicrobial therapy, and supportive care when needed. Hospitalization is often required. To avoid the emergence of resistant strains, therapy should be guided by urine culture whenever possible. If empirical therapy is necessary, the antibacterial spectrum of the antibiotic agent should include the most relevant pathogens. A fluoroquinolone with mainly renal excretion, an aminopenicillin plus a β-lactam inhibitor (BLI), a Group 2 or 3a cephalosporin or, in the case of parenteral therapy, an aminoglycoside, are recommended alternatives (LE: 1b, GR: B). In case of failure of initial therapy, or in case of clinically severe infection, a broader-spectrum antibiotic should be chosen that is also active against Pseudomonas, e.g. a fluoroquinolone (if not used for initial therapy), an acylaminopenicillin (piperacillin) plus a BLI, a Group 3b cephalosporin, or a carbapenem, with or without combination with an aminoglycoside. The duration of therapy is usually 7-14 days (LE: 1b, GR: A), but has sometimes to be prolonged for up to 21 days. Until predisposing factors are completely removed, true cure without recurrent infection is usually not possible. Therefore, a urine culture should be carried out 5-9 days after the completion of therapy and also 4-6 weeks later.

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