Urogenital Tract Infection

Characteristics of Acute Bacterial Prostatitis in Korean: Seung Chol Park; Korean J Urogenit Tract Infect Inflamm 2013;8(1):1-6. Published online April 30, 2013

Abstract PDF: Prostatitis is the most common urological diagnosis in men younger than 50 years of age and the third most common urological diagnosis in men older than 50 years of age after two major prostatic diseases ? benign prostatic hyperplasia and prostatic cancer. Acute bacterial prostatitis is a rare disease that accounts for about 5% of prostatitis cases but is relatively easy to diagnose due to its clinical symptoms. This disease constitutes a urological emergence, with obvious signs and symptoms of a urinary tract infection, including dysuria, and urinary frequency. With acute bacterial prostatitis, patients often present with intense suprapubic pain, urinary obstruction, fever, malaise, arthralgia, and myalgia. The most frequent bacteria responsible for causing acute bacterial prostatitis include Escherichia coli, Enterococcus, Proteus, Pseudomonas, Klebsiella, and Serratia. Antimicrobial treatment should be initiated immediately in patients presenting with acute bacterial prostatitis. Initially, parenteral administration of high doses of antibiotics, such as a broad-spectrum penicillin derivatives, a third-generation cephalosporin with or without an aminoglycoside, or a quinolone, are required until the fever and other signs and symptoms of infection subside. After initial improvement, an oral regimen, in particular quinolone, is appropriate and should be prescribed for at least 4 weeks.

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Chronic Prostatitis/Chronic Pelvic Pain Syndrome: What Are the Starting and Worsening Factors?: Hong Chung; Korean J Urogenit Tract Infect Inflamm 2013;8(1):7-12. Published online April 30, 2013

Abstract PDF: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in the absence of any identifiable pathology such as cancer, curable infection, or anatomic abnormalities is defined as “urologic pain or discomfort in the pelvic region, associated with urinary symptoms and/or sexual dysfunction, lasting for at least 3 of the previous 6 months”. However, etiologic factors of CP/CPPS remain unknown. The traditional marker of inflammation, namely white blood cells in prostatic fluids, dose not correlate with the predominant symptom of pelvic pain. The role of normal bacterial flora in prostate in inciting the inflammatory response has also been reconsidered. Nanobacterial infection might be an important etiologic factor of type III prostatitis. An imbalance toward increased proinflammatory and decreased anti-inflammatory cytokines has been implicated, and its correlation with pelvic pain has also been observed to some extent. Pelvic pain also correlates with the neurotrophin (nerve growth factor) implicated in neurogenic inflammation and central sensitization. Finally, psychological stress may produce measurable biochemical changes and affect other processes. Here, the author reviewed the existing literature on etiology involved in the mechanisms of CP/CPPS.

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Asymptomatic Prostatitis: Clinical Significances and Management: In-Chang Cho, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2013;8(1):13-19. Published online April 30, 2013

Abstract PDF: Asymptomatic inflammatory prostatitis (National Institutes of Health, category IV) has been introduced as a separate clinical entity among other prostatitis syndromes. Asymptomatic inflammatory prostatitis is characterized by the presence of significant amount of leukocytes (white blood cells) in prostate-specific samples (post-prostatic massage urine, expressed prostatic secretion, semen, and prostate biopsy) but no subjective symptoms are found, and is therefore diagnosed solely in the laboratory. There have been many questions regarding the clinical role of asymptomatic inflammatory prostatitis and its impact on the management of prostate disease and sterility. This review presents the current definition of asymptomatic inflammatory prostatitis, summarizes the clinical evidence on the two important issues prostate specific antigen and pyospermia, and discusses the optimal approaches to reduce its confounding impact on prostate cancer screening and indiscriminate use of antibiotics.

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Infection in Patients Undergoing Transrectal Ultrasound Guided Prostate Biopsy: Seung Il Jung; Korean J Urogenit Tract Infect Inflamm 2013;8(1):20-26. Published online April 30, 2013

Abstract PDF: With the widespread popularity of prostate specific antigen testing, transrectal ultrasound (TRUS)-guided prostate biopsy has become a common urological procedure. The most common risks and complications associated with TRUS-guided biopsy include hematuria, hematospermia, and hematochezia. In addition, some patients develop urinary tract infections, acute bacterial prostatitis, bacteremia, and, eventually, urosepsis. Although it is commonly accepted that use of a prophylactic antimicrobial agent will lower the incidence of post biopsy infection, there is little consensus regarding the most appropriate antimicrobial regimens. Fluoroquinolone (FQ) was the best analyzed class, with higher numbers of studies and patients. According to recent data, occurrence of infectious complications after prostate biopsy has increased in recent years. Several recent studies have highlighted an increasing trend of infectious complications due to FQ resistant organisms among men undergoing TRUS guided prostate biopsy. TRUS guided prostate biopsy can result in significant morbidity, which is occurring at an increasing rate due to the increasing prevalence of FQ resistant Escherichia coli in rectal flora. Risk factors for harboring FQ resistant E. coli should be considered before prostate biopsy, and rectal swab screening cultures may provide useful evidence for selection of appropriate antimicrobials for prophylaxis and treatment of prostate biopsy-associated infections. The estimate of the incidence of sepsis following TRUS-guided prostate biopsy is low; however, the initial treatment of patients with prophylaxis failure and identification of antibiotic-resistant bacterial strains might be the most important means for prevention of urosepsis.

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Risk Factors of Infectious Complications after Transurethral Prostate Surgery in Patients with Preoperative Sterile Urine: Eu Chang Hwang, Seong Hyeon Yu, Jong Beom Kim, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park; Korean J Urogenit Tract Infect Inflamm 2013;8(1):27-31. Published online April 30, 2013

Abstract PDF: Purpose: To determine the risk factors of infectious complications after transurethral surgery of the prostate in patients with sterile urine.
Materials and Methods: A total of 183 patients who underwent transurethral resection of the prostate or holmium laser enucleation of the prostate were reviewed. All patients had urinalyses and urine cultures preoperatively, on the day of catheter removal, and at two weeks postoperatively. Patients were divided into two groups according to whether preoperative urinalysis showed sterile urine (group I, n=99) or not (group II, n=84). Clinical parameters were compared between the two groups. Univariate and multivariate logistic regression were used for estimation of infectious complications after surgery in group I.
Results: Compared with group II, group I showed younger age, fewer post voided residuals, low prostate specific antigen levels, short-term duration of oral antibiotic therapy, and low incidence of infectious complications (p＜0.05). In univariate analysis in group I, age, diabetes mellitus (DM), prostate volume, resection weight, and duration of oral antibiotic therapy showed an association with infectious complications (p＜0.05). Factors showing independent association with infectious complications in group I were DM (odds ratio [OR], 7.31; 95% confidence interval [CI], 1.83-29.0; p=0.005), resection weight (OR, 1.03; 95% CI, 1.01-1.06; p=0.039), and duration of oral antibiotics (OR, 0.64; 95% CI, 0.43-0.94; p=0.025).
Conclusions: Kinds of antibiotics showed no effect on infectious complication, therefore, second generation cephalosporin is recommended for reduction of antibiotic resistance. Clinicians should be aware of the high risk for infectious complication in patients with DM and who underwent large volume resection of the prostate.

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Effect of the Severity of Chronic Prostatitis Symptoms on Premature Ejaculation among Korean Males in Their 40-50s: Sung Bin Kim, Yoo Seok Kim, In-Chang Cho, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2013;8(1):32-37. Published online April 30, 2013

Abstract PDF: 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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Comparative Analysis between Top-Down and Down-Top Approach in Children with Febrile Urinary Tract Infection: Jae Hyun Ahn, Seung Chan Jeong, Sang Don Le; Korean J Urogenit Tract Infect Inflamm 2013;8(1):38-42. Published online April 30, 2013

Abstract PDF: 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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Outbreaks and Seasonal Variation of Mumps Orchitis: Report of Multicenter Data in Korea: Hoon Choi, Jae Hyun Bae, Seung Il Jung, Seung Ki Min, Tae Hyung Kim, Yong Gil Na, Gil Ho Lee; Korean J Urogenit Tract Infect Inflamm 2013;8(1):43-46. Published online April 30, 2013

Abstract PDF: Purpose: Mumps is an infectious viral disease that often results in painful swelling of testis preceded by parotitis. We report multicenter data on mumps orchitis from five community hospitals.
Materials and Methods: From January 2011 to December 2012, 98 patients diagnosed with acute mumps orchitis were treated at five community hospitals in different districts of Korea. As a report on an outbreak of mumps orchitis, age, bilaterality, monthly occurrence frequency, and vaccination status were recorded retrospectively.
Results: The mean age of the 98 patients was 19.7 (range from 10 to 38) years old. Age distribution of patients included 60 teens (61.2%), 31 in their twenties (31.6%), and seven in their thirties (7.2%). No evidence of a previous mumps vaccination was found in medical records from six patients (6.1%), and the vaccination status of one patient was unknown. Bilateral orchitis was noted in eight patients (8.2%), and 90 patients (91.8%) had unilateral orchitis. Right-sided orchitis was noted in 50 patients (51.0%), and left-sided orchitis was noted in 40 patients (40.8%). Autumn (September to November) was the most prevalent season, with 35 outbreaks (35.7%). Seasonal outbreaks occurred in 13 patients (13.2%) in spring (3rd- 5th), 24 patients (24.7%) in summer (6th-8th), and 26 patients (26.4%) in winter (12th-2nd).
Conclusions: In spite of continued vaccination, mumps orchitis is still a prevalent disease. Therefore, due to a large number of outbreaks, mumps orchitis should still be considered, especially in teenagers and during autumn season. Conduct of additional long-term follow-up and large prospective studies is needed in Korea.

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Comparison between Fournier’s Gangrene and Scrotal Abscess Using Fournier’s Gangrene Severity Index: Seung-Jea Shin, Dong-Soo Ryu; Korean J Urogenit Tract Infect Inflamm 2013;8(1):47-51. Published online April 30, 2013

Abstract PDF: Purpose: To evaluate effective factors in the survival of patients with Fournier’s gangrene (FG) and scrotal abscess, and to determine the validity of the Fournier’s gangrene severity index (FGSI), which was designed for determining disease severity in these patients.
Materials and Methods: Twenty-eight men who treated for FG were enrolled. The data were evaluated about medical history, extent of body surface area involved (%), and the FGSI, which index presents patients’ vital signs (body temperature, heart and respiratory rates) and metabolic parameters (serum sodium, potassium, creatinine, bicarbonate, hematocrit, and white blood cell count). All the patients had antibiotic treatment and radical surgical debridement. The data were assessed according to whether the patient of FG survived or died, and also compared in patients with scrotal abscess (n=26).
Results: Of the evaluated 28 FG patients, 6 died (21.4%). The difference in median age between survivors (57.5 years) and those who died (69.0 years) was not significant (p=0.18). Escherichia coli is the most common pathogen in 25% of FG and 15% of scrotal abscess patients. The median extent of the body surface area involved in patients who survived and died was 2.5% and 3.5%, respectively (p =0.13). However, the median FGSI scores for nonsurvivors and survivors of FG, and patients of scrotal abscess were 10.0±3.6, 3.3±2.6, and 0.9±2.6, respectively (p＜0.01). The heart rate and serum creatinine level at the admission were significant prognostic parameters in patients with FG.
Conclusions: The FGSI score appeared to be predicts the disease severity and the patient's survival in patients with FG and scrotal abscess.

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Synchronous Verrucous Carcinoma and Squamous Cell Carcinoma of Penis by Different Human Papillomavirus Infections: Yumi Seo, Gil Ho Lee; Korean J Urogenit Tract Infect Inflamm 2013;8(1):52-54. Published online April 30, 2013

Abstract PDF: Synchronous verrucous carcinoma and squamous cell carcinoma of the penis is a rare condition. We report on a case of penile carcinoma with a well demarcated and ulcerated endophytic squamous carcinoma lesion by human papillomavirus 16 and 61 types, and a whitish exophytic verrucous carcinoma lesion by an unknown lower risk human papillomavirus type.

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Xanthogranulomatous Inflammation of Urachus: Jeong Hyun Oh, Jae Min Chung, Seong Choi; Korean J Urogenit Tract Infect Inflamm 2013;8(1):55-58. Published online April 30, 2013

Abstract PDF: Urachal xanthogranuloma is an extremely rare disease. An 18-year-old male presented with lower abdominal pain, hematuria, and dysuria. An urachal mass with bladder invasion, which was suspected to be an urachal carcinoma or abscess, was observed on computed tomography. Exploratory laparotomy, excision of the urachus, and partial cystectomy was performed by way of a lower midline incision. Histopathologic examination identified the mass as an urachal xanthogranuloma.

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Renal Actinomycosis Accompanying Staghorn Calculi: Ki Soo Lee, Joon Yeop Jee, Young Eun Seo, Jin Sook Jeong, Won Yeol Cho; Korean J Urogenit Tract Infect Inflamm 2013;8(1):59-61. Published online April 30, 2013

Abstract PDF: 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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