Urogenital Tract Infection

Management of Candida Urinary Tract Infection in the Elderly: Sang Jin Kim, Jae Hyun Ryu, Yun Beom Kim, Seung Ok Yang; Urogenit Tract Infect 2019;14(2):33-41. Published online August 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.2.33

Abstract PDF: Candida urinary tract infections in elderly patients are becoming increasingly common. The risk factors for the development of candiduria include old age, use of broad-spectrum antibiotics, corticosteroids and indwelling urethral catheters, as well as diabetes mellitus, urological abnormalities, and hematological malignancies. The presence of signs and symptoms of infection are unusual, and the intensity of fungal growth in culture does not correlate with the outcome. Elderly patients often present with atypical signs and symptoms of infection. Careful assessment of the patient’s clinical status should be undertaken before treatment is initiated. The indications for antifungal therapy are the same for older and younger individuals, and the initial antifungal therapy should be selected based on the infecting organism and local epidemiology. Fluconazole is the mainstay of treatment. On the other hand, Candida glabrata is more common in elderly patients and is often refractory to fluconazole therapy. The selection of drug therapy for elderly patients should consider the comorbidities, risk of drug-drug interactions, and dose adjustment for physiological function.

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Risk Factor Associated with Recurrence after OM-89 (Uro-Vaxom^®) Treatment for Female Recurrent Cystitis: Ji-Yeon Han; Urogenit Tract Infect 2019;14(2):42-45. Published online August 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.2.42

Abstract PDF: Purpose: This study evaluated the risk factors associated with recurrence OM-89 (Uro-Vaxom^®) treatment for female recurrent cystitis.
Materials and Methods: The medical records of patients who received OM-89 for at least six months were reviewed retrospectively. Patients were excluded from the analysis if they had an abnormal lower urinary tract anatomy, residual urine volume ≥200 ml, a history of genitourinary tuberculosis, urological cancer or pelvic radiation, indwelling urinary catheter, or had genitourinary surgery within the previous six months. Patients were categorized into two groups: (1) no recurrence and (2) recurrent cystitis after OM-89. The risk factors in the two groups were compared. The recurrent cystitis was defined as two more infections in six months or three or more in one year.
Results: A total of 52 female were included. Group 1 had 35 (67.3%) patients and group 2 had 17 (32.7%) patients. Before and after the OM-89, the mean cystitis episodes for six months of groups 1 and 2 were 4.19±4.60 (range, 2-24) and 1.17±1.79 (range, 0-6), respectively, which were decreased significantly (p <0.001). For recurrence after the OM-89, the only risk factor was uncontrolled diabetes (fasting plasma glucose level >120 mg/dl±casual plasma glucose >180 mg/dl) (p=0.002). No significant differences in the age, menopause, daily water intake, hormone replacement therapy or history of extended-spectrum beta-lactamase-producing Escherichia coli were observed between the two groups.
Conclusions: OM-89 was effective in the management of recurrent cystitis in female. On the other hand, uncontrolled diabetes was a risk factor for treatment failure of OM-89.

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How Women Evaluate Syndromic Recurrent Urinary Tract Infections: Woong Bin Kim, Sang Wook Lee, Kwang Woo Lee, Jun Mo Kim, Young Ho Kim, Min Eui Kim; Urogenit Tract Infect 2019;14(2):46-54. Published online August 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.2.46

Abstract PDF: Purpose: To investigate the clinical manifestations of patients with the principal complaint of syndromic recurrent urinary tract infection (UTI), correlate these symptoms with the results of urine cultures, and identify the characteristics that can be used to differentiate UTI from similar diseases.
Materials and Methods: A total of 212 consecutive patients with syndromic recurrent UTIs over a 24 month period were evaluated. The major symptoms were recorded using the UTISA questionnaire and VAS. The patients were divided into group A (n=98; positive urine and urethral swab cultures) and group B (n=114; negative cultures), and the symptoms were compared. For group B, cystoscopy was used to diagnose 61 patients who complained of pain levels ≥6 on the VAS.
Results: The proportion of patients with the classic symptoms of UTI (dysuria, urinary frequency, lower abdominal discomfort during bladder filling, and urgency) was similar in groups A and B. Significantly more patients complained of urethral pain in group B, and significantly fewer patients had gross hematuria, low back pain, a post-voiding sensation of residual urine, and general symptoms compared to group A. Of the 61 patients with a VAS ≥6, 29, 28, and four were diagnosed with bladder pain syndrome, interstitial cystitis, and urethral pain syndrome, respectively.
Conclusions: In patients with syndromic recurrent UTI, the classic symptoms were not sufficiently characteristic to allow bacterial cystitis to be differentiated from other bladder diseases. Diagnostic cystoscopy and VAS can assist in making a differential diagnosis in patients with non-bacterial syndromic recurrent UTIs.

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Gabapentin for the Treatment of Chronic Pelvic Pain Syndrome in Patients with High Pain Score: Seok Cho, In-Rae Cho; Urogenit Tract Infect 2019;14(2):55-59. Published online August 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.2.55

Abstract PDF: Purpose: The underlying pathogenic mechanisms of chronic pelvic pain syndrome (CPPS) are unclear. A growing body of evidence suggests that the urogenital pain of CPPS may be neuropathic in origin. The objective of this study was to determine if gabapentin can be an effective treatment for the symptoms of CPPS with severe pain.
Materials and Methods: Thirty five males with CPPS (category IIIa 25, IIIb 10) and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total pain score ≥9 in the previous six months were enrolled in this study between October 2010 and December 2011. The dosage of gabapentin was increased from 300 mg/d to 600 mg/d during the first four weeks. The primary outcome was evaluated as an improvement in the NIH-CPSI from the baseline to week eight.
Results: This study examined 35 males with CPPS and a mean age of 54.2±9.8 years, mean disease duration of 34.2±27.7 months, and a mean prostate volume of 24.9±5.3 ml. The decrease in the total NIH-CPSI pain domain at four weeks was significant with no change observed after eight weeks. Between the category IIIa and IIIb CPPS patients, the change in the total pain domain was not significant.
Conclusions: Gabapentin may be effective in some males with CPPS who have a high pain score. More gabapentin may be useless and possibly harmful if gabapentin does not decrease the pain at four weeks.

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Recurrent Urinary Tract Infection from Urethral Mesh Erosion after Midurethral Mesh Sling Surgery: Ji-Yeon Han; Urogenit Tract Infect 2019;14(2):60-63. Published online August 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.2.60

Abstract PDF: This paper presents three cases of recurrent urinary tract infections from urethral mesh erosion after transobturator midurethral sling (MUS) surgery. The patients were operated on using a MUS with a mesh for stress urinary incontinence. A few years after surgery (0.3 to 7 years), patients complained of recurrent pain in the urethra with voiding symptoms. In all cases, urethrocystoscopy was performed and an erosion of the sling directly across the urethra was found. Patients were managed by dissecting the urethra and removing the mesh via the transvaginal approach under general anesthesia.

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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: What Is “Quality of Evidence” and Why Is It Important to Clinicians?’ (A Secondary Publication): Ho Won Kang, Jae Hung Jung, Do Kyung Kim, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Eu Chang Hwang, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation; Urogenit Tract Infect 2019;14(2):64-70. Published online August 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.2.64

Abstract PDF: This article is second translation of a GRADE series published in the BMJ to create a highly structured, transparent, and informative system for rating quality of evidence for developing recommendations. The process to develop a guideline, we should formulate a clear question with specification of all outcomes of importance to patients. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) offers four levels of evidence quality: high, moderate, low, and very low for these patient-important outcomes. Randomized trials begin as high quality evidence and observational studies as low quality evidence. Although randomized trials begin as high quality evidence, quality may be downgraded as a result of study limitations (risk of bias), inconsistency (variability in results), indirectness, imprecision (wide confidence intervals), or publication bias. While the quality of evidence derived from observational studies starts at ‘low’ but may be upgraded based on a very large magnitude of effect, a dose-response gradient, and if all plausible biases would reduce an apparent treatment effect.

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