Urogenital Tract Infection

Urinary Tract Infection and Bladder Dysfunction in Children: Sungchan Park, Kun Suk Kim; Korean J Urogenit Tract Infect Inflamm 2008;3(2):149-161. Published online October 31, 2008

Abstract PDF: Recognition that bacteriuria may cause renal parenchymal and functional loss has prompted recommendations for rapid diagnosis and evaluation of urinary tract infection (UTI). Rapid recognition of a UTI and rapid and appropriate treatment with antibiotics are important to prevent renal damage. The goal of UTIs management in children is based on identifying and modifying factors that may increase risk of renal parenchymal and functional loss. Various factors for UTI in children appear to be distinct for each individual and should be evaluated to find associated disease. Symptoms of nocturnal and diurnal incontinence are common in children with recurrent UTIs. Urodynamic study in neurologically normal children with recurrent UTI and incontinence has shown abnormal cystometry and voiding pattern. Bacteriuria or constipation may provoke abnormal detrusor-sphincter activity or vice versa. There is an important relationship between constipation, detrusor instability, reflux, UTI, and enuresis. Overall approach and management in children with UTI and bladder dysfunction should therefore be needed.

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Urinary Tract Infections and Bacteriuria in the Elderly: Diagnosis and Treatment: Duk Yoon Kim; Korean J Urogenit Tract Infect Inflamm 2008;3(2):162-167. Published online October 31, 2008

Abstract PDF: The elderly population is now increasing in the world. A higher incidence of bacteriuria and urinary tract infection (UTI) is observed in the elderly patients, in both long-term care facilities and at home. The management of elderly patients with UTI is increasing in clinical significance. Bacteriuria (≥ 105 CFU/ml) is a very common phenomenon in the elderly people, occurring twice as frequently in women than in men. Almost all of UTI in the elderly is complicated UTI. Control of the underlying diseases in the urinary tract is quite important in the management of UTIs in the elderly patients. For pyelonephritis, switch therapy using aminoglycosides and fluoroquinolones, carbapenems, third-generation cephalosporines, or penicillins are selections of choice. The recommended duration of treatment for patients with pyelonephritis is 14 days. Seven to 10 days of treatment using fluoroquinolones or trimethoprim-sulfamethoxazole is recommended for the treatment of elderly patients with symptomatic cystitis. There are symptomatic and asymptomatic types of bacteriuria. Although asymptomatic bacteriuria is quite common in the elderly population, antibiotic treatment has no benefit for such patients. Intravaginal estrogen replacement is one of choice for the prevention of recurrent UTIs in postmenopausal women.

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Complementary and Alternative Therapies for the Treatment and Prevention of Urinary Tract Infection in the Elderly: Bong Suk Shim; Korean J Urogenit Tract Infect Inflamm 2008;3(2):168-177. Published online October 31, 2008

Abstract PDF: "Urinary tract infection (UTI) and asymptomatic bacteriuria are common in the elderly population. Bacteriuria increases with age, is more common in institutionalized or hospitalized patients than in those living at home. In the elderly patients, the atypical presentation of UTIs make diagnosis and treatment more difficult. Further urologic investigation should be considered in the elderly patients with reinfection and long-term suppressive therapy may be necessary. There is, unfortunately, no ideal antibiotic to treat and prevent urinary tract infection in the elderly. A comprehensive integrative management strategy for UTIs in the elderly includes both conventional and complementary and alternative therapies. Historically, natural remedies were used for a variety of medical problems and are helpful to UTIs, relieving discomfort, encouraging recovery and prevention. Although natural remedies are being studied for UTIs, it is important to seek medical attention and not self-medicate. This review concerned complementary and alternative therapies commonly using for UTI in the elderly and focused in detail on those with published data."

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Male Circumcision and Sexually Transmitted Infection: In Rae Cho, Soung Yong Cho; Korean J Urogenit Tract Infect Inflamm 2008;3(2):178-184. Published online October 31, 2008

Abstract PDF: Recently the male circumcision becomes a hot issue not only in abroad but especially in Korea. Under this circumstance, it will be right that doctors and scholars restart to study about the merits and demerits of male circumcision. There is no clear answer yet about its advantages and disadvantages in sexual transmitted disease. The only issue is that WHO and UNAIDS admit the male circumcision as significant precautionary measure against HIV after finishing a large scale study. However it will be difficult to follow the Western statistics impetuously since the course of diffusion of HIV is different from USA, and there is no any study in Korea about the merits and demerits of male circumcision. Therefore we conclude that it will be a impetuous assertion to argue that the male circumcision should be done before the adolescence, before starting an active sexual life, without any countermeasure.

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Applications and Limitations of Polymerase Chain Reaction in Sexually Transmitted Disease: Kwang Woo Lee, Young Ho Kim; Korean J Urogenit Tract Infect Inflamm 2008;3(2):185-193. Published online October 31, 2008

Abstract PDF: Sexually transmitted diseases (STDs) are one type of important infectious diseases in patients who suffer from the genitourinary tract infections. Screening and detecting STDs is a form of secondary prevention, which interrupts further transmission as well as progression of the infection and its sequelaes. In an effort to better diagnose, treat, and control STDs, a number of new diagnostic assays using molecular techniques have been developed. Improved diagnostic testing by means of polymerase chain reaction (PCR) testing is now commercially available and may increase diagnostic capability. PCR has resulted in revisions of the proportion of STDs that are asymptomatic, and has increased measured prevalence of some STDs, notably. As a consequence of these molecular tools, the diagnostic repertoire of the clinical laboratory for the diagnosis of STDs will expand significantly, allowing investigators to better diagnose and more effectively control the spread of STDs. However, with such new technology, new problems and challenges have arisen, such as the risk of sample contamination resulting in false-positive results, and the presence of inhibitors resulting in false-negative results.

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Chemopreventive Effect of Aspirin on the Prostate Cancer: Bong Suk Shim, Hana Yoon; Korean J Urogenit Tract Infect Inflamm 2008;3(2):194-198. Published online October 31, 2008

Abstract PDF: "Purpose: Aspirin, which widely being used in prevention of cerebrovascular or cardiovascular disease also has cancer preventive effect in the colon, esophagus, and bladder. In this study, we aimed to investigate its preventive effect in the prostatic tissue in respect of inflammation and malignancy. Materials and methods: From January 2004 to December 2007, 164 patients who had been done prostatic biopsy either due to high PSA (4ng/dL), digital rectal examination, or transrectal ultrasonography were included to this study. They were devided into three groups according to their duration of aspirin medication; group A (not medicated at all, N=74), group B (less than 5 years of medication duration, N=60), and group C (5 or more than 5 years of medication duration, N=28). Serum PSA, prostate volume, and positive yielding rate of transrectal biopy were analyzed. Results: Mean age of each group was 69.23 (A), 70.78 (B), 67.05 (C) years old (p>0.05). Mean prostatic volume was not significantly different in each group (42.48, 43.72, and 41.97gm, respectively, p>0.05). However, the positive yielding rate was significantly lower in group C (3.5%) rather than group A (38.1%) or group B (31.6%) (p<0.05). Logistic regression analysis of the effect of the duration of aspirin medication to positive yielding rate of prostatic cancer showed significantly decreased incidence of positive rate of prostatic cancer in patients with 5 year or longer duration of medication (OR=0.72; 95% CI 0.35~1.50 vs. OR=0.06; 95% CI 0.01~0.48). Conclusion: This study supports the cancer preventive effect of aspirin. Lower incidence of positive rate in the patients who take aspirin over 5 years or longer, shows that the prolonged medication of aspirin may protect the development of prostate cancer."

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The Influence of Past History of Prostatitis on the Risk Factor of Prostate Cancer: Sung Yong Cho, Hyun Dong Song, In Rae Cho; Korean J Urogenit Tract Infect Inflamm 2008;3(2):199-203. Published online October 31, 2008

Abstract PDF: "Purpose: The study is carried out to investigate the influence of chronic prostatitis history on the risk factor of prostate cancer. Materials and methods: The investigation was proceeded with 64 patients diagnosed with prostate cancer through prostate biopsy from 2003 to 2006. We have surveyed the past history of prostatitis of the prostate cancer patients by a questionaires. The existence and nonexistence of past history of prostatitis divided the prostate cancer patients into two groups. We compared the differences between the groups of prostate cancer patients with the gleason score, clinical stage, prostate volume, protate specific antigen (PSA), prostate specific antigen density (PSAD), node invasion and metastatic lesion. Results: There were 15 patients (23.4%) among prostate cancer patients. In case of prostate cancer patients with past history of prostatitis, the mean age was 73.7±7.4, prostate volume 50.4±27.2ml, PSA 91.8±125.5 ng/ml, PSAD 1.8±2.8, respectively. The number of patients without past history of prostatitis were 49 and the mean age was 74.7±5.3years, prostate volume 43.2±20.4ml, PSA 33.9±46.1ng/ml and PSAD 0.7±0.8. There was significant difference in PSA and PSAD, but in the other factors were not. With Gleason score, clinical stage, node invasion and metastasis, there was no significant difference respectively. Conclusion: Our study demonstrates that the past history of prostatitis in prostate cancer patients increases the PSA. The past history of prostatitis may have influence on the PSA, and it can cause for confusion with the prognostic evaluation of prostate cancer."

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Comparison of Prostatic Biopsy Results according to Patterns of Prostate Specific Antigen after Antibiotic Therapy in Chronic Prostatitis Patients: Hong Koo Ha, Sung Woo Park, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2008;3(2):204-209. Published online October 31, 2008

Abstract PDF: "Purpose: We investigated the prostatic cancer rate according to patterns of PSA after antibiotics medication. Materials and Methods: Ninety-five patients with lower urinary tract symptoms (LUTS) and pyuria were treated with quinolone. Pyuria defined as more than 5 WBC/HPF in expressed prostatic secretion or VB3. We evaluated serum PSA level before and after antibiotic treatment and prostatic biopsy results in patients without decreased PSA under 4ng/ml. We compared prostatic cancer rate between 23 patients with decreasing PSA but above 4ng/ml (group A) and 22 patients without decreasing PSA than premedication (group B). Results: Of the 96 patients, 51 patients (53.1%) demonstrated serum PSA decreased lower than 4ng/ml. The remaining 45 patients were underwent prostate biopsy and prostatic cancer was found in 6 patients. Mean age and mean prostate volume in group A and group B were 61.4±12.7years, 61.9±10.4years (p=0.702) and 32.0±8.7gm, 31.7±5.6gm (p=0.532), respectively. Mean serum PSA before and after treatment were 7.84±2.97 ng/ml, 8.05±3.62ng/ml (p=0.246) and 4.53±2.33ng/ml, 8.55±3.25 (p=0.042) in group A and B, respectively. Positive predictive value for prostatic cancer increased from 0.063 to 0.133 in pretreatment and posttreatment patients (p=0.644) and from 0.043 to 0.227 in group A and B, respectively (p=0.039). Conclustions: Antibiotic treatment can decrease the serum PSA for chronic prostatitis and improve positive predictive value for prostatic cancer. Therefore we should consider prostate biopsy in patient without decreasing PSA after antibiotic medication."

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Isolation of Methicillin-Resistant Staphylococcus aureus from the Urinary Tract: Clinical Characteristics and Antimicrobial Resistance: Lim Dong Hoon, Moon Hyoung Yoon, Rho Joon, Kim Cheol Sung; Korean J Urogenit Tract Infect Inflamm 2008;3(2):210-216. Published online October 31, 2008

Abstract PDF: "Purpose: In specific patient populations, Staphylococcus aureus can be an important primary urinary pathogen. However, the significance of staphylococcal bacteriuria is uncertain. In present study, clinical characteristics and antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) bacteriuria were evaluated Materials and Methods: We performed antimicrobial susceptibility test of 50 MRSA stains isolated from urine in Chosun University Hospital from May 2007 to August 2008 and analysed clinical chracteristics of 50 cases with MRSA bacteriuria, retrospectively. Results: Among 1209 stains isolated from urine, 50 stains were MRSA showing 5.1%. Of 50 patient, 62% had undergone recent urinary catheterization and 94% was long-term care patients. Forteen of patients had symptomatic urinary tract infection at the time of initial isolation of MRSA, and 2% was bacteremic. 23.2% of asymptomatic patients had undergoing MRSA pneumonia or MRSA wound infection treatments. Asymptomatic patients had follow-up culture data; 55.8% of cultures was positive for MRSA (median duration of MRSA bacteriuria, 3.2months). However, nobody had subsequent staphylococcal infections. 20.9% were negative for MRSA at additional cultures. According to in vitro susceptibility test, habekacin, vancomycin, quinupristin-dalfopristin, trimethoprim-sulfamethoxazole, nitrofurantoin, linezolid, teicoplanin, rifampicin showed relatively higher sensitivity. Conclusions: In some cases with MRSA bacteriuria, MRSA was a cause of urinary tract infections that cause some symptoms or bacteremia. MRSA could be isolated by reason of bacteremia from infection of other organs, colonization, or contamination. Therefore, it seems that an active observation of symptoms or repetitive urine cultures should be done, to make a difference. And antimicrobial susceptibility test is necessary, because the rate of MRSA and the resistance of MRSA are increasing."

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Clinical Analysis of Fournier's Gangrene 9 Cases: Jung Dam Gim, Ki Ho Kim; Korean J Urogenit Tract Infect Inflamm 2008;3(2):217-222. Published online October 31, 2008

Abstract PDF: "Purpose: Fournier's gangrene is a rare and rapidly progressive infection of the genitalia, perineum, and abdominal wall. The mortality rate from this infection ranges from 0 to 67 percent. One of the most important determinants of the overall outcome is early recognition and extensive surgical debridement combined with broad-spectrum antibiotics therapy. The aim of this study was to review the clinical outcomes of 9 consecutive patients who suffered with Fournier’s gangrene and the related medical literature to highlight the current status of this disease. Materials and methods: We retrospectively reviewed the medical records of 9 patients with the Fournier’s gangrene who had been treated at Dong-guk University Hospital between March 1999 and December 2007. Results: The mean age was 60 years (range: 38~82), and the male to female ratio was 8:1. The most common cause of Fournier’s gangrene was perianal abscess (n=6, 66.6%) and the most common disease associated with Fournier’s gangrene was diabetes mellitus (n=5, 55.5%). The most common cultured organisms were K pneumoniae and E. coli. We performed aggressive surgical debridement combined with broad spectrum antibiotics therapy. The potential ports of entry for the causuative bacteria were anorectum (66%), urinary tract (22%) and skin (11%) The number of surgical procedures per patient ranged between 1 and 7 (mean: 3.54). Diverting colostomy was required in 22.2% (n=2) of the cases. One of them had multiple debridement at the thigh. Suprapubic cystostomy and both orchiectomies were performed in 1patient, respectively. One patient died due to sepsis. Conclusions: Fournier’s gangrene is a life-threatening disease, but the mortality rate can be diminished via early diagnosis and aggressive surgical intervention. And the use of broadspectrum antibiotics is mandatory. "

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Analysis of Renal and Perinephric Abscesses: with Treatment as the Center: Soo Dong Kim, Jae Jin Kwak, Chan Wook Shin, Won Yeol Cho; Korean J Urogenit Tract Infect Inflamm 2008;3(2):223-227. Published online October 31, 2008

Abstract PDF: "Purpose: The objective was to analyze the renal and perinephric abscesses with treatment as the center. Patients and methods: The medical records of 47 patients with renal and prinephric abscesses treated at our hospital from January 1990 to December 2007 were reviewed. The data collected included underlying conditions, size and multiplicity of abscess, cultured organisms, associated disease and treatment method. Results: The mean age of the patients was 47.7 years old (4~84), and men and women were 12 and 35 cases, respectively. In 24 cases the abscess were happened in right kidney, and bilateral cases were 4 cases. Multiple abscess were 11 cases, and the size of abscess was variable from 1cm to 6cm. Below 4cm size of abscess were 25 cases, and beyond 4cm size of abscess were 22 cases. Diabetes mellitus (31.9%), hypertension (17.0%) and urolithiasis (12.8%) were the most common underlying conditions and 11 cases were multiple. The abscess size of twenty-five cases were less than 4cm. Pyuria were found in 29 (61%) and causative organisms were found in 17 cases. The most common organisms are E. coli. Interventional treatments were performed in 23 cases: surgical drainage (1 case), percutaneous drainage (13 cases), nephrectomy (9 cases). Among the percutaneous drainage, nephrectomy was done in 2 cases. Open surgery was performed in cases that associated urologic disease existed, abscesses were multiple and abscess size was more than 4cm. The interventional treatment was decreased after 2000 year. Conclusions: Renal and perinephric abscesses are successfully managed by medical treatment. But for more good results, we considered underlying conditions, size and multiplicity of abscess."

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Renal Abscess and Perirenal Abscess: Single Center Experience: Hosup Kwak, Sunghyup Choi, Jaeil Chung, Kweonsik Min, Dong-il Kang; Korean J Urogenit Tract Infect Inflamm 2008;3(2):228-235. Published online October 31, 2008

Abstract PDF: "Purpose: To compare the differences between renal abscess and perirenal abscess in causes, clinical courses, treatment method and their outcome. Material and methods: From January 2001 to July 2008, we retrospectively reviewed the medical records of 66 patients who were diagnosed and treated for renal and perirenal abscess at our center. Seventy-one kidneys were involved. Renal and perirenal abscess were 40 and 31 cases, respectively. We divided 2 groups and analyzed patients characteristics, symptoms, underlying diseases, pathogenic organisms, abscess size, treatment duration, and clinical outcome. Results: The average age of the patients was 47.9 years and female was predominant (M:F=1:2.9) (p= 0.0009). Diabetes mellitus (33.8%), liver cirrhosis (19.7%) and kidney diseases (19.7%) were the most common predisposing factors. Diabetes mellitus was more frequently combined with perirenal abscess group (p=0.0419). The symptom-diagnosis duration and hospitalized period of perirenal abscess group were longer than those of renal abscess group (13.5±14.9 vs 8.3±9.9days and 26.5±21.1 vs 13.5±14.9 days; p=0.0823 and 0.0005, respectively). Escherichia coli, Staphylococcus aureus, Klebsiella pneumonia were common pathogens in two group. The mean size of the renal and perirenal abscess were 2.85cm (range 1~7.7) and 5.84cm (range 1.5~13) (p<0.0001). Most of the renal abscesses received only antimicrobial agents (75%) and were cured on discharge. However, 22 cases in 31 perirenal abscess (71%) were needed an interventional treatment: needle aspiration 6 (19.4%), percutaneous drainage 15 (45.2%), open drainage 1 (3.2%), nephrectomy 1 (3.2%). Mortalities of renal and perirenal abscess were 2.7% (1/37) and 13.8% (4/29) (p=0.222), respectively. Conclusions: There were significant differences between renal abscess and perirenal abscess in their size, treatment strategies, period of treatment, clinical outcome. On comparison with renal abscess, perirenal abscess was bigger, more aggressive treated, longer hospitalized, and more fatal. We must consider their dissimilarities in treatment."

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Condyloma Lata Mimicking as a Condyloma Accuminata with Syphilis: Seung Hoon Cho, Myung Jin Lee, Jong Wan Lim, Yun Won Park, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2008;3(2):236-239. Published online October 31, 2008

Abstract PDF: Condyloma lata is white lesions associated with secondary syphilis. Considering the recent increased in the incidence of syphilis in the Republic of Korea, such lesions are likely to present frequently. Differential diagnosis between Condyloma lata and Condyloma accuminata is required because they have in common with veneral warts the fact that they are both raised lesions on the vulva (or penis) or anus. A 20-year-old man was referred for a chancre at penile glans and numerous perianal masses. Serologic test for syphilis (VDRL, TPHA) will be positive. We misconceived condyloma accuminata with primary syphilis, then circumcision and perianal masses excision were done with Benzathine Penicillin G 24-hundred thousand U IM injection. As a pathologic result, they were doubted strongly skin lesions of syphilis, and HPV detection test was negative.

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Primary Tuberculosis in Spermatic Cord Mimicking as an Inguinal Hernia: Youl Keun Seong; Korean J Urogenit Tract Infect Inflamm 2008;3(2):240-243. Published online October 31, 2008

Abstract PDF: Genital tuberculosis occuring in the spermatic cord is a very rare disease. A 64-year old patient presented with a mass on the right side of the inguinal area which had been painful and had gradually enlarged since 2 weaks ago. Under the ultrasonoghaphic diagnosis of a right inguinal hernia, surgical exploration was performed. The lesion was tuberculosis histopathologically and there was no apparent coexisting tuberculous lesion elsewhere in the body. After postoperative ajuvant antituberculous therapy for 4 months, recurrence has not been found.

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Jaundice and Acute Pyelonephritis due to a Giant Urinoma: Sung Dae Kim, Dong Sub Lee, Dong Wan Sohn, Sae Woong Kim, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2008;3(2):244-248. Published online October 31, 2008

Abstract PDF: Disruption of the urinary collecting system can produce internalized urine leaks that can be continous urine extravasation and form an encapsulated collection of urine, which is known as a urinoma. Urinoma is also called as pararenal pseudocyst and usually the result of renal injury and may be the result of obstructive uropathy from a ureteral stone or pelvic mass or even a urological procedure. Although urinoma may induce the urinary infection such as acute pyelonephritis, it may not give rise to jaundice due to biliary tract obstruction. We describe an unusual case of jaundice and acute pyelonephritis due to a giant urionoma after high grade renal injury.

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Cystic Renal Cell Carcinoma Mimicking a Renal Abscess: Jae Min Chung, Kyu Seop Kim, Seong Ju Kim, Byung Ju Sung, Sang Don Lee, Seong Choi; Korean J Urogenit Tract Infect Inflamm 2008;3(2):249-252. Published online October 31, 2008

Abstract PDF: Cystic renal cell carcinoma is one form of renal cell carcinoma. The radiographic and pathologic findings of cystic renal cell carcinoma are often more confusing and less specific than the findings of solid renal cell carcinoma. We report a case of cystic renal cell carcinoma mimicking a renal abscess.

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Cytokine Profiling of Prostatic Fluid From Cancerous Prostate Glands Identifies Cytokines Associated with Extent of Tumor and Inflammation: In Rae Cho, Hyun Dong Song; Korean J Urogenit Tract Infect Inflamm 2008;3(2):253-265. Published online October 31, 2008

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Guidelines on the Management of Acute Uncomplicated Cystitis and Recurrent Urinary Tract Infections in Women: Hana Yoon; Korean J Urogenit Tract Infect Inflamm 2008;3(2):266-277. Published online October 31, 2008

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