Urogenital Tract Infection

Pregnancy and Urinary Tract Infection: Tae Nam Kim, Dong Gil Shin, Sang Don Lee, Jeong Zoo Lee; Korean J Urogenit Tract Infect Inflamm 2009;4(2):141-149. Published online October 31, 2009

Abstract PDF: Urinary tract infections (UTIs) represent the most common bacterial infection in pregnant and non-pregnant women. Physiologic changes of pregnancy increase a woman’s susceptibility to UTIs. Progesterone effects and mechanical compression by the gravid uterus impair emptying of the bladder and lead to increased bladder residual volume and vesicoureteral reflux. Relative stasis of urine in the ureters results in hydronephrosis. Furthermore, pregnancy-related changes in glomerular filtration rate increases the urinary glucose concentration and alkalinity, thereby facilitating bacterial growth. The signs and symptoms of UTIs vary by the type of infection. UTIs in pregnancy is classified by the site of bacterial proliferation as follows: asymptomatic bacteriuria, cystitis, pyelonephritis.

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Spinal Cord Injury and Urinary Tract Infection: Min Gu Park, Du Geon Moon; Korean J Urogenit Tract Infect Inflamm 2009;4(2):150-158. Published online October 31, 2009

Abstract PDF: Urinary tract infection (UTI) is the most frequently reported secondary impairment in individuals with spinal cord lesion (SCI). UTI is responsible for major morbidiry and mortality in SCI patients. Due to chronic bacterial infection within biofilms, an antibacterial treatment based on a urinary culture of bacteria in the urine and its antimicrobial susceptibility may fail to eradicate catheter associated UTI. The classic symptoms of UTI are unreliable indicators in SCI patients with neurogenic bladder. It is widely accepted that intermittent catheterization, when compared with indwelling catheters, reduces the risk of UTI in SCI patients and is the preferred method of bladder drainage in SCI patients. Guidelines for selecting antimicrobial agents in SCI patients are similar to guidelines for the treatment of complicated UTI in the general population.

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Treatment and Prevention of Catheter-Associated Urinary Tract Infections: Seung Hyuk Yim, U-Syn Ha, Dong Wan Sohn, Seung-Ju Lee, Chang Hee Han, Choong Bum Lee, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2009;4(2):159-169. Published online October 31, 2009

Abstract PDF: Urinary tract infections (UTIs) represent the second most often observed infectious diseases in community, following the respiratory tract infections. Approximately 40% of nosocomial infections originate in the urinary tract; about 80% of urinary tract infections is related to urinary catheterization. The duration of catheterization is the most important risk factor for development of UTIs and additional risk factors include female sex, diabetes mellitus, renal function impairment, lack of antimicrobial therapy, and not maintaining a closed drainage system. There are many methods for preventing catheter-associated urinary tract infections (CAUTI); (i) an indwelling catheter should be introduced under antiseptic conditions; (ii) urethral trauma should be minimized by the use of adequate lubricant and the smallest possible catheter; (iii) the catheter system should remain closed; and (iv) the duration of catheterization should be minimal. Antimicrobial urinary catheters can prevent or delay the onset of CAUTI, but the effect on morbidity is not known. Antibiotic treatment is recommended only in symptomatic infection (bacteremia, pyelonephritis, epididymitis, prostatitis), but systemic antimicrobial treatment of asymptomatic CAUTI is only recommended in the following circumstances; (i) patients undergoing urological surgery or implantation of prosthesis; (ii) treatment may be part of a plan to control nosocomial infection due to a particularly virulent organism prevailing in a treatment unit; (iii) patients who have a high risk of serious infectious complications; and (iv) infections caused by strains causing a high incidence of bacteremia.

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Urosepsis: Management and Prevention: Myung Ki Kim, Hyung Jin Kim; Korean J Urogenit Tract Infect Inflamm 2009;4(2):170-176. Published online October 31, 2009

Abstract PDF: "The urogenital tract is the source of sepsis in 25% of all cases, mostly as a consequence of acute pyelonephritis, obstructive urolithiasis or renal abscess. Urosepsis is associated with a considerably high mortality rate of 20∼42%, especially in elderly patients, diabetics, and those under immunosuppression. Septic shock and multiorgan failure are the most common causes of death in affected individuals. Patients with urosepsis should be diagnosed at an early stage, especially in the case of a complicated urinary tract infection. Early tissue oxygenation, appropriate initial antibiotic therapy and rapid identification and control of the septic focus in the urinary tract are critical steps in the successful management of a patient with severe urosepsis. Urosepsis can due to both community- or nosocomial-acquired infections. Most nosocomial urosepsis can be avoided by measures used to prevent nosocomial infection such as reduction of hospital stay, early removal of indwelling urethral catheters, avoidance of unnecessary urethral catheterizations, correct use of closed catheter systems and attention to simple daily asepsis techniques in order to avoid crossinfection."

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Management of Genital Human Papillomavirus Infection: Sang-Kuk Yang; Korean J Urogenit Tract Infect Inflamm 2009;4(2):177-183. Published online October 31, 2009

Abstract PDF: More than 100 types of human papillomavirus (HPV) have been identified based on DNA homology, and more than 40 types of them can infect the anogenital area. HPV infections can cause genital warts, and high-risk genotypes are associated with penile and cervical cancer. The majority of HPV infections are asymptomatic, unrecognized, or subclinical. HPV high-risk genotype 16, 18, 35, 51, 58 are reported to the common causes of cervical cancer in Korea. Diagnosis of genital warts can be easily made by visual inspection, and the primary treatment goal is the removal of the warts. Although several treatment modalities for genital warts show similar effectiveness, 20∼50% of patients will experience recurrences of warts after therapy within 3-6 months. Although several well-designed studies have examined the association between male circumcision and HPV infection, results are still inconsistent. To date, the two first-generation vaccines (Gardasil?, Merck & Co., Inc., Whitehouse Station, USA; Cervarix?, GSK Biologicals, Belgium) have been used for prevention of cervical cancer, and both vaccines have been approved for use in women only, despite men being known to be the responsible vector. Currently there are no published data demonstrating that the vaccine can protect men from getting genital warts or HPV-related penile cancer. The increasing incidence of HPV infection and genital warts highlights the need for an clinical trials conducted in men to reveal the reduction rate of the HPV vaccines.

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Clinical Features according to Co-morbidity in Patients Visiting Emergency Room due to Acute Hemorrhagic Cystitis: Hong Koo Ha, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2009;4(2):184-189. Published online October 31, 2009

Abstract PDF: "Purpose: To evaluate the clinical features according to co-morbidity in patients with acute hemorrhagic cystitis who visited the emergency room. Materials and Methods: We evaluated 60 patients who visited the emergency room due to acute hemorrhagic cystitis symptoms. We evaluated voiding and storage symptoms, urine analysis, urine culture, and presence of co-morbidities, and analyzed clinical features between group of presence of co-morbidity (group I) and absence of co-morbidity (group II) through review of medical records. Results: The mean age of 60 patients was 55.3±22.3 years (19-84) including 14 male (23.3%) and 46 female (76.7%). The mean age of group I (n=37) and II (n=23) were 62.9±19.8 (22-84) and 43.4 ±17.8 years (19-74), respectively (p=0.102). The most common clinical symptom was dysuria (35.0%) followed by frequency (11.7%) and urgency (3.3%). Pyuria more than 5 WBC/HPF in urine was revealed in 36 patients (60.0%): 22 (59.5%) and 14 (60.8%) in group I and II, respectively (p>0.05). Positive urine culture was found in 25 patients (41.7%): 18 (81.8%) in group I and 7 (18.4%) in group II, respectively (p<0.05), and cultured organisms were E. coli (68.0%), Entrococcus (20.0%), Pseudomonas (4.0%) and Sphingomonas (4.0%). Conclusions: Patients with acute hemorrhagic cystitis were more frequently found in female. The most common symptom was dysuria and more than half of the patient showed positive urine culture. Positive urine culture was more frequently revealed in patients with co-morbidity."

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A Clinical Survey of Renal and Perirenal Abscess: Byung Hoon Chi, Tae Hyung Kim, Se Jun Park, Jun Young Kim; Korean J Urogenit Tract Infect Inflamm 2009;4(2):190-195. Published online October 31, 2009

Abstract PDF: "Purpose: This study was performed to assess the recent trend of renal or perirenal abscess. Materials and Methods: We have analyzed retrospectively 18 in-patients with renal or perirenal abscess at our hospital from June 2002 to May 2009. Results: Mean age was 49.1±18.4years. Thirteen cases were renal and 5 cases were perirenal abscess. The most common predisposing factor was diabetes mellitus (22.2%). Fever with flank pain (66.7%) was the most common symptom. The duration of symptom was longer in patients with perirenal abscess (9.6 days) than renal abscess (5.9 days). On the urine culture, 4 cases of E. coli (22.2%) were detected. On the blood culture, 3 cases were positive; E. coli was in 2 cases and S. epidermidis in 1 case. Among 10 cases of abscess culture, E. coli was in 8 cases and S. epidermidis was in 1 case. The remaining 1 case was sterile. Most of patients were diagnosed by CT scan with ultrasonography (94.4%). Antibiotics only treatment was done in 9 patients (50%) with small renal abscess (<30mm). Four (2.2%) of percutaneous aspiration was done (renal 2, perirenal 2). Three cases (16.7%) of surgical drainage was done (renal 1, perirenal 2). One case of nephrectomy in non-functioning kidney and 1 case of double-J stenting with ESWL was done. Conclusions: We suggest that the early detection by CT scan with ultrasonography and the proper selection of management is very important in successful outcome of renal or perirenal abscess."

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Significance of Pyospermia in the Patients with Varicocele: Moung Jin Lee, Seung Hoon Cho, Jong Wan Lim, Seung Tae Lee, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2009;4(2):196-201. Published online October 31, 2009

Abstract PDF: "Purpose: Pain is one of the indications to treat varococele at any age. The purpose of this study is to find the significance of pyospermia in the patients surgically treated for scrotal pain associated with varicocele. Material and Methods: From January 2002 to December 2008, a total of 365 men underwent varicocelectomy. As the preoperative semen analysis, we classified patients of scrotal pain into two groups as pyospermia group I (N=136) and non-pyospermia group II (N=112). Preoperative and postoperative clinical symptoms were analyzed. The result was classified into completely resolved, partially resolved and unchanged based on the relief of pain. Results: Of 365 men, 248 (67.95%) patients were available for follow-up 3 months postoperatively. Among 119 patients with scrotal pain who have received the varicocelectomy, 42 (65.63%) and 5 (7.8%) patients in group I (64 patients) reported completely resolved and partially resolved respectively (mean response rate 73.44%). In group II (55 patients), 42 (76.36%) and 8 (14.55%) reported completely and partially resolved respectively (mean response rate 90.90%) (p<0.05). Seventeen and 5 patients in group I and II reported persistent pain, respectively. Conclusions: Patients with pyospermia surgically treated for scrotal pain associated with varicocele have tendency to have persistent pain after surgical treatment. This result may help the varicocele patients with persistent pain after receiving the surgery."

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Effect of Associated Diseases to Renal and Perirenal Abscesses: Dong Gil Shin, Hong Koo Ha, Jae Min Chung, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2009;4(2):202-209. Published online October 31, 2009

Abstract PDF: "Purpose: We analyzed the clinical experiences of patients with renal and perirenal abscesses during the last 10 years according to associated diseases. Materials and Methods: We reviewed the medical records of 63 patients with renal, perirenal, and mixed abscesses treated at two hospital from January 1999 to August 2009. The patients were divided into 3 groups: group A consisted of 11 patients without associated diseases, group B consisted of 31 patients with nonurological associated diseases and group C consisted of 21 patients with urological associated diseases. Results: A male to female sexual ratio of 63 patients was 1:2, and the mean age was 51.4±15.2 years, respectively. The most common associated diseases were diabetes mellitus (39.7%) and liver disease (19.0%). The most common urological associated diseases were nephrolithiasis (11.1%) and ureteral obstruction (7.9%). Fever or flank pain were the common symptom. The most common isolated uropathogen in urine, blood and pus culture was E. coli. The hospitalized, clinical and laboratory improvement duration of group A was significantly shorter than group B and C, respectively. The hospitalized, clinical and laboratory improvement duration was not significantly different between group B and C. Most patients are cured or improved on discharge from hospital in all abscesses. Conclusions: We suggest that the renal and perirenal abscesses with associated diseases needs longer hospitalized days and more intensive treatment than that without associated diseases."

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Antibiotic Resistance Patterns of Escherichia coli and Non-Escherichia coli Gram Negative Uropathogens in Pediatric Urinary Tract Infections for the Years 2001-2008: Jun-mo Kim, Hee-bong Shin, Kwang-Woo Lee, Young-Ho Kim, Min-Eui Kim; Korean J Urogenit Tract Infect Inflamm 2009;4(2):210-219. Published online October 31, 2009

Abstract PDF: "Purpose: Because many gram negative bacterial species among the members of the Enterobacteriaceae are implicated hospital acquired infection including catheter-associated infection, antimicrobial resistance between Escherichia coli (E. coli) and other gram negative uropathogens could be different. We evaluated the epidemiologic data and antibiotic resistance patterns of E. coli and other gram negative uropathogens. Materials and Methods: Between February 2001 and November 2008, we retrospectively analyzed positive urine samples of 618 pediatric patients under 15 years of age with the first urinary tract infection (UTI) by E. coli and 419 other gram negative uropathogens. Mean age was 1.0±2.4 years. We compared antibiotic resistnace rate according to E. coli and non-E. coli group, each gram negative bacteria, age group, gender, and early and late period. Results: Although resistance rate of E. coli to ciprofloxacin (9.7%) and co-trimoxazole (34.1%) is higher than non-E. coli gram negative uropathogen (2.4%, 21.5%), resistance rate of non-E. coli gram negative uropathogen to ampicillin (90.9%), amoxicillin-clavulanic acid (52.0%), 1st to 3rd generation cephalosporins (65.2% to 23.6%), and imipenem (2.6%) is higher than E. coli. The resistance rate to co-trimoxazole of age group of 1-15 years is higher than age group of less than 1 year in both E. coli (44.0% Vs 30.4%) and non-E. coli gram negative uropathogens (28.0% Vs 18.9%). In comparison between early and late period, resistance rate to 3rd generation cephalosporin (32.9% Vs 17.6%) and gentamicin (36.0% Vs 16.1%) was decreased. Conclusions: The resistance rate of gram negative uropathogens other than E. coli to ampicillin, cephalosporins, and imipenem was higher than E. coli. Because our result shows resistance rate to amikacin is low in all of gram negative uropathogen including E. coli, it could be reasonable choice in the empirical treatment of the first UTI in children."

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Prostatic Tuberculosis with Painless Gross Hematuria: Cheol Ho Park, Yoon Il Kang, Dong Hoon Lim, Jun Rho, Chul Sung Kim; Korean J Urogenit Tract Infect Inflamm 2009;4(2):220-223. Published online October 31, 2009

Abstract PDF: Genitourinary tuberculosis contributes to 10-14% of extrapulmonary tuberculosis. The most common site of genital tuberculosis is the epididymis. Prostate tuberculosis is uncommon and is usually found incidentally following transurethral resection. A 78 year old man was admitted to our hospital with painless gross hematuria. Urine culture and cytology was negative, but serum prostate specific antigen was 29.7 ng/ml. Prostate biopsy demonstrated prostatitis and nodular hyperplasia. Transurethral prostatectomy was performed and histology revealed prostate tuberculosis.

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Pyeloureteritis Cystica accompanied by Nonfunctioning Kidney: Jun Back Park, Chang Min Im, Seung IL Jung, Chan Choi, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu; Korean J Urogenit Tract Infect Inflamm 2009;4(2):224-227. Published online October 31, 2009

Abstract PDF: Pyeloureteritis cystica is a rare cystic disease formed in the mucosa or submucosa of the renal pelvis and ureter caused by chronic inflammation and irritation, and characterized by multiple filling defects noted on the contrast imaging. The clinical course is usually slow, but manifests if the lesionscause infection or obstruction. Stones are further complication to the disease. We report a case of 69-year-old woman with right flank pain, who had an pyeloureteritis cystica withnonfunctioning kidney caused by proximal ureter stone. The diagnosis was made after nephroureterectomy, followed by pathologic examination.

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Purple Urine Bag Syndrome: Woo Seok Choi, Seyung Kim, Jae Rock Oh, Seong Ho Lee, Chong Wook Lee, Sang Kon Lee; Korean J Urogenit Tract Infect Inflamm 2009;4(2):228-231. Published online October 31, 2009

Abstract: Purple urine bag syndrome is a rare condition in which the urinary drainage bag turns purple. It occurs predominantly in chronically catheterized women and associated with urinary tract infections. Herein, 3 cases of purple urine bag syndromes are reported in 1 elderly man and 2 elderly women.

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Infected Urachal Cyst: Kang Sup Kim, Chang Sik Youn, Seung Woo Yang, Young Ho Kim, Eugene Hwang, Jae Sung Lim, Ki Hak Song, Chong Koo Sul; Korean J Urogenit Tract Infect Inflamm 2009;4(2):232-234. Published online October 31, 2009

Abstract PDF: Although most cases of urachal cyst are asymptomatic, they are frequently detected after complication by infection. We report a 43-year-old woman who was diagnosed preoperatively an infected urachal cyst and was performed primary excision. A pus culture drained from the cyst was no growth in microscopic exam. Pathologic examination showed acute and chronic inflammation of the urachal cyst. The post-operative course was non specific and there was no evidence of wound infection.

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Malignant Fibrous Histiocytoma in Renal Pelvis found after Excretion of Dioctophyma Renale at Voiding: Yong Hyeuk Choi, Sung Yong Cho, Mee Joo, Jae Sook Rye, In Rae Cho; Korean J Urogenit Tract Infect Inflamm 2009;4(2):235-239. Published online October 31, 2009

Abstract PDF: The giant kidney worm, Dioctophyma renale infection is a common, widely distributed parasite of mink and some other carnivorous animal but very rarely reported in human. A 57 years old man, visited our department because of left lower quadrant pain and hematuria, foreign body like earthworm. The foreign body is identified as Dioctophyma renale. Computed tomography showed the irregular shape mass in the renal pelvis and upper ureter. We performed radical nephroureterectomy with bladder cuff excision and the mass was pathologically confirmed as the malignant fibrous histiocytoma and not contained any egg or parasite.

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Infected Urachal Cyst detected by Abscess Discharge through the Abdominocutaneous Fistula below the Umbilicus: Hyun-Min Kim, Dae-Gun Moon, Hyung-Woo Kim, Jung-Ho Hwang, Jun-Tak Park; Korean J Urogenit Tract Infect Inflamm 2009;4(2):240-243. Published online October 31, 2009

Abstract PDF: Infected urachal cyst is a rare disorder. While the urachal cyst is usually aymptomatic, the infected cyst may mimic a variety of acute intraabdominal infection. We have experienced a case of infected urachal cyst in a 59 year old woman complaining of localized abdominal pain and discharge through the abdominocutaneous fistula under the umbilicus. Abdominal sonogram and abdominal computerized tomography demonstrated a cystic mass posterior to central abdominal wall. Pus was drained from the cystic lesion through the track to fistula site on the skin.

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Novel Biomarkers for the Diagnosis of Urinary Tract Infection: A Systematic Review: Kun Chul Lee, In Rae Cho; Korean J Urogenit Tract Infect Inflamm 2009;4(2):244-256. Published online October 31, 2009

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전립선염과 만성골반통 증후군: 유럽비뇨기과학회 가이드라인: Hana Yoon; Korean J Urogenit Tract Infect Inflamm 2009;4(2):257-263. Published online October 31, 2009

Abstract: "Prostatitis and chronic pelvic pain syndrome (CPPS) are diagnosed by symptoms and evidence of inflammation and infection localized to the prostate. Recent improvement in classification and application of modern methods, including molecular biology, should allow proper systematization of treatment. Acute bacterial prostatitis can be a serious infection. Parenteral administration of high doses of a bactericidal antibiotic is usually required, which may include a broad-spectrum penicillin, a third-generation cephalosporin, or a fluoroquinolone. Treatment is required until there is defeverescence and normalization of infection parameters (IIIB). In chronic bacterial prostatitis, and if infection is strongly suspected in CPPS, a fluoroquinolone or trimethoprim should be given orally for 2 weeks after the initial diagnosis. Antibiotics only continued if pre-treatment cultures are positive and/or the patient has reported positive effects from the treatment. A total treatment period of 4-6 weeks is recommended (IIIB). Patients with CPPS are treated empirically with numerous medical and physical modalities. Despite the existence of some scientifically valid studies, no specific recommendations have been made until now."

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