Urogenital Tract Infection

Asymptomatic Bacteriuria: Chang-Hee Han, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2010;5(2):119-128. Published online October 31, 2010

Abstract PDF: Asymptomatic bacteriuria is common. Among healthy adults, bacteriuria increases with age, and occurs more frequently in women than men. Individuals with underlying genitourinary abnormalities, such as spinal cord injuries or with indwelling catheters also have a very high prevalence of bacteriuria. Bacteriuria per se in most population is benign. It has been shown to have adverse outcomes in pregnant women, in whom it is associated with pyelonephritis, low-birth weight and premature birth, and in patients undergoing traumatic genitourinary procedures associated with mucosal bleeding, in whom there is a high risk of bacteremia and sepsis. In other populations, clinical trials have consistently shown no benefits of screen for or treatment of asymptomatic bacteriuria. For some immunocompromised persons, such as those with neutropenia or post-renal transplant, further evaluation to describe the natural history and impact of bacteriuria is required.

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Postmenopausal Women and Urinary Tract Infection: Hana Yoon; Korean J Urogenit Tract Infect Inflamm 2010;5(2):129-133. Published online October 31, 2010

Abstract PDF: "Urinary tract infection (UTI) is a common condition in elderly women. Despite the high prevalence of bacteriuria in the elderly, factors predisposing such women to UTI have been underexplored or compared to those identified in premenopausal women. The lack of estrogen, which characterizes the postmenopause, plays an important role in the pathogenesis of this condition. In postmenopausal women with recurrent UTI, therapy with oral or intravaginal estrogen reduced the rate of recurrence significantly. For other patients, an antimicrobial prophylactic regimen should be recommended in addition to hormonal treatment. In the case of an acute UTI, the antimicrobial treatment policy is similar to that in pre-menopausal women. In the case of recurrent UTI, a urological or gynecological evaluation should be performed, in order to exclude malignant or obstructive causes, detrusor failure or a genital infection."

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Recurrent Cystitis: Min Eui Kim; Korean J Urogenit Tract Infect Inflamm 2010;5(2):134-142. Published online October 31, 2010

Abstract PDF: Recurrent cystitis is common among young healthy women with anatomically and physiologically normal urinary tract, and represents the main cause of morbidity and health care burden in this population. The interaction between specific infecting bacteria and urinary tract epithelial characteristics implies the pathogenesis of the disease. Several pathogen-related factors, including periurethral bacterial colonization and Escherichia coli virulence, as well as host behavioral risk factors, including voiding dysfunction, high intercourse frequency, oral contraceptive and spermicide use predispose people to recurrent cystitis. The management of recurrent cystitis is the same as that for sporadic cystitis. Continuous or post-coital prophylaxis with low dose antimicrobials or intermittent self-treatment with antimicrobials has all been demonstrated to be effective in managing recurrent cystitis. Prospective prevention methods for recurrent cystitis include the use of natural compounds, bacterial interferenceand immunization. These approaches appear to be promising for the management of cystitis. Further understanding of the pathogenesis of recurrent cystitis will lead to more effective and safe methods to prevent these common infections.

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Acute Pyelonephritis: Ki Hak Song, Ji Young Lee, Young Ho Kim; Korean J Urogenit Tract Infect Inflamm 2010;5(2):143-150. Published online October 31, 2010

Abstract PDF: Acute pyelonephritis is a very common upper urinary tract infection, and most of them may be uncomplicated and resolve without serious sequelae. Acute pyelonephritis is defined as clinical symptoms and signs such as abrupt onset of chills, fever, and flank or costovertebral angle pain and/or tenderness. The incidence of acute pyelonephritis is higher in young women than in men and then the incidence is similar to women over 65 years old. In general, acute pyelonephritis is caused by microorganisms ascending from the bladder into the upper urinary tract. E. coli is the most common uropathogen causing pyelonephritis, accounting for 70∼90% of infections. Recently, antibiotic resistance against E. coli and uropathogen is remarkably noted in uncomplicated acute pyelonephritis as well as uncomplicated UTI. The purpose of this study was to determine the recent trends of acute pyelonephritis, to suggest change to current strategies in the management and prevention of acute pyelonephritis, and to review 2010 EAU guideline and recent literatures.

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Genital and Urethral Warts: Keon Cheol Lee, In Rae Cho; Korean J Urogenit Tract Infect Inflamm 2010;5(2):151-160. Published online October 31, 2010

Abstract PDF: External genital warts are one of the most common sexually transmitted infections (STI) which appear as typical skin growing lesions in the perigenital and perianal regions. The causative organisms are low-risk human paillomavirus (HPV), mostly types 6, 11. Physical examination assisted with bright light and magnification is usually enough for diagnosis, but biopsy is needed in cases that are refractory to treatment or exhibit atypical lesion appearance. Genital warts are benign and resolves spontaneously in some patients and removal of lesions do not guarantee elimination of all organisms or confer protection from recurrence. Treatment is consisted of diverse drug application locally and surgical therapy. Urethral warts are uncommon presentation of HPV and could be treated by endoscopic surgery accompanied by intraurethral instillation of medications. Vaccination for HPV is promising up to 4 years and can be an important strategy against HPV, but have to be proven with additional long-term results.

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Clinical Characteristics of Urinary Catheter Use: A Single Center Study in Gyeong-in Province: Jun-Mo Kim, Woong-Bin Kim, Jae-Heon Kim, Kwang-Woo Lee, Young-Ho Kim, Min-Eui Kim; Korean J Urogenit Tract Infect Inflamm 2010;5(2):161-166. Published online October 31, 2010

Abstract PDF: "Purpose: The aim of this study was to assess the clinical characteristics of several types of urinary catheters on prevalence, indication and duration of use at a single medical center. Materials and Methods: This cross-sectional study was performed to investigate the prevalence of in-patients with urinary catheters at 9AM 8th July 2010 among a total of 843 cases at a university hospital located in the Gyeong-in province. We also examined the indication, duration of catheterization use, and the results of urinalysis and urine culture. Results: The prevalence of in-patients with urinary catheter at our hospital was 12% (103/843 cases). The urethral Foley catheter was the most commonly used, in 88.3% of cases. The duration of catheter use was related to indications, short-term use was common in perioperative use (64.7%) and urine output measurement (72.7%), intermediate-term and long-term use were common in bladder outlet obstruction (50%) and prolonged immobilization (50%), respectively. The positive urine culture rate and grade of pyuria were increased in long-term use (81.8%, 3.0grade) compared to short-term (57.1%, 0.9grade) and intermediate-term use (41.6%, 1.8grade) (p<0.001, p=0.032) Conclusions: The urinary catheter was used in 12% of in-patients at a single tertiary medical center, and 88% of used catheter was urethral Foley catheter. The duration of catheter was related to indication, and incidence of pyuria and bacteriuria was higher in long-term use than in short or intermediate-term use. The establishment of a proper Korean guideline for the management of urinary catheter and regular education at each medical center are needed."

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Changes of Causative Organisms and Antibiotic Sensitivity of Urinary Tract Infection in the Southern Area of Kyoung-gi Do for Recent 4 Years: Jae Young Jeong, Jeong Hwan Son, Jae Il Kim, Seok Heun Jang; Korean J Urogenit Tract Infect Inflamm 2010;5(2):167-175. Published online October 31, 2010

Abstract PDF: "Purpose: We studied the changes in antibiotic sensitivity to causative organisms of urinary tract infection for the past 4 years, in order to provide useful information on the choice of adequate drugs for the treatment of urinary tract infection (UTI). Materials and Methods: We analyzed 7,938 uropathogens and their antibiotic sensitivities in 5,609 patients admitted or visited our hospital (located in the southern area of Kyoung-Gi Do) with more than 105cfu/ml of urine culture from January 2006 to December 2009 retrospectively. Results: The incidence of UTI increased with age and was highest in the first decade (33.0%), followed by seventh decade (11.9%). The most common pathogenic organism was E. coli (43.4%), followed by Klebsiella (13.6%), Enterococcus (7.9%), Staphylococcus (4.8%) and Serratia (4.6%). The incidence of E. coli and Klebsiella increased from respectively 39.3% and 10.1% in 2006, to 46.7% and 14.3% in 2009, while the incidence of Enterococcus and Staphylococcus decreased. In E. coli, resistance to antimicrobial agents was increased in ampicillin (69.6 to 72.0%), ciprofloxacin (38.4 to 47.0%), ceftazidime (12.3 to 19.0%), but decreased in trimethoprim/sulfamethoxazole (42.1 to 37%) and sensitivity to amikacine was above 90%. For the Gram-positive organisms, vancomycin and teicoplanin showed higher sensitivities. Conclusions: E. coli is the most common causative organism of UTI and its resistance to antimicrobial agents is increasing. Fluoroquinolone use should be restricted due to high resistance and economic. The use of amikacin or trimethoprim/sulfamethoxazole as empirical treatment for UTI should be considered. "

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Changes in Detection Rate of Causative Organisms in Patients with Urethritis Symptoms and Signs: Seung Hyuk Yim, Myung Sun Choi, U-Syn Ha, Dong Wan Sohn, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2010;5(2):176-181. Published online October 31, 2010

Abstract PDF: "Purpose: Male urethritis is one of the most common sexually transmitted infections (STIs), but the etiology is still unclear in many cases. We retrospectively studied and compared the detection rate of the causative organisms in patients with urethritis symptoms and signs between 2000 and 2009. Materials and Methods: We reviewed the medical records of 181 patients with urethritis symptoms and signs who had undergone a gram stain, urethral swab culture, multiplex polymerase chain reaction (mPCR) assay in 2000 and 2009 at a single hospital. Changes in detection rate of the causative organisms between 2000 and 2009 were analyzed. Results: The common pathogens in 2009/2000 were Ureaplasma urealyticum (27.40% vs. 13.89%, p=0.025), Mycoplasma species (12.33% vs. 5.56%, p=0.107), Chlamydia trachomatis (10.96% vs. 12.04%, p=0.827) and Neisseria gonorrhoeae (4.11% vs. 1.85%, p=0.367). Detection rate of Ureaplasma urealyticum significantly increased in 2009 compared to 2000 (p=0.025). Conclusions: Ureaplasma urealyticum was the most common pathogen of nongonococcal urethritis in our study. In particular, Ureaplasma urealyticum was found to have increased significantly in recent years."

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Detection of Mycoplasma genitalium and Ureaplasma urealyticum Infection in Female Commercial Sex Workers: Gilho Lee, Hee Yoon Park; Korean J Urogenit Tract Infect Inflamm 2010;5(2):182-187. Published online October 31, 2010

Abstract PDF: "Purpose: To detect Ureaplasma urealyticum (U. urealyticum) and Mycoplasma genitalium (M. genitalium) infections in female commercial sex workers (FCSW) in Korea. Materials and Methods: Total 127 samples from FCSWs were randomly collected. Endo-cervical swab was obtained and DNA was extracted from the samples. Gene amplification was performed with specific primers for U. urealyticum and M. genitalium from the patients’ DNA. Results: Of the 127 samples, 49 samples were positive by amplification of U. urealyticum and 7 samples were positive by amplification of M. genitalium. In this study, the prevalence of U. urealyticum and M. genitalium in FCSW were 38.5% and 5.51%, respectively. Conclusions: Detection of U. urealyticum was relatively high, whereas detection of M. genitalium was relatively low in FCSW in Korea. Further studies should be performed to characterize the mycoplasma infections in sexually transmitted infectious core groups."

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The Clinical Significance of Granulomatous Prostatitis after Intravesical BCG Immunotherapy: Soo Dong Kim, Jung Ho Kim, Jung Min Ha, Won Yeol Cho; Korean J Urogenit Tract Infect Inflamm 2010;5(2):188-192. Published online October 31, 2010

Abstract PDF: "Purpose: To evaluate the clinical significance of granulomatous prostatitis (GnP) after intravesical bacillus Calmette-Guerin (BCG) therapy (GnP-BCG) for superficial bladder transitional cell carcinoma or carcinoma in situ. Materials and Methods: We reviewed the medical records and transrectal ultrasonography (TRUS) of 193 patients who had undergone transurethral resection of bladder tumor and had received intravesical BCG therapy from January, 2003 through to December, 2009. Among them, 19 patients underwent prostate biopsy due to elevated prostate specific antigen (PSA) or abnormal TRUS finding. Results: Six of 19 patients (31.5%) who had sustained symptom were identified as GnP, of whom one patient had concurrent prostate cancer. The other 5 patients’ symptoms were spontaneously resolved and their PSA normalized by conservative care. Conclusions: Since GnP-BCG has a similar clinical appearance to prostate cancer, we should differentiate GnP-BCG from prostate cancer. However, the natural history of GnP-BCG is that of slow and complete resolution after conservative treatment. We suggest conservative treatment before undergoing prostate biopsy in patients with BCG immunotherapy to reduce unnecessary invasive intervention."

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The Treatment of Emphysematous Pyelonephritis: Availability of Percutaneous Renal Drainage and Broad-spectrum Antimicrobials: Suk Gun Jung, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2010;5(2):193-198. Published online October 31, 2010

Abstract PDF: "Purpose: The therapeutic approaches to patients with emphysematous pyelonephritis remain controversial. We evaluated the usefulness of percutaneous drainage and broad-spectrum antimicrobials in patients with emphysematous pyelonephritis. Materials and Methods: From January 2001 to May 2010, 17 patients (14 females and 3 males) with emphysematous pyelonephritis (EPN) were managed at our institution. We retrospectively reviewed patient characteristics, causative pathogens, treatment methods, hospital stay duration, and treatment outcomes. The diagnosis of EPN was confirmed by the presence of intraparenchymal and/or perinephric gas burbles in imaging studies. Treatment modalities were consisted of emergency nephrectomy in 7 patients (Group A), percutaneous renal drainage in 6 patients (Group B) and medical therapy only in 4 patients (Group C). Results: The mean age of total patients was 58.4±14.8 (38-84) years. The most common underlying disease was diabetes. Serum blood sugar levels were not appropriately controlled in 12 among 14 diabetics. The cure rates and mean hospital stay in Groups A, B and C were 85.7%, 83.3%, and 30 days, 12 days, respectively. The mortality rates were 50% in type I and 37.2% in type II, according to the computed tomography findings. Conclusions: Combining broad-spectrum antibiotic therapy with percutaneous renal drainage is a safe and effective treatment of emphysematous pyelonephritis, especially in high-risk patients for whom nephrectomy under general anesthesia are not feasible."

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Fournier’s Gangrene: Six Years of Experience with 33 Patients and Validity of the Fournier’s Gangrene Severity Index Score in Korean Patients: Eu Chang Hwang, Seong Woong Na, Young Jung Kim, Jun Seok Kim, Sun-Ouck Kim, Seung Il Jung, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu, Lu Ji Wan; Korean J Urogenit Tract Infect Inflamm 2010;5(2):199-206. Published online October 31, 2010

Abstract PDF: "Purpose: To identify predictive factors of survival in patients with Fournier’s gangrene (FG), and to determine the validity of the Fournier’s Gangrene Severity Index Score (FGSIS) in Korean patients. Materials and Method: Thirty-three patients with FG were enrolled. Data were collected regarding medical history, symptoms, physical examination findings, admission laboratory tests, and the extent of body surface area involved (%). The FGSIS, which was developed to assign a numerical score that describes the disease acuity, was used in our study. The data were assessed based on whether or not the patient had survived. Results: Of the 33 patients, 16 survived (48.5%, Group I) and 17 died (51.5%, Group II). Isolated FGSIS and admission laboratory parameters that were statistically different in the two groups included heart rate (p=0.009), white blood cell count (WBC; p=0.035), and serum calcium (p=0.001). The mean body surface area in Group II was statistically different from that of Group I (6.4% vs. 2.4%, p=0.001). The mean FGSIS for groups I and II was 6.6±3.7 and 8.2±4.1, respectively (p=0.26). Based on univariate regression analysis, disease severity had no correlation with the FGSIS. However, isolated parameters, including heart rate, WBC count, serum total calcium level, and the extent of body surface area involved was associated with disease severity. Conclusions: Although the FGSIS was not shown to be a predictive factor for disease severity, metabolic parameters and the extent of body surface area involved appeared to be important factors for predicting FG severity."

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Emphysematous Prostatitis Accompanied by Septicemia: Jae Min Chung, Jung Choi, Jun Taik Lee; Korean J Urogenit Tract Infect Inflamm 2010;5(2):207-210. Published online October 31, 2010

Abstract PDF: Emphysematous prostatitis is an uncommon condition which is characterized by air pockets and abscess within the prostate. We report 68-year-old man with emphysematous prostatitis accompanying septicemia. He was successfully treated with antibiotics and transurethral resection of prostatic abscess.

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Primary Repair of Erosion after Artificial Urinary Sphincter Implantation: Yong Seung Lee, Hong Wook Kim, Jang hwan Kim; Korean J Urogenit Tract Infect Inflamm 2010;5(2):211-213. Published online October 31, 2010

Abstract PDF: Erosion is a common complication after artificial urinary sphincter implantation and a major cause of sphincter removal. A 73-year old man presented with exposure of artificial urinary sphincter connector and tube through the scrotal skin 13 months after implantation. He had taken radical prostatectomy for prostate cancer. After 10 days of aseptic dressing, the exposed connector was changed and the exposed wound was closed. After a 5-month follow-up period, there has been no complication in both wound and the functions of the artificial urinary sphincter. In conclusion, the small exposure of implantation device through erosion without active infection can be managed with primary repair, rather than initial removal of the device.

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The Risk Factors for Antimicrobial Resistance among the Escherichia coli Strains Isolated from Korean Patients with Acute Uncomplicated Cystitis: A Prospective and Nationwide Study: Gilho Lee, Yoon Soo Gyung; Korean J Urogenit Tract Infect Inflamm 2010;5(2):214-219. Published online October 31, 2010

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Clinical Guideline for the Management of Urinary Tract Infections and Urolithiasis in Pregnant Women: Yun Kwan Ro, Hwancheol Son; Korean J Urogenit Tract Infect Inflamm 2010;5(2):220-224. Published online October 31, 2010

Abstract PDF: Urinary tract infection (UTI) is common in pregnant women. Urine culture is the gold standard for diagnosis of UTI, and E. coli is the most common pathogen. Antibiotic treatment of symptomatic or asymptomatic bacteriuria reduces the rate of pyelonephritis and low weight birth, although there is still no consensus on the optimal antibiotic regimen. Urolithiasis in pregnant women is the most common non-obstetrical cause of renal colic pain. Diagnosis and treatment are difficult. Special consideration should be taken in choosing the correct tool for diagnosis. Expectant therapy with pain medication and hydration should be considered first, although ureteroscopic stone removal has been shown to be safe and effective.

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