Urogenital Tract Infection

Antimicrobial Prophylaxis in Urological Surgery: Shingo Yamamoto, Katsumi Shigemura, Hiroshi Kiyota, Soichi Arakawa, Japanese Research Group for UTI; Urogenit Tract Infect 2016;11(3):77-85. Published online December 31, 2016

Abstract PDF: Surgical site infection (SSI) is defined as an infection occurring within one month from surgery or intervention. SSIs are classified into three categories: Clean, clean-contaminated, and contaminated. They are defined as procedures that avoid entering the urinary tract, involve entry of the urinary tract, and involve the bowels, respectively. The purpose of antimicrobial prophylaxis (AMP) is to protect the surgical wound from contamination by normal bacterial flora. AMP should be based on penicillin with beta-lactamase inhibitors, or first- or second-generation cephalosporins. Broad-spectrum antimicrobials, such as third- and fourth-generation cephalosporins or carbapenems, should be used to treat postoperative infections but not AMP. AMP should be started no less than 30 minutes prior to the start of the operation. AMP should be administered by a single dose or be terminated within 24 hours in cases of transurethral, clean, or clean-contaminated surgery, and within 2 days in cases of bowl (contaminated) surgery. These guidelines are applicable preoperatively only for non-infected, low-risk patients. The risk of patients for infection should be evaluated preoperatively, such as with a urine culture test. In cases with preoperative infection or bacteriuria that can cause an SSI or urinary tract infection following surgery, patients must receive adequate preoperative treatment based on their individual situation.

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The Association between Chronic Inflammation and Recurrent Cystitis in Women: Hong Chung; Urogenit Tract Infect 2016;11(3):86-92. Published online December 31, 2016

Abstract PDF: Recurrent urinary tract infection is a common infectious disease seen in the clinic. It is very prevalent in women; as many as 15% of women develop urinary tract infection each year, and at least 25% have one or more recurrences. Chronic inflammation and increased urothelial apoptosis reflect a common pathophysiology in various lower urinary tract dysfunctions, causing bladder storage symptoms. It has been suggested that chronic inflammation could be associated with overactive detrusor and increased levels of urinary nerve growth factor and creatinine. The level of urinary nerve growth factor may decrease after an effective antimuscarinic therapy. Recurrent urinary tract infection could be prevented by using nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors. Intravesical hyaluronate and chondroitin sulfate reduce the incidence of recurrent bacterial cystitis, and treatment with hyaluronate targets bacterial adherence to the bladder mucosa in interstitial cystitis/bladder pain syndrome. This article reviews the pathophysiology of chronic inflammation of the bladder and investigates the association between chronic inflammation and recurrent urinary tract infection.

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How Do You Diagnose Recurrent Urinary Tract Infections and Confirm the Diagnosis?: Hoon Choi, Jae Hyun Bae; Urogenit Tract Infect 2016;11(3):93-96. Published online December 31, 2016

Abstract PDF: Recurrent urinary tract infections (UTIs) are the most prevalent conditions affected mainly by reinfection by the same bacteria in young women with no functional or anatomic problem. Recurrent UTIs present both storage (dysuria, irritative etc.) and voiding symptoms. For example, frequency subsequently followed by sexual intercourse is a powerful predictor of recurrent UTI. In patients with morbid situations or other factors, recurrent complicated infections or sepsis may be aggravated. Escherichia coli is the most common organism responsible for UTIs, but Pseudomonas, Proteus, Klebsiella, and other organisms are also frequent, particularly, in patients higher risk of complicated infections. Urine culture is not often needed to diagnose typical uncomplicated infection. Generally, urine culture with more than 10² colony-forming units/ml is used to diagnose UTIs in symptomatic patients. Recurrent UTIs could be managed with several techniques with the help of urine culture and by imaging studies when suspicious of anatomical abnormalities.

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The Effect of Intrarectal Lidocaine Gel Instillation before Transrectal Ultrasound Guided Prostate Biopsy: Yoo Seok Kim, Soon Ki Kim, Kwibok Choi, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2016;11(3):97-102. Published online December 31, 2016

Abstract PDF: Purpose: To compare pain induced by a transrectal ultrasound (TRUS)-guided prostate biopsy in men between using local lidocaine gel or plain lubricant.
Materials and Methods: Between January and October of 2014, a total of 63 consecutive patients undergoing TRUS-guided prostate biopsy for elevated prostate-specific antigen (PSA) levels and/or a suspicious digital rectal examination were randomized to two groups: lidocaine group and control group. In the lidocaine group (n=31), patients received 20 ml of 2% lidocaine gel and betadine solution soaked gauze was administered via a transrectal route 10 minutes before the procedure. In the control group (n=32), 20 ml plain lubricant and betadine solution soaked gauze was administrated under the same condition. After the biopsy procedure, patients were asked to rate their pain perception on a 10-point visual analog scale (VAS) score.
Results: There was no statistically significant difference with the mean patient age, PSA, prostate volume, biopsy duration time between lidocaine group and control group. The mean pain score and number of patients with VAS ≥5 in the lidocaine group (4.14±2.0, 10) were significantly lower than those in the control group (5.78±2.3, 19). In younger men (≤65 years), pain was reported significantly less in the lidocaine group than in the control group. Complication rates were not different between the two groups.
Conclusions: Intrarectal lidocaine gel is a simple, safe, and efficacious for reducing pain and discomfort during the TRUS-guided prostate biopsy procedure. It appears to have an enhanced effect, especially in younger than in older men.

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Serum CCL11 Levels in Benign Prostatic Hyperplasia and Prostate Cancer: Kyu-Shik Kim, Hong-Sang Moon, Sung-Yul Park, Hwan-Sik Hwang, Jung-Hyun Kim, Sang-Su Kim, Ik-Hwan Han, Ki-Jun Kim, Chang-Suk Noh, Jae-Sook Ryu; Urogenit Tract Infect 2016;11(3):103-108. Published online December 31, 2016

Abstract PDF: Purpose: CC-chemokine ligand 11 (CCL11; eotaxin-1), an eosinophil chemoattractant chemokine, has been proposed as a serum marker for prostate cancer (PCa) by two research groups. We investigated the usefulness of CCL11 in diagnosing prostatic diseases, such as benign prostatic hyperplasia (BPH) and PCa.
Materials and Methods: CCL11 was measured in the sera of 139 men with BPH, 44 men with PCa, and 45 control men attending an outpatient health-screening clinic. A commercial enzyme-linked immunosorbent assay kit was used to measure CCL11.
Results: CCL11 concentrations were significantly higher in men with BPH and PCa than in normal men (72.9±3.15 and 80.0±4.91 pg/ml vs. 57.6±8.24). In addition, a receiver operating characteristic (ROC) analysis of serum CCL11 levels showed that the areas under the ROC curves were 0.661 (p=0.001) and 0.654 (p=0.012) for BPH and PCa, respectively, compared with normal men.
Conclusions: CCL11 may be helpful in diagnosing prostatic diseases, such as BPH and PCa.

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Clinical Usefulness of Procalcitonin as a Predictive Marker in Accordance with the Severity of Female Patients with Uncomplicated Acute Pyelonephritis: Young-Joo Kim; Urogenit Tract Infect 2016;11(3):109-113. Published online December 31, 2016

Abstract PDF: Purpose: Acute pyelonephritis (APN) is accompanied by bacteremia and has a high incidence of mortality. Currently, there is a limited number of rapid diagnostic tests that can predict the severity of infection and suitable treatments for patients with APN. Herein, we determined whether serum procalcitonin (PCT) is a useful predictive and early cognitive marker according to the severity of APN.
Materials and Methods: Patients were divided into four groups according to the severity of infection: (1) No systemic inflammatory response syndrome (SIRS), (2) SIRS, (3) severe sepsis, and (4) septic shock. We measured the inflammatory biomarkers−PCT, C-reactive protein (CRP), and erythrocyte sedimentation rate. One way ANOVA analysis was performed between the measured infection markers and the severity of infection. The p-value of less than 0.05 was considered by the post-hoc multiple comparisons.
Results: A total of 381 patients with APN were divided into four groups: (1) no SIRS (n=126, 33.1%), (2) SIRS (n=185, 48.6%), (3) severe sepsis (n=47, 12.3%), and (4) septic shock (n=23, 6.0%). PCT (p<0.001) and CRP (p=0.002) showed a significant difference among the group. Greater severity of infection grade was associated with higher PCT and CRP values. According to the multivariate analysis, there was a statistically significant difference of PCT among all grades.
Conclusions: The serum PCT was a helpful marker for predicting severity of APN. Moreover, be a useful predictor of sepsis and septic shock.

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Successful Treatment of Seminal Vesicle Abscess with Rectal Fistula after Rectal Decompression: Report of a New Case: Jae-Wook Chung, Yun-Sok Ha, Jun Nyung Lee, Hyun Tae Kim, Eun Sang Yoo; Urogenit Tract Infect 2016;11(3):114-117. Published online December 31, 2016

Abstract PDF: Seminal vesicle abscess is a rare urologic disease. Herein, we report our experience of the first case of a 41-year-old male patient with neurogenic bladder who underwent successful treatment of seminal vesicle abscess with rectal fistula after rectal decompression. Only a simple insertion of the rectal tube with intravenous antibiotics was able to remove the seminal vesicle abscess with rectal fistula without any percutaneous, transvesical, or transurethral drainage of the abscess. Rectal decompression should be considered in advance as a treatment of seminal vesicle abscess with rectal fistula before performing any invasive abscess drainage or fistulectomy.

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Ureteral Obstruction Caused by Aspergilloma in a Non-Immunosuppressive Patient: Jun Bo Chang, Phil Hyun Song, Jae Young Choi; Urogenit Tract Infect 2016;11(3):118-120. Published online December 31, 2016

Abstract PDF: Although rarely, aspergillosis can cause obstructive uropathy. This generally occurs in patients with immunosuppressive conditions. Herein, we report a case of aspergilloma that caused ureteral obstruction in a 79-year-old man with no immunosuppressive conditions. A computed tomography revealed that his left pelvocalyceal system and ureter showed mild dilation, without a definite obstructive lesion. The fungal bezoar was removed using an ureteroscopy. The patient was successfully treated with antifungal medication.

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