Urogenital Tract Infection

Host-Pathogen Interactions in Urinary Tract Infections: Young Hwii Ko, Jae Young Choi, Phil Hyun Song; Urogenit Tract Infect 2019;14(3):71-79. Published online December 31, 2019; DOI: https://doi.org/10.14777/uti.2019.14.3.71

Abstract PDF: Urinary tract infections (UTIs) are classified by the host condition. Uncomplicated infections are caused most commonly by uropathogenic Escherichia coli (UPEC) and affect otherwise healthy people, whereas complicated infections are commonly caused by species, such as Proteus mirabilis, and affect patients with underlying difficulties, such as a urinary tract abnormality or catheterization. The outcome of infection caused by these bacteria is dictated by the immune response to the UTI and the host factors that influence the susceptibility to disease. This review focuses on the host pathogen interactions in UTI, including an identification of additional virulence factors and therapeutic or prophylactic targets, particularly by UPEC and P. mirabilis.

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Early Experiences of a Minimal Invasive Intra-Prostatic Implant, Prostatic Urethral Lift for Benign Prostatic Hyperplasia Treatment in Korea: Jonghyup Yang, Dongho Shin, Jaewoo Sung, Shinjay Cho, Sungmin Kang, Hyun Cheol Jeong, Sae Woong Choi, Woong Jin Bae, Sae Woong Kim; Urogenit Tract Infect 2019;14(3):80-86. Published online December 31, 2019; DOI: https://doi.org/10.14777/uti.2019.14.3.80

Abstract PDF: Purpose: As a minimal invasive device for benign prostatic hyperplasia (BPH) treatment, prostatic urethral lift (PUL) is widely accepted worldwide but not widely used in Korea. We investigated the one-year results of for patients with BPH in Korea.
Materials and Methods: From April 2017 to June 2018, 42 patients with BPH were treated with PUL under local anesthesia with sedation. International Prostate Symptom Score (IPSS) and maximum urinary flow rate and post-void residual (PVR) were evaluated preoperatively and 1, 3, 6, and 12 months later.
Results: Mean age was 69.57±8.58 years old, and mean prostatic volume was 37.17±12.19 cc. Preoperative total IPSS and quality of life (QOL) were 19.94±7.81 and 3.69±1.30, respectively. Total IPSS improved to 11.26±7.22 (p<0.001), and QOL was 2.42±1.43 (p=0.01) after one month. Patients showed no evidence of inflammation related to the implants. IPSS and QOL were somewhat worse after 3 months but were better than baseline at 6 and 12 months. Preoperative maximum flow rate (Qmax) was 9.71±5.45 ml/sec, and one month after surgery, it had improved to 12.63±7.33 (p=0.01); it remained good at 3, 6, and 12 months (12.63±7.38, 12.45±7.39, 14.73±9.67). PVR was not significant at any points postoperative (80.61±67.91 to 43.95±8.19, p=0.119). No patient reported retrograde ejaculation, erectile dysfunction or urinary tract infection.
Conclusions: We evaluated the one-year efficacy of PUL for BPH treatment in Korea, and found significant improvement of IPSS, QOL and Qmax. It is expected that not only the improvement of voiding symptom but also the preservation of sexual function with a low risk of adverse events.

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Is Double J Stenting or Percutaneous Nephrostomy More Suitable for Maximizing the Clinical Effects of Temporary Urinary Diversion for Acute Pyelonephritis with a Complicated Ureteral Stone?: Jeonghyouk Choi, Taesoo Choi, Dong-Gi Lee, Gyeong Eun Min, Hyung Lae Lee, Koo Han Yoo; Urogenit Tract Infect 2019;14(3):87-92. Published online December 31, 2019; DOI: https://doi.org/10.14777/uti.2019.14.3.87

Abstract PDF: Purpose: This study compared the clinical benefits of double J (DJ) ureteral stenting with percutaneous nephrostomy (PCN) for the management of acute pyelonephritis (APN) with complicated ureteral stones.
Materials and Methods: The records of 85 patients with complicated APN between December 2006 and July 2017 were reviewed retrospectively. Sixty one patients who underwent DJ or PCN for the management of acute urinary obstruction were enrolled in this study. Some of the participants were excluded for concurrent renal stones, multiple ureteral stones, ureteral stricture, malignancy, and anatomical anomalies. The patient and stone characteristics and peri-procedural laboratory test results of the groups were compared. The success rate, depending on the type of urinary diversion and the presence of immediate complications, were also analyzed.
Results: In this study, 19 patients underwent DJ stenting, and 42 patients underwent PCN as a transient urinary diversion. No failed procedures or immediate complications requiring subsequent intervention were encountered (Clavien–Dindo grade II-V). Urologists preferred PCN to DJ stenting in cases with an elevated serum creatinine level (p=0.001) and higher C-reactive protein (CRP) level (p<0.001). The indicative parameters for renal injury and septic conditions (white blood cell count, segment neutrophil, and creatinine levels) tended to show immediate improvement, whereas CRP did not; however, the differences in markers were not significant (p=0.701, 0.962, 0.288, and 0.360, respectively).
Conclusions: Both DJ stenting and PCN were safe and feasible methods for the management of complicated APN. With experienced urologists or radiologists, there may be little danger of prolonged renal failure or other procedure-related complications.

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Clinical Course of the Benign Prostate Hyplasia Patients during the Intermittent Use of 5-Alpha Reductase Inhibitors: Kwibok Choi, Byounghoon Kim, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2019;14(3):93-98. Published online December 31, 2019; DOI: https://doi.org/10.14777/uti.2019.14.3.93

Abstract PDF: Purpose: 5-Alpha reductase inhibitors (5ARI), inhibit the conversion of testosterone to dihydrotestosterone, which is essential in prostate hyperplasia, and decreases the prostate volume directly. On the other hand, 5ARI have a range of side effects, such as sexual dysfunction. After the discontinuation of 5ARI, prostate regrowth occurs rapidly until it reaches the baseline size. This study examined the effects of 5ARI when used intermittently.
Materials and Methods: Between March 2009 and May 2017, patients who visited one physician’s outpatient clinic and were diagnosed with BPH underwent transrectal ultrasonography. The selected patients began to take 5ARI until the prostate size decreased at least 10% of the baseline (the first medication). After confirming adequate prostate shrinkage, the patients stopped medication until prostate regrowth reached 50% of the decreased size. After regrowth, they restarted medication for one year (second medication). The prostate size, serum prostate specific antigen (PSA) levels, international prostate symptom score (IPSS) scores, and maximum flow rate (Qmax) in uroflowmetry were collected after the first and second medication and compared using paired t-tests.
Results: Sixty patients with a mean age of 65.1 years were included in the study. The prostate size and serum PSA level increased after the second medication compared to the first, and the prostate reduction and Qmax in uroflowmetry decreased significantly. On the other hand, the symptoms felt by the patients surveyed by the IPSS scores showed no significant difference.
Conclusions: 5ARI appear to be less effective in reducing the prostate volume and improving uroflowmetry after discontinuation.

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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: Going from Evidence to Recommendations’ (A Secondary Publication): Eu Chang Hwang, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Jae Hung Jung, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation; Urogenit Tract Infect 2019;14(3):99-103. Published online December 31, 2019; DOI: https://doi.org/10.14777/uti.2019.14.3.99

Abstract PDF: This article is the third translation of a GRADE series published in the BMJ for developing and presenting recommendations for managing patients. The strength of a recommendation reflects the extent to which we can be confident that desirable effects of an intervention outweigh any undesirable effects. GRADE classifies the strength of recommendations as strong or weak. The strength of recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, quality of the evidence, variability in values and preferences, and the appropriate usage of resources.

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