Urogenital Tract Infection

What Are the Barriers to Human Papillomavirus Vaccination for Male in South Korea?: Sangrak Bae, Sooyoun Kim; Urogenit Tract Infect 2022;17(3):53-60. Published online December 31, 2022; DOI: https://doi.org/10.14777/uti.2022.17.3.53

Abstract PDF PubReader ePub: The human papillomavirus (HPV) virus causes genital warts, a sexually transmitted disease, as well as cervical and vulvar cancer in females and penile cancer in males. In addition, it this virus causes various diseases, including head and neck cancer and anal cancer. Vaccines can prevent malignant tumors caused by the HPV virus, and various projects are being conducted to eradicate HPV worldwide. The national inoculation program is a representative project among them. In Korea, only females are vaccinated; males are not included in the national mandatory vaccination list. Various reasons preventing HPV vaccination for males include cost-effectiveness, fear and misperception of side effects after vaccination, problems with the effectiveness of vaccination, and lack of social awareness about the need for vaccination, including parents, and the lack of research on male HPV disease. As female’s right to health is emphasized, HPV disease, which has become more important in treatment, will never be cured if it is managed only for females. Because the disease is transmitted sexually, managing and controlling HPV in males is also essential. In that sense, males must also be included as nationally required vaccination targets.

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The Urinary Microbiome: A Pediatric Urological Perspective: Sang Don Lee, Jae Min Chung; Urogenit Tract Infect 2022;17(3):61-70. Published online December 31, 2022; DOI: https://doi.org/10.14777/uti.2022.17.3.61

Abstract PDF PubReader ePub: The human microbiome is currently being studied with increasing interest. The microbiome refers to the microorganisms living in the body and their genetic information. The human body is known to contain 1.3 to 10 times more microorganisms than human cells. The Human Microbiome Project was started in 2007 to characterize the human microbiome and analyze its role in human health and diseases. Based on the recent microbiome literature, alterations in the microbiome are associated with several non-urological diseases in pediatrics, such as infantile colic, necrotizing enterocolitis, asthma, atopy, obesity, type-1 diabetes, autism, atopic dermatitis, psoriasis, and bronchial asthma. While some urinary microbiome studies (including prostate cancer, bladder cancer, interstitial cystitis, urge urinary incontinence, overactive bladder, stone disease, and urinary tract infections) have been conducted in adults, there are very few pediatric urinary microbiome studies. This study reviews the role of the urinary microbiome in urinary tract diseases from a pediatric urological perspective.

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Importance to Promote Awareness in Patients with Recurrent Cystitis: Sun-tae Ahn, Mi-mi Oh; Urogenit Tract Infect 2022;17(3):71-75. Published online December 31, 2022; DOI: https://doi.org/10.14777/uti.2022.17.3.71

Abstract PDF PubReader ePub: In spite of a high cure rate, cystitis is a common disease in women that often recurs within a year. The uncomfortable symptoms associated with recurrent cystitis affect the quality of life and overall daily life. However, the awareness pertaining to the treatment or prevention of recurrent cystitis has remained the same. Physicians and patients are unaware that recurrent cystitis can lead to several problems, such as socioeconomic burden and antibiotic abuse. Therefore, there is a requirement to enhance awareness of the socio-economic burden of recurrent cystitis, the effects on the quality of life of patients, and the importance of prevention and management after treatment.

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The Feasibility of Radical Prostatectomy for Medication Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Seung Chan Jeong; Urogenit Tract Infect 2022;17(3):76-80. Published online December 31, 2022; DOI: https://doi.org/10.14777/uti.2022.17.3.76

Abstract PDF PubReader ePub: Purpose: The purpose of this study was to compare the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scores of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) given pharmacological treatment with those who additionally had prostate cancer and underwent surgical treatment.
Materials and Methods: From January 2000 to March 2021, a total of 7,650 patients were diagnosed with chronic prostatitis (N41.1) at our hospital, of which 234 patients were additionally diagnosed with prostate cancer. After excluding patients with severe benign prostatic hyperplasia (＞100 g)-related lower urinary tract symptoms or neurological and psychiatric abnormalities, or advanced prostate cancer, 52 patients undergoing pharmacological treatment with a combination of drugs and 20 patients who underwent radical prostatectomy due to additional prostate cancer were included in the analysis. The NIH-CPSI scores of the two groups were compared at the first outpatient visit, 3 months, and 6 months after the first visit. The p-values were calculated using the Mann-Whitney U test, and the Wilcoxon signed rank test.
Results: Patients who underwent radical prostatectomy for prostate cancer showed significant reductions in the voiding and quality of life scores in the NIH-CPSI, but not the pain score at 3 months. After 6 months, there was a significant decrease in the overall NIH-CPSI. On the other hand, in the group on pharmacological therapy, the decrease was statistically significant only in the voiding score at 6 months. However, in the surgery group, 3 patients were found to be suffering from urinary incontinence, and 7 patients from erectile dysfunction.
Conclusions: Radical prostatectomy, therefore, appears to be a promising treatment that can be carefully considered for patients with refractory CP/CPPS who do not receive adequate treatment and thus have a poor quality of life.

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Korean Multicenter Study of Infectious Complications after Transurethral Prostate Surgery in Patients with Preoperative Sterile Urine: Seong Hyeon Yu, Seung Il Jung, Eu Chang Hwang, Tae-Hyoung Kim, Jae Duck Choi, Koo Han Yoo, Jeong Woo Lee, Dong Hoon Koh, Sangrak Bae, Seung Ok Yang, Joongwon Choi, Seung Ki Min, Hoon Choi; Urogenit Tract Infect 2022;17(3):81-88. Published online December 31, 2022; DOI: https://doi.org/10.14777/uti.2022.17.3.81

Abstract PDF PubReader ePub: Purpose: To evaluate the efficacy of antibiotic prophylaxis and determine the risk factors of infectious complications after transurethral surgery of the prostate.
Materials and Methods: Seven hundred and seventy-two patients who underwent transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HOLEP) were reviewed. Of these, this study enrolled 643 patients without bacteriuria who had not received antibiotics for urinary tract infections for two weeks before surgery. The patients were divided into two groups according to the duration of the antibiotics (Group 1: less than one day, n=396 vs. Group 2: more than one day, n=247).
Results: The overall incidence of postoperative infectious complications in 643 patients was 5.0% (32/643). When postoperative infectious complications were compared according to the duration of the antibiotics (Group 1 vs. Group 2), the infectious complications rates were 5.6% (22/396) vs. 4.0% (10/247), respectively (p=0.393). When postoperative infectious complications were compared according to the duration of antibiotics (Group 1 vs. Group 2) in the TURP and HOLEP groups, the infectious complications rates were 6.3% (12/192) vs. 1.0% (1/103) (p=0.035) and 4.9% (10/203) vs. 6.0% (8/134) (p=0.677), respectively. The duration of Foley catheterization was independently associated with infectious complications (p=0.003).
Conclusions: The results showed that prolonged postoperative catheterization affects postoperative infectious complications associated with transurethral prostate surgery. Although antibiotics administered for less than one day are effective for antibiotic prophylaxis of transurethral prostate surgery, a longer antibiotic therapy is recommended for TURP.

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An Eight-Year Experience of Transvaginal Urethral Diverticulectomy: A Single-Center Study: Hyeon Woo Kim, Jeong Zoo Lee, Yangkyu Park, Dong Gil Shin; Urogenit Tract Infect 2022;17(3):89-95. Published online December 31, 2022; DOI: https://doi.org/10.14777/uti.2022.17.3.89

Abstract PDF PubReader ePub: Purpose: This study aimed to analyze and report the surgical outcomes in female patients with urethral diverticulum (UD) over an eight-year period at a single center.
Materials and Methods: Data of 49 UD females who underwent transvaginal urethral diverticulectomy between October 2011 and December 2019 were collected. The characterization of UD was reviewed using pelvic imaging studies. The pre- and post-operative symptoms, post-operative complications, and pathological findings were analyzed by reviewing the medical records.
Results: The most frequent pre-operative symptom was dysuria (n=18), followed by incontinence (n=14), and these symptoms persisted until 3 months post-operatively in one and six patients, respectively. Pre-operative incontinence was cured in eight patients; however, de novo stress urinary incontinence occurred in five patients within a month after surgery. Submucosal macroplastique injection was administered to these patients; of whom, one was cured and three showed an improvement. Recurrent UD was found in seven patients at a mean of 14.14±17.21 months post-operatively, and a repeat diverticulectomy was performed in six of them; of these, one recurred again and was cured after the third diverticulectomy. Urethral strictures were observed in two patients within a month after the operation but improved after urethral dilatation. Bleeding and surgical site infections were observed in one and two patients, respectively, but were successfully managed conservatively. According to the pathological report, only one was diagnosed with urethral adenocarcinoma.
Conclusions: Transvaginal urethral diverticulectomy can effectively manage UD, and its post-operative complications can be successfully managed by a proper treatment.

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Treatment Modality of Prostatic Abscess according to Size: A Retrospective Study: Gwon Kyeong Lee, Kyoung Ha Jang, Woo Seop Seong, Byeong Jin Kang, Kyung Hwan Kim, Hong Koo Ha; Urogenit Tract Infect 2022;17(3):96-102. Published online December 31, 2022; DOI: https://doi.org/10.14777/uti.2022.17.3.96

Abstract PDF PubReader ePub: Purpose: This study aimed to determine the treatment modality for prostatic abscesses according to size.
Materials and Methods: Twenty-five patients diagnosed with prostatic abscesses were retrospectively reviewed. All patients were treated with intravenous empirical and appropriate antibiotics according to culture results. They were grouped according to the size of the prostate abscess based on computed tomography results (group A, with prostate abscess ≤2 cm, n=10; group B, with prostate abscess size >2 cm, n=15), and their treatment modality and outcomes were compared.
Results: The prostatic abscess sizes were 1.31±0.37 and 3.49±1.06 cm for groups A and B, respectively. Prostate-specific antigen, prostatic volume, and comorbidity were not significantly different (p>0.05), whereas pelvic pain was significantly different (p=0.028). There was no difference in the microorganisms isolated from urine and blood culture, empirical antibiotics, and broad-spectrum antibiotics between the two groups (p>0.05). More patients in group B underwent transurethral abscess deroofing than those in group A (p=0.040). Patients in group B had a more extended hospitalization period and intravenous antibiotics duration than those in group A (p=0.024 and p=0.013, respectively). Group B had more cases of septic shock, intensive care unit admission, and mortality events than group A (p=0.024, p=0.001, and p=0.061, respectively). However, prostatic abscess recurrence and urological chronic complication did not significantly differ (p>0.05).
Conclusions: Appropriate use of antibiotics is crucial. This study shows that the treatment of patients with prostatic abscess >2 cm is more difficult, but transurethral abscess deroofing can lower mortality, prostatic abscess recurrence, and urological chronic complications.

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Predictor for Ureteral Stent Removal in Gynecological Cancer Patients with a Ureteral Obstruction: Sung Hyun Ji, Young Kwon Hong, Young Dong Yu, Seung-Ryeol Lee; Urogenit Tract Infect 2022;17(3):103-109. Published online December 31, 2022; DOI: https://doi.org/10.14777/uti.2022.17.3.103

Abstract PDF PubReader ePub: Purpose: This study investigated the possibility of ureteral stent removal in patients with gynecological cancer and ureteral obstruction.
Materials and Methods: From February 2010 to March 2022, the records of 121 patients with gynecological cancer and ureteral obstruction undergoing periodic ureteral stent replacement were reviewed retrospectively. Ureteral stent removal was attempted in patients who showed improvement in hydronephrosis on abdominal computed tomography (CT) after ureteral stent insertion and who lost symptoms. Success was defined as not having to reinsert the stent because there were no uncomfortable symptoms. The following were evaluated as predictors for ureteral stent removal: pre-removal serum creatinine, hypertension, diabetes, asymptomatic bacteriuria, type of gynecologic malignancy, prior radiotherapy, hydronephrosis laterality, obstruction level, hydronephrosis etiology, ureteral stent size, and ureteral stent duration. The hydronephrosis changes on abdominal CT were also evaluated.
Results: Among 121 patients, 74 with 81 obstructed ureters were evaluated. Of the 81 ureters, successful removal occurred in 30 (37.0%). There were significant differences between the success and failure cases regarding asymptomatic bacteriuria, prior radiotherapy, and hydronephrosis etiology. Logistic regression analysis showed that asymptomatic bacteriuria and hydronephrosis etiology were significant predictors of ureteral stent removal (p<0.05). There were also significant differences in the hydronephrosis changes depending on asymptomatic bacteriuria and hydronephrosis etiology (p<0.05).
Conclusions: In patients with gynecological cancer who have a ureteral stent in place due to ureteral obstruction, ureteral stent removal may be considered in patients who do not have asymptomatic bacteriuria or other etiologies, such as external ureteral pressure or ureteral cancer metastasis.

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