Urogenital Tract Infection

Advances in the Diagnosis of Urinary Tract Infection: A Narrative Review: Juan Victor Ariel Franco, Nicolás Meza; Urogenit Tract Infect 2025;20(1):17-27. Published online April 30, 2025; DOI: https://doi.org/10.14777/uti.2550020010

Abstract PDF: Urinary tract infections are among the most frequent bacterial infections, significantly impacting patient morbidity and healthcare resources. Prompt and accurate diagnosis is crucial to ensure effective treatment, prevent complications such as pyelonephritis or sepsis, and reduce inappropriate antibiotic use, contributing to antimicrobial resistance (AMR). Despite consensus across international guidelines from organizations, challenges persist, particularly in distinguishing true infections from asymptomatic bacteriuria or nonspecific symptoms, especially in older adults. Recent advancements in diagnostic technology have emerged to address these limitations, including molecular diagnostics, point-of-care testing (POCT), and artificial intelligence (AI)-driven predictive models. Molecular techniques, notably polymerase chain reaction, loop-mediated isothermal amplification, and metagenomic next-generation sequencing, offer enhanced sensitivity and specificity, rapid detection times, and comprehensive identification of pathogens and resistance profiles. POCT innovations, such as lateral flow immunoassays, enzymatic-based rapid tests, and novel biosensors, facilitate prompt bedside diagnosis, although specificity challenges remain. Meanwhile, AI and machine learning models demonstrate significant potential for risk stratification, prediction of infection, and improving antibiotics prescription practices yet face barriers related to validation, practical integration, and clinical acceptability. Despite promising developments, significant gaps remain, including limited real-world implementation evidence, high costs, and insufficient data from diverse populations. Further rigorous clinical studies, economic evaluations, and practical implementation assessments are urgently required. Addressing these research gaps could substantially improve patient outcomes, optimize antibiotic stewardship, and reduce the global burden of AMR.

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Efficacy of Urovaxom for Improving Chronic Pelvic Pain Syndrome Symptoms in Prostate Cancer Patients Who Underwent Radical Prostatectomy: A Multicenter, Prospective Cohort Study: Jun-Koo Kang, Yun-Sok Ha, Sungchan Park, Tae Gyun Kwon, Tae-Hwan Kim; Urogenit Tract Infect 2025;20(1):42-47. Published online April 30, 2025; DOI: https://doi.org/10.14777/uti.2550014007

Abstract PDF: Purpose
Chronic pelvic pain syndrome (CPPS) is a multifactorial condition that can significantly diminish quality of life. Although some patients have reported persistent pelvic pain after radical prostatectomy (RP), the prevalence and direct causal relationship between CPPS and RP remain unclear. This multicenter prospective study aimed to evaluate the efficacy of Urovaxom for improving CPPS symptoms. Materials and Methods: A total of 52 prostate cancer patients who underwent RP were enrolled and administered Urovaxom (60 mg/day) for 12 weeks. Changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), and inflammation markers (white blood cell [WBC], C-reactive protein [CRP]) were analyzed using the Wilcoxon signed-rank test.
Results
After 12 weeks of treatment, the NIH-CPSI total score significantly decreased from 19 (interquartile range [IQR], 16–23) to 12.5 (IQR, 8.0–16.8) (p<0.001). The OABSS total score decreased from 8 (IQR, 4–11) to 5 (IQR, 3.0–7.8), and the IPSS total score decreased from 13.5 (IQR, 10.0–22.8) to 10.5 (IQR, 5.0–17.0) (p<0.001). WBC levels showed a slight increase (p=0.028), but the clinical relevance of this change is uncertain and warrants further investigation. CRP changes were not statistically significant (p=0.274).
Conclusions
Urovaxom demonstrated significant efficacy in improving CPPS symptoms, particularly pain and reduced quality of life, in patients following RP. These findings suggest Urovaxom as a potential therapeutic option for CPPS after management using RP.

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A Commentary on “Outbreak of Cystoscopy- Related Urinary Tract Infections With Pseudomonas aeruginosa in South Korea, 2022: A Case Series”: Byoungkyu Han; Urogenit Tract Infect 2025;20(1):52-54. Published online April 30, 2025; DOI: https://doi.org/10.14777/uti.2550010005

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Hemangioma Mistaken for Renal Cell Carcinoma in a Patient With End-Stage Renal Disease: A Case Report: Hyung-Lae Lee, Dong-Gi Lee, Jeong Woo Lee, Jeonghyouk Choi; Urogenit Tract Infect 2025;20(1):48-51. Published online April 30, 2025; DOI: https://doi.org/10.14777/uti.2550008004

Abstract PDF: Hemangiomas are rare, benign vascular neoplasms that are more common in patients with end-stage renal disease. Here, we describe 2 cases of hemangioma misdiagnosed as renal cell carcinoma before renal transplantation. The key finding in our case was the misdiagnosis of hemangiomas as renal cell carcinoma based on computed tomography and magnetic resonance imaging in patients with end-stage renal disease. Because living transplantation was planned for our patients, we performed rapid surgical resection of the heterogeneously enhancing renal masses to avoid delays in transplantation. Our case highlights the importance of rapid surgical resection of enhanced renal masses to confirm diagnosis, thereby avoiding delays in patients scheduled for renal transplantation.

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Mortality and Risk Factors for Emphysematous Pyelonephritis in Korea: A Multicenter Retrospective Cohort Study: Seung-Kwon Choi, Jeong Woo Lee, Seung Il Jung, Eu Chang Hwang, Joongwon Choi, Woong Bin Kim, Jung Sik Huh, Jin Bong Choi, Yeonjoo Kim, Jae Min Chung, Ju-Hyun Shin, Jae Hung Jung, Hong Chung, Sangrak Bae, Tae-Hyoung Kim; Urogenit Tract Infect 2025;20(1):34-41. Published online April 30, 2025; DOI: https://doi.org/10.14777/uti.2550006003

Abstract PDF: Purpose
Emphysematous pyelonephritis (EPN) is a life-threatening disease requiring immediate treatment. This multicenter retrospective cohort study aimed to analyze the mortality rate and risk factors associated with EPN. Materials and Methods: Between January 2011 and February 2021, 217 patients diagnosed with EPN via computed tomography who visited 14 teaching hospitals were retrospectively analyzed. Clinical data, including age, sex, comorbidities, Huang and Tseng classification, hydronephrosis, acute kidney injury, blood and urine tests, surgical interventions, percutaneous drainage, and conservative treatments, were compared between the survival and death groups. Risk factors for mortality due to EPN were analyzed using univariate and multivariate methods.
Results
The mean age of survivors and deceased patients was 67.8 and 69.0 years, respectively (p=0.136). The sex distribution (male/female) was 48/146 and 8/15, respectively (p=0.298). Of the 217 patients, 23 died, resulting in a mortality rate of 10.6%. In univariate analysis, the Huang and Tseng classification (p=0.004), platelet count (p=0.005), and acute kidney injury (p=0.007) were significantly associated with mortality from EPN. In multivariate analysis, only the Huang and Tseng classification (p=0.029) was identified as a risk factor. Mortality rates according to the Huang and Tseng classification were as follows: class I (5.88%), class II (7.50%), class IIIa (14.28%), class IIIb (25.00%), and class IV (23.07%).
Conclusions
EPN is associated with a high mortality rate. Among various clinical factors, the Huang and Tseng classification was the most significant indicator for predicting mortality.

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A Narrative Review of Syphilis Notification Systems in Korea: Change to Mandatory Surveillance System: Seung-Ju Lee, Jin Bong Choi; Urogenit Tract Infect 2025;20(1):28-33. Published online April 30, 2025; DOI: https://doi.org/10.14777/uti.2550004002

Abstract PDF: New cases of syphilis are clearly showing an increasing trend worldwide. However, in a sentinel surveillance system, the collection of information on disease outbreaks is limited, making it difficult to understand the overall outbreak situation and perform detailed analyses of patients' demographic characteristics and disease stages. In accordance with the revision of the Infectious Disease Prevention Act, syphilis was converted from a grade 4 infectious disease subject to sentinel surveillance to a grade 3 infectious disease subject to mandatory surveillance from January 1, 2024, with all medical institutions required to report syphilis diagnosis within 24 hours.

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Emerging Insights Into Microbiome Therapeutics for Urinary Tract Infections: A Narrative Review: Hoonhee Seo, Md Abdur Rahim, Indrajeet Barman, Mohammed Solayman Hossain, Hanieh Tajdozian, Fatemeh Ghorbanian, Md Sarower Hossen Shuvo, Jiho Choi, Sukyung Kim, Heejo Yang, Ho-Yeon Song; Urogenit Tract Infect 2025;20(1):4-16. Published online April 30, 2025; DOI: https://doi.org/10.14777/uti.2448034017

Abstract PDF: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, affecting millions annually and posing a significant global health concern. Traditional therapies for UTIs are becoming increasingly ineffective due to rising drug resistance and their tendency to disrupt the host's healthy microbiota, leading to further side effects. Consequently, there is an urgent need to develop alternative therapeutic agents that differ from conventional regimens and have fewer or no side effects. In this context, microbiome therapeutics offer a promising solution, given their demonstrated efficacy against various infectious diseases. Advances in scientific technology, particularly next-generation sequencing, have deepened our understanding of urinary microbiome dynamics, revealing a complex interplay within the urobiome that influences the onset and progression of UTIs. Uropathogenic bacteria do not solely cause UTIs; shifts in the composition of the urinary microbiome and interactions within the microbial community, known as host-microbiota interactions, also play a significant role. Although recent studies underscore the potential of targeting the urinary microbiome to manage UTIs and related complications, this field is still emerging and faces numerous regulatory and technical challenges. Further in-depth and comprehensive research is required to advance this pioneering concept into clinical practice.

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Editorial for UTI 2025 Vol. 20 No. 1 - Highlights of This Issue’s Papers and the UTI Editors’ Pick: Koo Han Yoo; Urogenit Tract Infect 2025;20(1):1-3. Published online April 30, 2025; DOI: https://doi.org/10.14777/uti.2025edi01

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The Necessity of Human Papillomavirus Vaccination in Men: A Narrative Review: Sooyoun Kim, Sangrak Bae; Urogenit Tract Infect 2024;19(3):51-59. Published online December 31, 2024; DOI: https://doi.org/10.14777/uti.2448030015

Abstract PDF PubReader ePub: Anogenital wart caused by human papillomavirus (HPV) is the most common sexually transmitted infection. High-risk strains, such as types 16 and 18, cause penile cancer in men, cervical and vulvar cancers in women, and head and neck cancers and anal cancer in both sexes. Since these malignant tumors can be prevented through vaccination, the importance of vaccination is emphasized. However, because HPV is known to cause cervical cancer, vaccination is only being administered to women. Some countries vaccinate men as well, but in South Korea, only girls are included in the National Immunization Program. However, screening for HPV in men is not possible, and the virus causes various malignant tumors, with a sharp increase in head and neck cancers, as well as a surge in genital warts in the country. In addition, HPV worsens sperm quality. Moreover, the need for vaccines is increasing as the known methods for preventing HPV-related diseases in men are decreasing and the disease burden is increasing. As cost-effectiveness studies have shown that the cost-effectiveness of vaccination is lower for men than for women, it is unlikely that male vaccination will be included in national immunization programs. Many countries overseas, especially a very small number of OECD (Organization for Economic Cooperation and Development) countries including South Korea, are implementing mandatory vaccination for women. Vaccinating men and women, would be cost-effective and efficient in achieving herd immunity. In addition to herd immunity, the inclusion of male vaccination in the National Immunization Program is imperative given the rapidly increasing incidence of diseases in men.

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Outbreak of Cystoscopy-Related Urinary Tract Infections With Pseudomonas aeruginosa in South Korea, 2022: A Case Series: Beomsoo Kim, Young-Sin Choi, Jun-Koo Kang, Yun-Sok Ha, Seock Hwan Choi, Bum Soo Kim, Hyun Tae Kim, Eun Sang Yoo, Tae Gyun Kwon, Jae-Wook Chung, Tae-Hwan Kim; Urogenit Tract Infect 2024;19(3):97-103. Published online December 31, 2024; DOI: https://doi.org/10.14777/uti.2448028014

Abstract PDF PubReader ePub: Purpose
This study conducted an epidemiological investigation of Pseudomonas aeruginosa urinary tract infections (UTIs) following cystoscopy at Chilgok Kyungpook National University Hospital. Materials and Methods: From May 16 to July 15, 2022, among 353 patients who underwent cystoscopy, 6 patients reported febrile UTIs following cystoscopy. They were admitted to the urology department of the hospital after visiting the Emergency Department. P. aeruginosa was found in the urine cultures of 4 of the 6 hospitalized patients. During the epidemiological investigation, no changes were observed in factors such as the reprocessing procedures for endoscopic equipment. Therefore, microbiological tests were performed using environmental samples derived from the endoscopic equipment and cleaning process.
Results
P. aeruginosa was identified in a dual-enzymatic detergent (EmPower) used during the endoscope cleaning process. After changing the disinfectant and cleaning process, no further bacterial growth was observed in subsequent microbiological tests.
Conclusions
This study highlights the potential of cystoscopes to serve as reservoirs for bacteria due to inadequate cleaning during the disinfection process. To minimize the risk of infections following cystoscopy, it is important to pay close attention to the reprocessing and cleaning of cystoscopes.

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Postoperative Microscopic Pyuria and Role of Damage-Associated Molecular Pattern: A Literature Review: Min-Kyu Kim, Ki Hong Kim; Urogenit Tract Infect 2024;19(3):73-79. Published online December 31, 2024; DOI: https://doi.org/10.14777/uti.2448026013

Abstract PDF PubReader ePub: All patients who undergo transurethral prostate surgery exhibit pyuria and microscopic hematuria in postoperative urinalysis. Postoperative asymptomatic pyuria is associated with the inflammatory process and surface remodeling of the prostate, rather than infection. Various studies have investigated the incidence, duration, and risk factors for postoperative pyuria, noting that factors like age, surgery time, and prostate size can influence outcomes. Postoperative pyuria reflects tissue recovery and inflammation, and the use of antibiotics in asymptomatic patients may not be appropriate.

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Klebsiella pneumoniae-Induced Emphysematous Prostatic Abscess Accompanied by a Spinal Cord Infarction: Case Report: Seong Uk Jeh, Min Sung Choi, Chang Seok Kang, Dae Hyun Kim, Jae Hwi Choi, See Min Choi, Sung Chul Kam, Jeong Seok Hwa, Jae Seog Hyun; Urogenit Tract Infect 2024;19(3):104-108. Published online December 31, 2024; DOI: https://doi.org/10.14777/uti.2448024012

Abstract PDF PubReader ePub: Various strains can be found in emphysematous prostatic abscesses (EPAs), but the most frequent causative organism is Klebsiella pneumoniae . Hypervirulent K. pneumoniae can disseminate to distant sites by forming a muco-polysaccharide network outside the capsule. Here, we present the first case of K. pneumoniae in an EPA accompanied by a spinal cord infarction. A 65-year-old man was referred to our hospital due to sudden-onset paraplegia after a 5-day history of fever, myalgia, and voiding difficulty. Abdominal computed tomography revealed a collection of air pockets in the prostate, and diffusion-weighted magnetic resonance imaging showed high signal intensity in the thoracic spinal cord. The patient was initially treated with antibiotics and surgical drainage. On the third hospital day, therapeutic heparin was added after discussion with a neurologist. The patient had no inflammatory symptoms, experienced some improvement in paraplegia, and was discharged on the 14th hospital day. This study adhered to the case report guidelines.

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Mechanistic Insights Into Persistent Bacterial Cystitis as a Basis for Vaccine Development: A Narrative Review: Karen Serrano-Arevalo, Manisha Naskar, Hae Woong Choi; Urogenit Tract Infect 2024;19(3):60-72. Published online December 31, 2024; DOI: https://doi.org/10.14777/uti.2448022011

Abstract PDF PubReader ePub: Urinary tract infections (UTIs) are primarily caused by uropathogenic Escherichia coli (UPEC), which frequently lead to recurrent infections. These bacteria utilize several strategies to establish infection in the host; in particular, virulence factors such as fimbriae and α-hemolysin facilitate persistent infection, evade host immune responses, and minimize antibiotic exposure. To date, antibiotics have been the primary treatment for UTIs. However, an increasing emphasis has been placed on the need for UTI vaccines, with mucosal vaccine products now available in several countries. Additionally, vaccines targeting intracellular UPEC, utilizing adjuvants, are currently under development. Understanding the pathogenic mechanisms of uropathogens has enabled the development of new treatment approaches, paving the way for next-generation preventive and therapeutic methods that could effectively manage recurrent UTIs in the future.

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Artificial Intelligence for Autonomous Robotic Surgery in Urology: A Narrative Review: Dae Young Lee, Hee Jo Yang; Urogenit Tract Infect 2024;19(3):80-88. Published online December 31, 2024; DOI: https://doi.org/10.14777/uti.2448020010

Abstract PDF PubReader ePub: Artificial intelligence (AI) has emerged as a transformative force in various sectors, including medicine, where it processes high-dimensional data to improve diagnostics and treatment outcomes. This review explores AI applications in urological surgery, highlighting advancements such as image classification and robotic assistance in surgical procedures. AI has demonstrated exceptional diagnostic accuracy, with some systems achieving up to 99.38% in detecting prostate cancer. Additionally, AI facilitates real-time anatomical recognition and instrument delineation, increasing surgical precision. While current robotic systems operate under human supervision, ongoing research aims to advance autonomous surgical capabilities. The future of AI in robotic surgery is promising, especially regarding the possibility of improved outcomes; nonetheless, challenges related to autonomy, safety, and ethics remain.

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Impact of the Timing of Percutaneous Nephrostomy on the Prognosis of Obstructive Urolithiasis With Sepsis: A Retrospective Cohort Study: Ji Eun Yu, Hyung Joon Kim, Hong Wook Kim, Young Seop Chang, Jin Bum Kim, Dong Hoon Koh; Urogenit Tract Infect 2024;19(3):89-96. Published online December 31, 2024; DOI: https://doi.org/10.14777/uti.2448018009

Abstract PDF PubReader ePub: Purpose
The aim of this study was to investigate the prognostic impact of time to percutaneous nephrostomy (PCN) insertion on obstructive ureteral stones with sepsis. Materials and Methods: Data were collected on patients who presented at our Emergency Department between 2017 and 2021 with obstructive uropathy due to urinary stones and underwent PCN insertion. Patients were stratified into 4 groups in accordance with the quick sepsis-related organ failure (qSOFA) score at presentation (<2 or ≥2) and time to PCN insertion (<4 hours or ≥4 hours) as follows: group 1, qSOFA < 2 and time to PCN insertion < 4 hours; group 2, qSOFA < 2 and time to PCN insertion ≥ 4 hours; group 3, qSOFA ≥ 2 and time to PCN insertion < 4 hours; group 4, qSOFA ≥ 2 and time to PCN insertion ≥ 4 hours. The prognostic impacts of the time to PCN insertion were compared between these groups
Results
The total cohort consisted of 96 patients, of whom 70 were classified as either group 1 or 2 (qSOFA < 2). Overall, 37 patients had a positive urine culture. The median time to PCN insertion was 218 minutes, and the median length of stay was 14 days. The hospitalization period was significantly shorter in group 3 than in group 4 (p=0.041).
Conclusions
A shorter length of stay was associated with more rapid PCN insertion in patients with obstructive uropathy and a high risk of sepsis.

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Hyperbaric Oxygen Therapy for the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Case Report: Kwang Jin Kim, Yoonsuk Lee, Yong Sung Cha, Tae Wook Kang, Hyun Chul Chung, Hong Chung, Hyun Kim, Jae Hung Jung; Urogenit Tract Infect 2024;19(2):44-47. Published online August 31, 2024; DOI: https://doi.org/10.14777/uti.2024.19.2.44

Abstract PDF PubReader ePub: Hyperbaric oxygen therapy (HBOT) was conducted on two male patients with chronic prostatitis/chronic pelvic pain syndrome who were resistant to conventional medical therapies. Both patients underwent 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 90 min/day, five days/week for four weeks) in a hyperbaric chamber. The follow-up period was three months. Although the patients reported a slight improvement in the pain domain of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) after HBOT, no changes were noted in the other domains of NIH-CPSI and International Prostate Symptom Score. No adverse events were encountered during or after HBOT.

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Robotic Excision of a Huge Seminal Vesicle Cyst, Including Intracystic Papillary Adenoma, Saving Fertility: Tae Hoon Oh, Ill Young Seo; Urogenit Tract Infect 2024;19(2):40-43. Published online August 31, 2024; DOI: https://doi.org/10.14777/uti.2024.19.2.40

Abstract PDF PubReader ePub: A seminal vesicle cyst is a rare disease, and an intracystic papillary adenoma within the seminal vesicle is extremely rare. The diagnosis and treatment of these diseases are challenging because of the limited data. This paper presents a robotic excision of a huge seminal vesicle cyst, including an intracystic papillary adenoma, preserving fertility in a 40-year-old man.

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Effect of Residual Stone Fragments on Patient-Reported Quality of Life after Endoscopic Kidney Stone Surgery: Sang Hee Lee, Jun-Koo Kang, Jae-Wook Chung, Yun-Sok Ha, Jun Nyung Lee, Seock Hwan Choi, Hyun Tae Kim, Tae-Hwan Kim, Eun Sang Yoo, Tae Gyun Kwon, Bum Soo Kim; Urogenit Tract Infect 2024;19(2):31-39. Published online August 31, 2024; DOI: https://doi.org/10.14777/uti.2024.19.2.31

Abstract PDF PubReader ePub: Purpose: This study examined the effects of residual fragments (RF) on the patient-reported quality of life (QOL) after kidney stone surgery, such as retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), using the Korean version of the Wisconsin Stone Quality of Life Questionnaire (K-WISQOL).
Materials and Methods: The medical records of 156 patients who underwent RIRS or PCNL and completed the preoperative and postoperative K-WISQOL from January 2021 to September 2023 were analyzed retrospectively. The patients were divided into RIRS and PCNL groups by the surgical method. The participants completed the K-WISQOL within four weeks before and after treatment. The patients’ baseline characteristics, surgical outcomes, and K-WISQOL scores were compared according to the presence of RF in each surgical group.
Results: Of the 156 patients, 95 underwent RIRS, and 61 underwent PCNL. In the RIRS group, the patients’ baseline characteristics and surgical outcomes were similar in the stone-free (SF) and RF subgroups. The changes in all K-WISQOL domain scores and total scores were similar in the two subgroups. In the PCNL group, the RF subgroup had a significantly higher proportion of staghorn stones, a significantly larger mean stone diameter and significantly longer operation time than those of the SF subgroup. But, the changes in all K-WISQOL domain scores and total scores were not significantly different between the two subgroups, as observed in the RIRS group.
Conclusions: This study showed that the presence of RFs after endoscopic kidney surgery did not affect the short-term patient-reported QOL regardless of the surgical methods.

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Trend Analysis of Sexually Transmitted Infection Treatments in Korea: Soeon Park, Byung Kyu Han, Sangrak Bae, Seung-Ju Lee, Jin Bong Choi; Urogenit Tract Infect 2024;19(2):25-30. Published online August 31, 2024; DOI: https://doi.org/10.14777/uti.2024.19.2.25

Abstract PDF PubReader ePub: Purpose: The revision of the 2023 Guidelines for the Treatment of Sexually Transmitted Infections (STIs) has been released. Hence, it is necessary to analyze the current status of STI treatments in Korea.
Materials and Methods: A questionnaire was distributed to urologists and gynecologists from December 2022 to January 2023 through an online survey program. Three hundred and forty-one urologists and 302 gynecologists responded to the questionnaire.
Results: For Neisseria gonorrhea treatment, ceftriaxone 500 mg and 100 mg of doxycycline twice daily for seven days were most preferred by urologists (22.58%). The treatment most preferred by gynecologists (15.23%) was 500 mg of ceftriaxone and 1 g of azithromycin in a single dose. Both urologists and gynecologists generally treat Chlamydia trachomatis according to the treatment guidelines. For treating Mycoplasma genitalium, 29.03% of urologists preferred administering azithro-mycin at 500 mg once daily, followed by 250 mg for four days. In contrast, 33.11% of gynecologists preferred doxycycline 100 mg twice daily for seven days.
Conclusions: Most urologists and gynecologists followed the treatments recommended in the 2nd edition of the STI treatment guidelines, revised in 2016. As many treatment regimens have changed because of the recent increase in antibiotic-resistant STIs, there is a need to encourage them to follow the new treatment guidelines.

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Does Music Have a Calming Effect on Pain and Anxiety in Patients Undergoing Cystoscopy?: Ye Chan Joo, Ji Eun Yu, Jae Hyun Baik, Young Seop Chang, Jin Bum Kim, Hyung Joon Kim, Dong Hoon Koh, Hong Wook Kim; Urogenit Tract Infect 2024;19(1):3-9. Published online April 30, 2024; DOI: https://doi.org/10.14777/uti.2024.19.1.3

Abstract PDF Supplementary Material PubReader ePub: Purpose: Cystoscopy is a diagnostic test performed frequently in urology outpatient clinics. Despite the large number of inspections, the associated pain, discomfort, or anxiety can markedly affect patient compliance and adherence to subsequent surveillance protocols. This study conducted a prospective, randomized study to investigate the potential efficacy of music and pyuria on pain or anxiety during outpatient cystoscopy.
Materials and Methods: In this single-institution, randomized study, the participants were assigned to a music-intervention or non-music control group. The music-intervention group underwent an identical procedure with the addition of Johann Sebastian Bach’s “Air on the G String” from Suite No. 3 in D major, BWV 1068. Urinalysis was performed to determine if pyuria affects pain during the procedure.
Results: The patient-reported outcomes, encompassing the changes in the STAI-X-1 (State-Trait Anxiety Inventory-X-1) scores, subjective levels of discomfort, embarrassment, satisfaction, and pain, were similar in the two groups. In contrast, the surgeons reported statistically significant differences in their evaluations of the same items as patient-reported outcomes of the two groups. The patient-reported pain showed no significant differences between the pyuria-negative group (0-2 and 3-5 WBC/HPF) and pyuria-positive group (>5 WBC/HPF).
Conclusions: The data from this study do not support the hypothesis that musical intervention during cystoscopy alleviates pain or anxiety to any significant extent. In addition, pyuria did not affect the patient’s reported pain. Nevertheless, a notable impact was observed in the surgeons’ assessments, suggesting that the musical accompaniment may alter the surgeons’ perception of patient pain and anxiety levels throughout the procedure.

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Pelvic Pain in Men with Mycoplasma Genitalium: Yumi Seo; Urogenit Tract Infect 2024;19(1):16-23. Published online April 30, 2024; DOI: https://doi.org/10.14777/uti.2024.19.1.16

Abstract PDF PubReader ePub: Purpose: There are debates about Mycoplasma genitalium (M. genitalium) causing prostate infection and inducing pelvic pains. Consequently, M. genitalium-associated pelvic pains were characterized and their manifestation in male pelvic pain syndrome (MPPS) was evaluated through a case-control study.
Materials and Methods: The presence of M. genitalium-associated pelvic pains was examined in 113 M. genitalium-infected men, and the typical presentations of mycoplasma-associated MPPS were characterized through a case-control study involving 80 mycoplasma-infected and 234 case-matched uninfected controls. Finally, changes in symptoms following antimicrobial treatments were compared between 27 cured and 14 persistently infected cases.
Results: Pain locations from 113 men were followed as items-1a for 25.7%, 1b for 21.2%, 1c for 31%, 1d for 18.6%, 2a for 59.3%, and 2b for 23% from the Korean National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire. In addition, the sum scores from the pain domain, voiding domain and total score were 6.68±4.75, 2.69±2.66, and 15.00±8.66, respectively. Successful antibiotic therapy significantly reduced the total score from baseline (15.148±6.798 vs. 5.357±7.025, p=0.001). From the case-control study, mycoplasma-infected men had pains more frequently during urination (1c) and on the tip of the penis (2a) (all p=0.0001) than the controls.
Conclusions: It was found that M. genitalium infection is associated with clinically significant male pelvic pains, which improved with adequate antimicrobial therapies. Urethral irritation symptoms without pyuria may be the typical characteristics of mycoplasma-associated pelvic pains in MPPS.

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Is Routine Voiding Cystourethrogram Necessary Following Endoscopic Subureteral Injection for Primary Low-Grade Vesicoureteral Reflux?: Jun-Koo Kang, Min Ji Park, Min Hyun Cho, Jun Nyung Lee; Urogenit Tract Infect 2024;19(1):10-15. Published online April 30, 2024; DOI: https://doi.org/10.14777/uti.2024.19.1.10

Abstract PDF PubReader ePub: Purpose: An endoscopic subureteral injection (EI) using a bulking agent is a highly successful surgical procedure, particularly for low-grade vesicoureteral reflux (VUR). Despite the serious adverse effects, routine voiding cystourethrogram (VCUG) to determine radiographic success after EI remains controversial. This study evaluated the necessity of routine postoperative VCUG in children with primary low-grade VUR.
Materials and Methods: From January 2016 to August 2021, children who underwent EI for primary low-grade (I-III) VUR with a history of febrile urinary tract infection (fUTI) were analyzed retrospectively. From January 2016 to July 2018, routine VCUG following EI was performed on all children. Thereafter, postoperative VCUG was performed only if indicated. Clinical success was defined as no fUTI during a 12-month follow-up, and radiographic success was defined as the disappearance of VUR on postoperative VCUG. The clinical and radiographic outcomes in both groups were compared.
Results: Thirty-six children were analyzed in this study. Three children (8.3%) experienced postoperative fUTI. In the routine group, clinical and radiographic success was observed in 16/17 (94.1%) and 15/17 (88.2%), respectively. Two children in the routine group experienced radiographic failure. Among these, one child showed clinical success, and the other underwent additional EI due to clinical failure. Of the indicated group, clinical failure was observed in 2/19 (10.5%). Of them, persistent VUR was identified in one child.
Conclusions: Clinical and radiologic success after EI for primary low-grade VUR is high, and routine VCUG for confirming radiographic success has a limited impact on the clinical course.

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Male Human Papilloma Virus Infections: How to Prepare for Vaccination Strategies: Jeonghyouk Choi, Koo Han Yoo; Urogenit Tract Infect 2024;19(1):1-2. Published online April 30, 2024; DOI: https://doi.org/10.14777/uti.2024.19.1.1

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Giant Fibroepithelial Polyp in the Renal Pelvis to the Upper Ureter: Kyung Jin Chung; Urogenit Tract Infect 2023;18(3):119-122. Published online December 31, 2023; DOI: https://doi.org/10.14777/uti.2023.18.3.119

Abstract PDF PubReader ePub: Benign ureteral tumors are rare owing to the predominance of malignancies in ureter tumors. Among them, fibroepithelial polyps are very rare, and giant fibroepithelial polyps are even rarer. This paper reports the author’s experience of giant fibroepithelial polyps detected incidentally. A 47-year-old woman was referred for severe right flank pain to the author’s center. A kidney computed tomogram revealed a long soft tissue lesion in the right kidney, upper polar calyx, pelvis, and whole proximal ureter with hydronephrosis. The radiologic reading was right renal pelvis urothelial cancer. Endoscopic removal was deemed impossible because the mass was filling the entire renal pelvis and upper ureter, so a nephroureterectomy was performed. After the nephroureterectomy, the pathology findings revealed a giant fibroepithelial polyp. This paper reports the treatment of giant fibroepithelial polyps of the ureter. Clinicians should consider the possibility of benign tumors and recommend a cautious approach to treatment if discovered.

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Case of Life-Threatening Pneumonia during the Treatment of a Patient with Acute Bacterial Prostatitis: Kyung Kgi Park, Sung Dae Kim, Young-Joo Kim, Jung-Sik Huh; Urogenit Tract Infect 2023;18(3):114-118. Published online December 31, 2023; DOI: https://doi.org/10.14777/uti.2023.18.3.114

Abstract PDF PubReader ePub: Acute bacterial prostatitis is an acute urinary tract infection associated with a bladder outlet obstruction or an immunosuppressed state. A 51-year-old man patient visited the hospital with fever, chills, and acute urinary retention that started the day before his visit after consuming a significant amount of alcohol. Conservative treatments, including catheterization for urinary drainage and antibiotics, were performed. On the third day of treatment for acute prostatitis, he complained of dyspnea. The level of oxygen differentiation was reduced significantly, and the tracheal insertion and ventilator were maintained after the radiological examination. The ventilator was discontinued, and the prostate abscess was operated on the eighth day of hospitalization. He was discharged without complications. This paper reports a case of life-threatening pneumonia and a prostate abscess during the treatment of a patient with acute bacterial prostatitis with a review of the relevant literature.

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Spontaneous Bladder Perforation in a Patient with a Long-Term Intraurethral Catheter: Taegi Choi, Hyunkyung Lee, Junseok Kim, Sunghoon Lee, Younkyung Cho, Eunyoung Kang, Jinsun Kang, Sumin Lee, Eunju Na; Urogenit Tract Infect 2023;18(3):110-113. Published online December 31, 2023; DOI: https://doi.org/10.14777/uti.2023.18.3.110

Abstract PDF PubReader ePub: Urinary catheters are commonly used to address various urinary problems. However, the catheter itself can be a cause of several complications, including catheter-associated urinary tract infections, damage to the bladder and kidneys, and, in extremely rare cases, bladder perforation. We present a case of spontaneous bladder perforation in a patient who had a long-term indwelling intraurethral catheter. The patient with prior hypoxic brain damage suddenly developed tachypnea, tachycardia, and oxygen desaturation. Computed tomography and retrograde cystography revealed an extraperitoneal bladder perforation with an intra-pelvic abscess. Antibiotics were prescribed and a urinary catheter was inserted for drainage. After 11 weeks, the abscess resolved, and the catheter was removed to enable self-voiding. The perforation was attributed to chronic inflammation and distension of the bladder wall caused by the intraurethral catheter. Given the potential complications associated with long-term urinary catheterization, the timely removal of indwelling catheters should be considered.

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Risk Factors for Sepsis after Retrograde Intrarenal Surgery: Single Center Experience: Jinseok Kang, Koo Han Yoo, Taesoo Choi, Gyeong Eun Min, Dong-Gi Lee, Hyung-Lae Lee, Jeonghyouk Choi; Urogenit Tract Infect 2023;18(3):93-100. Published online December 31, 2023; DOI: https://doi.org/10.14777/uti.2023.18.3.93

Abstract PDF PubReader ePub

Purpose: To evaluate risk factors for sepsis after retrograde intrarenal surgery for treatment of renal stones.
Materials and Methods: We analyzed the clinical data of 243 patients with kidney stones who visited our institution between April 2017 and April 2023. Age, sex, body mass index, underlying disease, location and size of stones, previous history of stones, previous history of urinary tract infections, duration of surgery, preoperative drainage, application of ureteral balloon dilation, and laboratory test results were included in the analysis.
Results: The mean age of the patients was 58.4 (±15.0) years; there were more men (53.1%) than women (46.9%). Of the 243 patients, the overall rate of sepsis was 5.8% (n=14) and the total mortality rate was 0.4% (n=1). In univariate analysis, history of urinary tract infection (p=0.019), positive preoperative urine culture test (p=0.009), operative duration of more than 90 min (p=0.004), and application of ureter balloon dilation (p=0.016) were statistically significant. In multivariate analysis, positive finding in the urine culture test performed before surgery (p=0.003), operation duration >90 min (p=0.005), and use of balloon dilation during surgery (p=0.011) were statistically significant.
Conclusions: There is a risk of progression to postoperative sepsis if bacteria are detected in the urine culture before surgery, if the operative time exceeds 90 min, or if balloon dilation is performed during surgery. Given that the probability of progression to sepsis is approximately 6%, close observation and active treatment are needed for patients with these risk factors.

Citations

Citations to this article as recorded by

Analysis of postoperative infection factors of retrograde intrarenal surgery combined with negative pressure equipment for renal stones
Deheng Cui, Qinghong Ma, Qiuyan Zhang, Lian Zhang, Guoqiang Chen
Scientific Reports.2024;[Epub] CrossRef

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Impact of Microbial Infection on Sperm Parameters of Seminal Bacteria in Asymptomatic Subfertile Males: Sae Byuk Chang, Tae Jin Kim, Tae Heon Kim, Seung-Ryeol Lee, Young Kwon Hong, Dong Soo Park, Sun-Mi Cho, Dong Hyeon Lee, Young Dong Yu; Urogenit Tract Infect 2023;18(3):82-92. Published online December 31, 2023; DOI: https://doi.org/10.14777/uti.2023.18.3.82

Abstract PDF PubReader ePub: Purpose: This study examined the effects of asymptomatic bacteriospermia on the semen quality of subfertile males. The types of bacteria and their antibiotic susceptibility were also analyzed.
Materials and Methods: Semen was collected and analyzed from 510 subfertile males. One hundred and seventy-nine males showed bacteriospermia, while 331 males did not. The bacterial species, sperm parameters, hormone levels, underlying disease, and lifestyle patterns were compared between the two study groups.
Results: The bacteriospermic males showed significantly higher rates of leukocytospermia (p=0.001) and deoxyribonucleic acid (DNA) fragmentation than the non-bacteriospermic males. Sperm motility was significantly lower in the bacteriospermic males than in non-bacteriospermic males. The most common seminal bacterial species were Prevotella bivia (P. bivia, 41.3%) and Ureaplasma urealyticum (U. urealyticum, 13.4%). U. parvum showed the highest recurrence rates (31.8%) three months after the initial antibiotic treatment. Regarding the sperm parameters of bacteriospermic males, the sperm concentration, total motility, progressive motility, leukocytospermia, and DNA fragmentation were improved significantly after the initial antibiotics treatment. Multivariate logistic regression analyses revealed P. bivia, U. urealyticum, and U. parvum to be associated with the decreased motility and increased DNA fragmentation of spermatozoa. P. bivia was also associated with a decreased sperm concentration (p=0.002) and vitality (p=0.013).
Conclusions: Bacteriospermia decreased the sperm concentration, motility, normal morphology, and vitality. P. bivia is the most commonly observed bacteria in subfertile males. Appropriate antibiotic therapy of seminal bacteria species had a strong positive impact on improving the semen parameters.

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Impact of Antibiotics on the Efficacy of Immune Checkpoint Inhibitors in Metastatic Urothelial Carcinoma: Do Gyeong Lim, Ho Yeon Lee, Ho Seok Chung, Eu Chang Hwang, Seung Il Jung, Dong Deuk Kwon; Urogenit Tract Infect 2023;18(3):75-81. Published online December 31, 2023; DOI: https://doi.org/10.14777/uti.2023.18.3.75

Abstract PDF PubReader ePub: Purpose: Emerging evidence has suggested that prior or concurrent antibiotic (ATB) use may be associated with a poor response to immune checkpoint inhibitors (ICIs) in patients with some solid tumors. This study examined the effects of ATB use on the oncological outcomes of patients receiving ICIs for mUC.
Materials and Methods: Patients receiving ICIs for mUC between 2018 and 2020 were assessed retrospectively. Those with over three cycles of atezolizumab or pembrolizumab were included. ATB use, defined as ≥ three days within 60 days before or three months after ICI administration, was compared between groups for oncological outcomes.
Results: Thirty-one patients were examined. The ATB-use and no-ATB-use groups consisted of 15 (48.4%) and 16 patients (51.6%), respectively. The ATB-use group showed a lower disease control rate (56.3% vs. 13.3%, p=0.023) than the no-ATB-use group. The objective response rate in the ATB-use group was lower than the no-ATB-use group, but the difference was statistically insignificant (43.7% vs. 13.3%, p=0.113). The ATB-use group had shorter progression-free survival (median three vs. six months, log-rank p=0.045) and shorter overall survival (median three vs. 14 months, log-rank p=0.023) than the no-ATB-use group. The most commonly used antibiotics were fluoroquinolones (46.7%), cephalosporins (40.0%), non-cephalosporin beta-lactams (6.7%), and nitrofurantoin (6.7%).
Conclusions: ATB may be associated with poorer oncological outcomes in patients with mUC who received ICI therapy. Hence, further research will be needed to understand the relationship between the modulation of ATB-related dysbiosis and gut microbiota composition with the oncological outcomes in patients with mUC.

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A Case Report of Self-Inflicted Surgical Castration: Koo Han Yoo, Sung-Goo Chang; Urogenit Tract Infect 2023;18(3):107-109. Published online December 31, 2023; DOI: https://doi.org/10.14777/uti.2023.18.3.107

Abstract PDF PubReader ePub: Religious beliefs are a very significant part of one’s life. We report the case of a strongly religious man who sought to remove his testicles. After enlisting in the military, the man had a surgical castration performed on him while on vacation from military service. The procedure aimed to rid the man of his libido, which he saw as a hindrance to his religious life. After the removal of the testes, his serum testosterone was 0.25 ng/ml. The luteinizing hormone, 22.1 (1.7-8.6 mIU/ml), and follicle stimulating hormone, 53.5 (1.5-12.4 mIU/ml) were elevated. Testicular scans showed an absence of both testes. This appears to be an unfortunate situation caused by false religious beliefs and the reckless use of internet resources.

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