Pub Date : 2019-12-01DOI: 10.14777/uti.2019.14.3.80
J. Yang, D. Shin, Jaewoo Sung, S. Cho, Sungmin Kang, H. Jeong, Saewoong Choi, W. Bae, S. Kim
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.
{"title":"Early Experiences of a Minimal Invasive Intra-Prostatic Implant, Prostatic Urethral Lift for Benign Prostatic Hyperplasia Treatment in Korea","authors":"J. Yang, D. Shin, Jaewoo Sung, S. Cho, Sungmin Kang, H. Jeong, Saewoong Choi, W. Bae, S. Kim","doi":"10.14777/uti.2019.14.3.80","DOIUrl":"https://doi.org/10.14777/uti.2019.14.3.80","url":null,"abstract":"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.","PeriodicalId":287735,"journal":{"name":"Urogenital Tract Infection","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129947959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.14777/uti.2019.14.3.71
Y. Ko, Jae Young Choi, P. Song
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.
{"title":"Host-Pathogen Interactions in Urinary Tract Infections","authors":"Y. Ko, Jae Young Choi, P. Song","doi":"10.14777/uti.2019.14.3.71","DOIUrl":"https://doi.org/10.14777/uti.2019.14.3.71","url":null,"abstract":"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.","PeriodicalId":287735,"journal":{"name":"Urogenital Tract Infection","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127828415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.14777/uti.2019.14.3.87
Jeonghyouk Choi, T. Choi, Dong-Gi Lee, G. Min, Hyung‐Lae Lee, K. Yoo
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.
{"title":"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?","authors":"Jeonghyouk Choi, T. Choi, Dong-Gi Lee, G. Min, Hyung‐Lae Lee, K. Yoo","doi":"10.14777/uti.2019.14.3.87","DOIUrl":"https://doi.org/10.14777/uti.2019.14.3.87","url":null,"abstract":"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.","PeriodicalId":287735,"journal":{"name":"Urogenital Tract Infection","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127316367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.14777/uti.2019.14.3.93
Kwibok Choi, Byounghoon Kim, I. Cho, S. Min
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.
{"title":"Clinical Course of the Benign Prostate Hyplasia Patients during the Intermittent Use of 5-Alpha Reductase Inhibitors","authors":"Kwibok Choi, Byounghoon Kim, I. Cho, S. Min","doi":"10.14777/uti.2019.14.3.93","DOIUrl":"https://doi.org/10.14777/uti.2019.14.3.93","url":null,"abstract":"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.","PeriodicalId":287735,"journal":{"name":"Urogenital Tract Infection","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131288729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.14777/uti.2019.14.2.64
H. Kang, J. Jung, Do Kyung Kim, J. Ku, Hyun Jin Jung, H. Kim, E. Hwang
This article is second translation of a GRADE series published in the BMJ to create a highly structured, transparent, and informative system for rating quality of evidence for developing recommendations. The process to develop a guideline, we should formulate a clear question with specification of all outcomes of importance to patients. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) offers four levels of evidence quality: high, moderate, low, and very low for these patient-important outcomes. Randomized trials begin as high quality evidence and observational studies as low quality evidence. Although randomized trials begin as high quality evidence, quality may be downgraded as a result of study limitations (risk of bias), inconsistency (variability in results), indirectness, imprecision (wide confidence intervals), or publication bias. While the quality of evidence derived from observational studies starts at ‘ low ’ but may be upgraded based on a very large magnitude of effect, a dose-response gradient, and if all plausible biases would reduce an apparent treatment effect.
{"title":"Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: What Is “Quality of Evidence” and Why Is It Important to Clinicians?’ (A Secondary Publication)","authors":"H. Kang, J. Jung, Do Kyung Kim, J. Ku, Hyun Jin Jung, H. Kim, E. Hwang","doi":"10.14777/uti.2019.14.2.64","DOIUrl":"https://doi.org/10.14777/uti.2019.14.2.64","url":null,"abstract":"This article is second translation of a GRADE series published in the BMJ to create a highly structured, transparent, and informative system for rating quality of evidence for developing recommendations. The process to develop a guideline, we should formulate a clear question with specification of all outcomes of importance to patients. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) offers four levels of evidence quality: high, moderate, low, and very low for these patient-important outcomes. Randomized trials begin as high quality evidence and observational studies as low quality evidence. Although randomized trials begin as high quality evidence, quality may be downgraded as a result of study limitations (risk of bias), inconsistency (variability in results), indirectness, imprecision (wide confidence intervals), or publication bias. While the quality of evidence derived from observational studies starts at ‘ low ’ but may be upgraded based on a very large magnitude of effect, a dose-response gradient, and if all plausible biases would reduce an apparent treatment effect.","PeriodicalId":287735,"journal":{"name":"Urogenital Tract Infection","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123429290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.14777/uti.2019.14.2.42
Ji-Yeon Han
Purpose: This study evaluated the risk factors associated with recurrence OM-89 (Uro-Vaxom ® ) treatment for female recurrent cystitis. Materials and Methods: The medical records of patients who received OM-89 for at least six months were reviewed retrospectively. Patients were excluded from the analysis if they had an abnormal lower urinary tract anatomy, residual urine volume ≥ 200 ml, a history of genitourinary tuberculosis, urological cancer or pelvic radiation, indwelling urinary catheter, or had genitourinary surgery within the previous six months. Patients were categorized into two groups: (1) no recurrence and (2) recurrent cystitis after OM-89. The risk factors in the two groups were compared. The recurrent cystitis was defined as two more infections in six months or three or more in one year. Results: A total of 52 female were included. Group 1 had 35 (67.3%) patients and group 2 had 17 (32.7%) patients. Before and after the OM-89, the mean cystitis episodes for six months of groups 1 and 2 were 4.19±4.60 (range, 2-24) and 1.17±1.79 (range, 0-6), respectively, which were decreased significantly (p ＜ 0.001). For recurrence after the OM-89, the only risk factor was uncontrolled diabetes (fasting plasma glucose level ＞ 120 mg/dl±casual plasma glucose ＞ 180 mg/dl) (p=0.002). No significant differences in the age, menopause, daily water intake, hormone replacement therapy or history of extended-spectrum beta-lacta-mase-producing Escherichia coli were observed between the two groups. Conclusions: OM-89 was effective in the management of recurrent cystitis in female. On the other hand, uncontrolled diabetes was a risk factor for treatment failure of OM-89.
{"title":"Risk Factor Associated with Recurrence after OM-89 (Uro-Vaxom®) Treatment for Female Recurrent Cystitis","authors":"Ji-Yeon Han","doi":"10.14777/uti.2019.14.2.42","DOIUrl":"https://doi.org/10.14777/uti.2019.14.2.42","url":null,"abstract":"Purpose: This study evaluated the risk factors associated with recurrence OM-89 (Uro-Vaxom ® ) treatment for female recurrent cystitis. Materials and Methods: The medical records of patients who received OM-89 for at least six months were reviewed retrospectively. Patients were excluded from the analysis if they had an abnormal lower urinary tract anatomy, residual urine volume ≥ 200 ml, a history of genitourinary tuberculosis, urological cancer or pelvic radiation, indwelling urinary catheter, or had genitourinary surgery within the previous six months. Patients were categorized into two groups: (1) no recurrence and (2) recurrent cystitis after OM-89. The risk factors in the two groups were compared. The recurrent cystitis was defined as two more infections in six months or three or more in one year. Results: A total of 52 female were included. Group 1 had 35 (67.3%) patients and group 2 had 17 (32.7%) patients. Before and after the OM-89, the mean cystitis episodes for six months of groups 1 and 2 were 4.19±4.60 (range, 2-24) and 1.17±1.79 (range, 0-6), respectively, which were decreased significantly (p ＜ 0.001). For recurrence after the OM-89, the only risk factor was uncontrolled diabetes (fasting plasma glucose level ＞ 120 mg/dl±casual plasma glucose ＞ 180 mg/dl) (p=0.002). No significant differences in the age, menopause, daily water intake, hormone replacement therapy or history of extended-spectrum beta-lacta-mase-producing Escherichia coli were observed between the two groups. Conclusions: OM-89 was effective in the management of recurrent cystitis in female. On the other hand, uncontrolled diabetes was a risk factor for treatment failure of OM-89.","PeriodicalId":287735,"journal":{"name":"Urogenital Tract Infection","volume":"267 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121310181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.14777/uti.2019.14.2.46
W. Kim, Sang Wook Lee, K. Lee, Jun Mo Kim, Y. H. Kim, Min Eui Kim
Purpose: To investigate the clinical manifestations of patients with the principal complaint of syndromic recurrent urinary tract infection (UTI), correlate these symptoms with the results of urine cultures, and identify the characteristics that can be used to differentiate UTI from similar diseases. Materials and Methods: A total of 212 consecutive patients with syndromic recurrent UTIs over a 24 month period were evaluated. The major symptoms were recorded using the UTISA questionnaire and VAS. The patients were divided into group A (n=98; positive urine and urethral swab cultures) and group B (n=114; negative cultures), and the symptoms were compared. For group B, cystoscopy was used to diagnose 61 patients who complained of pain levels ≥6 on the VAS. Results: The proportion of patients with the classic symptoms of UTI (dysuria, urinary frequency, lower abdominal discomfort during bladder filling, and urgency) was similar in groups A and B. Significantly more patients complained of urethral pain in group B, and significantly fewer patients had gross hematuria, low back pain, a post-voiding sensation of residual urine, and general symptoms compared to group A. Of the 61 patients with a VAS ≥6, 29, 28, and four were diagnosed with bladder pain syndrome, interstitial cystitis, and urethral pain syndrome, respectively. Conclusions: In patients with syndromic recurrent UTI, the classic symptoms were not sufficiently characteristic to allow bacterial cystitis to be differentiated from other bladder diseases. Diagnostic cystoscopy and VAS can assist in making a differential diagnosis in patients with non-bacterial syndromic recurrent UTIs.
{"title":"How Women Evaluate Syndromic Recurrent Urinary Tract Infections","authors":"W. Kim, Sang Wook Lee, K. Lee, Jun Mo Kim, Y. H. Kim, Min Eui Kim","doi":"10.14777/uti.2019.14.2.46","DOIUrl":"https://doi.org/10.14777/uti.2019.14.2.46","url":null,"abstract":"Purpose: To investigate the clinical manifestations of patients with the principal complaint of syndromic recurrent urinary tract infection (UTI), correlate these symptoms with the results of urine cultures, and identify the characteristics that can be used to differentiate UTI from similar diseases. Materials and Methods: A total of 212 consecutive patients with syndromic recurrent UTIs over a 24 month period were evaluated. The major symptoms were recorded using the UTISA questionnaire and VAS. The patients were divided into group A (n=98; positive urine and urethral swab cultures) and group B (n=114; negative cultures), and the symptoms were compared. For group B, cystoscopy was used to diagnose 61 patients who complained of pain levels ≥6 on the VAS. Results: The proportion of patients with the classic symptoms of UTI (dysuria, urinary frequency, lower abdominal discomfort during bladder filling, and urgency) was similar in groups A and B. Significantly more patients complained of urethral pain in group B, and significantly fewer patients had gross hematuria, low back pain, a post-voiding sensation of residual urine, and general symptoms compared to group A. Of the 61 patients with a VAS ≥6, 29, 28, and four were diagnosed with bladder pain syndrome, interstitial cystitis, and urethral pain syndrome, respectively. Conclusions: In patients with syndromic recurrent UTI, the classic symptoms were not sufficiently characteristic to allow bacterial cystitis to be differentiated from other bladder diseases. Diagnostic cystoscopy and VAS can assist in making a differential diagnosis in patients with non-bacterial syndromic recurrent UTIs.","PeriodicalId":287735,"journal":{"name":"Urogenital Tract Infection","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116189970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.14777/uti.2019.14.2.33
Sang Jin Kim, Jae Hyun Ryu, Y. Kim, Seung Ok Yang
Candida urinary tract infections in elderly patients are becoming increasingly common. The risk factors for the development of candiduria include old age, use of broad-spectrum antibiotics, corticosteroids and indwelling urethral catheters, as well as diabetes mellitus, urological abnormalities, and hematological malignancies. The presence of signs and symptoms of infection are unusual, and the intensity of fungal growth in culture does not correlate with the outcome. Elderly patients often present with atypical signs and symptoms of infection. Careful assessment of the patient’s clinical status should be undertaken before treatment is initiated. The indications for antifungal therapy are the same for older and younger individuals, and the initial antifungal therapy should be selected based on the infecting organism and local epidemiology. Fluconazole is the mainstay of treatment. On the other hand, Candida glabrata is more common in elderly patients and is often refractory to fluconazole therapy. The selection of drug therapy for elderly patients should consider the comorbidities, risk of drug-drug interactions, and dose adjustment for physiological function.
{"title":"Management of Candida Urinary Tract Infection in the Elderly","authors":"Sang Jin Kim, Jae Hyun Ryu, Y. Kim, Seung Ok Yang","doi":"10.14777/uti.2019.14.2.33","DOIUrl":"https://doi.org/10.14777/uti.2019.14.2.33","url":null,"abstract":"Candida urinary tract infections in elderly patients are becoming increasingly common. The risk factors for the development of candiduria include old age, use of broad-spectrum antibiotics, corticosteroids and indwelling urethral catheters, as well as diabetes mellitus, urological abnormalities, and hematological malignancies. The presence of signs and symptoms of infection are unusual, and the intensity of fungal growth in culture does not correlate with the outcome. Elderly patients often present with atypical signs and symptoms of infection. Careful assessment of the patient’s clinical status should be undertaken before treatment is initiated. The indications for antifungal therapy are the same for older and younger individuals, and the initial antifungal therapy should be selected based on the infecting organism and local epidemiology. Fluconazole is the mainstay of treatment. On the other hand, Candida glabrata is more common in elderly patients and is often refractory to fluconazole therapy. The selection of drug therapy for elderly patients should consider the comorbidities, risk of drug-drug interactions, and dose adjustment for physiological function.","PeriodicalId":287735,"journal":{"name":"Urogenital Tract Infection","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130681321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.14777/uti.2019.14.2.60
Ji-Yeon Han
This paper presents three cases of recurrent urinary tract infections from urethral mesh erosion after transobturator midurethral sling (MUS) surgery. The patients were operated on using a MUS with a mesh for stress urinary incontinence. A few years after surgery (0.3 to 7 years), patients complained of recurrent pain in the urethra with voiding symptoms. In all cases, urethrocystoscopy was performed and an erosion of the sling directly across the urethra was found. Patients were managed by dissecting the urethra and removing the mesh via the transvaginal approach under general anesthesia.
{"title":"Recurrent Urinary Tract Infection from Urethral Mesh Erosion after Midurethral Mesh Sling Surgery","authors":"Ji-Yeon Han","doi":"10.14777/uti.2019.14.2.60","DOIUrl":"https://doi.org/10.14777/uti.2019.14.2.60","url":null,"abstract":"This paper presents three cases of recurrent urinary tract infections from urethral mesh erosion after transobturator midurethral sling (MUS) surgery. The patients were operated on using a MUS with a mesh for stress urinary incontinence. A few years after surgery (0.3 to 7 years), patients complained of recurrent pain in the urethra with voiding symptoms. In all cases, urethrocystoscopy was performed and an erosion of the sling directly across the urethra was found. Patients were managed by dissecting the urethra and removing the mesh via the transvaginal approach under general anesthesia.","PeriodicalId":287735,"journal":{"name":"Urogenital Tract Infection","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132410861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.14777/uti.2019.14.2.55
Seok Cho, I. Cho
Purpose: The underlying pathogenic mechanisms of chronic pelvic pain syndrome (CPPS) are unclear. A growing body of evidence suggests that the urogenital pain of CPPS may be neuropathic in origin. The objective of this study was to determine if gabapentin can be an effective treatment for the symptoms of CPPS with severe pain. Materials and Methods: Thirty five males with CPPS (category IIIa 25, IIIb 10) and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total pain score ≥ 9 in the previous six months were enrolled in this study between October 2010 and December 2011. The dosage of gabapentin was increased from 300 mg/d to 600 mg/d during the first four weeks. The primary outcome was evaluated as an improvement in the NIH-CPSI from the baseline to week eight. Results: This study examined 35 males with CPPS and a mean age of 54.2±9.8 years, mean disease duration of 34.2±27.7 months, and a mean prostate volume of 24.9±5.3 ml. The decrease in the total NIH-CPSI pain domain at four weeks was significant with no change observed after eight weeks. Between the category IIIa and IIIb CPPS patients, the change in the total pain domain was not significant. Conclusions: Gabapentin may be effective in some males with CPPS who have a high pain score. More gabapentin may be useless and possibly harmful if gabapentin does not decrease the pain at four weeks.
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