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Wagenlehner F, Kresken M, Wohlfarth E, Bahrs C, Grabein B, Strohmaier WL, Naber KG. [Therapy of cystitis with nitroxoline-NitroxWin : Prospective, multicenter, non-interventional study and microbiological resistance surveillance]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1186-1192. [PMID: 37650911 PMCID: PMC10630225 DOI: 10.1007/s00120-023-02167-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND According to German AWMF S3 guideline nitroxoline is recommended as one of the first-choice antibiotics for treatment of acute uncomplicated cystitis (UC) in women. Under real-world conditions the clinical efficacy of nitroxoline should be checked in a noninterventional, prospective and multicenter study (NIS) and the prevalence of nitroxoline resistance in E. coli be monitored. MATERIALS AND METHODS Female patients with UC treated with nitroxoline (recommended dosage 250 mg tid for 5 days) were included by urologists, general practitioners (GPs), and internists in family medicine throughout Germany from April-December 2022 and followed for 21-28 days. The diagnosis and course of therapy were judged by the Acute Cystitis Symptom Score (ACSS) questionnaire and laboratory investigations (leukocyturia etc). Separately, a nationwide resistance surveillance was performed during 2019-2020 in collaboration with 23 laboratories to collect urinary E. coli isolates and test their susceptibility to nitroxoline. RESULTS Of the 316 patients with mean (SD) age of 57.2 (±20.4 [median 62.5]) years who were included in the NIS, 193/248 (86.3%) in the per-protocol group and in 193/263 (81.44%) in the intention-to-treat group were clinically successful. Furthermore, 96% of the patients rated the tolerability of nitroxoline as "very good" or "good". All 272 E. coli isolates tested were susceptible to nitroxoline. CONCLUSIONS Nitroxoline showed very good clinical results in the NIS, and 100% of the tested E. coli urine isolates were susceptible to nitroxoline. Nitroxoline can still be recommended as one of the first-choice antibiotics for treatment of UC in women.
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Affiliation(s)
- Florian Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität, Gießen, Deutschland
| | | | | | - Christina Bahrs
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena/Friedrich-Schiller-Universität, Jena, Deutschland
- Klinische Abteilung für Infektionen und Tropenmedizin, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Beatrice Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene, LMU Klinikum, München, Deutschland
| | | | - Kurt G Naber
- Abteilung für Urologie, Technische Universität München, München, Deutschland.
- , Karl-Bickleder-Str. 44c, 94315, Straubing, Deutschland.
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Radzhabov A, Zamuddinov M, Alidjanov JF, Pilatz A, Wagenlehner FM, Naber KG. Linguistic and Clinical Validation of the Tajik Acute Cystitis Symptom Score for Diagnosis and Patient-Reported Outcome in Acute Uncomplicated Cystitis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1549. [PMID: 37763668 PMCID: PMC10534607 DOI: 10.3390/medicina59091549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Acute Cystitis Symptom Score (ACSS) is a self-reporting questionnaire for clinical diagnosis and follow-up of acute uncomplicated cystitis (AC) in women. The ACSS, originally developed in Uzbek and Russian, both considered original languages, is now available in several other languages. This study aimed to translate and validate the ACSS in the Tajik language. Material and Methods: Linguistic validation was carried out according to the Linguistic Validation Manual for Patient-Reported Outcomes Instruments guidelines. Clinical validation was performed by enrolling fifty-four Tajik-speaking women. All women included in this study were first interviewed about the understandability of all questions and statements in the final Tajik ACSS and were asked to fill in form A at the first visit (diagnostics) and form B at any follow-up visit (patient-reported outcome). Results: Thirty-three women, median (range) age of 35 (18-77), were diagnosed with AC (patient group), while twenty-one women, median (range) age of 34 (20-61) (p = 0.109), were enrolled as the control group without any other urological disease. For the diagnostics of AC, a summary score of the six typical symptoms ("Typical" domain) showed the best balance between sensitivity (0.73) and specificity (0.71) at 5 and above. Cronbach's alpha [95% CI] and split-half reliability [95%] were 0.82 [0.76; 0.98] and 0.84 [0.77; 0.87], respectively. At the follow-up visit, the patients reported a significant reduction in the "Typical" domain and an improvement in the "Quality of Life" domain. Conclusion: The Tajik ACSS showed good reliability and diagnostic values and may be used as a reliable tool for the diagnosis and patient-reported outcome in women with AC in clinical and epidemiological studies and for daily practice.
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Affiliation(s)
| | - Musluhuddin Zamuddinov
- Departments of Urology, Madadi Akbar Clinic, Dushanbe 734025, Tajikistan;
- Departments of Urology, Olami Tib Clinic, Dushanbe 734060, Tajikistan
| | - Jakhongir F. Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, 35392 Giessen, Germany; (J.F.A.); (A.P.); (F.M.W.)
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, 35392 Giessen, Germany; (J.F.A.); (A.P.); (F.M.W.)
| | - Florian M. Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, 35392 Giessen, Germany; (J.F.A.); (A.P.); (F.M.W.)
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, 80333 Munich, Germany
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Arda E, Alidjanov J, Ates S, Çek M, Piatz A, Wagenlehner FM, Naber KG. Linguistic and clinical validation of the Turkish version of Acute Cystitis Symptom Score for the diagnosis and patient-reported outcome in acute uncomplicated cystitis. Investig Clin Urol 2023; 64:279-288. [PMID: 37341008 DOI: 10.4111/icu.20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE The Acute Cystitis Symptom Score (ACSS) was developed as a self-reporting questionnaire for diagnosing and monitoring acute uncomplicated cystitis (AC) in female patients. The study aims at the translation of the ACSS into Turkish from the original Uzbek including its linguistic, cognitive and clinical validation. MATERIALS AND METHODS After forward and backward translation of the ACSS from Uzbek to Turkish and vice versa, the cognitive assessment of the Turkish ACSS was performed on 12 female subjects to achieve the final study version. RESULTS The clinical validation was performed on a total of 120 female respondents including 64 Patients with AC and 56 controls without AC. For clinical diagnosis of AC, the predefined summary score of the typical symptoms of >6 showed high values (95% confidence interval) for sensitivity (0.88 [0.77-0.94]), specificity (0.98 [0.91-1.00]), and diagnostic accuracy (0.93 [0.86-0.97]). All patients were followed up between five to nine days after the baseline visit. Forty-four (68.75%) patients used antimicrobial treatment, whereas the rest (31.25%) preferred non-antimicrobial treatment. The severity scores of the typical symptoms and the quality of life were reduced significantly at follow-up. Using different (favored) thresholds for successful and non-successful treatment a clinical success rate between 54.7% and 64.1% (60.9%) was achieved. CONCLUSIONS After translation from the original Uzbek and cognitive assessment, the Turkish ACSS showed similar good results for clinical diagnosis and patient-reported outcome as in other languages validated so far and could therefore now be used for clinical studies as well as in everyday practice.
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Affiliation(s)
- Ersan Arda
- Department of Urology, Medical Faculty of Trakya University, Edirne, Türkiye
| | - Jakhongir Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Sinan Ates
- Department of Gynaecology, Medical Faculty of Trakya University, Edirne, Türkiye
| | - Mete Çek
- Department of Urology, Medical Faculty of Trakya University, Edirne, Türkiye.
| | - Adrian Piatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
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Piontek K, Donhauser T, Kann G, Fechtner M, Apfelbacher C, Gabes M. Patient-reported outcome measures for uncomplicated urinary tract infections in women: a systematic review. Qual Life Res 2023:10.1007/s11136-023-03358-5. [PMID: 36795285 PMCID: PMC10329060 DOI: 10.1007/s11136-023-03358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE To conduct a systematic review of the quality of existing patient-reported outcome measures (PROMs) for use in women with uncomplicated urinary tract infections (UTIs) applying the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for their use in future research. METHODS A systematic literature search was performed in PubMed and Web of Science. Studies reporting on the development and/or validation of any PROMs for uncomplicated UTIs in women were considered eligible. We evaluated the methodological quality of each included study using the COSMIN Risk of Bias Checklist, and further applied predefined criteria for good measurement properties. Finally, we graded the evidence and derived recommendations for the use of the included PROMs. RESULTS Data from 23 studies reporting on six PROMs were included. From those, the Acute Cystitis Symptom Score (ACSS) and the Urinary Tract Infection-Symptom and Impairment Questionnaire (UTI-SIQ-8) can be recommended for further use. Both instruments showed sufficient content validity. We further found high-quality evidence for sufficient internal consistency of the UTI-SIQ-8, while this criterion was not assessed for the ACSS due to a formative measurement model. All other PROMs have the potential to be recommended for use, but require further validation. CONCLUSION The ACSS and the UTI-SIQ-8 have the potential to be recommended for use in women with uncomplicated UTIs in future clinical trials. For all included PROMs, further validation studies are indicated. SYSTEMATIC REVIEW REGISTRATION PROSPERO.
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Affiliation(s)
- Katharina Piontek
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Gesina Kann
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Marie Fechtner
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Michaela Gabes
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Klußmann D, Wagenlehner F. Rezidivierende Harnwegsinfektionen – was tun? Dtsch Med Wochenschr 2022; 147:1140-1145. [DOI: 10.1055/a-1866-9470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Was ist neu?
Nicht antibiotische Therapieregime Neben allgemeiner Aufklärung und Beratung über Risikofaktoren von Harnwegsinfektionen sind vor allem die nichtantibiotischen Therapie-Optionen zur Rezidivreduktion wichtig. Das Ziel hierbei ist es, Resistenzentwicklungen und den entsprechenden unerwünschten Nebenwirkungen von Antibiotika vorzubeugen. Zu den nicht antibiotischen Strategien zählen allen voran eine persönliche Beratung mit Vermittlung von Verhaltensempfehlungen, die Immunoprophylaxe, Phytotherapeutika, sowie eine lokale Östrogensubstitution
Antibiotische Prävention Bei hohem Leidensdruck der Patientinnen ist jedoch nach entsprechender Abwägung auch eine antibiotische Prophylaxe in Betracht zu ziehen. Zusammenfassend sollte eine individuelle Beratung erfolgen und es sollte mit einem multimodalen Therapieansatz behandelt werden.
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Affiliation(s)
- Daniel Klußmann
- Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
| | - Florian Wagenlehner
- Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
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Why D-Mannose May Be as Efficient as Antibiotics in the Treatment of Acute Uncomplicated Lower Urinary Tract Infections—Preliminary Considerations and Conclusions from a Non-Interventional Study. Antibiotics (Basel) 2022; 11:antibiotics11030314. [PMID: 35326777 PMCID: PMC8944421 DOI: 10.3390/antibiotics11030314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Urinary tract infections (UTIs) are very frequent in women and can be caused by a range of pathogens. High recurrence rates and increasing antibiotic resistance of uropathogens make UTIs a severe public health problem. d-mannose is a monosaccharide that can inhibit bacterial adhesion to the urothelium after oral intake. Several clinical studies have shown the efficacy of d-mannose in the prevention of recurrent UTIs; these also provided limited evidence for the efficacy of d-mannose in acute therapy. A recent prospective, non-interventional study in female patients with acute cystitis reported good success rates for treatment with d-mannose. Here, we present data from a post hoc analysis of this study to compare the cure rate of d-mannose monotherapy with that of antibiotics. The results show that d-mannose is a promising alternative to antibiotics in the treatment of acute uncomplicated UTIs in women.
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Choi JB, Cho KJ, Han KH, Alidjanov JF, Pilatz AME, Wagenlehner FME, Naber KG, Choe HS, Lee SJ. Translation and validation of the Korean version of acute cystitis symptom score. Investig Clin Urol 2022; 63:221-227. [PMID: 35244997 PMCID: PMC8902427 DOI: 10.4111/icu.20210421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/18/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose Acute Cystitis Symptom Score (ACSS) is a simple self-reporting questionnaire initially developed in Uzbek language to help diagnose acute uncomplicated cystitis (AUC). The purpose of this study was to translate the ACSS to Korean and validate the Korean version of ACSS using Korean-speaking women. Materials and Methods The original version of ACSS in Uzbek was translated into the target (Korean) version according to internationally accepted guidelines for the translation and cultural adaptation. Cognitive interviews were then conducted for five women with symptoms of AUC and five women without AUC who were native speakers of the Korean language to investigate the clarity, understandability, and acceptability of the translation. The final Korean version of the ACSS was tested in 50 women (31 AUC patients and 19 controls) for clinical validation. Results Reliability test for 9 questions (6 questions about typical symptoms of AUC, and 3 questions on quality of life) showed high values (Cronbach’s alpha=0.853). The sum score of typical symptoms showed the highest balance for diagnostic sensitivity and specificity (area under the ROC curve=0.935). Sensitivity and specificity to predict AUC were 90.3% and 89.5% at cut-off score 6 of the typical domain. Conclusions The Korean version of the ACSS showed high levels of reliability and validity, similar to other validated versions in different languages. It will play an important role in practice and/or clinical research for diagnosis and treatment efficacy monitoring of Korean-speaking women suffering from AUC.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang Jun Cho
- Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Hun Han
- Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jakhongir F. Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Adrian M. E. Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Florian M. E. Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Hyun-Sop Choe
- Department of Urology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Diagnosis of acute cystitis in primary care: symptom-based versus urinalysis-based diagnosis. Prim Health Care Res Dev 2022; 23:e74. [DOI: 10.1017/s1463423622000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Aim:
This study aimed to provide insight into the congruity of acute cystitis (AC) diagnosis in women, measured both by the Acute Cystitis Symptom Score (ACSS) questionnaire and urine test(s).
Background:
The ACSS questionnaire was developed as a self-administering tool for assessing urinary symptoms, quality of life (QoL) and treatment outcomes in healthy, nonpregnant female patients.
Methods:
This prospective observational cohort study compared AC diagnosis based on the questionnaire with a GP diagnosis based on dipstick/dipslide test(s). ACSS questionnaire form A (typical and differential symptoms, QoL and relevant conditions) was filled in by the patient group, women suspected for AC visiting a GP practice with a urine sample, and the reference group, women visiting a community pharmacy for any medication. Analyses were performed assuming that the GP diagnosis based on urine test(s) was correct. Divergent result(s) of urine test(s) and ACSS questionnaire were analysed for scores of all individual questionnaire domains. Statistical analyses included descriptive statistics and the positive predictive value (PPV) and the negative predictive value (NPV) of the ACSS questionnaire and the urine test(s).
Findings:
In the patient group, 59 women were included, 38 of whom a GP positively diagnosed for AC. The reference group included 70 women. The PPV of the ACSS questionnaire was 77.3%, and the NPV was 73.3%. Analysis of patient data for divergent results showed that differential symptoms, QoL and relevant conditions explained false-positive and false-negative results. Revised results (most probable diagnosis) based on this analysis showed a PPV and NPV of 88.6% and 73.3% for the ACSS questionnaire and 100% and 76.2% for the urine test(s). For use in primary care, a reduction in false-positive and false-negative results can be achieved by including scores for differential symptoms, QoL and relevant conditions, alongside a total typical symptoms score of 6 or higher.
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Westhoff N, Anokhin A, Patroi P, Neuberger M, Siegel F, Pfalzgraf D. Prospective Evaluation of Antibiotic Management in Ureteral Stent and Nephrostomy Interventions. Urol Int 2021; 106:411-418. [PMID: 34333486 DOI: 10.1159/000517546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Screening for and treating asymptomatic bacteriuria (ABU) or administering antibiotic prophylaxis is recommended during ureteral stent and nephrostomy interventions. This study investigates the frequency of postinterventional infectious complications to gain insight into the need for antibiotics. METHODS Between September 2016 and June 2019, 168 insertions/exchanges of ureteral stents or nephrostomies were recorded in a prospective multicenter study. Patients without a symptomatic UTI did not receive antibiotic treatment/prophylaxis. Asymptomatic patients in whom their urologist already administered an antibiotic treatment served as a comparative group. Follow-up included postinterventional complications within 30 days. Symptoms were assessed by the Acute Cystitis Symptom Score (ACSS) before and after the intervention. Predictors of increasing postinterventional symptoms were analyzed by a multivariable logistic regression model. RESULTS One hundred forty-five interventions were eligible. One hundred twenty-two (84.1%) interventions were performed without antibiotic treatment. Preinterventional ABU was detected in 54.4% and sterile urine in 22.8% (22.8% without culture). Postinterventional infectious complications did not differ between patients with versus without antibiotics. Transurethral interventions aggravate symptoms (p = 0.034) but do not increase infectious complications compared to percutaneous interventions. Patients without diabetes mellitus are at higher risk for increasing symptoms. CONCLUSION Results indicate that peri-interventional antibiotic treatment may be omitted in patients without symptomatic UTI. Symptoms must be differentiated between infectious and procedure-associated origins.
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Affiliation(s)
- Niklas Westhoff
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexey Anokhin
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Fifth Department of Internal Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Paul Patroi
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Manuel Neuberger
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Pfalzgraf
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Urology, Heilig-Geist-Hospital, Bensheim, Germany
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Alidjanov JF, Khudaybergenov UA, Ayubov BA, Pilatz A, Mohr S, Münst JC, Ziviello Yuen ON, Pilatz S, Christmann C, Dittmar F, Mirsaidov NM, Buch-Heberling M, Naber KG, Bjerklund Johansen TE, Wagenlehner FME. Linguistic and clinical validation of the acute cystitis symptom score in German-speaking Swiss women with acute cystitis. Int Urogynecol J 2021; 32:3275-3286. [PMID: 34170341 PMCID: PMC8227360 DOI: 10.1007/s00192-021-04864-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The Global Prevalence Study of Infections in Urinary tract in Community Setting (GPIU.COM) includes epidemiological aspects of acute cystitis (AC) in women in Germany and Switzerland. The primary study relates to the German version of the Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for self-diagnosis and monitoring the symptomatic course of AC in women. The current study aimed to analyze the validity and reliability of the German ACSS in German-speaking female patients with AC in Switzerland. METHODS Anonymized patient data were collected and analyzed from women with AC at the first visit (diagnosis) and follow-up visits as baseline and controls, respectively. Data from 97 patients with a median age of 41 years underwent analysis. Psychometric and diagnostic characteristics of the ACSS were measured and statistically analyzed. RESULTS Average internal consistency of the ACSS resulted in a Cronbach's alpha (95% CI) of 0.86 (0.83; 0.89) and did not differ significantly between the Swiss and German cohorts. Diagnostic values of the ACSS for the Swiss cohort were relatively lower than for the German cohort, possible due to discrepancies between definitions of UTI in national guidelines. CONCLUSIONS The analysis showed that the German version of the ACSS is also suitable for use in the German-speaking female population of Switzerland. Minor differences in definitions of AC between German and Swiss guidelines explain the observed discrepancies in diagnostic values of the ACSS between cohorts.
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Affiliation(s)
- Jakhongir F Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Rudolph-Buchheim str. 7, 35392, Giessen, Hessen, Germany.
| | | | - Bekhzod A Ayubov
- Department of Urological Surgery, Republican Specialized Scientific-Practical Medical Center of Urology, Tashkent, Uzbekistan
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julia C Münst
- Department of Gynaecology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | | | | | - Corina Christmann
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Florian Dittmar
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Nodir M Mirsaidov
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Mareike Buch-Heberling
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Truls E Bjerklund Johansen
- Department of Urology of Oslo University Hospital, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
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11
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Faßl D, Wagenlehner F. [What to do about recurrent urinary tract infections]. Aktuelle Urol 2021; 52:255-259. [PMID: 33860479 DOI: 10.1055/a-1387-7515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urinary tract infections are among the most common bacterial infections. A significant proportion of urinary tract infections recur, which leads to impairments in patients' physical intimacy, social contacts and ability to work. The standardised ACSS questionnaire can provide help in establishing a diagnosis and assessing the course of the disease. In addition to general education and counselling on risk factors for urinary tract infections, non-antibiotic treatment options are particularly important for reducing recurrence. This aims to prevent the development of resistance to antibiotics and their undesirable side-effects. Non-antibiotic strategies most notably include personal counselling with communication of behavioural recommendations, immunoprophylaxis, phytotherapeutics and local oestrogen substitution. However, in cases of high patient suffering, antibiotic prophylaxis should also be considered after due deliberation. In summary, individual counselling should take place and treatment should be given in a multimodal therapeutic approach.
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Affiliation(s)
- Daniel Faßl
- Justus Liebig Universität Giessen Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Giessen
| | - Florian Wagenlehner
- Justus Liebig Universität Giessen Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Giessen
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Gágyor I, Rentzsch K, Strube-Plaschke S, Himmel W. Psychometric properties of a self-assessment questionnaire concerning symptoms and impairment in urinary tract infections: the UTI-SIQ-8. BMJ Open 2021; 11:e043328. [PMID: 33589460 PMCID: PMC7887375 DOI: 10.1136/bmjopen-2020-043328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To validate the urinary tract infection-Symptom and Impairment Questionnaire (UTI-SIQ-8), a questionnaire that consists of four items to assess the symptom severity for dysuria, urgency, frequenc, and low abdominal pain and four items to assess the resulting impairment of activity by UTIs. DESIGN Prospective observation study. SETTING German primary care practices. PARTICIPANTS An unselected population of women with UTI. Women could participate online via a web application for smartphones, smartwatches and tablets or use a paper-and-pencil version. MAIN OUTCOMES Psychometric properties of the UTI-SIQ-8 regarding reliability, validity and sensitivity to change by using factor analysis and multilevel and network analysis. RESULTS Data from 120 women with a total of 769 symptom reports across 7 days of measurement were analysed. The majority of the participating patients (87/120) used the web application via smartphones or other devices. The reliability of the UTI-SIQ-8 was high, with Cronbach's alpha of .86 at intake; convergent and discriminant validity was satisfactory. Intraclass correlation demonstrated high sensitivity to change, with 68% of the total variance being due to time differences. These daily changes in an individual's symptoms moved parallel with daily changes in the EQ-5D-5L (b=1.68, SE=0.12, p<0.001) and the visual analogue scale (b=0.03, SE=0.003, p<0.001), also highlighting convergent validity with respect to daily changes in symptom severity. CONCLUSIONS The present findings support the UTI-SIQ-8 questionnaire as an economic, reliable and valid instrument for the assessment of symptom severity and symptom change in women with uncomplicated UTI. The web application helped patients to report symptoms on a daily basis. These findings may encourage primary care physicians to use the UTI-SIQ-8 in their daily practice and researchers to apply it to studies involving patients with uncomplicated UTI.
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Affiliation(s)
- Ildikó Gágyor
- Department of General Practice, Julius-Maximilians-Universitat Wurzburg, Wurzburg, Germany
- Department of General Practice/Family Medicine, University Medical Center Göttingen, Gottingen, Niedersachsen, Germany
| | - Katrin Rentzsch
- Psychological Assessment and Personality Psychology, Psychologische Hochschule Berlin, Berlin, Germany
- Department of Psychology, University of Göttingen, Göttingen, Germany
| | - Stephanie Strube-Plaschke
- Department of General Practice/Family Medicine, University Medical Center Göttingen, Gottingen, Niedersachsen, Germany
| | - Wolfgang Himmel
- Department of General Practice/Family Medicine, University Medical Center Göttingen, Gottingen, Niedersachsen, Germany
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Alidjanov JF, Naber KG, Pilatz A, Wagenlehner FM. Validation of the American English Acute Cystitis Symptom Score. Antibiotics (Basel) 2020; 9:antibiotics9120929. [PMID: 33352734 PMCID: PMC7766804 DOI: 10.3390/antibiotics9120929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 01/11/2023] Open
Abstract
The diagnosis of acute uncomplicated cystitis (UC) is usually based on clinical symptoms. The study aims to develop and validate the American-English Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for diagnosis and patient-reported outcome in women with acute uncomplicated cystitis (UC). After certified translation into American-English and cognitive assessment, the clinical validation of the ACSS was performed embedded in a US phase-II trial. 167 female patients with typical symptoms of UC were included in the study following US Food and Drug Administration (FDA) guidance. At Day 1 (diagnosis), the mean (SD) sum score of the six ACSS typical symptoms reached 10.60 (2.51). Of 100 patients followed-up last time on Day 5 or 6 (End-of-treatment, EoT), 91 patients showed clinical success according to the favored ACSS criteria (sum score of typical symptoms 0.98 (1.94)). There was no correlation between the severity of symptoms on Day 1 or between clinical success rate at EoT and level of bacteriuria on Day 1. The American-English ACSS showed high predictive ability and responsiveness and excellent levels of reliability and validity. It can now be recommended as the new master version in clinical and epidemiological studies, in clinical practice, or for self-diagnosis of women with symptoms of UC.
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Affiliation(s)
- Jakhongir F. Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
- Correspondence: ; Tel.: +49-176-5806-8639
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, 81675 Munich, Germany;
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
| | - Florian M. Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
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Abstract
BACKGROUND Urinary tract infections (UTIs) are among the most common infections. Especially complicated UTIs have a broad bacterial spectrum, sometimes having high antibiotic resistance rates. The clinical course might be very different and can range from spontaneous cure to fulminant sepsis. OBJECTIVES Which initial therapy is adequate for which UTI entity and what are the corresponding guidelines recommendations? MATERIALS AND METHODS This is a review of the current S3 guideline urinary tract infection, the guideline parenteral initial therapy of bacterial infections from the Paul Ehrlich Society, the guideline urological infections from the European Association of Urology (EAU) and the guideline on recurrent uncomplicated UTI in women from the American Urological Association (AUA). RESULTS Adequate antibiotic therapy is based on the stratification into complicated and uncomplicated, as well as upper and lower infections, and on specific risk factors (e.g., urinary tract catheter) that can be classified according to the ORENUC criteria. Based on this classification, the choice for an empirical antibiotic therapy is made. The spectrum of pathogens should therefore be limited in order to use antibiotics with a narrow spectrum of activity and little collateral damage if possible, thus, preventing both the development of resistance and complications. CONCLUSIONS Adequate empirical antibiotic therapy and prophylaxis in line with guidelines is based on the clinical classification and risk factors.
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Di Vico T, Morganti R, Cai T, Naber KG, Wagenlehner FM, Pilatz A, Alidjanov J, Morelli G, Bartoletti R. Acute Cystitis Symptom Score (ACSS): Clinical Validation of the Italian Version. Antibiotics (Basel) 2020; 9:E104. [PMID: 32131404 PMCID: PMC7148481 DOI: 10.3390/antibiotics9030104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
Acute Cystitis Symptom Score (ACSS) is an 18-item self-reporting questionnaire for clinical diagnosis and follow-up of acute uncomplicated cystitis (AUC) in women. The ACSS, originally developed in Uzbek and Russian languages, is now available in several languages. The purpose of the study was to validate the ACSS questionnaire in the Italian language. Linguistic validation was carried out according to Linguistic Validation Manual for Patient-Reported Outcomes Instruments guidelines. Clinical validation was carried out by enrolling one hundred Italian-speaking women. All women were asked to fill in the ACSS questionnaire during their medical visit. Fifty-four women, median age 36 (Inter Quartile Range 28-49), were diagnosed with AUC, while 46 women, median age 38 (IQR 29-45), were enrolled as the control group attending the hospital's fertility center for couples. The most frequently isolated pathogen in AUC was Escherichia coli (40; 74.0%) followed by Enterococcus faecalis (7; 13.0%) and Staphylococcus saprophyticus (3; 5.6%). Receiver operating characteristic (ROC) curve analysis performed at the first diagnostic visit on a typical symptoms domain cut-off score of 6 revealed a sensitivity of 92.5% and specificity of 97.8%. The Italian version of the ACSS has proved to be a reliable tool with a high accuracy in diagnosis and follow-up in women with AUC. The ACSS may also be useful for clinical and epidemiological studies.
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Affiliation(s)
- Tommaso Di Vico
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy
| | - Riccardo Morganti
- SOD Clinical Trial Statistical Support, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Tommaso Cai
- Urology Unit, S. Chiara Regional Hospital, 38122 Trento, Italy
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, 80333 Munich, Germany
| | - Florian M.E. Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Adrian Pilatz
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Jakhongir Alidjanov
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Girolamo Morelli
- Department of Critical Medicine, University of Pisa, 56126 Pisa, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy
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Abele-Horn M, Pantke E, Eckmanns T. Wege zum fachgerechten und verantwortungsvollen Umgang mit Antibiotika. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:572-579. [DOI: 10.1007/s00103-018-2723-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Reevaluation of the Acute Cystitis Symptom Score, a Self-Reporting Questionnaire. Part I. Development, Diagnosis and Differential Diagnosis. Antibiotics (Basel) 2018; 7:antibiotics7010006. [PMID: 30720775 PMCID: PMC5872117 DOI: 10.3390/antibiotics7010006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/16/2022] Open
Abstract
This study aimed to reevaluate the Acute Cystitis Symptom Score (ACSS). The ACSS is a simple and standardized self-reporting questionnaire for the diagnosis of acute uncomplicated cystitis (AC) assessing typical and differential symptoms, quality of life, and possible changes after therapy in female patients with AC. This paper includes literature research, development and evaluation of the ACSS, an 18-item self-reporting questionnaire including (a) six questions about "typical" symptoms of AC, (b) four questions regarding differential diagnoses, (c) three questions on quality of life, and (d) five questions on additional conditions that may affect therapy. The ACSS was evaluated in 228 women (mean age 31.49 ± 11.71 years) in the Russian and Uzbek languages. Measurements of reliability, validity, predictive ability, and responsiveness were performed. Cronbach's alpha for ACSS was 0.89, split-half reliability was 0.76 and 0.79 for first and second halves, and the correlation between them was 0.87. Mann-Whitney U test revealed a significant difference in scores of the "typical" symptoms between patients and controls (10.50 vs. 2.07, p < 0.001). The optimal threshold score was 6 points, with a 94% sensitivity and 90% specificity to predict AC. The "typical" symptom score decreased significantly when comparing before and after therapy (10.4 and 2.5, p < 0.001). The reevaluated Russian and Uzbek ACSS are accurate enough and can be recommended for clinical studies and practice for initial diagnosis and monitoring the process of the treatment of AC in women. Evaluation in German, UK English, and Hungarian languages was also performed and in other languages evaluation of the ACSS is in progress.
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Kranz J, Schmidt S, Lebert C, Schneidewind L, Schmiemann G, Wagenlehner F. Uncomplicated Bacterial Community-Acquired Urinary Tract Infection in Adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:866-873. [PMID: 29271346 PMCID: PMC5763001 DOI: 10.3238/arztebl.2017.0866] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 08/30/2017] [Accepted: 10/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Uncomplicated bacterial community-acquired urinary tract infection is among the more common infections in outpatient practice. The resistance level of pathogens has risen markedly. This S3 guideline contains recommendations based on current evidence for the rational use of anti - microbial agents and for the prevention of inappropriate use of certain classes of antibiotics and thus of the resulting drug resistance. The prevention of recurrent urinary tract infection is considered in this guideline for the first time. METHODS The guideline was updated under the aegis of the German Urological Society (Deutsche Gesellschaft für Urologie). A systematic literature search (period: 2008-2015) concerning the diagnosis, treatment, and prevention of uncomplicated urinary tract infections was carried out in the Cochrane Library, MEDLINE, and Embase databases. Randomized, controlled trials and systemic reviews were included. Relevant guidelines were identified in a guideline synopsis. RESULTS Symptom-oriented diagnostic evaluation is highly valued. For the treatment of cystitis, fosfomycin-trometamol, nitrofurantoin, nitroxolin, pivmecillinam and trimethoprim are all equally recommended. Fluorquinolones and cephalosporins are not recommended. Uncomplicated pyelonephritis with a mild to moderate clinical course ought to be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For acute, uncomplicated cystitis, with mild to moderate symptoms, symptomatic treatment alone may be considered instead of antibiotics after discussion of the options with the patient. Mainly non-antibiotic measures are recommended for prophylaxis against recurrent urinary tract infection. CONCLUSION Physicians who treat uncomplicated urinary tract infections should familiarize themselves with the newly revised guideline's recommendations on the selection and dosage of antibiotic treatment so that they can responsibly evaluate and plan antibiotic treatment for their affected patients.
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Affiliation(s)
- Jennifer Kranz
- Department of Urology and Pediatric Urology, St. Antonius Hospital Eschweiler, Academic Teaching Hospital of RWTH Aachen, Eschweiler; UroEvidence@Deutsche Gesellschaft für Urologie, Berlin; Pharmacy, Nuremberg Hospitals; Hematology/Oncology, Department of Internal Medicine C, Faculty of Medicine, University of Greifswald; Department of Care Research, Institute for Public Health and Nursing Care Research, University of Bremen; Department of Urology, Pediatric Urology and Andrology, University Hospital of Gießen and Marburg Ltd., Justus-Liebig University Gießen
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Kranz J, Schmidt S, Lebert C, Schneidewind L, Vahlensieck W, Sester U, Fünfstück R, Helbig S, Hofmann W, Hummers E, Kunze M, Kniehl E, Naber K, Mandraka F, Mündner-Hensen B, Schmiemann G, Wagenlehner FME. Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. Urologe A 2017; 56:746-758. [DOI: 10.1007/s00120-017-0389-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Magyar A, Alidjanov J, Pilatz A, Nagy K, Arthanareeswaran VKA, Póth S, Bécsi A, Wagenlehner FME, Naber KG, Tenke P, Köves B. The role of the Acute Cystitis Symptom Score questionnaire for research and antimicrobial stewardship. Validation of the Hungarian version. Cent European J Urol 2017; 71:134-141. [PMID: 29732220 PMCID: PMC5926636 DOI: 10.5173/ceju.2018.1530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/17/2018] [Accepted: 01/20/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction The Acute Cystitis Symptom Score (ACSS) is a new self-reporting tool to evaluate the symptoms of uncomplicated acute cystitis (AC) in women. The linguistic and clinical validation process of the Hungarian version used in this study may serve as a guide for the validation of the ACSS in other languages. Material and methods In this prospective cohort study, women with AC (Patients) and those without (Controls) filled in the Hungarian ACSS version, during their visits to physician's office. Statistical analysis included ordinary descriptive values, calculation of reliability, validity, discriminative ability, responsiveness (sensitivity, specificity) and comparative analysis. Results Thirty-one patients were recruited for validation along with 37 controls. Statistical analyses resulted in excellent values of internal consistency, discriminative ability and validity for diagnosis of AC. At the cut-off at a score of 6 in the 'typical' domain, positive and negative predictive values were 97% and 92%, sensitivity and specificity were 90% and 97%, respectively. Conclusions The ACSS has demonstrated benefits for diagnosis and patient-reported outcome assessment. It is objective, fast, and cost-effective, and may help to easily confirm the accurate diagnosis of AC. Therefore, it may be especially important for clinical and epidemiological studies on AC in women.
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Affiliation(s)
- András Magyar
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Jakhongir Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Károly Nagy
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | | | - Sándor Póth
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - András Bécsi
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | | | - Péter Tenke
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Béla Köves
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
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Fritzenwanker M, Imirzalioglu C, Chakraborty T, Wagenlehner FM. Modern diagnostic methods for urinary tract infections. Expert Rev Anti Infect Ther 2016; 14:1047-1063. [DOI: 10.1080/14787210.2016.1236685] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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