1
|
Maeda K, Nakano Y, Shigemura K, Fujisawa M. Urinary tract infections after retrograde pyelography and prophylactic antibiotics. J Infect Chemother 2023; 29:1132-1136. [PMID: 37611743 DOI: 10.1016/j.jiac.2023.08.011] [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: 06/12/2023] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Retrograde pyelography (RP) is performed for examination of upper urinary tract cancers and hydronephrosis. Although urinary tract infections (UTI) are known to be complicated by the examination, there are few reports on the frequency of occurrence and prophylactic antibiotics. METHODS The incidence of UTI and febrile UTI (f-UTI) and patient background information were compared in 388 patients who underwent RP at our hospital from January 2018 to December 2022. We also examined the administration of pre-RP antibiotics. RESULTS Of the 388 patients who underwent RP, 27 (6.9%) had UTI and 17 (4.4%) had f-UTI. Of the 27 UTI cases, 25 (92.6%) were pyelonephritis; 20 (74.0%) were hospitalized and 2 (7.4%) presented with septic shock and were managed in the intensive care unit. When comparing the background of patients with UTI, no significant differences were found in the present study, but when limited to the 17 cases of f-UTI, the presence of hydronephrosis before RP and not prescribing antibiotics before RP were associated with significantly higher incidence of f-UTI (p = 0.019, p = 0.036, respectively). Especially for patients without pyuria and bacteriuria before RP, prescribing antibiotics before RP resulted in 0 cases of f-UTI (p = 0.020). CONCLUSION This retrospective study showed that the presence of hydronephrosis before RP and not prescribing prophylactic antibiotics before RP are risk factors for f-UTI.
Collapse
Affiliation(s)
- Koki Maeda
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuzo Nakano
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Katsumi Shigemura
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan; Department of Medical Innovation Engineering, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, Japan.
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| |
Collapse
|
2
|
Kohada Y, Goriki A, Yukihiro K, Ohara S, Kajiwara M. The risk factors of urinary tract infection after transurethral resection of bladder tumors. World J Urol 2019; 37:2715-2719. [DOI: 10.1007/s00345-019-02737-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/20/2019] [Indexed: 01/02/2023] Open
|
3
|
Van Cleynenbreugel B, Kılıç Ö, Akand M. Retrograde intrarenal surgery for renal stones - Part 1. Turk J Urol 2017; 43:112-121. [PMID: 28717532 DOI: 10.5152/tud.2017.03708] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/12/2017] [Indexed: 12/20/2022]
Abstract
The main aim in the treatment of renal stones is to clearance of the stones completely with the least morbidity. Parallel to the improvements in technology during recent years, new flexible ureterorenoscopes and effective lithotripters such as holmium laser have been developed, thus retrograde intrarenal surgery (RIRS) has become an efficient and safe option in the management of urinary system stone disease with a gradually increasing popularity. Therewithal, innovations in auxiliary equipment such as guide-wires, ureteral access sheath and stone baskets have made this procedure more effective. With this modality, nowadays, the vast majority of renal stones can be treated successfully without need of open surgery or percutaneous nephrolithotomy. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, in cases with prior unsuccessful shock wave lithotripsy (SWL), infundibular stenosis, renoureteral malformation, musculoskeletal deformity, bleeding diathesis as well as obese patients. The efficiency of this procedure has been also proved in pediatric patients. In the first part of this detailed review for RIRS, history, indications and contraindications, preoperative preparation, antibiotic prophylaxis, anesthesia, surgical technique related to flexible ureteroscopes and auxiliary equipment being used, postoperative care and complications of this operation are discussed with up-to-date literature.
Collapse
Affiliation(s)
- Ben Van Cleynenbreugel
- Department of Urology, Katholieke Universiteit Leuven School of Medicine, Leuven, Belgium
| | - Özcan Kılıç
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| | - Murat Akand
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| |
Collapse
|
4
|
Chew BH, Flannigan R, Kurtz M, Gershman B, Arsovska O, Paterson RF, Eisner BH, Lange D. A Single Dose of Intraoperative Antibiotics Is Sufficient to Prevent Urinary Tract Infection During Ureteroscopy. J Endourol 2016; 30:63-8. [DOI: 10.1089/end.2015.0511] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ben H. Chew
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan Flannigan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Kurtz
- Department of Urology, Massachusetts General Hospital, Harvard Medical School
| | - Boris Gershman
- Department of Urology, Massachusetts General Hospital, Harvard Medical School
| | - Olga Arsovska
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan F. Paterson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian H. Eisner
- Department of Urology, Massachusetts General Hospital, Harvard Medical School
| | - Dirk Lange
- University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
|
6
|
Alsaywid BS, Smith GHH. Antibiotic prophylaxis for transurethral urological surgeries: Systematic review. Urol Ann 2013; 5:61-74. [PMID: 23798859 PMCID: PMC3685747 DOI: 10.4103/0974-7796.109993] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 07/10/2012] [Indexed: 11/06/2022] Open
Abstract
The use of antibiotic prophylaxis to prevent urinary tract infection and bacteremia (sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of urinary tract infection and bacteremia. The aim of this review is to evaluate the effectiveness of antibiotic prophylaxis in reducing the risk of urinary tract infection in patients who had transurethral urological surgeries. We have selected all RCTs of adult population who underwent all different types of transurethral urological surgery, including cystoscopy, transurethral resection of prostate and transurethral resection of bladder tumor, and received prophylactic antibiotics or placebo/no treatment. At first, more than 3000 references were identified and reviewed; of which 42 studies with a total of 7496 patients were included in the final analysis. All those trials were analyzing antibiotic prophylaxis versus placebo/no treatment, and they were significantly favoring antibiotic use in reducing all outcomes, including bacteriuria (RR 0.36, 95% CI 0.29 to 0.46, P < 0.0001) with moderate heterogeneity detected (I2 48%), symptomatic UTI (RR 0.38, 95% CI 0.28 to 0.51, P < 0.0001) with no significant heterogeneity was detected (I2= 17%), bacteremia (RR 0.43, 95% CI 0.23 to 0.82, P < 0.0001) with no noted heterogeneity (I2 = 0%), and fever ≥38.5 Celsius (RR 0.41, 95% CI 0.23 to 0.73, P = 0.003); also, there was no noted heterogeneity (I2 = 0%). However, using antibiotic prophylaxis did not reduce the incidence of low grade temperature (RR 0.82, 95% CI 0.61 to 1.11, P = 0.20) or in moderate grade temperature (RR 1.03, 95% CI 0.71 to 1.48, P = 0.89). Antibiotic prophylaxis appears to be an effective intervention in preventing urinary tract infections and its sequels following transurethral urological surgeries in patients with preoperative sterile urine.
Collapse
Affiliation(s)
- Basim S Alsaywid
- Department of Urology, The Sydney Children's Hospitals Network: Westmead Campus, Sydney, Australia ; Department of Surgery, The Urology Section, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia ; Conjoint Associate Lecturer, University of New South Wales, School of Women's and Children's Health, Sydney, Australia
| | | |
Collapse
|
7
|
Ramaswamy K, Shah O. Antibiotic Prophylaxis After Uncomplicated Ureteroscopic Stone Treatment: Is There a Difference? J Endourol 2012; 26:122-5. [DOI: 10.1089/end.2011.0360] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Krishna Ramaswamy
- Department of Urology, New York University School of Medicine, New York, New York
| | - Ojas Shah
- Department of Urology, New York University School of Medicine, New York, New York
| |
Collapse
|
8
|
Gross AJ, Netsch C. Retrograde Intrarenal Surgery (RIRS). Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
9
|
Matsumoto M, Shigemura K, Yamamichi F, Tanaka K, Nakano Y, Arakawa S, Fujisawa M. Prevention of Infectious Complication and Its Risk Factors after Urological Procedures of the Upper Urinary Tract. Urol Int 2012; 88:43-7. [DOI: 10.1159/000332224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 08/22/2011] [Indexed: 11/19/2022]
|
10
|
Lawrentschuk N, Colombo R, Hakenberg OW, Lerner SP, Månsson W, Sagalowsky A, Wirth MP. Prevention and Management of Complications Following Radical Cystectomy for Bladder Cancer. Eur Urol 2010; 57:983-1001. [DOI: 10.1016/j.eururo.2010.02.024] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 02/17/2010] [Indexed: 01/11/2023]
|
11
|
Shokeir AA, Al Ansari AA. Iatrogenic infections in urological practice Concepts of pathogenesis, prevention and management. ACTA ACUST UNITED AC 2009; 40:89-97. [PMID: 16608804 DOI: 10.1080/00365590510031093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this paper we review the pathogenesis, prevention and management of iatrogenic infection in urological practice. A systematic literature search was conducted using MEDLINE. The topics discussed include the commonest home-care, outpatient, endourologic and open surgical procedures. In addition, we discuss iatrogenic urinary infections associated with special situations, including urinary diversion, urologic prostheses, diabetes mellitus, dialysis, kidney transplantation and complicated urinary tract infections (UTIs). The findings of the literature review are as follows. Prophylactic antibiotics are not recommended with clean intermittent catheterization. With prolonged catheterization, antibiotics should not be used unless symptoms of pyelonephritis or septicemia become apparent. With transrectal prostate biopsy, infection can be prevented by rectal cleansing, use of smaller needles and administration of antimicrobial prophylaxis before and after the procedure. With ureteral stents, antibiotics should be restricted to patients with clinical signs of infection and high-risk patients. Infections after transurethral resection of the prostate can be prevented by avoiding risk factors and using perioperative antibiotics. In endourological procedures, antibiotic prophylaxis is indicated in cases of infected stones, preoperative UTIs or prolonged procedures. Antibiotics are not recommended for clean wounds, as prophylaxis for clean-contaminated wounds or as therapy for contaminated and dirty wounds. In patients with urinary diversion, the objective is to prevent pyelonephritis by avoiding both reflux and obstruction of the upper urinary tract. In patients with urological prostheses, the most important measure to overcome iatrogenic infection is prevention. In dialysis patients, iatrogenic infections can be prevented by the development of new catheter materials that are less susceptible to biofilms. In kidney transplant recipients, iatrogenic infections can be prevented by treating all types of infection prior to transplantation and by using peri- and postoperative prophylactic antibiotics.
Collapse
Affiliation(s)
- Ahmed A Shokeir
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | | |
Collapse
|
12
|
Stranne J, Aus G, Hansson C, Lodding P, Pileblad E, Hugosson J. Single‐dose orally administered quinolone appears to be sufficient antibiotic prophylaxis for radical retropubic prostatectomy. ACTA ACUST UNITED AC 2009; 38:143-7. [PMID: 15204401 DOI: 10.1080/00365590310022590] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate a new prophylaxis routine, which was introduced at our clinic in December 1998, comprising a single oral dose of antibiotic given prior to radical retropubic prostatectomy (RRP). MATERIAL AND METHODS A total of 60 men scheduled to undergo RRP were included in a prospective study and received antibiotic prophylaxis in the form of a single oral dose of quinolone. Cultures were made from the tip of the catheter and from urine sampled at the time of extraction as well as 1 and 2 weeks post-extraction. The outcome of this prospective study of 60 men was then compared to the total numbers of patients operated on in 1998 (n = 103) and 1999 (n = 140) by means of a retrospective analysis of clinical files. RESULTS No cases of sepsis occurred. Two weeks after catheter removal, 15/60 patients had persisting bacteriuria. No other signs of infection were detected. Six patients developed a stricture of the anastomotic area during follow-up (mean duration 18.9 months). When the study group was compared to all patients operated on in 1998 and 1999 no increases in the incidence of anastomotic strictures or serious infections or in the length of hospitalization could be detected. CONCLUSION A single dose of antibiotic given before RRP appears to be sufficient prophylaxis.
Collapse
Affiliation(s)
- Johan Stranne
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | | | | | | | | |
Collapse
|
13
|
Yokoyama M, Fujii Y, Yoshida S, Saito K, Koga F, Masuda H, Kobayashi T, Kawakami S, Kihara K. Discarding antimicrobial prophylaxis for transurethral resection of bladder tumor: A feasibility study. Int J Urol 2008; 16:61-3. [DOI: 10.1111/j.1442-2042.2008.02188.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Cantwell CP, Wah TM, Gervais DA, Eisner BH, Arellano R, Uppot RN, Samir AE, Irving HC, McGovern F, Mueller PR. Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol 2008; 19:1034-40. [PMID: 18589317 DOI: 10.1016/j.jvir.2008.04.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 04/03/2008] [Accepted: 04/07/2008] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To describe early experience with cooled dextrose 5% in water (D5W) solution retrograde pyeloperfusion during radiofrequency (RF) ablation of renal cell carcinoma (RCC) within 1.5 cm of the ureter with respect to feasibility, safety, and incidence of residual/recurrent tumor in proximity to the cooled collecting system. MATERIALS AND METHODS Between November 2004 and April 2007, 17 patients underwent 19 RF ablation sessions of RCCs within 1.5 cm of the ureter during cooled D5W pyeloperfusion (nine men, eight women; mean tumor size, 3.5 cm; mean age, 73 y; mean distance to ureter, 7 mm). RF ablation was performed with pulsed impedance control current. The records and imaging studies of patients treated with this technique were reviewed for demographics, indication, technique, complications, and tumor recurrence. RESULTS All 19 RF ablation and ureteral catheter placement procedures were technically successful. No patient developed a ureteral stricture or hydronephrosis during a mean of 14 months of follow-up (range, 4-32 months). Three patients had residual tumor on the first follow-up imaging study, but all three tumors were completely ablated after a second RF ablation session. No complications or deaths occurred. No recurrent tumor was seen anywhere in the treated tumors, and there was complete ablation of the tumor margin in proximity to the collecting system. CONCLUSIONS RF ablation of RCC within 1.5 cm of the ureter is feasible with cooled D5W retrograde pyeloperfusion and is not associated with reduced efficacy, ureteral injury, or early recurrence.
Collapse
Affiliation(s)
- Colin P Cantwell
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Matsumoto T, Kiyota H, Matsukawa M, Yasuda M, Arakawa S, Monden K. Japanese guidelines for prevention of perioperative infections in urological field. Int J Urol 2007; 14:890-909. [PMID: 17880286 DOI: 10.1111/j.1442-2042.2007.01869.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For urologists, it is very important to master surgical indications and surgical techniques. On the other hand, the knowledge of the prevention of perioperative infections and the improvement of surgical techniques should always be considered. Although the prevention of perioperative infections in each surgical field is a very important issue, the evidence and the number of guidelines are limited. Among them, the preparation of guidelines has progressed, especially in gastrointestinal surgery. The Center for Disease Control and Prevention (CDC) proposed guidelines for the prevention of surgical site infections, which have been used worldwide. In urology, the original guidelines were different from those of general surgery, due to many endourological procedures and urine exposure in the surgical field. The Japanese Society of UTI Cooperative Study Group has thus framed these guidelines supported by The Japanese Urological Association. The guidelines consist of the following nine techniques: open surgeries, laparoscopic surgeries, transurethral resection of bladder tumor, ureterorenoscope and transurethral lithotripsy, transurethral resection of the prostate, prostate biopsy, cystourethroscope, pediatric surgeries in the urological field, and extracorporeal shock wave lithotripsy and febrile neutropenia. These are the first guidelines for the prevention of perioperative infections in the urological field in Japan. Although most of these guidelines were made using reliable evidence, there are parts without enough evidence. Therefore, if new reliable data is reported, it will be necessary for these guidelines to be revised in the future.
Collapse
Affiliation(s)
- Tetsuro Matsumoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | | | | | | | | | | |
Collapse
|
16
|
Shrim A, Garcia-Bournissen F, Koren G. Pharmaceutical Agents and Pregnancy in Urology Practice. Urol Clin North Am 2007; 34:27-33. [PMID: 17145358 DOI: 10.1016/j.ucl.2006.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urologic medical conditions are not frequently encountered during pregnancy. Still, urologists often are asked to treat pregnant patients for conditions that require prescriptions. In the generally healthy population of pregnant women, the use of pharmaceutical agents is usually reserved for women who have either infections or necessary surgical procedures. This article addresses the implications for pregnancy of common urologic conditions in generally healthy pregnant women, namely simple urinary tract infections that demand nitrofurantoin and complex urinary tract infections that necessitate fluoroquinolones treatment. It also examines the implications of nonobstetric surgical intervention.
Collapse
Affiliation(s)
- Alon Shrim
- The Motherisk Program, Division of Clinical Pharmacology/Toxicology, Hospital for Sick Children, The University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | | | | |
Collapse
|
17
|
Randomized prospective comparison of fosfomycin and cefotiam for prevention of postoperative infection following urological surgery. J Infect Chemother 2007; 13:324-31. [DOI: 10.1007/s10156-007-0544-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 06/08/2007] [Indexed: 11/30/2022]
|
18
|
Turan H, Balci U, Erdinc FS, Tulek N, Germiyanoglu C. Bacteriuria, pyuria and bacteremia frequency following outpatient cystoscopy. Int J Urol 2006; 13:25-8. [PMID: 16448428 DOI: 10.1111/j.1442-2042.2006.01219.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The assumed necessity of antimicrobial prophylaxis prior to cystoscopy is controversial. In this study, the rate of bacteriuria, pyuria and bacteremia in outpatients who underwent cystoscopy without antimicrobial prophylaxis is investigated prospectively. METHODS The study included 75 patients who underwent cystoscopy for various indications and had sterile urine prior to intervention. A clean midstream urine sample was obtained 24 h before and 48 h after the procedure. Blood cultures were taken 1 h after cystoscopy. Patients were questioned for newly developed symptoms 48 h after cystoscopy. Blood cultures were taken again from patients who presented with fever. RESULTS Six patients (8%) developed significant bacteriuria, and six patients (8%) developed pyuria without significant bacteriuria. Bacteremia was not determined in any of the patients. The association between presence of pyuria prior to the procedure and development of bacteriuria after the procedure was significant (P < 0.05). Four patients out of six who had bacteriuria were asymptomatic. In our study we found significant bacteriuria after cystoscopy in 8% of patients, and no bacteremia. CONCLUSIONS Thus we conclude that cystoscopy is a safe and well-tolerated procedure. Antimicrobial prophylaxis should not be administrated unless specific indications are present.
Collapse
Affiliation(s)
- Hale Turan
- Ankara Training and Research Hospital Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
19
|
Abstract
Ureteroscopy has undergone a dramatic evolution over the last two decades. Although ureteroscopic injury is the most common cause of ureteral trauma because of the large number of ureteroscopic procedures performed, improvements in instrumentation and technique have resulted in a reduced incidence of serious complications. Despite significant technologic advances, however, surgical misadventures still occur, some of which have lasting consequences. Careful attention to instrument selection and surgical technique are critical to reduce untoward events related to ureteroscopy. As such, adverse sequelae associated with ureteroscopy should be related to the underlying pathology itself rather than to the treatment.
Collapse
Affiliation(s)
- D Brooke Johnson
- Division of Urology, University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, UT 84132, USA
| | | |
Collapse
|
20
|
Abstract
Urinary catheter-related infections are commonly seen in several different patient populations and lead to substantial morbidity. The overall health care costs caused by these infections are sizable given how often urinary catheters are used in acute care settings, extended care facilities, and in persons with injured spinal cords. Recent attention has appropriately focused on biofilm development on the catheter surface because biofilm has important implications for the pathogenesis, treatment, and prevention of catheter-related infection. Because the most important risk factor for infection is duration of catheterization, indwelling urethral catheterization should be avoided or at least limited whenever possible. Additional methods to prevent this infection include aseptic insertion and maintenance use of a closed drainage system, anti-infective catheters in patients at high-risk for infection, and systemic antibiotics in select patients. Alternative urinary collection strategies may be appropriate in certain patient groups. Specifically, condom catheters should be considered in men likely to be adherent with this urinary collection method, suprapubic catheters should be considered in patients requiring long-term indwelling drainage, and intermittent catheterization seems appropriate in patients with injured spinal cords. Future research should focus on additional methods for preventing this common infection.
Collapse
Affiliation(s)
- Sanjay Saint
- Ann Arbor VA Medical Center, Ann Arbor, MI, USA.
| | | |
Collapse
|
21
|
Christiano AP, Hollowell CM, Kim H, Kim J, Patel R, Bales GT, Gerber GS. Double-blind randomized comparison of single-dose ciprofloxacin versus intravenous cefazolin in patients undergoing outpatient endourologic surgery. Urology 2000; 55:182-5. [PMID: 10688075 DOI: 10.1016/s0090-4295(99)00412-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To compare the efficacy of single-dose oral ciprofloxacin with intravenous cefazolin as a prophylactic agent in patients undergoing outpatient endourologic surgery. METHODS One hundred patients were enrolled in a double-blind, randomized study to receive either ciprofloxacin (500 mg) or cefazolin (1 g) before surgery. A postoperative clinical evaluation and urine cultures were performed 5 to 10 days after surgery. Patients undergoing ureteral stent insertion or exchange, ureteroscopy, bladder biopsy, retrograde pyelography, collagen injection, and internal urethrotomy were included. RESULTS Postoperative urinary tract infection occurred in 7 (9.1%) of 77 patients, including 3 (8.1%) of 37 and 4 (10.0%) of 40 of those who received ciprofloxacin and cefazolin, respectively (P = 0.77). There were no episodes of sepsis, and no patient with infection required hospitalization. The total cost associated with the administration of prophylactic antibiotics in the study population was $3657 less in those 50 patients who received ciprofloxacin than in the 50 patients who received cefazolin. CONCLUSIONS A single oral dose of ciprofloxacin in patients undergoing outpatient endourologic surgery was equally effective as cefazolin in preventing postoperative urinary tract infection, but was associated with markedly lower overall costs.
Collapse
Affiliation(s)
- A P Christiano
- Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois 60637, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Martin C, Viviand X, Cottin A, Savelli V, Brousse C, Ragni E, Richaud C, Mallet MN. Concentrations of ceftriaxone (1,000 milligrams intravenously) in abdominal tissues during open prostatectomy. Antimicrob Agents Chemother 1996; 40:1311-3. [PMID: 8723493 PMCID: PMC163318 DOI: 10.1128/aac.40.5.1311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Ceftriaxone concentrations in abdominal tissues were evaluated at different stages of open prostatectomy. Ceftriaxone was administered as antibiotic prophylaxis, and 15 consecutive patients were given a single dose of ceftriaxone (1,000 mg intravenously in 1 min) 30 min before surgery. Ceftriaxone concentrations in tissue were determined at three stages of the surgical procedure; upon the opening of the abdominal cavity, during the prostatectomy, and upon the closure of the abdominal cavity. Samples of the following tissues or sample were assayed: epiploic and abdominal-wall fat; Retzius' space, bladder, and prostate tissue; and urine. During the different stages of the surgical procedure, for all patients, and in the different tested tissues, ceftriaxone concentrations greater than or equal to the cutoff point (4 micrograms/g of tissue) were measured. The highest concentrations were obtained in the bladder (43 +/- 18 micrograms/g) and in the prostate (35 +/- 18 micrograms/g). In fatty tissues, concentrations were between 13 +/- 5 and 22 +/- 8 micrograms/g. All patients (15 of 15) had ceftriaxone levels in tissue greater than the MICs for the potential pathogens (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis). In conclusion, during open prostatectomy and after the use of a single dose of ceftriaxone (1,000 mg), high antibiotic levels were obtained throughout the surgical procedure in the tissues potentially involved in postoperative infection.
Collapse
Affiliation(s)
- C Martin
- Department of Anesthesia and Intensive Care, Hôpital Nord, Marseille, France
| | | | | | | | | | | | | | | |
Collapse
|