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Pramod N, Henry F, Ramanujan S, Jevnikar W, Bena J, Schwartz R, Jeffery J, Sorkhi S, Sauer R, McNall S, Freeman S, Wymer K, Mandeville J, Civellaro S, Humphreys M, Bhojani N, De S. High-Risk Patients Undergoing Holmium Laser Enucleation of the Prostate Have Fewer Infections with a Longer Course of Preoperative Antibiotics. J Endourol 2024; 38:598-604. [PMID: 38829325 DOI: 10.1089/end.2023.0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Introduction: There are minimal data to guide antibiotic management of patients undergoing holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia. Specifically, management of high-risk patients who are catheter dependent or have positive preoperative urine cultures varies widely. We aimed to evaluate the effect of preoperative antibiotic duration on infectious complications in high-risk patients undergoing HoLEP. Methods: A multi-institutional retrospective review of patients undergoing HoLEP between 2018 and 2023 at five institutions was performed. Patients were defined as high risk if they were catheter-dependent (indwelling urethral catheter, self-catheterization, or suprapubic tube) or had a positive preoperative urine culture. These patients were categorized into long course (>3 days) or short course (≤3 days) of preoperative antibiotics. The primary outcome was 30-day infectious complications defined as a positive urine culture with symptoms. A t-test or Wilcoxon rank-sum test was used for continuous variables and Fisher's exact test was used for categorical variables. Logistic regression analysis was conducted to identify associations with infectious complications. Results: Our cohort included 407 patients, of which 146 (36%) and 261 (64%) were categorized as short course and long course of preoperative antibiotics, respectively. Median preoperative antibiotic duration was 1 day (interquartile range [IQR]: 0, 3 days) and 7 days (IQR: 5, 7 days) in the short and long cohorts, respectively. Thirty-day postoperative infectious complications occurred in 11 (7.6%) patients who received a short course of antibiotics and 5 (1.9%) patients who received a long course of antibiotics (odds ratio 0.24, 95% confidence interval 0.07-0.67; p = 0.009). Variables such as age, positive urine culture, and postoperative antibiotic duration were not significantly associated with postoperative infection after propensity score weighting. Conclusion: In high-risk patients undergoing HoLEP, infectious complications were significantly lower with a long course vs short course of antibiotics. Further prospective trials are needed to identify optimal preoperative antibiotic regimens.
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Affiliation(s)
- Nikhil Pramod
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fabrice Henry
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suruchi Ramanujan
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Jevnikar
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jim Bena
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan Schwartz
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Ruben Sauer
- Department of Urology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shannon McNall
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Samantha Freeman
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | | | | | - Simone Civellaro
- Department of Urology, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Naeem Bhojani
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Smita De
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Rhim WK, Woo J, Kim JY, Lee EH, Cha SG, Kim DS, Baek SW, Park CG, Kim BS, Kwon TG, Han DK. Multiplexed PLGA scaffolds with nitric oxide-releasing zinc oxide and melatonin-modulated extracellular vesicles for severe chronic kidney disease. J Adv Res 2024:S2090-1232(24)00118-8. [PMID: 38537702 DOI: 10.1016/j.jare.2024.03.018] [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: 11/13/2023] [Revised: 03/15/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION With prevalence of chronic kidney disease (CKD) in worldwide, the strategies to recover renal function via tissue regeneration could provide alternatives to kidney replacement therapies. However, due to relatively low reproducibility of renal basal cells and limited bioactivities of implanted biomaterials along with the high probability of substance-inducible inflammation and immunogenicity, kidney tissue regeneration could be challenging. OBJECTIVES To exclude various side effects from cell transplantations, in this study, we have induced extracellular vesicles (EVs) incorporated cell-free hybrid PMEZ scaffolds. METHODS Hybrid PMEZ scaffolds incorporating essential bioactive components, such as ricinoleic acid grafted Mg(OH)2 (M), extracellular matrix (E), and alpha lipoic acid-conjugated ZnO (Z) based on biodegradable porous PLGA (P) platform was successfully manufactured. Consecutively, for functional improvements, melatonin-modulated extracellular vesicles (mEVs), derived from the human umbilical cord MSCs in chemically defined media without serum impurities, were also loaded onto PMEZ scaffolds to construct the multiplexed PMEZ/mEV scaffold. RESULTS With functionalities of Mg(OH)2 and extracellular matrix-loaded PLGA scaffolds, the continuous nitric oxide-releasing property of modified ZnO and remarkably upregulated regenerative functionalities of mEVs showed significantly enhanced kidney regenerative activities. Based on these, the structural and functional restoration has been practically achieved in 5/6 nephrectomy mouse models that mimicked severe human CKD. CONCLUSION Our study has proved the combinatory bioactivities of the biodegradable PLGA-based multiplexed scaffold for kidney tissue regeneration in 5/6 nephrectomy mouse representing a severe CKD model. The optimal microenvironments for the morphogenetic formations of renal tissues and functional restorations have successfully achieved the combinatory bioactivities of remarkable components for PMEZ/mEV, which could be a promising therapeutic alternative for CKD treatment.
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Affiliation(s)
- Won-Kyu Rhim
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - Jiwon Woo
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - Jun Yong Kim
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea; Department of Biomedical Engineering and Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU) 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 16419, Republic of Korea; Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU) 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 16419, Republic of Korea
| | - Eun Hye Lee
- Joint Institute for Regenerative Medicine, Kyungpook National University, Jung-gu, Daegu 41944, Republic of Korea
| | - Seung-Gyu Cha
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - Da-Seul Kim
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - Seung-Woon Baek
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea; Department of Biomedical Engineering and Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU) 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 16419, Republic of Korea; Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU) 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 16419, Republic of Korea
| | - Chun Gwon Park
- Department of Biomedical Engineering and Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU) 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 16419, Republic of Korea; Intelligent Precision of Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU) 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 16419, Republic of Korea
| | - Bum Soo Kim
- Joint Institute for Regenerative Medicine, Kyungpook National University, Jung-gu, Daegu 41944, Republic of Korea; Department of Urology, School of Medicine, Kyungpook National University, Jung-gu, Daegu 41944, Republic of Korea
| | - Tae Gyun Kwon
- Joint Institute for Regenerative Medicine, Kyungpook National University, Jung-gu, Daegu 41944, Republic of Korea; Department of Urology, School of Medicine, Kyungpook National University, Jung-gu, Daegu 41944, Republic of Korea
| | - Dong Keun Han
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea.
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Marino F, Rossi F, Murri R, Sacco E. Antibiotic prophylaxis in urologic interventions: Who, when, where? Urologia 2024; 91:11-25. [PMID: 38288737 DOI: 10.1177/03915603231226265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Periprocedural prophylaxis in medicine encompasses the set of measures (physical, chemical, and pharmacological) used to reduce the risk of infection. Antibiotic prophylaxis (AP) refers to the administration of a short-term regimen of antibiotics shortly before a medical procedure to reduce the risk of infectious complications that can result from diagnostic and therapeutic interventions. The outspreading growth of multidrug-resistant bacterial species and changes in the bacterial local ecosystem have impeded the development of a unique scheme of AP in urology. OBJECTIVES To review the literature and current guidelines regarding AP for urological diagnostic and therapeutic procedures, and to define agents, timing, and occasions when administering pharmacological prophylaxis. Secondly, according to current literature, to open new scenarios where AP can be useful or useless. RESULTS Major gaps in evidence still exist in this field. AP appears useful in many invasive procedures and some sub-populations at risk of infectious complications. AP is not routinely recommended for urodynamic exams, diagnostic cystoscopy, and extracorporeal shock-wave lithotripsy. The available data regarding the use of AP during the transperineal prostate biopsy are still unclear; conversely, in the case of the transrectal approach AP is mandatory. AP is still considered the gold standard for the prevention of postoperative infective complications in the case of ureteroscopy, percutaneous nephrolithotomy, endoscopic resection of bladder tumor, endoscopic resection of the prostate, and prosthetic or major surgery. CONCLUSION The review highlights the complexity of determining the appropriate candidates for AP, emphasizing the importance of considering patient-specific factors such as comorbidities, immunocompetence, and the nature of the urologic intervention. The evidence suggests that a one-size-fits-all approach may not be suitable, and a tailored strategy based on the specific procedure and patient characteristics is essential.
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Affiliation(s)
- Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Francesco Rossi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
- Department of Urology, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Rita Murri
- Università Cattolica Del Sacro Cuore, Rome, Italy
- Department of Infectious Disease, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Emilio Sacco
- Università Cattolica Del Sacro Cuore, Rome, Italy
- Department of Urology, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
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Lin J, Yang Z, Ye L, Hong Y, Cai W, Pan H, Fu H, Wu J. Pathogen species are the risk factors for postoperative infection of patients with transurethral resection of the prostate: a retrospective study. Sci Rep 2023; 13:20943. [PMID: 38016988 PMCID: PMC10684857 DOI: 10.1038/s41598-023-47773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023] Open
Abstract
This study aimed to analyze the infection risk factors for transurethral resection of the prostate (TURP) and establish predictive models to help make personalized treatment plans. Our study was designed one-center and retrospectively enrolled 1169 benign prostatic hyperplasia (BPH) patients. Risk factors were explored for postoperative infection. A TURP-postoperative infection (TURP-PI) model with infection prediction values was created. The improved-TURP-PI (I-TURP-PI) model, including extra new factors (pathogens species), was also built to see whether it could optimize the prediction abilities. At last, we developed a nomogram for better clinical application. Operation time, preoperative indwelling urinary catheter (PIUC), and positive preoperative urine culture were independent risk factors (all P < 0.05). Interestingly, pathogens species in pre-surgery urine (PEnterococcus faecium = 0.014, PPseudomonas aeruginosa = 0.086) were also independent risk factors. Patients with positive Enterococcus faecium (37.50%) were most likely to have postoperative infection. We built two models with AUCTURP-PI = 0.709 (95% CI 0.656-0.763) and AUCI-TURP-PI = 0.705 (95% CI 0.650-0.760). The nomogram could help improve the prediction ability. To our knowledge, our study is the first to use pathogen species in urine before surgery as risk factors for infection prediction after TURP. TURP-PI and I-TURP-PI models have essential roles in predicting patients' postoperative infections and in better postoperative antibiotic decision-making.
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Affiliation(s)
- Jiexiang Lin
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Zesong Yang
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Liefu Ye
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Yun Hong
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Wanghai Cai
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Honghong Pan
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Haishou Fu
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Clinical Laboratory, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
| | - Jinfeng Wu
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
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Serum and Prostatic Tissue Concentrations of Cefazolin, Ciprofloxacin and Fosfomycin after Prophylactic Use for Transurethral Resection of the Prostate. Antibiotics (Basel) 2022; 12:antibiotics12010022. [PMID: 36671223 PMCID: PMC9855043 DOI: 10.3390/antibiotics12010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
The optimal drug of choice, its time of administration and duration of antibiotic prophylaxis in patient undergoing a TURP procedure are still matters of debate. In this study, we evaluated the concentrations of cefazolin, ciprofloxacin and fosfomycin in the human prostate in a cohort of men undergoing TURP. We compared prostate tissue concentrations to the serum concentrations and MICs of common uropathogens, to determine the appropriateness of the current presurgical prophylactic antibiotics and to gain supportive data about the suitability of fosfomycin for antibiotic prophylaxis in men undergoing urological procedures of the prostate. After a single intravenous dose of cefazoline or an oral dose of ciprofloxacin prior to TURP, concentrations in serum and prostate tissue of well above the MIC (EUCAST breakpoint) of common uropathogens (Enterobacterales) were reached, and both antibiotics seem potentially effective in preventing postsurgical infections. A single dose of oral and intravenous administration of fosfomycin both led to serum concentrations above the MIC for uncomplicated urinary tract infections (8 µg/mL). The MIC for other infections (32 µg/mL) was only reached after a single dose of intravenous fosfomycin. We were unable to detect fosfomycin concentrations in prostate tissue.
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Zeng XT, Jin YH, Liu TZ, Chen FM, Ding DG, Fu M, Gu XQ, Han BM, Huang X, Hou Z, Hu WL, Kang XL, Li GH, Li JX, Li PJ, Liang CZ, Liu XH, Liu ZY, Liu CX, Liu JM, Luo GH, Luo Y, Qin WJ, Qiu JH, Qiu JX, Shang XJ, Shi BK, Sun F, Tian GX, Tian Y, Wang F, Wang F, Wang YH, Wang YJ, Wang ZP, Wang Z, Wei Q, Xiao MH, Xu WH, Yi FX, Zhu CY, Zhuang QY, Zhou LQ, Zou XF, Xing NZ, He DL, Wang XH. Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition). Mil Med Res 2022; 9:14. [PMID: 35361280 PMCID: PMC8974007 DOI: 10.1186/s40779-022-00371-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 02/08/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline "2018 Standard Edition". However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons' surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons' skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.
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Affiliation(s)
- Xian-Tao Zeng
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Tong-Zu Liu
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Fang-Ming Chen
- Department of Urology, Tianjin Third Central Hospital Affiliated To Nankai University, Tianjin, 300170, China
| | - De-Gang Ding
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, 450003, China
| | - Meng Fu
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Xin-Quan Gu
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Bang-Min Han
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Xing Huang
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhi Hou
- Department of Urology, Qinghai University Affiliated Hospital, Xi'ning, 810012, China
| | - Wan-Li Hu
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xin-Li Kang
- Department of Urology, People's Hospital of Hainan Province, Hainan Affiliated Hospital of Hainan Medical University Haikou, Haikou, 570311, China
| | - Gong-Hui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Jian-Xing Li
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Pei-Jun Li
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, 750003, China
| | - Chao-Zhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xiu-Heng Liu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zhi-Yu Liu
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, 116023, Liaoning, China
| | - Chun-Xiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510282, China
| | - Jiu-Min Liu
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Guang-Heng Luo
- Department of Urology Surgery, Guizhou Province People's Hospital, Guiyang, 550002, China
| | - Yi Luo
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Wei-Jun Qin
- Department of Urology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, China
| | - Jian-Hong Qiu
- Department of Urology, The 980St Hospital of the PLA Joint Logistics Support Force (Bethune International Peace Hospital of PLA), Shijiazhuang, 050082, China
| | - Jian-Xin Qiu
- Department of Urology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, 710038, China
| | - Xue-Jun Shang
- Department of Andrology, Jinling Hospital Affiliated to Nanjing University School of Medicine, Nanjing, 210002, China
| | - Ben-Kang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Fa Sun
- Department of Urology Surgery, Guizhou Province People's Hospital, Guiyang, 550002, China
| | - Guo-Xiang Tian
- Department of Geriatrics, The Seventh Medical Center of Chinese, PLA General Hospital, Beijing, 100027, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Feng Wang
- Department of Urology, People's Hospital of Tibet Autonomous Region, Lhasa, 850000, China
| | - Feng Wang
- Department of Urology, South China Hospital, Shenzhen University, Shenzhen, 518111, Guangdong, China
| | - Yin-Huai Wang
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Yu-Jie Wang
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Zhi-Ping Wang
- Department of Urology, Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou, 730030, China
| | - Zhong Wang
- Department of Urology, Shanghai 9Th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 88 South Keyuan Road, Chengdu, 610041, China
| | - Min-Hui Xiao
- Department of Urology, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming, 650041, China
| | - Wan-Hai Xu
- Department of Urology, The Fourth Hospital of Harbin Medical University, Heilongjiang Key Laboratory of Scientific Research in Urology, Harbin, 150001, China
| | - Fa-Xian Yi
- Department of Urology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010059, China
| | - Chao-Yang Zhu
- Department of Urology, Huaihe Hospital of Henan University, Kaifeng, 475000, Henan, China
| | - Qian-Yuan Zhuang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, The Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, China
| | - Xiao-Feng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Nian-Zeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Da-Lin He
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Xing-Huan Wang
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. .,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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7
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Chen YT, Hou CP, Juang HH, Lin YH, Yang PS, Chang PL, Chen CL, Weng SC, Tsui KH. Comparison of Outcome and Quality of Life Between Thulium Laser (VelaTM XL) Enucleation of Prostate and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). Ther Clin Risk Manag 2022; 18:145-154. [PMID: 35237038 PMCID: PMC8885124 DOI: 10.2147/tcrm.s352583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/15/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Yu-Ting Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Health and Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Horng-Heng Juang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Anatomy, School of Medicine, Chang Gung University, Tao-Yuan, Taipei, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Pei-Shan Yang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Anatomy, School of Medicine, Chang Gung University, Tao-Yuan, Taipei, Taiwan
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chien-lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shu-Chuan Weng
- Health and Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Shu-Chuan Weng, Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taipei, Taiwan, Email
| | - Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Urology, Shuang Ho Hospital, TMU Research Center of Urology and Kidney, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
- Correspondence: Ke-Hung Tsui, Taiwan Innovative Medical Association, Department of Urology, Shuang Ho Hospital, College of Medical, Taipei Medical University, Taipei, Taiwan, Email
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8
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Wroclawski ML, Castellani D, Heldwein FL, Teles SB, Cha JD, Zhao H, Herrmann T, Chan VWS, Teoh JYC. Shedding light on polypragmasy of pain after transurethral prostate surgery procedures: a systematic review and meta-analysis. World J Urol 2021; 39:3711-3720. [PMID: 33787985 DOI: 10.1007/s00345-021-03678-6] [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: 12/19/2020] [Accepted: 03/17/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE AND OBJECTIVE To evaluate and compare the incidences of post-operative pelvic pain (PPP) in patients undergoing ablation, enucleation and conventional transurethral resection of the prostate (TURP). METHODS A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Using MEDLINE via PubMed and Cochrane CENTRAL, randomised control trials (RCTs) and observational studies reporting PPP rates post-ablation, enucleation or TURP were identified. The risk of biases (RoB) in RCTs and observation studies were assessed using the Cochrane RoB1.0 tool and the Newcastle-Ottawa Scale, respectively. RESULTS 62 studies were included for qualitative analysis, while 51 of them reported number of patients with PPP post-intervention. Three observational studies and 13 RCTs compared the rates of PPP in patients undergoing ablation, enucleation or TURP. The most reported types of PPP are dysuria, abdominal pain and irritative symptoms. The pooled incidence of PPP at 1-month follow-up in patients undergoing ablation, enucleation and TURP were 0.15 (95% CI 0.10-0.22), 0.09 (95% CI 0.04-0.19 and 0.10 (95% CI 0.06-0.15), respectively. PPP is no longer prevalent at 3-months and onwards post-operatively. Ablation is associated with a higher risk of PPP than enucleation (RR 2.19, 95% CI 1.04-4.62) and TURP (RR 2.40, 95% CI 1.03-5.62) in observational studies but not RCTs; and there were no significant differences in the rates of PPP upon comparison of other modalities. CONCLUSION PPP is common after transurethral benign prostatic hyperplasia surgery. Patients undergoing ablation had a higher rate of post-intervention PPP than those undergoing enucleation and TURP in observational studies.
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Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo, Brazil. .,BP-a Beneficência Portuguesa de São Paulo, São Paulo, Brazil. .,Faculdade de Medicina Do ABC, Santo André, Brazil.
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Flavio L Heldwein
- Department of Urology, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | | | - Hongda Zhao
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.,Department of Urology, Hanover Medical School (MHH), Hanover, Germany
| | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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9
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Effectiveness of appropriate antibiotic prophylaxis for transurethral resection of the prostate in the era of antibiotic resistance. Infect Control Hosp Epidemiol 2021; 43:1693-1697. [PMID: 34261570 DOI: 10.1017/ice.2021.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The results of this study demonstrate the lower incidence of posttransurethral resection of the prostate (TURP) urinary tract infection (UTI) among patients receiving appropriate antibiotic prophylaxis (AAP) versus inappropriate antibiotic prophylaxis (27% vs 47%; P < .001). Preoperative urine culture procurement and APP are critical for post-TURP UTI prevention in the era of antibiotic resistance.
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10
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The Effect of Pre-TURP Bladder Irrigation with 0.2% Chlorhexidine in Patients with Foley Catheter Regarding Postoperative Bacteremia Decrease. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.101296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Transurethral resection of the prostate (TURP) has been widely used for patients suffering from bladder colonization with bacteria, increasing the probability of bacteremia and sepsis despite consuming prophylaxis antibiotics. Objectives: The study aimed to evaluate the effect of pre- TURP bladder irrigation with 0.2% chlorhexidine in reducing postoperative bacteremia. Methods: This clinical trial study was conducted on 60 benign prostatic hyperplasia (BPH) patients who were candidates for TURP in the urology department of Al-Zahra Hospital. All patients suffered from urinary catheters, and they were allocated into two groups (n = 30). Antibiotic prophylaxis was prescribed for all the patients. In the case group, the bladder was rinsed by chlorhexidine 0.2% before TURP; however, and the bladder in the control group was rinsed by distilled water. Postoperative bacteremia were evaluated using procalcitonin (PCT) measurement and BACTEC automated blood culture six hours after surgery. Results: Positive BACTEC blood culture was observed in three (10%) and no (0%) patients in the control and case groups, respectively (P = 0.071). Moreover, 6.6 % and 46.6 % of the patients in the control group had low and high PCT levels, respectively. Furthermore, 40 % and 6.66 % of the patients in the case group had low and high PCT levels, respectively. There was a significant difference between the two groups in terms of the PCT level (P < 0.01). Conclusions: The frequency of patients with a high PCT level was higher in the control group than in the case group, suggesting that chlorhexidine in the catheterized patients undergoing TURP reduced the number of bacteria in the bladder.
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11
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Kyono Y, Endo F, Shimbo M, Ohwaki K, Hattori K. Positive urine culture under indwelling urethral catheterization is a risk factor for febrile complications after holmium laser enucleation of the prostate (HoLEP). Low Urin Tract Symptoms 2021; 13:377-382. [PMID: 33847442 DOI: 10.1111/luts.12380] [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: 01/16/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the incidence of and risk factors for febrile complications (FCs) in patients undergoing holmium laser enucleation of the prostate (HoLEP). METHODS This retrospective study enrolled 847 consecutive patients who underwent HoLEP in our hospital from June 2006 to December 2018. FCs were defined as a body temperature ≥38.0°C within 30 days after surgery. The incidence of FCs was determined and possible risk factors assessed using multivariate logistic regression analysis. RESULTS Overall, 87 (10.3%) patients presented with FCs, and 6 (0.7%) had urosepsis, with no fatal complications. Multivariate logistic regression analysis revealed that patients with preoperative positive urine culture and urethral catheterization had an increased risk of FCs compared with those with a negative culture who did not need catheterization (odds ratio [OR] 2.587, 95% confidence interval [CI] 1.307-5.121). A negative urine culture with catheterization and a positive culture without catheterization were not associated with the development of FCs (OR 0.320, 95% CI 0.040-2.553 and OR 1.370, 95% CI 0.662-2.365, respectively). Other significant risk factors included preoperative serum albumin levels (OR 0.382, 95% CI 0.173-0.846) and immediate postoperative body temperature (OR 2.559, 95% CI 1.549-4.230). CONCLUSIONS FCs are relatively common among patients after HoLEP despite preoperative prophylactic antibiotic administration. Surgeons may need to consider performing screening of urine cultures prior to HoLEP, especially in patients with urethral catheterization, even if asymptomatic. If the culture is positive, prophylactic antibiotics should be tailored according to bacterial susceptibility.
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Affiliation(s)
- Yoko Kyono
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Fumiyasu Endo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuhiro Ohwaki
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
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12
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Jayanth ST, Chandrasingh J, Sahni RD, Mukha RP, Kumar S, Devasia A, Kekre NS. Efficacy of 1 versus 3 days of intravenous amikacin as a prophylaxis for patients undergoing transurethral resection of the prostate: A prospective randomized trial. Indian J Urol 2021; 37:133-139. [PMID: 34103795 PMCID: PMC8173930 DOI: 10.4103/iju.iju_494_20] [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: 09/05/2020] [Revised: 11/03/2020] [Accepted: 02/13/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: There are no uniform guidelines on the duration of antibiotic prophylaxis for transurethral resection of the prostate (TURP). The objective of this study was to evaluate the efficacy of 1 day versus 3 days of intravenous amikacin as prophylaxis, before TURP. Materials and Methods: In this prospective randomized control trial, patients with sterile preoperative urine culture were randomized to receive either 1 day (Group A) or 3 days (Group B) of intravenous (IV) amikacin. All patients had their catheter removed on the 3rd day and a midstream urine culture was obtained on the 4th day. The follow-up was scheduled at 1 week and at 1 month. The rate of bacteriuria on the 4th postoperative day was analyzed as the primary outcome. The secondary outcomes included symptomatic urinary tract infection (UTI), its risk factors, and other complications at 1 month. Results: Of the 338 patients randomized, 314 patients were evaluable until day 7 and 307 until 1 month. Bacteriuria rate at day 4 (Group A: 8.8% [95% confidence interval (CI): 4.2–13.2]; Group B: 4.4% [95% CI: 1.2%–7.7%], P = 0.124, Fisher's exact test) was similar in both the groups. At 1 month, the rate of symptomatic UTI was also similar in both the groups (3.5% [95% CI: 0.8–6.9] vs. 1.7% [95% CI: 0.2–4.2], P = 0.344, Fisher's exact test). Bacteriuria (colony-forming unit, >104/ml) at day 4 was a significant risk factor for developing symptomatic UTI (P = 0.006). Antibiotic resistance was higher in Group B (P = 0.002) (Group A: 7.1% [95% CI: 6.3–20] vs. Group B: [71%, CI: 38–104], P = 0.0021, Fisher's exact test). Conclusion: One day is possibly noninferior to 3 days of IV amikacin as prophylaxis in patients undergoing TURP with respect to bacteriuria and symptomatic UTI, with an added advantage of lower antibiotic resistance.
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Affiliation(s)
| | - J Chandrasingh
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rani Diana Sahni
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv Paul Mukha
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Kumar
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Antony Devasia
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
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13
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Does a Recent Urinary Tract Infection Increase the Risk of Postprocedure Urinary Tract Infection After Onabotulinum Toxin A? Female Pelvic Med Reconstr Surg 2021; 27:121-125. [PMID: 31295185 DOI: 10.1097/spv.0000000000000753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the risk of postprocedure urinary tract infection (UTI) after injection of onabotulinum toxin A (BTX-A) in women who had a UTI within 30 days before procedure. METHODS This was a retrospective cohort study of women who underwent their first injection of BTX-A from 2010 to 2016. Two cohorts were identified: (1) recent UTI (within 30 days before injection) and (2) no recent UTI. Our primary outcome was UTI within 90 days after BTX-A. Continuous variables were analyzed using the Wilcoxon rank sum test, and categorical variables were analyzed using Fisher exact or χ2 tests. RESULTS One hundred sixty-six women underwent their first BTX-A injection. Twenty-five (15%) had a recent UTI and 141 (85%) did not. Women with a recent UTI were more likely to have a subsequent infection (52% vs 26%, P < 0.01). However, in a logistic regression model, controlling for history of recurrent UTI, age, history of diabetes mellitus, periprocedural antibiotics, and urinary retention requiring catheterization, the association between having a recent UTI, and a subsequent UTI was no longer significant (adjusted odds ratio, 1.98; 95% confidence interval, 0.60-6.50; P = 0.26). CONCLUSIONS Performing a first injection of BTX-A within 30 days of a UTI does not increase the odds of postprocedure UTI. Therefore, BTX-A therapy does not need to be delayed after a recent UTI.
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14
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Bradshaw AW, Pe M, Bechis SK, Dipina T, Zupkas P, Abbott JE, Papagiannopoulos D, Cobb KD, Sur RL. Antibiotics are not necessary during routine cystoscopic stent removal: A randomized controlled trial at UC San Diego. Urol Ann 2020; 12:373-378. [PMID: 33776335 PMCID: PMC7992522 DOI: 10.4103/ua.ua_130_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/28/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction: Current American Urological Association (AUA) Best Practice Statement recommends antibiotic prophylaxis for cystoscopy with manipulation, including stent removal; although no Level 1b trials explicitly address prophylaxis for stent removal. We sought to determine the efficacy of prophylactic antibiotics to prevent infectious complications after stent removal. Materials and Methods: Following institutional review board approval, patients undergoing removal of ureteral stent placed during stone surgery were recruited from July 2016 to March 2019. Patients were recruited at the time of stent removal and randomized to treatment (single dose 500 mg oral ciprofloxacin) or control group (no antibiotics). Telephone contact was attempted within 14 days of stent removal to assess for urinary tract infection (UTI) symptoms, antibiotic prescriptions, or Emergency Department visits. Primary outcome was UTI within 1 month of stent removal – defined by irritative voiding symptoms, fever or abdominal pain associated with positive urine culture (Ucx) (>100k colony-forming units/mL). Results: Seventy-seven patients were enrolled, with 58 meeting final inclusion criteria for the analysis (33 treatment, 25 controls). No differences were seen with clinical and demographic variables, except a higher body mass index in the treatment group (P = 0.007). Positive Ucx rate before stone surgery (16.7% vs. 11.8%, P = 0.819) and at the time of stent removal (16.0% vs. 11.1%, P = 0.648) was not significantly different in treatment versus control groups, respectively. Primary outcome: No patients in either cohort developed symptomatic culture-diagnosed UTI within 1 month of stent removal. Of patients with documented phone follow-up (treatment n = 29, control n = 22), only one patient (control) reported any positive response on phone survey. Conclusions: We found a low infectious complication rate regardless of antibiotic prophylaxis use during cystoscopic stent removal. The necessity of antibiotics during routine cystoscopic stent removal warrants possible reevaluation of the AUA best practice statement.
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Affiliation(s)
| | - Mark Pe
- Genesis Healthcare, San Diego, CA, USA
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15
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Khan FU, Khan Z, Ahmed N, Rehman A. A General Overview of Incidence, Associated Risk Factors, and Treatment Outcomes of Surgical Site Infections. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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16
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Togo Y, Fukui K, Ueda Y, Kanamaru S, Shimizu Y, Wada K, Sadahira T, Yamada Y, Matsumoto M, Hamasuna R, Ishikawa K, Takai M, Maekawa Y, Yasuda M, Kokura K, Kondoh N, Takiuchi H, Yamamoto S. Comparison of single‐ and multiple‐dose cefazolin as prophylaxis for transurethral enucleation of prostate: A multicenter, prospective, randomized controlled trial by the Japanese Research Group for Urinary Tract Infection. Int J Urol 2020; 27:244-248. [DOI: 10.1111/iju.14181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Yoshikazu Togo
- Department of Urology Hyogo College of Medicine NishinomiyaHyogoJapan
| | - Koji Fukui
- Department of Urology Takarazuka City Hospital TakarazukaHyogoJapan
| | - Yasuo Ueda
- Department of Urology Nishinomiya Municipal Central Hospital NishinomiyaHyogoJapan
| | - Sojun Kanamaru
- Department of Urology Kobe City Nishi‐Kobe Medical Center Kobe HyogoJapan
| | - Yosuke Shimizu
- Department of Urology Kobe City Nishi‐Kobe Medical Center Kobe HyogoJapan
| | - Koichiro Wada
- Department of Urology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama OkayamaJapan
| | - Takuya Sadahira
- Department of Urology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama OkayamaJapan
| | - Yusuke Yamada
- Department of Urology Hyogo College of Medicine NishinomiyaHyogoJapan
| | - Masahiro Matsumoto
- Department of Urology University of Occupational and Environmental Health Japan KitakyushuFukuokaJapan
| | - Ryoichi Hamasuna
- Department of Urology Federation of National Public Services Affiliated Personal Mutual Aid Associations Shin‐Kokura Hospital Kitakyushu FukuokaJapan
| | - Kiyohito Ishikawa
- Department of Urology Fujita Health University School of Medicine Toyoake AichiJapan
| | - Manabu Takai
- Department of Urology Kizawa Memorial Hospital MinokamoGifuJapan
| | - Yuka Maekawa
- Department of Urology Gifu University Hospital GifuGifuJapan
| | - Mitsuru Yasuda
- Center for Nutrition Support and Infection Control Gifu University Hospital Gifu GifuJapan
| | - Koji Kokura
- Department of Urology Takarazuka City Hospital TakarazukaHyogoJapan
| | - Nobuyuki Kondoh
- Department of Urology Kyowakai Kyoritsu Hospital Kawanishi Hyogo Japan
| | - Hidekazu Takiuchi
- Department of Urology Nishinomiya Municipal Central Hospital NishinomiyaHyogoJapan
| | - Shingo Yamamoto
- Department of Urology Hyogo College of Medicine NishinomiyaHyogoJapan
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17
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Kranz J. [Infection management in TURP shows need for improvement despite evidence-based guideline recommendations : Results from the Global Prevalence Study of Infections in Urology]. Urologe A 2019; 58:1350-1352. [PMID: 31309251 DOI: 10.1007/s00120-019-1001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J Kranz
- St.-Antonius Hospital, Klinik für Urologie und Kinderurologie, Lehrkrankenhaus der RWTH Aachen, Dechant‑Deckers‑Straße 8, 52249, Eschweiler, Deutschland. .,Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
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18
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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
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19
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Speich B, Bausch K, Roth JA, Hemkens LG, Ewald H, Vogt DR, Bruni N, Deuster S, Seifert HH, Widmer AF. Single-dose versus 3-day cotrimoxazole prophylaxis in transurethral resection or greenlight laser vaporisation of the prostate: study protocol for a multicentre randomised placebo controlled non-inferiority trial (CITrUS trial). Trials 2019; 20:142. [PMID: 30782183 PMCID: PMC6381623 DOI: 10.1186/s13063-019-3237-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/31/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) and Greenlight laser vaporisation (GL) of the prostate are frequently performed urological procedures. For TURP, a single-dose antimicrobial prophylaxis (AP) is recommended to reduce postoperative urinary tract infections. So far, no international recommendations for AP have been established for GL. In a survey-based study in Switzerland, Germany and Austria, urologists reported routinely extending AP primarily for 3 days after both interventions. We therefore aim to determine whether single-dose AP with cotrimoxazole is non-inferior to 3-day AP with cotrimoxazole in patients undergoing TURP or GL of the prostate. METHODS/DESIGN We will conduct an investigator-initiated, multicentre, randomised controlled trial. We plan to assess the non-inferiority of single-dose AP compared to 3-day AP. The primary outcome is the occurrence of clinically diagnosed symptomatic urinary tract infections which are treated with antimicrobial agents within 30 days after randomisation. The vast majority of collected outcomes will be assessed from routinely collected data. The sample size was estimated to be able to show the non-inferiority of single-dose AP compared to 3-day AP with at least 80% power (1 - β = 0.8) at a significance level of α = 5%, applying a 1:1 randomisation scheme. The non-inferiority margin was determined in order to preserve 70% of the effect of usual care on the primary outcome. For an assumed event rate of 9% in both treatment arms, this resulted in a non-inferiority margin of 4.4% (i.e. 13.4% to 9%). To prove non-inferiority, a total of 1574 patients should be recruited, in order to have 1416 evaluable patients. The study is supported by the Swiss National Science Foundation. DISCUSSION For AP in TURP and GL, there is a large gap between usual clinical practice and evidence-based guidelines. If single-dose AP proves non-inferior to prolonged AP, our study findings may help to reduce the duration of AP in daily routine-potentially reducing the risk of emerging resistance and complications related to AP. TRIAL REGISTRATION Clinicaltrials.gov, NCT03633643 . Registered 16 August 2018.
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Affiliation(s)
- Benjamin Speich
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kathrin Bausch
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan A. Roth
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and 721 Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben, 4031 Basel, Switzerland
| | - Lars G. Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hannah Ewald
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- University Medical Library, University of Basel, Basel, Switzerland
| | - Deborah R. Vogt
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Bruni
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefanie Deuster
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Hans-H. Seifert
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas F. Widmer
- Division of Infectious Diseases and 721 Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben, 4031 Basel, Switzerland
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Baten E, Van Der Aa F, Orye C, Cartuyvels R, Arijs I, van Renterghem K. Antibiotic prophylaxis in TURP: a prospective analysis concerning antibiotic stewardship and a potential reduction of antibiotic use in TURP. World J Urol 2019; 37:2467-2472. [DOI: 10.1007/s00345-019-02676-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/05/2019] [Indexed: 11/30/2022] Open
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Köves B, Tenke P, Tandogdu Z, Cai T, Bogenhard F, Wullt B, Naber K, Bartoletti R, Cek M, Kulchavenya E, Perepanova T, Pilatz A, Bonkat G, Erik Bjerklund Johansen T, Wagenlehner F. Transurethral Resection of the Prostate: are We Following the Guidelines? - Outcomes from the Global Prevalence of Infections in Urology (GPIU) Study. J Chemother 2018; 31:15-22. [PMID: 30508403 DOI: 10.1080/1120009x.2018.1542552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transurethral resection of the prostate (TURP) is one of the most common urological procedures. With the increasing rate of multiresistant infections including urosepsis, it is essential for all surgeons to adhere to the relevant international guidelines to prevent infectious complications. The aim of this prospective, multinational, multicentre study was to evaluate compliance with recommended infection control measures regarding TURP procedures. The study was performed as a side questionnaire to the annual Global Prevalence Study of Infections in Urology (GPIU) between 2006 and 2009. Patients that had undergone TURP were eligible. Baseline data about hospitals and patients were collected. The questionnaire contained questions regarding preoperative microbiological investigations, catheter care and performance of perioperative antibiotic prophylaxis. A total of 825 men were included from 138 participating centres from Africa, Asia, Europe and South America. Only 50.1% of the patients received perioperative antibiotic prophylaxis with a median duration of 3 days (interquartile range [IQR] = 1-7 days). Preoperative urine culture was taken in 59.2%. The catheter was replaced in 1 week prior to the surgery only in 38.3% of cases. Compliance with the recommended infection control measures regarding TURP were only moderate, despite high grade recommendations in relevant international Guidelines. Stronger guideline adherence is necessary to improve patient care decrease antibiotic consumption in line with antibiotic stewardship in surgical practices.
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Affiliation(s)
- Bela Köves
- a Department of Urology , South-Pest Teaching Hospital , Budapest , Hungary
| | - Peter Tenke
- a Department of Urology , South-Pest Teaching Hospital , Budapest , Hungary
| | - Zafer Tandogdu
- b Department of Urology,Newcastle University, Northern Institute For Cancer Research , Newcastle Upon Tyne , United Kingdom
| | - Tommaso Cai
- c Department of Urology , Santa Chiara Regional Hospital , Trento , Italy
| | - Florian Bogenhard
- d Department of Bioinformatics , Technische Hochschule Mittelhessen , Giessen , Germany
| | - Björn Wullt
- e Department of Microbiology, Immunology and Glycobiology , Lund University , Lund , Sweden
| | - Kurt Naber
- f Department of Urology , Technical University of Munich , Munich , Germany
| | - Riccardo Bartoletti
- g Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy
| | - Mete Cek
- h Department of Urology , Trakya Medical School , Edirne , Turkey
| | | | | | - Adrian Pilatz
- k Department of Urology, Paediatric Urology and Andrology , Justus-Liebig-University , Gießen , Germany
| | - Gernot Bonkat
- l Department of Urology, Alta uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry (COB), University Basel , Basel , Switzerland
| | | | - Florian Wagenlehner
- k Department of Urology, Paediatric Urology and Andrology , Justus-Liebig-University , Gießen , Germany
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Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions. Int Urol Nephrol 2018; 50:1923-1937. [DOI: 10.1007/s11255-018-1971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
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Rizzo M, Trombetta C. Profilassi antibiotica nelle procedure urologiche. Urologia 2018; 85:S24-S28. [PMID: 30081775 DOI: 10.1177/0391560318770098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antibiotic prophylaxis in urological procedures Thousands of patients receive every day an antibiotic prophylaxis before diagnostic or therapeutic urological procedures. Aim of antibiotic prophylaxis is to reduce the risk of infective complications, unfortunately good quality evidences for the best choice of prophylaxis strategy are often lacking. Nowadays antimicrobial resistance is a major health problem caused primarily by overuse of antibiotics. It is the responsibility of all physicians to practice antibiotic stewardship avoiding the unnecessary use of this precious drugs. Given the previous consideration prophylaxis should be chosen on the base of the best evidences, if evidences are lacking prophylaxis should be tailored on the base of each patient individual features and risk factor for infection complications. This narrative review of antibiotic prophylaxis in urological procedure resumes the principle to follow for the correct management of antibiotic prophylaxis in urological procedure.
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Affiliation(s)
- Michele Rizzo
- Clinica Urologica, Università di Trieste, Trieste, Italy
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Panach-Navarrete J, Valls-González L, Sánchez-Cano E, Medina-González M, Castelló-Porcar A, Martínez-Jabaloyas JM. Comparison of three different antibiotic protocols in transurethral resection of bladder tumour and the possible infectious risk factors: A non-randomized, prospective study. Can Urol Assoc J 2018; 12:E466-E674. [PMID: 29989880 DOI: 10.5489/cuaj.5207] [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]
Abstract
INTRODUCTION We sought to investigate three different antibiotic protocols in transurethral resection of a bladder tumour (TURBT), and the possible infectious risk factors of this surgery. METHODS We conducted a non-randomized, prospective study, gathering cases of patients in whom TURBT had been performed. The sample was divided into three groups based on those who received antibiotics as: a single preoperative dose (Group A); a preoperative dose, plus a long protocol during the hospitalization (Group B); a preoperative dose, plus a long protocol during the hospitalization, plus five days at home (Group C). Intra- and postoperative data that could be relevant to infections was gathered. RESULTS A total of 219 patients were included. In the multivariate analysis, it was observed that the patients in Group A were more prone to re-hospitalization due to fever than were those from Group C (odds ratio [OR] 11.13; p=0.03). Furthermore, the cases with tumour necrosis and those who entered surgery with a urinary catheter were more prone to have a temperature above 37.5°C (OR6.74; p=0.02 and OR6.4; p=0.04, respectively), as well as have an increased risk per every additional tumour in the cystoscopy (OR 1.32; p=0.01). Those who received mitomycin had a lower chance of a positive urine culture (OR 0.29; p=0.01), contrary to those patients with over two days of hospitalization (OR 4.11; p<0.01) and those who entered surgery with a urinary catheter (OR 12.35; p=0.02). CONCLUSIONS Those patients that only received a single dose of antibiotic before TURBT may have an increased risk of re-hospitalization due to fever in comparison to those who received prolonged antibiotic protocols. In addition, there are perioperative factors in this surgery that predict the risk of infectious complications.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Lorena Valls-González
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Eduardo Sánchez-Cano
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - María Medina-González
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Ana Castelló-Porcar
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
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Shin B, Chung HS, Hwang EC, Jung SI, Kwon DD. Antibiotic Prophylaxis in Radical Prostatectomy: Comparison of 2-Day and More than 2-Day Prophylaxis. J Korean Med Sci 2017; 32:1009-1015. [PMID: 28480660 PMCID: PMC5426237 DOI: 10.3346/jkms.2017.32.6.1009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/04/2017] [Indexed: 11/27/2022] Open
Abstract
The efficacy of antibiotic prophylaxis in radical prostatectomy (RP) remains to be established. We retrospectively compared the occurrence of perioperative infections after RP between the 2 different antibiotic protocols. This study involved 428 cases of laparoscopic radical prostatectomy (LRP). After excluding patients who had no perioperative urine culture data, 313 consecutive patients who underwent LRP for prostate carcinoma were classified into 2 groups according to the duration of antimicrobial prophylaxis. To group 1 (153 patients), a second-generation cephalosporin was administered for less than 2 days, whilst the remaining 160 patients in group 2 were administered the drug for more than 2 days. The overall incidence of postoperative bacteriuria was 50.8%, being significantly higher in group 1 (56.9%) than in group 2 (45%). The incidence of surgical site infection (SSI) was significantly higher in group 1 (5.2%) than in group 2 (0.6%). Multivariate analysis revealed that old age, duration of antibiotics for more than 2 days, and duration of Foley catheter placement were independently associated with postoperative infectious complications (all, P < 0.05). Multivariate analysis revealed that duration of antibiotics for more than 2 days, duration of Foley catheter placement, and duration of surgical drain placement were independently associated with postoperative SSI (all, P < 0.05). The incidence of postoperative bacteriuria and SSI were higher in patients who received antibiotics for a short duration. Based on our results, we demonstrated that the outcome of postoperative infectious complications is dependent on old age, short antibiotic administration duration, and prolonged Foley catheterization. Prolonged drain placement is associated with SSI, whilst a longer duration of antibiotics use and prolonged Foley catheterization are associated with a decrease in the incidence of SSI.
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Affiliation(s)
- Bosung Shin
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Schneidewind L, Kranz J, Schlager D, Barski D, Mühlsteadt S, Grabbert M, Queissert F, Frank T, Pelzer AE. Mulitcenter study on antibiotic prophylaxis, infectious complications and risk assessment in TUR-P. Cent European J Urol 2017; 70:112-117. [PMID: 28461999 PMCID: PMC5407338 DOI: 10.5173/ceju.2017.941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/18/2016] [Accepted: 01/09/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Transurethral resection of the prostate is one of the most frequent urological procedures. Urinary tract infections represent major sequelae, but data about antibiotic prophylaxis in TUR-P are controversial and outdated. MATERIAL AND METHODS We conducted a retrospective multicentre study of TUR-P in ten German hospitals. Primary endpoints were epidemiological and outcome data of TUR-P. Secondary endpoints were the identification of factors associated with febrile UTIs and sepsis after TUR-P. RESULTS We included 444 patients with a median age of 71.0 years. Nearly every patient (93.5%) received some kind of antibiotic prophylaxis. Complication rates were 4.9% for febrile UTIs and 2.3% sepsis. Significant risk factors associated with febrile UTIs were pre-existing risk factors for UTIs (p = 0.035) and a duration of catheterization of more than three days (p <0.0001). Significant risk factors for sepsis were duration of surgery of more than 60 minutes (p = 0.030) and again a duration of catheterization of more than three days (p <0.0001). Interestingly, 50.8% of the cases had evidence of chronic prostatitis in their histological specimen. This evidence of chronic prostatitis was significantly associated with febrile UTIs (p = 0.019) and sepsis (p = 0.018). CONCLUSIONS Duration of catheterization is one of the major risk factors for infectious complications after TUR-P. Antibiotic prophylaxis in TUR-P needs prospective investigation. These future studies should also address chronic prostatitis a priori.
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Affiliation(s)
- Laila Schneidewind
- University of the Saarland Medical Center, Institute of Virology, Homburg, Germany
- equal author contribution
| | - Jennifer Kranz
- St.-Antonius-Hospital, Department of Urology and Paediatric Urology, Eschweiler, Germany
- equal author contribution
| | - Daniel Schlager
- University of Freiburg Medical Center, Department of Urology, Freiburg (Brsg.), Germany
| | - Dimitri Barski
- Lukas Hospital Neuss, Department of Urology, Neuss, Germany
| | - Sandra Mühlsteadt
- Martin Luther University Halle-Wittenberg, Department of Urology, Halle, Germany
| | - Markus Grabbert
- Ludwig Maximilians University, Department of Urology, Munich, Germany
| | - Fabian Queissert
- University of Muenster Medical Center, Department of Urology, Muenster, Germany
| | - Tanja Frank
- RoMed Hospital Rosenheim, Department of Urology, Rosenheim, Germany
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Yamamoto S, Shigemura K, Kiyota H, Wada K, Hayami H, Yasuda M, Takahashi S, Ishikawa K, Hamasuna R, Arakawa S, Matsumoto T. Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition. Int J Urol 2016; 23:814-824. [DOI: 10.1111/iju.13161] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Shingo Yamamoto
- Department of Urology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Katsumi Shigemura
- Department of Urology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | | | - Koichiro Wada
- Department of Urology; Okayama University Hospital; Okayama Kagawa Japan
| | - Hiroshi Hayami
- Department of Urology; Graduate School of Medical and Dental Sciences; Kagoshima University; Kagoshima Japan
| | - Mitsuru Yasuda
- Department of Urology; Graduate School of Medicine; Gifu University; Gifu Japan
| | - Satoshi Takahashi
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Hokkaido Japan
| | - Kiyohito Ishikawa
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Ryoichi Hamasuna
- Department of Urology; University of Occupational and Environmental Health; Kitakyushu Fukuoka Japan
| | - Soichi Arakawa
- Department of Urology; Kobe University Graduate School of Medicine; Kobe Hyogo Japan
| | - Tetsuro Matsumoto
- Department of Urology; University of Occupational and Environmental Health; Kitakyushu Fukuoka Japan
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Mohee AR, Gascoyne-Binzi D, West R, Bhattarai S, Eardley I, Sandoe JAT. Bacteraemia during Transurethral Resection of the Prostate: What Are the Risk Factors and Is It More Common than We Think? PLoS One 2016; 11:e0157864. [PMID: 27391962 PMCID: PMC4938130 DOI: 10.1371/journal.pone.0157864] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/06/2016] [Indexed: 11/18/2022] Open
Abstract
The aim of this work was to investigate the microbial causes, incidence, duration, risk factors and clinical implications of bacteraemia occurring during transurethral resection of the prostate (TURP) surgery to better inform prophylaxis strategies. An ethically approved, prospective, cohort study of patients undergoing TURP was conducted. Clinical information and follow-up details were collected using standardized data collection sheets. Blood was obtained for culture at 6 different time points peri-procedure. Standard of care antibiotic prophylaxis was given prior to surgery. Bacteriuria was assessed in a pre-procedure urine sample. Histopathology from all prostate chips was assessed for inflammation and malignancy. 73 patients were consented and 276 blood samples obtained. No patients developed symptomatic bacteraemia during the procedure, 17 patients developed asymptomatic bacteraemia (23.2%). Enterococcus faecalis and Pseudomonas aeruginosa were the most common organisms cultured. 10 minutes after the start of the TURP, the odds ratio (OR) of developing bacteraemia was 5.38 (CI 0.97-29.87 p = 0.05), and 20 minutes after the start of the procedure, the OR was 6.46 (CI 1.12-37.24, p = 0.03), compared to before the procedure. We also found an association between the development of intra-operative bacteraemia and recent antibiotic use (OR 4.34, CI 1.14-16.62, p = 0.032), the presence of a urinary catheter (OR 4.92, CI 1.13-21.51, p = 0.034) and a malignant histology (OR 4.90, CI 1.30-18.46, p = 0.019). There was no statistical relationship between pre-operative urine culture results and blood culture results. This study shows that asymptomatic bacteraemia is commonly caused by TURP and occurs in spite of antibiotic prophylaxis. Our findings challenge the commonly held view that urine is the primary source of bacteraemia in TURP-associated sepsis and raise the possibility of occult prostatic infection as a cause of bacteraemia. More work will be needed to determine the significance of transient bacteraemia in relation to more serious complications like infective endocarditis and malignancy.
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Affiliation(s)
- Amar Raj Mohee
- Department of Urology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, United Kingdom
| | - Deborah Gascoyne-Binzi
- Department of Microbiology, The Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom
| | - Robert West
- Department of Biostatistics, The University of Leeds, Woodhouse Lane, Leeds, United Kingdom
| | - Selina Bhattarai
- Department of Pathology, The Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom
| | - Ian Eardley
- Department of Urology, The Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom
| | - Jonathan A. T. Sandoe
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom
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Nyongole O, Akoko L, Mwanga A, Mchembe M, Kamala B, Mbembati N. Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania. Pan Afr Med J 2015; 22:226. [PMID: 26952184 PMCID: PMC4761242 DOI: 10.11604/pamj.2015.22.226.6253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 10/20/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Antimicrobial prophylaxis for urologic procedures is a major issue, as potential advantages of antibiotic administration should be carefully weighed against potential side effects, microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic use in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third world environment. Methods This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software. Results Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction. Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or treatment intention. Conclusion Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.
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Affiliation(s)
- Obadia Nyongole
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Larry Akoko
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Ally Mwanga
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Mabula Mchembe
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Benjamin Kamala
- Department of community Medicine, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Naboth Mbembati
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
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Abstract
The essential value of antimicrobial prophylaxis is to defend the patient undergoing invasive diagnostic procedures or surgery against infectious complications by reducing the bacterial load. Escherichia coli remains the predominant uropathogen (70-80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10 to 15%). Klebsiella, Enterobacter, Proteus species, and enterococci infrequently cause uncomplicated cystitis and pyelonephritis. The pathogens traditionally associated with UTI are altering many of their features, particularly because of antimicrobial resistance. Currently, only transurethral resection of prostate and prostate biopsy has been well studied and has high and moderately high levels of evidence in favor of using antibiotic prophylaxis. Other urological interventions have not been well studied. The moderate to low evidence suggests that there is no need for antibiotic prophylaxis in cystoscopy, urodynamic investigations, and extracorporeal shock-wave lithotripsy, whereas the low evidence favors the use of antibiotic prophylaxis for therapeutic ureterorenoscopy and percutaneous nephrolithotomy. The scarce data from studies on transurethral resection of bladder tumors cannot provide a definitive indication for antibiotic prophylaxis for this intervention.
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Mrkobrada M, Ying I, Mokrycke S, Dresser G, Elsayed S, Bathini V, Boyce E, Luke P. CUA Guidelines on antibiotic prophylaxis for urologic procedures. Can Urol Assoc J 2015; 9:13-22. [PMID: 25737749 DOI: 10.5489/cuaj.2382] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marko Mrkobrada
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Ivan Ying
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Stephanie Mokrycke
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - George Dresser
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Sameer Elsayed
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Varunkumar Bathini
- Department of Surgery, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Erin Boyce
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Patrick Luke
- Department of Surgery, Schulich School of Medicine, London Health Science Centre, London, ON
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[Antibiotic prophylaxis in urology]. Urologia 2014; 81:209-17. [PMID: 25532466 DOI: 10.5301/uro.5000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Antibiotic prophylaxis (AP) is used to minimize infectious complications resulting from interventions. Due to high rates of development of bacterial resistance and side effects, the use of antibiotics must be weighed on the basis of high levels of evidence. The main endpoints of urology AP are the prevention of symptomatic urogenital infections, urosepsis and wound infections. The purpose of this review is to bring objectives, principles and recommendations on urology AP according to the latest scientific evidence. METHODS We carried out a systematic search of MEDLINE, EMBASE and the Cochrane Library using keywords such as AP, prophylaxis, antibiotics, urological surgery, urogenital surgery and the names of the urologic procedures. The results of studies on the AP for each procedure were classified according to the levels of evidence and grades of recommendation from the European Association of Urology. RESULTS There are a number of good quality studies on AP about endoscopic resection of the prostate (TURP), urodynamic studies and transrectal prostate biopsies (trPB). The majority of the studies about other procedures have several limitations (sample size, consistency of definitions, statistics and trial design). Lack of consistency in the definitions of infectious complications does not allow comparison between different studies. CONCLUSIONS The AP is evidence-based is indicated only for TURP and trPB. It is desirable to perform randomized, prospective and controlled trials in order to rationalize the use of antibiotics, improve the cost/benefit ratio and reduce bacterial antibiotic resistances.
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Abreu D, Campos E, Seija V, Arroyo C, Suarez R, Rotemberg P, Guillama F, Carvalhal G, Campolo H, Machado M, Decia R. Surgical Site Infection in Surgery for Benign Prostatic Hyperplasia: Comparison of Two Skin Antiseptics and Risk Factors. Surg Infect (Larchmt) 2014; 15:763-7. [DOI: 10.1089/sur.2013.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Diego Abreu
- Department of Urology, Pasteur Hospital, Montevideo, Uruguay
| | - Enrique Campos
- Department of Urology, Pasteur Hospital, Montevideo, Uruguay
| | - Verónica Seija
- Laboratory of Bacteriology, Pasteur Hospital, Montevideo, Uruguay
| | - Carlos Arroyo
- Department of Urology, Pasteur Hospital, Montevideo, Uruguay
| | - Ruben Suarez
- Department of Urology, Pasteur Hospital, Montevideo, Uruguay
| | - Pablo Rotemberg
- Department of Urology, Pasteur Hospital, Montevideo, Uruguay
| | | | - Gustavo Carvalhal
- Department of Urology, Pontifical Catholic University, Porto Alegre, Brazil
| | - Horacio Campolo
- Department of Urology, Pasteur Hospital, Montevideo, Uruguay
| | - Miguel Machado
- Department of Urology, Pasteur Hospital, Montevideo, Uruguay
| | - Ricardo Decia
- Department of Urology, Pasteur Hospital, Montevideo, Uruguay
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Cheng KC, Lee LF, Chan HC, Cho CL, Chau H, Lam KM, So HS. Efficacy of routine screening of urine culture before transurethral prostatectomy on the improvement of the postoperative outcome: A single-centre experience. SURGICAL PRACTICE 2014. [DOI: 10.1111/1744-1633.12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Lee-Fung Lee
- Department of Surgery; United Christian Hospital; Hong Kong
| | - Hoi-Chak Chan
- Department of Surgery; United Christian Hospital; Hong Kong
| | - Chak-Lam Cho
- Department of Surgery; Tseung Kwan O Hospital; Hong Kong
| | - Hin Chau
- Department of Surgery; United Christian Hospital; Hong Kong
| | - Kin-Man Lam
- Department of Surgery; Tseung Kwan O Hospital; Hong Kong
| | - Hing-Sing So
- Department of Surgery; United Christian Hospital; Hong Kong
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Abstract
There are specific indications in urological procedures [transurethral resection of the prostate (TURP), transurethral resection of the bladder (TURB), endoscopic procedures, and all interventions classified as contaminated or dirty] requiring antibiotic prophylaxis. Most postoperative infections are caused by enterococci of the Gram-positive strains and Enterobacteriaceae of the Gram-negative ones. As reported by the European Center for Disease Prevention and Control (ECDC), there are increasing numbers of antibiotic-resistant pathogens. Most Enterococcus faecium strains are ampicillin-resistant and the Enterobacteriaceae have a high prevalence of extended-spectrum beta-lactamase (ESBL) producers, for which the cephalosporins and penicillins are not drugs of choice. In recent years, there are also increasing numbers of Gram-negative strains that are able to produce carbapenemases and for which the only therapeutic options are gentamicin, tigecycline and colistin. An alternative to these drugs, from a prophylactic point of view, is fosfomycin, an old antibiotic that maintains bactericidal activity against both enterococci and multidrug-resistant Enterobacteriaceae. Available in an oral formulation as trometamol salt, fosfomycin reaches high plasma and urine concentrations, and is therefore a possible alternative to other drugs both for therapy and urological prophylaxis.
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Hwang EC, Jung SI, Kwon DD, Lee G, Bae JH, Na YG, Min SK, Son H, Lee SJ, Chung JM, Chung H, Cho IR, Kim YH, Kim TH, Chang IH. A prospective Korean multicenter study for infectious complications in patients undergoing prostate surgery: risk factors and efficacy of antibiotic prophylaxis. J Korean Med Sci 2014; 29:1271-7. [PMID: 25246747 PMCID: PMC4168182 DOI: 10.3346/jkms.2014.29.9.1271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/27/2014] [Indexed: 11/20/2022] Open
Abstract
This multicenter study was undertaken to determine the efficacy of antibiotic prophylaxis and identify the risk factors for infectious complications after prostate surgery in Korean patients. A total of 424 patients who underwent surgery of the prostate were reviewed. All patients underwent urinalysis and urine culture preoperatively and postoperatively. Efficacy of antibiotic prophylaxis and risk factors for infectious complications were investigated. Infectious complications were observed in 34.9% of all patients. Factors independently associated with infectious complications were diabetes mellitus (adjusted OR, 1.99; 95% CI, 1.09-3.65, P=0.025) and operation time (adjusted OR, 1.08; 95% CI, 1.03-1.13, P=0.004). Clinicians should be aware of the high risk of infectious complications in patients with diabetes and those who undergo a prolonged operation time. Neither the type nor duration of prophylactic antibiotics resulted in differences in infectious complications.
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Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University, Hwasun, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University, Hwasun, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University, Hwasun, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Gilho Lee
- Department of Urology, Dankook University, College of Medicine, Cheonan, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Jae Hyun Bae
- Department of Urology, Korea University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Yong Gil Na
- Department of Urology, Chungnam National University, College of Medicine, Daejeon, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Seung Ki Min
- Department of Urology, National Police Hospital, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Sun Ju Lee
- Department of Urology, Kyung Hee University, School of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Jae Min Chung
- Department of Urology, Kosin University, College of Medicine, Busan, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Hong Chung
- Department of Urology, Konkuk University, School of Medicine, Chungju, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - In Rae Cho
- Department of Urology, Inje University, College of Medicine, Busan, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Young Ho Kim
- Department of Urology, Soon Chun Hyang University, College of Medicine, Bucheon, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Tae-Hyoung Kim
- Department of Urology, Chung-Ang University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
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Hartley B. Older patient perioperative care as experienced via transurethral resection of the prostate (TURP). J Perioper Pract 2014; 24:135-40. [PMID: 25007475 DOI: 10.1177/175045891402400602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This reflective piece takes a holistic approach to an older patient having a transurethral resection of the prostate, commonly known as a TURP. It concentrates on the effects of age and likely comorbidities, and how the care given at each stage--preoperatively, anaesthetically, surgically and postoperatively--by the perioperative team can help to optimise the outcome for the patient. The article offers a critical appraisal of the best evidence available which supports the development of evidence based practitioners.
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Junuzovic D, Hasanbegovic M. Risk factors analysis for occurrence of asymptomatic bacteriuria after endourological procedures. Med Arch 2014; 68:249-53. [PMID: 25568546 PMCID: PMC4240560 DOI: 10.5455/medarh.2014.68.249-253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/15/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction: Endourological procedures are performed according to the principles of aseptic techniques, jet still in certain number of patients urinary tract infections may occur. Considering the risk of urinary tract infection, there is no unique opinion about the prophylactic use of antibiotics in endourological procedures. Goal: The objective of this study was to determine the connection between endourological procedures and occurrence of urinary infections and to analyze the risk factors of urinary infection for patients who were hospitalized at the Urology Clinic of the Clinical Center University of Sarajevo CCUS. Materials and Methods: The research was conducted as a prospective study on a sample of 208 patients of both genders, who were hospitalized at the Urology Clinic of the CCUS and to whom some endourological procedure was indicated for diagnostic or therapeutic purposes. We analyzed data from patient’s histories of illness, laboratory tests taken at admission and after endourological procedures, also surgical programs for endoscopic procedures. All patients were clinically examined prior to endoscopic procedures while after the treatment attention was focused to the symptoms of urinary tract infections. Results: Statistical analysis of the tested patients indicates that there is no significant difference in the presence of postoperative, compared to preoperative bacteriuria, which implies that the endourological procedures are safe procedures in terms of urinary tract infections. Preoperatively, the most commonly isolated bacteria was Escherichia coli (30.9%) and postoperatively, Enterococcus faecalis (25%). Statistically significant effect on the occurrence of postoperative bacteriuria has preoperative bacteriuria, duration of postoperative catheterization, and duration of hospitalization. Conclusion: In everyday urological practice, it is very important to identify and control risk factors for the development of urinary infection after endourological procedures, with main objective to minimize occurrence of infectious complications.
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Affiliation(s)
| | - Munira Hasanbegovic
- Urology Clinic, Clinical Center of Sarajevo University, Bosnia and Herzegovina
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May A, Broggi E, Lorphelin H, Tabchouri N, Giretti G, Pereira H, Bruyere F. Comparison of the risk of postoperative infection between transurethral vaporesection and transurethral resection of the prostate. Lasers Surg Med 2014; 46:405-11. [PMID: 24665004 DOI: 10.1002/lsm.22240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE We observed in our department at 3 months two episodes of bacteremia postoperatively to photoselective vaporization of the prostate (PVP). We decided to compare the frequency of postoperative urinary tract infections (POUTIs) in patients with preoperative bacterial colonization of urine between PVP and transurethral resection of the prostate (TURP). MATERIALS AND METHODS From January 2010 to December 2011, we studied patients who underwent PVP or TURP for benign prostatic obstruction in our department. Preoperative urine culture (UC) was carried out for all patients and we included those with preoperative bacterial colonization of the urinary tract. Patients were treated preoperatively with an appropriate antibiotic treatment and/or inductive prophylactic antibiotics. Patients were diagnosed with POUTI if they had clinical signs of infections (e.g., fever) and a positive UC during the month after surgery. RESULTS Patients were treated by PVP in 49 cases and TURP in 62 cases. A preoperative indwelling urinary catheter was inserted in 80% of the patients. During the postoperative period, eight episodes of fever were identified in the PVP group (16%), five (8%) in the TURP group (P = 0.18). We then studied the subgroup of patients with multiple bacteria strains present in the preoperative UC and identified significant differences. The risk of POUTI was significantly higher in patients treated by PVP than in those treated by TURP (P = 0.018). CONCLUSIONS We found significant differences between subgroups of patients with positive preoperative cultures (containing various bacterial strains). The risk of POUTI was significantly higher in patients treated by PVP.
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Affiliation(s)
- Alexandre May
- Department of Urology, Bretonneau University Hospital, Tours, France
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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.
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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
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41
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 685] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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43
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Togo Y, Yamamoto S, Tanaka S, Kanematsu A, Ogawa O, Miyazato M, Saito H, Arai Y, Hoshi A, Terachi T, Fukui K, Kinoshita H, Matsuda T, Yamashita M, Kakehi Y, Tsuchihashi K, Sasaki M, Ishitoya S, Onishi H, Takahashi A, Ogura K, Mishina M, Okuno H, Oida T, Horii Y, Hamada A, Okasyo K, Okumura K, Iwamura H, Nishimura K, Manabe Y, Hashimura T, Horikoshi M, Mishima T, Okada T, Sumiyoshi T, Kawakita M, Kanamaru S, Ito N, Aoki D, Kawaguchi R, Yamada Y, Kokura K, Nagai J, Kondoh N, Kajio K, Yoshimoto T. Antimicrobial prophylaxis to prevent perioperative infection in urological surgery: a multicenter study. J Infect Chemother 2013; 19:1093-101. [DOI: 10.1007/s10156-013-0631-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 05/28/2013] [Indexed: 11/30/2022]
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Abstract
BACKGROUND This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2008 and previously updated in 2010.Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. OBJECTIVES To determine whether perioperative antibiotics reduce pain and other morbid outcomes following tonsillectomy. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 20 March 2012. SELECTION CRITERIA All randomised controlled trials examining the impact of perioperative administration of systemic antibiotics on post-tonsillectomy morbidity in children or adults. DATA COLLECTION AND ANALYSIS Two authors independently collected data. Primary outcomes were pain, consumption of analgesia and secondary haemorrhage (defined as significant if patient re-admitted, transfused blood products or returned to theatre, and total (any documented) haemorrhage). Secondary outcomes were fever, time taken to resume normal diet and activities and adverse events. Where possible, we generated summary measures using random-effects models. MAIN RESULTS Ten trials, comprising a pooled total of 1035 participants, met the eligibility criteria. Most did not find a significant reduction in pain with antibiotics. Similarly, antibiotics were mostly not shown to be effective in reducing the need for analgesics. Antibiotics were not associated with a reduction in significant secondary haemorrhage rates (risk ratio (RR) 0.49, 95% CI 0.08 to 3.11, P = 0.45) or total secondary haemorrhage rates (RR 0.90, 95% CI 0.56 to 1.44, P = 0.66). With regard to secondary outcomes, antibiotics reduced the proportion of patients with fever (RR 0.63, 95% CI 0.46 to 0.85, P = 0.002). AUTHORS' CONCLUSIONS The present systematic review, including meta-analyses for select outcomes, suggests that although individual studies vary in their findings, there is no evidence to support a consistent, clinically important impact of antibiotics in reducing the main morbid outcomes following tonsillectomy (i.e. pain, need for analgesia and secondary haemorrhage rates). The limited benefit apparent with antibiotics may be a result of positive bias introduced by several important methodological shortcomings in the included trials. Based on existing evidence, therefore, we would advocate against the routine prescription of antibiotics to patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials.
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Affiliation(s)
- Muthuswamy Dhiwakar
- Kovai Medical Center and Hospital (KMCH), KMCH Comprehensive Cancer Center, Coimbatore, India.
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45
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El Basri A, Petrolekas A, Cariou G, Doublet JD, Hoznek A, Bruyere F. Clinical Significance of Routine Urinary Bacterial Culture After Transurethral Surgery: Results of a Prospective Multicenter Study. Urology 2012; 79:564-9. [DOI: 10.1016/j.urology.2011.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 11/12/2011] [Accepted: 11/15/2011] [Indexed: 11/15/2022]
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46
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Grabe M. Antibiotic prophylaxis in urological surgery, a European viewpoint. Int J Antimicrob Agents 2011; 38 Suppl:58-63. [DOI: 10.1016/j.ijantimicag.2011.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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47
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Grabe M, Botto H, Cek M, Tenke P, Wagenlehner FME, Naber KG, Bjerklund Johansen TE. Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures. World J Urol 2011; 30:39-50. [PMID: 21779836 DOI: 10.1007/s00345-011-0722-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 06/14/2011] [Indexed: 12/21/2022] Open
Affiliation(s)
- Magnus Grabe
- Department of Urology, Skåne University Hospital, S-20502, Malmö, Sweden.
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48
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Brooks N. Antimicrobial prophylaxis for the prevention of infective endocarditis. Br J Hosp Med (Lond) 2011; 72:336-40. [PMID: 21727813 DOI: 10.12968/hmed.2011.72.6.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
National and international guidelines on antimicrobial prophylaxis to prevent infective endocarditis have provoked controversy and consternation among many doctors and patients. This article addresses the evidence that underlies these guidelines.
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Affiliation(s)
- Nicholas Brooks
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester
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49
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Huang X, Shi HB, Wang XH, Zhang XJ, Chen B, Men XW, Yu ZY. Bacteriuria After Bipolar Transurethral Resection of the Prostate: Risk Factors and Correlation With Leukocyturia. Urology 2011; 77:1183-7. [DOI: 10.1016/j.urology.2010.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 08/10/2010] [Accepted: 08/13/2010] [Indexed: 11/27/2022]
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50
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Song L, Zhu Y, Han P, Chen N, Lin D, Lai J, Wei Q. A Retrospective Study: Correlation of Histologic Inflammation in Biopsy Specimens of Chinese Men Undergoing Surgery for Benign Prostatic Hyperplasia With Serum Prostate-specific Antigen. Urology 2011; 77:688-92. [DOI: 10.1016/j.urology.2010.07.493] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/22/2010] [Accepted: 07/23/2010] [Indexed: 10/18/2022]
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