Bacteriology of Urine Specimens Obtained from Men with Symptomatic Benign Prostatic Hyperplasia

Background:

Bacteriuria and urinary tract infections are common sequelae of benign prostatic hyperplasia (BPH). Thus, the knowledge of urine bacteriology in men with symptomatic BPH in our environment may play a complementary role in management.

Objectives:

To determine the incidence of bacteriuria and the antibiotic sensitivity pattern of bacterial isolates in cultured urine samples of men with symptomatic BPH.

Patients and Methods:

This was a 1 year prospective study. All patients who presented with lower urinary tract symptoms due to BPH and who met the inclusion criteria were studied. Urine samples were obtained from the patients for microscopy, culture, and sensitivity following standard protocol.

Results:

Ninety-four patients were studied. The age range was 53–80 years with a mean of 65.5 ± 7.8 years. Bacterial isolates were noted in 42 (44.7%) patients. Six of these had two different species of bacterial organisms isolated. Escherichia coli noted in 20 (47.6%) specimens was the most common organism isolated while the least common, Providencia species, was noted in 1 (2.4%). The bacterial isolates were mostly sensitive to imipenem, meropenem, and nitrofurantoin, but showed greater resistance to cefuroxime, gentamicin, and ofloxacin. There was no significant difference between the means for age (P = 0.80), duration of symptoms (P = 0.09), and prostate size (P = 0.52) in the patients with and those without bacteriuria.

Conclusion:

Bacteriuria is a common finding in patients with symptomatic BPH in our setting. The bacterial isolates showed high level of resistance to oral cephalosporins and fluoroquinolones. There is a need to update guidelines in empiric use of antibiotics in this group of patients.

Antibiotic prophylaxis for transrectal prostate biopsy: a comparison of one-day and five-day regimen

AIMS AND OBJECTIVES

To determine the difference in outcome between a 1- day and 5- day antibiotic regimen in the prevention of infective complications following transrectal prostate biopsy.

PATIENTS AND METHODS

This prospective comparative study was done in the urology unit of University of Benin Teaching Hospital over a period of 14 months. Eighty seven patients were randomly assigned to 2 groups prior to the procedure. The patients in group I (N=42) received oral ciprofloxacin (500mg, 12 hourly) and oral metronidazole (400mg, 8 hourly) for 1 day while those in group II (N=45) received same antibiotic combination for 5 days. Urine samples for culture were taken an hour before the procedure and then 5 days after in all patients. Temperature monitoring with an easy-to-use thermometer was done thrice daily by the patients. Post biopsy fever and positive urine cultures were indicative of infection.

RESULTS

The mean age of the patients was 68.5 ± 8.1 years. Infective complications occurred in 8(19%) in group I and 7(15.6%) in group II. Fever was noted in 5 patients in group I and 4 patients in group II (p=0.73) while positive urine culture was noted in 4 patients in each group (p=1.00). Complications were minor and transient except in a case of septicaemia in group II that required hospitalisation. Escherischia coli was the most common organism isolated from positive urine cultures.

CONCLUSION

A 1-day antibiotic regimen of oral ciprofloxacin and metronidazole is as effective as a 5-day regimenin the prevention of infective complications following transrectalprostate biopsy.

Advanced carcinoma of the prostate presenting as a supraclavicular mass: case report

Advanced carcinoma of the prostate presenting initially with supraclavicular lymphadenopathy is uncommon. These are 2 cases of advanced prostate cancer that presented initially with persistent painless left supraclavicular mass. Both patients had elevated prostate specific antigen (PSA) level. This as well as histological finding of metastatic adenocarcinoma following biopsy of the neck masses necessitated referral to the urologists. Urological review revealed enlarged hard nodular prostate and transrectal prostate biopsy findings in keeping with high grade adenocarcinoma in both cases. The patients had initial clinical and biochemical response to androgen deprivation therapy with resolution of neck masses within 4-8 weeks of treatment. The authors advocate that men presenting with persistent supraclavicular masses should have a digital rectal examination (DRE) and a PSA test as part of their initial assessment.

Iatrogenic urological injuries complicating obstetric and gynaecological procedures

INTRODUCTION

Urinary tract injuries are known complications of pelvic surgeries. Although a few instances have been noted, they remain a source of great concern to surgeons due to their associated morbidity and occasional mortality. We report our experience with the management of iatrogenic urological injuries that complicated obstetric and gynaecological surgeries over a five-year period.

METHODS

We reviewed all cases of urological injuries managed in our unit that were deemed to be of obstetric and gynaecological origins within the study period.

RESULTS

A total of 16 patients were identified as having iatrogenic urological injuries following obstetric and gynaecological surgeries. Only four patients presented early. Five patients had injuries to the bladder, while 12 had ureteric injuries; one of the 16 patients had both types of injuries. Seven cases of ureteric injuries affected only the left ureter, while three were bilateral and two affected the right ureter. One patient with a vesicovaginal fistula (VVF) was successfully managed by urethral catheter drainage alone. Three patients had transabdominal repair of the VVF, while ten had ureteroureterostomy and one had diversion procedure. Simple nephrectomy was performed for one patient with a non-functioning kidney.

CONCLUSION

Iatrogenic urological injuries are still common in our environment. In order to reduce the risk of injury, adequate preoperative preparation is recommended and meticulous surgical technique based on proper understanding of the anatomy of the urogenital system should be practised by the surgeon.