Editorial Comment to Summary of the UAA-AAUS guidelines for urinary tract infections.

Abstract

Choe et al. described the essence of the Urological Association of Asia and Asian Association of Urinary Tract Infection and Sexually Transmitted Diseases guidelines for urinary tract infections (UTI).1 International Journal of Urology (IJU) is currently the official journal of the Urological Association of Asia, so a summary of these guidelines has been published in this issue of IJU. A unique aspect of this summary of the UTI guidelines is the description of urological disease-related UTI; for example, complicated UTI by benign prostatic hyperplasia or complicated UTI by urolithiasis; or systemic disease-related UTI, such as complicated UTI by diabetes mellitus. Basically, UTI is mainly classified into uncomplicated or complicated UTI with regard to the presence of urinary tract-underlying disease.2 In addition, the latter (complicated UTI) includes systemic diseases related to the immune system, such as diabetes mellitus, steroid dosing or chemotherapy.3 This review (summary of guidelines) nicely showed how readers should manage or pay attention to each UTI specifically for such urological diseases. At the same time, the authors also introduced catheter-associated UTI, and demonstrated the points that are necessary to pay attention to, such as the important difference of causative bacteria: Candida species are the most common uropathogens, followed by enterococci, Escherichia coli, Pseudomonas spp., Klebsiella spp. and staphylococci. This trend is considered to be partly different from non-catheter-associated UTI and the readers can clearly understand it, resulting in an understanding of how to manage catheter-associated UTI and select antibiotics for treatment. Furthermore, urologists are surgeons, and might like to know about surgery-related UTI; for example, benign prostatic hyperplasia- or urolithiasis-related UTI. The authors did not elaborate on surgery-associated matters, and IJU readers might expect more information on this. Future revision or another guideline (possibly not only prevention, but also “how to manage surgery-related urological infection including UTI by means of not only medicine but surgical intervention4”) might be necessary. Another aspect I would like to emphasize as a feature of this review (summary of guideline) is that there are comparatively more detailed descriptions of urogenital tuberculosis and pediatric UTI. Basically, in Japan, urogenital tuberculosis is not often seen, but still does occur elsewhere in the world. In particular, bacillus Calmette–Guérin-related urogenital tuberculosis sometimes emerges during or after treatment for bladder carcinoma in situ,5 and sometimes becomes severe as a systemic disease; however, many urologists are not fully familiar with the management of this, so these parts of the summary would surely contribute to IJU readers’ knowledge. Regarding pediatric UTI, in the Japanese urological system, this is in many cases dealt with by pediatric urologists, and many general urologists in the Japanese system are familiar with adult urology, but not with pediatric urology. Based on this point, this summary of the guidelines concisely describes this category; for example, vesicoureteral reflux-related matters, and helps general urologists to very easily understand this. In summary, this review (summary of Urological Association of Asia and Asian Association of Urinary Tract Infection and Sexually Transmitted Diseases UTI guidelines) demonstrates the current consensus of UTI treatments regulated by guidelines. Further assessment, such as surgical-related UTI or management by surgical intervention, would be required in the future. None declared.