Frequency Of Urinary Tract Infections Research Articles

Oncological relevance of neuro-urological diseases

Apart from a few exceptions, there is currently little scientific evidence on the oncological relevance of neuro-urological diseases. Most research has been conducted into the association between long-term spinal cord injury with its consequences for the lower urinary tract and the occurrence of bladder cancer. These cancers differ in many ways from bladder cancers in patients without spinal cord injury: patients are 20 years younger on average, tumours are very often already muscle-invasive and poorly differentiated with a high proportion of squamous cell carcinomas, and the prognosis is poor. These characteristics also occur in spinal cord injury patients without permanent catheter drainage of the urinary bladder. Although the pathophysiological association has not been clarified in detail, the presence of a neurogenic bladder appears to be the decisive link between spinal cord injury and the occurrence of bladder cancer. Pathological pressure conditions in the urinary bladder and frequent urinary tract infections or asymptomatic bacteriuria resulting from neurogenic lower urinary tract dysfunction could be the decisive pathophysiological factors. In this respect, urinary bladder cancer in persons with a chronic spinal cord injury represents a model tumour after denervation. The clinically important question of screening requires future interdisciplinary research approaches.

A Clarification of the Concept of Clean Intermittent Catheterization Adherence Using the Evolutionary Method

Background and purpose:Clean intermittent catheterization (CIC) nonadherence may lead to renal compromise, incontinence, and frequent urinary tract infections in patients with spinal cord injury and spinal dysraphism. Adherence to CIC lacks definition in the nursing literature despite implications for research and clinical practice, including patient education. The aim of this concept analysis was to analyze how CIC adherence is conceptualized and synthesize a definition for nursing.Method:Rodgers’ evolutionary concept analysis method was used to analyze the concept of CIC adherence in patients and caregivers. We searched databases to identify studies describing CIC adherence and identified common attributes, antecedents, and consequences. A definition was synthesized, and an exemplar was developed to illustrate the concept in practice.Results:Sixteen sources were analyzed. The attributes of CIC adherence were initiation, execution, including prescribed process and prescribed frequency, and persistence. Antecedents included the presence of neurogenic bladder, acceptance, and engagement. Consequences included improved health outcomes and quality of life.Implications for practice:Adherence to CIC lacks definition in the nursing literature despite implications for research and clinical practice. A unified definition of CIC adherence will facilitate nurses’ efforts to plan effective care, anticipate support barriers and opportunities, and develop strategies for improving CIC adherence.

Yenidoğanlarda Uzamış Sarılıkta İdrar Yolu Enfeksiyonunun Sıklığı ve Rolü

Objective: The study aims to investigate the frequency and role of urinary tract infection (UTI) in prolonged jaundice in preterm and term neonates.
 Materials and Methods: This retrospective study occurred at Zeynep Kamil Maternity and Children's Hospital in Istanbul between January 2014 and April 2018. The study involved 391 neonates who presented to our outpatient clinics with prolonged jaundice. UTI was defined as urine culture growth of at least 10.000 colony-forming units per millilitre (CFU/ml) in samples obtained via urethral catheterization. Birth weight, sex, gestational age, chronological age, laboratory results, hospital courses of patients, ultrasound findings and phototherapy history were recorded. 
 Results: UTI frequency was found to be 2.8% in 391 neonates with prolonged jaundice. Nine of them were male (81.8%), and 2 were female (18.2%). Eight patients with UTI (72.7%) were term and 3 (29.3%) were preterm. History of phototherapy, presence of leukocyturia or nitrituria, white blood cell count, and thrombocyte counts were significantly higher in the UTI group.
 Conclusion: Prolonged jaundice may be the first sign of UTI in neonates. Routine urine culture in neonates with prolonged jaundice may be useful, especially in those with a history of phototherapy and high white blood cell and thrombocyte counts.

LOW-INTENSITY SHOCKWAVE TREATMENT FOR NEUROGENIC BLADDER WITH CHRONIC URINE RETENTION - CASE REPORT

We present a case of neurogenic bladder accompanied by chronic urine retention in a patient diagnosed with multiple sclerosis (MS). This condition was effectively managed by low-intensity shockwave therapy (Li-ESWT). Low-intensity focused shockwave therapy (Li-ESWT) is becoming increasingly important in the treatment of urological problems. This case study investigates the feasibility and efficacy of using Li-ESWT to reduce post-void residual volume in persons with neurogenic bladder, representing the first examination of its sort. Bladder dysfunction (BD) frequently occurs in patients who have been diagnosed with multiple sclerosis (MS). Bladder dysfunction (BD) can occur due to the impairment of nerve impulses in the central nervous system regions involved for regulating bladder function and managing the contractions of the urinary sphincters, which is caused by the lesions associated with multiple sclerosis (MS). Urinary retention can cause various symptoms, including insufficient bladder emptying, urinary incontinence, frequent urinary tract infections, urosepsis resulting in the development of kidney abscesses due to localised kidney infection, and reduced kidney function. Optimal bladder function is essential for individuals with MS, as it plays a critical role in preserving kidney health, preventing urinary tract infections and incontinence, reducing the frequency of MS episodes, and improving their overall well-being. A 31-year-old woman was referred to our urology office with a chronic urinary tract infection caused by a neurogenic bladder with a significant volume of residual urine. A kidney abscess formation was identified as a complication. Li-ESWT, which stands for low-intensity extracorporeal shockwave therapy, was used as a part of a multimodal strategy to treat the urinary bladder. This treatment was delivered off-label. The therapy was given on a weekly basis for a period of 6 weeks. The procedure included administering 2500 shocks at a rate of four pulses per second, with an energy flux density (EFD) of 0.25 millijoules per square millimetre. The EFD (Energy Flux Density) used in our study exceeded 0.32 mJmm2,4, the fR (frequency rate) was set at 8 Hz (pulses per second), the treatment sessions consisted of 12 cycles of Li-ESWT (Low-Intensity Extracorporeal Shockwave Therapy), and a total of 3000 shocks were administered. At the intervals of one week, three months, six months, nine months, and twelve months following the administration of Li-ESWT and tadalafil 2.5 mg, the post-void residual (PVR) volume was consistently below 50 ml. The Li-ESWT treatment effectively reduced the post-void residual urine volume.Low-intensity extracorporeal shockwave therapy (Li-ESWT) can safely and efficiently decrease the amount of urine left in the bladder after voiding in individuals with neurogenic bladder caused by multiple sclerosis (MS). We have effectively demonstrated that Li-ESWT is a feasible and safe treatment for chronic urine retention, resulting in a decrease of post-void residual (PVR) volume from 200 ml to 50 ml. In the future, Li-ESWT has the potential to be advanced as a more efficacious alternative therapy for individuals experiencing chronic urinary retention. Further investigation is necessary to confirm the effectiveness of ESWT in addressing the neurogenic bladder.

Eucalyptus extract and its synergistic effect on bacteria causing urinary tract infections in Diyala province

To assess the impact of E. camaldulensis extract against bacteria that are isolated from urine sample from UTI patient in Baquba city Then mix this plant with antibiotics to see its effect. In addition to examine those pathogens bacteriologically. The sensitivity of the isolates to (13) antibiotics was tested, and the bacterial isolates showed a variation in the rates of their resistance to these antibiotics. The results showed that the antibiotic Imipenem had the most effect on the bacterial isolates under study, while the bacterial isolates showed high resistance to the rest of the antibiotics. The minimum inhibitory concentration (MIC) was determined for 3 antibiotics, namely, Gentamycin, Amikacin and Amoxicillin. These values for the antibiotics ranged between <4-1024, <4-1024 <<512-1024) mcg/ml, respectively. The Ethanolic Extract of Eucalyptus Exhibit highest antibacterial effect on S.areus on (o.62 g/1.5 ml and 0.31g/750ml). Lower respectively antibacterial effect on Proteus and Pseudomonas but no antibacterial effect against Klebsiella. Bacterial isolates were selected on the basis of their most frequent urinary tract infections and their resistance to the effect of antibiotics (K. pneumoniae, P. aeruginosa and S. aureus). The amount of the mixed effect was determined by mixing Eucalyptus with three antibiotics, namely Amikacin and Gentamycin Amoxicillin. The minimum inhibitory concentration of the isolates under study was compared before and after mixing the antibiotics. The effect of mixing was a synergistic effect for all bacterial isolates. On the other hand, the synergistic effect was clear on the gram-positive isolates of S. aureus between eucalyptus and beta-lactams (and Amoxicillin).

Colovesical Fistula due to Sigmoid Diverticulitis

Introduction. The incidence of colonic diverticulosis has risen significantly. Diverticular disease is the most frequent cause of colovesical fistulas, which are uncommon complications of diverticulitis. Clinical signs, such as fecaluria and pneumaturia, are typically required to confirm its presence. Finding the cause of the disease so that the proper therapy can be started is the primary goal of a diagnostic workup rather than observing the fistula tract itself. Case Presentation. We present a 43-year-old man complaining of frequent urinary tract infections for six months. On CT abdomen and pelvis, a colovesical fistula was diagnosed. Surgery was performed, and after the division between the sigmoid colon and the bladder, a sigmoidectomy and an end-to-end colorectal anastomosis were performed. During the surgery, the fistula tract was not detected. The patient was discharged in excellent condition on day six, and the catheter was removed on day 10. Conclusion. In conclusion, as in our case, any patient with a urinary tract infection should be suspected of having this condition, especially if he has persistent symptoms that have not responded to standard medical care. Patients who present with fecaluria, pneumaturia, and other specific symptoms of a colovesicular fistula do not necessarily need a barium enema or cystography to confirm the presence of the fistula.

Hormonal Medications for Genitourinary Syndrome of Menopause.

Genitourinary syndrome of menopause is a common, under-reported, and undertreated chronic progressive condition requiring long-term treatment. Hypoestrogenism in the urogenital tissues is associated with bothersome dyspareunia, vulvovaginal symptoms, overactive bladder, and frequent urinary tract infections. Vaginal hormone therapies, including vaginal estrogen and intravaginal dehydroepiandrostenedione, are safe and effective and improve symptoms and clinical findings. Systemic hormone therapy treats vulvovaginal atrophy less effectively than vaginal hormone therapies with increased stress and urge urinary incontinence. Oral ospemifene effectively treats vaginal dryness and dyspareunia. Clinicians need to ask about symptoms of genitourinary syndrome of menopause, confirm the diagnosis, and suggest appropriate treatment options.

Long Term Follow-Up Of Patients With Nonrefluxing Hydronephrosis.

The aim of this study is to examine the long-term prognosis of children with ureteropelvic junction obstruction-like hydronephrosis (UPJO-like HN). The files of children with hydronephrosis (HN) were analyzed retrospectively. Patients with vesicoureteral reflux (VUR) and other genitourinary anomalies were excluded. The final status of the HN, the need for surgery, and urinary tract infection (UTI) frequency were evaluated. The study included 219 patients with 302 renal units (RU) with HN. Surgery rate was higher in RUs with larger kidney size and parenchymal thinning (p:<0.001 for both). Hydronephrosis resolved in 113 (40.2%) RUs, improved in 66 (23.3%), unchanged in 100 (35.5%) and worsened in 4 (1.4%). The frequency of recovery and improvement was found to be less in RUs with severe HN, large kidney size, and thin parenchyma. The UTI frequency was higher in severe HN group (12.2% vs 30.6% p:<0.001). Children with mild HN had an excellent prognosis. Although the majority of the patients with high-grade HN had also a good prognosis, it seems important to closely follow up patients with severe HN, increased kidney size, and accompanying parenchymal thinning. Clinicians should be aware of the increased frequency of UTIs in children with severe HN.

Abstract 087: Cocaine‐Induced Acute Spinal Cord Ischemia Syndrome

Introduction Acute spinal cord ischemia syndrome (ASCIS) is a rare disease that is thought to comprise roughly only 1.2% of all strokes [1, 2]. These strokes primarily occur in the anterior spinal cord artery (ASA) and/or the posterior spinal cord artery (PCA) territory and can have widely variable clinical presentation. The use of recreational cocaine in young adults is well known to be responsible for acute ischemic and hemorrhagic strokes in individuals who lack other vascular risk factors. What is significantly rarer with few reported cases, however, is cocaine‐related ASCIS as the etiology of non‐traumatic acute spinal cord myelopathy [3‐7]. Methods N/A Results A 40‐year‐old female with a history of type I Diabetes mellitus, bipolar disorder, and polysubstance abuse presented with acute‐onset bilateral lower limb weakness, sensory loss, neck pain, and bladder incontinence. On admission, she reported using intravenous crack cocaine in the evening before admission and experiencing a fall in the bathroom a few hours after. She was unable to move her lower limbs following this fall. On examination, there was flaccid weakness in both lower extremities with decreased pinprick sensation below the T4 level and absent sensation below the thighs on both sides. She had no trauma preceding her symptoms and denied any recent vaccinations or travel history. An urgent CT (computed tomography) scan of the cervical, thoracic, and lumbar spine ruled out any obvious traumatic injury. Her urine drug screen was positive for cocaine, opiate, cannabinoid, and benzodiazepine. MRI (Magnetic Resonance Imaging) of the brain without contrast was unremarkable. MRI of the spine with contrast demonstrated two areas of T2 hyperintensities from C5‐C6 and T4 to the conus with cord expansion. The lesion in the thoracic spinal cord showed contrast enhancement and spared the dorsal column. Lumbar puncture was traumatic and showed elevated protein (&gt;300 mg/dl) as well as elevated glucose (186 mg/dl). CSF studies, including meningitis/encephalitis panel, gram stain and culture, flow cytometry, cytology, and oligoclonal bands were negative. Serum autoimmune myelopathy panel, serum Aquaporin‐4 antibodies and MOG (Myelin Oligodendrocyte Glycoprotein) antibodies were negative. The other etiologies of non‐traumatic myelopathy, including HIV, Treponema pallidum, and HTLV‐I/II antibodies, were negative. A diagnostic spinal angiogram was completed with no evidence of arteriovenous fistula or aortic dissection. She completed five days of plasma exchange without any improvement and was transferred to an acute rehabilitation facility. At four months follow‐up, she continues to be flaccid in her lower limbs and requires a urinary catheter leading to frequent urinary tract infections. Conclusion While cocaine‐related cerebrovascular events are well documented, very few cases of cocaine‐related ASCIS have been described. The mechanism is thought to be multifactorial due vasospasm, cerebral vasculitis, vascular thrombosis, cardioembolism from cocaine‐induced myocardial infarction or cardiomyopathy, and hypertensive surges [9]. Due to the scarcity of these events, the patient outcomes are unclear. Other studies on outcomes of spinal cord ischemia have shown that ASIA Impairment Scale (AIS) score, lesion level, and patient age were the strongest predictors of neurologic and functional outcomes, whereas etiology of the ischemia had no effect on outcomes [10].

Efflux Pumps, Biofilm Formation, and Susceptibility Testing of Escherichia Coli Isolated from Urinary Tract Infection

Urinary tract infections (UTIs) are infectious diseases of the urinary system caused by several causative agents, including parasites, viruses, fungi and bacteria. The most frequent UTI cause is Escherichia coli (E.coli). Antibiotic resistance in E. coli has been linked to overexpression of the efflux system. This study aimed to isolate various bacteria from UTI and then select E. coli isolates to study the prevalence of the efflux pump genes TetA and MdfA.This study included 150 midstream urine samples from patients suffering from UTI (115 females and 35 males) with ages ranging between(5-70)years. The results showed that only 100 samples exhibited bacterial growth; 72.5% referred to female patients, while 27.5% referred to male patients. Infection with bacteria occurred most frequently in the age group of 21-30 years. Bacterial isolates were identified by macroscopic and microscopic examination, biochemical test and VITEK2 system. The result showed that 40% of these growth were confirmed to be E.coli,19% Klebsiella pneumonia,17% Staph.aureus, 13%Proteus mirabilis,7% Pseudomonas aeroginosa, 2% Staph. saprophyticus,1%Proteus vulgaris and 1%Enterobacter cloaca.The results of sensitivity to antibiotics showed that UPEC isolates were utterly resistant to novobiocin and rifampin 100%, ampicillin 87.5%, cefotaxime 85%, tetracycline82.5%, ciprofloxacin77.5%, trimethoprim-sulfamethoxazole 50%, gentamicin 22.5%, nitrofurantoin 17.5% and meropenem 2.5%. All of the isolates were multidrug resistant. The result of the biofilm-formation ability of E.coli isolates showed that 31/40(77.5%) of isolates producing biofilm were divided into three groups: 1 (2,5%) had strong biofilm formation, 4(10%) were moderate, and 26(65 %) were weak. The phenotypic detection of the efflux pumps was observed in 100% of the bacterial isolates at a concentration of 0.5 mg/l of ethidium bromide(ETBR). The prevalence of the TetA and MdfA efflux pump genes was 72.5% for each. The gel electrophoresis showed that the molecular weight of TetA and MdfA genes were 131bp and 403bp respectively. Keywords: Efflux pumps, Urinary Tract, Infection, Parasites, E-coli.

Chemical Modification of Tiopronin for Dual Management of Cystinuria and Associated Bacterial Infections.

Cystinuria is an inherited autosomal recessive disease of the kidneys of recurring nature that contributes to frequent urinary tract infections due to bacterial growth and biofilm formation surrounding the stone microenvironment. In the past, commonly used strategies for managing cystinuria involved the use of (a) cystine crystal growth inhibitors such as l-cystine dimethyl ester and lipoic acid, and (b) thiol-based small molecules such as N-(2-mercaptopropionyl) glycine, commonly known as tiopronin, that reduce the formation of cystine crystals by reacting with excess cystine and generating more soluble disulfide compounds. However, there is a dearth of simplistic chemical approaches that have focused on the dual treatment of cystinuria and the associated microbial infections. This work strategically exploited a single chemical approach to develop a nitric oxide (NO)-releasing therapeutic compound, S-nitroso-2-mercaptopropionyl glycine (tiopronin-NO), for the dual management of cystine stone formation and the related bacterial infections. The results successfully demonstrated that (a) the antibacterial activity of NO rendered tiopronin-NO effective against the stone microenvironment inhabitants, Escherichia coli and Pseudomonas aeruginosa, and (b) tiopronin-NO retained the ability to undergo disulfide exchange with cystine while being reported to be safe against canine kidney and mouse fibroblast cells. Thus, the synthesis of such a facile molecule aimed at the dual management of cystinuria and related infections is unprecedented in the literature.

Effects of vitamins A, C, and D and zinc on urinary tract infections

Urinary tract infection (UTI) is responsible for a significant portion of the overall expenses of health care as well as mortality rates globally. We searched through the available research to evaluate whether micronutrient supplements affect the frequency and intensity of UTI in children Papers that investigated the effects of vitamins D and C, zinc, and multiple micronutrient supplementations (MMS) on the incidence and severity of UTI in pediatric patients were pooled together. A random effects model was used to conduct a meta-analysis of data. Vitamin D supplementation reduced the risk of UTI and shortened the duration of symptoms in children. If a clinical diagnosis or laboratory investigation was used to confirm UTI, the relative probability of UTI with vitamin D was remote from the null than using the self-report. If vitamin C was administrated, the frequency of UTI was reduced, and the period of clinical manifestations was cut to half. It was not possible to determine the impact of using zinc supplements. According to the findings of the current review, taking micronutrient supplements such as zinc, vitamins C and D, and multiple micronutrient supplementation could assist in preventing UTI and lessen its clinical outcome in pediatric patients. More research is required to establish the effect of individual or combination of micronutrients on the treatment outcomes of UTI.

Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility?

BackgroundPatients with neurogenic lower urinary tract dysfunction (NLUTD) often rely on some type of catheterization for bladder emptying. Intermittent catheterization (IC) is considered the gold standard and is preferred over continuous catheterization, since it is considered to cause fewer urinary tract infections (UTIs) than indwelling catheterization. The main objective of our study was to describe UTI prevalence (at visit) and incidence (within the last 12 months) and urine culture characteristics between patients using an indwelling catheter versus (vs) those performing IC.MethodsIn this cross-sectional study, we prospectively evaluated from 02/2020 to 01/2021 patients with NLUTD undergoing urine cultures for prophylactic reasons or due to UTI symptoms. At visit, all patients underwent a standardized interview on current UTI symptoms as well as UTI history and antibiotic consumption within the past year. Patients using an indwelling catheter (n = 206) or IC (n = 299) were included in the analysis. The main outcome was between-group differences regarding UTI characteristics.ResultsPatients using an indwelling catheter were older (indwelling catheter vs IC: median 66 (Q1-Q3: 55—77) vs 55 (42—67) years of age) and showed a higher Charlson comorbidity index (indwelling catheter vs IC: median 4 (Q1-Q3: 2–6) vs 2 (1–4) (both p < 0·001).A total of 40 patients from both groups were diagnosed with a UTI at visit (indwelling catheters vs IC: 8% (16/206) vs 8% (24/299); p = 0·782), and the number of UTIs within the past 12 months was not significantly different between groups. Overall, Escherichia coli (21%), Enterococcus faecalis (17%), and Klebsiella spp. (12%) were the most frequently detected bacteria.ConclusionsIn this cohort of patients with NLUTD, we did not find relevant differences in UTI frequency between groups. These results suggest that UTI-related concerns should not be given undue emphasis when counseling patients for catheter-related bladder emptying methods.

Urinary Tract Infection and Associated Factors among Pregnant Women Receiving Antenatal Care at a Primary Health Care Facility in the Northern Region of Ghana.

Urinary tract infection (UTI) is frequently encountered during pregnancy and is associated with adverse maternal, fetal, and neonatal effects. However, very little information is available on the prevalence of UTI among pregnant women in the northern part of Ghana, a region with a high birth rate. This study employed a cross-sectional analysis of the prevalence, antimicrobial profile, and risk factors associated with UTI in 560 pregnant women attending primary care for antenatal check-ups. Sociodemographic obstetrical history and personal hygiene information were obtained using a well-structured questionnaire. Afterward, clean catch mid-stream urine samples were collected from all participants and subjected to routine microscopy examination and culture. Of 560 pregnant women, 223 cases (39.8%) were positive for UTI. There was a statistically significant association between sociodemographic, obstetric, and personal hygiene variables and UTI (p < 0.0001). Escherichia coli (27.8%) was the commonest bacterial isolate followed by CoNS (13.5%) and Proteus species (12.6%). These isolates exhibited greater resistance to ampicillin (70.1-97.3%) and cotrimoxazole (48.1-89.7%) but were fairly susceptible to gentamycin and ciprofloxacin. Gram-negative resistance to meropenem was up to 25.0%, and Gram positives resistance to cefoxitin and vancomycin was up to 33.3% and 71.4% respectively. The current findings extend our knowledge of the high frequency of UTIs and associated risk factors in pregnant women with E. Coli being the predominant and usual isolate. Variation existed in the resistance pattern of isolates to various drugs, underscoring the need to perform urine culture and susceptibility before treatment.

Sigmoido-vesical fistula secondary to hernia mesh migration; a long-term rare complication of laparoscopic transabdominal preperitoneal inguinal hernia repair

A 47-year old male presented with frequent urinary tract infections (UTIs), hematuria and pneumaturia with a past history of laparoscopic bilateral inguinal hernia repair 5 years ago. Ultrasonography (USG) and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, cystoscopy revealed a mesh in the urinary bladder making apparent the diagnosis of Sigmoido-vesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon and urinary bladder with rent closure of the fistulous opening was done successfully. Our case thus, highlights the long-term rare complication of transabdominal preperitoneal (TAPP) surgery.

Urinary Tract Infection in Renal Transplant Recipients: Incidence, Microbiological Profile and Predisposing Factors in India

Renal transplant recipients (RTR) commonly encounter urinary tract infection (UTI) as the prevalent bacterial infection. In our geographical area, one-fourth of RTRs are susceptible to UTI during the post-transplant period. The improvement in surgical techniques and increased immunosuppression have enhanced graft survival. However, the subsequent escalation of infectious complications is concerning. Thus, we aimed to evaluate the frequency, predisposing factors, and microbiological characteristics of UTI among RTR.

Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women

Vaginal estrogen is considered to be the standard of care for recurrent urinary tract infection prevention in women with hypoestrogenism. However, literature supporting its use is limited to small clinical trials with narrow generalizability. This study aimed to assess the association between vaginal estrogen prescription and the frequency of urinary tract infections over the following year in a diverse population of women with hypoestrogenism. Secondary objectives included evaluation of medication adherence and predictors of postprescription urinary tract infection. This multicenter retrospective review included women who were prescribed vaginal estrogen for the indication of recurrent urinary tract infection from January 2009 through December 2019. Recurrent urinary tract infection was defined as having ≥3 positive urine cultures (separated by at least 14 days) in the 12 months preceding the index vaginal estrogen prescription. Patients were asked to fill their prescriptions and continue care within Kaiser Permanente Southern California system for at least 1 year. Exclusion criteria included anatomic abnormalities, malignancy, or mesh erosion of the genitourinary tract. Data on demographics, medical comorbidities, and surgical history were collected. Adherence was captured through refill data after the index prescription. Low adherence was defined as no refills; moderate adherence was defined as 1 refill; high adherence was defined as ≥2 refills. Data were abstracted from the electronic medical record system using the pharmacy database and diagnosis codes. A paired t test was used to compare pre- and postprescription urinary tract infections over the year preceding and following the vaginal estrogen prescription. A multivariate negative binomial regression was used to evaluate predictors of postprescription urinary tract infection. The cohort included 5638 women with a mean (±standard deviation) age of 70.4 (±11.9) years, body mass index of 28.5 (±6.3) kg/m2, and baseline urinary tract infection frequency of 3.9 (±1.3). Most of the participants were White (59.9%) or Hispanic (29.7%) and postmenopausal (93.4%). The mean urinary tract infection frequency in the year following the index prescription decreased to 1.8 (P<.001) from 3.9 in the year preceding the prescription, which is a 51.9% reduction. During the 12 months after the index prescription, 55.3% of patients experienced ≤1 urinary tract infections, and 31.4% experienced no urinary tract infections. Significant predictors of postprescription urinary tract infection included age of 75 to 84 years (incident rate ratio, 1.24; 95% confidence interval, 1.05-1.46) and >85 years (1.41; 1.17-1.68), increased baseline urinary tract infection frequency (1.22; 1.19-1.24), urinary incontinence (1.14; 1.07-1.21), urinary retention (1.21; 1.10-1.33), diabetes mellitus (1.14; 1.07-1.21), and moderate (1.32; 1.23-1.42) or high medication adherence (1.33; 1.24-1.42). Patients with high medication adherence demonstrated more frequent postprescription urinary tract infections than patients with low adherence (2.2 vs 1.6; P<.0001). In this retrospective review of 5600 women with hypoestrogenism who were prescribed vaginal estrogen for the prevention of recurrent urinary tract infections, the frequency of urinary tract infection decreased by more than 50% in the following year. Baseline urinary tract infection frequency, increasing age, urinary incontinence or retention, and diabetes were associated with an increased risk of postprescription urinary tract infection. The paradoxical finding that women with moderate and high medication adherence experienced the lowest-magnitude reduction in urinary tract infection frequency may represent unobserved selection or unmeasured confounding.

MP15-20 URINARY TRACT INFECTION AFTER RADIATION THERAPY OR RADICAL PROSTATECTOMY ON PROGNOSIS OF PATIENTS WITH PROSTATE CANCER: A POPULATION-BASED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP15-20 URINARY TRACT INFECTION AFTER RADIATION THERAPY OR RADICAL PROSTATECTOMY ON PROGNOSIS OF PATIENTS WITH PROSTATE CANCER: A POPULATION-BASED STUDY Se Young Choi, Jong Hyun Tae, Byung Hoon Chi, In Ho Chang, Tae-Hyoung Kim, Soon Chul Myung, Jung Hoon Kim, Jin Wook Kim, and Yong Seong Lee Se Young ChoiSe Young Choi More articles by this author , Jong Hyun TaeJong Hyun Tae More articles by this author , Byung Hoon ChiByung Hoon Chi More articles by this author , In Ho ChangIn Ho Chang More articles by this author , Tae-Hyoung KimTae-Hyoung Kim More articles by this author , Soon Chul MyungSoon Chul Myung More articles by this author , Jung Hoon KimJung Hoon Kim More articles by this author , Jin Wook KimJin Wook Kim More articles by this author , and Yong Seong LeeYong Seong Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We assessed the trends in urinary tract infections (UTIs) and prognosis of patients with prostate cancer after radical prostatectomy (RP) and radiation therapy (RT) as definitive treatment options. METHODS: The data of patients diagnosed with prostate cancer between 2007 and 2016 were collected using the National Health Insurance Service database. The incidence of UTIs was evaluated in patients treated with RT, open/laparoscopic RP, and robot-assisted RP. Cox proportional hazard analysis and Kaplan–Meier analysis were performed to assess survival. RESULTS: In total, 28,887 patients received definitive treatment. In the acute phase (<3 months), RP was associated with more frequent UTIs than RT; however, in the chronic phase (>12 months), RT was associated with more frequent UTIs than RP. The standardized incidence ratios were 2.47 for upper UTIs and 3.04 for lower UTIs. Open/laparoscopic RP was associated with a higher risk of UTIs than RT, whereas robot-assisted RP was not. In the patients with UTIs, the year of PC diagnosis, Charlson Comorbidity Index score, primary treatment, age at UTI diagnosis, type of UTI, hospitalization, and sepsis from UTI were risk factors for overall survival. CONCLUSIONS: In patients treated with RP or RT, the incidence of UTIs was higher than that in the general population. The frequency of UTIs differed between patients treated with RP and RT. Open/laparoscopic RP was associated with a higher risk of UTIs than RT, whereas robot-assisted RP was not. UTI characteristics may be related to a poor prognosis. Source of Funding: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2022R1F1A1076502 & NRF-2022R1A2C2008207) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e200 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Se Young Choi More articles by this author Jong Hyun Tae More articles by this author Byung Hoon Chi More articles by this author In Ho Chang More articles by this author Tae-Hyoung Kim More articles by this author Soon Chul Myung More articles by this author Jung Hoon Kim More articles by this author Jin Wook Kim More articles by this author Yong Seong Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

MP52-03 IMPACT OF GENTAMICIN INTRAVESICAL INSTILLATION ON SYMPTOMATIC UTI FREQUENCY AND BACTERIAL RESISTANCE IN ADULT NEUROGENIC BLADDER PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP52-03 IMPACT OF GENTAMICIN INTRAVESICAL INSTILLATION ON SYMPTOMATIC UTI FREQUENCY AND BACTERIAL RESISTANCE IN ADULT NEUROGENIC BLADDER PATIENTS Elizabeth J. Adams, Alexander V. Stanisic, Theresa Meyer, Angie Jang, Rachel Berkowitz, Ilina Rosoklija, Elizabeth Yerkes, David Chu, Janna L. Williams, Diana K. Bowen, and Stephanie J. Kielb Elizabeth J. AdamsElizabeth J. Adams More articles by this author , Alexander V. StanisicAlexander V. Stanisic More articles by this author , Theresa MeyerTheresa Meyer More articles by this author , Angie JangAngie Jang More articles by this author , Rachel BerkowitzRachel Berkowitz More articles by this author , Ilina RosoklijaIlina Rosoklija More articles by this author , Elizabeth YerkesElizabeth Yerkes More articles by this author , David ChuDavid Chu More articles by this author , Janna L. WilliamsJanna L. Williams More articles by this author , Diana K. BowenDiana K. Bowen More articles by this author , and Stephanie J. KielbStephanie J. Kielb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with neurogenic lower urinary tract dysfunction (NLUTD) may experience recurrent urinary tract infections (UTIs) refractory to traditional preventative measures given their bladder management needs. In smaller scale pediatric studies, intravesical gentamicin instillation has been described as a prophylactic measure to prevent UTIs in patients with NLUTD who catheterize. We describe a robust cohort of adult patients with NLUTD utilizing intravesical gentamicin. The objectives of the study were to 1) Evaluate whether there was a reduction in UTI frequency after initiating gentamicin prophylaxis; 2) Determine if UTI-related hospitalizations decreased with gentamicin use; 3) Assess for increased gentamicin resistance with use of bladder instillations. METHODS: A retrospective cohort study of adult NLUTD patients who have used prophylactic gentamicin instillations at an academic institution between 2007 and 2022 was conducted. All patients intermittently self-catheterized or had an indwelling catheter. Exclusion criteria included absence of at least one symptomatic UTI documented in the medical record prior to gentamicin initiation. The number of UTIs and UTI-related hospitalizations for each patient were abstracted. Urine culture data was reviewed for gentamicin resistance. UTIs were defined as presence of urologic symptoms associated with positive culture. Statistical significance was assessed using Wilcoxon signed-rank test. RESULTS: Forty-three patients with NLUTD were reviewed. Median length of time using gentamicin instillations was 22.9 months (IQR 26.2), with 38 patients continuing to use the instillations at the time of analysis. Overall, there was a significant reduction in the average number of UTIs per year from after initiation of gentamicin from 3.7 [SD=2.7] before gentamicin to 1.6 [SD=2.2] while using gentamicin (p<0.001). The average number of UTI-related inpatient admissions did not significantly change with gentamicin instillation prophylaxis (0.9/year prior to gentamicin initiation, 0.5/year on gentamicin; p=0.06). The proportion of cultured bacteria resistant to gentamicin did not significantly increase after initiation of the instillations (p=0.3). CONCLUSIONS: Gentamicin instillations significantly reduced the number of UTIs experienced by adult NLUTD patients who catheterize and did not increase bacterial resistance to gentamicin. Prospective studies in patients with NLUTD are needed to further define the ideal administrative protocol and patient characteristics for optimal therapeutic success. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e703 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth J. Adams More articles by this author Alexander V. Stanisic More articles by this author Theresa Meyer More articles by this author Angie Jang More articles by this author Rachel Berkowitz More articles by this author Ilina Rosoklija More articles by this author Elizabeth Yerkes More articles by this author David Chu More articles by this author Janna L. Williams More articles by this author Diana K. Bowen More articles by this author Stephanie J. Kielb More articles by this author Expand All Advertisement PDF downloadLoading ...

MP70-03 THE ROLE OF CIRCUMCISION IN PREVENTING URINARY TRACT INFECTIONS IN CHILDREN WITH ANTENATAL HYDRONEPHROSIS: SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP70-03 THE ROLE OF CIRCUMCISION IN PREVENTING URINARY TRACT INFECTIONS IN CHILDREN WITH ANTENATAL HYDRONEPHROSIS: SYSTEMATIC REVIEW AND META-ANALYSIS Justin Chan, Adree Khondker, Min Joon Lee, Jin Kyu Kim, Michael Chua, Joana Dos Santos, Natasha Brownrigg, Juliane Richter, Armando Lorenzo, and Mandy Rickard Justin ChanJustin Chan More articles by this author , Adree KhondkerAdree Khondker More articles by this author , Min Joon LeeMin Joon Lee More articles by this author , Jin Kyu KimJin Kyu Kim More articles by this author , Michael ChuaMichael Chua More articles by this author , Joana Dos SantosJoana Dos Santos More articles by this author , Natasha BrownriggNatasha Brownrigg More articles by this author , Juliane RichterJuliane Richter More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , and Mandy RickardMandy Rickard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Circumcision has been reported to reduce the risk of urinary tract infection (UTI) in boys with congenital urinary tract anomalies, a diverse group of conditions that includes hydronephrosis. Our aim was to specifically compare the rates of UTIs in circumcised vs. uncircumcised boys with antenatal hydronephrosis by conducting a systematic review and meta-analysis. METHODS: A comprehensive search was performed until December 2021. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed measures included UTIs, continuous antibiotic prophylaxis (CAP) use, renal function, development of cortical scarring, as well as circumcision complications. Odds ratios (OR) and mean difference with 95% confidence interval (CI) were extrapolated from available data. Random-effects meta-analysis were performed, and confounders were assessed with subgroup analysis. RESULTS: Sixteen studies describing 7,503 boys with antenatal hydronephrosis were identified, including 4,116 boys who were uncircumcised and 3,387 boys who were circumcised. The median follow-up time was 24.0 months (range: 6.0 - 152.4 months). Uncircumcised and circumcised boys were found to have UTI rates of 19.1% and 6.1%, respectively. This translates to a number needed to treat (NNT) of 8. Overall effect estimates demonstrate that circumcised boys have a significantly reduced odds of developing any UTI [OR 0.23, 95% CI 0.17, 0.31; p<0.001]. Furthermore, there was a significantly reduced odds of developing UTI on CAP [OR 0.18, 95% CI 0.11, 0.32; p<0.001]. When stratifying by etiology of antenatal hydronephrosis, circumcision reduced the odds of UTI in boys with vesicoureteral reflux [OR 0.24, 95% CI 0.12, 0.47; p<0.00001], or posterior urethral valve [OR 0.29, 95% CI 0.13, 0.64; p=0.002]. Long term renal function, development of renal scarring, and postoperative complications were not consistently reported, which prohibited pooling. Most studies had moderate risk of bias. CONCLUSIONS: Current evidence suggests that circumcision reduces the frequency of UTIs in boys with antenatal hydronephrosis. Based on these findings, circumcision should be considered in boys with antenatal hydronephrosis to prevent the risk of developing UTI. Further research is warranted to individualize the prophylactic role of circumcision for patients with different etiologies and grade of hydronephrosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1003 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Chan More articles by this author Adree Khondker More articles by this author Min Joon Lee More articles by this author Jin Kyu Kim More articles by this author Michael Chua More articles by this author Joana Dos Santos More articles by this author Natasha Brownrigg More articles by this author Juliane Richter More articles by this author Armando Lorenzo More articles by this author Mandy Rickard More articles by this author Expand All Advertisement PDF downloadLoading ...