History Of Cystitis Research Articles

Prevalence and risk factors of extended-spectrum beta-lactamase producing E. coli causing urinary tract infections in Iceland during 2012–2021

PurposeTo investigate the association of potential risk factors for urinary tract infections (UTI) caused by E. coli producing ESBL vs. not producing ESBL in Iceland.MethodsObservational, case-control study including a cohort of 27,747 patients (22,800 females, 4,947 males; 1207 cases, 26,540 controls) of all ages with UTI caused by E. coli in 2012 to 2021 at the clinical microbiology laboratory covering about 2/3 of the Icelandic population. Clinical patient data was obtained from three national databases. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) as a measure of association between ESBL and exposure variables.ResultsThe proportion of samples with ESBL-producing E. coli increased during the study period, from 2.6% in 2012 to 7.6% in 2021 (p < 0.001). ESBL-positive strains were detected in 1207 individuals (4.4%), 905 females (4.0%) and 302 males (6.1%). The following risk factors were identified: Male sex, higher age, institution type (hospital, nursing home), hospital-associated UTI, Charlson comorbidity index score ≥ 3, history of cystitis or hospitalization in the past year, and prescriptions for certain antibiotics or proton pump inhibitors (PPIs: OR 1.51) in the past half year. The antibiotic associated with the highest risk was ciprofloxacin (OR 2.45).ConclusionThe prevalence of UTIs caused by ESBL-producing E. coli has been increasing in Iceland. The strongest risk factors for ESBL production were previous antibiotic use, especially ciprofloxacin, and previous PPI use, both considered to be overprescribed. It is important to promote the prudent use of these drugs.

Qualitative study on shared decision making in cystitis management in general practice.

Cystitis is commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice. To identify barriers and facilitators for applying SDM in cystitis management in general practice. Qualitative explorative research in general practice with healthcare professionals (HCPs; GPs and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients). Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis. Ten GPs, seven GP assistants, and 15 patients were interviewed. We identified the following three main barriers and one key facilitator: (1) applying SDM is deemed inefficient; (2) HCPs assume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; (3) patients are largely unaware of the various non-antibiotic treatment options for cystitis; and (4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary. SDM is infrequently applied in cystitis treatment in general practice owing to the current focus on efficient cystitis management that omits patient contact, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM, which should be co-created with HCPs and patients, and fit into the current efficient cystitis management.

Anthropometric characteristics of patients suffering from chronic cystitis

Introduction. With a depressingly high prevalence of chronic cystitis (it is believed that half of women suffer from acute cystitis at least once in their lives), there is still no clarity on this disease. We were unable to find any studies on the anthropometric characteristics of patients with chronic cystitis either in the domestic or in the English literature.Objective. To assess the anthropometric characteristics of patients with chronic recurrent cystitis.Material &amp; methods. A prospective multicenter cohort study included 91 patients with symptoms of acute cystitis. All underwent anthropometric measurements, analyzed complaints, studied anamnesis morbi et vitae, performed a study on a gynecological chair; urine was sent for general analysis and bacteriological examination for nonspecific microflora with the determination of the sensitivity of the isolated pathogen to antimicrobial drugs. The patients answered questions about the Russian version of the Acute Cystitis Symptom Score (ACSS). A urethra and cervical canal smear was studied using the polymerase chain reaction method to identify the causative agents of sexually transmitted infections. The diagnosis was considered confirmed in the presence of leukocyturia, bacteriuria, and the sum of symptoms on the ACSS scale was 6 or more.Results. The duration of chronic recurrent cystitis was averaged at 7.1 ± 4.2 years. The age of the patients ranged from 18 to 49 years, averaging 28.9 ± 3.9 years. The height ranged from 150 cm to 178 cm, on average 165.9 ± 7.1 cm. The average weight was within the normal range: 64.2 ± 6.1 kg. However, the spread in the cohort by body weight was two-fold: from 42 to 86 kg. Overweight was found in five (5.5%) patients; two patients (2.2%), on the contrary, had a body weight deficit. When analyzing anthropometric indicators, along with the obvious ones (direct dependence of the duration of the disease on the age of the patient; direct dependence of the quality of life on the severity of symptoms), other statistically significant correlations were established: a positive relationship between age and weight, weight and duration of the disease.Conclusion. The analysis showed that overweight women respond to treatment worse, they have a longer history of cystitis. Neither typical symptoms nor ACSS score correlated with any of the anthropometric measures.

Clinical Experience with a Medical Device Containing Xyloglucan, Hibiscus, and Propolis for the Control of Acute Uncomplicated Urinary Tract Infection-like Symptoms

Background: The development of drug resistance among causative agents has resulted in the need to change the paradigm toward alternative therapeutic approaches for uncomplicated urinary tract infections (UTIs). The objective of the present study was to evaluate the efficacy of an oral medical device containing xyloglucan, hibiscus, and propolis in clinical practice with a cohort of women from Switzerland with UTI-like symptoms and the administration of concomitant drugs. Materials and Methods: This work describes an observational, prospective, and multicenter study involving 103 women attending a primary care physician for a symptomatic episode, or recurrence, of acute uncomplicated cystitis between August 2018 and June 2019. Utipro®Plus was administered orally, with patients being prescribed two capsules per day for 5 days to control discomfort symptoms or one capsule per day for 15 consecutive days per month (followed by a 15-day break for a 3-month cycle) to prevent recurrences. Results: A total of 84 women (81.6%) did not require an additional consultation, whereas 17 (16.5%) required a second one. Inadequate treatment response was found in 7 women out of the 19 who required a further consultation (36.8%): 3 women with no history of cystitis (out of 13, 23.1%) and 4 with recurrent cystitis (out of 6, 66.7%). None of the women from the study reported an adverse event. Conclusions: The studied product containing xyloglucan, hibiscus, and propolis is safe and effective for the treatment of a broad spectrum of women with acute uncomplicated or recurrent UTI-like symptoms.

Shared decision making for women with uncomplicated Cystitis in Primary Care in the Netherlands: a qualitative interview study

BackgroundUrinary tract infections (UTIs) are common, especially among women. Antibiotics are commonly used to treat UTIs, but might not always be necessary, for example in the case of uncomplicated UTIs such as cystitis. Shared decision making (SDM) could reduce the risk of unnecessary antibiotic prescriptions for uncomplicated cystitis. We investigated the current management and the use of SDM for uncomplicated cystitis in primary care.MethodsWe performed a qualitative semi-structured interview study among 23 women with a history of cystitis, 12 general practitioner (GP) assistants, and 12 GPs in the Netherlands from July to October 2020. All interviews were individually performed by telephone. The data were analyzed through the use of using open and axial coding.ResultsThe GP assistants managed the initial diagnostics and treatment of uncomplicated cystitis in all general practices. Usually, antibiotics were considered the standard treatment of cystitis. In most general practices, SDM was not used in the treatment of uncomplicated cystitis, mainly because of a lack of time. Women reported that they valued being involved in the treatment decision-making process, but they were not always involved. Further, both GP assistants and GPs indicated that SDM would improve the care pathway of uncomplicated UTIs.ConclusionIn our study, SDM was infrequently used to help women with uncomplicated cystitis. To reduce the use of antibiotics for uncomplicated UTIs, a tailored intervention is needed to implement SDM for the treatment of uncomplicated cystitis in primary care.

First report of nephrocutaneous fistula in a cat

Nephrocutaneous fistula (NCF) is a very serious rare renal disorder that had not been recorded in cats. This case report describes - for the first time - the features and treatment of a nephrocutaneous fistula in a 3-year-old female intact Persian cat. The cat was referred with a history of lethargy, anorexia, vomiting and recurrent abscess discharging purulent material at the right flank region. Moreover, the cat had a history of cystitis, urethritis and urethral obstruction since 12 months. Physical, laboratory, radiographic and ultrasonographic examinations were performed. The cat was treated with simple nephrectomy and excision of the fistulous tract. The animal showed dehydration, fever, painful abdominal palpation, right nephromegaly, anaemia, neutrophilic leukocytosis and moderate azotaemia. Abdominal radiographs revealed a large radiodense mass at the mid abdomen displacing the intestine caudally. Ultrasonography revealed a renal abscess with marked enlargement of the right kidney, hyperechoic purulent content and loss of parenchymal details of the right kidney. Complete recovery of the cat without any complications was seen after surgical treatment. In conclusion, nephrocutaneous fistula should be listed as one of renal diseases in cats. Nephrectomy as well as excision of the fistulous tract appear to be successful in the treatment of this disorder in cats.

Эпидемиологическое исследование распространенности цистита у женщин Воронежской области

Introduction. The article is devoted to an epidemiological study of the prevalence of cystitis and risk factors for recurrence this disease. Materials and methods. The study is based on the data obtained during the screening survey of 1014 women in the age group of 18-80 years old, permanently residing in the Bobrovsky district of the Voronezh region. Based on the age of the subjects, 3 groups were formed: Group 1 (general group) - 1014 women, Group 2 (fertile age) - 551 women, Group 3 (postmenopausal age) - 463 women. To study the influence of risk factors on the development of cystitis, the following criteria were used: antibiotic therapy, sex life, urinary disorders, gastrointestinal tract (GIT) dysfunction, etc. The obtained material was processed using the computer program Statistics 10.0. 𝛘2 was used as a statistical tool. Results. Of the total number of women surveyed, 15.3% had risk factors according to the ORENUC classification system based on the clinical picture of UTI, anatomical level of UTI, the severity of infection, classification of risk factors and the availability of appropriate antimicrobial therapy. The largest number of risk factors was found in postmenopausal patients (p &lt;0.05). It was found that despite the fact that most of the subjects were sexually active, the absence of sexual activity and the presence of one sexual partner did not affect the presence of a history of cystitis episode (p&gt; 0.05), however, it was revealed that the history of cystitis was significantly associated with functions of the gastrointestinal tract (p&lt;0.05). The use of tactics aimed at active detection of cystitis, by means of questionnaires, can increase the detection rate of cystitis by 10 times. Discussions. In our study, we did not find a large number of cases of recurrent cystitis, in contrast to previously published works, which cited figures from 10 to 30% of the number of women, however, by means of questionnaires, we managed to deduce the prevalence of cystitis in the studied region in women over 18 years old. which amounted to 17.4%. The figure obtained is consistent with data published in previously papers. Conclusions. TThis study has confirmed the previously published works indicating the relationship of cystitis with gastrointestinal diseases. In addition, we found that the prevalence of cystitis (having one or more episodes during a lifetime) in the study group was 17.4%. The annual incidence of cystitis in the study group was 3.2%, while according to official statistics in the region it does not exceed 0.4%. The latter fact indicates the need for further research and strengthening of sanitary and edu- cational work among the population (Internet, TV, radio, newspapers, etc.).

Leiomyosarcoma of Urinary Bladder, A Review of Two Cases

Abstract Introduction/Objective Leiomyosarcomas of the urinary bladder are rare smooth muscle tumor, and constitute 1% of all bladder malignancies. Although rare, leiomyosarcoma is a clinically significant disease, presenting as a high-grade advanced malignancy with associated substantial morbidity and mortality, if not treated early. The diagnosis can be delayed because of the asymptomatic presentation until the tumor reaches an advanced stage. Methods We present two cases of leiomyosarcoma of the urinary bladder. First case: a 63 years old female with a history of cervical carcinoma treated with radiation, 25 years ago, followed by uncomplicated clinical course, until recent development of vesicovaginal fistula. During her work up with cystoscopy, a large bladder mass was identified. Second case: a 71 years old female with a history of treated breast cancer, who presented with recurrent history of cystitis and hematuria. Cystoscopy revealed a nodular mass in the right posterior bladder wall. Results Microscopically, both lesions were highly cellular with infiltrative, interlacing fascicles of spindle cells and associated mitosis, cellular atypia and necrosis. Immunohistochemistry revealed positive expression of muscle- specific actin, desmin, and caldesmon; with negative expression of ALK-1, EMA, Cytokeratins and GATA3, in both the cases. Other spindle cell lesions including, leiomyoma, inflammatory myofibroblastic tumor and sarcomatoid carcinoma were included in the differential diagnosis, and ruled out by morphology and immunohistochemistry. Conclusion Our cases highlight the importance of awareness of the occurrence of leiomyosarcomas, a rare manifestation in bladder. Although rare, but they present with a poor outcome. The differential diagnosis of spindle cell lesions is extensive, including close benign and malignant mimics, the treatment of all being very different. Immediate radical cystectomy has been associated with longer survival rates for leiomyosarcoma. Leiomyosarcoma, being aggressive, with associated high recurrence rate and metastatic potential, an early correct diagnosis would aid in the institution of proper management.

A rare cause for hematuria: Lymphoma of the urinary bladder

AbstractPrimary lymphomas of the urinary bladder are rare and majority present with hematuria. Patients are usually elderly females with a history of recurrent cystitis. The diagnosis is clinched after imaging and biopsy of suspicious lesions in the bladder. The prognosis is good irrespective of the modality of treatment. With this background, we report a case of primary marginal zone lymphoma of the urinary bladder (Stage IE) in a young lady with no history of cystitis, who presented with isolated hematuria. After treatment with radiotherapy alone, patient is in complete remission for the past 18 months. The timely diagnosis in a patient with hematuria holds the key to successful treatment and its importance cannot be overemphasized.

Acute Pyelonephritis Associated with Ruptured Abdominal Aortic Aneurysm: An Unusual Presentation.

We describe a rare presentation of acute pyelonephritis associated with a ruptured abdominal aortic aneurysm. A 68-year-old female presented to the emergency department with a 3 day history of cystitis. General examination revealed the acute onset of pain in the left flank accompanied by fever and chills. Blood tests revealed leucocytosis 25,400×109/L and C-reactive protein 495 mg/L (<6.1), while urinary sediment analysis revealed many leucocytes and gram-negative bacteria. The patient was admitted with acute pyelonephritis. On the third day of admission, the urine culture isolated Escherichia coli sensitive to the antibiotic prescribed; however, the patient clinically deteriorated. A computed tomography scan revealed a ruptured abdominal aortic aneurysm involving the left renal artery. The patient underwent an exploratory laparotomy but uncontrollable haemorrhage led to a fatal outcome.This case highlights a rare case of acute pyelonephritis associated with a ruptured abdominal aortic aneurysm. A computed tomography scan or abdominal ultrasound should be considered whenever a patient has acute pyelonephritis with a C-reactive protein >400 mg/L in order to exclude complications and other potentially fatal pathologies.LEARNING POINTSAcute pyelonephritis can lead to a ruptured abdominal aortic aneurysm.There should be a high index of suspicion for other concomitant acute pathologies in patients with pyelonephritis and a C-reactive protein >400 mg/L.A low threshold for abdominal imaging, either a computed tomography scan or abdominal ultrasound, may allow for the diagnosis of pathologies with a high mortality rate, such as a ruptured abdominal aortic aneurysm, at an early stage and thus result in better prognosis.

The effectiveness of nitrofurantoin, fosfomycin and trimethoprim for the treatment of cystitis in relation to renal function

ObjectivesWe evaluated the effect of renal function on clinical failure rates of nitrofurantoin, fosfomycin and trimethoprim for the treatment of cystitis in primary care. MethodsData were retrospectively obtained from 78 Dutch general practitioner (GP) practices between 2013 and 2019. Eligible episodes in patients (>11 years) were those requiring 5 days of nitrofurantoin (NF5), single-dose fosfomycin–trometamol (FT1), 3 days of trimethoprim (TMP3) for uncomplicated cystitis, or 7 days of nitrofurantoin (NF7) or trimethoprim (TMP7) for complicated cystitis. Clinical failure was defined as second antibiotic prescription for cystitis or pyelonephritis within 28 days post-prescription. Mixed effects regression analysis was used, with patient and GP practice as random effects and demography, comorbidity, and cystitis history as fixed effects. ResultsAdjusted odds ratios (aORs) for clinical failure per 10mL/min decrease in estimated glomerular filtration rate (eGFR) were 1.05 (95% CI: 1.01–1.09) for NF5 (n = 24,591), 0.96 (95% CI: 0.92–1.01) for FT1 (n = 5359), 0.98 (95% CI: 0.89–1.08) for TMP3 (n = 1064), 1.05 (95% CI: 1.02–1.09) for NF7 (n = 10,628) and 1.02 (95% CI: 0.93–1.14) for TMP7 (n = 831). In uncomplicated cystitis and eGFR ≥60 mL/min, clinical failures occurred in 14.6% (1895/12 980) of NF5-treated, 20.7% (266/1283) of FT1-treated (aOR versus NF5 1.37, 95% CI 1.18–1.59) and 20.8% (66/318) of TMP3-treated patients (aOR 1.42, 95% CI 1.07–1.87 versus NF5). In uncomplicated cystitis and eGFR <60 mL/min, FT1 resulted in 16.0% (39/244) and NF5 in 23.3% clinical failures (110/472), aOR: 0.61, 95% CI: 0.39–0.95). ConclusionsIn eGFR ≥60 mL/min treatment with fosfomycin or trimethoprim for uncomplicated cystitis was associated with more clinical failure than treatment with nitrofurantoin, while in eGFR <60 mL/min nitrofurantoin was associated with more clinical failure than fosfomycin–trometamol. Renal function, if known, should be considered in the clinical decision-making for cystitis treatment.

Von Hansemann Cells from Fresh Urine Sediment Samples in the Diagnosis of Malakoplakia.

Background:Malakoplakia is characterized by the presence of plaques with macrophages containing inclusion bodies. The diagnosis of this disease is carried out by biopsy of the lesion. The objective of this paper was to assess the value of fresh urine sediment in the diagnosis of malakoplakia.Materials and Methods:Five suspected cases of malakoplakia that showed macrophages with inclusions called bodies of Michaelis-Gutmann (von Hansemann cells) in unstained urine sediment were processed with Papanicolaou, Giemsa, and periodic acid-Schiff (PAS) stains. Four of the five patients had a history of cystitis and had developed antibiotic resistance. The other patient had the characteristics cells in a routine urinalysis.Results:Papanicolaou stain revealed intracytoplasmic eosinophilic or basophilic bodies, single or multiple in macrophages. Such bodies were stained deep red with PAS technique. Giemsa stain showed these bodies with a faint basophilic coloration, sometimes with a central core. Bladder biopsies established the definitive diagnosis, showing bodies within and outside macrophages, with a concentric “birds-eye” or “owl-eye” (targetoid) appearance.Conclusions:Finding of von Hansemann cells in fresh urine sediment of patients with cystitis and a history of resistance to antibiotic scan leads to the diagnosis of malakoplakia. Giemsa stain can show in some cases the characteristic central core of Michaelis-Gutmann bodies. Malakoplakia is probably the result of an acquired defect in macrophage function causing impairment of bactericidal activity. A correct diagnosis is important because the spread to ureters with bilateral stenosis and obstruction can lead to kidney failure.

Factors associated with hematuric struvite crystalluria in cats

The aim of the study was to identify any dietary, signalment, geographic and clinical factors associated with hematuric struvite crystalluria (HSC) in a population of cats that visit general care veterinary hospitals in the USA. In total, 4032 cats that had a first-time diagnosis of HSC and 8064 control cats with no history of hematuria or crystalluria were identified from medical records of all cats examined between 2007 and 2011 at 790 US veterinary hospitals. Extracted variables included age, sex, neuter status, breed, diet, urinalysis results and history of cystitis. Potential associations between these variables and HSC were estimated. Controlling for other factors, young cats fed a dry diet had an increased likelihood of HSC relative to young cats fed a non-dry diet. However, as age increased, the likelihood of HSC declined for cats fed a dry diet and increased for cats fed a non-dry diet. Moreover, the odds of HSC were significantly greater when cats were unneutered (vs neutered; odds ratio [OR] 45.52) or had a thin (vs heavy) body condition (OR 23.81), diagnosis of cystitis (OR 2.84), urine protein concentration >30 mg/dl (OR 4.72), alkaline (vs neutral) urine pH (OR 3.34), pyuria (OR 23.67) or bacteriuria (OR 2.24). The present study provides estimates of the strengths of association between HSC and certain signalment and clinical characteristics of cats. This information could help clinicians to perform a more directed screening for struvite crystalluria in certain cat populations. Follow-up studies that build on the findings of this study could explore the clinical importance of HSC in cats.

Ketamine and Its Pharmacologic Profile in Psychiatric Disorders

Ketamine is used to treat psychiatric conditions at low doses to minimize risks associated with anesthetic sedation. Dissociative phenomena and minimally increased heart rate and blood pressure are among the most common but transient side effects during intravenous ketamine infusion. When used in common medical practice as an anesthetic, analgesic, and antidepressant, there is little evidence to support nonreversible adverse events. Several retrospective studies have demonstrated that daily, illicit use of ketamine at high doses over a period of years is associated with neurocognitive dysfunction and ketamine-induced cystitis. Although ketamine may have use in special populations, screening for active psychosis, illicit ketamine use, a history of cystitis, and severe or uncontrolled cardiovascular disease is critical when determining the appropriateness of ketamine treatment. [ Psychiatr Ann. 2018;48(4):170–174.]

Microbiological Characteristics of Unresolved Acute Uncomplicated Cystitis.

This study sought to compare the antimicrobial susceptibility rates between acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who were considered unresolved cases, and newly presenting acute uncomplicated cystitis patients without recent antimicrobial use within 3 months and to determine whether different treatment strategies should be applied according to recent antimicrobial exposure (RAE). Female acute uncomplicated cystitis patients with Escherichia coli growth, who visited our hospital's urology department from 2010 to 2014, were divided according to RAE. The antimicrobial susceptibility of E. coli was compared between the group with RAE and the group with no antimicrobial exposure (NAE) within 3 months. The total number of acute uncomplicated cystitis patients with E. coli growth was 259: 40 patients comprised the RAE group and 219 patients formed the NAE group. The mean age was significantly older and previous recurrent cystitis history was higher in the RAE group (p < 0.05). Furthermore, the antimicrobial susceptibility of E. coli to amoxicillin-clavulanic acid, cefotaxime, cefoxitin, ciprofloxacin, and trimethoprim-sulfamethoxazole was significantly lower in the RAE group, with susceptibility results of 64.7%/88.0% (RAE/NAE), 77.5%/89.0%, 79.4%/95.3%, 31.3%/64.2%, and 42.5%/70.6%, respectively. RAE was an independent factor for antimicrobial resistance. This study showed that antimicrobial susceptibilities were significantly lower in acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who are defined as unresolved cases. Our results suggest that first-line antimicrobials might show poor efficacy in cases of unresolved, acute uncomplicated cystitis and alternative or secondary antimicrobials should be considered in these cases.

FP744COMPARISON OF DIFFERENT SEXUAL DYSFUNCTION SCALES IN FEMALES PATIENTS ON RENAL REPLACEMENT THERAPY

Introduction and Aims: Sexual dysfunction (SD) is commonly seen in the female dialysis population and is associated with depression and a lower quality of life. Although there have been many reports regarding the improvement of SD after kidney transplantation, those outcomes are not consistent. SD frequency in female patients has been evaluated with different scales in previous studies, and the ratios varies according to the used scales. In addition, there is no a study comparing several scales for SD in this population. This study aimed to investigate SD frequency with different scales, and risk factors in the females under renal replacement therapy and in the healthy ones. Methods: A total of 70 kidney transplant patients (Tx), 46 hemodialysis (HD) and 45 predialysis (PreD) patients and 54 healthy females were included into the study. Sociodemographic and risk factor survey forms, the hospital anxiety depression scale, the 36-Item Short Form Health Survey, Arizona Sexual Experiences Scale (ASEX), the Golombok Rust Inventory of Sexual Satisfaction (GRISS) and the Female Sexual Function Index (FSFI) were used. Results: Ages of the patients in the control and Tx groups were significantly lower than those of the HD and PreD groups. There were differences in the ratios of asthenia and fatigue, pelvic surgery, urinary incontinence, cystitis history, dyspareunia, smoking, use of antidepressant and beta blockers between the groups. The depression and anxiety ratios of the groups were similar. The physiological health scores of the control group were significantly higher than those of the PreD and Tx groups, and also scores of the Tx group than those of the HD and PreD groups. Mental health scores of the control group were significantly higher than those of the PreD and HD groups. The prevalence ratio for SD with ASEX in HD group (54.3%) was significantly higher than those of Tx (24.3%) and the control (25.9%) groups, and also the rate of PreD group (44.4%) than that of Tx. SD ratios of the groups with GRISS were similar. The SD ratio of Tx group with FSFI (16.1%) was significantly lower than that of HD group (41.9%). Logistic regression analysis showed systolic blood pressure, finding sexual information adequate and presence of anxiety with ASEX; age, presence of anxiety and education time of mother with GRISS; finding sexual information adequate, presence of anxiety and depression with FSFI as independent risk factors for SD. There were significant differences in all study population and Tx group between SD ratios with FSFI and GRISS. In all study population 15 persons had SD according to FSFI, but not to GRISS, and 31 persons had SD according to GRISS, but not to FSFI (p=0.026). According to FSFI, sensitivity of GRISS was 0.70, and specificity was 0.71. In Tx group 4 persons had SD according to FSFI, but not to GRISS, and 16 persons had SD according to GRISS, but not to FSFI (p=0.012). According to FSFI, sensitivity of GRISS was 0.60, and specificity was 0.69. Conclusions: As a result, different results were obtained when SD frequency and risk factors in the patients on renal replacement therapy were assessed with different scales in our study. Therefore, new scales in these patients should be developed and their reliability should be evaluated in larger patient groups. FP744 Table 1: The frequency of sexual dysfunction with different scales in the groups

Investigation of poorer bladder cancer survival in women in NSW, Australia: a data linkage study

To investigate the associations of a range of personal and clinical variables with bladder cancer survival in men and women in NSW to see if we could explain why bladder cancer survival is consistently poorer in women than in men. All 6880 cases of bladder cancers diagnosed in NSW between 2000 and 2008 were linked to hospital separation data and to deaths. Separate Cox proportional hazards regression models of hazard of bladder cancer death were constructed for those who did or did not undergo cystectomy. A total of 16% of patients with bladder cancer underwent cystectomy (16% of men and 15% of women). Women who underwent cystectomy were 26% more likely to die than men (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.59) after adjustment for age, stage, time from diagnosis to cystectomy, distance from treatment facility and country of birth. None of the above covariates had a material effect on the difference in hazard between women and men; however, when stratified by a history of cystitis, the adjusted hazard was 55% higher in women (HR 1.55, 95% CI 1.15-2.10) than in men with a history of cystitis while, in the absence of this history, there was no difference in the hazard between men and women (HR 0.99, 95% CI 0.57-1.70). This apparent modification of the effect of sex on bladder cancer outcome was not seen in patients treated only by resection: the adjusted HRs in women relative to men were 1.10 (95% CI 0.92-1.31) in those with a history of cystitis and 1.21 (95% CI 0.98-1.50) in those without. A history of haematuria did not modify appreciably the association of sex with bladder cancer outcome. Women's poorer survival from bladder cancer compared with that of men remains unexplained; however, the possibility that some factor associated with a history of cystitis may contribute to or explain the poorer outcome in women merits further investigation.

Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study

Objective To assess the natural course and the important predictors of severe symptoms in urinary tract infection and the effect of antibiotics and antibiotic resistance.Design Observational study.Setting Primary care.Participants 839...

Virulence Characteristics and Phylogenetic Background of Ciprofloxacin Resistant Escherichia coli in the Urine Samples from Korean Women with Acute Uncomplicated Cystitis

To clarify the characteristics of the virulence factors (VFs) of ciprofloxacin resistant Escherichia coli (CFRE) with acute uncomplicated cystitis (AUC), we determined the VFs and the phylogenetic background of all 54 CFRE strains and the 55 randomly selected ciprofloxacin sensitive E. coli strains (CFSE) from patients with AUC in 22 Korean hospitals. The prevalence of the VFs was as follows: fimA, papEF, papGIII, sfaI, dafaBC, cnf1, and hlyA were presented in 96%, 54%, 68%, 91%, 49%, 72%, and 29% of the samples, respectively. The expressions of papEF, cnf1, and hlyA were significantly more prevalent in the CFSE. Moreover, the expressions of cnf, and papEF significantly reduced the risk of ciprofloxacin resistance. The CFSE was also marginally associated with the group B2 (P=0.05). Although the presence of pyuria and a previous cystitis history were not related with the phylotyping and the expressions of VFs, group B2, and fimA and papEF were more expressed in the younger age patients (P<0.05). In conclusion, the CFRE exhibits a selective loss of VFs and the non-B2 phylotype in Korean AUC patients. The group B2 and the presence of fimA and papEF are associated with a younger age of AUC patients.

Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study

To estimate clinical and dipstick predictors of infection and develop and test clinical scores; to compare management using clinical and dipstick scores with commonly used alternative strategies; to estimate the cost-effectiveness of each strategy; and to understand the natural history of urinary tract infection (UTI) and women's concerns about its presentation and management. There were six studies: (1) validation development for diagnostic clinical and dipstick scores; (2) validation of the scores developed; (3) observation of the natural history of UTI; (4) randomised controlled trial (RCT) of scores developed in study 1; (5) economic analysis of the RCT; (6) qualitative study of patients in the RCT. Primary care. Women aged 17-70 with suspected UTI. Patients were randomised to five management approaches: empirical antibiotics; empirical delayed antibiotics; target antibiotics based on a higher symptom score; target antibiotics based on dipstick results; or target antibiotics based on a positive mid-stream specimen of urine (MSU). Antibiotic use, use of MSUs, rates of reconsultation and duration, and severity of symptoms. (1) 62.5% of women had confirmed UTI. Only nitrite, leucocyte esterase and blood independently predicted diagnosis of UTI. A dipstick rule--based on having nitrite or both leucocytes and blood--was moderately sensitive (77%) and specific (70%) [positive predictive value (PPV) 81%, negative predictive value (NPV) 65%]. A clinical rule--based on having two of urine cloudiness, offensive smell, reported moderately severe dysuria, moderately severe nocturia--was less sensitive (65%) (specificity 69%, PPV 77%, NPV 54%). (2) 66% of women had confirmed UTI. The predictive values of nitrite, leucocyte esterase and blood were confirmed. The dipstick rule was moderately sensitive (75%) but less specific (66%) (PPV 81%, NPV 57%). (3) Symptoms rated as moderately bad or worse lasted 3.25 days on average for infections sensitive to antibiotics; resistant infections lasted 56% longer, infections not treated with antibiotics 62% longer and symptoms associated with urethral syndrome 33% longer. Symptom duration was shorter if the doctor was perceived to be positive about prognosis, and longer with frequent somatic symptoms, previous history of cystitis, urinary frequency and more severe symptoms at baseline. (4) 66% of the MSU group had laboratory-confirmed UTI. Women suffered 3.5 days of moderately bad symptoms if they took antibiotics immediately but 4.8 days if they delayed taking antibiotics for 48 hours. Taking bicarbonate or cranberry juice had no effect. (5) The MSU group was more costly over 1 month but not over 1 year. Cost-effectiveness acceptability curves showed that for a value per day of moderately bad symptoms of over 10 pounds, the dipstick strategy is most likely to be cost-effective. (6) Fear of spread to the kidneys, blood in the urine, and the impact of symptoms on vocational and leisure activities were important triggers for seeking help. When patients are asked to delay taking antibiotics the uncomfortable and worrying journey from 'person to patient' needs to be acknowledged and the rationale behind delaying the antibiotics made clear. To achieve good symptom control and reduce antibiotic use clinicians should either offer a 48-hour delayed antibiotic prescription to be used at the patient's discretion or target antibiotic treatment by dipsticks (positive nitrite or positive leucocytes and blood) with the offer of a delayed prescription if dipstick results are negative.