Management of urinary tract infection in geriatric hospital patients

As the elderly population increases, so does the prevalence of urinary tract infections in the elderly population in long-term care facilities and the associated medical costs. Screening tests and treatment for asymptomatic bacteriuria in elderly residents in the community or in long-term care facilities are not recommended. However, febrile urinary tract infections should be treated with proper antibiotics. Patients who have risk factors for urinary tract infections require prompt therapy. Catheter-associated bacteriuria is the most common hospital-acquired infection. The most important risk factor associated with an increased likelihood of developing catheter-associated bacteriuria is the duration of catheterization. Long-term catheter indwelling should be avoided, and it is necessary to reduce unnecessary catheter insertion. Most patients are asymptomatic, and they do not require treatment. Symptomatic catheter-associated infections should be treated. The best strategy for reducing catheter-associated infections involves careful aseptic insertion of the catheter and maintenance of a closed dependent drainage system. Steps must be taken to reduce urinary tract infections and urinary catheter-related infections in light of the increasing elderly population.

Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic

PURPOSE: To evaluate the distribution of ureteral stones and to determine their characteristics and expulsion rate based on their location. MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) findings of 246 patients who visited our Emergency Department (ED) for renal colic caused by unilateral ureteral stones between January 2013 and April 2014. Histograms were constructed to plot the distribution of stones based on initial CT findings. Data from 144 of the 246 patients who underwent medical expulsive therapy (MET) for 2 weeks were analyzed to evaluate the factors responsible for the stone distribution and expulsion. RESULTS: The upper ureter and ureterovesical junction (UVJ) were 2 peak locations at which stones initially lodged. Stones lodged at the upper ureter and ureteropelvic junction (group A) had a larger longitudinal diameter (4.21 mm vs. 3.56 mm, p=0.004) compared to those lodged at the lower ureter and UVJ (group B). The expulsion rate was 75.6% and 94.9% in groups A and B, respectively. There was no significant difference in the time interval from initiation of renal colic to arrival at the ED between groups A and B (p=0.422). Stone diameter was a significant predictor of MET failure (odds ratio [OR], 1.795; p=0.005) but the initial stone location was not (OR, 0.299; p=0.082). CONCLUSIONS: The upper ureter and UVJ are 2 peak sites at which stones lodge. For stone size 10 mm or less, initial stone lodge site is not a significant predictor of MET failure in patients who have no previous history of active stone treatment in the ureter.

The Effectiveness of Silodosin for Nocturnal Polyuria in Elderly Men With Benign Prostatic Hyperplasia: A Multicenter Study / 대한배뇨장애요실금학회지

PURPOSE: To investigate improvement in nocturia and nocturnal polyuria in nocturnal polyuria patients after silodosin administration by using a 3-day frequency volume chart. METHODS: This was a prospective multicenter study. We enrolled nocturnal polyuria patients (nocturnal polyuria index [NPi]>0.33), aged > or =60 years, diagnosed with the 3-day frequency volume charts of patients with benign prostatic hyperplasia taking alpha-blockers. Of the 54 patients, 30 (55.6%) completed the study according to the study protocol (per-protocol group), and 24 dropped out (dropout group). RESULTS: Of the 24 patients in the dropout group, 5 withdrew consent due to side effects or lack of efficacy, 7 were lost to follow-up at 4 weeks, 8 were lost to follow-up at 12 weeks, and 4 dropped out due to failure to complete 3-day frequency volume charts at 12 weeks. In the per-protocol group, there was significant improvement in the International Prostate Symptom Score (IPSS), especially question numbers 1, 3, 4, 5, 6, 7, and the quality of life question (P=0.001, P=0.007, P0.33. Considering the high dropout rate of our study due to no implementation of 3-day frequency volume charts, prospective and large-scale studies are needed to confirm our results.

Simultaneous Robot-Assisted Laparoendoscopic Single-Site Partial Nephrectomy and Standard Radical Prostatectomy

Recently, patients with urologic malignancies are treated with robot-assisted surgery and the expanded role of robot-assisted surgery includes even those patients with two concomitant primary urologic malignancies. In an effort to further reduce port site-related morbidity, robot-assisted laparoendoscopic single-site surgery (RLESS) has been developed. Therefore, we present herein our early experience and feasibility of simultaneous RLESS partial nephrectomy and standard robotrobot-assisted laparoendoscopic radical prostatectomy (RALP) on 3 patients with synchronous renal masses and prostate cancer.

Clinical Outcomes of CyberKnife Radiotherapy in Prostate Cancer Patients: Short-term, Single-Center Experience

PURPOSE: In this retrospective study, we analyzed the outcomes of prostate cancer patients treated with the CyberKnife radiotherapy system (Accuray). MATERIALS AND METHODS: Between 2007 and 2010, 31 patients were treated for prostate cancer by use of the CyberKnife radiotherapy system. After excluding six patients who were lost to follow-up, data for the remaining 25 patients were analyzed. Patients were divided into the CyberKnife monotherapy group and a postexternal beam radiotherapy boost group. Clinicopathologic features and treatment outcomes were compared between the groups. The primary endpoint was biochemical recurrence-free survival period based on the Phoenix definition. Toxicities were evaluated by using the Radiation Therapy Oncology Group scoring criteria. RESULTS: Of 25 patients, 17 (68%) and 8 (32%) were classified in the monotherapy and boost groups, respectively. With a median follow-up of 29.3 months, most of the toxicities were grade 1 or 2 except for one patient in the boost group who experienced late grade 3 gastrointestinal toxicity. The overall biochemical recurrence rate was 20% (5/25) and the median time to biochemical recurrence was 51.9 months. None of the patients with low or intermediate risk had experienced biochemical recurrence during follow-up. Among D'Amico high-risk populations, 16.7% (1/6) in the monotherapy group and 50.0% (4/8) in the boost group experienced biochemical recurrence. CONCLUSIONS: Our data support that prostate cancer treatment by use of the CyberKnife radiotherapy system is feasible. The procedure can be a viable option for managing prostate cancer either in a monotherapy setting or as a boost after conventional radiotherapy regardless of the patient's risk stratification.

Discrepancies in Perception of Urinary Incontinence between Patient and Physician after Robotic Radical Prostatectomy

PURPOSE: Reported incidence of urinary incontinence after a radical prostatectomy (RP) varies between studies. This may be due not only to the definition of incontinence applied, but also how the information is acquired. We investigated the differences in perception of post robot-assisted laparoscopic RP (RALP) urinary incontinence acquired through doctor interviews and patient-reported questionnaires. MATERIALS AND METHODS: Of 238 consecutive men who underwent RALP by a single surgeon between July 2005 and February 2008, we evaluated 66 men using the International Consultation on Incontinence Questionnaire (ICIQ) at various time points after surgery. Each patient's ICIQ results were considered to be the patient's perceptions of urinary incontinence. The physician at the same time directly interviewed the patients about the number of pads used and considered complete continence to be equivalent to the use of no pads or safety liners. RESULTS: Of the 66 patients, the physician reported that 34 (51.5%) had obtained complete continence. However, analysis of the questionnaires of these 34 patients revealed that only 5 (14.7%) patients reported that they never leaked during the past 4 weeks. Most patients (11 patients, 32.4%) who did not use any pad did in fact reported leakage of a small or moderate amount of urine about once a day. CONCLUSION: Our results indicate that there are discrepancies in the perception of urinary incontinence between doctor and patient after RALP. Non-use of pads is not equivalent to obtaining complete urinary continence. Therefore, the number of pads used is not a good measure to determine the status of complete urinary continence.

When should Videourodynamic Study be Performed after Correcting the Defect in Patients with Myelodysplasia? / 대한비뇨기과학회지

PURPOSE: Because vesicourethral dysfunction in myelodysplasia patients is a major cause of upper urinary deterioration and urinary incontinence, urodynamic evaluation should be performed as early as possible. We attempted to establish the proper time when videourodynamic study should be performed and which patients require early interventional therapy. MATERIALS AND METHODS: Out of the 222 patients seen in the pediatric urology department, 22 patients underwent correction of myeloplasia defect from January 2001 to September 2004. Preoperatively, the patients were assessed with videourodynamic study, and the postoperative videourodynamic studies were repeated at 2 to 6 months intervals. Four urodynamic parameters (bladder volume, compliance, detrusor activity and detrusor sphincteric synergy) were identified, graded and then added to obtain the urodynamic score. RESULTS: There was no statically significant difference in all urodynamic parameters between the preoperative and postoperative 2 month videourodynamic studies, but a statistically significant difference was noted in compliance between the preoperative and postoperative 6 month videourodynamic studies. The compliance was more decreased in the patients who had received surgical correction in their older age and high detrusor activity was observed for these patients on the preoperative videourodynamic study. CONCLUSIONS: Postoperative videourodynamic study and early treatment are recommended for the patients who are at high risk for upper urinary tract deterioration. However, for the low risk patients, postoperative 2 month videourodynamic study can prevent unnecessary treatment.

Effect of 5alpha-Reductase Inhibitor in Expression of Transforming Growth Factor-beta1 in Benign Prostatic Hyperplasia Patients / 대한비뇨기과학회지

Purpose: Transforming growth factor (TGF)-beta is a member of the superfamily of polypeptides, which control cell cycle progression and a variety of other cellular activities. TGF-beta1 has been implicated as an effector of the induction of apoptosis in response to 5alpha-reductase inhibitor (5ARI) and; therefore, causes a decrease in the prostate volume. We investigated the effect of 5ARI in the expression of TGF-beta1 in benign prostatic hyperplasia (BPH). Materials and Methods: 50 patients diagnosed with BPH were divided into two groups. The control group (n=30), in which a transurethral resection of the prostate (TURP) was performed without medication, and the 5ARI group (n=20), who were administrated with 5 mg of 5ARI daily for at least 3 months, followed by TURP. The resected specimens were stained with anti-rabbit TGF-beta1 polyclonal antibody using immunofluoroscent staining. The expression of TGF-beta1 was analyzed with a confocal laser scanning microscope and an image analyzer. The mRNA level of TGF-beta1 was determined by reverse transcriptase-polymerase chain reaction (RT-PCR). Results: There were no statistical differences in the patient characteristics, including age, serum prostate-specific antigen (PSA) level and prostate volume, between the two groups. The expression of TGF-beta1 was demonstrated in the luminal epithelium and smooth muscle cells in BPH. TGF-beta1 was more strongly expressed in the luminal epithelium of both groups, and in the 5ARI group than the control (p<0.001). Conclusions: These results suggest that 5ARI up-regulates the expression of TGF-beta1 in BPH patients, and may a play role as an inhibitor in the proliferation of BPH through the TGF-beta1 signal pathway.