Prevalence of and Risk Factors for Levofloxacin-Resistant E. coli Isolated from Outpatients with Urinary Tract Infection

PURPOSE: Levofloxacin has been widely used because of its broad spectrum and excellent penetration of the prostate. But levofloxacin-resistant Escherichia coli (E.coli) has been reported all over the world. We analyzed the annual levofloxacin resistance of E. coli and its risk factors. MATERIALS AND METHODS: From 2005 to 2009, we retrospectively analyzed patients who had undergone a urine analysis and a urine culture at the Outpatient Section of the Department of Urology of Kwangju Christian Hospital. Among them, we chose 509 patients infected by E. coli and evaluated the resistance rate to levofloxacin and its risk factors. RESULTS: The annual rates of levofloxacin resistance of E. coli were 29.49% in 2005, 26.51% in 2006, 40.21% in 2007, 43.20% in 2008, and 31.75% in 2009. A close correlation with the resistance rate was shown in cases that had underlying neurogenic bladder (p=0.002, odds ratio [OR]=4.236), a history of ciprofloxacin (p<0.001, OR=3.753) and levofloxacin (p<0.001, OR=2.996) administration for at least 48 hours in the past year, urolithiasis (p=0.003, OR=3.317), and older age (p<0.001, OR=1.027). CONCLUSIONS: This study from 2005 to 2009 showed that the levofloxacin resistance rates of E. coli were high at over 25%. The risk factors that affected the levofloxacin resistance rates of E. coli were underlying neurogenic bladder, ciprofloxacin administration history, urolithiasis, levofloxacin administration history, and older age. Levofloxacin should be prescribed cautiously in patients with these risk factors until the pathogen is identified.

Prevalence of and Risk Factors for Levofloxacin-Resistant E. coli Isolated from Outpatients with Urinary Tract Infection

PURPOSE: Levofloxacin has been widely used because of its broad spectrum and excellent penetration of the prostate. But levofloxacin-resistant Escherichia coli (E.coli) has been reported all over the world. We analyzed the annual levofloxacin resistance of E. coli and its risk factors. MATERIALS AND METHODS: From 2005 to 2009, we retrospectively analyzed patients who had undergone a urine analysis and a urine culture at the Outpatient Section of the Department of Urology of Kwangju Christian Hospital. Among them, we chose 509 patients infected by E. coli and evaluated the resistance rate to levofloxacin and its risk factors. RESULTS: The annual rates of levofloxacin resistance of E. coli were 29.49% in 2005, 26.51% in 2006, 40.21% in 2007, 43.20% in 2008, and 31.75% in 2009. A close correlation with the resistance rate was shown in cases that had underlying neurogenic bladder (p=0.002, odds ratio [OR]=4.236), a history of ciprofloxacin (p<0.001, OR=3.753) and levofloxacin (p<0.001, OR=2.996) administration for at least 48 hours in the past year, urolithiasis (p=0.003, OR=3.317), and older age (p<0.001, OR=1.027). CONCLUSIONS: This study from 2005 to 2009 showed that the levofloxacin resistance rates of E. coli were high at over 25%. The risk factors that affected the levofloxacin resistance rates of E. coli were underlying neurogenic bladder, ciprofloxacin administration history, urolithiasis, levofloxacin administration history, and older age. Levofloxacin should be prescribed cautiously in patients with these risk factors until the pathogen is identified.

Epidemiologic Study of the Prevalence and Awareness of Cryptorchidism, Hydrocele, and Varicocele in Elementary Schools in Gwangju

PURPOSE: We investigated the prevalence and parent's concern of cryptorchidism, hydrocele and varicocele among elementary school boys. MATERIALS AND METHODS: A total of 1,795 elementary school boys who resided in Gwangju were investigated by questionnaires. Among them, 1,115 boys who agreed to a physical checkup underwent physical examination between May and June 2007. RESULTS: The most frequent anomaly was hydrocele, which was seen in 37 boys (3.31%) on questionnaires and physical examination. The other anomalies were cryptorchidism in 17 boys (1.52%) and varicocele in 7 boys (0.62%). Most of the boys and their parents were not aware of their cryptorchidism (70.58%) and varicocele (71.42%). The boys who replied in questionnaires that they had been diagnosed with hydrocele appeared to had undergone hydrocele repair in the past. CONCLUSIONS: By survey, the prevalence rates of cryptorchidism, hydrocele, and varicocele were 3.31%, 1.52%, and 0.62%, respectively. Education of the public and primary care physicians about cryptorchidism and varicocele and a screening system are needed to achieve better therapeutic outcome.

A Case of Latzko Partial Colpocleisis for Treating Huge Vesicovaginal Fistula

Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula. VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary leakage of urine into the vaginal canal. In addition to the medical sequelae from these fistulas, they often have a profound effect on the patient's emotional well-being. In the past it was mostly by obstetric causes. But now a days, posthysterectomy fistulas are most commonly seen. In 1914, Latzko published his partial colpocleisis technique for repair of posthysterectomy VVF, in which he employed the resection of scarred vaginal mucosa and a layered horizontal closure. Latzko's procedure has been cited, with his 95-100% success rates noted. Recently we experienced a case of huge vesicovaginal fistula. The patient is a 67-year-old woman with a history of constant urine leakage. The problem began after she had undergone total abdominal hysterectomy 30 years ago for uterine ruture. We repaired it by Latzko partial colpocleisis.

Study on the Effects and Safety of Propofol Anesthesia during Cystoscopy / 대한비뇨기과학회지

Purpose: Cystoscopy, as with other endoscopic procedures, is a fearful and painful for the majority of patients. To this reduce fear, pain and discomfort, the routine administration of sedative drugs, such as midazolam and propofol, is widely accepted for a gastrointestinal endoscopy. There have also been some studies on midazolam anesthesia during cystoscopy. However, the effects and safety of propofol anesthesia during cystoscopy have not been established. Therefore, the effects and safety of propofol anesthesia during cystoscopy were investigated in this study. Materials and Methods: 200 male patients were divided into 2 groups: Group A consisted of 80 patients sedated using 1mg/kg propofol IV, and group B consisted of 120 patients who received normal saline IV instead of propofol. All patients received 90mg diclofenac IM for pain control. There were no significant differences in the ages and weights between the two groups. The vital signs and oxygen saturation were monitored before, during and after the cystoscopy. The degree of pain and satisfaction of the patients and urologist were measured. Results: The pain scales were significantly reduced in group A compared to group B. Group A patients and the operator were also significantly more satisfied than those in group B. Although the blood pressure, pulse rate or respiratory rate changed during the cystoscopy, they were not clinically significant and there was no need for additional treatment. 12 patients in group A showed temporary hypoxia; however, they were treated with oxygen administration and recovered within several minutes. Conclusions: Propofol anesthesia during cystoscopy can be performed safely and effectively as an outpatient procedure, as long as there is adequate preparation and monitoring.

Ureteroscopic Removal of Multiple Renal Pelvis and Lower Calyceal Stones / 대한비뇨기과학회지

The goal of surgical stone management is to achieve maximal stone clearance with minimal morbidity to the patient. Because of its efficacy, efficiency and low morbidity, extracorporeal shock wave lithotripsy(ESWL) is the first-line treatment for almost all urinary calculi. However, stone clearance after ESWL has been shown to be affected by the stone burden, location, chemical composition and kidney anatomy. Especially, the success rate for ESWL is reduced in lower pole stone(LPS). Percutaneous nephrolithotomy(PNL) and retrograde ureteroscopic intrarenal surgery(RIRS) are alternative treatment options for stones refractory to ESWL such as LPS. Although effective, PNLsubjects the patient to increased morbidity compared to ESWL and RIRS. Because of its low morbidity and relatively high success rate, RIRS for LPS is an attractive treatment modality in selective patients. We report a case of multiple renal pelvis and lower calyceal stones treated with ureteroscopy.

Capillary Hemangioma of the Testis / 대한비뇨기과학회지

Capillary hemangioma of the testis is extremely rare. Because it is difficult to differentiate from malignant testicular tumors clinically and radiologically, radical orchiectomy is usually performed. Although the fate of hemangiomas of the testis left untreated is unknown, there is no evidence that hemangiomas become malignant. We report a case of a 2-year-old child with capillary hemangioma of the testis which was diagnosed as a malignant tumor preoperatively.

Prevalence of Varicoceles in Children and Adolescents in Namhae-gun / 대한비뇨기과학회지

PURPOSE: The aim of this study was to elucidate the current incidence of varicoceles in unselected Korean children and adolescents. MATERIALS AND METHODS: 4271 Korean school boys aged 7-18, resided in Namhaegun, Gyungnam province were investigated. The study population comprised more than 95% (4271/4403) of all boys in the respective age in a rural country with a total population of 61,820 (29,840 males and 31,980 females). All examinations were carried out by a single urologist from March to June 2000. The patients with varicocele were divided according to the classification of Dubin-Amelar. RESULTS: No case of varicocele was encountered in 1,233 boys between 7 to 10 years, while the incidence in the 3,038 boys aged 11 to 18 years was 9.61% (292 boys). There was a peak varicocele incidence from aged 14 to 16 (11.78-13.52%). The proportion of varicocele grades were grade I 21.58% (63/292), grade II 44.68% (131/292), grade III 33.56% (98/292). There were 2 cases of bilateral varicoceles. Other abnormalities found were 7 cryptorchidism (0.16%) and 27 hydroceles (0.63%). In 33 older boys (aged between 16-18) with varicocele, semen analyses were performed and two boys had subnormal sperm concentration. CONCLUSIONS: Our finding of peaking at ages 14 to 16 was parallel with the old Danish report,11 but our incidence was substantially lower than the report of 16.2%.

Two Cases of Blind Ending Duplication of Ureter / 대한비뇨기과학회지

The blind ending duplication of ureter represents a rare anomaly in development of ureteric bud, and may almost be asymptomatic. We report two cases of blind ending duplication of ureter, that were detected incidentally.

Two Cases of Inverted Papilloma of the Ureter / 대한비뇨기과학회지

Although inverted papillomas of urinary tract have been reported, the lesion of the ureter is rare and peculiar tumor characterized by unique microscopic finding. The prognosis of ureteral inverted papilloma is very favorable, only small number progress to higher grade tumor. We report 2 cases of ureteral inverted papilloma which were treated by segmental resection with end-to-end anastomosis of ureter.

Early Experience of Transperineal Prostatic Biopsy under Transrectal Ultrasound Guidance / 대한비뇨기과학회지

To evaluate the role of digital rectal examination(DRE), prostate specific antigen(PSA), transrectal ultrasound(TRUS) and prostate specific antigen density(PSAD) and the effectiveness of TRUS-guided perineal prostatic biopsy in the diagnosis of prostate cancer, the clinical data were reviewed from the 78 patients who were suggested to have prostate cancer with DRE, PSA or TRUS, and pathologically confirmed by TRUS-guided six systematic biopsy between May 1993 and February 1995. Of 78 patients, 15 patients(19.2%) had prostate cancer, 60 patients(76.9%) BPH, 2 patients (2.6%) chronic prostatitis and 1 patient(1.3%) prostatic metastasis from transitional cell carcinoma of the bladder. Only 2 of 15 cancers (13.3%) were localized cancer, while 10 of 15 cancers(66.7%) had distant metastasis. Although 35 patients received TURP among 60 patients with BPH, and their specimens were investigated pathologically whether prostate cancer was present, there was no prostate cancer. Of 34 patients whose PSA levels were below 10ng/ml, none had prostate cancer regardless of the results of DRE and TRUS. PSA had the highest sensitivity(100%) and DRE the highest specificity (79.4%) among the modalities. The positive predictive value of DRE, PSA and TRUS was 48.0%, 22.1% and 36.1% respectively. DRE and TRUS had 54.5% and 44.8% Positive predictive value in patients with elevated PSA level in contrast to 0% positive predictive value in patients with normal PSA level. Because 3 patients of prostate cancer with negative DRE and positive TRUS had elevated PSA level(>20ng/ml), the addition of TRUS to PSA and DRE was not helpful in early detection of prostate cancer. Although PSAD of prostate cancer group and non-prostate cancer group was 1.312+/-0.155(S.E.) and 0.279+/-0.036 respectively(p<0.05), we could not found any superiority of PSAD to PSA in early diagnosis of prostate cancer. In conclusion, these results suggest that PSA and DRE should be used as the first line modality in early diagnosis of prostate cancer, TRUS-guided prostatic biopsy may be considered as a confirmative modality in patients with elevated PSA level or abnormal DRE and the clinical.trials for standardization of the upper normal limit of PSA should be followed.

A Case of Ureteral Nephrogenic Adenoma / 대한비뇨기과학회지

Nephrogenic adenoma is a rare proliferative response of urothelium to chronic irritation or infection. It has been reported in the bladder, ureter, renal pelvis and urethra, but to date there have been only 15 reports, of its occurrence in the ureter. We present a further case of this lesion in this unusual location.

A Case of Urethral Perforation by Foreign Body / 대한비뇨기과학회지

Urethral foreign body extended to bladder and scrotum is very rare. We report a case of urethral perforation by plastic tube extended to bladder and scrotum with brief review of literature.

Coincidental occurrence of renal cell carcinoma and angiomyolipoma in the same kidney : a case report / 대한비뇨기과학회지

Coincidental occurrence of the renal cell carcinoma and renal angiomyolipoma in the same kidney is exceedingly rare, and it is usually presented as separated masses or nodules in cage of its occurrence. However, our case which has occurred in a 37-year-old-man without any stigmata of tuberous sclerosis is different because the angiomyolipoma and renal cell carcinoma are admixed in the same mass. To our knowledge, only 2 cases or combination of this tumors have been reported previously.

A case of asynchromous bilateral nonfunctioning adrenal cortical carcinoma / 대한비뇨기과학회지

Bilateral nonfunctioning adrenal cortical carcinoma is an extremely rare disease with poor prognosis. We report a case of asynchronous bilateral nonfunctioning adrenal cotical carcinoma. The patient was a 55 year-old man who had complained of discomfort in the right upper quadrant and flank area. There was no endocrinological abnomaliries. Abdominal CT revealed about 9.5 x 7.0 cm sized right adrenal mass. Under the impression of nonfunctioning adrenal cortical carcinorna, right radical adrenalectomy was performed. After 1 year from operation, 5.0 x 7.0 x 6.0 cm sized new mass was detected in the left adrenal gland with metastasis to the peritoneum.