Trial Comparing a Combined Regimen of Amikacin and Ciprofloxacin to Ciprofloxacin Alone as Transrectal Prostate Biopsy Prophylaxis in the Era of High Fluoroquinolone-Resistant Rectal Flora

BACKGROUND: To investigate whether addition of amikacin to fluoroquinolone (FQ) antimicrobial prophylaxis reduces infections after transrectal ultrasound-guided prostate biopsy (TRUSPB). METHODS: A total of 503 patients undergoing rectal swab were divided into three groups. Patients with FQ-sensitive rectal flora (group 1, n = 248) were administered ciprofloxacin before TRUSPB, and patients with FQ-resistant rectal flora were either administered ciprofloxacin (group 2, n = 97) or amikacin and ciprofloxacin (group 3, n = 158) before TRUSPB. RESULTS: Based on the rectal swab, FQ resistance was 54.9%, and extended-spectrum β-lactamase (ESBL) positivity was 17.2%. The incidence of infectious complication in group 1 was 1.6%. Groups 2 and 3, with FQ-resistant rectal flora, tended to have increased infectious complications (5.2% and 4.4%, respectively) but the difference between those results is not statistically significant. The most common pathogens of infectious complications in patients with FQ-resistant rectal flora were FQ-resistant and ESBL-producing Escherichia coli. E. coli pathogens isolated in Group 3 were amikacin-susceptible species. The operation history and ESBL positivity of rectal flora increased the incidence of infectious complications (odds ratio [OR] = 3.68; P = 0.035 and OR = 4.02; P = 0.008, respectively). DM and antibiotics exposure were risk factors for FQ resistance (OR = 2.19; P = 0.002) and ESBL positivity of rectal flora (OR = 2.96; P = 0.005), respectively. CONCLUSION: Addition of amikacin to ciprofloxacin prophylaxis could not reduce infectious complications in patients with FQ-resistant rectal flora. Despite the amikacin sensitivity of infectious complications, single-dose amikacin addition to ciprofloxacin prophylaxis has limitations.

The Adverse Effects of Cardiovascular Risk Factors on Lower Urinary Tract Symptoms and Erectile Function / 대한남성과학회지

PURPOSE: There are several reports about relationships between cardiovascular risk factors and lower urinary tract symptoms (LUTS). We investigated the effects of risk factors for vascular disease on LUTS and erectile function (ED). MATERIALS AND METHODS: We prospectively analyzed 273 patients who had LUTS or ED. A self administered questionnaire of International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) were given to patients. Cardiovascular risk factors including hypertension, smoking status, diabetes and dyslipidemia were determined in each patients. RESULTS: Mean age was 60.5+/-9.4 years. Mean IPSS, IIEF and IIEF-EF score were 15.9+/-5.9, 30.1+/-15.4 and 17.35+/-9.0, respectively. There are statistically significant differences in the IPSS (p=0.047), IIEF (p=0.024) and IIEF-EF domain score (p=0.044) between men with no risk factors and men with one or more risk factors. IPSS, IIEF and IIEF-EF score were 11.5+/-6.4, 39.8+/-11.9 and 19.6+/-8.7 in men with no risk factor (n=94), 16.6+/-5.6, 28.4+/-15.0 and 15.1+/-9.3 in men with at least one risk factor (n=179). In men with one to four risk factors, the mean IPSS was 14.5+/-5.1 (n=63), 16.3+/-4.4 (n=45), 21.2+/-5.5 (n=43) and 26.5+/-3.5 (n=28)(p=0.001); the mean IIEF score was 31.4+/-14.2, 27.8+/-16.8, 22.5+/-14.1 and 19.0+/-9.9 (p=0.037); the mean IIEF-EF score was 17.1+/-8.9, 14.7+/-9.0, 10.9+/-9.7 and 8.8+/-4.5 (p=0.023), respectively. CONCLUSIONS: Men with risk factors for vascular disease are more likely to have a higher IPSS and a lower IIEF and IIEF-EF score than men without risk factors. These results suggests that vascular disease of men is significantly related with the progression of LUTS and ED.

Comparison of the Efficacy of Antibiotic Monotherapy and Antibiotic Plus Alpha-blocker Combination Therapy for Patients with Inflammatory Chronic Prostatitis/Chronic Pelvic Pain Syndrome / 대한비뇨기과학회지

PURPOSE: The objectives of this study was to compare the efficacy of antibiotic monotherapy with antibiotic plus alpha-blocker combination therapy for the treatment of inflammatory chronic pelvic pain syndrome (CPPS) patients. MATERIALS AND METHODS: Between October 2005 and May 2006, 69 patients who were diagnosed as CPPS(National Institutes of Health; NIH-catagory IIIa), were included in this study. The patients were randomly placed into two groups: group I was treated with gatifloxacin alone(35 patients), and group II was treated with gatifloxacin and doxazosin(34 patients) for 6 weeks. For all the patients, the urinalysis, expressed prostatic massage, the National Institute of Health-Chronic Prostatitis Symptom Index(NIH-CPSI) and a distal rectal examination(DRE) were performed at the initial visit. The NIH-CPSI was compared both before and after the treatment. RESULTS: On the initial diagnosis, the mean CPSI of the group I patients was 24.0+/-6.3, and that for the group II patients was 24.7+/-6.9. After the treatment, that of the group I was 16.6+/-5.4, and that of group II was 13.4+/-5.3. After 6 weeks of treatment, the changes in the total CPSI scores had significantly improved in group II compared with group I(p<0.05). A statistically significant improvement occurred in the pain score, the voiding symptom score and the quality of life in the group II compared with group I(p<0.05) CONCLUSIONS: This study suggests that combination therapy of antibiotic plus alpha-blocker would be more effective than antibiotic monotheraphy for treating patients with inflammatory chronic prostatitis/chronic pelvic pain syndrome.

Effects of Mesenchymal Stem Cells on Stress Incontinence in a Rat Model / 대한비뇨기과학회지

PURPOSE: Several study trials have used stem cells to treat stress incontinence in an animal model. In this study, we compared injecting either periurethral mesenchymal stem cells(MSC) or normal saline(C) to increase the leak point pressure(LPP) and closing pressure(CP) in a rat model of stress urinary incontinence. MATERIALS AND METHODS: Sprague Dawley rats(250g each, 12 weeks old) were divided into the MSC group(n=5) and group C(n=5). They were anesthetized and the pudendal nerve was transected bilaterally via a ventral incision in order to denervate the external urethral sphincter. The MSCs were obtained from both femurs of Sprague Dawley rats(150g each, 6 weeks, n=10). After 1 week, the MSCs were stained by 4'-6-diamidino- 2-phenylindole(DAPI), which was injected into both sites of the proximal external urethra(n=1.5x10(6)). At 3 weeks after injection, cystometry was performed and this was followed by cord transection at the T9-10 level with the rat under anesthesia. Visually identified LPP and CP measurements were evaluated with using a vertical tilt/intravesical pressure clamp. The urethral tissues of the rats were harvested for histology. RESULTS: Both the LPP and CP measurements were significantly higher in the MSC group when compared with that of the C group(p<0.05). The mean LPP of the MSC group and group C was 42.3+/-2.1cmH2O and 25.8+/-1.7cmH2O, respectively. The mean CP of the MSC group and group C was 31.7+/-2.5cmH2O and 21.3+/-1.1cmH2O, respectively. The existence of DAPI-stained MSCs in the injected periurethral tissue was verified by histology after the completion of the study. CONCLUSIONS: Injection of MSCs into the periurethal tissue after transection of the bilateral pudendal nerve in rats led to an increase in the LPP and CP. This finding suggests that MSCs can be used as one of the potentially effective cell therapies for stress urinary incontinence.

Effects of Mesenchymal Stem Cells on Stress Incontinence in a Rat Model / 대한비뇨기과학회지

PURPOSE: Several study trials have used stem cells to treat stress incontinence in an animal model. In this study, we compared injecting either periurethral mesenchymal stem cells(MSC) or normal saline(C) to increase the leak point pressure(LPP) and closing pressure(CP) in a rat model of stress urinary incontinence. MATERIALS AND METHODS: Sprague Dawley rats(250g each, 12 weeks old) were divided into the MSC group(n=5) and group C(n=5). They were anesthetized and the pudendal nerve was transected bilaterally via a ventral incision in order to denervate the external urethral sphincter. The MSCs were obtained from both femurs of Sprague Dawley rats(150g each, 6 weeks, n=10). After 1 week, the MSCs were stained by 4'-6-diamidino- 2-phenylindole(DAPI), which was injected into both sites of the proximal external urethra(n=1.5x10(6)). At 3 weeks after injection, cystometry was performed and this was followed by cord transection at the T9-10 level with the rat under anesthesia. Visually identified LPP and CP measurements were evaluated with using a vertical tilt/intravesical pressure clamp. The urethral tissues of the rats were harvested for histology. RESULTS: Both the LPP and CP measurements were significantly higher in the MSC group when compared with that of the C group(p<0.05). The mean LPP of the MSC group and group C was 42.3+/-2.1cmH2O and 25.8+/-1.7cmH2O, respectively. The mean CP of the MSC group and group C was 31.7+/-2.5cmH2O and 21.3+/-1.1cmH2O, respectively. The existence of DAPI-stained MSCs in the injected periurethral tissue was verified by histology after the completion of the study. CONCLUSIONS: Injection of MSCs into the periurethal tissue after transection of the bilateral pudendal nerve in rats led to an increase in the LPP and CP. This finding suggests that MSCs can be used as one of the potentially effective cell therapies for stress urinary incontinence.