Virulence factors and susceptibility patterns of candida species isolated from patients with obstructive uropathy and bladder cancer

Candiduria is a common and high risk event in patients with uropathies and cancer. In this study we investigated the distribution of 3 virulence factors namely: biofilm formation [BF], secreted aspartyl proteinase [SAP] and phospholipase activity [PLA] among different Candida species isolated from inpatients with candiduria. The susceptibility patterns of Candida isolates to antifungal agents, including the new voriconazole, were evaluated in vitro and the association of these virulence factors with resistance was studied. Urine specimens from 250 patients divided into 3 groups were examined: Group1 [n=50] cancer bladder; Group2 [n=100] obstructive uropathy and Group 3 [n=100] simple recurrent urinary tract infection [UTI]. Candida isolates were identified by CHROM-agar, and by Candifast Es Twin test. Susceptibility testing to antifungal agents was evaluated by disc diffusion test using fluconazole [FCZ] 30microg discs and E test strips for Minimum inhibitory concentration [MIC] determination of FCZ, voriconazole [VCZ] and Amphotericin B [AMB]. Assessment of BF was performed by tube and spectrophotometric plate adherence methods and quantitated by crystal violet staining and XTT reduction assays. PLA was screened using Sabouraud egg yolk agar and SAP was detected using bovine serum albumin agar [BSA]. The overall prevalence of candiduria was 24% with highest incidence among obstructive uropathy patients [67.2%]. Isolation rate of Candida [C]. nonalbicans species [C. tropicalis ,C. krusei and C. glabrata] was significantly higher than C. albicans [73.1% versus 26.8%; p256microg/ml]. Voriconazole, the new triazole antifungal agent, was active against all isolated Candida species with a sensitivity rate of 82%-100% and low MIC values [0.064-1microg/ml] except in C. glabrata species [22%]. All isolated Candida species were more sensitive to VCZ compared to FCZ; particularly C. krusei isolates [90% versus 9%]. AMB remained to be an effective drug with absolute sensitivity and low MIC

Extended pyelonephrolithotomy [modified resnick S technique] for the management of stagging renal stones

Seventeen patients with stagging renal stones extending mainly to lower calyces with or without multiple calyceal stones or extensions, 13 with intrarenal pelves were included in our study. We used a combination of Gil- vernet [s extended pyelolithotomy technique and Resnick[spyelo-nephrototomy technique. None of our cases needed blood Transfusion, none had serious post- operative bleeding and none developed hypertension during a follow- up period of 3 years. Only 1 patient had residual calyceal stone that was managed later by ESWL. We concluded that this is a safe operative technique for the management of some stanging renal stones, with low rate of complications.

hemodynamics of sexual dysfunction following nerve sparing Radical cystoprostatectomy

Fourteen patients with invasive bladder cancer underwent penile duplex scanning and dynamic infusion cavemosometry preoperatively to assess arterial and venous hemodynamics. Nine of these patients were impotent after nerve sparing Radical cystoprostatectomy and had repeated duplex scanning and cavemosornetry six months postoperatively. On penile duplex all 9 patients had arterial insufficiency on at least one side in-spite of individual vesical arteries ligation. On dynamic cavernosometry. 2 patients had the criteria suggestive of corporoveno-occlusive dysfunction. We concluded that impotence following nerve sparing radical cystoprostatectomy is predominantly arterial in nature. The possible causes and points of technique are discussed