UROLOGIC DISEASES IN THE EMERGENCY DEPARTMENT.

(Objectives) This paper aimed to report the clinical statistics on urologic diseases treated in the emergency department (ED). (Patients and methods) We retrospectively evaluated 1,480 patients diagnosed with urologic diseases in the ED between January 2013 and December 2014. We reviewed the patients' sex, age, main complaints, emergency grade, care-seeking process, hospitalization, examination items, and diagnosis. We also reviewed the correct-diagnosis rates of patients who visited the ED for the first time and were followed up at the urology department. (Results) Of the patients, 2.6% were diagnosed as having a urologic disease, with a male-to-female ratio of 1.5:1. The age distribution ranged from 0 to 101 years, with a median age of 53 years. Patients who required hospitalization accounted for 17.8%. The diagnoses were urolithiasis (546 cases), cystitis (220 cases), and pyelonephritis (137 cases), in order of frequency. The correct-diagnosis rates of urolithiasis (91.2%), benign prostatic hyperplasia (75.0%), and pyelonephritis (71.9%) were high. However, those of testicular torsion (0%), urologic neoplasm (26.7%), prostatitis (35.7%), and epididymitis (35.7%) were low. (Conclusion) In the ED, 82.2% of cases of urologic diseases were mild and did not require hospitalization. The correct-diagnosis rate of acute scrotum was low, as it was difficult to diagnose and thus difficult to manage in the ED. Therefore, urologists should cooperate with ED staff and warn them that cases of acute scrotum should be subjected to emergency consultation.

Biofilm formation among methicillin-resistant Staphylococcus aureus isolates from patients with urinary tract infection.

Staphylococci have been confirmed to form biofilms on various biomaterials. The purpose of this study was to investigate biofilm formation among methicillin-resistant Staphylococcus aureus (MRSA) isolates from patients with urinary tract infection (UTI) and to assess the relationship between biofilm-forming capacities and virulence determinants/clinical background. Over a 12-year period from 1990 through 2001, a total of 109 MRSA isolates were collected from patients (one isolate per patient) with UTI at the urology ward of Okayama University Hospital. We used the in vitro microtiter plate assay to quantify biofilm formation. We then investigated the presence of several virulence determinants by polymerase chain reaction assay and found eight determinants (tst, sec, hla, hlb, fnbA, clfA, icaA, and agrII) to be predominant among these isolates. Enhanced biofilm formation was confirmed in hla-, hlb-, and fnbA-positive MRSA isolates, both individually and in combination. Upon review of the associated medical records, we concluded that the biofilm-forming capacities of MRSA isolates from catheter-related cases were significantly greater than those from catheter-unrelated cases. The percentage of hla-, hlb-, and fnbA-positive isolates was higher among MRSA isolates from catheter-related cases than those from catheter-unrelated cases. Our studies suggest that MRSA colonization and infection of the urinary tract may be promoted by hla, hlb, and fnbA gene products.

Role of fosfomycin in a synergistic combination with ofloxacin against Pseudomonas aeruginosa growing in a biofilm.

We examined the combined effect of fosfomycin and ofloxacin against Pseudomonas aeruginosa biofilms of four clinical isolates with different susceptibilities to ofloxacin. A clear synergistic effect was detected in all four strains in accordance with their susceptibilities to ofloxacin. To clarify the mechanism of this synergistic action, changes in cellular accumulation of ofloxacin into fosfomycin-pretreated cells and morphological changes in cells treated with fosfomycin, ofloxacin, or fosfomycin plus ofloxacin were investigated. Pretreatment with fosfomycin significantly enhanced cellular uptake of labeled or unlabeled ofloxacin in biofilm cells as well as in floating cells. The accumulation of ofloxacin into fosfomycin-pretreated biofilm cells was further enhanced by treating cells simultaneously with ofloxacin and fosfomycin. Morphological studies using scanning electron microscopy (SEM), transmission electron microscopy (TEM), and confocal laser scanning microscopy (CLSM) demonstrated that fosfomycin induced dramatic changes in cell shape and the outer membrane structure responsible for the altered membrane permeability of both surface and embedded biofilm cells. The resulting increased accumulation of ofloxacin in multilayers of biofilm cells was correlated with the kinetics of biofilm cell eradication, and this synergistic killing effect was confirmed by a combined study using SEM, TEM, and CLSM.

[A Japanese version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI, Okayama version) and the clinical evaluation of cernitin pollen extract for chronic non-bacterial prostatitis].

PURPOSE: The chronic prostatitis syndromes are common disorders in urologic practice and present various clinical symptoms. The development of a chronic prostatitis symptom index appropriate for judgment of therapeutic effects is awaited since the pathophysiology and appropriate treatment are not well defined so far. We developed a Japanese version of the National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI, Okayama version), and examined its usefulness. In addition, we evaluated clinical effects of Cernilton for chronic nonbacterial prostatitis using this symptom index. SUBJECTS AND METHODS: A total of 87 patients including 34 patients with NIH chronic prostatitis category III, 35 patients with BPH and 18 patients for control group who visited the Department of Urology at Okayama University Medical School filled in the questionnaire of our Japanese version of the NIH-CPSI to compare the NIH-CPSI scores among three groups. Twenty-four patients with NIH chronic prostatitis category III (IIIa 16, IIIb 8) were treated with Cernilton and the NIH-CPSI scores were examined before and after its administration. RESULTS: The pain/discomfort domain score was 9.79 (mean) in the chronic prostatitis group, 1.66 in the BPH group and 0.39 in the control group; that of the urinary symptom domain was 3.82, 3.29 and 0.72, respectively; and that of the quality of life (QOL) was 8.21, 4.17 and 1.39, respectively. The pain/discomfort domain score was significantly higher in the chronic prostatitis group than in the other groups; the QOL domain score was higher in the order of the chronic prostatitis group, the BPH group and the control group. In the chronic prostatitis group, there was a significant, positive correlation between the pain/discomfort domain score and that of the QOL, and between the urinary symptom domain score and that of the QOL. These results suggested the usefulness of our Japanese version of the NIH-CPSI as a parameter of the severity of chronic prostatitis. Examination of changes in the NIH-CPSI scores revealed that scores of the items in all domains were significantly lower 4 to 6 weeks after the start of administration of Cernilton than those obtained before the drug administration in patients with chronic prostatitis. CONCLUSIONS: A Japanese version of NIH-CPSI (Okayama version) accurately reflects clinical symptoms and the QOL in patients with chronic prostatitis. It seemed to be a useful and appropriate system for scoring symptoms of chronic prostatitis, indicating further studies on translation, adaptation and validation of the NIH-CPSI in Japan.