ABSTRACT
INTRODUCTION: In urology, antibiotic prophylaxis is advised by the French Association of anesthesiology (SFAR) and the Infectious Disease Committee of the French Association of urology guidelines published in 2010. No guideline exists concerning the implantation of neuromodulation implants. MATERIAL AND METHOD: A literature analysis was performed on sacral modulation and antibiotic prophylaxis. Then guidelines were discussed by reviewers. Items that showed no consensus were then discussed again to arrive at recommendations. RESULTS: Antibiotic prophylaxis is recommended during the test phase as well as in the case of installation of sacral neuromodulation (Grade C). Antibiotic recommended (Grade B) are: cefotetan or cefoxitin, 2g dose by slow intravenous injection or amoxicillin-clavulanic acid at a dose of 2 g, intravenously or, in the case of allergy vancomycin at a dose of 15 mg/kg or the clindamycin has 600 mg intravenously. CONCLUSIONS: Despite the lack of high level of evidence, antibiotic prophylaxis seems necessary when setting up of electrode case of sacral neuromodulation.
Subject(s)
Antibiotic Prophylaxis/standards , Electric Stimulation Therapy , Electrodes, Implanted , Prosthesis-Related Infections/prevention & control , Humans , Urinary Incontinence/therapy , Urinary Retention/therapyABSTRACT
The candiduria are frequently encountered in urology. We present the recommendations of the Infectious Diseases Committee of the French Association of Urology for diagnosis, treatment and monitoring of urinary tract infections. C. albicans is the most frequently isolated species, representing 60% of the isolates. Immunosuppression, diabetes mellitus, age extremes of life, the presence of catheters or procedures on the urinary tract are risk factors for Candida urinary tract infection. The candiduria is usually asymptomatic and does not need treatment. Only 4-14% of patients with candiduria have symptoms of urinary infection. It is necessary before choosing candiduria isolated on a first urinalysis to eliminate contamination by conducting a second harvest. In patients surveyed, the removal of the material allows the resolution of the candiduria nearly half the time and represents the first step of management. Oral fluconazole is the recommended treatment for cystitis (400 mg on day 1 and 200 mg daily for 7 to 14 days). In cases of pyelonephritis without associated candidemia, the first-line therapy is fluconazole (3-6 mg/kg/day) for 14 days or amphotericin B at a dose of 0.5 to 0.7 mg/kg/day with or not associated to flucytosine when potentially resistant strain (C. glabrata).
Subject(s)
Candidiasis/diagnosis , Candidiasis/drug therapy , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Algorithms , Candidiasis/urine , Humans , Urinary Tract Infections/urineABSTRACT
Resistance progression of the Neisseria gonorrhoeae to quinolones and the decreasing sensitivity to cephalosporin implicate to actualise the guidelines for managing urethritis. We present the guidelines from the committee of infectious diseases of the French Association of Urology to manage acute urethritis.
Subject(s)
Urethritis/diagnosis , Urethritis/drug therapy , Humans , Male , Urethritis/microbiologyABSTRACT
The French Association of anesthesiology (SFAR) has published in 1999 the Antibiotic prophylaxis guidelines. Antibiotic resistance has increased and new procedures appeared so new recommendations were needed. We present the antibiotic prophylaxis guidelines from the committee of infectious diseases of the French Association of Urology.
Subject(s)
Antibiotic Prophylaxis/standards , Urologic Diseases/drug therapy , Anesthesiology , France , Humans , Practice Guidelines as Topic , Societies, Medical , Urologic Diseases/economics , Urologic Diseases/surgery , UrologySubject(s)
Research Design , Bacterial Infections/diagnosis , Bacterial Infections/therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Evidence-Based Medicine , Female , Humans , Male , Practice Guidelines as Topic , Textbooks as Topic , Urologic Diseases/diagnosis , Urologic Diseases/therapyABSTRACT
Urinary tract infections are frequent. The aim of these guidelines is to improve the management of urionary tract infections. Increasing antibiotic prescriptions may increase bacterial drug resistance. Asymptomatic bacteriuria, bacterial count, pyuria are defined and the clinical value of the bacterial culture and urinary dipstick test are discussed. The good antibiotic use depends on bacteriological, pharmaceutical, patient characteristics and economic findings which are precised in these guidelines.
Subject(s)
Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Urologic Diseases/diagnosis , Urologic Diseases/drug therapy , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacteriuria/diagnosis , Colony Count, Microbial , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Drug Resistance, Bacterial , Female , Humans , Leukocyte Count , MaleABSTRACT
The management of uncomplicated lower urinary tract infections (UTI) implicate to look for risk factors and complications. Bacterial or radiological exams are not recommanded and short course of antibiotic is effective for treating uncomplicated UTI. Complicated UTI needs clinical, bacteriological and radiological exams, longer treatments are recommanded. Recurrent UTI definition is precised in these guidelines.
Subject(s)
Cystitis/diagnosis , Cystitis/drug therapy , Acute Disease , Anti-Bacterial Agents/therapeutic use , Cystitis/etiology , Female , Humans , Male , Postmenopause , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/drug therapy , Pregnancy Complications/etiology , Recurrence , Risk Factors , Urinary Tract Infections/complications , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapyABSTRACT
The initial management of pyelonephritis needs to look for complicating factors. Ultrasound and X ray of the abdomen are able to rule out a urinary dilatation or a stone. The treatment is then surgical with renal drainage. Additional investigations such as a CT scan should be performed in patients with complicating factors or recurrence. In uncomplicated pyelonephritis a ambulatory treatment with 2 weeks of fluoroquinolones or cephalosporine Gr3 is sufficient. More severe cases should be admitted to a hospital and treated with initial cephalosporin Gr 3 plus aminoside for 3 to 6 weeks.
Subject(s)
Pyelonephritis/diagnosis , Pyelonephritis/therapy , Acute Disease , Anti-Bacterial Agents/therapeutic use , Drainage , Female , Humans , Male , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/therapy , Ultrasonography , Urinary Tract/diagnostic imaging , UrographyABSTRACT
A urinary infection in a febrile man is classiquely defined as a prostatitis. Investigation exams look for complicating factors or post voiding residual which should be drained. Antibiotic treatment should begin with a fluroquinolone or cephalosporin gr 3 for 3 to 6 weeks.
Subject(s)
Prostatitis/diagnosis , Prostatitis/drug therapy , Acute Disease , Anti-Bacterial Agents/therapeutic use , Humans , Male , Prostatitis/classificationABSTRACT
The Valtrac ring is a biofragmentable ring used for gastrointestinal anastomoses. Over a two-year period, 15 anastomoses in 16 patients (mean age: 60 years) were performed with the Valtrac ring: 10 ileal, 4 ileocolonic, and 1 jejunojejunal anastomoses. One anastomosis could not be performed because of an excessively narrow ileal lumen. The mean stay in the intensive care unit was 3 days: gastric aspiration was maintained for an average of 1 week, as return of gastrointestinal motility was long, with first flatus on the 6th day and the first stools on the 7th day. Complications consisted of 2 cases of gastrointestinal fistula (11th and 13th days) one of which was fatal, evisceration on the 7th day, a transient partial bowel obstruction and one bowel obstruction treated medically on the 27th day, due to pancreatitis. Our results are not identical to those reported in the literature. It is often difficult to insert the current form of the Valtrac ring into a healthy ileum, as the smallest ring is often too large. In contrast with gastrointestinal surgery, the anastomoses performed in urology involve a non-thickened, non-distended small intestine.
