Antimicrobial Prophylaxis in Transurethral Resection of the Prostate: Results of a Randomized Trial.

PURPOSE: We sought to determine whether omitting antimicrobial prophylaxis is safe in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative catheter. MATERIALS AND METHODS: We conducted a multicenter randomized controlled trial from September 17, 2017 until December 31, 2019 in 5 hospitals. Patients with pyuria (>100 white blood cells/ml) and a preoperative indwelling catheter were excluded. Postoperative fever was defined as a body temperature ≥38.3C. A noninferiority design was used with a 6% noninferiority margin and null hypothesis (H0) that the infection risk is at least 6% higher in the experimental (E) than in the control (C) group; H0: C (antimicrobial prophylaxis group) - E (no antimicrobial prophylaxis group) ≥ Δ (6% noninferiority margin). A multivariable, logistic regression was performed regarding posttransurethral resection of the prostate fever and antimicrobial prophylaxis with co-variates: (clot-)retention and operating time. The R Project® for statistical computing was used and a p value of 0.05 was considered as statistically significant. RESULTS: Of the patients 474 were included for multivariable analysis and 211/474 (44.5%) received antimicrobial prophylaxis vs 263/474 (55.5%) patients without antimicrobial prophylaxis. Antibiotics were fluoroquinolones in 140/211 (66.4%), cephazolin in 58/211 (27.5%) and amikacin in 13/211 (6.2%) patients. Fever occurred in 9/211 (4.4%) patients with antimicrobial prophylaxis vs 13/263 (4.9%) without antimicrobial prophylaxis (p=0.8, risk difference 0.006 [95% CI -0.003-0.06, relative risk 1.16]). We were able to exclude a meaningful increase in harm associated with omitting antimicrobial prophylaxis (p=0.4; adjusted risk difference 0.016 [95% CI -0.02-0.05]). CONCLUSIONS: Our data demonstrate the safety of omitting antimicrobial prophylaxis in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative indwelling catheter.

Vesicoureteric reflux (VUR) in children: where are we now?

In 1960 Hodson and Edwards published their landmark paper about the association between chronic pyelonefritis and vesicoureteric reflux (VUR). Since then, the approach for VUR became more important (1). In the last 30 years there have been multiple publications on vesicoureteric reflux (VUR) and discussions at Pediatric Urology meetings with the purpose to give answers to the questions what the best treatment is for VUR, at what age the treatment is advocated, does it prevent for febrile urinary tract infections (UTI's) and does it stop of decreases the risk for reflux nefropathy and renal scars Well known are the International Reflux Study (1981) with a European and an American arm in which the researchers compared medical approaches with surgical approaches to reflux, and the Birmingham Reflux study (1987) which was a prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children with five years observation (2). In 2009 the group from John Hopkins (Baltimore, USA) published their interim results from a randomized placebo-controlled study of children with VUR (the RIVUR Study) (3). The most recent randomized controlled trial (RCT) is the Swedish Reflux Trial published in the Journal of Urology 2010, July. This was set up as a RCT to compare 3 treatment alternatives, including antibiotic prophylaxis, endoscopic therapy and surveillance as the control group, in regard to recurrent febrile UTIs, renal damage and VUR status after 2 years (4). Since these new data are available, we want to give an update in this specific and interesting field in Pediatric Urology.

Reflujo vesicoureteral (RVU) en niños: ¿dónde estamos actualmente? / Vesicoureteric reflux (VUR) in children: where are we now?

En 1960 Hodson y Edwards publicaron su memorable trabajo sobre la asociación entre la pielonefritis crónica y el reflujo vesicoureteral (RVU). Desde entonces, el abordaje del RVU se ha vuelto cada vez más importante (1). En los últimos 30 años ha habido múltiples publicaciones sobre el reflujo vesicoureteral (RVU) y discusiones en reuniones de Urología Pediátrica con el propósito de dar respuesta a las preguntas ¿cuál es el mejor tratamiento para el RVU?, ¿a qué edad se aconseja el tratamiento?, ¿previene las infecciones febriles del tracto urinario?, y si el tratamiento consigue detener o disminuir el riesgo de nefropatía por reflujo y de cicatriz renal. Son bien conocidos el Estudio Internacional del Reflujo (1981) con una rama europea y otra estadounidense en el cual se compararon el tratamiento médico y el abordaje quirúrgico del reflujo, y el estudio Birmingham del año (1987) que era un ensayo prospectivo con 5 años de seguimiento, comparando tratamiento quirúrgico y no quirúrgico del reflujo vesicoureteral severo en niños (2). En 2009, el grupo del John Hopkins (Baltimore, USA) publicó sus resultados provisionales de un estudio aleatorizado controlado con placebo en niños con RVU (Estudio RIVUR) (3). El ensayo aleatorizado controlado más reciente es el estudio Sueco sobre Reflujo publicado en Journal of Urology en Julio del 2010. Este fue elaborado como un estudio aleatorizado para comparar 3 alternativas terapéuticas que incluían profilaxis antibiótica, tratamiento endoscópico y vigilancia como grupo control, comparando los resultados de infecciones del tracto urinario (ITUs) recurrentes, daño renal y el estado del RVU después de 2 años de seguimiento (4). En vista de que estos nuevos datos están disponibles, queremos hacer una actualización sobre este campo específico e interesante de la urología pediátrica(AU)

In 1960 Hodson and Edwards published their landmark paper about the association between chronic pyelonefritis and vesicoureteric reflux (VUR). Since then, the approach for VUR became more important (1). In the last 30 years there have been multiple publications on vesicoureteric reflux (VUR) and discussions at Pediatric Urology meetings with the purpose to give answers to the questions what the best treatment is for VUR, at what age the treatment is advocated, does it prevent for febrile urinary tract infections (UTI’s) and does it stop of decreases the risk for reflux nefropathy and renal scars. Well known are the International Reflux Study (1981) with a European and an American arm in which the researchers compared medical approaches with surgical approaches to reflux, and the Birmingham Reflux study (1987) which was a prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children with five years observation (2). In 2009 the group from John Hopkins (Baltimore, USA) published their interim results from a randomized placebo-controlled study of children with VUR (the RIVUR Study) (3). The most recent randomized controlled trial (RCT) is the Swedish Reflux Trial published in the Journal of Urology 2010, July. This was set up as a RCT to compare 3 treatment alternatives, including antibiotic prophylaxis, endoscopic therapy and surveillance as the control group, in regard to recurrent febrile UTIs, renal damage and VUR status after 2 years (4). Since these new data are available, we want to give an update in this specific and interesting field in Pediatric Urology(AU)

Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy--should we reassess our practices for antibiotic prophylaxis?

Although the estimate of the incidence of sepsis following transrectal ultrasound-guided prostate biopsy (TRUSPB) is low, fluoroquinolone-resistant infections after prostate biopsy are being increasingly noted. This study was aimed at determining the prevalence of faecal carriage of fluoroquinolone-resistant Escherichia coli strains before TRUSPB and at evaluating potential predisposing risk factors. The incidence of sepsis after prostate biopsy was determined, and our routine practice for antibiotic prophylaxis for TRUSPB was evaluated. A prospective study was conducted in 342 consecutive patients undergoing prostate biopsy between December 2009 and July 2010. Before TRUSPB, a rectal swab was cultured. The correlation between the presence of fluoroquinolone-resistant strains and plausible risk factors was investigated by the use of a questionnaire. Of the 236 patients included, 22.0% (52/236) harboured ciprofloxacin-resistant E. coli strains. The use of fluoroquinolones in the 6 months before biopsy was associated with an increased risk of faecal carriage of fluoroquinolone-resistant E. coli strains (p <0.01). Faecal carriage of fluoroquinolone-resistant E. coli strains was an important risk factor for infectious complications after TRUSPB (p <0.01). In conclusion, a significant number of patients have faecal carriage of fluoroquinolone-resistant E. coli strains (22.0%) before TRUSPB. The use of fluoroquinolones in the previous 6 months before biopsy is a risk factor for faecal carriage of fluoroquinolone-resistant E. coli strains and for infectious complications after TRUSPB. Hence, the universal administration of fluoroquinolones should be reconsidered.

Can vaginal pH be measured from the wet mount slide?

OBJECTIVES: To assess the accuracy of vaginal pH measurement on wet mount microscopy slides compared with direct measurements on fresh vaginal fluid. We also tested whether differences in accuracy were dependent on the sampling devices used or on the diagnosis of the vaginal infections. STUDY DESIGN: Using a cotton swab, cytobrush or wooden spatula a vaginal fluid specimen was collected from 84 consecutive women attending a vulvo-vaginitis clinic. A pH strip (pH range 4-7, Merck) was brought in contact with the vaginal fluid on the sampling device and on the glass slide after adding one droplet of saline and performing microscopy by two different people unaware of the microscopy results of the clinical exam. Values were compared by Fisher exact and Student's t-tests. RESULTS: pH measurement from microscopy slides after the addition of saline causes systematic increases of pH leading to false positive readings. This is true for all types of disturbance of the flora and infections studied, and was seen in the abnormal as well as in the normal or intermediate pH range. CONCLUSION: Vaginal pH should be measured by bringing the pH strip in direct contact with fresh vaginal fluid without first adding saline.

Recurrent flank pain caused by eosinophilic ureteritis mimicking urinary stone disease: a case report.

Flank pain is caused by a variety of pathologies of which urinary stone disease is the most frequent. Eosinophilic ureteritis is a rare stenosing condition of the ureter. Eosinophilic ureteritis can cause flank pain and/or unilateral hydronephrosis. On pathological examination it is characterised by a marked infiltration of the submucosal layers by eosinophils. A relationship of this condition with atopy, hypereosinophilic syndrome and prior ureteral trauma has been described. Surgical resection of the stenosing segment with end-to-end anastomosis is usually a successful treatment. In some cases of proximal disease total nephro-ureterectomy has been performed. One author describes remission of disease after a prolonged oral corticosteroid regimen. In this article we report another case of eosinophilic ureteritis and discuss different treatment strategies.