ABSTRACT
INTRODUCTION: There are controversies in the literature regarding the need for and duration of antibiotic prophylaxis in patients treated with extracorporeal shock wave lithotripsy (ESWL) who have a negative urine culture before treatment. In order to determine the efficacy of antibiotic prophylaxis in ESWL treatment of patients with proven sterile urine, a randomized trial was performed. METHODS: Patients were randomized for placebo and 1 or 7 days antibiotic prophylaxis (cefuroxime or ciprofloxacin), starting 30 min before ESWL. Post-ESWL studies (immediately and 2 and 6 weeks after ESWL) included patient history, urine culture and Gram stain. RESULTS: After 2 weeks 20% of the patients and after 6 weeks 23% of the patients had bacteriuria, but there was no statistical significance between patients treated with placebo or those receiving prophylactic treatment. Only 2-3% of the patients (in the prophylaxis and placebo group) had clinical and bacteriological signs of a urinary tract infection, either 2 or 6 weeks after ESWL, possibly caused by re-infection, however, since bacteria were found in none of the urine samples collected directly after ESWL. There was no beneficial effect of antibiotic prophylaxis, in the prevention of urinary tract infections in patients with a nephrostomy catheter or dilatation at the site of treatment. CONCLUSION: We conclude that in patients with urine proven sterile prior to ESWL there is no need for antibiotic prophylaxis.
Subject(s)
Anti-Infective Agents/therapeutic use , Antibiotic Prophylaxis , Cefuroxime/analogs & derivatives , Cephalosporins/therapeutic use , Ciprofloxacin/therapeutic use , Lithotripsy , Ureteral Calculi/therapy , Urinary Tract Infections/prevention & control , Administration, Oral , Anti-Infective Agents/administration & dosage , Cefuroxime/administration & dosage , Cefuroxime/therapeutic use , Cephalosporins/administration & dosage , Ciprofloxacin/administration & dosage , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Injections, Intravenous , Male , Middle Aged , Prospective Studies , Time FactorsSubject(s)
Prostatic Hyperplasia/diagnosis , Cystoscopy , Guidelines as Topic , Humans , Male , Prostate/diagnostic imaging , Prostate/pathology , Prostatic Hyperplasia/physiopathology , Prostatic Hyperplasia/therapy , Radiography , Ultrasonography , Urinalysis , Urinary Bladder/pathology , Urinary Bladder Neck Obstruction/physiopathology , Urinary Tract/diagnostic imaging , Urinary Tract/pathology , Urologic Diseases/diagnosis , Urologic Diseases/therapy , World Health OrganizationABSTRACT
PURPOSE: We studied the relationship between lower urinary tract symptoms as measured by the international prostate symptom score (I-PSS) and urodynamic findings in elderly men. MATERIALS AND METHODS: We evaluated 803 consecutive patients with lower urinary tract symptoms via the I-PSS and urodynamics with pressure-flow studies. RESULTS: A statistically significant correlation was found between all I-PSS questions (except intermittency) and objective parameters of obstruction. However, the clinical significance of this finding is minimal because a large overlap of symptom scores exists among patients with different grades of bladder outlet obstruction. The filling component of the I-PSS correlated somewhat better with obstruction than did the voiding component. CONCLUSIONS: It seems impossible to diagnosis bladder outlet obstruction from symptoms alone. It does not even seem possible to define subgroups in which further urodynamic examination is indicated.
Subject(s)
Prostatic Hyperplasia/complications , Urinary Bladder Neck Obstruction/etiology , Urodynamics , Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Prostatic Hyperplasia/physiopathology , Urinary Bladder Neck Obstruction/physiopathologyABSTRACT
PURPOSE: The reliability of the International Prostate Symptom Score (I-PSS) was tested in patients with lower urinary tract symptoms and/or benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 71 consecutive men with benign prostatic hyperplasia and/or lower urinary tract symptoms was asked to complete the I-PSS at baseline and 8 weeks later. At the second visit the physician also completed the I-PSS according to the complaints of the patient. Variability between both scores was evaluated by calculation of duplo errors and results were compared to the clinical data. RESULTS: A considerable variability existed between the I-PSS results obtained at baseline and 8 weeks. The duplo error was 4.3. In a regression analysis of I-PSS, including all clinical parameters, only free flow had some predictive value for I-PSS outcomes. CONCLUSIONS: It is important to consider the variability of the I-PSS score when making decisions concerning treatment.
Subject(s)
Prostatic Hyperplasia/diagnosis , Severity of Illness Index , Urination Disorders/diagnosis , Follow-Up Studies , Humans , Male , Middle Aged , Predictive Value of Tests , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/epidemiology , Regression Analysis , Reproducibility of Results , Surveys and Questionnaires , Time Factors , Urination Disorders/epidemiology , Urination Disorders/etiology , UrodynamicsABSTRACT
PURPOSE: We evaluated the urethrocystoscopic findings and results of urodynamic studies in elderly men with voiding complaints. MATERIALS AND METHODS: A total of 492 consecutive patients with voiding complaints underwent a standardized screening program, including transrectal ultrasonography of the prostate, urodynamic investigations with pressure-flow study analysis and flexible urethrocystoscopy. RESULTS: A significant correlation was found between bladder trabeculation and grade of bladder outlet obstruction. Detrusor instability correlated significantly with grade of trabeculation. Grade of obstruction showed a clear correlation with prostatic occlusion of the urethra and the presence of a middle lobe at cystoscopy. CONCLUSIONS: The findings at urethrocystoscopy correlate well with those of urodynamic investigations.
