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MP-08.20 The “Ketamine Bladder”: An Emerging Public Health Problem?
MODERATED POSTER SESSIONS
antibiotics resulted in the greatest CPSI difference (-13.6, p⬍0.001; 95% CI -16.7,10.6). In respect to responder analysis compared to placebo, anti-inflammatories showed the greatest response rates (RR 1.8, p⬍0.001; 95% CI 1.5,2.1) followed by alpha-blockers (RR 1.4, p⫽0.007; 95% CI 1.1,1.8) and antibiotics (RR 1.2, p⫽0.430, 95% CI 0.8, 2.0). Conclusion: Previous recommendations may have been premature. Alpha-blockers, antibiotics and/or anti-inflammatory/immune modulation therapy appear to be beneficial for some patients with CP/ CPPS. However the magnitude of effect and disconnect between mean CPSI decrease and response rates compared to placebo suggest that directed multimodal, rather than mono-therapy with these agents, be considered for optimal management of CP/CPPS.
MP-08.19 Prevalence of Antimicrobial Resistance in Rectal Normal Flora of Patients Undergoing Transrectal Ultrasonography-guided Prostate Biopsy in Korea Park S1, Kim M2, Cheon M3, Lee J1, Rim J1 1 Wonkwang University School of Medicine and Hospital, Iksan, South Korea; 2Chonbuk National University Medical School, Jeonju, South Korea; 3 Presbyterian Medical Center, Jeonju, South Korea Introduction: Fluoroquinolone is the most common prophylactic antibiotics used for transrectal ultrasonography (TRUS)-guided prostate biopsy. However, the frequency of fluoroquinolone resistant E Coli is increasing. The aim of this study was to determine the prevalence of antimicrobial resistance in rectal normal flora of patients undergoing TRUS-guided prostate biopsy. Materials and Methods: Between May 2010 and October 2010, rectal swabs were cultured from patients before TRUSguided prostate biopsy in 3 tertiary centers of Chonbuk Province, South Korea. The swabs were culture on EBM and McConkey agar at 37°C. Antimicrobial sensitivity tests were performed according to NCCLS guidelines. Results: Of the 160 patients who had a rectal swab taken before prostate biopsy, E Coli was isolated from rectal swab of 106 patients. Mean age was 68.1 years, median serum prostate specific antigen was 5.6 ng/ml, and mean prostate volume measured by TRUS was 43.8 ml. 33.7%,
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29.1%, 26.7%, 23.3%, 12.8%, 9.3%, 5.8%, 1.2% and 0% of the E Coli were resistant to ampicillin, piperacillin, levofloxacin, TMP/SMX, gentamicin, cephalothin, cefotaxim, amikacin and meropenem. Conclusions: There are high level of resistances to ciprofloxacin and ampicillin, very low level of resistance to amikacin in the E Coli in the bowel flora. The prevalence of resistance to ciprofloxacin in Korea is much higher than those of Western countries. Therefore, fluoroquinolone alone seems to be inappropriate as prophylactic use before TRUS-prostate biopsy.
MP-08.20 The “Ketamine Bladder”: An Emerging Public Health Problem? Rajpal S1, Marri R2, Green E3, Srirangam S2 1 Stepping Hill Hospital, Stockport, UK; 2 Royal Blackburn Hospital, Blackburn, UK; 3Manchester Royal Infirmary, Manchester, UK Introduction: Ketamine is becoming increasingly popular as a short-acting, recreational dance drug in the UK. It has an adverse impact on the urinary tract and increasing patient numbers are presenting with ketamine-induced bladder dysfunction. We report our initial experience. Materials and Methods: Data from eight patients presenting to three hospitals in North-West England with urinary symptoms following ketamine abuse was analysed. Results: All eight patients were males (mean age 30.5 years, range 20-43) (follow-up 3-24 months) with a history of Ketamine abuse. Presenting symptoms included severe lower urinary tract symptoms (LUTS) (n⫽6), pelvic pain (n⫽1), loin pain (n⫽1) and haematuria (n⫽4). Two had renal impairment. Cystoscopy revealed a small capacity bladder (range 28-100 mls) with varying amounts of mucosal erythema. Biopsy confirmed severe mucosal inflammation. Ultrasound demonstrated hydronephrosis (n⫽4), with one patient requiring nephrostomy insertion. Urodynamics revealed detrusor overactivity (n⫽1). Ketamine cessation resulted in varying degrees of symptomatic relief in all patients though one underwent cystectomy with neo-bladder reconstruction for refractory LUTS. Another is awaiting the same procedure while a third underwent urinary diversion. Conclusions: Ketamine-mediated urinary tract dysfunction poses an emerging and significant problem amongst the younger
population. Presenting symptoms are varied, often severe, and a high index of suspicion is mandatory for prompt diagnosis. Immediate cessation of ketamine initiates symptomatic improvement, though a significant proportion will require surgery for intractable LUTS. A co-ordinated, multi-centre response will improve our understanding and help establish management guidelines for this debilitating new phenomenon.
MP-08.21 Correlation with Urinary Epithelium and Primary Symptoms in Interstitial Cystitis: Investigation of Scanning Electron Microscopy Yokoyama T, Fukumoto K, Ohira S, Hara R, Fujii T, Jo Y, Miyaji Y, Nagai A Kawasaki Medical School, Kurashiki, Japan Introduction and Objective: Interstitial cystitis (IC) remains a poorly understood urological condition. However, it is suggested that the pathophysiology of IC involves disruption of the urothelial barrier, leading to symptoms and disease. We investigated associations between bladder epithelium and urinary symptoms for patients with interstitial cystitis by using scanning electron microscopy (SEM). Material and Methods: Bladder tissue biopsies from 13 patients with IC (9 females and 4 males with a ranged of 19 to 80 year-old) were performed from November 2008 to January 2011, and examined by HE staining, astra blue staining for mast cell, and SEM. Three pathology features were noted (1) mast cell counts in lamina propria on astra blue stain (2) loss of urothelium on H.E. stain and SEM (3) inflammation in lamina propria on H.E stain. Symptoms were evaluated before treatment by IPSS, QOL index, and O’Leary and Sant score. Results: Hunner’s ulcer was observed in only one patient by macroscopic findings of this study. The mean IPSS score was 21.0 with a ranged of 7 to 32. The mean QOL score was 5.4 with a ranged of 3 to 6. The mean O’Leary and Sant score was 12.8 with a ranged of 5 to 20 (symptom index), and 10.0 with a ranged of 4 to 16 (problem index). The number of mast cell ⬎30 cells/mm2 was 6 of 13 patients. Four patients had severe to moderate inflammation findings in H.E. staining. There is no correlation between the number of mast cell, degree of inflammation and each symptom score. More than 50 % of loss of urothelium was observed in 4 patients by SEM and H.E. The denude of urothelium
UROLOGY 78 (Supplement 3A), September 2011
antibiotics resulted in the greatest CPSI difference (-13.6, p⬍0.001; 95% CI -16.7,10.6). In respect to responder analysis compared to placebo, anti-inflammatories showed the greatest response rates (RR 1.8, p⬍0.001; 95% CI 1.5,2.1) followed by alpha-blockers (RR 1.4, p⫽0.007; 95% CI 1.1,1.8) and antibiotics (RR 1.2, p⫽0.430, 95% CI 0.8, 2.0). Conclusion: Previous recommendations may have been premature. Alpha-blockers, antibiotics and/or anti-inflammatory/immune modulation therapy appear to be beneficial for some patients with CP/ CPPS. However the magnitude of effect and disconnect between mean CPSI decrease and response rates compared to placebo suggest that directed multimodal, rather than mono-therapy with these agents, be considered for optimal management of CP/CPPS.
MP-08.19 Prevalence of Antimicrobial Resistance in Rectal Normal Flora of Patients Undergoing Transrectal Ultrasonography-guided Prostate Biopsy in Korea Park S1, Kim M2, Cheon M3, Lee J1, Rim J1 1 Wonkwang University School of Medicine and Hospital, Iksan, South Korea; 2Chonbuk National University Medical School, Jeonju, South Korea; 3 Presbyterian Medical Center, Jeonju, South Korea Introduction: Fluoroquinolone is the most common prophylactic antibiotics used for transrectal ultrasonography (TRUS)-guided prostate biopsy. However, the frequency of fluoroquinolone resistant E Coli is increasing. The aim of this study was to determine the prevalence of antimicrobial resistance in rectal normal flora of patients undergoing TRUS-guided prostate biopsy. Materials and Methods: Between May 2010 and October 2010, rectal swabs were cultured from patients before TRUSguided prostate biopsy in 3 tertiary centers of Chonbuk Province, South Korea. The swabs were culture on EBM and McConkey agar at 37°C. Antimicrobial sensitivity tests were performed according to NCCLS guidelines. Results: Of the 160 patients who had a rectal swab taken before prostate biopsy, E Coli was isolated from rectal swab of 106 patients. Mean age was 68.1 years, median serum prostate specific antigen was 5.6 ng/ml, and mean prostate volume measured by TRUS was 43.8 ml. 33.7%,
S92
29.1%, 26.7%, 23.3%, 12.8%, 9.3%, 5.8%, 1.2% and 0% of the E Coli were resistant to ampicillin, piperacillin, levofloxacin, TMP/SMX, gentamicin, cephalothin, cefotaxim, amikacin and meropenem. Conclusions: There are high level of resistances to ciprofloxacin and ampicillin, very low level of resistance to amikacin in the E Coli in the bowel flora. The prevalence of resistance to ciprofloxacin in Korea is much higher than those of Western countries. Therefore, fluoroquinolone alone seems to be inappropriate as prophylactic use before TRUS-prostate biopsy.
MP-08.20 The “Ketamine Bladder”: An Emerging Public Health Problem? Rajpal S1, Marri R2, Green E3, Srirangam S2 1 Stepping Hill Hospital, Stockport, UK; 2 Royal Blackburn Hospital, Blackburn, UK; 3Manchester Royal Infirmary, Manchester, UK Introduction: Ketamine is becoming increasingly popular as a short-acting, recreational dance drug in the UK. It has an adverse impact on the urinary tract and increasing patient numbers are presenting with ketamine-induced bladder dysfunction. We report our initial experience. Materials and Methods: Data from eight patients presenting to three hospitals in North-West England with urinary symptoms following ketamine abuse was analysed. Results: All eight patients were males (mean age 30.5 years, range 20-43) (follow-up 3-24 months) with a history of Ketamine abuse. Presenting symptoms included severe lower urinary tract symptoms (LUTS) (n⫽6), pelvic pain (n⫽1), loin pain (n⫽1) and haematuria (n⫽4). Two had renal impairment. Cystoscopy revealed a small capacity bladder (range 28-100 mls) with varying amounts of mucosal erythema. Biopsy confirmed severe mucosal inflammation. Ultrasound demonstrated hydronephrosis (n⫽4), with one patient requiring nephrostomy insertion. Urodynamics revealed detrusor overactivity (n⫽1). Ketamine cessation resulted in varying degrees of symptomatic relief in all patients though one underwent cystectomy with neo-bladder reconstruction for refractory LUTS. Another is awaiting the same procedure while a third underwent urinary diversion. Conclusions: Ketamine-mediated urinary tract dysfunction poses an emerging and significant problem amongst the younger
population. Presenting symptoms are varied, often severe, and a high index of suspicion is mandatory for prompt diagnosis. Immediate cessation of ketamine initiates symptomatic improvement, though a significant proportion will require surgery for intractable LUTS. A co-ordinated, multi-centre response will improve our understanding and help establish management guidelines for this debilitating new phenomenon.
MP-08.21 Correlation with Urinary Epithelium and Primary Symptoms in Interstitial Cystitis: Investigation of Scanning Electron Microscopy Yokoyama T, Fukumoto K, Ohira S, Hara R, Fujii T, Jo Y, Miyaji Y, Nagai A Kawasaki Medical School, Kurashiki, Japan Introduction and Objective: Interstitial cystitis (IC) remains a poorly understood urological condition. However, it is suggested that the pathophysiology of IC involves disruption of the urothelial barrier, leading to symptoms and disease. We investigated associations between bladder epithelium and urinary symptoms for patients with interstitial cystitis by using scanning electron microscopy (SEM). Material and Methods: Bladder tissue biopsies from 13 patients with IC (9 females and 4 males with a ranged of 19 to 80 year-old) were performed from November 2008 to January 2011, and examined by HE staining, astra blue staining for mast cell, and SEM. Three pathology features were noted (1) mast cell counts in lamina propria on astra blue stain (2) loss of urothelium on H.E. stain and SEM (3) inflammation in lamina propria on H.E stain. Symptoms were evaluated before treatment by IPSS, QOL index, and O’Leary and Sant score. Results: Hunner’s ulcer was observed in only one patient by macroscopic findings of this study. The mean IPSS score was 21.0 with a ranged of 7 to 32. The mean QOL score was 5.4 with a ranged of 3 to 6. The mean O’Leary and Sant score was 12.8 with a ranged of 5 to 20 (symptom index), and 10.0 with a ranged of 4 to 16 (problem index). The number of mast cell ⬎30 cells/mm2 was 6 of 13 patients. Four patients had severe to moderate inflammation findings in H.E. staining. There is no correlation between the number of mast cell, degree of inflammation and each symptom score. More than 50 % of loss of urothelium was observed in 4 patients by SEM and H.E. The denude of urothelium
UROLOGY 78 (Supplement 3A), September 2011