SMZ (3201600 MG) vs. control group in patients receiving turp

809

808 TRANSURETHRAL NEEDLE ABLATION FOR BACTERIAL PROSTATITIS: A 3-YEAR FOLLOW-UP Giannakopoulos

X.i,

Entezari

K.‘, Schulman

‘University Hospital of Ioannina, j loannina, Erasme Hospital, Urology, Brussels, Belgium

C.‘;

Sofikitis

Greece,

YJniv.

CHRONIC STUDY N.‘,

NON

ZlottaA.2

Clinics

of Brussels-

INTRODUCTION & OBJECTIVES: Chronic non bacterial prostatitis (III-A) is an entity disappointing both for physicians and patients. Recently transurethral needle ablation of the prostate (TUNA) has been evaluated for the treatment of chronic non bacterial prostatitis in small series and very short follow-up. We report here our long teim data (3 year follow-up) of TUNA used for the treatment of chronic non bacterial prostatitis. MATERIAL & METHODS: 39 consecutive patients (mean age 37; range 32-46) who failed conventional therapy with a clinical diagnosis of prostatitis type III-A and symptoms lasting for at least 36 months were treated by TUNA. Peak flow rate, a specific symptom score on prostatitis symptoms and quality of life questionnaires were analysed before and after therapy. Semen quality, motility and morphology, expressed prostatic secretion leucocytosis (EPS, > 15 WBC before TUNA) as well as the VB3 test (>15 WBC in the urine specimen before TUNA) were compared to baseline data at I, 3, 6, 12, 24 and 36 months after TUNA using the student t-test.

LONG-TERM, MULTICENTER, PROPHYLACTIC TREATMENT OF INFECTIONS IN FEMALE PATIENTS EXTRACT (OM-89) Schulman C.‘; study group

Vanden

Bossche

M.‘,

DOUBLE-BLIND STUDY OF RECURRENT URINARY TRACT USING AN ESCHERICHIA COLI

Alloussi

S.‘, Cozma

G.3, Multicenter

UT1

iUniv. Clinics of Brussels - Erasme Hosp., Urology, Brussels; Belgium, 2Univ. des Saarlandes, Urology and Kinderurologie, HombergSaar, Germany, 30M Pharma, MeyriniGeneva, Switzerland INTRODUCTION & OBJECTIVES: Recurrent are a common clinical problem especially among with antibiotics is limited, and alternatives such OM-89 is a lyophilized extract of selected E. coli and has been shown to reduce the rate of UTIs in

urinary tract infections (UTIs) women. Prophylactic treatment as immunotherapy are needed. strains in a capsule formulation double-blind studies.

MATERIAL & METHODS: In this multicenter. double-blind study, adult female patients could be enrolled if they had acute UT1 at the enrolment visit and positive bacteriological results in urinalysis (?103 bacteria/ml). Patients received OM-89 or a matching placebo as follows: 1 capsule per day for 90 days, 3 months without treatment, then the first 10 days in months 7, 8 and 9. Patients were followed-up for a total of 12 months. Primary efficacy criteria were UT1 rates over 12 months, distribution of UTIs and proportion of patients with UTI.

RESULTS: 2 patients were lost for follow-up. Quality of life (4.7 to 2.0) and symptom score (16.2 to 5.1) significantly improved from baseline at 36 months follow-up (all p 50%. EPS (83.4 to 21.9ifields) and VB3 (24.3 to 8.2/fields) significantly improved at 36 months follow-up as compared to pretreatment values (both p
RESULTS: A total of 453 patients were treated, 23 1 in the active group and 222 in the placebo group. The mean rate of post-baseline UTIs was significantly lower in the active group than in the placebo group (0.84 vs. 1.28; p
CONCLUSIONS: This study with a 3 year follow-up period supports the place of TUNA as a possible and effective treatment option for patients with chronic non-bacterial prostatitis who have failed conventional therapies. Randomised studies using TUNA for the treatment of this entity should be encouraged.

CONCLUSIONS: OM-89 significantly reduced the rate of UT1 during the I2 months of the study including 3 months of treatment followed by three 1O-day booster courses. These results further confirm that OM-89 is a valuable component of the management of recurrent UTI.

810 DO PROPHYLACTIC ANTIBIOTICS ON URINARY WITHDRAWAL STOP URINARY TRACT INFECTION? RANDOMISED DOUBLE-BLIND PLACEBO-CONTROLLED Wazait

H.D.,

Pate1 H., Van der Meullen

J., Kelsey

M., Miller

CATHETER A PILOT TRIAL

R., Emberton

Royal College of Surgeons of England and Whittington Hospital Clinical Effectiveness Unit, Department of Urology, London, United

M.

NHS Trust, Kingdom

INTRODUCTION & OBJECTIVES: Up to 25% of hospitalised patients undergo urinary catheterisation. This intervention is frequently complicated by catheter-associated urinary tract infection (CAUTI). We performed our study to check if antibiotics at withdrawal of a short term urinary catheter decreases incidence of UTI. MATERIAL & METHODS: Patients across specialities with a urethral catheter for 2-7 days were recruited at the time of withdrawal of their catheter. Patients were excluded if they underwent a recent urinary tract surgery were on antibiotics. Eligible patients were randomised to either a 48hour course of Ciprofloxacin (5OOmg bd.) tablets or placebo starting 2 hours prior to catheter withdrawal. Catheter urine sample (CSU) was obtained just before the start of trial medication. Follow-up was arranged at 7 and 14 days post catheter withdrawal. At follow up, patients filled a questionnaire for UT1 symptoms and mid-stream urine (MSU) was sent. RESULTS: Forty-one patients were recruited with complete follow-up (22 received ciprofloxacin and I8 received placebos). Of the ciprofloxacin group, three patients (14%) were bacteriuric at follow-up post catheter withdrawal (one symptomatic). The bacteriuria in two of these patients was due new infection. The cultured pathogens (2 Enterococci and 1 E. coli) were resistant to Ciprofloxacin. Of the placebo group, two patients (11%) were bacteriuric on follow up. One of these two cases was due to new infection with acinetobacter Baumann II resistant to ciprofloxacin. CONCLUSIONS: This study demonstrated that the risk of UT1 following the withdrawal of a urinary catheter is real even if patients are abacteriuric on withdrawal. It also demonstrated the high resistance of CAUTI’s to Ciprofloxacin in short-term catheters. The study failed to show significance for use of antibiotics to prevent UT1 post catheter withdrawal.

811 MULTI-CENTRE STUDY PROPHYLACTIC SINGLE TMP/SMZ (3200600MG) RECEIVING TURP

ABOUT THE EFFICACY OF A DOSE OF LEVOFLOXACLN (500MG) VS. VS. CONTROL GROUP IN PATIENTS

Waaenlehner F., Wagenlehner C., Naber infectiology of the DGU, Germany Hospital

St. Elisabeth,

Department

K., and members

of Urology.

Straubing,

of the working

group

Germany

INTRODUCTION & OBJECTIVES: TURP is one of the most frequent urological procedures. The efficacy of a prophylactic single dose of Levofloxacin vs. TMPiSMZ vs. a control group, receiving no antibiotic prophylaxis, in patients undergoing TURP, should be investigated in a multi-centre study. The arms were to assess the rate of bacteriuria (‘104/ml) 5-7 days, and 3-5 weeks after TURP, and postoperative complications. MATERIAL & METHODS: The study was prospective, randomized, multi-centric, open and comparative. Patients with sterile urine (<104/m1), scheduled for TURP and not having received antibiotics within four days prior, were enclosed. Patients received an oral single dose prophylaxis with either 5OOmg levofloxacin, or 320/1600mg TMP/SMZ, or no prophylaxis according to a 2:2: 1 randomisation. Clmical examination of the patients and urine culture were performed prior to, and 5-7 days, and 3-5 weeks after- TURP. RESULTS: 14 urological centres throughout Germany recruited 400 patients. 376 patients were evaluable until day 5-7, and 339 were evaluable until week 3-5. The overall bacteriuria rate at day 5-7 was 22% (levofloxacin 21%; TMPSMZ 20%; control group 3O”/a). Bacteriuria rate at week 3-5 was 28% (levofloxacin 26%; TMPiSMZ 26%; control gr-oup 36%). Complication rate at week 3-5 was 10% (levofloxacin 8%; TMPSMZ 10%; control group 16%). The rates of postoperative bacteriuria ranged widely between centres (O%-75%). Statistical significant (piO.05) risk factors for bacteriuria (range) were the qualification of surgeon (I 9%.37%), presence of a suprapubic catheter (22%.34%) and disconnection of the closed drainage system (25%52%). Total antibiotic consumption (for prophylaxis and treatment) in the control group was higher than in the groups with antibiotic prophylaxis (6.9 vs. 5.0 doses/ patient) (piO.01). Postoperative complications in patients with bacteriuria (‘IO~iml) were more frequent than in non bacteriuric (< 104/ml) patients (17% vs. 8%) (piO.01). CONCLUSIONS: It is debatable whether postoperative bacteriuria is the key parameter to define efficacy of antimicrobial prophylaxis in patients undergoing TURP. The rate of bacteriuria, however; correlated well with the overall rate of postoperative complications. Therefore, it seems reasonable to lower the rate of bacteriuria by prophylaxis. Since patients without antibiotic prophylaxis received at the end even more antibiotic doses than patients with prophylaxis, the overall selection pressure can obviously not be lowered by resig,ning prophylaxis. Therefore we conclude that at least patients at risk should receive antibiotic prophylaxis prior to TURP. European

Urology

Supplements

3 (2004)

No. 2, pp. 205