URINARY TRACT INFECTION AND RISK FACTORS AFTER URODYNAMIC STUDIES IN FEMALE STRESS URINARY INCONTINENCE

URINARY TRACT INFECTION AND RISK FACTORS AFTER URODYNAMIC STUDIES IN FEMALE STRESS URINARY INCONTINENCE

489 490 PLASMA CONCENTRATIONS, URINARY EXCRETION AND BACTERICIDAL ACTIVITY OF CIPROFLOXACIN XR (1000 MG) VERSUS LEVOFLOXACIN (500 MG) IN HEALTHY VOL...

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PLASMA CONCENTRATIONS, URINARY EXCRETION AND BACTERICIDAL ACTIVITY OF CIPROFLOXACIN XR (1000 MG) VERSUS LEVOFLOXACIN (500 MG) IN HEALTHY VOLUNTEERS RECEIVING A SINGLE ORAL DOSE

OUTCOME OF NEPHRECTOMY AND KIDNEY-PRESERVING PROCEDURES FOR THE TREATMENT OF EMPHYSEMATOUS PYELONEPHRITIS

Wagenlehner F.1, Kinzig-schippers M.2, Tischmeyer U.1, Wagenlehner C.1, Sörgel F.2, Weidner W.3, Naber K.G.1 1

Hospital St. Elisabeth, Dept. of Urology, Straubing, Germany, 2Institute for Biomedical and Pharmaceutical Research, IBMP, Nürnberg-Heroldsberg, Germany, 3University Giessen, Urologic Clinic, Giessen, Germany INTRODUCTION & OBJECTIVES: The new extended release formulation of ciprofloxacin – ciprofloxacin XR – was designed for once daily administration in the treatment of UTI. The aim of this study was to compare its plasma and urine concentrations and the activity in urine with those of levofloxacin. MATERIAL & METHODS: In a randomised cross-over study 12 volunteers (6 males, 6 females) received a single oral dose of 1,000mg ciprofloxacin XR versus 500mg levofloxacin. Pharmacokinetic parameters were calculated in plasma and urine. Urinary bactericidal titres (UBT) were determined in urine. The UBTs, i.e. the highest two-fold dilution (antibiotic free urine as diluent) of urine still bactericidal, were determined for a reference strain and 7 clinical uropathogens with the following MICs (μg/mL) for ciprofloxacin / levofloxacin: E. coli ATCC 25922 (0.008 / 0.03), K. pneumoniae (0.008 / 0.03), P. mirabilis (0.03 / 0.06), E. coli (Nx-res.) (0.125 / 0.25), P. aeruginosa (0.5 / 2), S. saprophyticus (0.25 / 0.25), S. aureus (0.125 / 0.125), and E. faecalis (1 / 1). RESULTS: The median maximum plasma concentration of ciprofloxacin XR was 3.19 μg/mL and that of levofloxacin 6.44 μg/mL. The median cumulative renal excretion of the parent drug was for ciprofloxacin XR 43% of the administered dose and for levofloxacin 80%. The median UBTs measured within the first 24h (representing the dosing interval) for both antibiotics were between 1:256 and 1:16,384 for E. coli ATCC 25922, K. pneumoniae and P. mirabilis, between 1:64 and 1:521 for E. coli (Nx-res.), between 1:8 and 1.128 for P. aeruginosa, between 1:32 and 1:2,048 for the staphylococcal strains, and between 1:8 and 1:128 for E. faecalis. The areas under the UBT-time-curve within the first 24h showed statistically significant (p<0.05) differences between both antibiotics for P. mirabilis and P. aeruginosa in favour of ciprofloxacin XR, and for S. aureus and E. faecalis in favour of levofloxacin. Thus, the urinary bactericidal activity of ciprofloxacin XR was somewhat higher against Gram-negative and somewhat lower against Gram-positive uropathogens compared with that of levofloxacin. CONCLUSIONS: We conclude from this study that once daily doses of ciprofloxacin XR 1,000mg and levofloxacin 500mg are probably clinically comparable in the treatment of complicated and hospital acquired UTI and should be tested in an appropriate clinical study.

Park B.S.1, Huh J.S.2, Jeon S.H.1, Lee S.J.1, Kim J.I.1, Chang S.G.1 1

Kyung Hee University Hospital, Urology, Seoul, South Korea, 2Cheju University Hospital, Urology, Jeju, South Korea INTRODUCTION & OBJECTIVES: To compare the outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis, we reviewed our experiences of emphysematous pyelonephritis over the past 18 years. MATERIAL & METHODS: The medical records of 17 patients with emphysematous pyelonephritis treated between October 1986 and September 2004 were retrospectively reviewed. RESULTS: Women outnumbered men (12 versus 5), and all patients had diabetes. Left kidney was affected in 8 cases and right in 7. 2 patients showed bilateral involvement. Obstruction of corresponding renoureteral unit was found in one patient. 13 (76%) of the 17 patients had in poor diabetic control (hemoglobin A1c > 7%). Diagnosis was confirmed by gas in parenchymal or perinephric space by abdominal x-ray or computed tomography. Escherichia coli was the most common organism present in urine cultures (52%), and was followed by Klebsiella pneumoniae (24%). Piperacillin/tazobactam was the most effective (86%) antibiotic, and ampicillin and first generation cephalosporins were least effective (100% resistance). Prompt efforts were to control diabetes, and intravenous antibiotics were given. Nephrectomy was performed in 10 patients and 9 patients were survived (success rate 90%). The success rate among those who received medical therapy alone was 50% (2 of 4 patients). Percutaneous drainage was performed in 3 patients and 2 were survived (success rate 67%). Overall mortality was 17.6% (3 of 17 patients). CONCLUSIONS: Immediate nephrectomy with glycemic control and antibiotics is crucial for the successful treatment of emphysematous pyelonephritis. However, in inoperable cases, percutaneous drainage can be an effective option for treatment.

491 URINARY TRACT INFECTION URODYNAMIC STUDIES IN INCONTINENCE

AND RISK FACTORS AFTER FEMALE STRESS URINARY

492 THE PREVALENCE OF TB IN 82 HAEMATOSPERMIC PATIENTS Mahmoudi S.A.

Choe J.H., Kim J.W., Kim W.T., Lee J.S., Seo J.T.

Eisa Hospital, Urology, Esfahan, Iran

Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Urology, Seoul, South Korea

INTRODUCTION & OBJECTIVES: The purpose of this study is to investigate

INTRODUCTION & OBJECTIVES: Urodynamic investigation is being increasingly used to evaluate lower urinary tract dysfunctions including female stress urinary incontinence (SUI). However, this investigation is an invasive procedure and may precipitate urinary tract infection (UTI). A prospective, observational study was performed to determine the incidence of UTI and identify the risk factors for UTI after urodynamic studies (UDS) in female SUI.

the prevalence of TB as an etiologic factor in hematospermia from 1994 to 2004 MATERIAL & METHODS: I carried out the study on 82 cases who were referred due to hematospermia. They were from 35 to 68 years old (the mean of 46.5). Besides hematospermia some of them had other symptoms such as

MATERIAL & METHODS: From September 2004 to July 2005, a total of 225 consecutive patients (mean age 51.4 years) with complaints of SUI were evaluated according to our protocol. This protocol included history and physical examination, urinalysis, urinary culture, voiding diary, pad test and UDS. UDS consisted of uroflowmetry, filling and voiding cystometry, pressure-flow studies, urethral pressure profile, and abdominal leak point pressure measurements. A urine specimen for urinalysis and urine culture was obtained before and 48 or more hours after the procedures. Urinary culture of 105 colony-forming units per millilitre (CFU/mL) or more was regarded as significant bacteriuria. UTI was defined as significant bacteriuria with symptoms related to the infection. To identify the risk factors to UTI, the clinical characteristics of all patients including age, body mass index, parity, medical and operation history, degree of pelvic organ prolapse, results of urinalysis and UDS were evaluated.

obstructive lower urinary tract symptoms, irritative urinary tract symptoms and

RESULTS: The prevalence of UTI was 6.2% (14 of 225 patients). Mean urodynamic testing time was 19.8 minutes (range 16 to 43). The urinalysis and urine culture after urodynamic investigation was evaluated at mean interval of 21.7 days. Univariate analysis demonstrated that a history of UTI (p = 0.002) and urological surgery or procedure (p = 0.02) predicted UTI. However, on multivariate analysis the past history of cystitis was the only significant independent risk factor (OR = 28.5, 95% CI = 4.309 to 188.488, p = 0.001).The uropathogens causing UTI were Escherichia coli (57.1%), Group B Streptococcus agalactiae (14.3%), Enterococcus faecalis (7.1%), Proteus mirabilis (7.1%), Klebsiella pneumoniae (7.1%) and Pseudomonas aeruginosa (7.1%).

RESULTS: In 3 patients BK culture was positive just in seminal fluid. In 2 cases

CONCLUSIONS: The prevalence of UTI after UDS was relatively low in female SUI patients. Our findings suggest that in most cases it may be unnecessary to use preventive prophylactic antibiotics. However, this study demonstrates that patients with previous history of cystitis or urologic surgery should be fully advised of the possibility of urinary infection and use of prophylactic antibiotics after UDS.

fluid and 24-hr. sample urine cultures because inspite of the presence of TB, early

painful ejaculation with figures as will be shown perfectly. Physical examination revealed irregular nodular prostate, BPH and normal appearing prostate in digital rectal examine with figures as will be shown. All the patients evaluated with spermogram, CBC, ESR, PSA, U/A, U/C. All the cases treated with antibiotics (fluroquinolons), NSAIDS and antiandrogens (mainly Finastride). 25 cases were found to be resistant to the treatment after 2 months. All of these patients were evaluated for TB by doing seminal fluid culture, early morning and 24hr. urinary BK cultures.

the cultures were positive in seminal fluid, early morning and 24-hr. urine samples. In 7 patients BK was positive just in 24-hr.urine sample. CONCLUSIONS: Based on this study, it is concluded that firstly, whenever we encountered with medical treated resistant hematospermic patient, we must consider TB as an etiologic factor and secondly, ruled it out by doing both seminal morning urine culture may be negative. By the way, seminal fluid and 24-hr. urine sample culture must be done coincidentally because each of them lonely may be inconclusive. Eur Urol Suppl 2006;5(2):145