Japanese guidelines for prevention of perioperative infections in urological field

For urologists, it is very important to master surgical indications and surgical techniques. On the other hand, the knowledge of the prevention of perioperative infections and the improvement of surgical techniques should always be considered. Although the prevention of perioperative infections in each surgical field is a very important issue, the evidence and the number of guidelines are limited. Among them, the preparation of guidelines has progressed, especially in gastrointestinal surgery. The Center for Disease Control and Prevention (CDC) proposed guidelines for the prevention of surgical site infections, which have been used worldwide. In urology, the original guidelines were different from those of general surgery, due to many endourological procedures and urine exposure in the surgical field. The Japanese Society of UTI Cooperative Study Group has thus framed these guidelines supported by The Japanese Urological Association. The guidelines consist of the following nine techniques: open surgeries, laparoscopic surgeries, transurethral resection of bladder tumor, ureterorenoscope and transurethral lithotripsy, transurethral resection of the prostate, prostate biopsy, cystourethroscope, pediatric surgeries in the urological field, and extracorporeal shock wave lithotripsy and febrile neutropenia. These are the first guidelines for the prevention of perioperative infections in the urological field in Japan. Although most of these guidelines were made using reliable evidence, there are parts without enough evidence. Therefore, if new reliable data is reported, it will be necessary for these guidelines to be revised in the future.     

A clinical evaluation of CS-807 in patients with urinary tract infections

CS-807 is a new cephalosporin orally available. The clinical efficacy and safety of this drug were evaluated in 13 patients with urinary tract infection, including 3 with simple cystitis and 10 with complicated infections. According to the response criteria defined by the Japanese UTI committee, the clinical effectiveness in 8 patients with complicated urinary tract infections regarded evaluable was excellent in 2, moderate in 4 and poor in 2, the overall efficacy rate being 75.0%. Only 1 of the 13 patients studied, developed temporary diarrhea as a drug related adverse reaction.     

Meta-analysis in urological clinical research

A systematic review is characterized by the application of the scientific method to the evaluation of scientific literature. When a systematic review uses statistical techniques to combine and summarize the results from previous studies, it is called meta-analysis. Meta-analysis is a working tool that facilitates the realization of systematic and quantitative reviews. Its greater objectivity and rigour in comparison with the traditional reviews make that meta-analysis techniques are little by little being generalized as standard instrument to evaluate scientific evidence. In this article we detail the objectives and applications of this type of studies, as well as the stages in its preparation, including the presentation of results.     

Need for urodynamic evaluation as a regular follow-up tool in assessment of long-term urological outcomes in patients with sacrococcygeal teratoma

AimTo assess the long-term urologic outcomes in follow-up of patients of sacrococcygeal teratoma (SCT) using urodynamic study (UDS) in addition to clinical and radiologic evaluation.MethodsA prospective study of clinical, radiological and urodynamic evaluation in patients with SCT who underwent resection between January 2002–June 2015 and were followed up till January 2016 was conducted.ResultsTotal 57 patients, 42 (73.7%) females and 15 (26.3%) males with 35 (62.4%) following treatment for benign and 22 (38.5%) for malignant disease were included. Twenty-eight of 57 (49.12%) had urological problems. Clinical complaints in 21 (36.8%) patients included stress urinary incontinence-14 (66.7%), enuresis-9 (42.9%), and poor stream or dribbling of urine-6 (28.6%). Eight of 51 patients (15.7%) had abnormal ultrasound findings, which included contracted, trabeculated thick walled bladder (3), bilateral hydronephrosis (3) and significant post void residue (PVR) (6). Seven of 57 underwent micturating cystourethrogram (MCU), 5 had an abnormal report[significant PVR (4), small trabeculated bladder (3), reflux (2) and large capacity bladder (1)]. Urodynamic study was done in 27 patients, 18/27 (66.7%) had abnormalities. Six patients without any clinical or ultrasonographic abnormalities had abnormal UDS. Total 28 (49.12%) had urological comorbidities. Three patients had overactive bladder, five dysfunctional voiding, one underactive bladder and one had giggle incontinence. Children were managed by behaviour therapy and pharmacotherapy.ConclusionUrodynamic evaluation could detect abnormalities in patients who had no urinary complaints or abnormality on ultrasound. The abnormalities have a potential for progressive upper tract damage. Urodynamics should be an integral part of urological surveillance in patients operated for SCT.Type of studyPrognostic study.Level of EvidenceLevel II (Prospective cohort study).     

Clinical evaluation of lymphoscintigraphy in urological disease

Clinical efficacy of lymphoscintigraphy was evaluated in 31 cases of urological disease. To diagnose metastatic change of malignant tumor, 99mTc-rhenium colloid (5mCi) was administrated from bilateral pedal region. Of these patients 12 had true positive finding, 2 had false positive finding, 2 had false negative finding, and 8 had true negative finding defined by lymphoscintigram and pathological finding. Overall accuracy of lymphoscintigraphy revealed 83% in correlation of pathological finding, 78% in lymphangiography. Accuracy between lymphangiography and pathological finding was 80%. The overall clinical efficacy of lymphoscintigraphy was the same as lymphangiography. The merit of this method was that we can examine easily, painlessly, and frequently.     

Clinical evaluation of piperacillin in the urological field

The sensitivity of 249 etiological bacterial strains causing inflammation isolated from patients with infections of the urogenital tract who were under treatment on an in-patient basis in our Department was examined by the Disc (3 concentration) assay method. Piperacillin (PIPC) was employed for prophylactic treatment in 18 patients against postoperative infections and for therapeutic treatment in 3 patients against complicated infections of urogenital tracts. The results of these studies are reported along with some discussion on the utility of PIPC in the urological field. The frequency of detection of bacteria isolated from the patients on their admission into our hospital was in the decreasing order of Streptococcus Sp., Proteus Sp. and E. coli Pseudomonas aeruginosa and Klebsiella Sp. also were noted in some of the patients. Pseudomonas aeruginosa, nonfermentative Gram's-negative bacilli (NF- GNB ), and Streptococcus Sp. were detected in many of the patients who had had an operation or who had been in hospital for a long time. The sensitivity of E. coli, Proteus Sp., Streptococcus Sp. and Pseudomonas aeruginosa was invariably more than 80%, while that of NF- GNB was more than 50%. PIPC was used for prophylactic treatment of patients against infections at the postoperative stage in the urogenital field. Out of 18 cases, it proved to be markedly effective in 14 cases and moderately effective in 4 cases. There was no poorly effective case. PIPC was employed for treatment in 5 cases complicated infections of urogenital tracts. There was no markedly effective case, and 2 moderately effective and 3 poorly effective cases resulted according to the UTI efficacy evaluation standards However, its bacteriological efficacy could be identified in all the treated cases. Therefore, PIPC is a valuable prophylactic antibiotic agent against infections after an operation in the urological field. It may also prove valuable in the therapeutic treatment of complicated infections in the urogenital tracts. PIPC has a relatively large margin of safety in terms of side effects as in the case of conventional penicillin group antibiotics.     

Daily administration of phosphodiesterase type 5 inhibitors for urological and nonurological indications

OBJECTIVES: Although the discovery of phosphodiesterases (PDEs) was made soon after the identification of cyclic adenosine monophosphate nearly half a century ago, their true importance in medicine has taken many decades to be realised. The recognition of the important role PDE enzymes play and the impact of altering intracellular cyclic nucleotide levels became significant for most urologists and clinicians in the early 1990s with the discovery of sildenafil, a PDE5 inhibitor (PDE5-I). Once approved around the world, on-demand use of PDE5-Is became the gold standard. Recently, the potential beneficial effects of PDE5-Is on the pulmonary, vascular, and other systems has led to examination of alternative dosing regimens. In this review, we have synthesised the available published peer-reviewed literature to provide a critical contemporary view of evolving indications for PDE5-Is and how alternative dosing regimens may impact on sexual and other functions. METHODS: MEDLINE search of all peer-reviewed English literature for the period 1990-2007. RESULTS: The plethora of articles detailing potential uses of PDE5-I in multiple fields of medicine was uncovered. Use of alternative dosing regimens shows great promise across a number of clinical indications, including post-radical retropubic prostatectomy, pulmonary hypertension, endothelial dysfunction, and salvage of on-demand PDE5-I nonresponders. CONCLUSIONS: Use of PDE5-I on a daily basis may evolve into a major form of drug administration both for men with erectile dysfunction and for those with a myriad of other conditions shown to benefit from this approach.     

A clinical study of urological examinations in uterus malignant tumors before treatment

Sixty six cases of uterus malignant tumors examined urologically before gynecologic treatment between 1980 and 1984 are reviewed retrospectively. The uterus lesion excluding 1 malignant mixed mesodermal tumor was cervical carcinoma in 55 cases and corpus carcinoma in 10 cases. Pathologically, 46 cases were squamous cell carcinoma, 10 were adenocarcinoma, 3 were squamous adenocarcinoma and 6 were unknown. Clinical staging according to classification of FIGO, was stage 0 in 3 cases, stage I in 23 cases, stage II in 28 cases, stage III in 3 cases, stage IV in 7 cases, and unknown in 2 cases. Only 4 cases (6.1%) had urological symptoms with no special relationship to the uterus lesion. Abnormal findings of urine tests were seen in 15 cases (22.7%). The incidence of hematuria and pyuria, which were seen in 12 and 10 cases, respectively, was high. Cystoscopic abnormality was revealed in 32 (51.6%) out of 62 cases. Protrusion of vesical wall was found in 11 cases (34.3%) and it was an important finding which showed a significant incidence. Edema was seen in 11 cases (34.3%). This was a sign of progression, and the observation on spread of lesion was important. Redness was seen in 3 cases (4.8%). It was considered to be the result of circulatory disturbance. At the same time observations on vascular change, edematous change etc. should be done in detail. Bleeding was seen in 1 case (1.6%), microscopic bleeding was seen more frequently than macroscopic bleeding. Abnormalities of ureteral orifice were significant only after other examinations were reviewed in addition to these signs. IVU was performed in 58 cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Familial risk of urological cancers: data for clinical counseling

Familial risks for cancer are important for clinical counseling and understanding cancer etiology. The nationwide Swedish Family-Cancer Database includes all Swedes born in 1932 and later (0 to 68-year-old offspring) with their parents, totaling over 10.2 million individuals. Urological cancer cases were retrieved from the Swedish Cancer Registry up to year 2000. Standardized incidence ratios (SIR) and 95% confidence limits (CI) were calculated for age-specific familial risk in offspring by an exact proband status. The familial risks for offspring cancer were increased at all urological sites from concordant cancer in the parent and in a sibling proband. The highest SIRs by parent were for testicular and prostate cancer (4.26 and 2.45). When a sibling was affected, even kidney cancer (4.74) showed a high SIR. For kidney cancers, and also for prostate and testicular cancers, the SIRs were higher among siblings than among offspring and parents, which may indicate the involvement of recessive effects. Family members of patients with prostate cancer or von Hippel Lindau disease can expect organized clinical counseling, but family members of patients with other urological cancers are probably not counseled. Guidelines for clinical counseling or action level should be developed for all urological cancers because of the established familial risks. Urological cancers also offer a challenge to molecular geneticists attempting to identify the susceptibility genes underlying the familial clustering.     

Purified fibronectin administration to patients with severe abdominal infections. A controlled clinical trial.

Subnormal plasma fibronectin (Fn) levels are found in patients with severe abdominal infections (SAI). The repletion of Fn has been postulated to have therapeutic benefit by virtue of its opsonic, reticuloendothelial system (RES) stimulating effects. A controlled, prospective trial of Fn administration was performed in patients with SAI to assess its use as an adjunct to standard procedures of intensive care. Thirty-three SAI patients were given daily doses of 0.8 g of purified Fn on days 1-5 following admission to the ICU, whereas 34 control patients received no Fn. All patients received the clinical care, antibiotics, and pharmacologic agents appropriate to their individual needs. The admission status and laboratory profiles of the two patient groups (+ and -Fn) were comparable on admission to the study. No side effects of the Fn preparation were observed. As judged by subgroup averages, the Fn replacement regimen was effective in elevating Fn levels to within normal range from day 2 onwards, as measured by immunological and functional assays. The estimated intravascular recovery of Fn averaged 82% in those patients who survived, yet only 52% in the nonsurvivors. Ultimate hospital mortality was 9/33 (27.3%) in the +Fn group versus 13/34 (38.2%) in the -Fn group (p = 0.244, Fisher's exact test). Although ultimate mortality was not significantly changed by the administration of Fn, the Fn treated patients appeared to survive longer than did the control patients. This trend was confirmed through the analysis of expected survival curves (D = 3.12, 0.1 greater than p greater than 0.05). When compared to the survivors, the ultimate nonsurvivors entered the study with statistically higher group averages of bilirubin and creatinine concomitant with lower averages of Fn, antithrombin III, C4, C3, C3b-INH, and transferrin. These differences persisted throughout the 11-day monitoring period; differences between survivors and nonsurvivors with respect to platelets, plasminogen, B-1-H, alpha-2-macroglobulin, and prealbumin appeared during the same period. Dramatic differences between the +Fn and -Fn treatment groups were not seen. Other than Fn, the Fn recipients only developed higher levels of the acute phase reactants C4, C3b-INH, B-1-H and alpha-1-antitrypsin (p less than 0.05) than did their non-Fn treated counterparts. In the present study, we again found a highly significant pattern of correlations between the absolute levels as well as the changes of Fn and other plasma proteins.(ABSTRACT TRUNCATED AT 400 WORDS)     

Clinical evaluation of long-term administration with terodiline hydrochloride for the treatment of patients with neurogenic bladder

Terodiline HCl was administered in a long-term study to 20 patients with neurogenic bladder and pollakisuria. Its efficacy on urinary frequency and urinary incontinence was studied together with its safety and changes in blood concentration. The dosing period extended from 2 through 53 weeks (21 weeks on the average). The drug was found effective in 62% of diurnal urinary frequency patients, 71% of nocturnal urinary frequency, 73% of urinary incontinence, and 69% of nocturnal enuresis. Side effects of dizziness and nasal obstruction were seen in only one case. The drug was judged to be useful in 75% of the patients studied. Terodiline HCl showed no further increase in plasma concentration due to the long-term administration, and it disappeared from plasma within one to two months after the last dosing.