Moderated Poster Session 12 Infection and MODERATED POSTERS

MODERATED POSTERS
Moderated Poster Session 12
Infection and
Inflammatory Diseases
Tuesday, September 10
1315-1445
MP-12.01
Dectin 1 – A Novel Activator of
Urogenital Innate Immunity
Lanz M1, Ali A2, Townes C1, Pickard R2,
Hall J1
1
Institute for Cell and Molecular
Biosciences, Newcastle University,
Newcastle upon Tyne, UK; 2Institute of
Cellular Medicine, Newcastle University,
Newcastle upon Tyne, UK
Introduction and Objectives: Candidiasis is a common urogenital infection
affecting up to three quarters of women
of fertile age. Toll-like-receptors (TLRs) in
vaginal and bladder epithelia are recognized as providing first-line innate immune defense against infection and recognize molecules present in C. albicans.
However, in macrophages an alternative
receptor, Dectin-1 provides the main
mode of activation for fungal infection.
We therefore investigated the role of Dectin-1 in urogenital epithelia using RT-4
and VK-2 E6/E7 cell-lines as models of
bladder and vaginal epithelium, respectively. We also compared these results
with primary tissue grown from biopsies.
Materials and Methods: Dectin-1 mRNA
expression was examined using RT-PCR
and sequencing. Dectin-1 receptor was
localized on cells using immunocytochemistry. The phosphorylation of adaptor protein SYK was detected using Western blot. Reporter-gene assays were used
to measure NF-κB activation by Dectin-1
and qRT-PCR was used to measure antimicrobial peptide (AMP) expression.
Results: Expression of Dectin-1 mRNA
was seen in both cell-lines but immunocytochemistry revealed significant differences in localization. In VK-2 vaginal
cells, a monolayer of cells was seen and
receptors expressed throughout the cell
membrane. In contrast, with RT-4 urothelial cells, multiple layers were visualized
with receptors only expressed on the
apical side. Similar expression was also
found in primary cells. Zymosan, a β-1.3
glucan polysaccharide found in the cell
wall of C. albicans induced phosphorylation of the adapter molecule SYK after 30
min. This was followed by activation of
NF-κB in RT4 urothelial cells (mean fold
increase: 9.13, SEM: 0.826) and VK2 vaginal cells (mean fold increase: 3.9, SEM:
0.39) as well as significant up-regulation
of Beta-Defensin-2 AMP expression by
16-hours compared to controls (p<0.05).
Conclusion: Dectin-1 is expressed in
urogenital epithelium and its stimulation
causes activation of proinflammatory
transcription factors through the adaptor
molecule SYK. This provides a TLR-independent pathway to activation of NF-κB
and up regulation of AMP expression,
including Beta-Defensin-2. In addition to
antifungal activity, Beta-Defensin-2 has
potent antibacterial activity. We postulate
a role for Dectin-1 in innate antifungal
immunity but also speculate that polysaccharide components of candida could
be used therapeutically to induce AMP
responses in bacterial urinary tract infection too.
MP-12.02
Resveratrol – A Potential Therapeutic
Alternative to Estrogen in the
Treatment of Recurrent Urinary Tract
Infection in Post-Menopausal Women
Townes C1, Ali A2, Lanz M1, Hall J1, Pickard R2
1
Institute for Cell and Molecular
Biosciences, Newcastle University,
Newcastle upon Tyne, UK; 2Institute of
Cellular Medicine, Newcastle University,
Newcastle upon Tyne, UK
Introduction and Objectives: Recurrent
urinary tract infection (rUTI) is common in post-menopausal women and
associated with vaginal mucosal atrophy
secondary to decreased estrogen. Local
vaginal estrogen is recognized as a useful treatment option, although its use is
limited by troublesome side-effects and
patient concerns. Estrogen has previously
been shown to enhance vaginal epithelial
responses to bacterial components by
increasing secretion of the antimicrobial
peptide Beta-Defensin-2 (BD2). As an
alternative to estrogen, in this study we
explore the therapeutic potential of a
plant extract, resveratrol, which is a phytoalexin (antimicrobial) and similar to
phytoestrogens.
Materials and Methods: The vaginal
cell-line VK2 E6/E7 was challenged with
E. coli flagellin (50ng/ml) in the presence
of therapeutic doses of estrogen (4nM)
or resveratrol (100uM) for 0, 4, 24 and
48 hours. BD2 peptide levels were determined by ELISA. Time-kill and invasion
assays using the E. coli strain NCTC10418
were used to determine antimicrobial
and protective activities, respectively.
Bacterial motility was assessed by motility
assay using semi-liquid LB media.
Results: Challenging VK2 cells with
UROLOGY 82 (3 Supplement 1), September 2013
flagellin for 24 hours resulted in a significant increase in BD2 peptide secretion from 238.0±21.49 (SEM) pg/ml to
496.9±115.3 (SEM) pg/ml (p<0.05). This
response was significantly enhanced by
the presence of estrogen which increased
BD2 secretion to 615.6±124.7 (SEM) pg/
ml (p<0.01). A similar increase in BD2
secretion, 686.5±35.87 (SEM) pg/ml,
was observed with resveratrol , however
this response was slower, occurring 48
hours post-treatment (p<0.01). Both
estrogen and resveratrol showed significant antimicrobial activity against E. coli,
reducing bacterial survival to 60.0±8.8%
(SEM) and 54.0±8.6% (SEM) respectively (p<0.05). The ability of E. coli to
invade VK2 cells (measured as invasion
frequency) was significantly reduced by
resveratrol from 0.02±0.002% (SEM) to
0.013±0.002% (SEM) (p<0.05), while
estrogen failed to have a significant effect.
Similarly, while estrogen had no effect
on the motility of E. coli, resveratrol at a
concentration of just 10μM significantly
(p<0.05) reduced motility by 25.8±4.2%
(SEM).
Conclusion: These data suggest that
resveratrol may provide a viable alternative to vaginally administered estrogen in
the treatment of rUTI in post-menopausal
women. As well as up-regulating host
antimicrobial activity, resveratrol also has
the benefit of a direct action on E. coli
invasion and motility.
MP-12.03
The Relationship of Helicobacter
Pylori Infection to Prostate
Cancer and Benign Prostatic
Hyperplasia: Is It Real?
Al-Marhoon M, Ouhtit A, Venkiteswaran
K, Al-Busaidi Q, Mathew J, Al-Haddabi I,
Shareef O, Rahman K, Aquil S, Ganguly S
Sultan Qaboos University, Muscat, Oman
Introduction and Objectives: Studies
have shown significant associations between chronic prostatitis and prostatic
carcinoma. Bacteria have been found in
the prostates of patients with chronic
prostatitis, benign prostatic hyperplasia
(BPH) and prostate cancer (PCa). The
aim of this study is to prove the association of Helicobacter Pylori (H. pylori)
infection to prostate diseases.
Materials and Methods: A hundred consecutive patients with prostate diseases
were enrolled in the study. Detection of
H. pylori DNA in prostate tissue from
patient with BPH and PCa was performed
using PCR and confirmed by DNA sequencing analysis.
Results: Mean patient age 68.7 years.
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MODERATED POSTERS
Pathological diagnosis of 100 patients
studied: 78% BPH and 19% prostate
cancer. PCR, nested PCR and sequencing
showed the presence of H. pylori DNA in
the prostatic tissue of 5 patients (1 PCa, 2
BPH, 2 BPH & chronic prostatitis) (Table
1). The analysis revealed, type of prostate
disease (BPH or PCa) is not associated
to the presence of PCR positive H. pylori
DNA in the prostate tissue (OR = 0.94,
95% CI = 0.09-23.34, P > 0.05).
Conclusion: This study proves for the
first time the detection of H. pylori DNA
in prostatic tissue of patients with BPH
and PCa. The limitations of this study
are the small number of prostate cancer
patients to make a statistical difference
between BPH and prostate cancer, and
the small number of positive samples
for H. pylori. This study is the trigger for
further multicenter studies to look for
the association of H. pylori infection with
BPH and PCa.
stricture and treated with bulbar urethral
stent (BUS) Allium, were investigated
retrospectively. Patients received prophylactic antibiotherapy beginning one day
before stent placement and continued
10 days postoperatively. Patients were
followed-up monthly. Residuel urine
measurement, uroflowmetry and urine
culture were performed. Stents of eight
patients were removed prematurely because of obstruction. No other cause of
obstruction was found during urethroscopy in these patients. Urinary infection
was investigated and stents which were
removed were cultured.
Results: Seven of the eight patients
(87.5%) who had urethral obstruction
had positive urine cultures (E.coli, Klebsiella pnomonia.Enterococcus fecalis).
Six of these seven patients (75%) also
had positive stent cultures (Enterococcus
fecalis, Klebsiella pnomonia, P.mirabilis).
One urine and two stent culture were
MP-12.03, Table 1. The Details of the 5 Patients PCR Positive for H. Pylori (+: Positive)
Patient
Pathological diagnosis
Age
(Years)
Presentation
PSA
(ug/L)
PCR
Stool
antigen
test
1
BPH&Prostatitis
66
LUTS
0.6
+
+
2
BPH
71
Haematuria
8.9
+
+
3
Prostate cancer
81
LUTS
10
+
+
4
BPH
79
LUTS
10.4
+
+
5
BPH&Prostatitis
79
LUTS
3.8
+
+
MP-12.04
New Stent Allium for the
Treatment of Recurrent Bulbar
Urethral Strictures: Does Urinary
Infection Cause Obstruction?
Nemut T1, Yavuz U2, Karadenizli A3, Çiftçi
S2, Üstüner M2, Ozkan L2, Culha M2
1
Sakarya University, Health School,
Sakarya, Turkey; 2Kocaeli University
Medical School, Urology Department,
Kocaeli, Turkey; 3Kocaeli University
Medical School, Microbiology
Department, Kocaeli, Turkey
Introduction and Objectives: Obstruction is one of the most important
complications of the retrieval stents.
Management of the factors that causes
obstruction would positively affect the
success of the treatment. The patients, in
whom, findings due to urethral obstruction were determined after stent placement in our study, were investigated.
Materials and Methods: The files of
the 39 patients with recurrent urethral
S110
negative in patients with urethral obstruction. Urine culture was positive in one
(3.2%) and stent culture in two patients
(6.4%) in which stents were removed on
time or prematurely because of other
complications without obstruction. The
rate of positive urine culture was statistically significant higher in patients with
urethral obstruction (Mann-Whitney U
test p< 0.005).
Conclusion: Allium BUS which was used
for treatment of recurrent urethral strictures in this study has a good adaptation
in bulbar urethra, reaches 44Fr calibration after implantation and prevents tissue hyperplasia in the lumen because of
polymeric cover. We think that the cause
of urethral obstruction in patients with
BUS is urinary infection.
MP-12.05
Selecting Antibiotics for Stone Surgery
Atalar K, Donaldson H, Shamsuddin A,
Dasgupta R
Charing Cross Hospital, London, UK
Introduction and Objectives: Selecting
correct antibiotic prophylaxis before surgery is of increasing importance, with the
emergence of resistant bacterial strains.
Furthermore it is important to target the
causative organisms with appropriate
antibiotics, as illustrated in guidelines
for stone procedures. We reviewed our
prospectively captured database of patients undergoing endourological stone
surgery over a 12 month period, to assess
the types of organism and the antibiotic
resistance patterns now emerging.
Materials and Methods: We reviewed
the records of all patients undergoing
ureterorenoscopy/ percutaneous nephrolithotomy/ cystolithopaxy during a 12
month period, under the care of 2 surgeons. Pre-operative urine cultures were
recorded, with the antibiotic resistance
patterns; positive cultures were treated
by antibiotics before surgery, and followed up to ensure the repeat cultures
were subsequently negative.
Results: From a total of 287 patients, 36
had a positive urine culture requiring
antibiotic treatment before surgery. E Coli
was the commonest organism (n=11),
with ESBL (extended spectrum beta-lactamase) accounting for 3 of these cases;
followed by Enterococcus faecalis (n=9),
Pseudomonas (n=4), Coliforms (n=4),
Klebsiella, Morganella, and Enterobacter
cloacae (all n=1). The multi-resistant
strains showed sensitivities to Meropenem, Ertapenem and Mecillinam.
Conclusion: Our results are consistent
with previous reports (BJUI 2009; 104:
760-4) showing that the 2 predominant
organisms causing urine infection are E
Coli and Enterococcus (Streptococcus)
faecalis; it is therefore important to ensure that both Gram positive and negative organisms are covered if antibiotic
prophylaxis is to be used in such surgery.
Worryingly there is an increase in multiresistant patterns, leaving few available
oral antibiotic choices, as particularly
demonstrable in the ESBL cases. We have
noted further emergence of resistance
to co-amoxiclav, trimethoprim and ciprofloxacin, and reiterate the advice of
guidelines that antibiotic prophylaxis in
endourology (J Endourol 2009; 23: 156770) should be rationalised according to
findings of such microbiological reviews.
MP-12.06
Multiple Sensitivity Phenotype
in Interstitial Cystitis/
Bladder Pain Syndrome
Fuoco M, Irvine-Bird K, Nickel J
Dept. of Urology, Queen’s University,
Kingston, Canada
UROLOGY 82 (3 Supplement 1), September 2013
MODERATED POSTERS
Introduction and Objectives: Phenotypic differentiation of patients with
Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) may allow for improved
understanding of the pathogenesis and
heterogeneity of the condition as well as
development of patient specific treatment
strategies. We have identified and clinically characterized a distinct subgroup of
IC/BPS patients with a multiple sensitivity
phenotype.
Materials and Methods: We have defined this IC/BPS associated multiple
sensitivity syndrome by at least three
confirmed allergies/sensitivities to
medications and/or environmental factors. IC/BPS patients identified with a
multiple sensitivity phenotype (cases)
were compared to age-matched IC/BPS
patients with few or no allergies (controls) randomly selected (1:2 ratio) from
our prospectively collected IC/BPS database. Characterizations and comparisons
were undertaken using our previously
described standardized case assessment
parameters (age, duration of symptoms,
medical history, ICSI and PUF symptom
scores, and UPOINT categorization).
Results: The study consisted of 17 cases
and 34 age-matched controls. Mean age
was 55 and 56 years in each group respectively. As predicted by the definition
for cases, there was statistically more
medication and environmental allergies in the cases versus controls. Cases
reported more concomitant illnesses
(mean 9.6 vs 6.2, p<0.001) and number
of bodily systems affected (mean 6.0 vs
3.8, p=<0.001). Prevalence of Irritable
Bowel Syndrome and Fibromyalgia was
higher in the case group (p=0.028,
p=<0.001, respectively). Additionally,
there were more reported psychiatric
diseases (p=0.019), allergic/immune diseases (p=0.003), and pulmonary diseases
(p<0.001) in the case group. Symptom
scores (ICSI and PUF) did not significantly differ between groups. UPOINT classification differed with more patients in
the case group being categorized in the
psychosocial and neuropathic/systemic
domains (p=0.045, 0.007 respectively).
Total UPOINT classification (score out of
6) was also higher in cases than controls
(mean 4.6 vs 3.2, p=0.001).
Conclusion: We have characterized a
distinct phenotypic group of patients
with IC/BPS and multiple sensitivities.
These patients have more associated nonbladder syndromes and conditions. The
observation and clinical differentiation of
this specific phenotype suggests further
research directions in the etiology and
pathogenesis of this group and may help
in developing phenotype targeted therapeutic strategies for patients with a concomitant multiple sensitivity syndrome
and IC/BPS.
MP-12.07
Influence of Chlamydia Trachomatis
Infection on the Course of Early
Postoperative Period in Patients
with Benign Prostatic Hyperplasia
Pasiechnikov S1,2, Mitchenko N2, Grytsai
V1, Glebov A2
1
Dept. of Urology, O.O. Bogomolets
National Medical University, Kyiv,
Ukraine; 2Department of Inflammatory
Diseases, SI Institute of Urology,
National Academy of Medical Sciences of
Ukraine, Kyiv, Ukraine
Introduction and Objectives: Some
authors relate the appearance of early
postoperative complications (EPC) after
the prostatectomy to the infection availability caused by opportunistic microorganisms. But the problem of possible
connection of these complications with
sexually transmitted infections has not
been considered. The objective of the
study is to investigate the connection
between the appearance of EPC after
open prostatectomy (OP) in patients with
benign prostatic hyperplasia (BPH) and
the occurrence of Chlamydia trachomatis
both in genital excreta (GE) and in the
prostatic tissue (PT) removed during the
operation.
Materials and Methods: There were
152 patients with BPH, who had had the
planned OP, examined. In addition to
the routine clinical examination, every
patient had the ultrasound examination
of prostate and of the volume of residual
urine, I-PSS, QoL, cytologic study of GE
(scraped from urethra and expressed
prostatic secretion). The infectivity with
Chlamydia trachomatis was studied using the polymerase chain reaction (PCR)
both in GE and in PT removed during the
operation. The following indices were
taken into account in patients for the
characteristics of the course of early postoperative period: long-term (more than 7
days) or profuse (including hematamponade of urinary bladder) macrohematuria,
wound abscess, development of acute
pyelonephritis, acute urethritis, acute
epididymoorchitis.
Results: In the investigation of infectivity
with Chlamydia trachomatis using PCR
both in GE and in PT removed during
the operation of 152 patients, 19 (12.5%)
demonstrated DNA Chlamydia trachomatis. Out of 152 patients, 51 (33.6%) had
EPC. The infectious inflammatory complications were observed in 35 (23.0%)
patients. Long-term or profuse macrohematuria took second place and was
observed in 22 (14.5%) patients. The EPC
structure in BPH patients in dependence
on the identified DNA Chlamydia trachomatis is presented in the Table 1.
Conclusion: Out of BPH patients who
need the planned surgical treatment
the rate of infectivity with Chlamydia
trachomatis is 12.5%. The incidence of
EPC in patients infected with Chlamydia
trachomatis is 2.3 times higher than in
uninfected patients due to 2.6 times
greater incidence of long-term or profuse
macrohematuria and 2.2 times - infectious inflammatory complications.
MP-12.07, Table 1. EPC Structure in BPH Patients According to Identification of DNA
Chlamydia Trachomatis.
Number of patients
Complications
Infected with Chlamydia
trachomatis (n=19)
Uninfected with
Chlamydia trachomatis
(n=133)
p-value
abs.n
%±SE
abs.n
%±SE
Wound abscess
2
10.5±7.0
3
2.3±1.3
>0.05
Acute epididymoorchitis
3
15.7±8.3
8
6.0±2.1
>0.05
Acute urethritis
2
10.5±7.0
9
6.8±2.2
>0.05
Acute pyelonephritis
2
10.5±7.0
9
6.8±2.2
>0.05
Total infectious inflammatory
complications
9
47.3±11.5
29
21.8±3.6
<0.05
Long-term or profuse
macrohematuria
6
31.6±10.7
16
12.0±2.8
>0.05
Total
15
78.9±9.4
45
33.8±4.1
<0.001
UROLOGY 82 (3 Supplement 1), September 2013
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MODERATED POSTERS
MP-12.08
Cranberry Juice Metabolite May
Modulate E.Coli Pathogenicity
Ho D, Chen C, Chang P, Lin W, Huang Y
Chang Gung Memorial Hospital, Pu-Z
City, Taiwan
Introduction and Objectives: Cranberries had been proven to prevent urinary
tract infections through changing the
adhesiveness of Escherichia coli (E. coli)
to urothelial cells. Various cranberry
preparations including extract powder,
capsules, and juice, have been shown to
be effective in clinical and epidemiological research. Since cranberries are most
commonly consumed as juice in a diluted
concentration, the aim of this study was
to investigate whether the equivalent
daily dose of cranberry juice is sufficient
to modify host urine in order to change
the uropathogenicity of E. coli.
Materials and Methods: Urine from
rats taking an equivalent daily dose of
cranberry juice, provided by Ocean Spray
Cranberries, Inc. (Taiwan), has been
shown to decrease the capability of E. coli
in hemagglutination, urothelium adhesion, nematode killing, biofilm formation,
and resisting phagocytosis. All of these
changes occurred after E. coli was incubated in cranberry metabolite-containing
urine, defined as urine opsonization.
Results: Urine opsonization of E. coli
resulted in a 40.9% (p=0.0038) decrease in hemagglutination ability, 66.7%
(p=0.0181) decrease in urothelium adhesiveness, a 16.7% (p=0.0004) increase in
the 50% lethal time in killing nematodes,
a 53.9% (p=5.9x10-4) decrease in biofilm
formation, and 656% (p=2.0x10-7) more
E. coli were engulfed in transformed
phagocytes.
Conclusion: An equivalent daily dose
of cranberry juice should be considered
potent enough to demonstrate urine
opsonization in E. coli.
MP-12.09
Vesicocolonic Fistulas Manifested
as Bladder Tumors
Ilievski A1, Ilievski P2, Stankov O1
1
Urology Clinic, Skopje, Republic of
Macedonia; 2Artesia General Hospital,
New Mexico, USA
Introduction and Objectives: Acquired
communication between the urinary tract
and the colon is a complication of an inflammatory process of the colon mainly diverticulitis with abscess, colorectal cancer,
bladder cancer or iatrogenic injury. The
most common cause of vesicocolonic fistula is diverticulitis with incidence of 50% of
all fistulas and other causes are very rare.
S112
Despite the fact most vesicocolonic fistulas
are the result of colon disease, patients
most often have urological symptoms.
The most relevant and pathognomonic
symptoms are pneumaturia, fecaluria and
other urological symptoms such as bladder
iritation, friquency, urgency, hematuria and
urinary infection.
Materials and Methods: We are presenting two cases with vesicocolonic fistula
manifested as a bladder tumor in the fifth
decade of their lives that, after diverticulitis, had symptoms of hematuria with passing blood clots and recurrent urinary infection. The other case was with symptoms
of urgency, frequency and bulging tumor
in the bladder extended from the bladder
dome to the rectosygmoid pouch.
Results: The diagnosis of fistula in these
cases was done by cystoscopy. One of
the patients who had hematuria before
cystosopy had ultrasound done and a
round mass was seen in the bladder. Later
a cystoscopy was done with removal of
the mass. Pathohystological report stated
colonic mucosa with hyperplastic change.
The other case, which was confirmed
by cystoscopy and bladder mucosa with
inflamation and bulging of the dome of
bladder, was seen, suspected as an urachus
tumor. Open exploratory laparotomy was
performed. During exploration a large
mass from the dome of the bladder to
the rectosygmoid pouch was found. The
mass was removed and partial cystectomy
was done but on biopsy inflammation
was found without evidence of neoplastic
disease. The finding showed sygmoid diverticulitis and resection of sigmoid colon
was performed with end-to-end sygmoid
reconstruction.
Conclusion: Vesicocolonic fistulas are a
rare complication of colon inflammation,
like diverticulitis. In patients with this inflammation, which is not rare in a western
country, if they have symptoms of urinary
infection with hematuria, especially if they
have pneumaturia or fecaluria a cystoscopy
should be done as a procedure for diagnosis of this kind of vesicocolonic fistula.
ultrasound-guided prostate biopsy (TRUSBx) is the standard procedure for diagnosing prostate cancer. However, one of the
most serious complications associated with
TRUS-Bx is infection such as acute prostatitis, and urosepsis. We aim to investigate
the risk factors associated with infectious
complications after TRUS-Bx.
Materials and Methods: This study
included 5827 patients who underwent
a TRUS-Bx between May 2003 and January 2013 at SNUBH. We retrospectively
reviewed the baseline demographics, and
clinical information including serum PSA
level, IPSS score, information on the antibiotics, prostate size, and number of biopsy
cores. All the variables were analyzed with
the Mann-Whitney U test for continuous
variables and chi-square test for categorical
variables. Adjusted odds ratios and their
95% confidence intervals were calculated
using multiple logistic regression.
Results: Mean age of the patients was
64.7±9.3 years, median serum PSA level
6.48 (interquartile range, 4.33~10.70) ng/
ml, mean IPSS score 12.3, and mean number of cores obtained by TRUS-Bx 12.6.
Twenty-eight (0.48%) patients presented
infectious complication that required
hospitalization. Multivariate logistic regression analysis retained the IPSS score
(OR=4.034, 95%CI 1.256-12.952, p=0.02),
and the use of third-generation cephalosporin (OR=0.134, 95%CI 0.048-0.374,
p<0.01) as independent predictors for
hospitalization. Of the 15 patients with
infectious complication who received prophylactic quinolone, quinolone-resistant
E.coli was collected in 11 patients, and
septic shock was presented in 3 patients.
Conclusion: With the emergence of
quinolone-resistant E.coli, third-generation
cephalosporin has been found to effectively reduce the risk of infectious complication and hospitalization after transrectal
ultrasound-guided prostate biopsy. The
independent risk factor associated with
infectious complications after TRUS-Bx was
the IPSS score, and the use of third-generation cephalosporin.
MP-12.10
The Importance of Antibiotics
Regimen in Transrectal
Ultrasound-Guided Biopsy:
Quinolone vs. Cephalosporin
Kim K1, Lee S1, Lee J1, Jung J1, Park Y1,
Jeong S1, Hong S1, Byun S1, Noh C2, Lee S1
1
Dept. of Urology, Seoul National
University Bundang Hospital, Seongnam,
South Korea; 2Dept. of Urology, Inje
University Hospital, Seoul, South Korea
MP-12.11
Seasonal Changes of Symptoms in
Patients with Chronic Prostatitis/
Chronic Pelvic Pain Syndrome:
A Seasonal Follow-Up Study
Lee G1, Bae J2
1
Dept. of Urology, Dankook University
College of Medicine, Cheonan, South
Korea; 2Dept. of Urology, Korea
University School of Medicine, Ansan,
South Korea
Introduction and Objectives: Transrectal
Introduction and Objectives: To evaluate
UROLOGY 82 (3 Supplement 1), September 2013
MODERATED POSTERS
whether the seasonal changes aggravate
the symptoms of the chronic prostatitis/
chronic pelvic pain syndrome (CP/CPPS).
Materials and Methods: A total of 77
men with CP/CPPS were serially evaluated
with the NIH-CPSI questionnaires every
2-3 months from Oct. 2008 to Oct. 2012.
The clinical characteristics are shown in
Table 1. The seasons were categorized
into spring & autumn (S&A), summer,
and winter.
Results: There were no significant differences in the mean NIH-CPSI scores among
the three seasons (Table 2). Significant
correlation in pain items was found between the S&A and summer, whereas it
was not found between the winter and
S&A or summer. High correlations were
found among the three seasons in urination symptoms, quality of life (QoL), and
total scores (Table 3A). In winter, both
pain items and urination symptoms were
highly correlated with the QoLs (pain,
r2=0.522; urination symptom, r2=0.250).
In S&A and summer, however, the only
urination symptoms were correlated with
QoL (Table 3B).
Conclusion: Pain is not increased in winter, but it has more impact on QoL in winter than S&A or summer. In addition, pain
is more determinant of QoL than urination
symptoms in the winter.
MP-12.11, Table 1. Clinical characteristics of
study subjects
No. of patients
77
Age (yr)
55.12 ± 11.88
PSA* (ng/mL)
1.94 ± 2.07
Volume (cm3)
32.18 ± 13.41
EPS+
9.18 ± 11.19
Initial NIH-CPSI++ score
Pain item 1-3 (sum)
3.08 ± 2.04
Pain item 4
3.51 ± 2.44
Voiding domain
5.52 ± 2.54
Quality of life domain
5.41 ± 2.37
Follow up (mo)
27.11 ± 10.00
No. of visiting
14.68 ± 5.33
*Prostate-specific antigen, +Expressed prostatic
massage, ++NIH-CPSI; Korean version of National
Institues of Health chronic prostatitis symptoms index.
MP-12.11, Table 3
Table 3A. Regression analysis for the scores of NIH-CPSI+ questionnaire among the three seasons
Parameter
Spring & autumn
Summer
Winter
Pain sum (Item 1-3)
Spring & autumn
1
r 2=0.304, p =0.000
r 2=0.010, p =0.399
Summer
1
r 2=0.002, p =0.734
Pain (Item 4)
Spring & autumn
1
r 2=0.396, p =0.000
r 2=0.005, p =0.532
Summer
1
r 2=0.000, p =0.962
Pain (Item 4)
Spring & autumn
1
r 2=0.341, p =0.000
r 2=0.009, p =0.415
Summer
1
r 2=0.002, p =0.737
Urination symptoms
Spring & autumn
1
r 2=0.464, p =0.000
r 2=0.290, p =0.000
Summer
1
r 2=0.372, p =0.000
Quality of Life
Spring & autumn
1
r 2=0.625, p =0.000
r 2=0.622, p =0.000
Summer
1
r 2=0.634, p =0.000
Total score
Spring & autumn
1
r 2=0.455, p =0.000
r 2=0.160, p =0.000
Summer
1
r 2=0.202, p =0.000
Table 3B. Regression analysis between QOL++ and the scores of NIH-CPSI+ questionnaire in different seasons
Parameter
Spring & autumn
Summer
Winter
Correlation between QOL++
and pain sum (Item 1-3)
r 2=0.002, p =0.735
r 2=0.001, p =0.764
r 2=0.433, p =0.000
and pain (Item 4)
r 2=0.019, p =0.233
r 2=0.000, p =0.958
r 2=0.511, p =0.000
and pain sum (Item 1-4)
r 2=0.010, p =0.387
r 2=0.001, p =0.829
r 2=0.522, p =0.000
and urination symptoms
r 2=0.277, p =0.000
r 2=0.345, p =0.000
r 2=0.250, p =0.000
and totals scores
r 2=0.346, p =0.000
r 2=0.4380, p =0.000
r 2=0.799, p =0.000
+
NIH-CPSI; Korean version of National Institutes of Health chronic prostatitis symptoms index.
++
Quality of life. We used SPSS software for Windows (version 11; SPSS, Chicago, IL, USA) for calculating the
Pearson’s correlation coefficient. Two-sided statistical tests were used in all analyses as noted with statistical
significance considered at p <0.05.
MP-12.12
Risk Factors for Ciprofloxacin
Resistance in Enterococcus
faecalis Strains from Male Patients
with Urinary Tract Infections
Lee G1, Bae J2
1
Dept. of Urology, Dankook University
College of Medicine, Cheonan, South
Korea; 2Dept. of Urology, Korea
University School of Medicine, Ansan,
South Korea
Introduction and Objectives: Urinary
tract infection (UTI) is one of the most
prevalent bacterial infections. Fluoroquinolone (FQ) therapy is a standard
MP-12.11, Table 2. The mean NIH-CPSI+ scores of the study
Parameter (score)
Spring & autumn
Summer
Winter
p-value++
Total
14.94 ± 4.98
14.38 ± 5.44
14.02 ± 6.97
p>0.05
Pain sum (Item 1-4)
6.45 ± 3.98
5.68 ± 3.84
5.62 ± 3.84
p>0.05
Urination symptoms
3.28 ± 1.95
3.36 ± 2.11
3.08 ± 2.00
p>0.05
Quality of Life
5.22 ± 2.28
5.40 ± 2.41
5.32 ± 2.45
p>0.05
Pain sum (Item 1-3)
2.95 ± 1.98
2.72 ± 2.00
2.65 ± 1.94
p>0.05
Pain (Item 4)
3.34 ± 2.34
2.88 ± 2.11
2.96 ± 2.09
p>0.05
+
NIH-CPSI; Korean version of National Institutes of Health chronic prostatitis symptoms inex.
++
ANOVA (analysis of variance) test was performed, Two-sided statistical tests were used in all analyses as noted
with statistical significance considered at p <0.05. All analyses were done using SPSS software for Windows
(version 11; SPSS, Chicago, IL, USA).
UROLOGY 82 (3 Supplement 1), September 2013
regimen for UTI. The prevalence and
risk factor analysis of FQ resistance in
enterococcal UTIs has not been well
documented. The aim of this study is to
evaluate the antimicrobial susceptibility
and risk factors for obtaining ciprofloxacin resistance in Enterococcus faecalis (E.
faecalis) strains from complicated UTI.
Materials and Methods: We evaluated 81
E. faecalis strains from 81 male patients
who admitted to a single hospital over 3
years. The Vitek 2 automatic system was
used to assess antimicrobials susceptibility.
Results: The antimicrobial resistance
rates were rare for ampicillin/sulbactum,
imipenem, and vancomycin in E. faecalis.
The resistance rate of E. fecalis is 46% for
levofloxacin, 47% for ciprofloxacin, and
58% for norfloxacin. E. faecalis strains
were highly resistant to erythromycin
(92%), and tetracycline (96%). The risk
factor analysis revealed that age intervals,
the underlying diseases, cauterization,
and the number of admissions did not increase the ciprofloxacin resistance. Conversely, patients with hospital acquired
infections (OR:18.15, 95% CI:3.46-95.13,
P=0.001), patients who were previously treated in a urological department
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MODERATED POSTERS
MP-12.12, Table 1. Multivariate Analysis of Risk Factors for Ciprofloxacin Resistant E. Faecalis Strains.
Risk factors
Age (yr)
OR1 (95% CI2)
p-value
1.002 (0.96-1.04)
0.911
Urine collection
Self voided
Catheter
1
0.769 (0.2-2.91)
0.699
Type of infection
CAUTI3
1
HAUTI4
18.151 (3.46-95.13)
0.001
No. of admission
None
1
1-2
1.666 (0.35-7.96)
0.522
>2
2.06 (0.45-9.41)
0.351
DM5
No
1
Yes
1.3 (0.33-5.09)
0.706
MP-12.14
Excellent Control of Infective
Complications after Transrectal
Prostate Biopsy with Cephalosporinbased Prophylactic Antibiotics and
the Simple Use of Suppositorytype Povidone-iodine
Oh J, Lee S, Hong Y, Hong J, Park D
Dept. of Urology, CHA Bundang Medical
Center, CHA University, Seongnam, South
Korea
CRF6
No
1
Yes
0.648 (0.08-5.23)
0.684
Combined urologic diseases
No
1
Yes
6.158 (1.5-25.41)
0.012
Staying in healthcare center
No
1
Yes
7.393 (1.32-41.22)
0.023
Cancer
No
1
Yes
2.189 (0.472-10.14)
0.317
OR, odds ratio; 2CI, confidence interval; 3CAUTI, community associated urinary tract infection; 4HAUTI,
hospital associated urinary tract infection; 5DM, diabetes mellitus; 6CRF, chronic renal failure.
1
(OR:6.15, 95% CI:1.5-25.41, P=0.012),
and patients who were transferred from
healthcare centers (OR:7.393, 95%
CI:1.32-41.22, P=0.023) all had increased
the risk of ciprofloxacin resistance than
the matched controls.
Conclusion: FQ is not a recommended
empirical therapy for E. faecalis from
complicated UTI in men anymore. Instead, ampicillin/sulbactum can be an
alternative for treating ciprofloxacin resistant E. faecalis strains associated UTI.
MP-12.13
Use of Peri-operative Gentamicin
in Radical Cystectomy: Does It
Cause More Harm than Good?
Mukherjee A1, Hilditch G2, Hendry D2
1
NHS, Greater Glasgow and Clyde,
Scotland; 2Gartnavel General Hospital,
Glasgow, Scotland
Introduction and Objectives: We reviewed a series of patients who underwent
radical cystectomy for high grade bladder
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was 73% (n=19/36). The rate of nephrotoxicity in cases performed by surgeon B
was 36% (5/14) in those receiving gentamicin. The overall mean change in creatinine from pre-operative to day 1 and day
2 post-operative values were significant
(p value < 0.0001, CI 95% was 5.4 for
those that received gentamicin and CI
95% was 4.0 for those that did not receive
gentamicin at induction).
Conclusion: The use of gentamicin as an
aminoglycoside antibiotic used during induction to prevent infection during radical
cyctectomy procedures is probably a risky
choice for routine prophylaxis in major
urological surgery. Its use impacts greatly
on long-term outcome of radical cystectomy surgery. Thus we have augmented
local pre-operative antimicrobial policy
guidelines as a result of our findings.
cancer and the subsequent development
of gentamicin-induced nephrotoxicity
manifested as deranged renal function
parameters amongst these patients.
Materials and Methods: Between two
distinct time periods from two separate
urologists (Surgeon A - February 2000 to
October 2002 and Surgeon B - May 2009
to May 2011), a total of 63 (48 male and
15 female) radical cystectomy cases were
undertaken at our institution. We found
that the rate for acute nephrotoxicity
(measurement of day 1 post-operative
creatinine and eGFR using MDRD formula) following radical cystectomy was
significantly higher amongst those patients who had been given peri-operative
gentamicin as a one off single dose during anaesthetic induction.
Results: Of the 41 cases that were performed by surgeon A, 26 patients were
given gentamicin peri-operatively and the
rate of nephrotoxicity (eGFR using MDRD
formula values less than or equal to 60)
Introduction and Objectives: Transrectal ultrasonography (TRUS)-guided
prostate biopsy is a standard procedure
for the detection of prostate cancer. In
this report, we describe a prostate biopsy
preparation protocol consisting of thirdgeneration cephalosporin-based prophylaxis and suppository-type povidoneiodine (Gynobetadine®).
Materials and Methods: From January
2004 to May 2012, we reviewed infective complications of 1,684 patients who
underwent TRUS guided prostate biopsy.
All patients received prophylactic antibiotics through single intravenous injection
of third-generation cephalosporin before
biopsy and oral administration of cefixime 100 mg for 5 days. All of the patients
received a Gynobetadine® 200 mg just
before biopsy. Infectious complications
were classified as sepsis, fever (> 38°C)
without sepsis, and other clinical infections. To evaluate the bactericidal effects
of Gynobetadine®, we prospectively
counted bacterial colonies in rectal samples that had been harvested with a rectal
swab from 150 patients who underwent
TRUS-guided prostate biopsy.
Results: The mean age was 65.6 years,
the median PSA level was 6.32 ng/ml and
the mean prostate volume was 44.0 ml.
UROLOGY 82 (3 Supplement 1), September 2013
MODERATED POSTERS
In total, complications occurred in 46
cases (2.73%), including 11 infective complications (0.65%) and 35 non-infective
complications (2.08%). In infective complications, 2 patients had fever without
sepsis, 9 patients had clinical urinary tract
infection without fever, and no sepsis was
reported. The clinical UTI cases included
3 epididymo-orchitis, 5 acute prostatitis
with mild fever below 38°C, and 1 prolonged pyuria without fever. There were
no cases of hospitalization. In prospectively performed in vitro experiments,
the mean bacterial colony counts before
rectal preparation with an enema or insertion of Gynobetadine® was 2.38×106,
and the colony counts were 1.81×103
after biopsy following a povidone-iodine
rectal enema and 8.1×102 after biopsy
following rectal preparation with Gynobetadine® (all p < 0.001).
Conclusion: The administration of
cephalosporin-based prophylactic antibiotics and the simple use of suppositorytype povidone-iodine led to an excellent
protocol for reducing infective complications. In particular, the simplicity of use
and cost effectiveness of Gynobetadine
were encouraging.
management of IC/PBS and compared
our experience of using this treatment to
the recently published literature.
Results: We identified 23 patients (21
female and 2 male) aged between 26-83
years (mean=50 years ± SD16 years)
with a clinical diagnosis of IC/PBS (between 2011 – 2012). Of the 23 patients
reviewed, 70% had bladder pain, 96%
had frequency, 78% had urgency, and 35%
urge incontinence. Following treatment
with a full course of HA, 74% reported
improvement in bladder pain, 78% reported improvement in urinary frequency, 44% improvement in urgency and 65%
had an improvement in bladder capacity.
This treatment was tolerated well by the
patients with minimal side effects. Only
2 patients had bladder pain during the
treatment course, one subsequently discontinued HA treatment.
Conclusion: HA offers a safe and effective management option for patients with
IC/PBS. However, further randomized
controlled trials with larger sample size
required to further investigate the longterm efficacy and safety.
MP-12.15
The Efficacy and Safety of Intravesical
Hyaluronic Acid in Patients with
Interstitial Cystitis / Painful Bladder
Syndrome: Practice Experience
Sambandan N, Kebbe Y, Briggs K,
Sutherland S, Hammadeh M
Dept. of Urology, Queen Elizabeth
Hospital, London, UK
MP-12.16
Risk Factors of Infectious
Complication after Ureteroscopic
Procedures of the Upper Urinary Tract
Sohn D1, Kim H1, Kim J1, Seo H2, Son J3,
Kim S1
1
Dept. of Urology, College of Medicine,
The Catholic University of Korea, Seoul,
South Korea; 2National Cancer Center,
Goyang, South Korea; 3Bung Dang Jae
Sang Hospital, Sungnam, South Korea
Introduction and Objectives: To assess the efficacy and safety of intravesical
hyaluronic acid (HA) in the management
of patients with Interstitial Cystitis/Painful
Bladder Syndrome (IC/PBS) in our hospital. Also to perform a literature review
about the use of Glycosaminoglycan
(GAGs) such as Hyaluronic acid (HA) and
Chondroitin sulphate (CS) in the management of IC/PBS and compare our findings to the published evidence available.
Materials and Methods: We reviewed
retrospectively the outcomes of 23
patients treated at our district general
hospital for IC/PBS with a full course of
HA using subjective urinary symptoms
assessment and a bladder diary before
and at 3, 6, and 12 months after completion of the course of HA. Patients were
investigated with urine microscopy, urine
cytology, ultrasound scan of the renal
tract, and conventional urodynamic
studies. We also performed a literature
review of studies using HA or CS for the
Introduction and Objectives: Ureteroscopic procedures are being commonly
performed in urology, only a few clinical
studies have been conducted on infectious complications after these procedures and overall understanding on the
preoperative use of prophylactic antibiotics is insufficient. This study examined
the incidence rate of infectious complications and the risk factors affecting the
incidence after ureteroscopic procedures.
Materials and Methods: We retrospectively reviewed the medical records of
531 patients who underwent ureteroscopy and ureteroscopic lithotripsy in our
hospital, including age, sex, past history,
comorbidity, urine analysis, urine culture,
blood test, hydronephrosis, urethral
catheter or ureteral stent, percutaneous
nephrostomy placement and others from
January 2002 to December 2011.
Results: A total of 20 patients (3.8%)
contracted infectious complications after
various procedures in the upper urinary
UROLOGY 82 (3 Supplement 1), September 2013
tract. Pyuria, hydronephrosis, and the
placement of urethral catheter, ureteral
stent, and percutaneous nephrostomy
are significant risk factors of infectious
complication. No significant differences
were shown in the types and start time
of prophylactic antibiotics. Diagnostic
ureteroscopy exhibited higher incidence
rate of infectious complication compare
to ureteroscopic lithotripsy.
Conclusion: Risk factors of infectious
complication were verified to be pyuria,
hydronephrosis, previous placement of
urethral catheter, ureteral stent, and percutaneous nephrostomy, and others.
MP-12.17
The Role of Innate Immunity
in Chronic Prostatitis
Ho D, Chen C, Chang P, Lin W, Huang Y
Chang Gung Memorial Hospital, Pu-Z
City, Taiwan
Introduction and Objectives: The mechanism of non-bacterial chronic prostatitis
(CP/CPPS) is still not clear. The main
hypothesis of this study is that abnormal
response of innate immunity may be a
cause of CP/CPPS. We suppose inflammasome, part of innate immunity, may result
in persist inflammation in CP/CPPS.
Materials and Methods: We induced CP/
CPPS in rat animal model with carrageenan. After we confirmed the tactile hyperalgesia in rats, local prostate inflammation
status and inflammasome expression was
checked. The amount of inflammasome
and its downstream protein was checked,
along with their prostate localization.
Chlorogenic acid (CHA), proved an active
ingredient of Chinese herbal remedy in
CP/CPPS treatment provided by Acrobio.
Inc, was used as treatment.
Results: Rats were proved CP/CPPS
once scrotal static tactile allodynia developed. CHA treatment relieved scrotal
hypersensitivity. Downstream protein of
inflammasome, i.e. IL-1beta and caspase
1, was found increased within prostate,
and decreased with CHA treatment.
Inflammasome, NALP1 but not NALP3,
was increased significantly in prostate
glandular endothelial cells. Treatment of
CHA changed the distribution pattern of
NALP1 in prostate.
Conclusion: We demonstrated a close
relationship between activation of inflammasome and pathophysiological changes
of CP/CPSS rats. The increase of inflammasome may be a possible mechanism of
CP/CPPS. Clinically active regimen for CP/
CPPS may inhibit inflammasome related
pathway. Our findings may provide new
treatment rationale for CP/CPPS.
S115