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Elshal AM, Allam KA, Abolazm AE, Nabeeh A, Osman Y. The Headache of Post-Transurethral Prostate Surgery Pyuria: Pursuit for Evidence. J Endourol 2024; 38:629-636. [PMID: 38613814 DOI: 10.1089/end.2023.0667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
Objective: To prospectively assess early post-transurethral prostate surgery (TUPS) urinalysis changes and bacteriuria with its clinical relevance. Methods: Patients with benign prostate obstruction enrolled for TUPS were prospectively assessed. Patients were assessed at 2, 4, 8, 12, and 24 weeks postoperatively by the dysuria-visual-analogue-scale (DVAS), international prostate symptom scores (IPSS)-quality of life, uroflow, and postvoid residual. Routine urinalysis was performed before discharge and at all visits. Midstream urine culture (MSUC) was performed before discharge, and 4 and 12 weeks postoperatively. Results: At final analysis, 152 patients were evaluable. Significant pyuria was reported in 52%, 96.1%, 94.1%, 71.7%, 78.9%, and 52.5% in, before discharge, 2-, 4-, 8-, 12-, and 24-week urinalysis postoperative, respectively. The mean time to nonsignificant pyuria (95% confidence interval [CI]) was 19.1 (17.5-20.7), 20.1 (17.3-22.9), 15.8 (12.8-18.8), and 14 (10.3-17.8) weeks after prostate resection, vaporization, enucleation, and incision, respectively (p = 0.03). Regardless the TUPS technique, half of patients had significant pyuria at 24 weeks postoperative. MSUC was positive in 37/152 (24.3%), 3/152 (2%), 23/152 (15.1%), and 5/152 (3.3%) preoperatively, before discharge, and 4 and 12 weeks postoperative, respectively. Only positive preoperative urine leukocyte esterase independently predicted positive 4-week MSUC (odds ratio 3.8, 95% CI 1.3-11.1, p = 0.013). No significant correlation was found between IPSS or DVAS and positive MSUC, nor between IPSS and postoperative pyuria at different follow-up points (p > 0.05). However, the degree of postoperative dysuria was significantly correlated with postoperative pyuria count by urinalysis at 2 weeks (r = 0.69, p = 0.03), 8 weeks (r = 0.26, p = 0.001), and 12 weeks (r = 0.23, p = 0.004). Conclusion: There is a persistent but gradually declining pyuria and microhematuria following TUPS up to 6 months postoperative. An earlier resolution was noted following prostate incision and enucleation. While routine urine analysis screening in these months would be of no clear clinical value, a routine urine culture would be of a reasonable significance at 1 month postoperatively.
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Affiliation(s)
- Ahmed M Elshal
- Depatment of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Khaled A Allam
- Depatment of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed E Abolazm
- Depatment of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Adel Nabeeh
- Depatment of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Depatment of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Lin J, Yang Z, Ye L, Hong Y, Cai W, Pan H, Fu H, Wu J. Pathogen species are the risk factors for postoperative infection of patients with transurethral resection of the prostate: a retrospective study. Sci Rep 2023; 13:20943. [PMID: 38016988 PMCID: PMC10684857 DOI: 10.1038/s41598-023-47773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023] Open
Abstract
This study aimed to analyze the infection risk factors for transurethral resection of the prostate (TURP) and establish predictive models to help make personalized treatment plans. Our study was designed one-center and retrospectively enrolled 1169 benign prostatic hyperplasia (BPH) patients. Risk factors were explored for postoperative infection. A TURP-postoperative infection (TURP-PI) model with infection prediction values was created. The improved-TURP-PI (I-TURP-PI) model, including extra new factors (pathogens species), was also built to see whether it could optimize the prediction abilities. At last, we developed a nomogram for better clinical application. Operation time, preoperative indwelling urinary catheter (PIUC), and positive preoperative urine culture were independent risk factors (all P < 0.05). Interestingly, pathogens species in pre-surgery urine (PEnterococcus faecium = 0.014, PPseudomonas aeruginosa = 0.086) were also independent risk factors. Patients with positive Enterococcus faecium (37.50%) were most likely to have postoperative infection. We built two models with AUCTURP-PI = 0.709 (95% CI 0.656-0.763) and AUCI-TURP-PI = 0.705 (95% CI 0.650-0.760). The nomogram could help improve the prediction ability. To our knowledge, our study is the first to use pathogen species in urine before surgery as risk factors for infection prediction after TURP. TURP-PI and I-TURP-PI models have essential roles in predicting patients' postoperative infections and in better postoperative antibiotic decision-making.
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Affiliation(s)
- Jiexiang Lin
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Zesong Yang
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Liefu Ye
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Yun Hong
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Wanghai Cai
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Honghong Pan
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Haishou Fu
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Clinical Laboratory, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
| | - Jinfeng Wu
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
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Zeng XT, Jin YH, Liu TZ, Chen FM, Ding DG, Fu M, Gu XQ, Han BM, Huang X, Hou Z, Hu WL, Kang XL, Li GH, Li JX, Li PJ, Liang CZ, Liu XH, Liu ZY, Liu CX, Liu JM, Luo GH, Luo Y, Qin WJ, Qiu JH, Qiu JX, Shang XJ, Shi BK, Sun F, Tian GX, Tian Y, Wang F, Wang F, Wang YH, Wang YJ, Wang ZP, Wang Z, Wei Q, Xiao MH, Xu WH, Yi FX, Zhu CY, Zhuang QY, Zhou LQ, Zou XF, Xing NZ, He DL, Wang XH. Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition). Mil Med Res 2022; 9:14. [PMID: 35361280 PMCID: PMC8974007 DOI: 10.1186/s40779-022-00371-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 02/08/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline "2018 Standard Edition". However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons' surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons' skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.
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Affiliation(s)
- Xian-Tao Zeng
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Tong-Zu Liu
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Fang-Ming Chen
- Department of Urology, Tianjin Third Central Hospital Affiliated To Nankai University, Tianjin, 300170, China
| | - De-Gang Ding
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, 450003, China
| | - Meng Fu
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Xin-Quan Gu
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Bang-Min Han
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Xing Huang
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhi Hou
- Department of Urology, Qinghai University Affiliated Hospital, Xi'ning, 810012, China
| | - Wan-Li Hu
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xin-Li Kang
- Department of Urology, People's Hospital of Hainan Province, Hainan Affiliated Hospital of Hainan Medical University Haikou, Haikou, 570311, China
| | - Gong-Hui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Jian-Xing Li
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Pei-Jun Li
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, 750003, China
| | - Chao-Zhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xiu-Heng Liu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zhi-Yu Liu
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, 116023, Liaoning, China
| | - Chun-Xiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510282, China
| | - Jiu-Min Liu
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Guang-Heng Luo
- Department of Urology Surgery, Guizhou Province People's Hospital, Guiyang, 550002, China
| | - Yi Luo
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Wei-Jun Qin
- Department of Urology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, China
| | - Jian-Hong Qiu
- Department of Urology, The 980St Hospital of the PLA Joint Logistics Support Force (Bethune International Peace Hospital of PLA), Shijiazhuang, 050082, China
| | - Jian-Xin Qiu
- Department of Urology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, 710038, China
| | - Xue-Jun Shang
- Department of Andrology, Jinling Hospital Affiliated to Nanjing University School of Medicine, Nanjing, 210002, China
| | - Ben-Kang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Fa Sun
- Department of Urology Surgery, Guizhou Province People's Hospital, Guiyang, 550002, China
| | - Guo-Xiang Tian
- Department of Geriatrics, The Seventh Medical Center of Chinese, PLA General Hospital, Beijing, 100027, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Feng Wang
- Department of Urology, People's Hospital of Tibet Autonomous Region, Lhasa, 850000, China
| | - Feng Wang
- Department of Urology, South China Hospital, Shenzhen University, Shenzhen, 518111, Guangdong, China
| | - Yin-Huai Wang
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Yu-Jie Wang
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Zhi-Ping Wang
- Department of Urology, Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou, 730030, China
| | - Zhong Wang
- Department of Urology, Shanghai 9Th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 88 South Keyuan Road, Chengdu, 610041, China
| | - Min-Hui Xiao
- Department of Urology, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming, 650041, China
| | - Wan-Hai Xu
- Department of Urology, The Fourth Hospital of Harbin Medical University, Heilongjiang Key Laboratory of Scientific Research in Urology, Harbin, 150001, China
| | - Fa-Xian Yi
- Department of Urology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010059, China
| | - Chao-Yang Zhu
- Department of Urology, Huaihe Hospital of Henan University, Kaifeng, 475000, Henan, China
| | - Qian-Yuan Zhuang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, The Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, China
| | - Xiao-Feng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Nian-Zeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Da-Lin He
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Xing-Huan Wang
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. .,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Choi JB, Min SK. Complicated urinary tract infection in patients with benign prostatic hyperplasia. J Infect Chemother 2021; 27:1284-1287. [PMID: 34144904 DOI: 10.1016/j.jiac.2021.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
Complicated urinary tract infection (UTI) is a symptomatic urinary infection accompanied by functional or structural abnormalities of the genitourinary tract. Benign prostatic hyperplasia (BPH) is a major cause of lower urinary tract obstruction in male patients, and bladder outlet obstruction (BOO) secondary to BPH can lead to UTIs in men. However, no evidence has clearly shown that UTI in the aging male population is associated with either post-void residual urine or BOO. Screening for the presence of bacteriuria is recommended prior to any procedure manipulating the urinary tract, and imaging studies of the upper urinary tract are recommended to identify underlying abnormalities. Recurrent or persistent UTI in men with BPH is an indication for surgical treatment. Asymptomatic bacteriuria should be screened for and treated before transurethral resection of the prostate (TURP). In addition, antibiotic prophylaxis reduced the risk of UTI in patients undergoing TURP. The choice of specific antimicrobial for prophylaxis should be based on local pathogen prevalence and individual antibiotic susceptibility. Patients with severe systemic infections require hospitalization, and empirical therapy should include an intravenous antimicrobial regimen. Further prospective studies are needed to refine the treatment process for complicated UTI in patients diagnosed with BPH.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Ki Min
- Goldman Urology Clinic, Seoul, Republic of Korea.
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Panach-Navarrete J, Valls-González L, Sánchez-Cano E, Medina-González M, Castelló-Porcar A, Martínez-Jabaloyas JM. Comparison of three different antibiotic protocols in transurethral resection of bladder tumour and the possible infectious risk factors: A non-randomized, prospective study. Can Urol Assoc J 2018; 12:E466-E674. [PMID: 29989880 DOI: 10.5489/cuaj.5207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to investigate three different antibiotic protocols in transurethral resection of a bladder tumour (TURBT), and the possible infectious risk factors of this surgery. METHODS We conducted a non-randomized, prospective study, gathering cases of patients in whom TURBT had been performed. The sample was divided into three groups based on those who received antibiotics as: a single preoperative dose (Group A); a preoperative dose, plus a long protocol during the hospitalization (Group B); a preoperative dose, plus a long protocol during the hospitalization, plus five days at home (Group C). Intra- and postoperative data that could be relevant to infections was gathered. RESULTS A total of 219 patients were included. In the multivariate analysis, it was observed that the patients in Group A were more prone to re-hospitalization due to fever than were those from Group C (odds ratio [OR] 11.13; p=0.03). Furthermore, the cases with tumour necrosis and those who entered surgery with a urinary catheter were more prone to have a temperature above 37.5°C (OR6.74; p=0.02 and OR6.4; p=0.04, respectively), as well as have an increased risk per every additional tumour in the cystoscopy (OR 1.32; p=0.01). Those who received mitomycin had a lower chance of a positive urine culture (OR 0.29; p=0.01), contrary to those patients with over two days of hospitalization (OR 4.11; p<0.01) and those who entered surgery with a urinary catheter (OR 12.35; p=0.02). CONCLUSIONS Those patients that only received a single dose of antibiotic before TURBT may have an increased risk of re-hospitalization due to fever in comparison to those who received prolonged antibiotic protocols. In addition, there are perioperative factors in this surgery that predict the risk of infectious complications.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Lorena Valls-González
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Eduardo Sánchez-Cano
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - María Medina-González
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Ana Castelló-Porcar
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
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Osman T, ElSaeed KO, Youssef HA, Shabayek M, Emam A, Hussein MS. Evaluation of the risk factors associated with the development of post-transurethral resection of the prostate persistent bacteriuria. Arab J Urol 2017; 15:260-266. [PMID: 29071162 PMCID: PMC5651946 DOI: 10.1016/j.aju.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/13/2017] [Accepted: 05/27/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives To determine the preoperative, intraoperative and postoperative risk factors that influence the development of persistent post-transurethral resection of the prostate (TURP) urinary tract infection (UTI) defined as pyuria and/or bacteriuria remaining for 3 weeks after surgery. Patients and methods This is a prospective study including 100 patients scheduled for TURP. Urine analysis and culture was performed immediately after catheter removal, then at 1 and 3 weeks postoperatively, and the results were correlated to various preoperative, intraoperative and postoperative potential risk factors to detect any significant relation to persistent UTI. Results There was a statistically significant relationship between bacteriuria and the following risk factors: old age, past history of diabetes mellitus, large prostatic size, positive preoperative urine analysis and culture, preoperative catheter use, previous urological interventions, large size of sheath, long duration of operation, postoperative catheter events and postoperative manual wash. Conclusions Many risk factors have been found to contribute to the development of post-TURP UTI and avoiding these factors can enhance recovery of patients undergoing TURP.
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Affiliation(s)
- Tarek Osman
- Department of Urology, Ain Shams University, Cairo, Egypt
| | | | | | | | - Ahmed Emam
- Department of Urology, Ain Shams University, Cairo, Egypt
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Schneidewind L, Kranz J, Schlager D, Barski D, Mühlsteadt S, Grabbert M, Queissert F, Frank T, Pelzer AE. Mulitcenter study on antibiotic prophylaxis, infectious complications and risk assessment in TUR-P. Cent European J Urol 2017; 70:112-117. [PMID: 28461999 PMCID: PMC5407338 DOI: 10.5173/ceju.2017.941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/18/2016] [Accepted: 01/09/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Transurethral resection of the prostate is one of the most frequent urological procedures. Urinary tract infections represent major sequelae, but data about antibiotic prophylaxis in TUR-P are controversial and outdated. MATERIAL AND METHODS We conducted a retrospective multicentre study of TUR-P in ten German hospitals. Primary endpoints were epidemiological and outcome data of TUR-P. Secondary endpoints were the identification of factors associated with febrile UTIs and sepsis after TUR-P. RESULTS We included 444 patients with a median age of 71.0 years. Nearly every patient (93.5%) received some kind of antibiotic prophylaxis. Complication rates were 4.9% for febrile UTIs and 2.3% sepsis. Significant risk factors associated with febrile UTIs were pre-existing risk factors for UTIs (p = 0.035) and a duration of catheterization of more than three days (p <0.0001). Significant risk factors for sepsis were duration of surgery of more than 60 minutes (p = 0.030) and again a duration of catheterization of more than three days (p <0.0001). Interestingly, 50.8% of the cases had evidence of chronic prostatitis in their histological specimen. This evidence of chronic prostatitis was significantly associated with febrile UTIs (p = 0.019) and sepsis (p = 0.018). CONCLUSIONS Duration of catheterization is one of the major risk factors for infectious complications after TUR-P. Antibiotic prophylaxis in TUR-P needs prospective investigation. These future studies should also address chronic prostatitis a priori.
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Affiliation(s)
- Laila Schneidewind
- University of the Saarland Medical Center, Institute of Virology, Homburg, Germany
- equal author contribution
| | - Jennifer Kranz
- St.-Antonius-Hospital, Department of Urology and Paediatric Urology, Eschweiler, Germany
- equal author contribution
| | - Daniel Schlager
- University of Freiburg Medical Center, Department of Urology, Freiburg (Brsg.), Germany
| | - Dimitri Barski
- Lukas Hospital Neuss, Department of Urology, Neuss, Germany
| | - Sandra Mühlsteadt
- Martin Luther University Halle-Wittenberg, Department of Urology, Halle, Germany
| | - Markus Grabbert
- Ludwig Maximilians University, Department of Urology, Munich, Germany
| | - Fabian Queissert
- University of Muenster Medical Center, Department of Urology, Muenster, Germany
| | - Tanja Frank
- RoMed Hospital Rosenheim, Department of Urology, Rosenheim, Germany
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Kim JK, Bae J, Lee HW, Lee KS, Cho MC. Does Postoperative Leukocyturia Influence Treatment Outcomes After Photoselective Vaporization of the Prostate (PVP)? A Prospective Short-Term Serial Follow-Up Study. Urology 2015; 86:581-6. [DOI: 10.1016/j.urology.2015.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/18/2015] [Accepted: 06/18/2015] [Indexed: 11/16/2022]
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9
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Comparison of Perioperative Outcomes including Severe Bladder Injury between Monopolar and Bipolar Transurethral Resection of Bladder Tumors: A Population Based Comparison. J Urol 2014; 192:1355-9. [DOI: 10.1016/j.juro.2014.05.100] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/17/2022]
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Hwang EC, Jung SI, Kwon DD, Lee G, Bae JH, Na YG, Min SK, Son H, Lee SJ, Chung JM, Chung H, Cho IR, Kim YH, Kim TH, Chang IH. A prospective Korean multicenter study for infectious complications in patients undergoing prostate surgery: risk factors and efficacy of antibiotic prophylaxis. J Korean Med Sci 2014; 29:1271-7. [PMID: 25246747 PMCID: PMC4168182 DOI: 10.3346/jkms.2014.29.9.1271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/27/2014] [Indexed: 11/20/2022] Open
Abstract
This multicenter study was undertaken to determine the efficacy of antibiotic prophylaxis and identify the risk factors for infectious complications after prostate surgery in Korean patients. A total of 424 patients who underwent surgery of the prostate were reviewed. All patients underwent urinalysis and urine culture preoperatively and postoperatively. Efficacy of antibiotic prophylaxis and risk factors for infectious complications were investigated. Infectious complications were observed in 34.9% of all patients. Factors independently associated with infectious complications were diabetes mellitus (adjusted OR, 1.99; 95% CI, 1.09-3.65, P=0.025) and operation time (adjusted OR, 1.08; 95% CI, 1.03-1.13, P=0.004). Clinicians should be aware of the high risk of infectious complications in patients with diabetes and those who undergo a prolonged operation time. Neither the type nor duration of prophylactic antibiotics resulted in differences in infectious complications.
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Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University, Hwasun, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University, Hwasun, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University, Hwasun, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Gilho Lee
- Department of Urology, Dankook University, College of Medicine, Cheonan, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Jae Hyun Bae
- Department of Urology, Korea University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Yong Gil Na
- Department of Urology, Chungnam National University, College of Medicine, Daejeon, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Seung Ki Min
- Department of Urology, National Police Hospital, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Sun Ju Lee
- Department of Urology, Kyung Hee University, School of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Jae Min Chung
- Department of Urology, Kosin University, College of Medicine, Busan, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Hong Chung
- Department of Urology, Konkuk University, School of Medicine, Chungju, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - In Rae Cho
- Department of Urology, Inje University, College of Medicine, Busan, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Young Ho Kim
- Department of Urology, Soon Chun Hyang University, College of Medicine, Bucheon, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - Tae-Hyoung Kim
- Department of Urology, Chung-Ang University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University, College of Medicine, Seoul, Korea
- The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII), Seoul, Korea
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El Basri A, Petrolekas A, Cariou G, Doublet JD, Hoznek A, Bruyere F. Clinical Significance of Routine Urinary Bacterial Culture After Transurethral Surgery: Results of a Prospective Multicenter Study. Urology 2012; 79:564-9. [DOI: 10.1016/j.urology.2011.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 11/12/2011] [Accepted: 11/15/2011] [Indexed: 11/15/2022]
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