1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Corkum KS, Hunter CJ, Grabowski JE, Lautz TB. Early postoperative fever workup in children: utilization and utility. J Pediatr Surg 2018; 53:1295-1300. [PMID: 28693850 DOI: 10.1016/j.jpedsurg.2017.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/24/2017] [Accepted: 06/15/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children. METHODS Single-institution, retrospective analysis of surgical patients undergoing an elective inpatient/observational surgery between 2011 and 2015 was performed. Early fever was defined >38.0°C within two days post-procedure. Encounters were queried for all blood cultures (BC), urinalysis (UA), urine cultures (UC), chest radiographs (CXR), and respiratory viral panels (RVP) obtained. RESULTS We identified 6943 patients, of whom 30.6% developed fever. UA was positive in 19.8% of patients tested. UC was positive in 15.7% of patients and 92.0% had a urinary catheter during surgery. BC was positive in 0.69% of patients, all with a central venous catheter. CXRs were considered infectious in 3.0% of patients tested. Patients with PICU stay and/or fever ≥38.9°C were more likely to undergo BC and UC, but no more likely to have a positive result compared those without PICU stay and/or fever <38.9°. CONCLUSION Early postoperative fever is common in pediatric surgical populations and rarely associated with an infectious source. Workup should be applied selectively. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Kristine S Corkum
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine J Hunter
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Julia E Grabowski
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL.
| |
Collapse
|
4
|
Sopeña-Sutil R, Medina-Polo J, Justo-Quintas J, Gil-Moradillo J, Garcia-Gonzalez L, Benítez-Sala R, Alonso-Isa M, Lara-Isla A, Tejido-Sanchez A. Healthcare-Associated Infections after Lower Urinary Tract Endoscopic Surgery: Analysis of Risk Factors, Associated Microorganisms and Patterns of Antibiotic Resistance. Urol Int 2018; 100:440-444. [PMID: 29649830 DOI: 10.1159/000488251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/05/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To review the incidence of healthcare-associated infections/urinary tract infection (UTI), risk factors, microorganisms isolated and antibiotic resistances in patients who underwent lower urinary tract endoscopic surgery (LUTES) in a tertiary care hospital. METHODS A prospective observational study was carried out including 1,498 patients who undergo LUTES. Patients with and without UTI after surgery were compared. We analysed infection incidence, risk factors, microorganisms isolated and antibiotic resistances. RESULTS Postoperative UTI incidence was 4.7%. Risk factors found: higher American Society of Anesthesiologists classification (OR 2.82; 95% CI 1.8-4.5; p < 0.00), immunosuppression (OR 2.89; 95% CI 1.2-7.2; p = 0.01), indwelling urinary catheter prior admission (OR 2.6; 95% CI 1.6-4.2; p < 0.00) and postoperative catheterization longer than 2 days (OR 1.74; 95% CI 1.7-4.3; p < 0.00). Transurethral resection of the bladder (TURB) had the highest infection rates (5.5%). Microorganisms isolated were Pseudomonas aeruginosa (23.5%), Escherichia coli (17.6%), Klebsiella pneumoniae and Enterococcus spp (11.8%). Resistance rates for flourquinolones varied between 28 and 80%, and Carbapenem-resistant Enterobacteriaceae rose up 20%. CONCLUSIONS Low percentage of UTI after endoscopic surgery was registered. TURB was the procedure with highest infection rate. Pseudomonas aeruginosa stands out as the most frequently isolated microorganism. Patient comorbidities, previous urinary catheter and postoperative catheter were identified as risk factors.
Collapse
|
5
|
Wei Y, Xu N, Chen SH, Li XD, Zheng QS, Lin YZ, Xue XY. Bipolar transurethral enucleation and resection of the prostate versus bipolar resection of the prostate for prostates larger than 60gr: A retrospective study at a single academic tertiary care center. Int Braz J Urol 2017; 42:747-56. [PMID: 27564286 PMCID: PMC5006771 DOI: 10.1590/s1677-5538.ibju.2015.0225] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 02/01/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of bipolar transurethral enucleation and resection of the prostate (B-TUERP) versus bipolar transurethral resection of the prostate (B-TURP) in the treatment of prostates larger than 60g. MATERIAL AND METHODS Clinical data for 270 BPH patients who underwent B-TUERP and 204 patients who underwent B-TURP for BPH from May 2007 to May 2013 at our center were retrospectively analyzed. Outcome measures included operative time, decreased hemoglobin level, total prostate specific antigen (TPSA), International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), quality of life (QoL) score, post void residual urine volume (RUV), bladder irrigation duration, hospital stay, and the weight of resected prostatic tissue. Other measures included perioperative complications including transurethral resection syndrome (TURS), hyponatremia, blood transfusion, bleeding requiring surgery, postoperative acute urinary retention, urine incontinence and urinary sepsis. Patients in both groups were followed for two years. RESULTS Compared with the B-TURP group, the B-TUERP group had shorter operative time, postoperative bladder irrigation duration and hospital stay, a greater amount of resected prostatic tissue, less postoperative hemoglobin decrease, better postoperative IPSS and Qmax, as well as lower incidences of hyponatremia, urinary sepsis, blood transfusion requirement, urine incontinence and reoperation (P<0.05 for all). CONCLUSIONS B-TUERP is superior to B-TURP in the management of large volume BPH in terms of efficacy and safety, but this finding needs to be validated in further prospective, randomized, controlled studies.
Collapse
Affiliation(s)
- Yong Wei
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shao-Hao Chen
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Dong Li
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing-Shui Zheng
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yun-Zhi Lin
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xue-Yi Xue
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| |
Collapse
|
6
|
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.
Collapse
Affiliation(s)
- Tarek Osman
- Department of Urology, Ain Shams University, Cairo, Egypt
| | | | | | | | - Ahmed Emam
- Department of Urology, Ain Shams University, Cairo, Egypt
| | | |
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
May A, Broggi E, Lorphelin H, Tabchouri N, Giretti G, Pereira H, Bruyere F. Comparison of the risk of postoperative infection between transurethral vaporesection and transurethral resection of the prostate. Lasers Surg Med 2014; 46:405-11. [PMID: 24665004 DOI: 10.1002/lsm.22240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE We observed in our department at 3 months two episodes of bacteremia postoperatively to photoselective vaporization of the prostate (PVP). We decided to compare the frequency of postoperative urinary tract infections (POUTIs) in patients with preoperative bacterial colonization of urine between PVP and transurethral resection of the prostate (TURP). MATERIALS AND METHODS From January 2010 to December 2011, we studied patients who underwent PVP or TURP for benign prostatic obstruction in our department. Preoperative urine culture (UC) was carried out for all patients and we included those with preoperative bacterial colonization of the urinary tract. Patients were treated preoperatively with an appropriate antibiotic treatment and/or inductive prophylactic antibiotics. Patients were diagnosed with POUTI if they had clinical signs of infections (e.g., fever) and a positive UC during the month after surgery. RESULTS Patients were treated by PVP in 49 cases and TURP in 62 cases. A preoperative indwelling urinary catheter was inserted in 80% of the patients. During the postoperative period, eight episodes of fever were identified in the PVP group (16%), five (8%) in the TURP group (P = 0.18). We then studied the subgroup of patients with multiple bacteria strains present in the preoperative UC and identified significant differences. The risk of POUTI was significantly higher in patients treated by PVP than in those treated by TURP (P = 0.018). CONCLUSIONS We found significant differences between subgroups of patients with positive preoperative cultures (containing various bacterial strains). The risk of POUTI was significantly higher in patients treated by PVP.
Collapse
Affiliation(s)
- Alexandre May
- Department of Urology, Bretonneau University Hospital, Tours, France
| | | | | | | | | | | | | |
Collapse
|
9
|
|