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Kranz J, Bartoletti R, Bruyère F, Cai T, Geerlings S, Köves B, Schubert S, Pilatz A, Veeratterapillay R, Wagenlehner FME, Bausch K, Devlies W, Horváth J, Leitner L, Mantica G, Mezei T, Smith EJ, Bonkat G. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Eur Urol 2024; 86:27-41. [PMID: 38714379 DOI: 10.1016/j.eururo.2024.03.035] [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] [Received: 03/12/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Urological infections significantly impact the wellbeing and quality of life of individuals owing to their widespread occurrence and diverse clinical manifestations. The objective of the guidelines panel was to provide evidence-based guidance on the diagnosis, treatment, and prevention of urinary tract infections (UTIs) and male accessory-gland infections, while addressing crucial public health aspects related to infection control and antimicrobial stewardship. METHODS For the 2024 guidelines on urological infections, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS Key recommendations emphasise the importance of a thorough medical history and physical examination for patients with urological infections. The guidelines stress the role of antimicrobial stewardship to combat the rising threat of antimicrobial resistance, providing recommendations for antibiotic selection, dosing, and duration on the basis of the latest evidence. CONCLUSIONS AND CLINICAL IMPLICATIONS This overview of the 2024 EAU guidelines offers valuable insights into managing urological infections and are designed for effective integration into clinical practice. PATIENT SUMMARY The European Association of Urology has issued an updated guideline on urological infections. The guidelines provide recommendations for diagnosis, treatment, and prevention, with a particular focus on minimising antibiotic use because of the increasing global threat of antimicrobial resistance.
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Affiliation(s)
- Jennifer Kranz
- Department of Urology and Pediatric Urology, RWTH Aachen University, Aachen, Germany; Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle, Germany.
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Franck Bruyère
- Department of Urology, CHRU Bretonneau, Tours, France; Université Francois Rabelais, PRES Centre Val de Loire, Tours, France
| | - Tommaso Cai
- Department of Urology, Santa Chiara, Regional Hospital, Trento, Italy
| | - Suzanne Geerlings
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bela Köves
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Sören Schubert
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Kathrin Bausch
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Wout Devlies
- Department of Urology, UZ Leuven, Leuven, Belgium
| | - József Horváth
- BKMK SZTE ÁOK Okt. Kh. Urológiai Osztálya, Kecskemét, Hungary
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Tunde Mezei
- Department of Urology, Telemark Hospital, Skien, Norway
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Gernot Bonkat
- alta Uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry, University of Basel, Basel, Switzerland
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Yadav S. Tuberculous Epididymitis in an Immunocompetent Indian Male: A Report of a Rare Case. Cureus 2023; 15:e46340. [PMID: 37920620 PMCID: PMC10618627 DOI: 10.7759/cureus.46340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/04/2023] Open
Abstract
Genitourinary tuberculosis is a relatively rare type of tuberculosis. Tuberculous epididymitis is an infection of the epididymis due to Mycobacterium tuberculosis. This report describes the case of a 32-year-old Indian male who presented with a small lump in his left scrotum. A diagnosis of genitourinary tuberculosis was established with radiometric investigations and the isolation of the bacteria from the cartridge-based nucleic acid amplification test. He was managed conservatively with anti-tuberculous drugs for six months.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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da Trindade JGA, Siquara-de-Sousa AC, Corrêa DG. Testicular tuberculosis. Rev Soc Bras Med Trop 2023; 56:e02212023. [PMID: 37493750 PMCID: PMC10367199 DOI: 10.1590/0037-8682-0221-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- Juliana Garcia Alves da Trindade
- Universidade Federal Fluminense, Departamento de Radiologia, Niterói, RJ, Brasil.Universidade Federal FluminenseDepartamento de RadiologiaNiteróiRJBrasil
| | - Ana Caroline Siquara-de-Sousa
- Universidade Federal Fluminense, Departamento de Patologia, Niterói, RJ, Brasil.Universidade Federal FluminenseDepartamento de PatologiaNiteróiRJBrasil
| | - Diogo Goulart Corrêa
- Universidade Federal Fluminense, Departamento de Radiologia, Niterói, RJ, Brasil.Universidade Federal FluminenseDepartamento de RadiologiaNiteróiRJBrasil
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Tuberculosis Epididymo-Orchitis Mimicking Malignancy Resulting from Intravesical Bacillus Calmette–Guérin Immunotherapy for Bladder Cancer: A Case Report of a Rare Complication. Diagnostics (Basel) 2022; 12:diagnostics12112663. [DOI: 10.3390/diagnostics12112663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Tuberculous epididymo-orchitis is a rare complication of intravesical bacillus Calmette–Guérin (BCG) immunotherapy for bladder cancer. We report a patient with bladder cancer and a history of intravesical BCG immunotherapy who presented with right scrotal pain for 1 week. A heterogeneous, hypoechoic, and solid mass surrounded by increased blood flow in the right testis was seen on scrotal echogram. Urine ordinary and tuberculosis culture yielded negative results. After failure of antibiotic treatment and the inability to rule out tumor, the diagnosis was confirmed by radical orchiectomy. Acid-fast staining of pus in the tumor and tumor tissue was positive, and a pus culture was positive for Mycobacteria tuberculosis complex. Right radical orchiectomy was performed, and anti-tuberculosis treatment with rifampicin, isoniazid, ethambutol, and pyrazinamide was given. The patient is still currently under anti-tuberculosis treatment, and no significant adverse effects have been noted. BCG-related epididymo-orchitis should be suspected in patients with a history of intravesical BCG immunotherapy if the empiric antibiotic treatment typically used to treat common epididymo-orchitis fails.
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