المؤلفون: Gaitonde S; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas., Christie AL; Simmons Comprehensive Cancer Center Biostatistics, University of Texas, Southwestern Medical Center, Dallas, Texas., Garigipati P; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas., Alhalabi F; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas., Zimmern PE; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.

المصدر: The Journal of urology [J Urol] 2023 Oct; Vol. 210 (4), pp. 649-658. Date of Electronic Publication: 2023 Jun 29.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Anti-Bacterial Agents*/therapeutic use , Urinary Tract Infections*/drug therapy , Urinary Tract Infections*/prevention & control, Humans ; Female ; Middle Aged ; Antibiotic Prophylaxis ; Menopause ; Clinical Protocols

مستخلص: Purpose: Antibiotic-refractory recurrent urinary tract infections are challenging to manage. Prior studies have shown that, in selected patients, electrofulguration of cystitis may disrupt potential nidus of recurrent urinary tract infections. We report on long-term outcomes of electrofulguration in women with at least 5 years of follow-up.
Materials and Methods: Following Institutional Review Board approval, we analyzed a cohort of nonneurogenic women with ≥3 symptomatic recurrent urinary tract infections/y and inflammatory lesions on cystoscopy who underwent electrofulguration, excluding those with alternate identifiable etiology for recurrent urinary tract infections or less than 5-year follow-up. Preoperative characteristics, antibiotic regimens, and annual urinary tract infections were reported. Primary outcome was clinical cure (0-1 urinary tract infection/y), improvement (>1 and <3/y) or failure (≥3/y) at last follow-up. Secondary outcomes included need for antibiotics or repeat electrofulguration. A subanalysis was performed for women with >10-year follow-up.
Results: From 2006 to 2012, 96 women met study criteria with median age 64. Median follow-up was 11 years (IQR: 10-13.5); 71 women had >10-year follow-up. Prior to electrofulguration, 74% used daily antibiotic suppression, 5% used postcoital prophylaxis, 14% used self-start therapy, and 7% were not on prophylaxis. At last post-electrofulguration visit, 72% of women were cured, 22% improved, and 6% failed. Antibiotic usage decreased post-electrofulguration ( P < .05). Five percent were on continuous antibiotics at last follow-up as compared to 74% on continuous antibiotics pre-electrofulguration (McNemar P < .05). Nineteen percent of women underwent a repeat electrofulguration.
Conclusions: In menopausal women with over 5-year follow-up after electrofulguration for antibiotic-refractory recurrent urinary tract infections, there appears to be durable clinical cure and improvement, with decreased need for long-term antibiotics.

المؤلفون: Advani SD; Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina., Turner NA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina., North R; Duke Aging Center, Duke University School of Medicine, Durham, North Carolina., Moehring RW; Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina., Vaughn VM; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah., Scales CD Jr; Department of Urology, Duke University School of Medicine, Durham, North Carolina.; Department Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.; Duke Clinical Research Institute, Durham, North Carolina., Siddiqui NY; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina., Schmader KE; Duke Aging Center, Duke University School of Medicine, Durham, North Carolina.; Durham VA Medical Center, Durham, North Carolina., Anderson DJ; Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.

المصدر: The Journal of urology [J Urol] 2024 May; Vol. 211 (5), pp. 690-698. Date of Electronic Publication: 2024 Feb 08.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Bacteriuria*/diagnosis , Bacteriuria*/drug therapy , Urinary Tract Infections*/diagnosis , Urinary Tract Infections*/drug therapy , Lower Urinary Tract Symptoms*/drug therapy, Adult ; Humans ; Retrospective Studies ; Urinalysis ; Anti-Bacterial Agents/therapeutic use

مستخلص: Purpose: Patients with suspected UTIs are categorized into 3 clinical phenotypes based on current guidelines: no UTI, asymptomatic bacteriuria (ASB), or UTI. However, all patients may not fit neatly into these groups. Our objective was to characterize clinical presentations of patients who receive urine tests using the "continuum of UTI" approach.
Materials and Methods: This was a retrospective cohort study of a random sample of adult noncatheterized inpatient and emergency department encounters with paired urinalysis and urine cultures from 5 hospitals in 3 states between January 01, 2017, and December 31, 2019. Trained abstractors collected clinical (eg, symptom) and demographic data. A focus group discussion with multidisciplinary experts was conducted to define the continuum of UTI, a 5-level classification scheme that includes 2 new categories: lower urinary tract symptoms/other urologic symptoms and bacteriuria of unclear significance. The newly defined continuum of UTI categories were compared to the current UTI classification scheme.
Results: Of 220,531 encounters, 3392 randomly selected encounters were reviewed. Based on the current classification scheme, 32.1% (n = 704) had ASB and 53% (n = 1614) did not have a UTI. When applying the continuum of UTI categories, 68% of patients (n = 478) with ASB were reclassified as bacteriuria of unclear significance and 29% of patients (n = 467) with "no UTI" were reclassified to lower urinary tract symptoms/other urologic symptoms.
Conclusions: Our data suggest the need to reframe our conceptual model of UTI vs ASB to reflect the full spectrum of clinical presentations, acknowledge the diagnostic uncertainty faced by frontline clinicians, and promote a nuanced approach to diagnosis and management of UTIs.

المؤلفون: Valentine-King MA; Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas., Trautner BW; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas., Zoorob RJ; Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas., Salemi JL; College of Public Health, University of South Florida, Tampa, Florida., Gupta K; Boston Veterans Affairs Healthcare System and Boston University School of Medicine, Boston, Massachusetts., Grigoryan L; Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.

المصدر: The Journal of urology [J Urol] 2024 Jan; Vol. 211 (1), pp. 144-152. Date of Electronic Publication: 2023 Oct 11.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, N.I.H., Extramural

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Urinary Tract Infections*/drug therapy , Urinary Tract Infections*/diagnosis , Cystitis*/drug therapy, Adult ; Female ; Humans ; Middle Aged ; Male ; Trimethoprim, Sulfamethoxazole Drug Combination ; Nitrofurantoin ; Escherichia coli ; Retrospective Studies ; Bayes Theorem ; Ciprofloxacin ; Microbial Sensitivity Tests ; Anti-Bacterial Agents/therapeutic use ; Anti-Bacterial Agents/pharmacology ; Drug Resistance, Bacterial

مستخلص: Purpose: Recurrent cystitis guidelines recommend relying on a local antibiogram or prior urine culture to guide empirical prescribing, yet little data exist to quantify the predictive value of a prior culture. We constructed a urinary antibiogram and evaluated test metrics (sensitivity, specificity, and Bayes' positive and negative predictive values) of a prior gram-negative organism on predicting subsequent resistance or susceptibility among patients with uncomplicated, recurrent cystitis.
Materials and Methods: We performed a retrospective database study of adults with recurrent, uncomplicated cystitis (cystitis occurring 2 times in 6 months or 3 times in 12 months) from urology or primary care clinics between November 1, 2016, and December 31, 2018. We excluded pregnant females, patients with complicated cystitis, or pyelonephritis. Test metrics were calculated between sequential, paired cultures using standard formulas.
Results: We included 597 visits from 232 unique patients wherein 310 (51.2%) visits had a urine culture and 165 had gram-negative uropathogens isolated. Patients with gram-negative uropathogens were mostly females (97%), with a median age of 58.5 years. Our antibiogram found 38.0%, 27.9%, and 5.5% of Escherichia coli isolates had resistance to trimethoprim-sulfamethoxazole, ciprofloxacin, and nitrofurantoin, respectively. Prior cultures (within 2 years) had good predictive value for detecting future susceptibility to first-line agents nitrofurantoin (0.85) and trimethoprim-sulfamethoxazole (0.78) and excellent predictive values (≥0.90) for cefepime, ceftriaxone, cefuroxime, ciprofloxacin, levofloxacin, gentamicin, tobramycin, piperacillin-tazobactam, and imipenem.
Conclusions: Considerable antibiotic resistance was detected among E coli isolates in patients with recurrent, uncomplicated cystitis. Using a prior culture as a guide can enhance the probability of selecting an effective empirical agent.

المؤلفون: Yoon G; Department of Population Health, NYU Grossman School of Medicine, New York, New York., Matulewicz RS; Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York., Major VJ; Department of Population Health, NYU Grossman School of Medicine, New York, New York.

المصدر: The Journal of urology [J Urol] 2022 Aug; Vol. 208 (2), pp. 234-236. Date of Electronic Publication: 2022 Mar 28.

نوع المنشور: Editorial

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Anti-Bacterial Agents*/therapeutic use , Urinary Tract Infections*/drug therapy, Academic Medical Centers ; Algorithms ; Humans

المؤلفون: Barnes HC; Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology & Obstetrics/Gynecology, Loyola University Medical Center, Maywood, Illinois., Wolff B; Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology & Obstetrics/Gynecology, Loyola University Medical Center, Maywood, Illinois., Abdul-Rahim O; Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois., Harrington A; Department of Pathology, Loyola University Chicago, Maywood, Illinois., Hilt EE; Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois., Price TK; Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois., Halverson T; Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois., Hochstedler BR; Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois., Pham T; Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology & Obstetrics/Gynecology, Loyola University Medical Center, Maywood, Illinois., Acevedo-Alvarez M; Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology & Obstetrics/Gynecology, Loyola University Medical Center, Maywood, Illinois., Joyce C; Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois., Fitzgerald CM; Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology & Obstetrics/Gynecology, Loyola University Medical Center, Maywood, Illinois., Schreckenberger PC; Department of Pathology, Loyola University Chicago, Maywood, Illinois., Brubaker L; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California., Wolfe AJ; Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois., Mueller ER; Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology & Obstetrics/Gynecology, Loyola University Medical Center, Maywood, Illinois.

المصدر: The Journal of urology [J Urol] 2021 Nov; Vol. 206 (5), pp. 1212-1221. Date of Electronic Publication: 2021 Jun 29.

نوع المنشور: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Anti-Bacterial Agents/*therapeutic use , Bacteriological Techniques/*methods , Bacteriuria/*drug therapy, Aged ; Aged, 80 and over ; Anti-Bacterial Agents/pharmacology ; Bacteriuria/diagnosis ; Bacteriuria/microbiology ; Bacteriuria/urine ; Female ; Humans ; Microbial Sensitivity Tests/methods ; Middle Aged ; Self Report ; Treatment Outcome

مستخلص: Purpose: We compared urinary tract infection (UTI) symptom resolution rates at 7-10 days in symptomatic women randomized to treatment based on standard urine culture (SUC) versus expanded quantitative urine culture (EQUC) results.
Materials and Methods: Women ≥18 years old who responded "yes" to "do you feel you have a UTI?" agreed to urethral catheterization and followup. Symptoms were assessed using the validated UTI Symptom Assessment (UTISA) questionnaire. Culture method was randomized 2:1 (SUC:EQUC); antibiotics were prescribed to women with positive cultures. The primary outcome, UTI symptom resolution, was determined 7-10 days following enrollment on all participants regardless of treatment.
Results: Demographic data were similar between groups. Of the SUC and EQUC groups 63% and 74% had positive cultures (p=0.10), respectively. Of participants with positive cultures 97% received antibiotics. Primary outcome data were provided by 215 of 225 participants (SUC 143 [95%], EQUC 72 [97%]). At the primary outcome assessment, 64% and 69% in the SUC and EQUC groups, respectively, reported UTI symptom resolution (p=0.46); UTISA scores improved from baseline in the EQUC arm compared to the SUC arm (p=0.04). In the subset of women predominated by non- Escherichia coli (76), there was a trend toward more symptom resolution in the EQUC arm (21%, p=0.08).
Conclusions: Symptom resolution was similar for the overall population ( E. coli and non- E. coli ) of women treated for UTI symptoms based on SUC or EQUC. Although the sample size limits conclusions regarding the utility of EQUC in women with non- E. coli uropathogens, the detected trend indicates that this understudied clinical subset warrants further study.

المؤلفون: Walton I; University of St. Andrews School of Medicine, Scotland, United Kingdom., Nickel JC; Queen's University, Kingston, Canada.

المصدر: The Journal of urology [J Urol] 2021 Nov; Vol. 206 (5), pp. 1087-1090. Date of Electronic Publication: 2021 Jun 29.

نوع المنشور: Editorial; Research Support, Non-U.S. Gov't; Review

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Microbiota*/drug effects, Anti-Bacterial Agents/*therapeutic use , Cystitis, Interstitial/*diagnosis , Urine/*microbiology, Anti-Bacterial Agents/radiation effects ; Bacteria/drug effects ; Bacteria/genetics ; Bacteria/isolation & purification ; Cystitis, Interstitial/drug therapy ; Cystitis, Interstitial/urine ; DNA, Bacterial/isolation & purification ; Female ; Humans ; Male ; RNA, Ribosomal, 16S/genetics ; Severity of Illness Index ; Sex Factors ; Urinary Bladder/drug effects ; Urinary Bladder/microbiology

المؤلفون: Sur RL; Comprehensive Kidney Stone Center, UC San Diego Health, San Diego, California.

المصدر: The Journal of urology [J Urol] 2023 Oct; Vol. 210 (4), pp. 581-582. Date of Electronic Publication: 2023 Aug 01.

نوع المنشور: Randomized Controlled Trial; Journal Article; Comment

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Nephrolithotomy, Percutaneous* , Infections* , Kidney Calculi*/surgery , Nephrostomy, Percutaneous*, Humans ; Anti-Bacterial Agents/therapeutic use ; Risk Factors

المؤلفون: Ishikawa K; Department of Infectious Diseases, St Luke's International Hospital, Tokyo, Japan.

المصدر: The Journal of urology [J Urol] 2023 Oct; Vol. 210 (4), pp. 581. Date of Electronic Publication: 2023 Jul 26.

نوع المنشور: Randomized Controlled Trial; Letter; Comment

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Nephrolithotomy, Percutaneous* , Infections* , Kidney Calculi*/surgery , Nephrostomy, Percutaneous*, Humans ; Anti-Bacterial Agents/therapeutic use ; Risk Factors

المؤلفون: Scott VCS; Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, California., Thum LW; Urology Specialists, Sioux Falls, South Dakota., Sadun T; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California., Markowitz M; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California., Maliski SL; School of Nursing, University of Kansas Medical Center, Kansas City, Kansas., Ackerman AL; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California., Anger JT; Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, California., Kim JH; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California.

المصدر: The Journal of urology [J Urol] 2021 Sep; Vol. 206 (3), pp. 688-695. Date of Electronic Publication: 2021 Jul 08.

نوع المنشور: Journal Article; Observational Study; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Fear* , Frustration*, Anti-Bacterial Agents/*adverse effects , Antimicrobial Stewardship/*methods , Urinary Tract Infections/*psychology, Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/administration & dosage ; Female ; Focus Groups ; Humans ; Middle Aged ; Qualitative Research ; Quality of Life ; Recurrence ; Urinary Tract Infections/drug therapy ; Young Adult

مستخلص: Purpose: We investigated the perspectives of women suffering from recurrent urinary tract infections using patient focus group discussions with an emphasis on patient attitudes toward the current prevention and treatment of urinary tract infection episodes.
Materials and Methods: Twenty-nine women with recurrent urinary tract infections were recruited from a tertiary urology practice to participate in one of 6 focus groups. Participants were asked questions related to urinary tract infection knowledge, prevention strategies, treatment and impact on quality of life. Grounded theory methods were used to analyze focus group transcripts and identify preliminary themes that describe patient attitudes toward current management strategies for recurrent urinary tract infections.
Results: The median age of participants was 46 years (range 20-81). The majority were Caucasian and held a college degree. The 7 preliminary themes identified during discussions fell into 2 categories: 1) negative impacts of taking antibiotics for prevention and treatment of recurrent urinary tract infections, and 2) resentment of the medical profession regarding their management of recurrent urinary tract infections. From the preliminary themes, the emergent concepts of "fear" and "frustration" became evident.
Conclusions: Focus group discussions of women with recurrent urinary tract infections suggest that many women are fearful of the adverse effects of antibiotics and are frustrated with the medical profession for not addressing their fears and optimizing antibiotic stewardship. There is a need for physicians to modify management strategies to address these concerns and to devote more research efforts to improving the nonantibiotic options for prevention and treatment of recurrent urinary tract infections, as well as management strategies that better empower patients.

المؤلفون: Koch GE; Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee., Tallman JE; Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee., Dmochowski RR; Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.

المصدر: The Journal of urology [J Urol] 2023 Jul; Vol. 210 (1), pp. 8-9. Date of Electronic Publication: 2023 Mar 31.

نوع المنشور: Editorial

بيانات الدورية: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0376374 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-3792 (Electronic) Linking ISSN: 00225347 NLM ISO Abbreviation: J Urol Subsets: MEDLINE

مواضيع طبية MeSH: Antimicrobial Stewardship*, Humans ; Operating Rooms ; Anti-Bacterial Agents/therapeutic use