scholarly journals Ideal timing of indwelling catheter removal after robot-assisted radical prostatectomy with a running barbed suture technique: a prospective analysis of 425 consecutive patients

2019 ◽  
Vol 38 (9) ◽  
pp. 2177-2183
Author(s):  
Sebastian Lenart ◽  
Ingrid Berger ◽  
Judith Böhler ◽  
Reinhard Böhm ◽  
Georg Gutjahr ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Acute Urinary Retention ◽  
Suture Technique ◽  
Catheter Removal ◽  
Barbed Suture ◽  
Robot Assisted ◽  
Indwelling Catheter ◽  
Group A ◽  
Group B ◽  
Tract Infections

Abstract Objective To compare prospectively early outcome and complications of catheter removal after robot-assisted radical prostatectomy (RARP) on the 4th or 7th day with a standardized running barbed suture technique. Introduction The time point of removing the indwelling catheter after RARP mainly depends on institute’s/surgeon’s preferences. Removal should be late enough to avoid urinary leakage and complications such as acute urinary retention (AUR) but early enough to avoid unnecessary catheter indwelling. Materials and methods A consecutive single-institutional series of patients underwent RARP between July 2015 and August 2017 and were entered in a prospectively maintained data base. Between July 2015 and December 2016 a cystogram was performed on 7th postoperative day (group A), thereafter the cystogram was performed on 4th postoperative day (group B). Incidence of acute urinary retention (AUR), urinary tract infections (UTI) and adverse events between the two cohorts was compared. Results 425 patients were analyzed (group A: n = 231; group B: n = 194). Both cohorts were comparable regarding demographic and oncological parameters. Watertight anastomosis was present in 84.8% in group A and in 82.5% in group B, respectively. AUR within 4 weeks after RARP occurred in 2.2% (n = 3) in A and 9.4% (n = 15) in B (p = 0.001). AUR within 72 h after catheter removal occurred in group A: 1% (n = 2) and in group B: 6.3% (n = 10) (p = 0.005). Symptomatic urinary tract infections occurred in 8.2% (n = 16) in group A and in 6.9% (n = 11) in group B. There were no differences in the rate of secondary anastomosis dehiscence. Age, BMI, prostate size, surgeon, or intraoperative bladder neck reconstruction were not correlated to the occurrence of AUR or UTI. Conclusions The removal of indwelling catheter on day 4 after a RARP with a running barbed suture shows similar anastomosis leakage rates as on the 7th postoperative day. However, AUR rates are higher for early removal. Patients scheduled for early removal should be carefully informed about the increased risk for AUR. Catheter indwelling time does not represent a risk factor for UTI.

MANAGEMENT OF URINARY TRACT INFECTION – AN AYURVEDA PERSPECTIVE

2021 ◽  
pp. 1-2
Author(s):  
Shetti U. M. ◽  
Nandigoudar S.S. ◽  
Kalanghot P. S.
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Urine Examination ◽  
Group A ◽  
Clinical Signs And Symptoms ◽  
Group B ◽  
Tract Infections

Urinary tract infections are the second most widespread infection and are elaborated in Ayurveda classical texts. The aim of the study is to compare the effect of the two well recognised and practised Ayurveda preparations in the treatment of urinary tract infection. 34 patients with proven UTI complaints in the age group of 20 to 60 years were randomly selected from out-patient and in-patient departments as per randomization chart and were divided into Group A and group B. Respectively in group A and group B, patients were advised 15 mL of Ardhabilwa kashaya and Brihatyadi kashaya before food thrice daily with equal quantity of water. After seven days follow up, assessment was done based on the clinical signs and symptoms. Urine examination at base th th line, 7 and at 15 day was performed.Study proved both drugs were clinically efcacious and statistically signicant in the management of urinary tract infection.

The Treatment of Urinary Tract Infections in Out-Patients. A Double-Blind Comparison between Trimethoprim and Nitrofurantoin

1981 ◽  
Vol 9 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Jan Sander ◽  
Einar Aandahl ◽  
Helga Fellner ◽  
Steinar Kalstad
Keyword(s):  
Urinary Tract ◽  
Side Effects ◽  
Urinary Tract Infections ◽  
Diffusion Method ◽  
Cure Rate ◽  
Disc Diffusion Method ◽  
Double Blind ◽  
Group A ◽  
Group B ◽  
Tract Infections

The rate of side-effects should today be more important for the choice of an agent for treatment of acute urinary tract infections than the cure rate, as this usually is above 90%. The side-effects with co-trimoxazole (trimethoprim-sulphamethoxazol) have been viewed as caused mainly by the sulphonamide component. In this randomized, double-blind trial Group A has been treated with trimethoprim 200 mg x 2 and Group B with nitrofurantoin 50 mg x 4 for a duration of 10 days. There was no difference in cure rate between the two groups. The rate of side-effects was 26% in Group A and 12% in Group B. In Group A 12% had skin eruptions, mostly appearing on Day 7 or later, in Group B 1.3% had eruptions. These differences are statistically significant (p < 0.05). This result, together with a survey of the literature, indicates that the frequency of these rashes might be related both to dosage and duration of treatment. The origin of the side-effects caused by co-trimoxazole should be reconsidered. The in vitro sensitivity against trimethoprim and nitrofurantoin was tested using a disc diffusion method in 98 infecting strains from patients in this study. Two per cent were resistant against trimethoprim and 81% against nitrofurantoin. We found no correlation between the size of the inhibition zone and bacteriological cure rate. This makes the value of the disc diffusion method in out-patients with acute urinary tract infections questionable.

scholarly journals 1446. The Impact of Enterobacteriaceae Isolate Breakpoints on Prescriber Treatment Choices for Discordant Pattern Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S528-S528
Author(s):  
Philip Lee ◽  
Yi Guo ◽  
Wendy Szymczak ◽  
Vijaya L Soma ◽  
Priya Nori
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Broad Spectrum ◽  
White Blood Cells ◽  
Narrow Spectrum ◽  
Broad Spectrum Antibiotics ◽  
Group A ◽  
Group B ◽  
Tract Infections ◽  
The Impact

Abstract Background Our institution revealed Enterobacteriaceae with discordant cefazolin (CEF)-resistant / ampicillin-sulbactam (SAM) susceptible patterns (CRASS-P). This discordance could be from the multiple MIC cephalosporin breakpoint adjustments from CLSI. SAM has higher resistance for gram-negative bacteria compared with cephalosporins such as CEF which is confirmed by our antibiogram. We sought to understand if narrow-spectrum antibiotic choices for CRASS-P urinary tract infections (UTIs) led to clinical cure (CC). Methods We conducted a retrospective review from January 2018 to February 2019 of all CRASS-P Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae isolates from urine cultures. Patients with any symptom related to a UTI, urinalysis with >10 white blood cells/high-powered field, urine culture with >10,000 colony-forming units/mL, and receipt of an antibiotic were included. CC was defined as symptom resolution within 48 hours with no return to care within 28 days of the positive urinary culture. “Group A” included patients prescribed narrow-spectrum antibiotics such SAM, CEF, or an oral cephalosporin (OC) vs. broad-spectrum antibiotics such as ceftriaxone, quinolones or sulfa-medications (“Group B”). Results There were 960/1356 (70.8%) CRASS-P urinary isolates and 244 patients met inclusion criteria. Of 244 patients, 72 were in Group A and 172 were in Group B. There was no difference in the diversity of the 3 uropathogens, P = 0.34 (Table 1). Median age was 69±20.3 and 67.5±23.9 years for Group A and Group B, respectively, P = 0.23. Females accounted for 73.6% and 77.9% in Group A and B, respectively, P = 0.51. Overall, patients reached CC in 98.6% (71/72) of Group A patients, compared with 92.4% (159/172) of Group B patients, P = 0.07. Antibiotics used in treatment are outlined in Figure 1. UTI was associated with bacteremia for 2 patients in Group A and 4 patients in Group B (P = 0.84). Both patients in Group A reached CC and used AMC for treatment. However, 1 out of 4 patients did not achieve CC in Group B. Conclusion The use of SAM or OC can spare the broad-spectrum antibiotics use for CRASS-P UTIs as there was no statistical difference in CC between the two groups. The use of SAM with CRASS-P bacteremia secondary to UTI is possible; however, future studies are needed. Disclosures All authors: No reported disclosures.

scholarly journals Role of phytotherapy associated with antibiotic prophylaxis in female patients with recurrent urinary tract infections

2013 ◽  
Vol 85 (4) ◽  
pp. 197 ◽  
Author(s):  
Emanuela Frumenzio ◽  
Daniele Maglia ◽  
Eleonora Salvini ◽  
Silvia Giovannozzi ◽  
Manuel Di Biase ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antibiotic Prophylaxis ◽  
Urinary Tract Infections ◽  
Female Patients ◽  
Recurrent Urinary Tract Infections ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Tract Infections

Objective: Aim of this study is to evaluate the efficacy of a phytotherapic which includes Solidago, Orthosiphon and Birch extract (Cistimev®) in association with antibiotic prophylaxis in female patients affected by recurrent urinary tract infections (UTIr). Materials and methods: Patients affected by UTIr older than 18 years started a 3-months antibiotic prophylaxis (Prulifloxacin 600 mg, 1 cps/week or Phosphomicyn 1 cachet/week) according to antibiogram after urine culture. The patients were divided in 2 groups: Group A: antibiotic prophylaxis plus phytotherapy (1 cps/die for 3 months) and Group B: antibiotic prophylaxis alone. Results: 164 consecutive patients were studied: 107 were included in group A (mean age 59 ± 17.3 years) and 57 (mean age 61 ± 15.7) in group B. During the treatment period the relapse frequencies between the two groups were not significantly different (p = 0.854): 12/107 (11.21%) patients interrupted the treatment for UTIr in group A and 6/57 (10.52%) in group B. In the long term follow-up the relapse UTI risk was significant different in the two groups with a relapse risk 2.5 greater in group B than in group A (p &lt; 0.0001). Conclusion: Our study demonstrated that in female patients affected by recurrent UTI, the association between antibiotic prophylaxis and of a phytotherapic which includes Solidago, Orthosiphon and Birch extract reduced the number of UTI in the 12 months following the end of prophylaxis and obtained a longer relapsing time, greatly improving the quality of life of the patients.

scholarly journals L-Methionine associated with Hibiscus sabdariffa and Boswellia serrata extracts are not inferior to antibiotic treatment for symptoms relief in patients affected by recurrent uncomplicated urinary tract infections: Focus on antibiotic-sparing approach

2018 ◽  
Vol 90 (2) ◽  
pp. 97 ◽  
Author(s):  
Tommaso Cai ◽  
Andrea Cocci ◽  
Daniele Tiscione ◽  
Marco Puglisi ◽  
Fabrizio Di Maida ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Urinary Tract ◽  
Antibiotic Treatment ◽  
Hibiscus Sabdariffa ◽  
Boswellia Serrata ◽  
Group A ◽  
Group B ◽  
Tract Infections

Objective: To evaluate the efficacy of a phytotherapic combination of L-Methionine associated with Hibiscus sabdariffa and Boswellia serrata for treatment of acute episodes of uncomplicated urinary tract infections (UTI) in women affected by recurrent UTIs. Materials and methods: In this randomized phase III clinical trial, adult females with uncomplicated UTI were enrolled into one of the following treatment groups: Group A: phytotherapic combination 1 tablet in the morning and 1 tablet in the evening for 7 days; Group B: Short term antibiotic treatment according to international guidelines recommendations. At baseline, all patients were evaluated by a urologist and quality of life (QoL) questionnaires and mid-stream urine culture. Same clinical and laboratory investigations were repeated at each follow-up visit. Results: Forty-six patients were enrolled in Group A and 47 in Group B. At the first follow-up (30 days), both groups showed a statistically significant improvement in quality of life scores as compared with baseline assessment [Group A: (QoL 94.3 VS 98.5 p < 0.001); Group B: (QoL 94.5 VS 98.7 p < 0.001)]. An improvement from baseline was also seen at the second followup evaluation after 3 months [Group A: (QoL 94.3 VS 99.1 p < 0.001); Group B: (QoL 94.5 VS 98.1 p < 0.001)]. At the second follow-up visit, a statistically significant difference in QoL was reported between the two groups (99.1 VS 98.1; p < 0.003) and a transition from UTI to asymptomatic bacteriuria (ABU) was observed 12 of 46 (26%) patients in Group A, while no patients in Group B demonstrated ABU (p = 0.007). Conclusions: Here, we demonstrated that this phytotherapic combination is able, in comparison to antibiotic treatment, to improve patients quality of life, reducing symptoms in acute setting and preventing the recurrences. Interestingly, a significantly higher proportion of patients in the phytotherapy group had ABU after three months. Our findings are of great interest in an antibiotic stewardship perspective.

scholarly journals Features and outcomes of secondary sepsis and urinary tract infections in COVID-19 patients treated with stem cell nebulization

2020 ◽  
Author(s):  
Gina M. Torres Zambrano ◽  
Rene Antonio Rivero ◽  
Carlos A. Villegas Valverde ◽  
Yendry Ventura Carmenate
Keyword(s):  
Stem Cells ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Protective Factor ◽  
Antimicrobial Agents ◽  
Rational Approach ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Tract Infections

AbstractBackgroundCOVID-19 is the defining global crisis of our time. Secondary complication such as urinary tract infections and sepsis, worsen the already established problem, creating a new challenge.ObjectiveTo characterize the features and outcomes in COVID-19 patients with sepsis and urinary tract infection.MethodsAn observational and analytical study was conducted within the framework of the SENTAD COVID clinical trial at the Abu Dhabi Stem Cells Center, were the patients received a nebulization therapy with the use of autologous stem cells (group A). Those patients were compared with a not stem cells treated control arm (group B), and both received the UAE COVID 19 standard management. An analysis of the culture samples, antimicrobial agents and the efficacy of the therapy on patient’s outcomes was done.ResultsA significant difference between the groups was found in the UTI incidence (p=*0.0206). Patients in group A showed a lower tendency to sepsis in comparison with group B (7% vs 21%), HR=0.35, (95% Confidence Interval: 0.13 – 0.91), p=0.0175. It was calculated a NNT=7.3. Candida albicans was the most frequently agent causing sepsis and UTI. The massive use of broad-spectrum antimicrobials was striking.ConclusionsWe found a protective factor of stem cells against secondary infection in COVID 19 cases, in terms of sepsis and UTI. The suggested immunomodulatory effect of stem cells offers a therapeutic strategy to manage the disease and avoid several complications. Antimicrobial agents can lead to increased opportunistic infections, so a rational approach to these treatments must be considered.

scholarly journals THE ANTIBIOTICS RESISTANCE AND THE PRESCRIPTIONS’ PATTERN FOR URINARY TRACT INFECTIONS AT KING FAHAD SPECIALIST HOSPITAL

2020 ◽  
pp. 48-51
Author(s):  
NORAH RA LNQER ◽  
AREEJ AL JASSER ◽  
MUGAHID A. MOBARK
Keyword(s):  
Urinary Tract ◽  
Empirical Therapy ◽  
Treated Group ◽  
Cross Sectional Study ◽  
Antibiotics Resistance ◽  
Klebsiella Pneumonia ◽  
Cross Sectional ◽  
Group A ◽  
Group B ◽  
Tract Infections

Objectives: Urinary tract infection (UTI) is one of the diseases with a highest prevalence in the world. This study evaluated the antibiotics resistant and the prescription pattern for UTI with the aim to participate as an effective monitoring study that enhances rational antibiotics’ prescription. Methods: We conducted a retrospective cross-sectional study at King Fahad Specialist Hospital from May 2018 to January 2019. We included a total of 306 patients with UTI. 204 patients diagnosed clinically and empirically treated (Group A), 102 patients underwent urine for culture and sensitivity tests (Group B). Results: UTI showed higher occurrence in female in both Groups A (61%) and B (65%). The mean age was higher in Group B (55.8 years) than Group A (39.44 years). The most commonly prescribed antibiotics for UTI were Trimethoprim + Sulfamethoxazole (TMP+SMX) (56%) and ciprofloxacin (15%). Escherichia coli was the most commonly isolated organism (36.3%) followed by Klebsiella pneumonia (30%). Although 41.17% of organisms were sensitive to TMP+SMX, 38.2% were resistant to it. The organisms were sensitive to amikacin in 80.4% and to gentamicin in 61.8% whereas, 61.8% were resistant to ampicillin. Luckily, no resistance was reported neither for nitrofurantoin nor for vancomycin. Conclusion: The study showed significant resistance to the commonly prescribed TMP+SMX and ciprofloxacin compared to absolute sensitivity to the less prescribed nitrofurantoin. This necessitates special consideration for local susceptibility in empirical therapy.

Comparative Study Between Clean Intermittent Self-Catheterization (Cisc) and Continuous Indwelling Catheterization (Cidc) in Relieving Acute Refractory Retention of Urine Due to Benign Enlargement of Prostate (Bep)

2020 ◽  
Vol 21 (2) ◽  
pp. 105-110
Author(s):  
Md Shawkat Alam ◽  
Sudip Das Gupta ◽  
Hadi Zia Uddin Ahmed ◽  
Md Saruar Alam ◽  
Sharif Muhammod Wasimuddin
Keyword(s):  
Comparative Study ◽  
Acute Urinary Retention ◽  
Bladder Capacity ◽  
Inclusion Criteria ◽  
College Hospital ◽  
Medical College ◽  
High Incidence ◽  
Group A ◽  
Group B ◽  
Better Than

Objective: To compare the clean intermittent self-catheterization (CISC) with continuous indwelling catheterization (CIDC) in relieving acute urinary retention (AUR) due to benign enlargement of prostate (BEP). Materials and Methods :A total 60 patients attending in urology department of Dhaka Medical college hospital were included according to inclusion criteria ,Patients were randomized by lottery into two groups namely group –A and group –B for CISC and IDC drainage respectively . Thus total 60 patients 30 in each group completed study. Results : Most men can safely be managed as out-patients after AUR due to BPH. The degree of mucosal congestion and inflammation within the bladder was found to be lower in those using CISC and the bladder capacity in these patients was also found higher.Patients with an IDC had a high incidence of UTIs then that of patients with CISC. During the period of catheterization the incidence of UTI was 43.3% in group B in comparison to 40% in group A; before TURP 36% in group B in comparison to 10% incidence in group A.According to patient’s opinion CISC is better than IDC in the management of AUR. Experiencing bladder spasm, reporting blood in urine, management difficulties, incidence and severity of pain were less in CISC group, and the method of CISC was well accepted by patients as well as their family members. Conclusion: From the current study it may be suggested that CISC is better technique for management of AUR patient due to BPH than IDC. It can also be very helpful when surgery must be delayed or avoided due to any reasons in this group of patients. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.105-110

Effect of an external urinary collection device for women on institutional catheter utilization and catheter-associated urinary tract infections

2020 ◽  
pp. 1-3
Author(s):  
Lindsey Rearigh ◽  
Gayle Gillett ◽  
Adrienne Sy ◽  
Terry Micheels ◽  
Luana Evans ◽  
...  
Keyword(s):  
Experimental Study ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Indwelling Catheter ◽  
Collection Device ◽  
Quasi Experimental ◽  
Tract Infections

Abstract External urinary collection devices (EUCDs) may reduce indwelling catheter usage and catheter-associated urinary tract infections (CAUTIs). In this retrospective quasi-experimental study, we demonstrated that EUCD implementation in women was associated with significantly decreased indwelling catheter usage and a trend (P = .10) toward decreased CAUTI per 1,000 patient days.

scholarly journals Incidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence

2017 ◽  
Vol 39 (10) ◽  
pp. 534-540 ◽  
Author(s):  
Elizabeth Hirakauva ◽  
Ana Bianchi-Ferraro ◽  
Eliana Zucchi ◽  
Marcio Kajikawa ◽  
Manoel Girão ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Placebo Group ◽  
Urinary Tract ◽  
Antibiotic Prophylaxis ◽  
Urine Culture ◽  
Placebo Control ◽  
Urodynamic Study ◽  
Group A ◽  
Group B ◽  
Group D

Introduction The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study. Methods Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS. Results We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria. We didn't observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group. Conclusion The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.

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