Optimizing individual treatment outcomes in men with lower urinary tract symptoms using storage subscale score/total International Prostate Symptom Score (IPSS) as a new IPSS ratio.

BACKGROUND/AIM: To evaluate the effects of the storage/total International Prostate Symptom Score (s/T) ratio on the selection and success of medical therapy in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: A total of 54 men (>45 years of age) with moderate or severe LUTS were divided into 2 groups according to the s/T ratio: Group 1 at <0.43 and Group 2 at >0.43. Tamsulosin (0.4 mg to Group 1) and tolterodine ER (4 mg to Group 2) were administered. Patients were evaluated during the 1st and 3rd months of follow-up treatment. RESULTS: Thirty-seven (68.5%) and 17 (31.5%) patients were in Groups 1 and 2, respectively. The mean s/T ratios in Groups 1 and 2 increased to 0.38 ± 0.19 from 0.33 ± 0.08 (P = 0.03) and decreased to 0.54 ± 0.18 from 0.59 ± 0.1 (P = 0.17) during the 3rd month of follow-up, respectively. The treatment success rates of Groups 1 and 2 were 88.4% and 75.7%, respectively. Nine unsuccessful cases were treated with combination therapy and the treatment success was 86.6% at follow-up. CONCLUSION: The s/T ratio is effective to determine symptom dominance in men with LUTS and can guide medical treatment selection through better identification of symptoms.

Is short course of antimicrobial therapy for asymptomatic bacteriuria before urologic surgical procedures sufficient?

INTRODUCTION: Duration of treatment of asymptomatic bacteriuria for patients undergoing urologic surgical procedures is undetermined. We compared the efficacy of long- versus short-course antimicrobial treatment in patients with asymptomatic bacteriuria undergoing urologic surgical procedures. METHODOLOGY: Patients were divided into two groups according to duration of antimicrobial treatment. Group A patients received a single dose of an appropriate antibiotic, determined by antimicrobial sensitivity testing, 30 to 60 minutes before the surgical procedure. If a urinary catheter was placed postoperatively, a second dose was given following the recommended dose interval. Group B patients received antimicrobial treatment prior to surgery at least until patient urine became sterile. All patients were monitored for signs and symptoms of septicemia following surgical procedures. RESULTS: None of the patients enrolled in the study developed infectious complications such as sepsis or upper urinary tract infection. In group A, 31 patients were treated with antimicrobials before 39 urological procedures. In group B, the mean treatment time for 28 patients before 30 urological procedures was 8.03 ± 3.86 days. There were also significant differences in length of stay and the cost of antimicrobial therapy between the groups (P < 0.0001). Isolation of an increased number of resistant microorganisms was associated with long course therapy in group B. CONCLUSIONS: Short course therapy protocol may be a practical, simple approach for antibiotic use; it decreases hospital stays, eliminates delayed procedure times, lowers the economic cost of antimicrobials and lessens the chance of superinfection with and spread of antimicrobial resistant microorganisms.