An antimicrobial prophylaxis protocol using rectal swab cultures for transrectal prostate biopsy.

PURPOSE: To evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy in our Veterans Affairs population. METHODS: Between June 1, 2013, and June 1, 2014, we implemented an antimicrobial prophylaxis protocol using rectal swab cultures on selective media containing ciprofloxacin for all men scheduled for TRUS-guided prostate biopsy. Data from 2759 patients from Jan 1, 2006 to May 31, 2013, before protocol implementation served as historical controls. Patients with fluoroquinolone (FQ)-susceptible organisms received FQ monotherapy, while those with FQ-resistant organisms received targeted prophylaxis. Our objective was to compare the rate of infectious complications 30 days after prostate biopsy before and after implementation of our antimicrobial protocol. RESULTS: One hundred and sixty-seven patients received rectal swab cultures using our protocol. Seventeen (14 %) patients had FQ-resistant positive cultures. Patients with positive FQ-resistant culture results were more likely to have had a history of previous prostate biopsy and a positive urine culture in the last 12 months (p = 0.032, p = 0.018, respectively). The average annual infectious complication rate within 30 days of biopsy was reduced from 2.8 to 0.6 % before and after implementation of our antimicrobial prophylaxis protocol using rectal swab cultures, although this difference was not statistically significant (p = 0.13). CONCLUSION: An antimicrobial prophylaxis protocol using rectal culture swabs is a viable option for prevention of TRUS-guided prostate biopsy infectious complications. After implementation of an antimicrobial prophylaxis protocol, we observed a nonsignificant decrease in the rate of post-biopsy infectious complications when compared to historical controls.

Long-Term Surgical Management of Severe Pelvic Injury and Resulting Neurogenic Bladder From an Improvised Explosive Device.

Reconstructive surgery can help veterans improve their quality of life and live free of chronic indwelling catheters following injury from an improvised explosive device.

High Rates of Inadequate Urine Volume Cause Failure of Clinic Based Uroflowmetry in Men with Lower Urinary Tract Symptoms.

INTRODUCTION: Clinic based uroflowmetry is commonly used in the diagnosis and management of lower urinary tract symptoms. AUA (American Urological Association) guidelines recommend 2 separate uroflowmetry tests with a voided volume greater than 150 ml for accurate interpretation. We characterized the interpretability of a series of uroflowmetry tests done at our institution and hypothesized that a significant number were noninterpretable because of inadequate urine volume. METHODS: Uroflowmetry results were collected from male patients at the UH (University of Utah Hospital) and VAMC (George Wahlen Veterans Affairs Medical Center) urology clinics between August 31, 2014 and September 30, 2014. Average time to perform uroflowmetry was determined. Tests with a volume of 150 ml or less were classified as noninterpretable. Data were characterized using descriptive statistics. RESULTS: During the study period 169 tests were collected, including 104 at UH and 65 at VAMC, of which 107 (63%) were noninterpretable. An estimated total of 1,452 tests were performed at UH and VAMC within a 12-month period. Average time to perform uroflowmetry by health care workers was 2 minutes 18 seconds. The estimated time loss per year for medical personnel due to noninterpretable uroflow studies was 35 hours. CONCLUSIONS: More than 50% of clinic based uroflowmetry tests at our institution had a voided volume of 150 ml or less and were deemed noninterpretable per AUA guidelines. Current clinic based uroflowmetry testing strategies are inefficient and wasteful. Reliable, accurate alternatives to clinic based uroflowmetry for the diagnosis and management of lower urinary tract symptoms should be explored.

Use of a polytetrafluoroethylene (GORE-TEX) bolster to close the renal parenchymal defect during open partial nephrectomy.

INTRODUCTION: Numerous surgical techniques have been described to facilitate closure of the renal parenchymal defect. We sought to describe the operative technique and define the safety and efficacy of using an expanded polytetrafluoroethylene (GORE-TEX; WL Gore and Associates, Flagstaff, AZ) bolster to aid in closure of the renal parenchymal defect at the time of open partial nephrectomy (OPN). TECHNICAL CONSIDERATIONS: A retrospective review of 175 patients who underwent an OPN using an expanded polytetrafluoroethylene (ePTFE) bolster at the Huntsman Cancer Hospital, University of Utah and Salt Lake City Veterans Affairs Medical Center from March 2005 to February 2013 was conducted. Postoperative complications occurring within 90 days were graded using the Clavien grading system. CONCLUSION: Overall, 57 patients (32.6%) experienced a postoperative complication. Fifteen patients (8.5%) had a Clavien ≥ grade-III complication. Ten patients (5.7%) received blood transfusions. Urine leak requiring intervention occurred in 2 patients (1.1%). Delayed hemorrhage requiring nephrectomy and pseudoaneurysm formation were rare, occurring in 1 patient each (0.6%). Infection of the ePTFE material occurred in 2 patients (1.1%). In both cases, it was explanted without requiring nephrectomy. The use of an ePTFE bolster is an effective and safe method of closing the renal parenchymal defect after OPN with an acceptable 90-day postoperative complication rate and a low risk of infection.