[A Case of Urethral Foreign Body from 40 Years Ago with Scrotum Abscess and Urethroscrotal Fistula].

A 70-year-old male came to our clinic with a high fever and left scrotal swelling. Following a diagnosis of left-side epididymitis, antibiotic treatment was started, though the swelling did not improve. Since an additional examination revealed an abscess in the left scrotum, scrotal incision and drainage were performed. Although the symptoms subsided, urine outflow from the incision was observed. The patient then noted that he had inserted a glass ball into the urethral meatus when he was about 30 years old. It was considered that an abscess and fistula had formed due to inflammation caused by the foreign body. Thus a transurethral surgical procedure was used for crushing and removal. The fistula disappeared within three months after the operation and the patient has not been affected by dysuria since that time. Symptoms may appear several years following insertion of a foreign body into the urethra. To the best of our knowledge, the present case is the longest term of indwelling, approximately 40 years, following insertion of a foreign body reported in Japan.

Antimicrobial prophylaxis to prevent perioperative infection in urological surgery: a multicenter study.

We prospectively investigated the rates of incidence of surgical site infection (SSI), urinary tract infection (UTI), and remote infection (RI) in 4,677 patients who underwent urological surgery from January to December 2010, including 2,507 endourological cases, 1,276 clean cases, 807 clean-contaminated cases, and 87 contaminated cases involving bowel segments. A single dose of antimicrobial prophylaxis (AMP) was administered in the endourological, clean, and clean-contaminated surgery cases, except for patients who underwent transurethral resection of the prostate (TURP) or percutaneous nephrolithotripsy (PNL). AMP was administered within 72 h in TURP and PNL, and AMP was administered within 48 h in contaminated surgery cases. In cases of endourological surgery, UTI was observed in 4% and RI in 0%, and SSI, UTI, and RI were seen in 1%, 1%, and 1%, respectively, of clean surgery cases, in 3%, 3%, and 2%, respectively, of clean-contaminated surgery cases, and in 17%, 30%, and 10%, respectively, of contaminated surgery cases. In multivariate analysis of the risk factors for infection, operative time was a significant risk factor for UTI in endourological surgery, and American Society of Anesthesiologists score and operative time were significant risk factors for RI in clean surgery. No significant risk factor was found in analyses of clean-contaminated and contaminated surgery cases. A single-dose AMP regimen was shown to be effective and feasible for prevention of perioperative infection in urological surgery.

[Influence of blood cells in urine samples on results of screening for urothelial carcinoma with NMP22 bladder chek].

We compared the sensitivity of Bladder Chek NMP22 with that of urine cytology in bladder cancer patients. Further, we evaluated the usefulness of Bladder Chek NMP22 in patients with benign diseases such as cystitis, urolithiasis, and benign prostate hyperplasia (BPH) and examined how blood cells in urine samples affect the results of Bladder Chek NMP22. Patients with macroscopic hematuria were excluded from this study. Of 77 bladder cancer patients, Bladder Chek NMP22 showed positive in 46.8%, while urine cytology in 33.8% (p = 0.16). Bladder Chek NMP22 and urine cytology showed positive in 31.8 and 0.0% in G1 (p = 0.004), 51.2 and 46.3% in G2 (p = 0.66) and 57.1 and 50% in G3 (p = 0.71); 44.4 and 88.9% in Tis (p = 0.052), 25.6 and 15.4% in Ta (p = 0.27), 72.2 and 33.3% in T1 (p = 0.02) and 81.8 and 54.5% in T2 or higher (p = 0.18), respectively. In bladder cancer patients with microscopic hematuria or pyuria, the positive rates of Bladder Chek NMP22 were 82.1 and 73.1%, respectively, whereas they were 26.5% (p < 0.001) and 33.3% (p = 0.002), respectively, in those without hematuria or pyuria. In 36 cystitis, 20 urolithiasis, and 19 BPH patients, the positive rates of Bladder Chek NMP22 were 58.3, 25.0 and 5.5%, respectively. Bladder Chek NMP22 showed higher sensitivity for detection of bladder cancer, especially in low-grade and low-stage cancers than urine cytology, but the result was likely affected by blood cells in urine samples. Thus, although Bladder Chek NMP22 may be less useful as the first device for screening of urothelial cancer in patients with hematuria or pyuria, it may show results of high quality when used in patients with negative urine cytology after excluding benign diseases.

[A questionnaire survey on the theory of postoperative infection prophylaxis in urologic surgery].

The implementation of the Japanese guidelines for prevention of postoperative infection in urological surgery, based on the Centers for Disease Control and Prevention (CDC) was surveyed. In October 2006, questionnaires about selection of prophylactic antibiotics, timing and period of administration, were distributed to 25 urologists. Surgical procedures were classified into four categories by contamination levels: 1. clean surgery, 2. clean-contaminated surgery, 3. contaminated surgery (surgery with urinary tract diversion using the intestine), and 4. laparoscopic surgery. Implementation of recommendations was about 70% in the selection of prophylactic antibiotics, and 20-30% for the timing of administration in four categories. Adequate implementation was low for the timing of administration. Period of administration in contaminated surgery was longest in all categories. Concerning the administration period and the selection of antibiotics for contaminated surgery, marked differences from recommendations were seen. Therefore further education in hospitals in Japan is needed.

Primary carcinoid tumor of the urinary bladder.

A polyp of about 1.0 cm diameter was incidentally found at the center of the posterior wall of the urinary bladder in a 73-year-old man on cystoscopic examination. A polyp was resected through a transurethral route without recurrence for 22 months. A polyp consisted of a tumor covered with mucosa of the bladder. Tumor cells have round or oval nuclei with fine chromatin and one or two nucleoli per nucleus, and finely granular eosinophilic cytoplasm, being arranged in a trabecular or tubular pattern. Furthermore, they showed positive staining for chromogranin-A and with Grimelius stain, indicating that the tumor is a carcinoid tumor. Since there was no evidence of carcinoid tumors in organs other than the urinary bladder, the present case is a primary carcinoid tumor (well differentiated endocrine tumor) of the urinary bladder which is extremely rare.

Clinical efficacy of oral administration of 200 mg gatifloxacin once daily for 3 days for the treatment of patients with uncomplicated cystitis.

To assess the clinical efficacy of oral antibiotic administration for the treatment of lower urinary tract infection (UTI), 102 female patients were given gatifloxacin (200 mg once daily for 3 days). Five to nine days after treatment, drug safety and clinical efficacy were assessed by evaluation of urinalysis and symptoms. Further, the patients were asked to report by mail whether they had persistent or recurrent symptoms at 4-6 weeks after treatment. The overall clinical cure rate was 93.1% (95/102). Of 94 patients with susceptible pathogens and 8 with resistant pathogens, 89 (94.7%) and 6 (75.0%), respectively, were judged as clinically cured. Four to 6 weeks after treatment, 57 (55.9%) of the 102 patients reported their micturition status by mail, and 6 (10.5%) of them claimed that they had some symptoms. The outcomes of this study suggest that a therapeutic regimen such as administration of fluoroquinolones once daily for 3 days can be recommended for the treatment of uncomplicated cystitis.