Prognostic significance of preoperative pyuria & neutrophil to lymphocyte ratio in patients with non-muscle-invasive bladder cancer: A prospective cohort study.

BACKGROUND: The most prevalent cancer of the urinary system and the fourth most frequent cancer in men is bladder cancer. Up to 45% of non-muscle-invasive bladder cancers (NMIBC), may develop into muscle-invasive disease within 5 years after initial diagnosis, depending on the risk profile. The neutrophil to lymphocyte ratio (NLR), which is an emerging marker of host inflammation and can be easily calculated from routine complete blood counts (CBCs) with differentials, has shown to be an independent prognostic factor for a variety of solid malignancies, including urinary tract cancer. Pyuria is a well-documented prognostic factor in urinary tract carcinomas, according to several research. The relationship between preoperative pyuria and recurrence in patients with NMIBC is unclear, even though some studies found that pyuria was a strong predictor of poor prognosis in patients with NMIBC. Our study's objective was to compare the prognostic effect of pre-treatment pyuria and NLR on the likelihood of progression and recurrence in individuals with primary NMIBC. MATERIALS AND METHODOLOGY: Data obtained from 100 bladder cancer patients who underwent transurethral resection of bladder tumor (TURBT) from June 2021 to January 2023 were evaluated prospectively. INCLUSION CRITERIA: Age more than 18 years, having tumor size less than 3 × 3 cm, single tumor, no H/O TURBT. EXCLUSION CRITERIA: Age less than 18 years, size more than 3 × 3 cm, multiple tumors, H/O TURBT. RESULTS: We demonstrated in the current study that, compared to NLR, preoperative pyuria was more substantially linked with intravesical recurrence, higher T stage and disease progression following TURBT for NMIBC.

Effect of Preoperative Bacteriuria and Pyuria on Intravesical Recurrence in Patients with Upper Tract Urothelial Carcinoma Undergoing Radical Nephroureterectomy.

BACKGROUND/AIM: We investigated the effect of bacteriuria and pyuria on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). PATIENTS AND METHODS: Preoperative bacteriuria and pyuria were defined as urine containing ≥5 bacteria/high-power field (HPF) and >5 white blood cells/HPF, respectively. Their associations with IVR were evaluated in 97 patients with UTUC undergoing RNU. RESULTS: Preoperative bacteriuria [n=15 (15%)] was significantly associated with preoperative pyuria [n=42 (43%), p<0.001]. During follow-up (median of 19 months), 45 (46%) patients developed IVR (median IVR-free survival=38 months). On multivariate analysis, preoperative bacteriuria was an independent predictor for reduced risk of IVR (hazard ratio=0.23, p=0.010). The 2-year IVR-free survival of patients with preoperative bacteriuria and pyuria was significantly longer than that of patients without preoperative bacteriuria (83% vs. 54%, p=0.028) and pyuria (69% vs. 50%, p=0.024), respectively. CONCLUSION: Bacteriuria and pyuria may reduce the risk of IVR in patients with UTUC undergoing RNU.

A case of sterile pyuria caused by Chlamydia trachomatis and Mycoplasma hominis: A diagnostic challenge.

Sterile pyuria is a highly prevalent condition with a wide aetiological spectrum, which often challenges the diagnostician. We describe the case of a middle-aged female admitted to the medical Intensive Care Unit for acute gastroenteritis, whose urinalysis revealed persistent sterile pyuria. Polymerase chain reaction assay in urine was positive for Chlamydia trachomatis and Mycoplasma hominis. She responded to antimicrobial therapy. We hereby reflect on the approach to a case of sterile pyuria and review the available literature on this entity.

Preoperative pyuria predicts advanced pathologic tumor stage and worse survival in patients with urothelial carcinoma of the upper urinary tract treated by radical nephroureterectomy.

OBJECTIVES: To investigate the association of preoperative pyuria with pathologic features and oncologic outcomes in patients with urothelial carcinoma of the upper urinary tract (UTUC) treated by radical nephroureterectomy (RNU). MATERIAL AND METHODS: A cohort of 176 patients treated with RNU from January 2001 to December 2014 were retrospectively reviewed. Logistic regression and survival analysis methodology was used to investigate the association of preoperative pyuria with clinicopathologic outcomes. RESULTS: Among this cohort, 36 (20.5%) presented with preoperative pyuria. Logistic regression revealed that pyuria was significantly associated with advanced pT stage (P = 0.001). During a median follow-up of 41 months (interquartile range: 22-60), 65 (37%) patients died, including 54 (31%) from UTUC. Overall survival rates at 3 year and 5 years in patients with pyuria were significantly lower than those in patients without pyuria (62.3% and 36.1% vs. 78.4% and 65.3%, respectively; P = 0.004). Also, cancer-specific survival rates at 3 year and 5 years in patients with pyuria were significantly lower than in patients without pyuria (65.7% and 50% vs. 80% and 67.6%, respectively; P = 0.016). Furthermore, in the multivariate analysis, after incorporating only preoperative factors, pyuria was found to be an independent predictor of overall survival and cancer-specific survival (P = 0.005 and P = 0.028, respectively). CONCLUSIONS: Preoperative pyuria among UTUC patients underwent RNU was significantly associated with advanced pathologic tumor stage and worse survival. Our data suggested that pyuria as a prognostic predictor could be valuable in preoperative risk stratification and guiding better therapeutic approaches, but further validation in a larger population is needed.

Isolated hematuria and sterile pyuria may indicate systemic lupus erythematosus activity.

OBJECTIVE: To identify patients presenting with isolated hematuria and/or pyuria in the absence of other systemic lupus erythematosus (SLE) disease activity, describe their demographics, and determine whether they present with evidence of SLE flare in a period adjacent to the presentation. METHODS: We studied patients followed at the University of Toronto Lupus Clinic between 1970 and 2012. An episode of isolated hematuria (> 5 red blood cells per high power field) and/or pyuria (> 5 white blood cells per high power field) was defined as 2 consecutive visits with these findings in the absence of other concurrent SLE manifestations such as proteinuria, casts, or azotemia. We then excluded patients whose findings might be explained by urinary tract infections, menstruation, urolithiasis, and/or anticoagulation. Only patients presenting with no other SLE disease activity were included. RESULTS: Isolated hematuria and/or pyuria were identified in 49 patients, of whom 17 were excluded according to the criteria above, leaving 32. Twenty-four patients had another renal manifestation 1 year before and/or after the occurrence; 27 had a non-renal manifestation 1 year before and/or after the occurrence; 3 patients had a biopsy in the same time frame, all with evidence of active lupus nephritis. Therefore the majority of patients with an occurrence of isolated hematuria and/or pyuria had evidence of renal or other non-renal SLE disease activity at a time adjacent to this presentation. CONCLUSION: Although not proven, our results suggest that these manifestations were associated with SLE activity, either before or after the episode, and therefore may represent a phase of active disease.

Historia natural de la piuria y microhematuria después de la cirugía de próstata / Natural History of Pyuria and Microhematuria After Prostate Surgery

Objetivo: Las alteraciones del examen general de orina (EGO) son comunes después de la cirugía prostática. Sin embargo, el tiempo de normalización no ha sido establecido. La presencia de estas alteraciones puede propiciar abordajes diagnósticos innecesarios. El objetivo de este estudio es determinar el tiempo de normalización para ambos parámetros. Material y métodos: Estudiamos pacientes sometidos a cirugía prostática sin complicaciones infecciosas durante su seguimiento. Incluimos pacientes sometidos a resección transuretral de próstata (RTUP) con energía monopolar y bipolar y a prostatectomía abierta (PA). Se utilizaron curvas de Kaplan-Meier para determinar el tiempo de persistencia. Se utilizó ANOVA para comparar los 3 grupos de acuerdo a la cirugía. Analizamos el impacto del uso preoperatorio de inhibidores de la 5-alfa reductasa y correlacionamos el peso del tejido resecado con la persistencia de ambos parámetros. Resultados: Analizamos 85 pacientes: 44 sometidos a RTUP monopolar, 27 a RTUP bipolar y 14 a PA. El tiempo de persistencia de piuria fue significativamente mayor que el de microhematuria, con una mediana de 274 vs 176 días. Estos resultados no se vieron afectados por el tipo de energía utilizada, ni por el uso de inhibidores de la 5-alfa reductasa. Encontramos una correlación entre el peso del tejido resecado y la persistencia de piuria posterior a cirugía endoscópica: 23 g (fue el mejor punto de corte). Conclusiones: La piuria persiste más que la microhematuria independientemente del tipo de cirugía. Existe una correlación entre el tejido resecado y la persistencia de piuria. La presencia de estas alteraciones después de la cirugía prostática no siempre es un hallazgo patológico (AU)

Objective: Urinalysis alterations are common after prostatic surgery. However, time to normalization has not been established. Presence of pyuria and microhematuria can lead to unnecessary diagnostic procedures. The objective of this study is to determine the time to normalization for both parameters. Materials and methods: We reviewed medical records of patients who underwent prostatic surgery without infectious complications during follow-up. We included patients who underwent transurethral resection of the prostate (TURP) with either monopolar or bipolar energy, or open prostatectomy (OP). Kaplan–Meier curves were used to determine the time of persistence of both parameters. ANOVA was used to compare the 3 groups according to the type of surgery. We analyzed the impact of preoperative use of 5-α-reductase inhibitors, and searched for a correlation between the weight of resected tissue and persistence of both parameters. Results: 85 patients were analyzed: 44 underwent monopolar TURP, 27 bipolar TURP, and 14 OP. Persistence of pyuria was significantly longer than microhematuria with a median of 274 days vs. 176 days. Neither the use of monopolar or bipolar energy, nor the use of preoperative 5α-reductase inhibitors affected the persistence time. We found a positive correlation between the resected tissue weight and the persistence of leukocyturia after endoscopic surgery: 23 g was the best cut-off point. Conclusions: Pyuria persists longer than microhematuria regardless of the type of surgery. There is a correlation between the resected tissue weight and the persistence of this feature. The presence of pyuria and microhematuria after prostatic surgery is not always a pathological finding (AU)

Recurrent urinary infection with Bifidobacterium scardovii.

Bifidobacterium species are difficult to identify and may be underreported or not recovered by many laboratories because of their slow growth. We emphasize the importance of the Gram stain in urine samples and the addition of enriched media and enhanced atmosphere over time for urine cultures with pyuria. This is the first report of a Bifidobacterium scardovii recurrent urinary infection in an elderly woman.

Prostatic inflammation detected in initial biopsy specimens and urinary pyuria are predictors of negative repeat prostate biopsy.

PURPOSE: Asymptomatic prostatic inflammation may cause increased prostate specific antigen in some men, leading to unnecessary repeat prostate biopsy. We determined whether histological findings of inflammation in initial biopsy specimens and/or clinical indicators of inflammation could predict the outcome of subsequent biopsy in men with a negative initial biopsy. MATERIALS AND METHODS: A total of 105 Japanese men with increased prostate specific antigen underwent repeat prostate biopsy after initial biopsy revealed no evidence of carcinoma. Of the cases 45 (42.8%) were positive for prostate cancer at repeat biopsy. We evaluated initial biopsy specimens for evidence of inflammation by mononuclear and polymorphonuclear leukocytes, serum and urinary white blood count, and C-reactive protein. RESULTS: Polymorphonuclear leukocyte infiltrates, urinary white blood count, patient age, prostate specific antigen at repeat biopsy, prostate volume, prostate specific antigen velocity and prostate specific antigen density were associated with the repeat biopsy outcome (p <0.05). Multivariate analysis revealed that age, prostate specific antigen density and urinary white blood count were independent predictors of outcome. On subgroup analysis of 63 men with serum prostate specific antigen less than 10 ng/ml before initial biopsy polymorphonuclear and mononuclear leukocyte inflammation, age, prostate specific antigen at repeat biopsy, prostate volume, prostate specific antigen velocity and prostate specific antigen density were associated with the outcome of repeat biopsy (p <0.05). Multivariate analysis showed that polymorphonuclear leukocyte infiltrate, prostate specific antigen density and age were independent predictors. CONCLUSIONS: Age, prostate specific antigen density, polymorphonuclear leukocyte inflammation in initial biopsy specimens and urinary pyuria are indicators of benign repeat biopsy. They help avoid unnecessary repeat biopsy in men with increased prostate specific antigen.

Sterile pyuria in patients with Kawasaki disease originates from both the urethra and the kidney.

To identify the origin of urinary leukocytes in Kawasaki disease (KD) patients with pyuria, we prospectively studied clinical and laboratory findings of 23 KD patients. Patients were divided into three groups: patients without pyuria, patients with pyuria in both voided urine and bladder urine obtained by transurethral catheterization (bladder pyuria) and patients with pyuria only in voided urine (urethral pyuria). Pyuria in voided urine was found in ten of 23 KD patients (43.5%), with subsequent urine cultures proving sterile. Five out of ten patients with pyuria in voided urine also exhibited pyuria in bladder urine, whilst the remaining patients did not have pyuria in bladder urine. Urinary protein levels were higher in patients with bladder pyuria and in patients with urethral pyuria than in patients without pyuria. Urinary beta2-microglobulin concentrations and serum blood urea nitrogen (BUN) and creatinine levels were higher in patients with bladder pyuria than in patients with urethral pyuria or in patients without pyuria, although the serum BUN and creatinine levels of patients with bladder pyuria were within the normal ranges. These results suggest that some patients with KD develop sterile pyuria that originates from the urethra and/or the kidney as a result of mild and subclinical renal injury.

Genitourinary tuberculosis in a medical center in southern Taiwan: an eleven-year experience.

BACKGROUND AND PURPOSE: Genitourinary tuberculosis is the second most common disease form of extrapulmonary tuberculosis. This study analyzed the clinical characteristics and outcome in 31 patients with genitourinary tuberculosis treated between 1994 and 2004 at a tertiary medical center in southern Taiwan. METHODS: Data were collected by chart review. Diagnosis was based on microbiological or histological proof plus compatible radiographic findings and clinical presentation. RESULTS: This study included 14 men (45%) and 17 women (55%). Their ages ranged from 31 to 81 years (mean, 58.1 years). Genitourinary symptoms (83.9%) were more frequent than constitutional symptoms (35.5%). Pyuria plus hematuria with sterile culture (51.6%) was the most common finding. Only 25.8% of patients had a known history of pulmonary tuberculosis. Diagnosis was based on microbiological findings in 11 patients (35.5%), and by histological findings in 20 (64.5%) patients. Intravenous pyelography revealed abnormalities in 94% of patients and renal ultrasonography in 79.2%. Imaging studies were characteristic of advanced stage in most patients. Twenty-five percent of patients were classified as having treatment failure after at least 6 months of therapy. The treatment failure rate was higher in patients with positive microbiological findings (71.4%) than in those with histological findings alone (5.9%, p=0.003). CONCLUSIONS: The high rate of treatment failure and advanced stage of disease at diagnosis are indicative of the challenge in the care of patients with genitourinary tuberculosis in Taiwan.

A study for the improvement of the cytological urine examination performances in upper tract infection diagnosis.

Diagnosis of the location of upper and lower urinary tract infection (UTI) is necessary in defining the therapeutic conduct that has a different period and intensity according to the infection location and in prognosis. Many studies show the lack of clinical criteria peculiarity in revealing the different location of UTI. As a result, the correct location of the level in which UTI develops is the necessity of paraclinical investigations. Urinary sample examination, in which urinary sediment microscopy is essential, is a reliable technique in fast detection and localization of UTI. Finding, in pyuria context, the classic significant bacteriuria (> or = 10(5) CFU/ml) or lower value bacteriuria (< or = 10(4) CFU/ml) confirms the UTI diagnosis. The upper tract infection prognosis increases when leukocyte cylinders, characteristic for pyelonephritis, appear together with intact or degraded leukocytes, single or grouped. We settled an algorithm to examine the urine samples in order to: Concentrate and preserve the structural integrity of leukocytes and cylinders, examining the conventional urinary sediment Precisely identify and differentiate these elements by vital coloration (leukocyte peroxidase coloration and Sternheimer - Malbin coloration) to establish more accurate the UTI level. The vital coloration for leukocyte peroxidase has cytological specificity, confirming the pyuria and the cylinders that contain leukocytes (leukocytary, granular, mixed) and obviously ameliorates the reliability and reproducibility of the urinary sediment cytological exam.

Significance of isolated hematuria and isolated pyuria in systemic lupus erythematosus.

Hematuria or sterile pyuria as isolated urinary findings present a clinical dilemma for the treating physician. Our objective was to determine whether isolated hematuria and isolated sterile pyuria are associated with active systemic lupus erythematosus (SLE) with respect to renal and non-renal disease activity. This is a descriptive study from a large SLE cohort followed prospectively at the University of Toronto Lupus Clinic. All episodes of isolated hematuria and isolated pyuria between 1970 and 2000 were identified from our database. Isolated hematuria was defined as > 5 red blood cells per high power field; isolated sterile pyuria was defined as > 5 white blood cells per high power field in the absence of urinary infection and other renal manifestations. Non-renal disease activity (defined as nrSLEDAI > 1) was determined at first episode of isolated hematuria and pyuria. Renal disease activity was assessed by scoring renal biopsies within 3 months of detecting isolated hematuria or sterile pyuria. Thirty-four percent (323/946) of our cohort had at least one episode of isolated hematuria. Seventy-seven percent of these patients had concurrent non-renal disease activity. Of the 22 biopsies scored with isolated hematuria, 96% were abnormal (WHO > class I), including 52% with active nephritis. Twenty-three percent (215/946) had at least one episode of isolated sterile pyuria. Seventy-eight percent of these patients had concurrent non-renal disease activity. All 12 biopsies scored with isolated pyuria were abnormal (WHO Class > 1), including 75% with active nephritis. The appearance of isolated hematuria and isolated pyuria is associated with active renal and non-renal disease activity. An ongoing debate has emerged regarding the significance of isolated hematuria and isolated pyuria with respect to SLE disease activity. The results of this study suggest that isolated hematuria and isolated pyuria is associated with active renal and non-renal disease activity. Thus isolated hematuria and isolated sterile pyuria should be considered manifestations of active SLE.

Indinavir nephropathy in an AIDS patient with renal insufficiency and pyuria.

Indinavir has been described to cause crystalluria and nephrolithiasis in a variable number of treated patients. Acute renal failure, often reversible with discontinuation of the medication, induction of a diuresis and correction of urinary obstruction if present, occurs in a smaller percent of patients. One recent report described renal biopsy findings, indinavir crystals within cellular casts in the collecting tubules, in a patient receiving this antiretroviral agent. We report a second case of a patient with mild renal insufficiency and pyuria following indinavir therapy and describe similar renal biopsy findings.

Comparison of the Gram-stained urethral smear and first-voided urine sediment in the diagnosis of nongonococcal urethritis.

The diagnostic sensitivity of the numbers of leukocytes in the sediment of first-voided urine and in gram-stained smears of urethral secretions was evaluated by a study of 62 men with symptoms of nongonococcal urethritis. Fifty-one patients (82.3%) had pyuria (defined as ten or more leukocytes per high-power field) in the sediment of first-voided urine, whereas 8 (45.2%) had more than four leukocytes per oil-immersion held in gram-stained urethral smears. Frequencies of positive first-voided urine sediments and urethral smears were similar in Chlamydia trachomatis--positive and -negative cases. Results of cultures, urinalyses, and urethral smears were not affected by recent micturition. Pyuria in the first-voided urine but not a positive urethral smear is a sensitive sign of urethritis whether or not urethral discharge is evident. Specimens of urethral secretions were subjected to different storage conditions to determine the effect on subsequent isolation of C. trachomatis. Equal rates of isolation were demonstrated for specimens that had been held at 4 degrees C for either four or 20-24 hr or frozen to -70 degrees C for one week prior to culture.

An etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis); an electron microscopic study.

Renal tissues were studied using electron microscopy (EM) and immunofluorescence microscopy (IFM) from three patients who were found to have chronic interstitial nephritis (pyelonephritis) by light microscopy (LM). By LM, 90% of the glomeruli in two patients and all glomeruli in one patient were normal. By EM, glomerular capillaries in all patients revealed generalized fusion of epithelial foot processes. In two patients, IFM for immunoglobulins, third component of complement and fibrinogen were negative. These two patients received corticosteroids for 6 to 12 weeks. In one, proteinuria markedly decreased (from 17.9 to 1.1 gm) in four weeks and in the other follow-up studies of renal histology revealed normal glomeruli and partial restoration of foot processes by LM and EM respectively. Thus, this study offers evidence for lipoid nephrosis (or minimal lesion disease) as an etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis). The impaired renal function in these patients is attributed to tubulo-interstitial disease rather than glomerular pathology. It remains to be determined whether the two disparate pathological conditions have coexisted or chronic interstitial nephritis had led to the appearance of lipoid nephrosis through an unidentified mechanism.