Is urethral microscopy useful in symptomatic male patients without urethral discharge?

National guidelines recommend that male patients presenting with symptoms of urethritis or epididymo-orchitis undergo a urethral swab for microscopy. However, this is resource intensive. The aim of this audit was to determine the proportion of symptomatic patients without urethral discharge who have positive findings on urethral swab microscopy and explore associations between presenting symptoms and microscopy findings. We conducted a retrospective audit of symptomatic male patients who underwent microscopy. There was a significant difference between the percentage of symptomatic patients with positive findings on microscopy in those with and without urethral discharge (67% vs 33%, p < 0.001). In a patient presenting with symptoms other than urethral discharge, the likelihood that positive findings on microscopy would occur in a patient with dysuria was 4.73 times more likely than if they did not have dysuria, when controlling for age, testicular pain or discomfort, and urethral discomfort or penile irritation (p < 0.01). In situations where there are limited resources, patients without urethral discharge presenting with dysuria could be prioritised. However, further research is required to identify and stratify which patients require microscopy.

[CORRESPONDENCE OF POLYMICROBIAL BACTERIURIA IN THE UNCOMPLICATED URINARY TRACT INFECTION OF THE PREMENOPAUSAL WOMAN].

(Objectives) We report the clinical features about polymicrobial bacteria detection cases in the uncomplicated urinary tract infection of the premenopausal woman from the voided midstream urine culture. (Methods) We retrospectively reviewed the premenopausal woman from 18-49 years patients visited Sendai City Hospital from April, 2006 to December, 2014, diagnosed uncomplicated cystitis or uncomplicated pyelonephritis. We analyzed for 375 specimens from the voided midstream urine culture. (Results) Among 375 specimens, the urine culture-positive for uropathogens were 211 specimens. The monomicrobial bacterial were detected in 184 specimens (87.2%) and polymicrobial bacterial specimens were 27 specimens (12.8%). The most combination group was the caused bacteria and periurethral microorganisms in 20 specimens (74.1%). Then 6 periurethral microorganisms specimens (22.2%), the caused bacteria were only 1 specimen was overlapped (3.7%). The case of urinary tract infections recurrence or revealed voiding dysfunction that need periodic treatment were more prevalent in the polymicrobial than the monomicrobial group (22.2% vs 9.8%, p=0.043). (Conclusions) When polymicrobial bacteria were detected in uncomplicated urinary tract infection in premenopausal woman, it was confirmed that there were the most combinations of caused bacteria and periurethral microorganisms. In these cases, treatment intended for only the caused bacteria. A risk of the infection recurrence and voiding dysfunction were statistically significant higher rate in the polymicrobial bacteria detection cases, and it might be necessary to consider that search to complicated urinary tract infection.

Toward a simple diagnostic index for acute uncomplicated urinary tract infections.

PURPOSE: Whereas a diagnosis of acute uncomplicated urinary tract infection (UTI) in clinical practice comprises a battery of several diagnostic tests, these tests are often studied separately (in isolation from other test results). We wanted to determine the value of history and urine tests for diagnosis of uncomplicated UTIs, taking into account their mutual dependencies and information from preceding tests. METHODS: Women with painful and/or frequent micturition answered questions about their signs and symptoms (history) of UTIs and underwent urine tests. A culture was the reference standard (10(3) colony-forming units per milliliter). A diagnostic index was derived using logistic regression with bootstrapped backward selection and parameter-wise shrinkage. Risk thresholds for UTI of 30% and 70% were used to analyze discriminative properties. Six models were compared: (1) history only, (2) history+ urine dipstick, (3) history+ urine dipstick + urinary sediment, (4) history+ urine dipstick+ dipslide, and (5) history+ urine dipstick+ urinary sediment+ dipslide; we then added (6) a test only for patients with an intermediate risk (between 30% and 70%) after the preceding test. RESULTS: One hundred ninety-six women were included (UTI prevalence 61%). Seven variables were selected from history (3), dipstick (2), sediment (1), and dipslide (1). History correctly classified 56% of patients as having a UTI risk of either <30% or >70%. History and urine dipstick raised this to 73%. The 3 models with the addition of urinary sediment and dipslide, separately and in combination, performed hardly better. The sixth model, in which those at intermediate risk after history and received an additional test, correctly classified 83%. The patient's suspicion of a UTI and a positive nitrite test were the strongest indicators of a UTI. CONCLUSIONS: Most women with painful and/or frequent micturition can be correctly classified as having either a low or a high risk of UTI by asking 3 questions: Does the patient think she has a UTI? Is there at least considerable pain on micturition? Is there vaginal irritation? Other women require additional urine dipstick investigation. Sediment and dipslide have little added value. External validation of these recommendations is required before they are implemented in practice.

Pyospermia in an adult cohort with persistent lower urinary tract symptoms and a history of ablated posterior urethral valve.

PURPOSE: To assess for the presence of lower urinary tract symptoms and abnormal semen parameters in adults with a history of PUV. MATERIALS AND METHODS: The study involved 29 male patients, aged 17-51 (mean 21.5 years), with a history of PUV. Ten had more severe symptoms of frequency, urgency and enuresis, and agreed to detailed study. Medical history, urine analysis, ultrasonography and voiding cystourethrogram were completed for all. Magnetic resonance imaging of the bladder, prostate, seminal vesicles and ejaculatory ducts, ultrasonography of the prostate, as well as semen analysis and culture, and measurement of serum levels of follicle-stimulating hormone, luteinizing hormone and testosterone were performed on the 10/29 patients with severe symptoms. RESULTS: Of the 8/10 patients who provided acceptable semen culture data, 88% (7/8) showed significant bacterial growth and pyospermia. On semen analysis, 3/8 patients had profound decreases in sperm count, 6/8 < 50% motility and 4/8 ≤ 30% normal forms. pH range for semen was 7.2-7.8 (mean 7.45). For all 10 patients, follicle-stimulating and luteinizing hormone values were within normal range. Elongation of the prostate was the only radiologic variant of the sex accessory structures. CONCLUSION: A significant finding of pyospermia and bacterial growth in semen culture is reported in a subpopulation of young men with a history of PUV and severe lower urinary tract symptoms. This may have an impact on fertility.

Urinary findings in young adults in Abakaliki, Nigeria.

OBJECTIVE: To determine the prevalence of urinary abnormalities in young adults living in Abakaliki, Southeastern Nigeria. METHOD: Two hundred and fifty (250) clean-catched mid-stream urine samples obtained between October 2005 and June 2006 from apparently healthy young adults, aged 18-25 years (mean = 19.7 +/- 4.1 years) resident in Abakaliki, comprising 151 (60.4%) females and 99 (39.6%) males were analysed using standard laboratory procedures and techniques. RESULTS: The prevalence of urinary abnormalities was found to be 20.7%. In addition to leucocyte esterase and pyuria, which were found in significantly more female samples than the males' (p < 0.05), there were generally more abnormalities in female urine samples than their male counterparts (p < 0.05). The major abnormalities recorded were pyuria (47.1%), bacteriuria (21.6%), proteinuria (14.0%) and haematuria (8.0%). CONCLUSION: The finding supports routine urine screening as an important disease surveillance approach in young adults Nigerians resident in Abakaliki metropolis.

Influence of intravesical potassium on pelvic floor activity in women with recurrent urinary tract infections: comparative urodynamics might lead to enhanced detection of dysfunctional voiding.

OBJECTIVES: To investigate the influence of intravesical potassium on pelvic floor activity (PFA) during voiding in women with recurrent urinary tract infections (rUTIs) by using comparative urodynamics (CUD). PATIENTS AND METHODS: CUD was conducted in 49 women (mean age 34.6 years, range 15-82) with rUTI. Every patient had two sessions of pressure-flow studies with simultaneous measurement of PFA by perineal surface electromyography (EMG); the first was with 0.9% saline and in the second the bladder was filled with 0.2 m KCl solution. All patients had voiding cysto-urethrography, and dysfunctional voiding (DV) was diagnosed when significant PFA was measured by EMG during voiding. RESULTS: Overall, DV was diagnosed in 37 patients (76%) using CUD; 16 (32%) had DV with saline on the pelvic floor EMG. In all these patients there were significantly greater EMG signals in the presence of KCL. In 21 patients (43%) DV was only detected using KCL; this improvement in the detection rate of DV was statistically significant (P = 0.006). Filling with KCl also prompted a statistically significant difference (P < 0.05) in maximum bladder capacity, maximum and average flow rates and in postvoid residual urine volume. CONCLUSION: The present data show that DV is present in most women with rUTI but cannot sufficiently be diagnosed by conventional urodynamics with standard 0.9% saline. The present study suggests that CUD might enhance the detection rates of DV.

Antagonistic activity of probiotic lactobacilli and bifidobacteria against entero- and uropathogens.

AIM: To develop in vitro assays for comparing the antagonistic properties and anti-oxidative activity of probiotic Lactobacillus and Bifidobacterium strains against various entero- and urinary pathogens. METHODS AND RESULTS: The antagonistic activity of five probiotic lactobacilli (Lactobacillus rhamnosus GG, Lactobacillus fermentum ME-3, Lactobacillus acidophilus La5, Lactobacillus plantarum 299v and Lactobacillus paracasei 8700:2) and two bifidobacteria (Bifidobacterium lactis Bb12, Bifidobacterium longum 46) against six target pathogens was estimated using different assays (solid and liquid media, anaerobic and microaerobic cultivation) and ranked (low, intermediate and high). Bacterial fermentation products were determined by gas chromatography, and the total anti-oxidative activity of probiotics was measured using linolenic acid test. Pyelonephritic Escherichia coli was highly suppressed by GG and both bifidobacteria strains. Lactobacilli strains 8700:2, 299v and ME-3 were the most effective against Salmonella enterica ssp. enterica in microaerobic while ME-3 and both bifidobacteria expressed high activity against Shigella sonnei in anaerobic milieu. Lact. paracasei, Lact. rhamnosus and Lact. plantarum strains showed intermediate antagonistic activity against Helicobacter pylori under microaerobic conditions on solid media. The highest anti-oxidative activity was characteristic for Lact. fermentum ME-3 (P < 0.05). No efficient antagonist against Clostridium difficile was found. The positive correlations between the pH, lactic acid production and anti-microbial activity for all tested probiotics were assessed. CONCLUSIONS: Developed experimental assays enable to compare the anti-microbial and -oxidative activity of Lactobacillus and/or Bifidobacterium probiotics, which have been claimed to possess the ability of suppressing the growth of various enteric and urinary pathogens. SIGNIFICANCE AND IMPACT OF THE STUDY: Screening Lactobacillus and Bifidobacterium sp. strains according to their activity in various environmental conditions could precede the clinical efficacy studies for adjunct treatment with probiotics in cure of different gastrointestinal and urinary tract infections.

Acute dysuria among female soldiers.

OBJECTIVE: To assess behavior patterns among active duty female soldiers presenting to military care facilities for acute dysuria. METHODS: A self-administered questionnaire was developed. One hundred twelve female soldiers presenting with acute dysuria and one hundred twenty-six presenting for other reasons were surveyed. RESULTS: During regular duty hours, the dysuria group drank less than the control group (21% and 14%, respectively; p = 0.004). However, field duty appeared to compound this problem, with the dysuria group drinking considerably less than the control group (79% and 19%, respectively; p = 0.002). Both groups stated that they postponed urination during working hours. The dysuria group postponed urination more than did the control group during regular duty (75% and 53%, respectively; p = 0.006) and field duty (79% and 65%, respectively; p = 0.008). CONCLUSIONS: Female soldiers presenting with dysuria were more likely to report fluid restriction and to postpone voiding during duty, behaviors that were reported even more frequently during field duty. Fluid restriction and postponed urination may be significant factors in the development of acute dysuria among female soldiers.

[Indwelling transurethral catheter]. / Probleme mit dem Dauerkatheter? So machen Sie ein notwendiges Ubel erträglich.

Apart from injuries occurring during catheter placement, the most important of the risks associated with indwelling transurethral catheters are incrustation of the catheter and infection, possibly leading on to urosepsis. Recommended countermeasures are the application of strict criteria when establishing the indication for catheterization, reversion to alternative measures, such as condom urinals, and the careful selection of catheter material.

No association between elevated post-void residual volume and bacteriuria in residents of nursing homes.

OBJECTIVE: To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. DESIGN: Cross-sectional study. SETTING: Three nursing homes in Jönköping, southern Sweden. SUBJECTS: A total of 147 elderly residents in municipal nursing homes. MAIN OUTCOME VALUES: PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. RESULTS: Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). CONCLUSION: Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.

Urinary urgency and frequency, and chronic urethral and/or pelvic pain in females. Can doxycycline help?

PURPOSE: Persistent urinary urgency and frequency, and chronic urethral and/or pelvic pain in women are often a diagnostic and therapeutic challenge. This can be frustrating for patients and physicians. The search for an infectious agent often proves futile and after multiple ineffective treatment regimens patients may be classified as having interstitial cystitis or referred to a psychiatrist as the last option. We evaluated whether treatment with doxycycline of the patient and her sexual partner would be beneficial. MATERIALS AND METHODS: Women presenting with a history of urinary urgency and frequency, and chronic urethral and/or pelvic pain often associated with dyspareunia and/or a history of recurrent urinary tract infection were evaluated. Initial examinations included urethral and cervical/vaginal swabs, serum analysis, urine examination and culture, and bladder barbitage. A total of 103 women with a median age of 46 years (range 21 to 84) and with a median symptoms history of 60 months (range 3 to 480) were included. All patients had trigonal leukoplakia at cystoscopy, in 15% an infectious organism was identified and 30% had leukocyturia. All were treated with doxycyclines, and a vaginal antimicrobic and/or antimycotic agent following the same regimen, including treatment of the sexual partner. RESULTS: After treatment with doxycycline 71% of the women were symptom-free or had a subjective decrease in symptoms. CONCLUSIONS: Treatment with doxycycline is effective in more than two-thirds of patients complaining of persistent frequency and urgency, chronic urethral and/or pelvic pain, and dyspareunia as well as a history of recurrent urinary tract infections. In women with negative urinary cultures but a history of urgency/frequency probative treatment with doxycycline is justified and endoscopic findings may support the hypothesis of chronic infection. This should be done especially before contemplating psychiatric treatment or diagnosing the patient with interstitial cystitis. We attribute this high success rate to simultaneous treatment of the sexual partner, who may be an asymptomatic carrier, although this remains to be proved.

Review of cases of children with gonorrhoea--source of infection.

This is a retrospective study to determine what effort was put into identifying the source of infection in children with gonorrhoea in Ibadan. The case files of eighty-four children aged 1 to 10 years who had gonococcal genital infections between 1983 and 1998 and presented at the Special Treatment Clinic of the University College Hospital, Ibadan were studied. Clinical manifestations of the 84 children include vaginal discharge (97.6%), urethritis (2.4%) and combined genital and eye infection (8.3%). A total of 103 relatives of 61 index subjects were examined. Of those in whom specimens were collected for microscopy culture and sensitivity, 27 (26.2%) had gonorrhoea. A history of sexual contact in the children studied was recorded in only (10.7%) cases, while four (4.7%) others without history of sexual intercourse had torn hymen. Sexual abuse or child neglect was suspected in this group. None of the named contacts was traceable by the health visitors. The recognition of a child with gonococcal infection identifies a cluster of family members who are at increased risk of having gonorrhoea. This study indicates that more effort will be required to find the source and mode of transmission of gonorrhoea in children.

Urinary tract infection after urodynamic studies in women: incidence and natural history.

OBJECTIVE: To study the incidence, natural history and symptomatic effects of bacteriuria after urodynamic studies in women. PATIENTS AND METHODS: In a prospective study in the urogynaecology clinic of a large District General Hospital, 214 women (mean age 52.3 years, range 23-81) underwent urodynamic studies. Bacteriuria was detected by semiquantitative culture at 2 and 7 days after the test. Women completed a 7-day diary of symptoms and events. RESULTS: The incidence of bacteriuria after urodynamic studies was 7.9%. Bacteriuria was transient in four of 17 women but persisted in nine and developed late in four; only one of 17 infections gave rise to symptoms. Irritative bladder symptoms after the test occurred in 34% of women, but only three went to their doctors because of concern about a possible urinary tract infection. Advancing age was the only variable associated with bacteriuria after urodynamic studies (P= 0.05). Menopausal status, past history of urinary tract infection, number of urethral instrumentations required, order number in a session, peak urinary flow rate and urodynamic diagnosis were not associated variables. CONCLUSIONS: In a large series of women presenting to a urogynaecology clinic, urodynamic investigations were associated with a high incidence of transient irritative symptoms but a low incidence of bacteriuria (8%). Infection was asymptomatic in most patients, but its natural history was unpredictable. Transient, persistent and late cases of bacteriuria all occurred. In this population, urodynamic studies are associated with a low level of morbidity.