Clinical benefit of early treatment with bone-modifying agents for preventing skeletal-related events in patients with genitourinary cancer with bone metastasis: A multi-institutional retrospective study.

OBJECTIVES: To evaluate the clinical benefit of bone-modifying agents and identify the risk factors of skeletal-related events in patients with genitourinary cancer with newly diagnosed bone metastasis. METHODS: This was a multicenter retrospective study including a total of 650 patients with bone metastasis of the following cancer types: hormone-sensitive prostate cancer (n = 443), castration-resistant prostate cancer (n = 50), renal cell carcinoma (n = 80) and urothelial carcinoma (n = 77). Clinical factors at the time of diagnosis of bone metastasis were analyzed. Early treatment with bone-modifying agents was defined as follows: administration of bone-modifying agents before the development of skeletal-related events and within 6 months from the diagnosis of bone metastasis. RESULTS: During the follow-up period (median 19.0 months, interquartile range 6.0-43.8 months), skeletal-related events were reported in 88 (20%) patients with hormone-sensitive prostate cancer, 17 (34%) patients with castration-resistant prostate cancer, 58 (73%) patients with renal cell carcinoma and 34 (44%) patients with urothelial carcinoma. Early treatment with bone-modifying agents significantly prolonged the time to the first skeletal-related event in castration-resistant prostate cancer, renal cell carcinoma and urothelial carcinoma, but not in hormone-sensitive prostate cancer. Bone pain and elevated alkaline phosphatase levels were independent predictive risk factors of the first skeletal-related event. The subgroup analysis showed that early treatment with bone-modifying agents was associated with prolonged time to the first skeletal-related events in patients with bone pain or elevated alkaline phosphatase levels. CONCLUSIONS: Early treatment with bone-modifying agents should be considered, especially for patients with bone pain and elevated alkaline phosphatase levels, to prevent skeletal-related events in patients with genitourinary cancer with bone metastasis.

SEVEN FAMILIAL DYSALBUMINEMIC HYPERTHYROXINEMIA CASES IN THREE UNRELATED JAPANESE FAMILIES AND HIGH-PERFORMANCE LIQUID CHROMATOGRAPHY ANALYSIS OF THE THYROXINE BINDING PROFILE.

OBJECTIVE: Familial dysalbuminemic hyperthyroxinemia (FDH) is caused by abnormal human serum albumin (HSA) with an increased thyroxine (T4) affinity leading to euthyroid hyperthyroxinemia. One- and 2-step immunoassays of serum samples from FDH patients (e.g., Japanese patients) with the HSA R218P mutation can yield false-positive free thyroxine (FT4) results. Therefore, it is difficult to distinguish FDH from syndrome of inappropriate secretion of thyroid-stimulating hormone (TSH) (e.g., syndrome of resistance to thyroid hormone, TSH-producing pituitary adenoma), even when multiple assays are used. To investigate T4 to HSA binding, we examined serum samples from 7 patients from 3 Japanese families with FDH. Clinically, abnormal thyroid function tests were noted in pregnant Patient 1. Patients 2 and 3 had histories of inappropriate treatment with antithyroid drugs and surgery. METHODS: All patients and affected family members were diagnosed with FDH using direct sequencing analysis. Gel filtration high-performance liquid chromatography was used for the biochemical analyses. RESULTS: The genomic analysis revealed a heterozygous missense mutation in HSA (R218P). In FDH patient sera, the albumin effluent corresponded to the peaks for total T4 (TT4); approximately 60% of the T4 in the effluent was detected as FT4. The results for the albumin effluent from healthy volunteer and TSHoma patient sera showed no corresponding TT4 peak. CONCLUSION: In the FDH patients, a relatively larger quantity of T4 was bound to abnormal HSA. This bound T4 was measured as FT4 during the analysis. ABBREVIATIONS: F = free; FDH = familial dysalbuminemic hyperthyroxinemia; HPLC = high-performance liquid chromatography; HSA = human serum albumin; PCR = polymerase chain reaction; SITSH = syndrome of inappropriate secretion of TSH; T = total; T3 = triiodothyronine; T4 = thyroxine; TSH = thyroid-stimulating hormone; WT = wild-type.

Insignificant role of bacillus Calmette-Guérin maintenance therapy after complete transurethral resection of bladder tumor for intermediate- and high-risk non-muscle-invasive bladder cancer: Results from a randomized trial.

OBJECTIVES: To investigate the effect of bacillus Calmette-Guérin maintenance therapy on patients with intermediate- and high-risk non-muscle-invasive bladder cancer receiving aggressive complete transurethral resection of bladder tumors standardized by well-trained surgeons. METHODS: A total of 95 patients were prospectively enrolled. Patients were diagnosed with multiple or recurrent non-muscle-invasive bladder cancer (Ta and T1), or with carcinoma in situ after complete transurethral resection of bladder tumors. Patients with Ta or T1 tumors without carcinoma in situ received six bacillus Calmette-Guérin instillations as induction therapy. Those with carcinoma in situ underwent eight bacillus Calmette-Guérin instillations as induction therapy. The patients were randomized into maintenance and non-maintenance groups. The maintenance group received intravesical bacillus Calmette-Guérin instillations once a week for 3 weeks at 3, 6, 12 and 18 months after bacillus Calmette-Guérin instillation. The primary end-point was recurrence-free survival. RESULTS: A total of 88 patients were evaluated. The average follow-up period was 48.3 ± 19.0 months. Five-year recurrence-free survival rates for the maintenance and non-maintenance groups were 80.1% and 79.3%, respectively. Five-year progression-free survival rates of the maintenance and non-maintenance groups were 92.4% and 85.3%, respectively. Recurrence- and progression-free survival rates did not significantly increase in the maintenance group compared with that in the non-maintenance group. CONCLUSIONS: Bacillus Calmette-Guérin maintenance therapy did not improve recurrence- and progression-free survival rates after the initial complete transurethral resection of bladder tumors compared with that after bacillus Calmette-Guérin induction therapy alone.

Surface terminations control charge transfer from bulk to surface states in topological insulators.

Topological insulators (TI) hold significant potential for various electronic and optoelectronic devices that rely on the Dirac surface state (DSS), including spintronic and thermoelectric devices, as well as terahertz detectors. The behavior of electrons within the DSS plays a pivotal role in the performance of such devices. It is expected that DSS appear on a surface of three dimensional(3D) TI by mechanical exfoliation. However, it is not always the case that the surface terminating atomic configuration and corresponding band structures are homogeneous. In order to investigate the impact of surface terminating atomic configurations on electron dynamics, we meticulously examined the electron dynamics at the exfoliated surface of a crystalline 3D TI (Bi 2 Se 3 ) with time, space, and energy resolutions. Based on our comprehensive band structure calculations, we found that on one of the Se-terminated surfaces, DSS is located within the bulk band gap, with no other surface states manifesting within this region. On this particular surface, photoexcited electrons within the conduction band effectively relax towards DSS and tend to linger at the Dirac point for extended periods of time. It is worth emphasizing that these distinct characteristics of DSS are exclusively observed on this particular surface.

Effects of green tea polyphenols on iodide-induced autoimmune thyroiditis in nonobese diabetic mice.

Because green tea polyphenols (GTPs) possess anti-inflammatory properties and are effective in inhibiting autoimmune diseases in experimental settings, we examined whether GTPs prevented the development of autoimmune thyroiditis in iodide-treated nonobese diabetic (NOD) mice, an animal model of Hashimoto's thyroiditis (HT). Mice were given 0.05% iodide water or iodide water supplemented with 0.2% GTPs for 8 weeks. GTPs administration led to an enhanced production of interleukin-10 by concanavalin A-stimulated splenocytes but did not interfere with thyroiditis development. Serum thyroxine levels were not influenced by GTPs. Our data suggest that administration of GTPs may not be an effective strategy for the prevention of HT.

Cerebral gray matter volume correlates with fatigue and varies between desk workers and non-desk workers.

Chronic fatigue syndrome (CFS), a clinical entity of chronic fatigue, has been associated with a decrease in regional gray matter volume (rGMV). In this study targeting a large number of healthy middle-aged individuals without CFS, the relationship between fatigue perception and rGMV was investigated. Considering that the work setting is an environmental factor that influences fatigue perception among healthy individuals, the differences between desk workers and non-desk workers were investigated. Chalder Fatigue Questionnaire (CFQ) scores were used for perceptional evaluation of fatigue, and rGMV of 110 brain regions was adapted with Statistical Parametric Mapping (SPM) 8 on 1.5 T magnetic resonance imaging (MRI) results for the volumetric calculation of gray matter. The CFQ scores were negatively correlated with the right supplementary motor area (SMC) and positively correlated with the right superior parietal lobule (SPL) and left basal forebrain in all participants (n = 1,618). In desk workers and non-desk workers, the CFQ scores correlated with different regions and yielded different mechanisms of fatigue perception in the brain. Identifying the gray matter regions correlated with fatigue perception in healthy individuals may help understand the early stage of fatigue progression and establish future preventive measures.

Effects of synthetic retinoid Am80 on iodide-induced autoimmune thyroiditis in nonobese diabetic mice.

We examined whether a synthetic retinoid Am80 prevented the development of autoimmune thyroiditis in iodide-treated nonobese diabetic mice, an animal model of Hashimoto's thyroiditis (HT). Am80 (0, 0.1 or 1 mg/kg/day) was orally administered in feed during the 8-week iodide treatment. While iodide ingestion effectively induced thyroiditis, Am80 administration failed to interfere with thyroiditis development and serum anti-thyroglobulin antibody levels regardless of the dose of the retinoid. Splenic T cell numbers, splenocyte proliferation and interferon-γ production were decreased in the Am80-treated mice. Our data suggest that Am80 is not a candidate for use in the prevention of HT.

The primary therapy chosen for patients with localized prostate cancer between the university hospital and its affiliated hospitals in Nara Uro-Oncological Research Group registration.

BACKGROUND: We investigated the differences between the preferential primary therapy conceived by the primary doctors and the primary therapy actually conducted for prostate cancer patients in Nara, Japan. METHODS: The distribution of primary therapy and clinical characteristics of 2303 prostate cancer patients - diagnosed between 2004 and 2006 at Nara Medical University and its 23 affiliated hospitals - were assessed. Moreover, the preferential primary therapy for the patients at each clinical stage (cT1-T3bN0M0) conceived by the primary doctors was investigated and compared to the actual therapy. RESULTS: Of all patients, 51% received primary androgen deprivation therapy (PADT), 30% underwent radical prostatectomy (RP), and 14% received radiation therapy (RT). The preferential primary therapy for cT1-2N0M0 was RP (92%) while 38% of the patients actually received PADT (RP: 40%). For cT3aN0M0, the preferential primary therapy was both RP and external beam radiation therapy (EBRT) while 58% of the patients actually received PADT (RP: 16%, EBRT: 24%). For cT3bN0M0, the most preferential primary therapy was EBRT (46%) while 67% of the patients actually received PADT (EBRT: 21%). This trend was more notable in the affiliated hospitals than in the University hospital. The hospitals with lower volume of RP per year significantly conducted PADT compared with those with higher volume of RP. CONCLUSIONS: PADT was commonly used to treat localized prostate cancer as well as locally advanced prostate cancer in Japan. There was a definite discrepancy between the preferential primary therapy conceived by the primary doctors and the actual therapy provided to the patients.

Erythrocyte zinc concentration as an indicator to distinguish painless thyroiditis-associated transient hypothyroidism from permanent hypothyroidism.

Red blood cell (RBC) zinc (Zn) concentration reflects a patient's mean thyroid hormone level over the preceding several months. The aim of this study was to examine whether RBC Zn level can be used as an indicator to distinguish painless thyroiditis-associated transient hypothyroidism (TH) from permanent hypothyroidism (PH). RBC Zn level was measured in 30 untreated PH patients with Hashimoto's thyroiditis and 7 untreated TH patients with painless thyroiditis in whom preceding transient thyrotoxicosis had been confirmed. RBC Zn concentration was significantly lower in TH patients than that in PH patients. There was a positive correlation between RBC Zn and serum TSH, and the latter was clearly lower in TH patients than that in PH patients. However, RBC Zn level was again significantly lower in TH patients than PH patients despite of the comparable serum TSH levels in both groups when RBC Zn was evaluated in patients with serum TSH levels of less than 50 mU/L. Thus TH patients could be identified with RBC Zn measurement, allowing us avoidance of unnecessarily prolonged T4 administration to them.

Association between components of family caregivers' sense of burden and types of paid care services provided in Japan.

OBJECTIVES: The aim was to identify significant relationships between the 21 components of caregivers' sense of burden in the Zarit Burden Interview and specific paid care services provided in Japan's long-term care insurance system. METHOD: We defined a service utilization level (SUL) that represents the amount of care services that caregivers were consuming. We calculated the ratios of people, among those with the same SUL value, whose sense of burden was weaker than a specific level. Finally, we conducted regression analysis and checked how this ratio varied compared to the change in SUL values. RESULTS: For 12 among 22 components, the use of paid care services in general were significantly and linearly related with a smaller number of people having the strongest sense of burden. Several pairs of burden components and care service types were identified indicating that the type of care services effectively alleviated that burden component. CONCLUSIONS: (1) Paid care services do relieve caregivers' sense of burden. (2) Measures to increase the ratio of people with the weakest sense of burden by encouraging the use of care services do not necessarily match those that decrease the ratio of people feeling the heaviest burden. (3) Policies that encourage caregivers to use more care services can be more effective if policy makers know which type of care service is related with a burden component.

How Does Reciprocal Exchange of Social Support Alleviate Individuals' Depression in an Earthquake-Damaged Community?

There is ample evidence to indicate the direct effects of receiving social support on mental health during and after a disaster. However, the importance of reciprocal exchanges of social support (i.e., balanced receipt and provision of social support) in maintaining the mental health status of individuals is not widely recognized. Using equity theory and reciprocity norms as a conceptual base, we distinguished two types of social support, namely, emotional support and instrumental support, and examined the effects of reciprocal exchanges of types of support on depression in survivors of an earthquake-damaged community. To collect data, in 2019, a questionnaire survey was conducted among 295 survivors of the 2015 Gorkha Earthquake in a rural village in Nepal. Our results showed that the relationship between reciprocal exchange of support and depression varied depending on the types of support. The amount of emotional support received by the individual alleviated his/her depression only when accompanied by giving emotional support. By contrast, the net amount of instrumental support given by the individual increased his/her depression. The practical implications of the study are discussed.

Aging Brains Degrade Driving Safety Performances of the Healthy Elderly.

The relationship between aging brains and driving safety performances (DSPs) of elderly drivers was studied. A total of 90 dementia-free participants (63 men and 27 women, mean age 75.31 ± 4.795 years) were recruited and their DSPs were analyzed on actual vehicles running through a closed-circuit course. DSPs were comprehensively evaluated on the basis of driving instructors' scores (DIS). Signaling and visual research behaviors, part of DSPs, were measured to supplement the DIS evaluation by driving recorders (DR) and wearable wireless sensors (WS), respectively. Aging brains were evaluated via magnetic resonance imaging (MRI) findings and experimentally assigned to two grades (high vs. low) of brain atrophy (BA) and leukoaraiosis (LA). Regression analyses on DIS and DR data, and logistic analysis on WS scores showed significant correlations of aging brains with degradation of DSPs. The participant group with more advanced BAs and LAs showed lower DIS, DR data, and WS scores representing degraded DSP regardless of age. These results suggest that MRI examinations from both volumetric and pathological perspectives of brains have the potential to help identify elderly drivers with dangerous driving behaviors. Brain healthcare, lifestyle improvements and medical treatments to suppress BA and LA, may contribute to preventing DSP degradation of elderly drivers with aging brains.

External validation of a genitourinary cancer-specific prognostic scoring system to predict survival for patients with bone metastasis (modified B-FOM scoring model): Comparison with other scoring models in terms of accuracy.

OBJECTIVE: We previously developed genitourinary (GU) cancer-specific scoring system for prediction of survival in patients with bone metastasis (the Bone-Fujimoto-Owari-Miyake [B-FOM] scoring model) based on five prognostic factors: the type of primary tumor (prostate cancer (PCa) vs renal cell carcinoma (RCC) and PCa vs urothelial carcinoma (UC)), poor performance status (PS), visceral metastasis, high Glasgow-prognostic score (GPS), elevated neutrophil-to-lymphocyte ratio (NLR). The aim of this study was to externally validate and further improve the performance of the B-FOM score. METHODS: The external validation cohort comprised 309 patients with GU cancer with bone metastasis from multiple institutions. Clinical factors were analyzed using Kaplan-Meier method and COX regression hazard model. Performance of a modified B-FOM score was compared to that of other scoring models by the Kaplan-Meier method and the area under the curve (AUC) of receiver operating characteristic curves. RESULTS: The median follow-up period of development and validation cohort were 25 and 17 months, respectively. Kaplan-Meier curve demonstrated that the type of primary tumor (RCC and UC vs PCa), poor PS, presence of visceral metastasis, high GPS, elevated NLR were significantly associated with shorter cancer-specific survival. Risk groups were successfully stratified by the modified B-FOM score classification. Moreover, the AUC of the modified B-FOM scoring model for predicting mortality at 6, 12, and 24 months were 0.895, 0.856, and 0.815, respectively, which were the highest among evaluated models. CONCLUSIONS: The B-FOM scoring model is a simple and accurate prediction tool. By using this scoring model at the time of the diagnosis of bone metastasis in patients with GU cancers, an individualized optimal treatment strategy can be selected.

Design of novel hypoxia-targeting IDO hybrid inhibitors conjugated with an unsubstituted L-TRP as an IDO affinity moiety.

We presented here design, syntheses and inhibitory activities of novel hypoxia-targeting IDO hybrid inhibitors conjugated with an unsubstituted L-Trp as an IDO affinity moiety without inhibitor 1MT, such as L-Trp-TPZ hybrids 1 (TX-2274), 2 (UTX-3), 3 (UTX-4), and 4 (UTX-2). TPZ-monoxide hybrids 1 and 3 were good competitive IDO inhibitors, while TPZ hybrids 2 and 4 were uncompetitive IDO inhibitors. Among them TPZ-monoxide hybrid 1 have the strongest IDO inhibitory activity. It suggests that TPZ-monoxide hybrids 1 and 3 are able to bind the active site of IDO, TPZ hybrids 2 and 4 are able to bind the enzyme-substrate complex. We proposed the possible mechanism of action of TPZ hybrid 2 that may first affect as a hypoxic cytotoxin, and then metabolized to TPZ-monoxide hybrid 1, which may do as an IDO inhibitor more effectively than its parent TPZ hybrid 2.

Gene cloning and enzymatic characteristics of a novel gamma-cyclodextrin-specific cyclodextrinase from alkalophilic Bacillus clarkii 7364.

A new gene, cda, was found in the downstream region of the cgt gene encoding cyclodextrin (CD) glucanotransferase from Bacillus clarkii 7364. Cda encoded by the cda was a cyclodextrinase that has extremely high specificity for gamma-CD. The rates of hydrolysis toward alpha- and beta-CD, maltooctaose and polysaccharides were less than 4% of that toward gamma-CD. Cda also has a transglycosylation activity, by which the maltotriose moiety was transferred from maltohexaose and maltopentaose. The comparison of the amino acid sequences between Cda and CD-degrading enzymes revealed the sequence of Cda has unique features. One of them is Gly247 next to the catalytic nucleophile Asp246. Most enzymes in GH family 13 have more bulky amino acids at this position. Other features in Cda are the lack of the N-domain in CD-degrading enzymes involving in the dimerization contributing to the preference of CDs and the existence of a long extra sequence in the C-terminus. Despite the lack of N-domain, Cda showed a dodecameric structure. The long extra sequence in the C-terminus might contribute to the oligomerization of Cda through a new mechanism. These unique features indicate that Cda is a novel type of CD-degrading enzyme.

Elderly pedestrians' self-regulation failures and crash involvement: The development of typologies.

The present study aims to identify, study, and develop typologies based on cases of elderly pedestrian collisions with vehicles where the pedestrians subjectively ascribe the collision at least in part to their own self-regulation failures. Semistructured interview surveys were conducted with 18 elderly people who had experienced a crash with a vehicle as a pedestrian aged 65 years or older. Personal construct theory is adopted as the theoretical underpinning, and it is assumed that pedestrians have their own subjective ways of making sense of the crashes they are involved in. It was found that 11 of the 18 participants ascribed the crashes at least in part to their own self-regulation failures. Cognitive maps of the 11 participants had a common structure, and the associated 11 incidents were classified with respect to the following dimensions: (a) self-regulation type, (b) self-regulation motivation, (c) cause of self-regulation failure, and (d) characteristics of the collisions that occurred after the self-regulation failure. Based on these findings, practical implications are found, and corresponding interventions that may reduce elderly pedestrian-vehicle crashes of this type are discussed. Specifically, this study demonstrates the necessity of education or other intervention that goes beyond informing elderly pedestrians of what is right and wrong in traffic environments. Another critical result-the need to motivate elderly pedestrians to respect and adhere to their own highly personal self-regulation, even if it is not against the social norms-is also presented and discussed.

Being watched over by a conversation robot may enhance safety in simulated driving.

INTRODUCTION: In an aging society that is more and more information-oriented, being able to replace human passengers' protective effects on vehicle drivers with those of social robots is both essential and promising. However, the effects of a social robot's presence on drivers have not yet been fully explored. Thus, using a driving simulator and a conversation robot, this experimental study had two main goals: (a) to find out whether social robots' anthropomorphic qualities (i.e., not the practical information the robot provides drivers) have protective effects by promoting attentive driving and alleviating crash risks; and (b) by what psychological processes such effects emerge. METHOD: Participants were recruited from young (n = 38), the middle-aged (n = 39), and the elderly (n = 49) age groups. They were assigned to either the treatment group (simulated driving in a conversation robot's presence) or the control group (simulated driving alone), and their driving performance was measured. Mental states (peaceful, concentrating, and reflective) also were assessed in a post-driving questionnaire using our original scales. RESULTS: Although the group of older participants did not experience protective effects (perhaps due to motion sickness), the young participants drove attentively, with the robot enhancing peace of mind. The protective effect was also observed among the middle-aged participants, and the verbal data analysis ascribed this to the robot's role of expressing sympathy, especially when the middle-aged drivers nearly had not-at-fault crashes, which caused them to be stressed. In conclusion, we discuss the practical implications of the results.

Comparison of cancer detection rates by transrectal prostate biopsy for prostate cancer using two different nomograms based on patient's age and prostate volume.

BACKGROUND: The aim of this study is to evaluate the efficacy of two different Nara Urological Research and Treatment Group (NURTG) nomograms allocating 6-12 biopsy cores based on age and prostate volume. MATERIALS AND METHODS: From April 2006 to July 2014, a total of 1,605 patients who underwent initial prostate biopsy were enrolled. Based on a nomogram taking the patient's age and prostate volume into consideration, 6-12 biopsy cores were allocated. Two types of nomogram were used, for the former group (before March 2009) and latter group (March 2009 onward). Cancer detection rates in all patients and those with prostate-specific antigen values in the gray zone (4.0-10 ng/mL) were compared. Predictive parameters for detection of prostate cancer in gray-zone patients were also investigated. RESULTS: The cancer detection rates in all patients and those in the gray zone were 48% and 38% in the former group and 54% and 41% in the latter group, respectively. The cancer detection rate in all patients was significantly higher in the latter group compared with the former group, but detection in gray-zone patients did not show a significant difference between the two groups (P=0.011 and P=0.37, respectively). Multivariate analysis indicated that age, digital rectal examination, prostate volume, transrectal ultrasonography findings, and volume/biopsy ratio were significant predictive parameters in gray-zone patients. The clinically insignificant cancer detection rate was significantly lower in the latter group compared with the former group (P=0.0008). CONCLUSION: The latter nomogram provided more acceptable detection rates of clinically significant and insignificant cancer than the former one, and we consider that an initial maximum 12-core transrectal ultrasound-guided needle biopsy may be sufficient for prostate cancer diagnosis.

Autonomously functioning thyroid nodule associated with thyrotoxic periodic paralysis.

Thyrotoxic periodic paralysis (TPP) is mainly associated with Graves' disease but rarely with autonomously functioning thyroid nodule (AFTN). We herein report a case of AFTN associated with TPP in which the latter resolved after (131) I therapy for the former. We analyzed the genes encoding thyrotropin receptor (TSHR), the alpha-subunit of the stimulatory G protein (Gsalpha), calcium channel CACNA1S and potassium channel KCNE3, and found that the patient does not carry the known mutations in these genes. Whereas the pathogenesis of TPP and AFTN remains to be understood, the present case suggests that ion channel defects responsible for familial hypokalemic periodic paralysis may not be associated with TPP, and that mutations in TSHR and Gs alpha genes may be less frequent in AFTN patients in the Japanese population.

[THE RISK FACTORS AND CHEMOPREVENTION OF FEBRILE URINARY TRACT INFECTION AFTER TRANSURETHRAL URETEROLITHOTRIPSY].

(Objectives) Transurethral Ureterolithotripsy (TUL) has become an increasingly more common treatment for ureteric stones since the reduction in ureteroscope diameter and other device improvements. At the same time, TUL sometimes shows postoperative febrile urinary tract infection (fUTI) with severe complications. Therefore we investigated the occurrence and risk factors of fUTI in our hospital, and assessed the effect of antibiotic prophylaxis prior to TUL. (Materials and methods) The subjects were 260 patients who underwent TUL in our department during the period from January 2011 to October 2014. We retrospectively reviewed the data of those who developed postoperative fUTI and identified the risk factors of postoperative fUTI. From November 2014 to August 2016, we enrolled 110 patients undergoing TUL with one or more risk factors in a prospective clinical trial of prophylactic oral levofloxacin (500 mg) for 1 week before TUL. The chi-squared test, Mann-Whitney U-test, and logistic regression analysis were used for data analysis (significance level of 0.05). (Results) Postoperative fUTI occurred in 43 (16.5%) of 260 patients. The risk factors of postoperative fUTI included preoperative pyelonephritis (P=0.02), preoperative ureteral stent placement (P=0.017), and operative time >90 min (P=0.005). Operative time was correlated with and could be substituted for pre-TUL stone size (P<0.0001). Chemopreventive therapy before TUL in patients with preoperative pyelonephritis, preoperative ureteral stent placement, or stones of >20 mm significantly reduced their risk of fUTI (P=0.012). (Conclusions) The use of antibiotic prophylaxis significantly reduces the risk of postoperative fUTI in patients with preoperative pyelonephritis, preoperative ureteral stent placement, or stones of >20 mm.