-
Central European Journal of Urology 2020Preoperative identification of high-grade bladder cancer presence can optimize patient management. The aim of this study was to assess the association between...
INTRODUCTION
Preoperative identification of high-grade bladder cancer presence can optimize patient management. The aim of this study was to assess the association between preoperative pyuria and the pathological features of bladder cancer.
MATERIAL AND METHODS
This retrospective analysis enrolled 943 patients undergoing transurethral resection of a bladder tumor. Patients were divided into two study groups based on the presence of pyuria in preoperative urine analysis, defined as the presence of >5 leukocytes in the high power field. Pyuria status as a potential predictive factor was then confronted with pathological features based on standard microscopic examination of the surgical specimen.
RESULTS
Among 943 recruited patients, 294 (31.2%) presented with pyuria. Patients with pyuria were older (71 vs. 68 years, p <0.05), had higher rates of large (≥3 cm) tumors (37% vs. 26%, p <0.05), and more frequently presented concomitant hematuria (58% vs. 24%, p <0.05). In case of recurrent tumors patients with pyuria more often received intravesical chemotherapy in the past (4.8% vs. 1.4%, p <0.05). Regarding oncological data, patients with pyuria had significantly higher tumor stage and grade. On multivariable analysis pyuria was independently associated with high-grade tumors (OR 1.97, 95% CI 1.45-2.67). Specificity and negative predictive value of pyuria as a biomarker of high-grade tumors were 76% and 68%, respectively.
CONCLUSIONS
Preoperative pyuria can be regarded as a predictor of the presence of high-grade bladder carcinoma in patients with bladder tumors.
PubMed: 33552566
DOI: 10.5173/ceju.2020.0289 -
Iranian Journal of Kidney Diseases Mar 2017Renal involvement is a rare complication of β-thalassemia. Both tubular and glomerular dysfunction might occur in these patients. The aim of this study was to evaluate... (Comparative Study)
Comparative Study
INTRODUCTION
Renal involvement is a rare complication of β-thalassemia. Both tubular and glomerular dysfunction might occur in these patients. The aim of this study was to evaluate and compare kidney function in the major, intermedia, and minor variants of β-thalassemia.
MATERIALS AND METHODS
Renal tubular and glomerular function of 72 patients with β-thalassemia (25 major, 23 intermedia, and 24 minor) were evaluated. Patients older than 40 years and those with chronic kidney disease, diabetes mellitus, congestive heart failure, associated infections, congenital anomalies of the kidney and urinary tract were excluded. Blood and urine samples were collected electrolytes and markers of kidney function.
RESULTS
Mean age at the time of study was significantly higher in the minor group. The majority of patients with thalassemia major were males. Hematuria and pyuria occurred in 4% to 8% of the patients. Serum level of all variables were within normal limits, with no significant difference between the three groups. Glomerular filtration rate was nonsignificantly higher in the major and intermedia groups, compared to the minor variant. A significantly lower urine phosphorus and uric acid excretion was noted with the minor variant. Urine phosphorus and uric acid excretion increased more frequently in the major and intermedia groups.
CONCLUSIONS
Tubular and glomerular functions appear to be well preserved in all variants of β-thalassemia.
Topics: Adolescent; Adult; Child; Creatinine; Cross-Sectional Studies; Female; Glomerular Filtration Rate; Hematuria; Humans; Iran; Male; Middle Aged; Nephrons; Pyuria; Uric Acid; Young Adult; beta-Thalassemia
PubMed: 28270645
DOI: No ID Found -
Clinical Microbiology and Infection :... Feb 2024Urinary tract infection (UTI) is common among older women. However, diagnosis is challenging because of frequent chronic lower urinary tract symptoms, cognitive...
OBJECTIVES
Urinary tract infection (UTI) is common among older women. However, diagnosis is challenging because of frequent chronic lower urinary tract symptoms, cognitive impairment, and a high prevalence of asymptomatic bacteriuria (ASB). Current urine diagnostics lack specificity, leading to unnecessary treatment and antimicrobial resistance. This study aimed to evaluate the diagnostic accuracy of 12 urine biomarkers for diagnosing UTI in older women.
METHODS
In this case-control study, cases were women ≥65 years with ≥2 new-onset lower urinary tract symptoms, pyuria, and one uropathogen ≥10 CFU/mL. Controls were asymptomatic and classified as ASB (one uropathogen ≥10 CFU/mL), negative culture, or mixed flora. Urine biomarker concentrations were measured through liquid chromatography-mass spectrometry and ELISA. Diagnostic accuracy parameters of individual biomarkers and a biomarker model were derived from receiver operating characteristic curves.
RESULTS
We included 162 community-dwelling and institutionalized older women. Five urine inflammatory biomarkers demonstrated high discriminative ability (area under the curve ≥0.80): interleukin 6, azurocidin, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinases 2, and C-X-C motif chemokine 9. Azurocidin exhibited the highest diagnostic accuracy (sensitivity 86% [95% CI 75%-93%] and specificity 89% [95% CI 82%-94%] at 16.7 ng/mmol creatinine). A combined biomarker and pyuria model showed improved diagnostic accuracy in patients with UTI and ASB, compared with pyuria alone.
DISCUSSION
We identified several urine biomarkers that accurately differentiated older women with UTI from asymptomatic women, including ASB. These findings represent a potential advancement towards improved diagnostics for UTI in older women and warrant validation in a diverse population.
Topics: Humans; Female; Aged; Male; Pyuria; Case-Control Studies; Urinary Tract Infections; Bacteriuria; Lower Urinary Tract Symptoms; Biomarkers
PubMed: 37805035
DOI: 10.1016/j.cmi.2023.09.023 -
Asian Journal of Urology Jul 2017Male patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are increasingly seen by family physicians worldwide due to ageing... (Review)
Review
Male patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are increasingly seen by family physicians worldwide due to ageing demographics. A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful. Good history taking, physical examination, targeted blood or urine tests, and knowing the red flags for referral are the mainstay of stratifying these patients. Case selection is always key in clinical practice and in the setting of the family physician. The best patient to manage is one above 40 years of age, symptomatic with nocturia, slower stream and sensation of incomplete voiding, has a normal prostate-specific antigen level, no palpable bladder, and no haematuria or pyuria on the labstix. The roles of α blockers, 5-α reductase inhibitors, and antibiotics in a primary care setting to manage this condition are also discussed.
PubMed: 29264228
DOI: 10.1016/j.ajur.2017.05.003 -
Journal of Yeungnam Medical Science Jan 2022The current guidelines for the diagnosis of acute pyelonephritis (APN) recommend that APN be diagnosed based on the clinical features and the presence of pyuria....
BACKGRUOUND
The current guidelines for the diagnosis of acute pyelonephritis (APN) recommend that APN be diagnosed based on the clinical features and the presence of pyuria. However, we observed that some of the patients who are diagnosed with APN do not have characteristic clinical features or pyuria at the initial examination. We performed this study to investigate the characteristics of APN without pyuria.
METHODS
A retrospective, cross-sectional study was conducted on 391 patients diagnosed with APN based on clinical and radiologic findings, between 2015 and 2019. The clinical features, laboratory results, and computed tomography (CT) findings were compared between patients with normal white blood cell (WBC) counts and those with abnormal WBC counts (WBC of 0-5/high power field [HPF] vs. >5/HPF) in urine.
RESULTS
More than 50% of patients with APN had no typical urinary tract symptoms and one-third of them had no costovertebral angle (CVA) tenderness. Eighty-eight patients (22.5%) had normal WBC counts (0-5/HPF) on urine microscopy. There was a negative correlation between pyuria (WBC of >5/HPF) and previous antibiotic use (odds ratio, 0.249; 95% confidence interval, 0.140-0.441; p<0.001), and the probability of pyuria was reduced by 75.1% in patients who took antibiotics before visiting the emergency room.
CONCLUSION
The diagnosis of APN should not be overlooked even if there are no typical clinical features, or urine microscopic examination is normal. If a patient has already taken antibiotics at the time of diagnosis, imaging studies such as CT should be performed more actively, regardless of the urinalysis results.
PubMed: 34411474
DOI: 10.12701/yujm.2021.01207 -
Journal of Feline Medicine and Surgery Oct 2022A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study...
OBJECTIVES
A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study was to determine the ability of a urinalysis and lower urinary tract signs (LUTS) to predict urine culture results in cats with AKI.
METHODS
Ninety-seven cats with AKI were included in this study. This was a retrospective, observational study. Medical records from 2008 to 2018 were reviewed to identify cats with AKI that had a paired urinalysis and urine bacterial culture. The sensitivity, specificity, positive predictive value and negative predictive values of microscopic bacteriuria, pyuria, hematuria and the presence of LUTS for predicting urine culture results was calculated.
RESULTS
Thirty-two percent of cats (n = 31) had a positive urine culture. Of these, 28 (90%) had bacteriuria, 21 (68%) had pyuria, 13 (42%) had hematuria and 10 (32%) had LUTS. Of the 42 cats without hematuria or pyuria, seven had a positive urine culture (17%). Bacteriuria had a high sensitivity (90%) and specificity (92%) for predicting urine culture bacterial growth. The absence of bacteriuria had a high negative predictive value for no bacterial growth (95%). The odds of a positive urine culture were increased with bacteriuria (odds ratio [OR] 114, 95% confidence interval [CI] 29-621; <0.001), pyuria (OR 21, 95% CI 7-70; <0.001) and LUTS (OR 5, 95% CI 1.7-16; = 0.004). Hematuria was not associated with a positive culture (sensitivity 42%, specificity 52%).
CONCLUSIONS AND RELEVANCE
Microscopic bacteriuria and pyuria on urine sediment evaluation and LUTS can be helpful for predicting bacterial culture results in cats with AKI and in settings where submitting a urine culture may not be financially feasible.
Topics: Acute Kidney Injury; Animals; Bacteriuria; Cat Diseases; Cats; Pyuria; Urinalysis; Urinary Tract Infections; Urine
PubMed: 35748789
DOI: 10.1177/1098612X221105309 -
IEEE Transactions on Bio-medical... Mar 2023The diagnosis of urinary tract infection (UTI) currently requires precise specimen collection, handling infectious human waste, controlled urine storage, and timely...
OBJECTIVE
The diagnosis of urinary tract infection (UTI) currently requires precise specimen collection, handling infectious human waste, controlled urine storage, and timely transportation to modern laboratory equipment for analysis. Here we investigate holographic lens free imaging (LFI) to show its promise for enabling automatic urine analysis at the patient bedside.
METHODS
We introduce an LFI system capable of resolving important urine clinical biomarkers such as red blood cells, white blood cells, crystals, and casts in 2 mm thick urine phantoms.
RESULTS
This approach is sensitive to the particulate concentrations relevant for detecting several clinical urine abnormalities such as hematuria and pyuria, linearly correlating to ground truth hemacytometer measurements with R = 0.9941 and R = 0.9973, respectively. We show that LFI can estimate E. coli concentrations of 10 to 10 cells/mL by counting individual cells, and is sensitive to concentrations of 10 cells/mL to 10 cells/mL by analyzing hologram texture. Further, LFI measurements of blood cell concentrations are relatively insensitive to changes in bacteria concentrations of over seven orders of magnitude. Lastly, LFI reveals clear differences between UTI-positive and UTI-negative urine from human patients.
CONCLUSION
LFI is sensitive to clinically-relevant concentrations of bacteria, blood cells, and other sediment in large urine volumes.
SIGNIFICANCE
Together, these results show promise for LFI as a tool for urine screening, potentially offering early, point-of-care detection of UTI and other pathological processes.
Topics: Urinalysis; Urinary Tract Infections; Point-of-Care Testing; Urine; Holography; Humans; Sensitivity and Specificity
PubMed: 36129868
DOI: 10.1109/TBME.2022.3208220 -
The Pediatric Infectious Disease Journal May 2020The gold standard for the diagnosis of acute pyelonephritis (APN) in children is the finding of both pyuria (P) and bacteriuria (B); however, some APN patients have...
BACKGROUND
The gold standard for the diagnosis of acute pyelonephritis (APN) in children is the finding of both pyuria (P) and bacteriuria (B); however, some APN patients have neither of these findings [APN(P(-);B(-))].
METHODS
In this study, we investigated APN patients who visited our hospital over 14 years to identify specific clinical characteristics of APN(P(-);B(-)).
RESULTS
A total of 171 APN patients were included in the study, and of these 29 were APN(P(-);B(-)). Of the APN(P(-);B(-)) patients, 25.9% had vesicoureteral reflux (VUR), the same percentage as the APN(P(+);B(+)) patients, and 69.0% of APN(P(-);B(-)) patients had already taken antibiotics before diagnosis. APN(P(-);B(-)) patients were older and had a longer duration between onset of fever and diagnosis than the patients with pyuria and/or bacteriuria. In addition, they showed higher C-reactive protein levels. APN(P(-);B(-)) patients had high levels of urinary α-1 microglobulin and urinary β-2 microglobulin.
CONCLUSIONS
APN is difficult to diagnose in febrile patients who display neither pyuria nor bacteriuria, but as these patients have the same risk for VUR as APN patients with pyuria and bacteriuria, a detailed history establishing the clinical course as well as urinary chemistry investigations, may assist in diagnosis.
Topics: Acute Disease; Adolescent; Age Factors; Bacteriuria; C-Reactive Protein; Child; Child, Preschool; Fever; Humans; Infant; Infant, Newborn; Pyelonephritis; Pyuria; Urine
PubMed: 32187138
DOI: 10.1097/INF.0000000000002609 -
Antimicrobial Prophylaxis in Transurethral Resection of the Prostate: Results of a Randomized Trial.The Journal of Urology Jun 2021We sought to determine whether omitting antimicrobial prophylaxis is safe in patients undergoing transurethral resection of the prostate without preoperative pyuria and... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
We sought to determine whether omitting antimicrobial prophylaxis is safe in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative catheter.
MATERIALS AND METHODS
We conducted a multicenter randomized controlled trial from September 17, 2017 until December 31, 2019 in 5 hospitals. Patients with pyuria (>100 white blood cells/ml) and a preoperative indwelling catheter were excluded. Postoperative fever was defined as a body temperature ≥38.3C. A noninferiority design was used with a 6% noninferiority margin and null hypothesis (H0) that the infection risk is at least 6% higher in the experimental (E) than in the control (C) group; H0: C (antimicrobial prophylaxis group) - E (no antimicrobial prophylaxis group) ≥ Δ (6% noninferiority margin). A multivariable, logistic regression was performed regarding posttransurethral resection of the prostate fever and antimicrobial prophylaxis with co-variates: (clot-)retention and operating time. The R Project® for statistical computing was used and a p value of 0.05 was considered as statistically significant.
RESULTS
Of the patients 474 were included for multivariable analysis and 211/474 (44.5%) received antimicrobial prophylaxis vs 263/474 (55.5%) patients without antimicrobial prophylaxis. Antibiotics were fluoroquinolones in 140/211 (66.4%), cephazolin in 58/211 (27.5%) and amikacin in 13/211 (6.2%) patients. Fever occurred in 9/211 (4.4%) patients with antimicrobial prophylaxis vs 13/263 (4.9%) without antimicrobial prophylaxis (p=0.8, risk difference 0.006 [95% CI -0.003-0.06, relative risk 1.16]). We were able to exclude a meaningful increase in harm associated with omitting antimicrobial prophylaxis (p=0.4; adjusted risk difference 0.016 [95% CI -0.02-0.05]).
CONCLUSIONS
Our data demonstrate the safety of omitting antimicrobial prophylaxis in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative indwelling catheter.
Topics: Aged; Amikacin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefazolin; Fluoroquinolones; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Single-Blind Method; Transurethral Resection of Prostate; Urinary Tract Infections
PubMed: 33560163
DOI: 10.1097/JU.0000000000001638 -
Clinical Rheumatology Oct 2020The aim of the present study is to identify the clinical manifestations and laboratory findings of children with Kawasaki disease (KD) in different age groups and to...
OBJECTIVES
The aim of the present study is to identify the clinical manifestations and laboratory findings of children with Kawasaki disease (KD) in different age groups and to recognize and treat KD in a timely manner.
METHODS
A total of 213 children with KD were divided into the following age groups: (1) infants, (2) toddlers, and (3) preschool age. Retrospective analysis of clinical data was performed among the groups. Categorical data were statistically compared by Chi-square analysis, and measurement data were compared using one-way ANOVA analysis.
RESULTS
Our study showed that (1) cough (40.5%), diarrhea (16.9%), and vomiting (8.5%) were also very common in KD patients. (2) Patients in the infant group more commonly developed cough and diarrhea, but were less frequently documented with lymphadenopathy and skin rash. (3) Elevation of platelets was more common in the infant group. When urine tests were compared among the three groups, the toddler group had a higher proportion of sterile pyuria, and infants younger than 1 year old had a lower proportion of proteinuria and positive urine ketones.
CONCLUSION
Cough, diarrhea, vomiting, and sterile pyuria were very common in infant KD patients less than 1 year old. They should be noted in patients with suspected KD for earlier diagnosis and timely treatments. Key Points • Patients with Kawasaki disease (KD) in different age groups showed different clinical manifestations and laboratory findings. • Cough, diarrhea, vomiting, and sterile pyuria were very common in infant KD patients less than 1 year old. • Paying more attentions to respiratory, gastrointestinal, and urinary manifestations or abnormalities might be helpful for earlier diagnosis of KD, especially incomplete KD, though they were not list in the diagnostic criteria.
Topics: Child, Preschool; China; Early Diagnosis; Humans; Infant; Mucocutaneous Lymph Node Syndrome; Pyuria; Retrospective Studies
PubMed: 32367406
DOI: 10.1007/s10067-020-05069-5