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Investigative and Clinical Urology May 2017According to the aging of society and the spread of antibiotic-resistant strains, it is worth considering the different aspects of epididymitis (EP) in older and younger...
PURPOSE
According to the aging of society and the spread of antibiotic-resistant strains, it is worth considering the different aspects of epididymitis (EP) in older and younger patients, even though the etiology and therapeutic strategies of this disease are considered to be established. Thus, we investigated how age affects EP-related symptoms.
MATERIALS AND METHODS
Data were gathered from 7 hospitals in Hyogo, Japan, and the correlations of age (older or younger) with urine findings such as pyuria or bacteriuria and EP-related symptoms such as fever were investigated.
RESULTS
In all 308 cases with full data for evaluation, there were 66 febrile (38℃ or higher) cases (21.4%) and bacteriuria was seen in 158 cases (51.3%). In the multivariate analysis, older age (65 years or older) was significantly correlated with the presence of pyuria (p=0.0156). Regarding the relationship between urine findings and EP-related symptoms, pyuria was significantly related to fever (37℃ or higher; p=0.0159).
CONCLUSIONS
Our data showed that older patients with EP had pyuria significantly more often than did younger patients, which correlated with EP-related symptoms (fever). These data suggest that age-specific guidelines may be necessary.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Bacteriuria; Child; Child, Preschool; Epididymitis; Fever; Humans; Male; Middle Aged; Pyuria; Risk Factors; Young Adult
PubMed: 28480347
DOI: 10.4111/icu.2017.58.3.205 -
Investigative and Clinical Urology Jul 2023About one-third of patients who undergo radical nephroureterectomy (RNUx) for upper tract urothelial carcinoma (UTUC) experience intravesical recurrence (IVR). This...
PURPOSE
About one-third of patients who undergo radical nephroureterectomy (RNUx) for upper tract urothelial carcinoma (UTUC) experience intravesical recurrence (IVR). This study investigated whether pyuria is a feasible predictor of IVR after RNUx in patients with UTUC.
MATERIALS AND METHODS
Seven hundred forty-three patients with UTUC who underwent RNUx at a single institute were analyzed in this study. The participants were divided into two groups: those without pyuria (non-pyuria) and those with pyuria. Kaplan-Meier survival analysis was performed, and p-values were assessed using the log-rank test. Cox regression analyses were performed to identify the independent predictors of survival.
RESULTS
The pyuria group had a shorter IVR-free survival period (p=0.009). The five-year IVR-free survival rate was 60.0% in the non-pyuria group vs. 49.7% in the pyuria group according to the Kaplan-Meier survival analysis. After the multivariate Cox regression analysis, pyuria (hazard ratio [HR]=1.368; p=0.041), a concurrent bladder tumor (HR=1.757; p=0.005), preoperative ureteroscopy (HR=1.476; p=0.013), laparoscopic surgery (HR=0.682; p=0.048), tumor multiplicity (HR=1.855; p=0.007), and a larger tumor (HR=1.041; p=0.050) were predictors of risk for IVR. There was no association between pyuria and recurrence-free survival (p=0.057) or cancer-specific survival (p=0.519) in the Kaplan-Meier survival analysis.
CONCLUSIONS
This study concluded that pyuria was an independent predictor of IVR in patients with UTUC after RNUx.
Topics: Humans; Nephroureterectomy; Urinary Bladder Neoplasms; Carcinoma, Transitional Cell; Retrospective Studies; Ureteroscopy; Pyuria
PubMed: 37417560
DOI: 10.4111/icu.20230066 -
Revue Medicale Suisse Mar 2022Acute interstitial nephritis is characterized by renal inflammation and interstitial edema. The clinical presentation is pauci-symptomatic and often non-specific. Acute...
Acute interstitial nephritis is characterized by renal inflammation and interstitial edema. The clinical presentation is pauci-symptomatic and often non-specific. Acute interstitial nephritis typically presents with acute renal failure, alone or with fever, eosinophilia, hematuria, sterile pyuria and small range proteinuria. An early diagnosis is crucial to prevent the morbidity and mortality associated with renal function decline. The most frequent etiology of this disease is drug-induced. A kidney biopsy is not systematically required to establish the diagnosis. It should be considered in the absence of renal function improvement 5 to 7 days after withdrawal of the causal agent. Although the benefits of glucocorticoid treatment have not been proven to date, its use may be associated with a better kidney function recovery.
Topics: Acute Disease; Acute Kidney Injury; Biopsy; Hematuria; Humans; Kidney; Nephritis, Interstitial
PubMed: 35235259
DOI: 10.53738/REVMED.2022.18.771.364 -
BMC Pregnancy and Childbirth Apr 2020Asymptomatic bacteriuria (ASB) and sterile pyuria (SP) are complexities of UTI whose prevalence are not known in the northern sector of Ghana. Our aim was to determine...
BACKGROUND
Asymptomatic bacteriuria (ASB) and sterile pyuria (SP) are complexities of UTI whose prevalence are not known in the northern sector of Ghana. Our aim was to determine the occurrence of sterile pyuria and asymptomatic bacteriuria among pregnant women accessing antenatal care at a secondary and tertiary care hospitals in Tamale, northern Ghana.
METHODS
A cross sectional study was conducted by screening 530 pregnant women with no signs of acute urinary tract infection attending antenatal clinic for a period of 6 months. Midstream urine was collected for microscopy, quantitative urine culture and antibiotic susceptibility testing. Data analysis was carried out using the Statistical Package for Social Sciences version 20.
RESULTS
Asymptomatic bacteriuria was respectively 20 and 35.5% at Tamale Central and Tamale Teaching Hospital out of the 390 and 90 women screened. Sterile pyuria was found among 66% of the 50 women presenting at Tamale Central Hospital. More than 64% of isolates recovered from ASB patients were S. aureus and coagulase negative Staph. (CoNS). Escherichia coli was the dominant species among members of the enterobacteriaceae isolated. Highest susceptibility was recorded against gentamicin and amikacin while most resistance was to Ampicillin, cotrimoxazole, chloramphenicol and nitrofurantoin. Resistance to imipenem and vancomycin were 28.8 and 52%, with strains showing multiple drug resistance of between 81 and 92%.
CONCLUSION
The prevalence of asymptomatic bacteriuria is appreciably higher (20-35.5%) than documented rates in the southern sector of the country. The presence of sterile pyuria which may be an indication of asymptomatic renal impairment and most often overlooked in antenatal management is 66%. Empirical treatment of UTIs at the Tamale Central and Teaching Hospital without confirmation of susceptibility may result in treatment failure. It is necessary to screen and treat pregnant women for ASB and SP due to the complications associated with these conditions.
Topics: Adult; Anti-Bacterial Agents; Bacteriuria; Cross-Sectional Studies; Escherichia coli; Female; Ghana; Hospitals; Humans; Microbial Sensitivity Tests; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Prenatal Care; Prevalence; Pyuria; Staphylococcus aureus; Urinary Tract Infections; Young Adult
PubMed: 32321461
DOI: 10.1186/s12884-020-02936-6 -
Journal of Clinical Medicine Aug 2021This study aims to investigate the clinical role of preoperative pyuria for predicting bacillus Calmette-Guérin (BCG) unresponsiveness in non-muscle invasive bladder...
This study aims to investigate the clinical role of preoperative pyuria for predicting bacillus Calmette-Guérin (BCG) unresponsiveness in non-muscle invasive bladder cancer (NMIBC). We performed a logistic regression analysis on 453 patients with NMIBC who were treated with BCG immunotherapy after a transurethral resection of bladder tumours, to evaluate predictive factors of BCG unresponsiveness. We also analysed univariate and multivariable survival data to estimate the prognostic impact of pyuria. Of the total study population, 37.6% (170/453) of patients had BCG unresponsiveness. A multivariable logistic regression analysis revealed that a history of upper urinary tract cancer (odds ratio (OR): 1.86, 95% confidence interval (CI): 1.04-3.32, -value = 0.035) and the presence of pyuria (OR: 1.51, 95% CI: 1.01-2.27, = 0.047) and tumour multiplicity (OR: 1.80, 95% CI: 1.18-2.75, -value < 0.001) were significant predictors of BCG unresponsiveness. A Cox proportional hazards analysis model showed that pyuria was a significant prognostic factor for progression-free survival (hazard ratio: 4.51, 95% CI: 1.22-16.66, = 0.024). A history of upper urinary tract cancer and the presence of pyuria and tumour multiplicity are predictive markers of BCG unresponsiveness. For patients with NMIBC who have preoperative pyuria, treatment using BCG should be considered cautiously.
PubMed: 34501211
DOI: 10.3390/jcm10173764 -
Scientific Reports May 2024Pyuria in dipstick examination serves as the most widespread screening tool for urinary tract infections (UTI). The absence of pyuria, however, does not exclude UTI. We...
Pyuria in dipstick examination serves as the most widespread screening tool for urinary tract infections (UTI). The absence of pyuria, however, does not exclude UTI. We investigated the diagnostic value of urinary calprotectin, a mediator protein of the innate immune system, which is released by leukocytes, for the detection of UTI and compared it with dipstick pyuria. Since even low numbers of leukocytes in the urine significantly increase urinary calprotectin concentrations, calprotectin might be a more sensitive marker than pyuria detected by dipstick. All 162 patients were prospectively included and underwent a urine dipstick, urine culture, quantification of proteinuria and determination of calprotectin in the urine. Urinary calprotectin was determined using an enzyme-linked immunosorbent assay (ELISA). UTI was defined as urine cultures with detection of one or a maximum of two uropathogenic bacteria with ≥ 10 colony-forming units per millilitre (CFU/ml). Exclusion criteria were acute kidney injury, chronic renal insufficiency and tumors of the urinary tract. 71 (43.8%) patients had a UTI. Of the 91 patients without UTI, 23 had a contamination and 19 had evidence of ≥ 10 CFU/ml considered to be asymptomatic bacteriuria. The median calprotectin concentration in patients with UTI and pyuria was significantly higher than in patients with UTI and without pyuria (5510.4 vs. 544.7 ng/ml). In ROC analyses, calprotectin revealed an area under the curve (AUC) of 0.70 for the detection of significant bacteriuria. Pyuria in dipstick examinations provided an AUC of 0.71. There was no significant difference between these AUCs in the DeLong test (p = 0.9). In patients with evidence of significant bacteriuria but without pyuria, a significantly higher calprotectin concentration was measured in the urine than in patients with neither pyuria nor UTI (544.7 ng/ml vs 95.6 ng/ml, p = 0.029). Urinary calprotectin is non-inferior to dipstick pyuria in the detection of UTI.
Topics: Humans; Leukocyte L1 Antigen Complex; Male; Female; Bacteriuria; Middle Aged; Aged; Biomarkers; Urinary Tract Infections; Adult; Pyuria; Prospective Studies; Urinalysis; Aged, 80 and over; ROC Curve; Enzyme-Linked Immunosorbent Assay; Sensitivity and Specificity
PubMed: 38806578
DOI: 10.1038/s41598-024-62605-y -
Urology Dec 2016Whereas coronary aneurysms are commonly associated with Kawasaki disease, involvement of the renal vasculature is exceedingly rare. Genitourinary involvement in patients...
Whereas coronary aneurysms are commonly associated with Kawasaki disease, involvement of the renal vasculature is exceedingly rare. Genitourinary involvement in patients with Kawasaki disease is typically limited to sterile pyuria and proteinuria. In this case, a 13-year-old girl who presented with right flank pain and microhematuria was found to have an intraparenchymal hemorrhagic mass on computerized tomography scan. Renal arteriography confirmed the diagnosis of pseudoaneurysm in a lower pole segmental artery branch and complete occlusion was achieved with endovascular embolization.
Topics: Adolescent; Aneurysm, False; Angiography; Embolization, Therapeutic; Female; Humans; Mucocutaneous Lymph Node Syndrome; Renal Artery; Tomography, X-Ray Computed
PubMed: 27287282
DOI: 10.1016/j.urology.2016.05.053 -
Pediatrics International : Official... Nov 2021False negative or positive results may occur in the urine dipstick test for leukocyte esterase (LE), which is used to determine urinary tract infection (UTI). We aimed...
BACKGROUND
False negative or positive results may occur in the urine dipstick test for leukocyte esterase (LE), which is used to determine urinary tract infection (UTI). We aimed to investigate the clinical importance of the presence or absence of pyuria in urine sediment for diagnosing UTI in the presence of positive LE in dipstick analysis.
METHODS
Patients admitted to the pediatric nephrology outpatient clinic with positive urine LE tests were divided into two groups: those without pyuria (Group 1) and those with pyuria (Group 2) in their urine sediment. Hospital files of the patients were evaluated retrospectively for demographic variables, lower or upper UTI symptoms, physical examination for phimosis and vulvovaginitis, urinalysis for LE and nitrite tests, urine sediment microscopy, urine culture, complete blood count and C-reactive protein. Both groups were compared for the significant growth of pathogenic bacteria in urine cultures along with clinical and laboratory parameters.
RESULTS
Among 578 children giving samples for urinalysis, there were 287 cases with positive LE tests. Groups 1 and 2 included 123 and 164 cases, respectively. The proportion of girls was higher in Group 1 and vulvovaginitis rate was higher among the girls in Group 1. Girls with vulvovaginitis were mostly prepubertal. Upper UTI symptoms, significant pathogen growth rate, and elevated acute phase response were more common in Group 2. In addition, the phimosis rate was more common among the boys in Group 1 with false positive LE test.
CONCLUSIONS
Children with positive LE tests without pyuria are mostly prepubertal girls and there is a high rate of vulvovaginitis in these girls. Unnecessary tests and treatments for UTI may be avoided with detailed history and physical examination in prepubertal girls who have a false positive LE test. We also found, for the first time, that a false positive LE test is significantly associated with phimosis in boys.
Topics: Carboxylic Ester Hydrolases; Child; Female; Humans; Male; Retrospective Studies; Sensitivity and Specificity; Urinalysis
PubMed: 33548092
DOI: 10.1111/ped.14643 -
Pediatrics Feb 2021Accuracy of pyuria for urinary tract infection (UTI) varies with urine concentration. Our objective of this study was to determine the optimal white blood cell (WBC)...
OBJECTIVES
Accuracy of pyuria for urinary tract infection (UTI) varies with urine concentration. Our objective of this study was to determine the optimal white blood cell (WBC) cutoff for UTI in young children at different urine concentrations as measured by urine specific gravity.
METHODS
Retrospective cross-sectional study of children <24 months of age evaluated in the emergency department for suspected UTI with paired urinalysis and urine culture during a 6-year period. The primary outcome was positive urine culture result as described in the American Academy of Pediatrics clinical practice guideline culture thresholds. Test characteristics for microscopic pyuria cut points and positive leukocyte esterase (LE) were calculated across 3 urine specific gravity groups: low <1.011, moderate 1.011 to 1.020, and high >1.020.
RESULTS
Of the total 24 171 patients analyzed, urine culture result was positive in 2003 (8.3%). Urine was obtained by transurethral in-and-out catheterization in 97.9%. Optimal WBC cutoffs per high-power field (HPF) were 3 (positive likelihood ratio [LR+] 10.5; negative likelihood ratio [LR-] 0.12) at low, 6 (LR+ 12; LR- 0.14) at moderate, and 8 (LR+ 11.1; LR- 0.35) at high urine concentrations. Likelihood ratios for small positive LE from low to high urine concentrations (LR+ 25.2, LR- 0.12; LR+ 33.1, LR- 0.15; LR+ 37.6, LR- 0.41) remained excellent.
CONCLUSIONS
Optimal pyuria cut point in predicting positive urine culture results changes with urine concentration in young children. Pyuria thresholds of 3 WBCs per HPF at low urine concentrations whereas 8 WBCs per HPF at high urine concentrations have optimal predictive value for UTI. Positive LE is a strong predictor of UTI regardless of urine concentration.
Topics: Child, Preschool; Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Leukocytes; Male; Pyuria; Retrospective Studies; Urinalysis; Urinary Tract Infections
PubMed: 33514634
DOI: 10.1542/peds.2020-014068 -
The American Journal of Medicine May 2017
Topics: Bacteriuria; Humans; Pyuria; Terminology as Topic; Urinary Tract Infections
PubMed: 28011317
DOI: 10.1016/j.amjmed.2016.11.039