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In Vivo (Athens, Greece) 2017We investigated the effect of bacteriuria and pyuria on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC) undergoing radical...
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.
Topics: Aged; Aged, 80 and over; Bacteriuria; Carcinoma, Transitional Cell; Disease-Free Survival; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Nephroureterectomy; Pyuria; Risk Factors; Urothelium
PubMed: 29102949
DOI: 10.21873/invivo.11193 -
Investigative and Clinical Urology Jan 2018To evaluate the rate of pyuria and bacteriuria after transurethral resection of bladder tumor (TURBT).
PURPOSE
To evaluate the rate of pyuria and bacteriuria after transurethral resection of bladder tumor (TURBT).
MATERIALS AND METHODS
We retrospectively evaluated data obtained from 363 patients who underwent TURBT between October 2012 and December 2013 at Seoul National University Hospital. Urinalysis and urine culture were assessed at 3, 6, 12, and 24 months postoperatively. Primary endpoint was the rate of bacteriuria (≥10/mL in a midstream) and pyuria (white blood cells ≥5/high-power field).
RESULTS
We analyzed 306 patients who were eligible for the study. Pyuria was present in 23.5% of patients in the 3rd postoperative month and in 31.7% of patients in the 24th postoperative month. Bacteriuria was present in 1.3% of patients in the 3rd postoperative month and in 2.6% of patients in the 24th postoperative month. Among urothelial carcinoma patients (n=220), 24.1% showed pyuria and 1.8% showed bacteriuria at the 3rd postoperative month. We found that 31.8% showed pyuria and 3.2% showed bacteriuria at the 24th postoperative month. There was no significant difference in the rate of pyuria and bacteriuria between the intravesical treatment group and the no-treatment group. Multivariate analysis demonstrated that pyuria in the 3rd postoperative month (odd ratio [OR], 2.254; p=0.039), tumor multiplicity (OR, 3.331; p=0.001), and the absence of intravesical treatment (OR, 4.927; p=0.001) increases the risk of tumor recurrence.
CONCLUSIONS
A significant proportion of patients showed pyuria after TURBT during the follow-up period. Additionally, presence of pyuria in the short-term follow-up period after TURBT constitutes a risk factor for recurrence of bladder cancer.
Topics: Administration, Intravesical; Aged; Aged, 80 and over; Antineoplastic Agents; Bacteriuria; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Postoperative Complications; Pyuria; Retrospective Studies; Risk Factors; Urinary Bladder Neoplasms; Urinary Tract Infections
PubMed: 29333509
DOI: 10.4111/icu.2018.59.1.10 -
Investigative and Clinical Urology Jan 2020To evaluate if preoperative sterile pyuria can be a prognostic factor for intravesical recurrence (IVR) and overall survival (OS)in patients with upper tract urothelial...
PURPOSE
To evaluate if preoperative sterile pyuria can be a prognostic factor for intravesical recurrence (IVR) and overall survival (OS)in patients with upper tract urothelial carcinoma (UTUC) undergoing surgery.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of patients who were diagnosed with UTUC from October 2003 to December 2016 at Korea University Medical Center. Sterile pyuria was defined as urine containing five or more white blood cells per high-power field in the absence of bacteria in urine culture. We used a stepwise multivariable Cox proportional hazards model to assess the independent effects of the prognostic factors for IVR and OS.
RESULTS
We investigated a total of 176 patients who were diagnosed with UTUC. Among them, 91 (51.7%) patients had preoperative sterile pyuria. There were no significant differences in the baseline characteristics between the pyuria and non-pyuria groups concerning tumor grade, T stage, tumor multiplicity, and recurrence history. However, there was a significant difference in the IVR between the two groups. In the multivariable analysis, preoperative sterile pyuria, diabetes mellitus, high-grade tumor, and lymphovascular invasion were revealed as independent risk factors for IVR, and only lymphovascular invasion was identified as an independent risk factor for OS.
CONCLUSIONS
Preoperative sterile pyuria is significantly associated with IVR in patients with UTUC undergoing surgery, but it is not associated with OS. Furthermore, diabetes mellitus, high-grade tumor, and lymphovascular invasion are also independent prognostic factors for these patients.
Topics: Aged; Carcinoma, Transitional Cell; Female; Humans; Leukocyte Count; Male; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasm Staging; Outcome Assessment, Health Care; Perioperative Period; Predictive Value of Tests; Prognosis; Pyuria; Risk Assessment; Urologic Neoplasms; Urologic Surgical Procedures
PubMed: 31942463
DOI: 10.4111/icu.2020.61.1.51 -
Wideochirurgia I Inne Techniki... Jun 2021The effect of repeated cystoscopy on bladder cancer (BC) patient anxiety and feelings is rarely evaluated.
INTRODUCTION
The effect of repeated cystoscopy on bladder cancer (BC) patient anxiety and feelings is rarely evaluated.
AIM
To compare the difference of patients' anxiety and subjective feelings caused by different cystoscopes.
MATERIAL AND METHODS
We prospectively included 192 BC patients who accepted regular cystoscopy follow-up after transurethral resection of bladder tumor (TURBT): 93 in the flexible group and 99 in the rigid group. The method of anesthesia and the order of examinations were consistent between different groups. We analyzed the anxiety level before cystoscopy, the maximum pain during the examination and the change of lower urinary tract symptoms (LUTS) before and after cystoscopy. Meanwhile, we analyzed the rate of gross hematuria and pyuria after cystoscopy. The anxiety and pain levels were evaluated by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and visual analogue scale (VAS). LUTS was reflected by the Core Lower Urinary Tract Symptom Score (CLSS). We distinguished gender during analysis.
RESULTS
The median APAIS score of male patients undergoing flexible or rigid cystoscopy was 8 vs. 12 (p < 0.01), and this result for females was 8 vs. 9 (p = 0.048). The median pain scores for men in the two groups was 1 vs. 2 (p < 0.01), respectively, and this outcome in female patients was 0 vs. 1 (p < 0.01). Patients in the rigid group had more CLSS change (0 vs. 1, p < 0.01). There was no difference in pyuria or gross hematuria rate after examination. Analysis in respective groups showed that men have more severe pain than women, 1 vs. 0 (p = 0.001) in the flexible group and 2 vs. 1 (p = 0.009) in the rigid group.
CONCLUSIONS
A flexible cystoscope can improve anxiety and subjective feelings of BC patients during cystoscopy follow-up.
PubMed: 34136037
DOI: 10.5114/wiitm.2020.100860 -
Kidney360 Feb 2021
Topics: Acute Kidney Injury; Corynebacterium Infections; Humans; Pyelitis; Pyuria
PubMed: 35373018
DOI: 10.34067/KID.0003832020 -
Pyuria, urinary tract infection and renal outcome in patients with chronic kidney disease stage 3-5.Scientific Reports Nov 2020Pyuria is common in chronic kidney disease (CKD), which could be due to either urinary tract infection (UTI) or renal parenchymal inflammation. Only little is known...
Pyuria is common in chronic kidney disease (CKD), which could be due to either urinary tract infection (UTI) or renal parenchymal inflammation. Only little is known regarding the association of pyuria or UTI with renal outcomes. We investigated 3226 patients with stage 3-5 CKD. Pyuria was defined as ≥ 50 WBC per high-power field (hpf) and was correlated to old age, female, diabetes, hypoalbuminemia, lower eGFR, and higher inflammation status. In Cox regression, patients with more than one episode of pyuria in the first year (11.8%) had increased risks for end-stage renal disease (ESRD) [hazard ratio (95% CI): 1.90 (1.58-2.28); p < 0.001], rapid renal function progression [odds ratio (95% CI): 1.49 (1.13-1.95); p = 0.001], and all-cause mortality [hazard ratio: 1.63 (1.29-2.05); p < 0.001], compared to those without pyuria. In a subgroup analysis, the risk of pyuria for ESRD was modified by CKD stages. We investigated the effects of UTI (urinary symptoms and treated by antibiotics) and pyuria without UTI (urine WBC < 50 to ≥ 10/hpf without any episodes of ≥ 50 WBC/hpf or UTI), while both groups were associated with clinical outcomes. In conclusion, CKD stage 3-5 patients with frequent pyuria or UTI episodes have increased risks of renal outcomes.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Female; Glomerular Filtration Rate; Humans; Kidney; Male; Middle Aged; Outcome Assessment, Health Care; Proportional Hazards Models; Pyuria; Renal Insufficiency, Chronic; Urinary Tract Infections
PubMed: 33173137
DOI: 10.1038/s41598-020-76520-5 -
BMC Musculoskeletal Disorders Sep 2021Current evidence does not recommend screening urine culture and curing asymptomatic bacteriuria (ASB) before joint arthroplasty. The bacteriuria count on pre-operative... (Observational Study)
Observational Study
BACKGROUND
Current evidence does not recommend screening urine culture and curing asymptomatic bacteriuria (ASB) before joint arthroplasty. The bacteriuria count on pre-operative urinalysis is a more common clinical parameter. We aimed to investigate whether the bacteriuria count on preoperative urinalysis can increase postoperative wound complications in primary total hip arthroplasty (THA).
METHODS
We conducted a retrospective study that included patients who underwent primary THA in our institution from 2012 to 2018. We obtained preoperative urinalysis results before THA during the same hospitalization and identified patients with abnormal urinalysis. Receiver operating characteristic (ROC) curves were first generated to evaluate the predicted value of leukocyte esterase (LE), nitrite, bacteriuria, and pyuria in the urinalysis for superficial wound infection. Then, all included patients were divided into two groups according to the preoperative urinalysis: a bacteriuria-positive group and a bacteriuria-negative group. The primary outcome was the superficial wound infection rate within 3 months postoperatively, and the secondary outcomes included wound leakage, prosthetic joint infection (PJI), pulmonary infection, urinary tract infection (UTI), readmission rate within 3 months postoperatively, and length of stay (LOS) during hospitalization. We utilized univariable analyses to compare the outcomes between the two groups. A multivariable logistic regression model was generated to explore the potential association between bacteriuria and the risk of superficial wound infection, wound leakage, and readmission rate controlling for baseline values.
RESULTS
A total of 963 patients were included in the study. One hundred sixty patients had abnormal urinalysis. The AUCs for LE, nitrite, bacteriuria, and pyuria were 0.507 (95% confidence interval (CI), 0.315 to 0.698), 0.551 (0.347 to 0.756), 0.675 (0.467 to 0.882), and 0.529 (0.331 to 0.728), respectively. Bacteriuria was diagnostically superior to LE, nitrite, and pyuria. Among the 963 patients, 95 had a positive bacteriuria on preoperative urinalysis, and only 9 (9.5%) had a positive urine culture. Compared with the bacteriuria-negative group, the bacteriuria-positive group had a higher superficial wound infection rate (4.2% vs. 0.6%, P = 0.008), higher wound leakage rate (11.6% vs. 4.5%, P = 0.007), higher readmission rate (5.3% vs. 1.3%, P = 0.015) within 3 months postoperatively and longer LOS (6.19 ± 2.89 days vs. 5.58 ± 2.14 days, P = 0.011). After adjustment, the bacteriuria-positive group had a significantly increased risk of superficial wound infection (OR = 7.587, 95%CI: 2.002 to 28.755, P = 0.003), wound leakage (OR = 3.044, 95%CI: 1.461 to 6.342, P = 0.003), and readmission (OR = 4.410, 95%CI: 1.485 to 13.097, P = 0.008).
CONCLUSION
Preoperative bacteriuria positivity on urinalysis significantly increased the risk of postoperative wound complications, readmission, and LOS in primary THA regardless of the result of the urine culture. Urinalysis is a fast and cost-acceptable test whose advantages have been underestimated.
LEVEL OF EVIDENCE
Level III, observational study.
Topics: Arthroplasty, Replacement, Hip; Bacteriuria; Humans; Retrospective Studies; Urinalysis; Urinary Tract Infections
PubMed: 34587938
DOI: 10.1186/s12891-021-04725-4 -
Journal of Ayub Medical College,... 2022Granulomatosis with polyangiitis (GPA) is an uncommon pauci-immune small-vessel necrotising granulomatous vasculitis mostly seen in age 45-60 years. We present the case...
Granulomatosis with polyangiitis (GPA) is an uncommon pauci-immune small-vessel necrotising granulomatous vasculitis mostly seen in age 45-60 years. We present the case of a formerly healthy 44 years old male presenting with dysuria and intermittent urinary retention for 8 months, not responding to empirical antibiotic therapy and TURP. A prostate biopsy showed necrotising granulomatous prostatitis. Urinalysis demonstrated persistent pyuria and haematuria, but cultures showed no growth. Subsequently he complained of fever, cough, dyspnoea and skin ulcers. CT of the chest showed multiple cavitatory lesions and pleural effusion. On work up, c-ANCA was positive and a diagnosis of granulomatosis with polyangiitis was established. This depicts a rarely seen presentation of prostatitis as the initial feature of GPA.
Topics: Humans; Male; Middle Aged; Adult; Granulomatosis with Polyangiitis; Prostatitis
PubMed: 36550673
DOI: 10.55519/JAMC-04-S4-10658 -
Archives of Disease in Childhood Jun 1962
Topics: Humans; Pyuria
PubMed: 13916273
DOI: 10.1136/adc.37.193.257 -
Trials Mar 2013Urinary tract infections (UTIs) are among the most common infectious diseases and drivers of antibiotic use and in-hospital days. A reduction of antibiotic use... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Urinary tract infections (UTIs) are among the most common infectious diseases and drivers of antibiotic use and in-hospital days. A reduction of antibiotic use potentially lowers the risk of antibiotic resistance. An early and adequate risk assessment combining medical, biopsychosocial and functional risk scores has the potential to optimize site-of-care decisions and thus allocation of limited health-care resources. The aim of this factorial design study is twofold: first, for Intervention A, it investigates antibiotic exposure of patients treated with a protocol based on the type of UTI, procalcitonin (PCT) and pyuria. Second, for Intervention B, it investigates the usefulness of the prognostic biomarker proadrenomedullin (ProADM) integrated into an interdisciplinary assessment bundle for site-of-care decisions.
METHODS AND DESIGN
This randomized controlled open-label trial has a factorial design (2 × 2). Randomization of patients will be based on a pre-specified computer-generated randomization list and independent for the two interventions. Adults with UTI presenting to the emergency department (ED) will be screened and enrolled after providing informed consent. For our first Intervention (A), we developed a protocol based on previous observational research to recommend initiation and duration of antibiotic use based on the clinical presentation of UTI, pyuria and PCT levels. For our second intervention (B), an algorithm was developed to support site-of care decisions based on the prognostic marker ProADM and distinct nursing factors on days 1 and 3. Both interventions will be compared with a control group conforming to the guidelines. The primary endpoints for the two interventions will be: (A) overall exposure to antibiotics and (B) length of physician-led hospitalization within a follow-up of 30 days. Endpoints are assessed at discharge from hospital, and 30 and 90 days after admission. We plan to screen 300 patients and enroll 250 for an anticipated estimated loss of follow-up of 20%. This will provide adequate power for the two interventions.
DISCUSSION
This trial investigates two strategies for improved individualized medical care in patients with UTI. The minimally effective duration of antibiotic therapy is not known for UTIs, which is important for reducing the selection pressure for antibiotic resistance, costs and drug-related side effects. Triage decisions must be improved to reflect the true medical, biopsychosocial and functional risks in order to allocate patients to the most appropriate care setting and reduce hospital-acquired disability.
TRIAL REGISTRATION NUMBER
ISRCTN13663741.
Topics: Adrenomedullin; Algorithms; Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Clinical Protocols; Emergency Service, Hospital; Guideline Adherence; Humans; Length of Stay; Patient Admission; Patient Discharge; Practice Guidelines as Topic; Precision Medicine; Predictive Value of Tests; Protein Precursors; Research Design; Switzerland; Time Factors; Treatment Outcome; Triage; Urinary Tract Infections
PubMed: 23522152
DOI: 10.1186/1745-6215-14-84