Elodi Dielubanza

Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care.

PURPOSE We evaluated targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound guided prostate biopsy based on rectal swab culture results. MATERIALS AND METHODS From July 2010 to March 2011 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy. Targeted prophylaxis used rectal swab cultures plated on selective media containing ciprofloxacin to identify fluoroquinolone resistant bacteria. Patients with fluoroquinolone susceptible organisms received ciprofloxacin while those with fluoroquinolone resistant organisms received directed antimicrobial prophylaxis. We identified men with infectious complications within 30 days after transrectal ultrasound guided prostate biopsy using the electronic medical record. RESULTS A total of 457 men underwent transrectal ultrasound guided prostate biopsy, and of these men 112 (24.5%) had rectal swab obtained while 345 (75.5%) did not. Among those who received targeted prophylaxis 22 (19.6%) men had fluoroquinolone resistant organisms. There were no infectious complications in the 112 men who received targeted antimicrobial prophylaxis, while there were 9 cases (including 1 of sepsis) among the 345 on empirical therapy (p=0.12). Fluoroquinolone resistant organisms caused 7 of these infections. The total cost of managing infectious complications in patients in the empirical group was

Urinary tract infections in women.

13,219. The calculated cost of targeted vs empirical prophylaxis per 100 men undergoing transrectal ultrasound guided prostate biopsy was

Erectile function after posterior urethroplasty for pelvic fracture‐urethral distraction defect injuries

1,346 vs

Radiation-induced angiosarcoma after mastectomy and TRAM flap breast reconstruction.

5,598, respectively. Cost-effectiveness analysis revealed that targeted prophylaxis yielded a cost savings of

Management of Non-catheter-associated Complicated Urinary Tract Infection

4,499 per post-transrectal ultrasound guided prostate biopsy infectious complication averted. Per estimation, 38 men would need to undergo rectal swab before transrectal ultrasound guided prostate biopsy to prevent 1 infectious complication. CONCLUSIONS Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infectious complications after transrectal ultrasound guided prostate biopsy caused by fluoroquinolone resistant organisms as well as a decrease in the overall cost of care.

Risk of urethral stricture recurrence increases over time after urethroplasty

Urinary tract infection (UTI) is the most common extraintestinal infectious disease entity in women worldwide, and perhaps one of the most formidable challenges in clinical practice given its high prevalence, frequent recurrence, and myriad associated morbidities in the setting of rapidly evolving antimicrobial resistance. Achieving timely symptom relief and infection control and preventing morbidity, growth of resistant organisms, and recurrent infection are often difficult. This article reviews epidemiology and pathogenesis of urinary tract infection in women; characterizes common patterns of infection, clinical red flags, and appropriate laboratory testing and imaging; explores emerging patterns of antimicrobial resistance; and reviews the updated guidelines for the treatment of uncomplicated UTI in women.

Are HIV-Infected Men Vulnerable to Prostate Cancer Treatment Disparities?

To determine the specific effect of pelvic fracture‐urethral distraction defect (PFUDD) injuries on erectile function (EF) in men after pelvic fractures, and to compare EF to that found in other studies of men who sustained pelvic fractures, as currently the relationship between erectile dysfunction (ED) and PFUDD has not been elucidated using validated questionnaires.

Sacral Neuromodulation Device Heating During Lumbar and Pelvic Magnetic Resonance Imaging—a Phantom Study

Radiation-induced angiosarcoma of the breast is being reported with increasing frequency as a result of the increased use of radiation therapy in conjunction with breast conservation surgery. However, this entity has not been well documented in patients undergoing mastectomy. The authors present a case of angiosarcoma occurring in a patient 6 years after undergoing mastectomy for invasive duct carcinoma with immediate transverse rectus abdominis musculocutaneous flap reconstruction followed by postoperative radiation therapy. The diagnosis of angiosarcoma was made by skin biopsy performed by the patients reconstructive surgeon on routine follow-up examination. This is the first reported case of postradiation angiosarcoma occurring in a postmastectomy breast reconstructed with autogenous tissue and it is unusual in that the cancer invaded the musculocutaneous flap. Diagnosis and management recommendations for radiation-induced angiosarcoma are discussed.

Impact of Age and Comorbidities on Use of Sacral Neuromodulation

This article presents an overview of non-catheter-associated complicated urinary tract infection (UTI) from a urologic point of view. Discussion includes the evaluation and workup a complicated UTI through history, physical examination, laboratory analysis, and radiographic studies. Specific types of complicated UTI, such as urinary obstruction and renal abscess, are reviewed.

Refinement and validation of the urethral stricture score in categorizing anterior urethral stricture complexity

To report a single institutional experience with urethroplasty outcomes and success rates at long‐term follow up.