Luigi Cormio

Bacterial Adhesion to Urethral Catheters: Role of Coating Materials and Immersion in Antibiotic Solution

Objective: To determine whether new coating materials (silver and hydrogel) or immersion in antibiotic solution may reduce or prevent bacterial adhesion to urethral catheters. Methods: Precut segment of Teflon–, silver– and hydrogel–coated urethral catheters were incubated with two uropathogenic bacterial strains with and without previous immersion in antibiotic solution. Tobramycin, ceftriaxone and ciprofloxacin solutions were used as these antibiotics are commonly administered for the prophylaxis and treatment of urinary tract infection (UTI), especially in hospitals. Results: Microbiological analysis showed that the new coating materials (silver and hydrogel) did not reduce bacterial adhesion to urethral catheters, whereas immersion in antibiotic solution yielded a statistically significant (p<0.05) reduction in bacterial adhesion to the test items. Among the antibiotic solutions tested, ciprofloxacin performed significantly better (p<0.005) than ceftriaxone and tobramycin. Conclusions: Immersion in a suitable antibiotic solution may significantly reduce bacterial adhesion to urethral catheters and consequently reduce the risk of UTI in connection with these devices. Although experimental, these findings may be of clinical relevance and provide grounds for further studies in vivo.

The effects of androgen depletion on human erectile function: a prospective study in male-to-female transsexuals

The objective of the study was to determine the effects of androgen depletion on erectile function in a population of male-to-female transsexuals. The erectile function of 25 consecutive male-to-female transsexuals on androgen depletion treatment and scheduled for surgical gender reassignment was prospectively evaluated using medical and sexual history, physical examination, total serum testosterone, International Index of Erectile Function (IIEF-15) questionnaire, penile colour-coded Doppler ultrasonography (CDU) after pharmacological stimulation and nocturnal penile tumescence (NPT) test. All but one had undetectable or low testosterone. Subjective erectile function, according to IIEF-15 scores, and penile CDU findings did not correlate with testosterone levels, whereas NPT test findings correlated well with testosterone levels. These findings would suggest that nocturnal erections are androgen-dependent whereas sexually induced erections are androgen-independent. It can also be assumed that testosterone is important but not essential for male erectile function and that other androgen-independent pathways can be responsible for sexually induced erections.

Vasoactive intestinal polypeptide (VIP) is not an androgen-dependent neuromediator of penile erection

The effects of castration on vasoactive intestinal polypeptide (VIP) immunostaining in human corpus cavernosum (CC) and the relationship between VIP immunostaining and erectile function were studied in patients with localised prostate cancer who had (Group 1=castrated) or had not (Group 2=control) undergone 3-month neoadjuvant chemical castration before radical prostatectomy. Evaluation of erectile function included medical and sexual history, physical examination, and measurement of total serum testosterone. CC biopsies were taken at the end of radical prostatectomy and samples immunostained with anti-human VIP antibody. Specific staining was quantified by image analysis and expressed in arbitrary units (AU). Chemical castration induced erectile function deterioration in 70% of patients due to loss of sexual interest and confidence in the ability of having an erection rather than reduced ability of obtaining sexually induced erections. Average VIP content was 34.5 AU in Group 1 and 39 AU in Group 2 and this difference was not statistically significant. Chemical castration does not influence VIP immunostaining of human CC, suggesting that VIP is not an androgen-dependent neuromediator of penile erection and that it can be responsible for sexually induced erections in castrated patients.

Oral prophylaxis with fosfomycin trometamol in transurethral prostatectomy and urological maneuvers: Literature review and personal experience

SummaryIn the literature there are three comparative and two open studies in which 1,395 patients received 3 g of fosfomycin trometamol per os 12 or three hours before and 24 hours after surgery: 625 patients received control substances or placebo. In the comparative studies the incidence of postoperative bacteriuria in patients treated with fosfomycin trometamol ranged from 2.9 to 7.6% at one week and from 1.2 to 3.2% at two to four weeks follow-up, and was lower than in patients treated with reference drugs or placebo. In the open study, postoperative bacteriuria ranged from 2.9 to 6.0% at one week follow-up. In our open study, 70 patients were evaluable. Four out of 70 (5.7%) developed fever ≥ 38°C, with positive urine culture, during the first three postoperative days. At two weeks follow-up another 5.7% showed a symptomatic urinary tract infection with a cumulative infection rate of 11.4%. In all cases, the bacteria were resistant to fosfomycin trometamol. A low incidence, 4.2%, of side effects, mainly related to the gastrointestinal tract, was observed. Fosfomycin trometamol proved to be effective with the advantage of no risk of cross resistance, practical pharmaceutical formulation with good patient compliance, good safety profile with few side effects and a satisfactory cost/benefit ratio.ZusammenfassungIn fünf publizierten Studien, von denen drei als Vergleichsstudien und zwei als offene Studien durchgeführt wurden, erhielten 1.395 Patienten 12 oder 3 h vor und 24 h nach einem chirurgischen Eingriff 3 g Fosfomycin Trometamol oral. Bei 625 Patienten wurden Vergleichssubstanzen oder Placebo verabreicht. Die Inzidenz an postoperativer Bakteriurie lag bei Patienten, die Fosfomycin Trometamol erhalten hatten, nach einer Woche bei 2,9 – 7,6% und bei Nachuntersuchungen nach zwei bis vier Wochen bei 1,2 – 3,2%. Sie war geringer als bei Patienten, die Vergleichssubstanzen oder Placebo erhalten hatten. In den offenen Studien hatten nach einer Woche 2,9 bis 6,0% der Patienten eine Bakteriurie entwickelt. In einer von uns durchgeführten offenen Studie waren 70 Patienten auswertbar. Vier von 70 (5,7%) entwickelten während der ersten drei postoperativen Tage Fieber von ≥ 38°C mit positiven Urinkulturen. Weitere 5,7% hatten bei der Nachkontrolle nach zwei Wochen eine symptomatische Harnwegsinfektion bekommen. Die kumulative Infektionsrate betrug 11,4%. In allen Fällen waren die Erreger resistent gegen Fosfomycin Trometamol. Die Nebenwirkungsrate war mit 4,2% gering; in den meisten Fällen handelte es sich um gastrointestinale Beschwerden. Fosfomycin Trometamol erwies sich als wirksam. Es hat den Vorteil fehlender Kreuzresistenz. Die Anwendungsform ist praktisch, sie sichert gute Patientencompliance, besitzt ein günstiges Sicherheitsprofil mit geringer Nebenwirkungsrate und befriedigendem Kosten-Nutzen-Quotienten.In the literature there are three comparative and two open studies in which 1,395 patients received 3 g of fosfomycin trometamol per os 12 or three hours before and 24 hours after surgery: 625 patients received control substances or placebo. In the comparative studies the incidence of postoperative bacteriuria in patients treated with fosfomycin trometamol ranged from 2.9 to 7.6% at one week and from 1.2 to 3.2% at two to four weeks follow-up, and was lower than in patients treated with reference drugs or placebo. In the open study, postoperative bacteriuria ranged from 2.9 to 6.0% at one week follow-up. In our open study, 70 patients were evaluable. Four out of 70 (5.7%) developed fever ≥ 38°C, with positive urine culture, during the first three postoperative days. At two weeks follow-up another 5.7% showed a symptomatic urinary tract infection with a cumulative infection rate of 11.4%. In all cases, the bacteria were resistant to fosfomycin trometamol. A low incidence, 4.2%, of side effects, mainly related to the gastrointestinal tract, was observed. Fosfomycin trometamol proved to be effective with the advantage of no risk of cross resistance, practical pharmaceutical formulation with good patient compliance, good safety profile with few side effects and a satisfactory cost/benefit ratio. In fünf publizierten Studien, von denen drei als Vergleichsstudien und zwei als offene Studien durchgeführt wurden, erhielten 1.395 Patienten 12 oder 3 h vor und 24 h nach einem chirurgischen Eingriff 3 g Fosfomycin Trometamol oral. Bei 625 Patienten wurden Vergleichssubstanzen oder Placebo verabreicht. Die Inzidenz an postoperativer Bakteriurie lag bei Patienten, die Fosfomycin Trometamol erhalten hatten, nach einer Woche bei 2,9 – 7,6% und bei Nachuntersuchungen nach zwei bis vier Wochen bei 1,2 – 3,2%. Sie war geringer als bei Patienten, die Vergleichssubstanzen oder Placebo erhalten hatten. In den offenen Studien hatten nach einer Woche 2,9 bis 6,0% der Patienten eine Bakteriurie entwickelt. In einer von uns durchgeführten offenen Studie waren 70 Patienten auswertbar. Vier von 70 (5,7%) entwickelten während der ersten drei postoperativen Tage Fieber von ≥ 38°C mit positiven Urinkulturen. Weitere 5,7% hatten bei der Nachkontrolle nach zwei Wochen eine symptomatische Harnwegsinfektion bekommen. Die kumulative Infektionsrate betrug 11,4%. In allen Fällen waren die Erreger resistent gegen Fosfomycin Trometamol. Die Nebenwirkungsrate war mit 4,2% gering; in den meisten Fällen handelte es sich um gastrointestinale Beschwerden. Fosfomycin Trometamol erwies sich als wirksam. Es hat den Vorteil fehlender Kreuzresistenz. Die Anwendungsform ist praktisch, sie sichert gute Patientencompliance, besitzt ein günstiges Sicherheitsprofil mit geringer Nebenwirkungsrate und befriedigendem Kosten-Nutzen-Quotienten.