Y. Nasu

Comparison of 25 and 75 mg/day naftopidil for lower urinary tract symptoms associated with benign prostatic hyperplasia: A prospective, randomized controlled study

Background:  The present study investigated the efficacy, safety, and utility of starting an α1d‐selective antagonist, naftopidil, at 75 or 25 mg/day in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).

Prospective Randomized Comparative Study of Antibiotic Prophylaxis in Urethrocystoscopy and Urethrocystography

Background: There has been a great deal of discussion regarding the necessity of the prophylactic use of antibiotics in transurethral procedures. In order to clarify this complicated issue, a randomized prospective study was performed for patients undergoing urethrocystoscopy or urethrocystography.

Primary non-Hodgkin lymphoma of the ureter

A 41-year-old woman presented with right flank pain. Excretory urography showed moderate hydronephrosis; retrograde pyelography and CT detected narrowing of the proximal third of the right ureter, caused by a softtissue mass of the ureteric wall with a maximum diameter of 2.5 cm and #6 cm long (Fig. 1). No other abnormality was found; most notably, there was no adenopathy. Right ureteroscopy revealed partial obstruction encircled by bulging lesions with a slightly uneven surface but intact mucosa. A ureteroscopic biopsy was taken with 5 F cup forceps; the histological examination showed non-Hodgkin lymphoma of the diCuse large Fig. 2. Histology shows submucosal infiltrating lymphoma cells, B-cell type (Fig. 2). A bone marrow specimen was mainly large-cell type. Haematoxylin and eosin, reduced from normal, establishing stage 1E of the Ann Arbor classifi×100. cation. The entire soft-tissue mass surrounding the ureter, detected by CT, completely disappeared after four tissue masses of the ureteric wall commonly represent courses of systemic chemotherapy followed by radioprimary neoplasms of the ureter or metastases to the therapy. A subsequent ureteroscopy and biopsy yielded ureter. In diCerentiating such lesions ureteroscopy prono positive findings. vides more definitive findings than radiography. To our knowledge, this is the first case in which malignant Comment lymphoma was diagnosed by ureteroscopic biopsy and the kidney was preserved successfully by chemotherapy Although detection of extranodal non-Hodgkin lymcombined with radiotherapy. phoma has been improved with the use of CT, primary lymphoma involving the ureteric wall without contiguous lymphadenopathy is an unusual occurrence. Only four other such cases have been reported [1–4]. Soft-

The absorption of pirarubicin instilled intravesically immediately after transurethral resection of superficial bladder cancer

Objectives To assess the validity of the prophylactic use of pirarubicin ([2′R]‐4‐O‐tetrahydropyranyl‐doxorubicin) immediately after transurethral resection of bladder tumour (TURBT), using pharmacodynamic studies.

Epidermal growth factor in urine from patients with bladder cancer

Abstract Epidermal growth factor (EGF), a mitogenic polypeptide with a molecular weight of 6000, is excreted in human urine in nanomolar quantities. Recently, some reports showed that urothelial neoplasm was related to the concentration of EGF in urine. In this study, EGF concentration in urine was measured by enzyme-linked immunosorbent assay (ELISA) in 207 samples from 112 male patients (30–90 years old, median 66.2) who had previously been treated for bladder cancer. Then, we tried to clarify the significance of urinary EGF as a marker for recurrence of bladder cancer in comparison with urine cytology. The samples were collected on occasional follow up cystoscopy. Urine from nine age-adjusted males without urological disease was also measured to obtain normal control values. In 123 samples from patients without tumors, EGF concentrations in urine decreased with age. In 84 samples obtained from patients with recurrent tumor, EGF concentrations were significantly lower than those in 123 samples from patients without tumors (P < 0.001) Furthermore, EGF concentrations in longitudinal samples collected the same patients during tumor recurrence and at the times when no tumor was detected were measured in 56 patients. EGF concentrations in the samples collected during tumor recurrence was significantly lower than that in specimens collected when there was no tumor (P < 0.01). There were no significant differences between the same samples collected during tumor recurrence with regard to tumor grade, stage shape and number of tumors. However, EGF concentration in urine from patients with carcinoma in situ (CIS) was lower than that in specimens from patients without CIS. These results indicate the usefulness of determining the EGF concentration as a marker for detecting bladder cancer recurrence. Urine cytology was also examined in the same series and findings were compared with those of urinary EGF. On cytology, class IV and V were considered positive, and on urinary EGF, less than l0 ng/mgCr were considered positive. Sensitivity was 25% for cytology and 57% for urinary EGF, while specificity was 98% and 66%, respectively. The predictive positive value was 0.88 and 0.53, respectively. With the combined use of urinary EGF and cytology, the sensitivity, specificity and predictive positive value were 68%, 64% and 0.92, respectively. In conclusion, urinary EGF seems to be a useful marker for detecting bladder cancer recurrence if performed in addition to cytology.

Impact of selective media for detecting fluoroquinolone-insusceptible/extended-spectrum beta-lactamase-producing Escherichia coli before transrectal prostate biopsy

To investigate the prevalence of fluoroquinolone‐insusceptible and/or extended‐spectrum beta‐lactamase‐producing Escherichia coli colonizing in the male rectum before transrectal prostate biopsy.

Acute Inflammatory Syndrome Paradoxically Induced by De Novo Purine Inhibitors Synthesis Before Renal Transplantation: A Case Report and Review of the Literature

BACKGROUND Mycophenolate mofetil (MMF) and mizoribine (MZR) are increasingly used as immunosuppressive agents for organ transplantation and chronic inflammation. We report a patient with rheumatoid arthritis who had an acute inflammatory syndrome triggered by preoperative immunosuppression therapy with both MMF and MZR. CASE REPORT A 41-year-old woman with IgA nephropathy was referred to our department for living donor renal transplantation. She had rheumatoid arthritis that was adequately treated with prednisolone 5 mg once a day and salazosulfapyridine 2000 mg once a day. MMF 1000 mg twice a day was started for desensitization therapy. Three days later, the patient developed arthritis in the joints of her left hand and elevated inflammatory markers. On day 7, MMF was switched to MZR 150 mg 3 times a day. However, the symptoms extended to both shoulders and the joints of the right foot; MZR was discontinued. The arthritis and inflammatory markers improved. Two months later, the patient was rechallenged with MMF followed by MZR, resulting in a similar clinical course as previously. Tacrolimus (TAC) 3 mg twice a day and everolimus (EVL) 0.5 mg twice a day were introduced as alternative immunosuppressant therapies. No arthritis occurred. ABO-compatible living donor renal transplantation was successfully performed. The patient received TAC, EVL, prednisolone, rituximab, and basiliximab, and her postoperative course was uneventful without arthritis or rejection. At 9 months postoperatively, the serum creatinine was 0.79 mg/dL. CONCLUSIONS Acute inflammatory syndrome is an extremely rare complication triggered by preoperative immunosuppression therapy. If antimetabolites cannot be used in immunologically high-risk patients, transplantation becomes very difficult. Clinicians should keep in mind this paradoxical reaction.

MP11-19 TARGETED ANTIBIOTIC PROPHYLAXIS BY β-LACTAMS BASED ON RECTAL SWAB CULTURE IS NOT SUFFICIENT TO PREVENT INFECTIVE COMPLICATIONS AFTER TRANSRECTAL PROSTATE BIOPSY

Group B: 188 patients who were given amikacin 15 mg / kg intramuscularly 60-120 min before the procedure. All patients underwent urinalysis and urine culture before and after the procedure. We identified post biopsy complications: bacteriuria, urinary tract infection, orchitis, pyelonephritis, sepsis, all of them were evaluated, all patients with a severe condition were hospitalized. The variables were correlated using Fishers Exact Test. RESULTS: In Group A, 4.3% of patients presented a febrile UTI and 0.97% presented sepsis. In Group B, 5.3% presented febrile UTI and .53% presented sepsis. Comparing both groups, we found no relationship between the dose and the risk for complications (p1⁄40.52). In the group analysis considering DM, a significant relationship for complication risks was not found, Group A (p1⁄40.62) and Group B (p1⁄40.58). The same in the analysis of overweight and obesity no significant relationship with complications was found, Group A (p1⁄40.85) and Group B (p1⁄40.65). CONCLUSIONS: Given its efficacy and simplicity, a single dose of 500mg of levofloxacin represents an excellent prophylaxis method in transrectal prostate biopsies guided by ultrasound. However, a single dose of amikacin shows similar results as levofloxacin, thus it can significantly reduce the cost of antibacterial therapy and have a similar safety profile.

RECTAL SWAB CULTURES CAN ASSESS FOR ALTERNATIONS IN MICROBIAL FLORA; RECTAL COLONIZATION OF FLUOROQUINOLONE RESISTANT ESHERICHIA COLI AMONG TRANSRECTAL ULTRASONOGRAPHY GUIDED PROSTATE BIOPSY PATIENTS

regression analysis. RESULTS: Forty-five patients were diagnosed with LS. The average age was 50.2 years (range 22.5-82.9) with an average follow-up of 44.2 months. Circumcision or meatotomy was performed in 10, and 7 were treated with clobetasol alone. Twenty-five had urethral disease necessitatinf 26 open surgical repairs. Meatoplasty was performed in 12 (46%), staged repair in 9 (35%), perineal urethrostomy in 4 (15%), and augmented repair in 1 (4%). Recurrent LS was diagnosed in 8 (32%) patients and confirmed with biopsy. Of the recurrences, 1 had undergone extended meatoplasty and 7 recurred following staged procedures: 4 after the first stage, and 3 after completion of the two-staged repair. One patient who had recurrence after a two-stage procedure, also had recurrent LS at the site of subsequent perineal urethrostomy. Younger age at time of diagnosis (p=0.044), bulbar urethra as site of LS (p=0.018), staged urethroplasty as type of intervention (p=0.003), increased number of prior endoscopic procedures (p=0.035), and increased number of prior open procedures (p=0.049) were associated with increased risk of LS recurrence. Race, circumcision status, treatment with steroid cream, and medical co-morbidities were not found to be significant. Multivariate logistic regression analysis did not find any independent risk factors for recurrent LS, though number of prior endoscopic procedures trended towards significance (p=0.12). CONCLUSIONS: Our data suggest the recurrence rate for LS is high, and that the buccal graft may not be the panacea once thought for treatment of LS. The association with previous instrumentation and lack of other associated risk factors suggest that the Koebner phenomenon may be an important factor in progression of LS.