- •1. Introduction
- •1.1 Classification
- •1.2 References
- •2.2 Background
- •2.3 Definition
- •2.4 Aetiological spectrum
- •2.5 Acute uncomplicated cystitis in pre-menopausal, non-pregnant women
- •2.8 UtIs in pregnancy
- •2.9 UtIs in post-menopausal women
- •2.11 References
- •19. Roberts fj.
- •27. Sanford jp.
- •28. Kinane df, Blackwell cc, Brettle rp, Weir dm, Winstanley fp, Eltor ra.
- •32. Nicolle le, Harding gkm, Preiksaitis j, Ronald ar.
- •50. Wadland wc, Planten da.
- •60. Vorland lh, Carlson k, Aalen odd.
- •3.2 Background
- •3.3 Aetiology
- •3.4 Pathogenesis
- •3.5 Signs and symptoms
- •3.7 Schedule of investigation
- •If findings indicate pathology
- •3.9 References
- •21. Jantausch pa, Rifai n, Getson p, Akrem s, Majd m, Wiedermann bl.
- •32. Rushton hg, Majd m, Jantausch b, Wiedermann l, Belman ab.
- •43. Kleinman pk, Diamond ba, Karellas a, Spevak mr, Nimkin k, Belenguer p.
- •4.2 Background
- •4.3 What are the acute effects of a uti on the kidney and do the lesions become chronic? Can they be prevented?
- •4.7 References
- •5.2 Definitions and classification
- •5.4 Treatment
- •5.5 Conclusions
- •5.6 References
- •6.2 Background
- •6.3 Definition and clinical manifestation of sepsis syndrome in urology
- •6.4 Physiology and biochemical markers
- •6.5 Prevention
- •6.6 Treatment of underlying disease
- •6.7 Conclusion
- •6.8 References
- •7.7 Therapy
- •7.8 Prevention
- •8.2 Prostatitis
- •8.3 Epididymitis and orchitis
- •8.4 References
- •1. Meares em, Stamey та.
- •2. Weidner w, Schiefer hg, Krauss h, Jantos Ch, Friedrich hj, Altmannsberger m.
- •3. Schaeffer aj.
- •8. Alexander rb, Ponniah s, Hasday j, Hebel jr.
- •26. Barbalias ga, Nikiforidis g, Liatsikos en.
- •27. Mayersak js.
- •28. Jimenez Cruz jf, Boronat f, Gallego j.
- •33. Naber kg, Weidner w.
- •9. Peri-operative antibacterial prophylaxis in urology
- •9.1 Summary
- •9.2 Introduction
- •9.3 Goals of peri-operative antibacterial prophylaxis
- •9.4 Indications for peri-operative antibacterial prophylaxis
- •9.5 Timing and duration of peri-operative antibacterial prophylaxis
- •9.6 Choice of antibiotics
- •9.7 Mode of application
- •9.8 Recommendations according to type of urological intervention
- •9.10 References
- •1. Rubin rh, Shapiro ed, Andriol vt, Davies rj, Stamm we.
- •3. Naber kg.
- •3. Recommendations for peri-operative antibacterial prophylaxis in urology (modified according to ref 1)
- •4. Antibacterial agents
- •4.1 Penicillins
- •4.2 Parenteral cephalosporins
- •4.3 Oral cephalosporins
- •4.4 Monobactams
- •4.5 Carbapenems
- •4.6 Fluoroquinolones
- •4.7 Macrolides
- •4.8 Tetracyclines
- •4.9 Aminoglycosides
- •4.10 Glycopeptides
- •4.11 References
26. Barbalias ga, Nikiforidis g, Liatsikos en.
Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. JUrol 1998; 159: 883-887.
27. Mayersak js.
Transurethral ultrasonography directed intraprostatic injection of gentamycin-xylocain in the management of the benign painful prostate syndrome. A report of a 5 year clinical study of 75 patients. Int Surg 1998; 83: 347-349.
28. Jimenez Cruz jf, Boronat f, Gallego j.
Treatment of chronic prostatitis: intraprostatic injection under echography control. JUrol 1988; 139: 967-970.
Darenkov AF, Simonov VI, Kuzrnin GE, Koshkarov H. Transurethral electroresection in chronic prostatitis and its complications. Urol Nefrol (Mosk.) 1989; 1: 18-23.
Frazier HA, Spalding TH, Paulson DF.
Total prostatoseminal vesiculectomy in the treatment of debilitating perineal pain. J Urol 1992; 148:409-411.
Sahin A, Eiley D, Goldfischer ER, Stravodimos KG, Zeren S, Isenberg HD, Smith AD. The in vitro bactericidal effect of microwave energy on bacteria that cause prostatitis. Urology 1998; 52: 411-415.
Nickel JC, Sorensen R.
Transurethral microwave thermotherapy for nonbacterial prostatitis: a randomized double-blind sham controlled study using new prostatitis specific assessment questionnaires. J Urol 1996; 155: 1950-1954.
33. Naber kg, Weidner w.
Prostatitis, epididymitis, orchitis. In: Infectious Diseases. Armstrong D, Cohen J (eds). London: Mosby, Harcourt Publishers Ltd, 1999, pp. 1-58.
34. Berger RE.
Epididymitis. In: Sexually Transmitted Diseases. Holmes KK, Mardh P-A, Sparling PF, Wiesner PJ (eds), New York: McGraw-Hill, 1984, pp. 650-662.
35. Nistal M, Paniagua R.
Testicular and Epididymal Pathology. Stuttgart: Thieme, 1984.
36. Robinson AJ, Grant JBF, Spencer RC, Potter C, Kinghom GR.
Acute epididymitis: why patient and consort must be investigated. Br J Urol 1990; 66: 642.
37. Riither U, Stilz S, Rohl E, Nunnensiek C, Rassweiler J, Dorr U, Jipp P.
Successful lnterferon-2, a therapy for a patient with acute mumps orchitis. Eur Urol 1995; 27: 174.
Aitchison M, Mufti GR, Farrell J, Paterson PJ, Scott R. Granulomatous orchitis. Br J Urol 1990; 66: 312.
Weidner W, Schiefer HG, Garbe Ch.
Acute nongonococcal epididymitis. Aetiological and therapeutic aspects. Drugs 1987; 34 (Suppl 1): 111.
Weidner W, Garbe Ch, WeiBbach L, Harbrecht J, Kleinschmidt K, Schiefer HG, Friedrich HJ. Initiale Therapie der akuten einseitigen Epididymitis mit Ofloxacin. Andrologische Befunde. Urologe A 1990; 29: 277-280.
Ludwig M, Jantos CA, Wolf S, Bergmann M, Failing K, Schiefer HG, Weidner W.
Tissue penetration of sparfloxacin in a rat model of experimental Escherichia coli epididymitis. Infection 1997; 25: 178-184.
9. Peri-operative antibacterial prophylaxis in urology
9.1 Summary
The main aim of antimicrobial prophylaxis in urology is to prevent symptomatic/febrile genito-urinary infections, such as acute pyelonephritis, prostatitis, epididymitis and urosepsis, as well as serious woundinfections.
The need for prophylaxis depends on the type of intervention and the individual risk for each individual patient. General antibiotic prophylaxis is not required in open operations without bowel segments. The same is true for reconstructive operations in the genital area, with the exception of long or secondary interventions, or implant surgery. For diagnostic interventions, peri-operative antibacterial prophylaxis is generally recommended only in transrectal prostate biopsy with a thick needle. Prophylaxis should always be considered in patients who have an increased risk of infection, and especially before a transurethral resection of the prostate (TURP) if there is a history of a UTI.
Generally, a single full dose of a suitable antibiotic, preferably administered parenterally (alternatively with oral drugs with excellent bioavailability, e.g. fluoroquinolones), is appropriate for prophylaxis. Only in the case of a prolonged intervention (> 3 hours) may additional doses be required, the size and timing of which are dictated by the pharmacokinetics of the antibiotic. Antibiotic prophylaxis should not be continued for > 24 hours. When continuous urinary drainage, e.g. indwelling catheter, stent, nephrostomy, etc., is left in place after an operation, prolongation of peri-operative antibacterial prophylaxis is contra-indicated.
Many antibiotics meet the criteria for use in prophylaxis (Appendix 4), e.g. second-generation cephalosporins, fluoroquinolones and aminopenicillins plus a BLI. Aminoglycosides should be reserved for high-risk patients and those who are allergic to (3-lactams. Broad-spectrum antibiotics, such as third-generation cephalosporins, acylaminopenicillins plus a BLI, or carbapenems, should be used only sparingly, e.g. if the site of the operation is contaminated with multi-resistant nosocomial bacteria. This applies also to the use of vancomycin.