요로병원성 E. coli는 만성 골반 통증을 유발한다.

박성운 대한요로생식기감염학회 2011 Urogenital Tract Infection Vol.6 No.1

만성전립선염/만성골반통증후군 (chronic prostatitis/chronic pelvic pain syndrome: CP/CPPS)의 원인은 잘 알려지지 않고 있지만 미생물에 의한 전립선 감염과 관련이 있는 것으로 추정되어왔다. 저자들은 요로감염을 유발하는 요로병원성 Escherichia coli (E. coli: uropathogenic Escherichia coli UPEC)의 일부에 의한 전립선 감염이 만성 통증을 유발하고 지속시킨다는 가설을 세웠다. 저자들이 시행한 실험을 보면 CP/CPPS로 진단된 환자에서 새롭게 동정된 E. coli 균주 (CP1 균주)를 이용하여 세포 배양과 세균성 전립선염이 있는 생쥐 모델에서 CP/CPPS의 발병에 관해 분자 수준의 발병기전을 연구하였다. 이들이 동정한 CP1은 그 계통형 (phylotype)과 독성인자 측면에서 대부분의 UPEC과는 구별되는 비전형적 균주이며, CP1은 NOD와 C57BL/6J 생쥐의 전립선 상피에 부착, 침입, 증식하여 전립선과 방광에 집락을 형성하였다. 하지만 골반 통증의 행동 평가를 통해 CP1 균주는 NOD 생쥐에서만 만성 골반 통증을 유발하고 그 통증이 지속됨을 알 수 있었으며 이와 같은 현상은 기존 실험에 많이 사용된 임상적 방광염을 유발하는 균주와는 다른 특성을 보여 주었다. 특이한 것은 이러한 통증은 비뇨생식기계 조직에서 세균이 없어진 후에도 지속되었다. CP1은 오직 NOD 생쥐에서만 골반 통증 행동을 보이게 했으며, NOD 생쥐와 비슷한 균체 집락 형성과 염증 수준을 보인 C57BL/6J 생쥐에서는 골반 통증 행동이 관찰되지 않았다. 따라서 미생물에 의해 전립선 감염 및 만성 골반 통증이 유발될 수 있으며, 이는 균주의 독성 인자와 숙주의 유전적 배경에 따른 기전을 통해 일어나게 된다.

하부 요로의 염증 모델

김재헌,배재현,정승민 대한요로생식기감염학회 2011 Urogenital Tract Infection Vol.6 No.2

하부요로의 염증은 사람에게 있어서 자주 일어난다. 요로감염을 제외하고는 아직까지 그 원인들이 밝혀져 있지는 않다. 동물모델은 하부요로와 관련된 증상을 조장하는 기전들을 조사하고 연구하며 또한 증상을 억제하는 치료법을 선택하는 연구에 있어 많이 이용되어 왔다. 이번 고찰은 고양이의 간실성 방광염, 신경인성 방광염, 자기면역성 방광염, 화학품 내지 세균성 물질 (lipopolysaccharide; LPS)을주입함으로써 나타나는 방광염을 포함한 다양한 하부요로염증의 동물 모델을 소개할 것이다. 동물 모델을 이용한 실험은 방광 염증을 일으키는 기전을 연구하는 데 있어서 계속 중요한 역할을 할 것이지만 몇몇 동물 모델은 실제 임상적인 질환을 일으키는 원인과 관련이 있는 지는 명확하지 않다. 이러한 주된 이유는 사람에게 있어서 이러한 질환을 일으키는 원인을 충분하게 이해하지 못하는데 있다. 하부 요로 염증의 예방과 치료를 위해서 행해지는 동물 모델 실험을 통해 얻어진 결과를 충분히 이해하기 위해서는 비교하고 번역하는 연구가 필요하다.

Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study

황의창,유호송,정승일,권동득,이선주,김태형,장인호,윤하나,심봉석,김광현,이동현,허정식,임동훈,조원진,민승기,이길호,김기호,김태환,이서연,양승옥,정재민,이상돈,한창희,배상락,최현섭,이승주,정홍,나용길,양승우,박성운,김영호,김태효,조원열,한준현,조용현,하유신,박흥재,대한요로생식기감염학회 대한요로생식기감염학회 2016 Urogenital Tract Infection Vol.11 No.1

Purpose: Recent studies have highlighted an increasing trend of infectious complications due to fluoroquinolone-resistant organisms among men undergoing transrectal prostate biopsy. This study evaluated the current incidence of infective complications after trans-rectal prostate biopsy for identification of risk factors in Korean men who received fluoroquinolone prophylaxis.Materials and Methods: A prospective, multicenter study was conducted in Korea from January to December 2015. Prostate biopsies performed with fluoroqui-nolone prophylaxis during 3 months in each center were included. A pre-biopsy questionnaire was used for identification of patient characteristics. Clinical variables including underlying disease, antibiotic prophylaxis, enema, povidone- iodine cleansing of the rectum, and infectious complications were evaluated. The primary outcome was the post-biopsy infection rate after fluoroquinolone prophylaxis. Univariable and multivariable analyses were used for identification of risk factors for infectious complications.Results: The study included 827 patients, of whom 93 patients (11.2%) reported receiving antibiotics in the previous 6 months and 2.5% had a history of prostatitis. The infectious complication rate was 2.2%. Post-biopsy sepsis was reported in 2 patients (0.2%). In multivariable analysis predictors of post-biopsy sepsis included person performing biopsy (adjusted odds ratio [OR], 4.05; 95% confidence interval [CI], 1.31-12.5; p=0.015) and operation history within 6 months (adjusted OR, 5.65; 95% CI, 1.74-18.2; p=0.004).Conclusions: The post-prostate biopsy infectious complication rate in this study was 2.2%. Person performing biopsy (non-urologists) and recent operation history were independent risk factors for infectious complications after trans-rectal prostate biopsy.

성기단순포진의 권고치료

박흥재 대한요로생식기감염학회 2014 Urogenital Tract Infection Vol.9 No.2

Herpes simplex virus (HSV) is a member of herpesviridae family viruses, which belong to DNA viruses. HSV-associated diseases are one of the most widespread infection and most genital herpes is caused by HSV type 2 (HSV-2). Treatment of genital herpes is complex. In addition to administration of the standard antiviral medications, an ideal management protocol should also address various aspects of the disease. Oral acyclovir, valacyclovir, and famciclovir are recommended for routine treatment. Long-term suppressive therapy is effective in reducing recurrence rate as well as the risk of transmission to others. However, antiviral drugs cannot cure HSV infection and persist during the lifetime of the host, often in latent form. Management of the sex partner, appropriate counseling, and prevention advice or education are equally important in management of genital herpes. This review provides a summary of several important recent guidelines regarding recommended management for the herpes genitalia.

The Feasibility of Radical Prostatectomy for Medication Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Seung Chan Jeong 대한요로생식기감염학회 2022 Urogenital Tract Infection Vol.17 No.3

Purpose: The purpose of this study was to compare the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scores of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) given pharmacological treatment with those who additionally had prostate cancer and underwent surgical treatment. Materials and Methods: From January 2000 to March 2021, a total of 7,650 patients were diagnosed with chronic prostatitis (N41.1) at our hospital, of which 234 patients were additionally diagnosed with prostate cancer. After excluding patients with severe benign prostatic hyperplasia (>100 g)-related lower urinary tract symptoms or neurological and psychiatric abnormalities, or advanced prostate cancer, 52 patients undergoing pharmacological treatment with a combination of drugs and 20 patients who underwent radical prostatectomy due to additional prostate cancer were included in the analysis. The NIH-CPSI scores of the two groups were compared at the first outpatient visit, 3 months, and 6 months after the first visit. The p-values were calculated using the Mann-Whitney U test, and the Wilcoxon signed rank test. Results: Patients who underwent radical prostatectomy for prostate cancer showed significant reductions in the voiding and quality of life scores in the NIH-CPSI, but not the pain score at 3 months. After 6 months, there was a significant decrease in the overall NIH-CPSI. On the other hand, in the group on pharmacological therapy, the decrease was statistically significant only in the voiding score at 6 months. However, in the surgery group, 3 patients were found to be suffering from urinary incontinence, and 7 patients from erectile dysfunction. Conclusions: Radical prostatectomy, therefore, appears to be a promising treatment that can be carefully considered for patients with refractory CP/CPPS who do not receive adequate treatment and thus have a poor quality of life.

Treatment Modality of Prostatic Abscess according to Size: A Retrospective Study

Gwon Kyeong Lee,Kyoung Ha Jang,Woo Seop Seong,Byeong Jin Kang,Kyung Hwan Kim,Hong Koo Ha 대한요로생식기감염학회 2022 Urogenital Tract Infection Vol.17 No.3

Purpose: This study aimed to determine the treatment modality for prostatic abscesses according to size. Materials and Methods: Twenty-five patients diagnosed with prostatic abscesses were retrospectively reviewed. All patients were treated with intravenous empirical and appropriate antibiotics according to culture results. They were grouped according to the size of the prostate abscess based on computed tomography results (group A, with prostate abscess ≤2 cm, n=10; group B, with prostate abscess size >2 cm, n=15), and their treatment modality and outcomes were compared. Results: The prostatic abscess sizes were 1.31±0.37 and 3.49±1.06 cm for groups A and B, respectively. Prostate-specific antigen, prostatic volume, and comorbidity were not significantly different (p>0.05), whereas pelvic pain was significantly different (p=0.028). There was no difference in the microorganisms isolated from urine and blood culture, empirical antibiotics, and broad-spectrum antibiotics between the two groups (p>0.05). More patients in group B underwent transurethral abscess deroofing than those in group A (p=0.040). Patients in group B had a more extended hospitalization period and intravenous antibiotics duration than those in group A (p=0.024 and p=0.013, respectively). Group B had more cases of septic shock, intensive care unit admission, and mortality events than group A (p=0.024, p=0.001, and p=0.061, respectively). However, prostatic abscess recurrence and urological chronic complication did not significantly differ (p>0.05). Conclusions: Appropriate use of antibiotics is crucial. This study shows that the treatment of patients with prostatic abscess >2 cm is more difficult, but transurethral abscess deroofing can lower mortality, prostatic abscess recurrence, and urological chronic complications.

What Are the Barriers to Human Papillomavirus Vaccination for Male in South Korea?

Sangrak Bae,Sooyoun Kim 대한요로생식기감염학회 2022 Urogenital Tract Infection Vol.17 No.3

The human papillomavirus (HPV) virus causes genital warts, a sexually transmitted disease, as well as cervical and vulvar cancer in females and penile cancer in males. In addition, it this virus causes various diseases, including head and neck cancer and anal cancer. Vaccines can prevent malignant tumors caused by the HPV virus, and various projects are being conducted to eradicate HPV worldwide. The national inoculation program is a representative project among them. In Korea, only females are vaccinated; males are not included in the national mandatory vaccination list. Various reasons preventing HPV vaccination for males include cost-effectiveness, fear and misperception of side effects after vaccination, problems with the effectiveness of vaccination, and lack of social awareness about the need for vaccination, including parents, and the lack of research on male HPV disease. As female’s right to health is emphasized, HPV disease, which has become more important in treatment, will never be cured if it is managed only for females. Because the disease is transmitted sexually, managing and controlling HPV in males is also essential. In that sense, males must also be included as nationally required vaccination targets.

Importance to Promote Awareness in Patients with Recurrent Cystitis

Sun-tae Ahn,Mi-mi Oh 대한요로생식기감염학회 2022 Urogenital Tract Infection Vol.17 No.3

In spite of a high cure rate, cystitis is a common disease in women that often recurs within a year. The uncomfortable symptoms associated with recurrent cystitis affect the quality of life and overall daily life. However, the awareness pertaining to the treatment or prevention of recurrent cystitis has remained the same. Physicians and patients are unaware that recurrent cystitis can lead to several problems, such as socioeconomic burden and antibiotic abuse. Therefore, there is a requirement to enhance awareness of the socio-economic burden of recurrent cystitis, the effects on the quality of life of patients, and the importance of prevention and management after treatment.

Host-Pathogen Interactions in Urinary Tract Infections

고영휘,최재영,송필현 대한요로생식기감염학회 2019 Urogenital Tract Infection Vol.14 No.3

Urinary tract infections (UTIs) are classified by the host condition. Uncomplicated infections are caused most commonly by uropathogenic Escherichia coli (UPEC) and affect otherwise healthy people, whereas complicated infections are com-monly caused by species, such as Proteus mirabilis, and affect patients with under-lying difficulties, such as a urinary tract abnormality or catheterization. The outcome of infection caused by these bacteria is dictated by the immune response to the UTI and the host factors that influence the susceptibility to disease. This review focuses on the host pathogen interactions in UTI, including an identification of additional virulence factors and therapeutic or prophylactic targets, particularly by UPEC and P. mirabilis.

Symptoms of Bacillus Calmette-Guerin Cystitis in Bladder Cancer Patients according to Tuberculosis Sequelae by Chest Radiography

서원익,강필문,윤장호,최석진,김완석 대한요로생식기감염학회 2017 Urogenital Tract Infection Vol.12 No.1

Purpose: Bacillus Calmette-Guerin (BCG) vaccination has been administered to most infants at birth in Korea; however, tuberculosis (TB) remains extant. TB can leave sequelae on chest radiography according to the immune response of the host. We investigated the symptoms of cystitis after intravesica instillations in bladder cancer, depending on the TB sequelae on chest radiography.Materials and Methods: One hundred forty-two patients with non-muscle invasive bladder cancer (NMIBC) underwent transurethral resection and intravesical BCG therapy for bladder cancer. Patients received a BCG induction course―with or without a maintenance course―and were divided into the two groups: Group A, which included patients with visible sequelae of TB on chest radiography (n=31) and group B, which included patients without visible sequelae of TB (n=111). Cystitis symptoms of BCG intravesical therapy were compared between the two groups. The recurrence and progression rates of bladder cancer were also analyzed.Results: The overall rate of cystitis symptoms was 32.3% (10/31) in group A and 33.3% (37/111) in group B. One patient in group A and three in group B did not complete the treatment course due to severe cystitis symptoms (p=0.876). Pyuria was reported when cystitis symptoms occurred in 80% (8/10) in group A and 56.8% (21/37) in group B. The recurrence and progression rates were not different between the two groups.Conclusions: Our results show that there was no significant difference of cystitis symptoms in accordance with the presence of TB sequelae in chest radiography when BCG instravesical therapy for NMIBC was performed.