Search

The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline - consisting 43 clinical questions - and overview its key practical issues.

Resume Escherichia coli (E. coli) est la bacterie la plus frequemment retrouvee dans les infections urinaires de l’adulte. Nous avons analyse le taux de resistance des E coli a l’acide nalidixique pendant 12 mois consecutifs dans un service d’urologie. Materiel et methode Nous avons realise une etude retrospective de tous les examens bacteriologiques urinaires positifs a E. coli pendant l’annee 2004 provenant d’un service d’urologie. Soixante quinze examens bacteriologiques etaient positifs a E. coli chez 68 malades. Il s’agissait dans 67 cas de prelevements urinaires (ECBU), de 6 hemocultures et de 2 collections drainees. 20 malades avaient eu une prise de fluoroquinolones dans les 6 mois precedents et 10 etaient diabetiques. Un E. coli resistant a l’acide nalidixique (NR) a ete isole chez 11 malades (16%) âges de 22 a 81 ans (mediane 58 ans). Les malades ayant eu un E. coli resistant a l’acide nalidixique (NR) ont ete compares aux patients dont l’E. coli etait sensible a l’acide nalidixique (NS). Resultats Les facteurs predictifs de resistance de l’E. coli a l’acide nalidixique etaient la temperature superieure a 38,4 °C (p=0,022), l’existence d’une hyper leucocytose (p=0,002) et la prise dans les 6 derniers mois de fluo-roquinolone (p=0,046). Conclusions La prise recente de fluoroquinolone et la severite de l’infection (hyper leucocytose et fievre superieure a 38,4 °C) doivent remettre en question la prescription de fluoroquinolones et preferer une autre classe d’antibiotique.

Escherichia coli (E. coli) is the micro-organism most frequently identified in urinary tract infections in adults. The authors analysed the nalidixic acid resistance rate of E. coli isolated over 12 consecutive months in a urology department.All E. coli-positive bacteriological examinations from a urology department during 2004 were retrospectively reviewed. Seventy five bacteriological examinations from 68 patients were positive for E. coli, corresponding to 67 urine cultures, 6 blood cultures and 2 drained collections. Twenty patients had taken fluoroquinolones during the previous 6 months and 10 patients were diabetic. A nalidixic acid-resistant (NR) E. coli was isolated in 11 patients (16%) aged 22 to 81 years (median: 58 years). Patients with nalidixic acid-resistant (NR) E. coli were compared to patients with nalidixic acid-susceptible (NS) E. coli.Predictive factors for nalidixic acid resistance of E. coli were fever higher than 38.4 degrees C (p = 0.022), leukocytosis (p = 0.002) and use of fluoroquinolones during the previous 6 months (p = 0.046).Prescription of a non-fluoroquinolone antibiotic may be preferable in the case of recent use of fluoroquinolones and signs of severe infection (leukocytosis and fever higher than 38.4 degrees C).

The frequency of vesicourethral anastomotic stricture after prostatectomy is estimated to be 14%, an average of 3 months after the operation. The authors report the cases of a 61-year-old man undergoing radical prostatectomy for localized prostate cancer. The postoperative course was marked by recurrent urinary retention and several urethrotomies failed to restore spontaneous voiding. A clip was finally visualized and removed by endoscopy. The patient has not experienced any further episodes of retention. This is the first published cases of clip migration responsible for anastomotic stricture after radical prostatectomy. This diagnosis must be considered in the case of repeated postoperative retention.