Pre-Bx rectal swab use reduces costs, lowers number of infections

Sarah Coleman Flury, MDOther infection/inflammation take-home messages from the AUA annual meeting include a study of predictors of fluoroquinolone resistance in the rectal vault of men undergoing prostate biopsy and a study of 1,310 patients evaluated over 16 years for CP/CPPS. The take-home messages were presented by Sarah Coleman Flury, MD, of Northwestern University, Chicago.

A cost-effectiveness analysis of targeted antimicrobial therapy in TRUS-guided prostate biopsy showed that use of rectal swabs prior to biopsy reduced costs, led to fewer infections, and improved patient quality of life.

The rate of infective complications after transrectal ultrasound (TRUS)-guided prostate biopsy increased significantly after transition to single-dose oral ciprofloxacin (Cipro) prophylaxis.

A study of predictors of fluoroquinolone resistance in the rectal vault of men undergoing prostate biopsy identified increasing age, recent antibiotic use, African-American and Hispanic race, and higher rates of benign pathology, including BPH and inflammation.

Potential risk factors to guide targeted screening for fluoroquinolone-resistant Escherichia coli in bowel flora are not sufficiently discriminatory to identify a specific high-risk group, supporting a case for prebiopsy rectal swab in all patients.

A prospective cohort trial of targeted antimicrobial prophylaxis before prostate biopsy used results of individual rectal flora cultures to drive antibiotic choice, resulting in a low rate of infectious complications, limited morbidity, and no sustained sequelae.

Continue to the next page for more take-home messages.

• A study of 1,310 patients evaluated over 16 years for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) showed that pain and urinary symptom patterns and quality of life remained consistent over time. Advances in clinical phenotyping and treatment occurred, leading to a changing clinical picture, particularly with the adoption of multimodal therapy.

• Use of next-generation sequencing of the urinary biome of patients with CP/CPPS showed bacteria in 75% of specimens and an average of two types of bacteria per sample, suggesting a potential for culture-driven treatment.

• Intraurethral inoculation of two types of laboratory mice with gram-positive bacteria from patients with CP/CPPS induced a pain response that varied by the genetic background of the host animal, suggesting host-pathogen interactions are involved in the development of pain in CP/CPPS.

• Trigger-point injection as an adjunct to standard treatment for CP/CPPS was well tolerated and led to symptom improvement in 50% of patients.

• Transcutaneous nerve stimulation for refractory CPPS resulted in subjective improvement in 62% of patients, including quality of life and urinary symptoms, and was associated with no adverse events.

• Use of a body pain map to characterize CPPS showed extra-abdominal and extrapelvic pain in three of four patients evaluated and was associated with worse quality of life and psychosocial issues, but not worse urinary symptoms.

• A randomized trial of CPPS treatment showed that the addition of a phosphodiesterase-type-5 inhibitor to an alpha-blocker and a fluoroquinolone led to greater improvement in symptoms and quality of life than did two-drug therapy.

• Almost two-thirds of a group of men with CPPS tested positive for small fiber polyneuropathy (SFPN), adding to evidence of SFPN involvement in CPPS etiology and suggesting alternative treatment strategies, such as intravenous immunoglobulin and immunomodulation.

Next: An analysis of urinary markers in women with IC/BPS

• An analysis of urinary markers in women with interstitial cystitis/bladder pain syndrome (IC/BPS) showed increased levels of VEGF and CXCL10, presence of the inflammatory cytokine IL-1a, and increased levels of urinary IL-1Ra with hydrodistention or fulguration, suggesting a possible role in alleviation of IC symptoms.

• Analysis of urinary fungal mycobiome in patients with bladder pain and urinary urgency revealed specific fungal community patterns correlated independently with urinary urgency and bladder pain symptoms and that loss of mycobiome diversity correlated positively with symptom severity.

• Genetic linkage analysis of patients with IC/BPS identified variants on chromosome 3 as a potential contributor to IC/BPS predisposition.

• Analysis of mast cell subtypes in patients with IC/BPS showed proliferation and activation of mast cells in a subset of patients with IC, suggesting a potential to develop treatment strategies specific to patients’ mast cell subtype.

• A subgroup of patients with IC/BPS and low anesthetic bladder capacity had a distinct mucosal gene expression profile, suggesting a phenotype potentially amenable to specific treatment strategies.

• A feasibility study of a male chronic genital pain clinic for men with chronic unexplained orchalgia provided rapid access to specialized expertise that led to identification of specific scrotal pathology and effective treatment, which reduced costs of managing the condition.

• Microdenervation of the spermatic cord for post-vasectomy pain syndrome led to successful and durable pain relief in 71% of patients, including those with multiple scrotal structures and those who had not benefited from prior procedures for the pain syndrome.

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