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PubMed1990

The histology of interstitial cystitis.

Several studies have reported histologic findings in interstitial cystitis (IC) bladder biopsy specimens. However, these studies used a variety of criteria to define IC, which may explain the variation noted in the histologic changes. Clinical experience shows that these biopsy specimens are often not helpful in confirming the diagnosis. Our study was designed to examine the histologic features identified in bladder biopsy specimens from patients with IC and compare them with biopsy specimens from a control population. Although IC patients as a group had a higher incidence and degree of denuded epithelium, ulceration, and submucosal inflammation, none of these findings was pathognomonic. In addition, these findings occurred only in interstitial cystitis patients with pyuria or small bladder capacity. The inflammatory infiltrate seen in IC was composed predominantly of lymphocytes, with increasing numbers of plasma cells as the degree of inflammation increased. There was no specific predilection for the inflammatory infiltrate to be perineural. Submucosal inflammation was associated with denuded epithelium, ulceration, pyuria, and a clinical response to therapy suggesting a pathophysiologic relationship. Epithelial and basement membrane thickness, submucosal edema, vascular ectasia, fibrosis, and detrusor muscle inflammation and fibrosis were not significantly different in the IC and control patients. These findings suggest that IC is a chronic submucosal inflammatory disease, at least in those patients with small bladder capacities or pyuria. IC is best diagnosed from its clinical features; the histologic changes identified in the bladder biopsy play a supportive role in this diagnosis. Mast cells play a limited role in the diagnosis of IC.

Biopsy↗
PubMed1991

[Prophylactic antibiotics after transurethral resection of prostate].

We studied whether or not prophylactic use of antibiotics following transurethral resection of prostate (TUR-P) was needed. The subjects were 152 patients preoperatively passing sterile urine who underwent TUR-P. They were divided into three groups: 35 with no use of antibiotics (no prophylaxis group), 70 with one day use of antibiotics (one day-prophylaxis group) and 47 with use of antibiotics until pyuria disappeared (long term-group). The three groups did not differ in their rates of fever episodes (greater than or equal to 38.0 degrees C) during the first two weeks nor in the time of disappearance of pyuria. The no prophylaxis group and the one day-group differed statistically in their cumulative rates of bacteriuria (greater than 10(4) CFU/ml) on the postoperative third day: 4 patients (11.4%) in the no prophylaxis group and none in the one day group (p less than 0.01). On the 90th day, however, no significant difference was found in that rate: 22 patients (62.9%) in the no prophylaxis group and 32 patients (45.7%) in the one day group, 70% of the bacteria isolated from urine during the follow up were Gram positive cocci. The time to the elimination of pyuria was not influenced by the use of antibiotics. Our study suggests that postoperative antibiotics for patients passing sterile urine is not necessary following TUR-P.

Aged↗
PubMed1992

The dipstick test in the diagnosis of UTI and the effect of pretreatment catheter exchange in catheter-associated UTI.

We examined the value of the dipstick test for detecting pyuria and bacteriuria in the diagnosis of urinary tract infection (UTI). The dipstick esterase test could be quickly assessed and could easily detect leukocyte esterase in the urine. This was well correlated with the conventional sedimentation method. The dipstick nitrate reduction method for detecting bacteriuria, however, was not well correlated with the urine culture method. These findings suggested that the dipstick esterase test was a useful method for detecting pyuria in the diagnosis of UTI, but not the dipstick nitrate reduction method. Catheter-associated UTI is the most difficult category of UTI to treat and control. One of the reasons for this is the formation of biofilm around the indwelling catheter. We attempted to evaluate the effect of catheter exchange just before treatment of catheter-associated UTI with either 300 or 600 mg/day of levofloxacin, one of the newer quinolones. However, we are unable to find any apparent effect on the drug's efficacy.

Bacteriuria↗
PubMed1985

Cystitis with ureteral reflux caused by ureaplasma urealyticum.

The authors present a case of a fifteen-year-old boy with urgency, suprapubic pain, hematuria, and pyuria with negative routine urine cultures. Cystoscopy revealed gross cystitis, and VCUG showed bilateral reflux and ureteral dilatation. Renal arteriograms, percutaneous renal biopsy, and bladder biopsy also were performed. After finding a positive culture for Ureaplasma, therapy with doxycycline rendered the patient asymptomatic and reflux improved on follow-up VCUG. Ureaplasma urealyticum should be considered in patients with symptomatic pyuria and negative routine cultures. Ureteral reflux, reversible with appropriate therapy, may be part of the infectious process.

Adolescent↗
PubMed1986

Screening for urinary tract infection using Bac-T-Screen bacteriuria device.

The Bac-T-Screen was used to process 795 urine specimens. Tests for urine specimens took slightly more than two minutes. The Bac-T-Screen predicted with 99 per cent accuracy if a specimen was negative for bacteriuria or pyuria. Thus, approximately one half of all carefully collected urine specimens need no further laboratory culture. In addition, the Bac-T-Screen detected bacteriuria with a sensitivity of 96 per cent at the 10(5) CFU/ml level of probability. Pyuria (1 +) was detected with a sensitivity of 98 per cent. The Bac-T-Screen can be used in an office practice as well as in the clinical laboratory.

Bacteriuria↗
PubMed1990

Survey of genitourinary organisms in a population of sexually active adolescent males admitted to a chemical dependency unit.

Sixty-two males consecutively admitted to an adolescent chemical dependency unit for treatment over a one-year period were studied. When interviewed, all denied having urogenital symptoms. Forty-eight reported having had sexual intercourse. Of these 48, 34 were screened (urethral swab) for Neisseria gonorrhoeae, Chylamydia trachomatis, Ureaplasma urealyticum, and Gardnerella vaginalis. Eighteen of the 34 males who had complete screening were found to harbor one or more organisms: 3 had Chlamydia, 13 had Ureaplasma, and 11 had Gardnerella. In addition, 61 of the original 62 subjects were tested for serum antibodies to Treponema pallidum and for pyuria. No subjects were found to have syphilis. Pyuria was present in all subjects with Chlamydia but in only two with Ureaplasma or Gardnerella.

Adolescent↗
PubMed1977

Anaerobic bacteriuria in a male urologic outpatient population.

We screened 517 urine samples from male outpatients, many of whom had underlying urinary tract pathology, for anaerobic and aerobic bacteriuria. Of the 153 specimens containing greater than 10(5) bacteria per ml. 20% yielded anaerobes only and an additional 6% revealed mixed anaerobic and aerobic growth. Pyuria was found more frequently in samples containing anaerobic bacteriuria than in those containing no growth but not as frequently as when aerobic bacteria were present. The high counts of anaerobic bacteria in first-voided specimens compared to midstream and post-prostatic massage aliquots suggested a urethral source for most bacteria. However, suprapubic aspiration of bladder urine demonstrated the organism in 2 of 10 patients with high numbers of anaerobes and pyuria in voided samples.

Aerobiosis↗
PubMed1984

Measurement of urinary leukocyte esterase activity: a screening test for urinary tract infections.

We evaluated the efficacy of testing for the presence of esterase (an enzyme released only from leukocytes) in the urine as an indicator of the presence of pyuria. We hypothesized that a "dipstick" test for urinary leukocyte esterase activity would be a rapid and simple screening technique for detecting urinary tract infections (UTI). To test our hypothesis we collected fresh urine specimens from 203 patients (148 outpatients, 55 inpatients) with a suspected UTI. Each specimen was divided into three aliquots; one was used for reagent strip testing (for leukocyte esterase, nitrite, and blood), one for microscopy, and one for culture. Of the 203 specimens, 49 showed significant bacteriuria (greater than or equal to 10(5) organisms/mL). The leukocyte esterase test was 100% sensitive (0% false negatives) with a 76% specificity (24% false positives) in predicting significant bacteriuria. Although a positive nitrite reaction was more specific (99% specificity, 0.6% false positives), it was insensitive (27% sensitivity, 73% false negatives). The high sensitivity of reagent strip leukocyte esterase testing for pyuria makes it a valuable screening test that should lead to the elimination of many needless urine cultures and microscopic examinations.

Adult↗
PubMed1985

Urinary infection in adult men: a laboratory perspective.

During a 10-week period all mid-stream urine specimens from males aged 15 years and upwards, excluding hospital in-patients, with symptoms suggesting urinary tract infection were examined by techniques capable of detecting aerobes and fastidious organisms. Five hundred and eighty-five such specimens were received; 85% were sent by general practitioners and 182 were from men aged less than 45 years, indicating that urinary symptoms are commoner in young men than is usually believed and that diagnosis and treatment are usually undertaken by general practitioners. One hundred and seventy-nine specimens yielded aerobic pathogens and 140 yielded fastidious organisms; 70% of the former and 33% of the latter showed pyuria. Only 12% of the 196 specimens showing pyuria yielded a negative culture. The possibility of prostatic infection and its relevance to treatment are discussed. Some post-treatment data are presented.

Adolescent↗
PubMed1991

Prognostic factors in the conservative treatment of ureteric stones.

A prospective study was made of 125 ureteric stones in order to detect factors which would predict the successful outcome of conservative treatment. The factors studied were the duration of pain prior to presentation, pyuria, haematuria, surface regularity of the stone and the degree of obstruction as seen radiologically. In stones less than or equal to 10 mm in size, conservative treatment was successful when the duration of pain was less than 30 days (39/45), when there was no significant pyuria (53/82), when the stones had an irregular surface (44/65) and when obstruction was only partial (55/88). Since most of these factors were interactive, further statistical analysis showed that duration of pain was the only significant factor in predicting the outcome of conservative treatment. In stones greater than 10 mm in size these factors had no predictive value and only 2/23 were passed spontaneously on conservative treatment.

Hematuria↗
PubMed1988

Detection of urinary tract infections by rapid methods.

A review of rapid urine screens for detection of bacteriuria and pyuria demonstrates a number of available alternatives to the culture method. Selection of one or more of these systems for routine use is dependent upon the laboratory and the patient population being tested. The laboratory approach to the diagnosis of urinary tract infection should consider the clinical diagnosis of the patient whenever possible. Keeping in mind that quantitative urine cultures alone cannot be used to detect infection in some patient populations unless lower colony counts are considered, a rapid screen may be a more practical approach. It has become accepted that 10(5) CFU/ml can no longer be used as the standard for all patient groups, that pyuria often is important in making the diagnosis of a urinary tract infection, and that most of the rapid screens are more sensitive than the culture method at 10(5) CFU/ml. Presently, no one approach can be recommended for all laboratories and all patient groups. However, each diagnostic laboratory should select one approach which is best for its situation. It is not practical, efficient, or cost effective to define a protocol for each possible clinical condition; however, all should be considered when developing a protocol. This protocol should be compatible with the patient population and communicated to the physicians. Use of a rapid screen should be beneficial to the patient, the physician, and the laboratory.

Bacterial Infections↗
PubMed1986

Aetiology of urinary symptoms in sexually active women.

Two hundred and fifty six unselected women, 50 of whom had urinary symptoms (frequency of urination or dysuria, or both), and who were attending a department of genitourinary medicine, were investigated. The urinary symptoms were associated both with pyuria and the isolation of undoubted pathogens from midstream urine (MSU) specimens. No associations were found between urinary symptoms and the isolation of Neisseria gonorrhoeae or Chlamydia trachomatis from the urethra or cervix; the recovery of Mycoplasma hominis from the urethra, cervix, or MSU; the recovery of Trichomonas vaginalis or Candida albicans from the vagina; or the presence of bacterial vaginosis. Urethral leucocytosis was associated with the isolation of T vaginalis but not with the recovery of N gonorrhoeae, C trachomatis, C albicans, or urinary pathogens. Pyuria was associated with the isolation of urinary pathogens and with the presence of trichomoniasis; it was not associated with the recovery of C trachomatis or M hominis.

Adolescent↗
PubMed1977

Urinary tract infections in childhood: the place of the nitrite test.

The effectiveness of the nitrite test available on the N-Multistix (Ames Co.) was compared with that of the microscopic examination of urine as a screening test for the detection of urinary tract infections in children presenting to a general paediatric clinic. The nitrite test gave a positive result in 59% of children with urinary infections, while microscopic pyuria (more than 50 white blood cells per cubic millimetre of uncentrifuged urine) was found in 72% of the same group. Of children who did not have a urinary tract infection, 2.8% had microscopic pyuria compared with only 0.2% who showed a false-positive nitrite test result. The ease and rapidity of the nitrite test make it a useful screening test for the presumptive diagnosis of urinary tract infections, and in certain circumstances it is preferable to the conventional microscopic examination of urine. However, as in the case of microscopic examination, urine culture must always be performed to avoid missing the urinary infections that are not detected by the screening test.

Bacteriuria↗
PubMed1986

Urinalysis and urine culture in women with dysuria.

In caring for women with acute dysuria, clinicians traditionally have relied on clinical findings to distinguish between acute pyelonephritis and "cystitis"; they have ordered urinalysis and urine culture regularly for patients with suspected acute pyelonephritis and ordered these tests inconsistently for patients with suspected "cystitis." Recent evidence indicates that "cystitis" may actually be any of six different clinical conditions, each of which is managed differently; subclinical pyelonephritis, lower urinary tract bacterial infection, chlamydial urethritis, other forms of urethritis, vaginitis, or dysuria without any urinary tract or vaginal infection. The distinction between these entities is made primarily from clinical findings. Urinalysis is also of great value in symptomatic patients; the presence of pyuria (and possibly indirect quantitation of pyuria by the leukocyte esterase test) is a reliable indicator of treatable infection, and its absence indicates infection is not present. In contrast, urine culture is of clear value only in patients with acute pyelonephritis or subclinical pyelonephritis.

Bacteriological Techniques↗
PubMed1990

[Asymptomatic bacteriuria in patients with diabetes mellitus].

The prevalence of asymptomatic bacteriuria and the relation of bacteriuria to pyuria, glycosuria and HbA1c in patients with diabetes mellitus were investigated. The study population included 110 diabetic patients and 100 healthy persons (control group). The ratio of bacteriuria was found as 25.5% (31.3% in women, 17.4% in men) in the diabetic group and as 9% (16% in women, 0% in men) in the control group. The prevalence of asymptomatic bacteriuria was significantly higher in the diabetic patients than in the control group (p less than 0.05). There was a significant relation between bacteriuria, pyuria and HbA1c levels (p less than 0.05). But, there wasn't any important correlation between bacteriuria and glycosuria.

Bacteriuria↗
PubMed1989

[Urinary tract infection associated with urinary calculi. 1. The significance of urinary tract infection in urinary calculi].

We investigated 158 cases of urinary stones (infection stones 56, metabolic stones 102) with special reference to pyuria, bacteriuria, stone culture and urease activities of isolated bacteria. Abacterial pyuria was noted in 9 out of 49 (18%) infection stones and in 53 of 77 (69%) metabolic stones. Bacteriuria was noted in 79% of the infection stones and 26% of the metabolic stones. Sixty-seven percent of the infection stones were infected with mainly urea splitting bacteria such as Proteus mirabilis and Staphylococcus. Twenty-three percent of metabolic stones were also infected. Though E. coli, a non-urea splitting bacteria, was isolated most frequently from metabolic stones, urease positive Staphylococcus and Pseudomonas were also isolated. Bacteria within stones could be predicted on the basis of urine culture results of only 20 of 41 infection stones and 8 of 24 metabolic stones. These facts are useful for selection of some antibiotics in the treatment of urinary tract infections associated with urinary calculi. Urinary infections of urea splitting bacteria in infection stones are thought to be initial factors of stone formation and those of non-urea splitting bacteria are to be superimposed. However, urea splitting bacteria in metabolic stones may convert them into infection stones in future.

Adult↗
PubMed1986

[Recurrence of acute uncomplicated cystitis--criteria for the evaluation of recurrence after antimicrobial chemotherapy].

UNLABELLED: The recurrence of female acute uncomplicated cystitis was investigated clinically. The criteria for the evaluation of recurrences were proposed, as follows; PATIENTS: Target infection is acute uncomplicated cystitis (AUC) which had satisfied the specifications of AUC Criteria by the UTI Committee of Japan and showed the excellent effects of an antimicrobial agent after a definite period of administration. Treatment period: Seven days; after 3 days' administration to evaluate the drug efficacy, patients shall take an additional 4 days' treatment. Interval of follow up proposed was 7 days. Evaluation of recurrence: Parameters of criteria are pyuria and bacteriuria. Recurrence: Pyuria greater than or equal to 10 WBCs/hpf and bacteriuria greater than or equal to 10(4)/ml. Evaluation of the day of recurrence: Evaluation should be made 14 days after the start of treatment. Urine sampling: After 7 days of treatment, midstream urine is collected and in cases with positive findings, catheterized urine should then be collected. Using these criteria it will be possible to evaluate and compare the ability of various antimicrobial agents to cure acute uncomplicated cystitis.

Acute Disease↗
PubMed1979

Urine microscopy and infection in general practice.

To test the value of urine microscopy 100 consecutive specimens were examined in the surgery and the results correlated with the subsequent laboratory culture reports.An assessment of the degree of pyuria was made by low power microscopy of a thick drop of fresh urine. A second specimen was examined under high power for the presence or absence of motile bacilli. The techniques used are described and quantified.The laboratory report was definitive in 88 of the 100 cultures. All the 33 specimens with 10(5) bacteriuria had some degree of pyuria and in 27 (82 per cent) motile bacilli had been found. In the 50 with no significant bacteriuria no motile bacilli had been seen in 38 (76 per cent).In these 88 specimens a diagnosis made in the surgery based entirely on bacterial microscopy would have been correct in 80 per cent, combined with cytological microscopy in 87 per cent, and with the addition of clinical features in 92 per cent.In the remaining 12 cases the laboratory report was inconclusive and would have made no difference to my conclusions.

Bacteriuria↗