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Male Human Papilloma Virus Infections: How to Prepare for Vaccination Strategies

Urogenital Tract Infection.2024;19(1):1-2. doi:10.14777/uti.2024.19.1.1

Human papillomavirus (HPV) infections are linked to benign and malignant urogenital conditions, with varying risks associated with different HPV genotypes.Genital warts, mainly caused by low-risk HPV types, have seen a recent surge in incidence, leading to escalating medical costs. While vaccines like Cervarix and Gardasil target females, the exclusion of Gardasil 9 raises questions about gender-neutral vaccination strategies. Studies highlight potential cost savings through male HPV vaccination but note the rising prices of HPV vaccines, particularly Gardasil 9. Recent findings underscore HPV's expansion into nasopharyngeal cancer, urging the introduction of male HPV vaccination programs.However, the increasing vaccine costs raise concerns about accessibility and affordability. Regulatory bodies and healthcare stakeholders must address these challenges to ensure equitable HPV prevention and control measures. Efforts to control vaccine pricing and promote comprehensive immunization strategies are crucial in mitigating the growing burden of HPV-related diseases.

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Pelvic Pain in Men with Mycoplasma Genitalium

Yumi SEO

Urogenital Tract Infection.2024;19(1):16-23. doi:10.14777/uti.2024.19.1.16

Purpose: There are debates about Mycoplasma genitalium (M. genitalium) causing prostate infection and inducing pelvic pains. Consequently, M. genitalium-associated pelvic pains were characterized and their manifestation in male pelvic pain syndrome (MPPS) was evaluated through a case-control study. Materials and Methods: The presence of M. genitalium-associated pelvic pains was examined in 113 M. genitalium-infected men, and the typical presentations of mycoplasma-associated MPPS were characterized through a case-control study involving 80 mycoplasma-infected and 234 case-matched uninfected controls. Finally, changes in symptoms following antimicrobial treatments were compared between 27 cured and 14 persistently infected cases. Results: Pain locations from 113 men were followed as items-1a for 25.7%, 1b for 21.2%, 1c for 31%, 1d for 18.6%, 2a for 59.3%, and 2b for 23% from the Korean National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire. In addition, the sum scores from the pain domain, voiding domain and total score were 6.68±4.75, 2.69±2.66, and 15.00±8.66, respectively.Successful antibiotic therapy significantly reduced the total score from baseline (15.148±6.798 vs. 5.357±7.025, p=0.001). From the case-control study, mycoplasma-infected men had pains more frequently during urination (1c) and on the tip of the penis (2a) (all p=0.0001) than the controls. Conclusions It was found that M. genitalium infection is associated with clinically significant male pelvic pains, which improved with adequate antimicrobial therapies. Urethral irritation symptoms without pyuria may be the typical characteristics of mycoplasma-associated pelvic pains in MPPS.

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Is Routine Voiding Cystourethrogram Necessary Following Endoscopic Subureteral Injection for Primary Low-Grade Vesicoureteral Reflux?

Jun-Koo KANG ; Min Ji PARK ; Min Hyun CHO ; Jun Nyung LEE

Urogenital Tract Infection.2024;19(1):10-15. doi:10.14777/uti.2024.19.1.10

Purpose: An endoscopic subureteral injection (EI) using a bulking agent is a highly successful surgical procedure, particularly for low-grade vesicoureteral reflux (VUR). Despite the serious adverse effects, routine voiding cystourethrogram (VCUG) to determine radiographic success after EI remains controversial. This study evaluated the necessity of routine postoperative VCUG in children with primary low-grade VUR. Materials and Methods: From January 2016 to August 2021, children who underwent EI for primary low-grade (I-III) VUR with a history of febrile urinary tract infection (fUTI) were analyzed retrospectively. From January 2016 to July 2018, routine VCUG following EI was performed on all children. Thereafter, postoperative VCUG was performed only if indicated. Clinical success was defined as no fUTI during a 12-month follow-up, and radiographic success was defined as the disappearance of VUR on postoperative VCUG. The clinical and radiographic outcomes in both groups were compared. Results: Thirty-six children were analyzed in this study. Three children (8.3%) experienced postoperative fUTI. In the routine group, clinical and radiographic success was observed in 16/17 (94.1%) and 15/17 (88.2%), respectively. Two children in the routine group experienced radiographic failure. Among these, one child showed clinical success, and the other underwent additional EI due to clinical failure. Of the indicated group, clinical failure was observed in 2/19 (10.5%). Of them, persistent VUR was identified in one child. Conclusions Clinical and radiologic success after EI for primary low-grade VUR is high, and routine VCUG for confirming radiographic success has a limited impact on the clinical course.

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Does Music Have a Calming Effect on Pain and Anxiety in Patients Undergoing Cystoscopy?

Ye Chan JOO ; Ji Eun YU ; Jae Hyun BAIK ; Young Seop CHANG ; Jin Bum KIM ; Hyung Joon KIM ; Dong Hoon KOH ; Hong Wook KIM

Urogenital Tract Infection.2024;19(1):3-9. doi:10.14777/uti.2024.19.1.3

Purpose: Cystoscopy is a diagnostic test performed frequently in urology outpatient clinics. Despite the large number of inspections, the associated pain, discomfort, or anxiety can markedly affect patient compliance and adherence to subsequent surveillance protocols. This study conducted a prospective, randomized study to investigate the potential efficacy of music and pyuria on pain or anxiety during outpatient cystoscopy. Materials and Methods: In this single-institution, randomized study, the participants were assigned to a music-intervention or non-music control group. The music-intervention group underwent an identical procedure with the addition of Johann Sebastian Bach’s “Air on the G String” from Suite No. 3 in D major, BWV 1068. Urinalysis was performed to determine if pyuria affects pain during the procedure. Results: The patient-reported outcomes, encompassing the changes in the STAI-X-1 (State-Trait Anxiety Inventory-X-1) scores, subjective levels of discomfort, embarrassment, satisfaction, and pain, were similar in the two groups. In contrast, the surgeons reported statistically significant differences in their evaluations of the same items as patient-reported outcomes of the two groups. The patient-reported pain showed no significant differences between the pyuria-negative group (0-2 and 3-5 WBC/HPF) and pyuria-positive group (>5 WBC/HPF). Conclusions The data from this study do not support the hypothesis that musical intervention during cystoscopy alleviates pain or anxiety to any significant extent.In addition, pyuria did not affect the patient’s reported pain. Nevertheless, a notable impact was observed in the surgeons’ assessments, suggesting that the musical accompaniment may alter the surgeons’ perception of patient pain and anxiety levels throughout the procedure.

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Robotic Excision of a Huge Seminal Vesicle Cyst, Including Intracystic Papillary Adenoma, Saving Fertility

Tae Hoon OH ; Ill Young SEO

Urogenital Tract Infection.2024;19(2):40-43. doi:10.14777/uti.2024.19.2.40

A seminal vesicle cyst is a rare disease, and an intracystic papillary adenoma within the seminal vesicle is extremely rare. The diagnosis and treatment of these diseases are challenging because of the limited data. This paper presents a robotic excision of a huge seminal vesicle cyst, including an intracystic papillary adenoma, preserving fertility in a 40-year-old man.

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Hyperbaric Oxygen Therapy for the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Case Report

Kwang Jin KIM ; Yoonsuk LEE ; Yong Sung CHA ; Tae Wook KANG ; Hyun Chul CHUNG ; Hong CHUNG ; Hyun KIM ; Jae Hung JUNG

Urogenital Tract Infection.2024;19(2):44-47. doi:10.14777/uti.2024.19.2.44

Hyperbaric oxygen therapy (HBOT) was conducted on two male patients with chronic prostatitis/chronic pelvic pain syndrome who were resistant to conventional medical therapies. Both patients underwent 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 90 min/day, five days/week for four weeks) in a hyperbaric chamber. The follow-up period was three months. Although the patients reported a slight improvement in the pain domain of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) after HBOT, no changes were noted in the other domains of NIH-CPSI and International Prostate Symptom Score. No adverse events were encountered during or after HBOT.

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Trend Analysis of Sexually Transmitted Infection Treatments in Korea

Soeon PARK ; Byung Kyu HAN ; Sangrak BAE ; Seung-Ju LEE ; Jin Bong CHOI

Urogenital Tract Infection.2024;19(2):25-30. doi:10.14777/uti.2024.19.2.25

Purpose: The revision of the 2023 Guidelines for the Treatment of Sexually Transmitted Infections (STIs) has been released. Hence, it is necessary to analyze the current status of STI treatments in Korea. Materials and Methods: A questionnaire was distributed to urologists and gynecologists from December 2022 to January 2023 through an online survey program. Three hundred and forty-one urologists and 302 gynecologists responded to the questionnaire. Results: For Neisseria gonorrhea treatment, ceftriaxone 500 mg and 100 mg of doxycycline twice daily for seven days were most preferred by urologists (22.58%).The treatment most preferred by gynecologists (15.23%) was 500 mg of ceftriaxone and 1 g of azithromycin in a single dose. Both urologists and gynecologists generally treat Chlamydia trachomatis according to the treatment guidelines. For treating Mycoplasma genitalium, 29.03% of urologists preferred administering azithromycin at 500 mg once daily, followed by 250 mg for four days. In contrast, 33.11% of gynecologists preferred doxycycline 100 mg twice daily for seven days. Conclusions Most urologists and gynecologists followed the treatments recommended in the 2nd edition of the STI treatment guidelines, revised in 2016.As many treatment regimens have changed because of the recent increase in antibiotic-resistant STIs, there is a need to encourage them to follow the new treatment guidelines.

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Effect of Residual Stone Fragments on Patient-Reported Quality of Life after Endoscopic Kidney Stone Surgery

Sang Hee LEE ; Jun-Koo KANG ; Jae-Wook CHUNG ; Yun-Sok HA ; Jun Nyung LEE ; Seock Hwan CHOI ; Hyun Tae KIM ; Tae-Hwan KIM ; Eun Sang YOO ; Tae Gyun KWON ; Bum Soo KIM

Urogenital Tract Infection.2024;19(2):31-39. doi:10.14777/uti.2024.19.2.31

Purpose: This study examined the effects of residual fragments (RF) on the patient-reported quality of life (QOL) after kidney stone surgery, such as retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), using the Korean version of the Wisconsin Stone Quality of Life Questionnaire (K-WISQOL). Materials and Methods: The medical records of 156 patients who underwent RIRS or PCNL and completed the preoperative and postoperative K-WISQOL from January 2021 to September 2023 were analyzed retrospectively. The patients were divided into RIRS and PCNL groups by the surgical method. The participants completed the K-WISQOL within four weeks before and after treatment. The patients’ baseline characteristics, surgical outcomes, and K-WISQOL scores were compared according to the presence of RF in each surgical group. Results: Of the 156 patients, 95 underwent RIRS, and 61 underwent PCNL. In the RIRS group, the patients’ baseline characteristics and surgical outcomes were similar in the stone-free (SF) and RF subgroups. The changes in all K-WISQOL domain scores and total scores were similar in the two subgroups. In the PCNL group, the RF subgroup had a significantly higher proportion of staghorn stones, a significantly larger mean stone diameter and significantly longer operation time than those of the SF subgroup. But, the changes in all K-WISQOL domain scores and total scores were not significantly different between the two subgroups, as observed in the RIRS group. Conclusions This study showed that the presence of RFs after endoscopic kidney surgery did not affect the short-term patient-reported QOL regardless of the surgical methods.

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Urogenital Tract Infection Reaches a Global Audience

Koo Han YOO

Urogenital Tract Infection.2024;19(3):49-50. doi:10.14777/uti.24edi001

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Mechanistic Insights Into Persistent Bacterial Cystitis as a Basis for Vaccine Development: A Narrative Review

Karen SERRANO-AREVALO ; Manisha NASKAR ; Hae Woong CHOI

Urogenital Tract Infection.2024;19(3):60-72. doi:10.14777/uti.2448022011

Urinary tract infections (UTIs) are primarily caused by uropathogenic Escherichia coli (UPEC), which frequently lead to recurrent infections. These bacteria utilize several strategies to establish infection in the host; in particular, virulence factors such as fimbriae and α-hemolysin facilitate persistent infection, evade host immune responses, and minimize antibiotic exposure. To date, antibiotics have been the primary treatment for UTIs. However, an increasing emphasis has been placed on the need for UTI vaccines, with mucosal vaccine products now available in several countries. Additionally, vaccines targeting intracellular UPEC, utilizing adjuvants, are currently under development. Understanding the pathogenic mechanisms of uropathogens has enabled the development of new treatment approaches, paving the way for next-generation preventive and therapeutic methods that could effectively manage recurrent UTIs in the future.

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