Objective:To investigate the distribution characteristics of urinary tract pathogens in patients with community-acquired urinary tract infection and their sensitivity to nenoxacin and levofloxacin.Methods:This prospective, multicenter clinical trial included patients with community-acquired urinary tract infection who were admitted to urological clinics at 9 clinical research centers from November 2021 to August 2022.Inclusion criteria: Patients aged 18-70 years with community-acquired acute uncomplicated cystitis(AUC), recurrent acute episodes of urinary tract infection(rUTI), and non-febrile complicated urinary tract infection(cUTI) with signs of urinary tract irritation and abnormal elevation of routine white blood cells in urine. Exclusion criteria: ①Patients who received effective antimicrobial therapy within 72 h before enrollment and lasted for more than 24 h. ②Fever (>37.3℃) or symptoms of upper urinary tract infection such as low back pain, tapping pain in the kidney area, etc. ③Indwelling urinary catheter. At the first visit, clean midstream urine samples were taken for bacterial culture, and the distribution characteristics of urinary pathogens of different types of urinary tract infections were analyzed. Extended spectrum β-lactamases (ESBLs) were measured for Gram-negative bacteria. The susceptibility of nenoxacin and levofloxacin to urinary tract pathogens was determined by disk diffusion method. Drug resistance rate, sensitivity rate were analyzed between different disease groups.Results:There were 404 enrolled patients from 9 hospitals, including 364 (90.1%) females and 40 (9.9%) males. A total of 177 strains of pathogenic bacteria were isolated, among which the highest proportion of Escherichia coli was 66.1% (117/177).Klebsiella pneumoniae was followed by 6.8% (12/177) and Streptococcus agalactis 5.1% (9/177). The bacterial spectrum distribution of AUC and rUTI were similar, and the proportions of Escherichia coli were 70.6% (85/119) and 65.9% (29/44), respectively. However, the proportions of Escherichia coli isolated from cUTI patients were only 28.6% (4/14) and Enterococcus faecalis 7.1%(1/14). The overall detection rate of ESBLs in Gram-negative bacteria was 30.9%(43/139). The sensitivity rate of nenoxacin was 74.6%(91/122), and the resistance rate was 25.4%(31/122). The overall sensitivity rate of levofloxacin was 44.9%(70/156) and the resistance rate was 36.5%(57/156). The rate of resistance of urinary tract pathogens to levofloxacin was 48.2% (27/56) in patients with previous urinary tract infection history, and 30.0% (30/100) in patients with no previous urinary tract infection history, the difference was statistically significant( P=0.023).The sensitivity rate of Gram-negative bacteria to nenofloxacin was 70.7% (65/92) and that to levofloxacin was 50.0% (46/92, P<0.001). The sensitivity of Gram-positive bacteria to nenofloxacin was 80.0% (16/20), and that to levofloxacin was 70.0% (14/20, P=0.009). Conclusions:The bacterial profile of out-patient community acquired urinary tract infection varies greatly according to different diseases. The proportion of Escherichia coli in AUC and rUTI patients is higher than that in cUTI. The detection rate of ESBLs in Gram-negative bacteria was lower than the domestic average.Patients with a history of urinary tract infection had a high risk of treatment failure with levofloxacin. The sensitivity of common urinary tract pathogens to nenofloxacin was higher than levofloxacin.

Solitary fibrous tumor is a rare mesenchymal tumor associated with NAB2-STAT6 fusion gene, which is rarely seen in kidney. A 16-year-old boy was hospitalized because of left back pain for more than 3 years. Abdominal CT/MRI identified a huge space-occupying lesion in the left kidney. Laparoscopic radical left nephrectomy was performed initially. Nevertheless, laparoscopic-to-open procedure was adopted due to the huge size of the tumor. The pathological diagnosis was renal solitary fibrous tumor. The symptoms of the patient disappeared and no recurrence was observed at the 2-month follow-up after the surgery.

The pathogenicity of Chlamydia and Mycoplasma in some non sexually transmitted infectious diseases in urology department is unknown. In this paper, the characteristics of related pathogens, detection methods and the related research on their pathogenicity in clinical diseases such as non-specific cystitis, sterile pyuria, lower urinary tract symptoms and upper urinary tract infection are reviewed to guide clinical practice.

Objective:To discuss the clinical management, such as characteristics, surgical timing and rational application of antifungal drugs in patients of upper urinary calculi with fungal infections.Methods:A retrospective analysis was performed on 4 patients with fungal infections during the treatment of upper urinary calculi from April 2017 to April 2019. Case 1, male, 55 years old, was admitted to the Department of Nephrology due to febrile urinary tract infection. Right ureteral stone was found during antibacterial treatment. Fever and fungal sepsis occurred after transurethral ureteroscopic lithotripsy. Case 2 Female, 48 years old, frequency and urgency occurred after percutaneous nephrolithotomy of right kidney in another hospital. Urine routine WBCs were full of vision, urine culture was Candida albicans, symptoms disappeared after 2 weeks of oral fluconazole 200 mg QD treatment, urine culture turned negative, discontinued fluconazole symptoms recurred in about 2-4 weeks and the urine culture turned positive, the condition was repeatedly for 1 year. The CT showed multiple small stones in both kidneys. Case 3 Male, 74 years old, frequency, urgency, and dysuria occurred after flexible ureteroscopic holmium laser lithotripsy of left kidney. Urine routine WBCs were full of vision, urine culture was Candida albicans. Symptoms slightly after 2 weeks of oral fluconazole 200 mg QD treatment according to drug sensitivity, but urine culture did not turn negative, discontinued fluconazole symptoms increased. The condition was lasted for one and a half years. His CT showed left kidney lower calyx stones. Case 4 male, 47 years old, frequency, urgency, and dysuria occurred after the surgery of left kidney stone for half a year. Urine routine WBCs were full of vision, urine culture was Candida tropicalis, combined with left kidney cast stones.Results:Case 1, male, 55 years old, was admitted to the Department of Nephrology due to febrile urinary tract infection. Right ureteral stone was found during antibacterial treatment. Fever and fungal sepsis occurred after transurethral ureteroscopic lithotripsy. Case 2 patient was performed bilateral ureteral stent placement for drainage, and two weeks after the oral fluconazole 200 mg QD, she was performed bilateral flexible ureteroscopic lithotripsy, then the urinary fungal infection was cured. Case 3 patient was performed left side ureteral stent placement and amphotericin B and fluconazole antifungal therapy. After his body temperature was normal, he was performed flexible ureteroscopic holmium laser lithotripsy, after the surgery the oral fluconazole 200 mg QD time was just 1 week, resulting in the formation of fungal balls in the left renal pelvis and secondary surgery. Oral fluconazole 200 mg QD combined with fluconazole continuous intraperitoneal perfusion ultimately 1 week cured him after and secondary surgery. Case 4 patient was performed percutaneous nephrostomy drainage and oral fluconazole 200 mg QD for 2 weeks. Then he was performed percutaneous nephrolithotomy lithotripsy, oral fluconazole 200 mg QD was continued until the stent was removed and urine culture turned negative, patient was cured. Case 4 patient had fungal bloodstream infection after ureteroscopic holmium laser lithotripsy. The temperature was normal after intravenous drip of fluconazole 200 mg QD antifungal therapy, and fungal endophthalmitis occurred in ophthalmology 1 week after discharge.Conclusions:Diabetes could be a high risk factor for upper urinary calculi complicated with fungal infection. It is difficult to control the fungal infection without stone removed and it is easy to relapse after surgery. Stones should be removed on the basis of antifungal therapy, and antifungal therapy should be continued after surgery at least 2 weeks after urinary stent removal. If fungal bloodstream infections is diagnosed, eye examination should be done to screen for endophthalmitis to determine if there is tissue dissemination and determine the course of treatment.

Objective To detection the urine of bacteria hyphae and intracellular bacterial communities in patients with indwelling urinary catheter and discuss intracellular bacterial comnmunities in the pathogenesis of catheter-related urinary tract infection.Methods From May 2014 to February 2016,95 cases with D-J stent indwelling were enrolled in this study,including 38 male patients and 57 female patients.The mean age was (43 ±21)years old,ranging from 25 to 83 years old.We recorded those patient g clinical symptoms,middle urine culture results.If the middle urine culture was positive,further pathology test and scanning electron microscopy for bacteria hyphae and intracellular bacterial communities would be considered.Results The middle urine culture showed positive in 21 cases (22％,21/95);The classification of bacteria included E.coli in 11 cases,dung enterococcus in 2 cases,klebsiella pneumonia in 4 cases,pseudomonas aeruginosa in 3 cases,epidermis staphylococcus aureus in 1 case.Among those 21 patients,9 cases had the symptoms of fever and shiver.Urine pathology testing found hyphae in 6 cases (6％,6/95).all others were E.coli infection.For scanning electron microscope,6 cases were found rodshaped bacteria and hyphae.3 cases were found intracellular bacterial communities.Conclusions The presence of intracellular bacterial communities made urothelial itself the source of endogenous bacteria of urinary tract infection.Catheter-related urinary tract infections in patients with recurrence maybe basically homology bacteria.

Objective To establish computer assisted virtual ureteroscopy (VU) through data from computerized tomography urography (CTU) of patients with renal stones and make validation of effectiveness.Methods From June of 2015 to January of 2016,23 cases of renal stones cases was selected by 5 experts in 3 different centers.There were 21 unbilateral cases and 2 bilateral cases.The age ranged from 31 to 79(54.7 ± 12.5).Mean stone burden was (19.0 ± 6.2) mm.Stone number ranged from 1 to 5 (2.7 ± 1.2).VU generation was accomplished by specialized software (Crusher) with incorporating CTU data.After patientspecific VUs were presented to the experts,and the FURS surgeries were all finished successfully,face and content validations about VU using modified Likert questionnaire ordinal 10-point rating scales were made.20 trainee were selected to do the flexible ureteroscopy lithotripsy with assistance of VU.After observation of CTU and VU,the numbers of renal calyces and stones found by the experts and trainees were recorded.The statistical analysis were made before and after observation of VU between the experts and trainees.Result Face and content validation of VU:overall usefulness 7.6 ± 0.5,graphics 7.6 ± 0.5,intrarenal collecting system 8.4 ± 0.5,stone details 8.4 ± 0.5,usefulness in surgical planning and training 8.0 ± 0.7.Significant improvement was found when the trainees doing the surgery with the help of VU.Compared with using CTU only,VU could help the trainees had better understanding of intrarenal structure and stone information [the number of calyces (16.7 ±3.7)vs.(24.6 ± 1.8),P ＜0.001;the number of stones (4.9 ± 1.4)vs.(8.2 ± 1.3),P ＜0.001].Before observation of VU,trainees found much fewer calyces and stones compared with experts (P =0.004 and P ＜ 0.001 respectively).However,this gap disappeared after VU observation (P =0.327 and 0.292 respectively).Conclusions Establishing computer assisted VU through CTU data from renal stone patients is feasible and rapid.VU can significantly improve trainee's view of intrarenal collecting system and stone information before practicing FURS.

Objective To introduce the surgery procedure of pin-shaped bipolar plasmakinetic transurethral en bloc resection of non muscle-invasive bladder urothelial carcinoma and investigate the clinical outcomes.Methods 42 cases of non muscle-invasive bladder urothelial carcinoma who received bipolar plasmakinetic transurethral en bloc resection from May 2015 to March 2016 were recruited in the present study.Male 29 cases, female 13 cases, average age 52-82 years old, average (65.6 ±12.3) years old.Wide basal tumors were noticed by preoperative cystoscopy, bladder tumors were confirmed by tumor biopsy.Full-thickness specimens were obtained in procedures, including tumor, mucosa, lamina propria layer, muscular layer, to accurately assess tumor infiltration depth and staging.Results All 42 cases were done by this procedure successfully.A total of 65 pieces of tumors were excised:36 in lateral wall, 19 in posterior wall, 10 in bladder triangle.Tumor diameter ranged from 0.5 to 3.5 cm, with an average (2.1 ± 0.6) cm.Postoperative pathological stages were clear:16 cases were Ta stage and 49 cases were T1 stage ( of which 32 were T1 G3 ) .Intraoperative obturator nerve reflex happened in 2 cases.Followed up for 2-11 months, average 6 months.Tumor recurrence in 3 cases, no progression case.Conclusions Pin-shaped bipolar plasmakinetic electrode transurethral en bloc resection of non muscle-invasive bladder urothelial carcinoma is safe and reliable and should be recommended in management of non muscle-invasive bladder urothelial carcinoma.Full-thickness postoperative specimens can provide accurately judgement of the depth of tumor invasion and pathological staging.

Objective To assess the efficacy and safety of oral fosfomycin trometamal in patients with lower urinary tract infections ( UTIs) caused by multi drug resistant ( MDR) bacteria in the clinical setting in China.Methods Multicenter study was conducted from January 2011 to December 2011 in 12 hospitals in China.Three hundred and fifty-six patients with non-fever lower UTls were treated by fosfomycin trometamal 3 g once daily.Three hundred and fifty cases with complete data were further evaluated .One hundred and twenty ( 34.3%) were male and 230 ( 65.7%) were female.The average age was ( 49.9 ± 16.6) years.Depending of the results of urine culture at the first visit ,142 patients with E.coli, Klebsiella pneumonia, proteus, Staphylococcus aureus, Staphylococcus epidermidis and entercocous were analyzed.The susceptibility of MDR bacteria to fosfomycin trometamol were calculated . The clinical efficacy , bacteriological efficacy of fosfomycin trometamol to these patients was evaluated .Results For the gram-negative bacteria detected by culture , among the E.coli, Klebsiella pneumonia and proteus, 50%(52/104) were Extended-Spectrum β-lactamases producing organisms . For the gram-positive bacteria ( n =38 ) detected by culture, methicillin-resistant staphylococcus accounts for 55%(11/20) of all the Staphylococcus and the other gram-positive bacteria were Enterococcus ( n=18 ) .Higher susceptibility rates to fosfomycin trometamol were observed among MDR bacteria (85.7%) and the clinical effective rate and bacteriological effective rate of fosfomycin trometamol were 96.4%( 53/55 ) and 87.5%( 42/48 ) , respectively .The incidence of drug-related adverse events (AEs) was 5.6%(20/356).The most common AE was diarrhea. No drug-related serious adverse events were found .Conclusions The distributions of uropathogens in China are complicated. The detection rate of MDR uropathogens is high . The dosing regimen of fosfomycin trometamal 3 g once daily is effective and tolerable for the patients with lower UTIs caused by MDR bacteria . It may represent good options for the empiric therapy for the patients with lower UTIs .

Objective To observe the incidence and transformation of pyuria and bacteriuria in different time point after TURP and supply the evidence for antibiotic application.Methods From March,2011 to May,2012,84 patients with BPH admitted in our hospital.Their ages ranged from 61 to 87 years old,mean (71.9±7.6) years.The volume of prostate in those patients ranged from 27.8 to 118 ml,mean (70.8±24.1) ml.The procedure of TURP was undergone in all of them.In one week after the operation,two urine specimens from each patient,one for urine routine examination and one for urine culture,were collected 24 h after the catheter have been withdrawn.The catheter was also cultured.During the following-up,urine routine examination and urine culture were regularly performed in 1,2,3 months after surgery.If the patient had both pyuria and bacteriuria,he should be excluded the study.Results The pyuria rate on one week,one month,two months and three months were 54.8％ (46/84),100.0％ (82/82),65.8％ (48/ 73),34.2％ (25/73),respectively.There is a significance difference among those groups (P＜0.05).It seemed that the pyuria would appear in all patients.However,the incidence would gradually decrease.It seemed that the pyuria has the tendency of self-recovery.A significant difference of prostatic resection volume after 3 months could be observed in the pyuria group (31.4±15.2 ml) and non-pyuria group (24.8±11.6 ml) (P＜0.05).The bacteriuria rate on one week,1,2,3 months were 7.1％ (6/84),11.0％ (9/82),6.8％ (5/73)and 0,respectively.There is no significance difference among the groups (P＞0.05).Conclusions Pyuria will appear after TURP and the incidence reduced gradually following the time.The pyuria alone without the bacteriuria may be explained by inflammation,that antibiotics were unnecessary.The bacteriuria alone without the pyuria may be considered as asymptomatic bacteriuria or bacterial colonization,antibiotics were unnecessary,either.

Objective To evaluate the clinical features and renal morphological changes of the patients with urinary tract infection associated ureteral stent.Methods From Oct.2012 to May.2013,21 patients were divided into three groups depending on the different conditions:Group A (n=7):patients who had febrile urinary tract infections associated with ureteral stents; Group B (n =7):patients with ureteral stents but no fever; Group C (n=7):patients who had febrile urinary tract infections but no ureteral stent.The clinical data,laboratory data and 99Tcm-dimercaptosuccinic acid (DMSA) renal scintigraphy results were recorded prospectively and analyzed.Results In Group A,there were two patients had flank pain and positive costovertebral angle percussion tcnderness.The mean value of white blood cells and Hs-CRP of Group A and Group C were obviously higher than Group B (P＜0.05).The ratios of pyuria were 100.0％,71.4％ and 100.0％ in Group A,B and C.The ratios of positive urine bacteuria culture were 100.0％,42.9％ and 100.0％ in Group A,B and C.The results of 99Tcm-DMSA renal scintigraphy demonstrated the decreased uptake in the different portion of the kidneys on the sides of ureteral stents inserted in all the patients in Group A but no such changes in Group B and Group C.Conclusions 99Tcm-DMSA renal scintigraphy can be used to judge the status of urinary tract infection associated ureteral stent.The febrile urinary tract infection associated with ureteral stents always means pyelonephritis occurs and prompt treatment must be given.