trimethoprim--sulfamethoxazole-drug-combination and Prostatic-Hyperplasia

Transurethral resection of the prostate (TURP) and Greenlight laser vaporisation (GL) of the prostate are frequently performed urological procedures. For TURP, a single-dose antimicrobial prophylaxis (AP) is recommended to reduce postoperative urinary tract infections. So far, no international recommendations for AP have been established for GL. In a survey-based study in Switzerland, Germany and Austria, urologists reported routinely extending AP primarily for 3 days after both interventions. We therefore aim to determine whether single-dose AP with cotrimoxazole is non-inferior to 3-day AP with cotrimoxazole in patients undergoing TURP or GL of the prostate.. We will conduct an investigator-initiated, multicentre, randomised controlled trial. We plan to assess the non-inferiority of single-dose AP compared to 3-day AP. The primary outcome is the occurrence of clinically diagnosed symptomatic urinary tract infections which are treated with antimicrobial agents within 30 days after randomisation. The vast majority of collected outcomes will be assessed from routinely collected data. The sample size was estimated to be able to show the non-inferiority of single-dose AP compared to 3-day AP with at least 80% power (1 - β = 0.8) at a significance level of α = 5%, applying a 1:1 randomisation scheme. The non-inferiority margin was determined in order to preserve 70% of the effect of usual care on the primary outcome. For an assumed event rate of 9% in both treatment arms, this resulted in a non-inferiority margin of 4.4% (i.e. 13.4% to 9%). To prove non-inferiority, a total of 1574 patients should be recruited, in order to have 1416 evaluable patients. The study is supported by the Swiss National Science Foundation.. For AP in TURP and GL, there is a large gap between usual clinical practice and evidence-based guidelines. If single-dose AP proves non-inferior to prolonged AP, our study findings may help to reduce the duration of AP in daily routine-potentially reducing the risk of emerging resistance and complications related to AP.. Clinicaltrials.gov, NCT03633643 . Registered 16 August 2018.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Drug Administration Schedule; Equivalence Trials as Topic; Humans; Laser Therapy; Male; Multicenter Studies as Topic; Prostatic Hyperplasia; Prostatic Neoplasms; Switzerland; Time Factors; Transurethral Resection of Prostate; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Transurethral microwave thermotherapy (TUMT) can be painful. Pain sensation limits treatment tolerance and consequently also treatment efficacy. Of our population of patients treated with TUMT, 22% (63/288) needed intravenous analgesia and, nevertheless, 6% (17/288) needed definitive treatment interruption. The aim of this study was to identify the mechanism of pain sensation during TUMT and to verify whether the prophylactic use of a sedative drug would improve treatment tolerance. Eighty-three patients undergoing TUMT treatment for benign prostatic hyperplasia at our department entered a prospective, randomized, single-blinded study. Thirty minutes before treatment, 40 patients (group A) received 960 mg cotrimoxazole orally while 43 patients (group B) received 960 mg cotrimoxazole and 10 mg oxazepam, both orally. Statistically significant improvement in treatment tolerance in group B in comparison with group A was found. Pain sensation during TUMT seemed to be mostly due to anxiety. It is concluded that the prophylactic use of a sedative drug is advisable in patients undergoing TUMT in order to improve treatment tolerance.

Topics: Analgesia; Conscious Sedation; Diathermy; Fentanyl; Humans; Male; Microwaves; Oxazepam; Pain; Prospective Studies; Prostatic Hyperplasia; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination

We studied 599 evaluable patients with benign prostatic hypertrophy at 7 urological units. Before transurethral prostatectomy the patients were randomized into 3 groups: group 1--197 patients given single-dose ceftriaxone (2 gm.), group 2--203 patients given 160/800 mg. trimethoprimsulfamethoxazole and group 3--199 controls given no antimicrobial prophylaxis. Patients with a preoperative indwelling catheter, positive urine culture, signs of active infection or preoperative antibiotic treatment were excluded. Postoperative infectious complications were demonstrated in 15 of 197 (7.6%), 25 of 203 (12.3%) and 43 of 199 (21.6%) patients in the study groups, respectively. The difference in infectious complications between groups 1 and 3 was statistically highly significant (p < 0.01) and between groups 2 and 3 it was significant (p < 0.05). Single-dose antibiotic prophylaxis proved to be useful in the prevention of serious infectious complications after transurethral prostatectomy.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Trimethoprim, Sulfamethoxazole Drug Combination

Transurethral resection of the prostate (TURP) surgery is standard treatment for symptomatic benign prostatic hyperplasia when medical therapy has failed. We describe a rare case of osteitis pubis secondary to a prostato-symphocoele sinus after standard bipolar TURP surgery. We also discuss diagnostic techniques and management strategies, and provide an insight into the aetiology of this rare phenomenon. Conservative management with intravenous antibiotics and an indwelling catheter was successful in our case. Treatment in more severe cases may include laparotomy with peritoneal or omental interposition or open retropubic radical prostatectomy to remove the entire sinus tract.

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Doxycycline; Humans; Magnetic Resonance Imaging; Male; Osteitis; Postoperative Complications; Prostatic Hyperplasia; Pubic Bone; Transurethral Resection of Prostate; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Vancomycin

300 consecutive TUR were prospectively examined bacteriologically. We used, lacking contraindications, Co-Trimoxazol as antibiotic prophylaxis, when urine at admittance was sterile, otherwise we treated the urinary infection. The antibiotics were applied from the beginning of the intervention until the catheter was removed. Of the 49 patients with a indwelling catheter 28 (57%) had an urinary infection. All but one were cured. 2 of 64 (3%) patients undergoing resection of a bladder tumour acquired asymptomatic nosocomial infection. 198 patients underwent TUR of the prostate with initially sterile urine. 7 patients suffered from fever in the postoperative course, in 6 cases the origin remained unclear. 3 patients showed an asymptomatic nosocomial infection. Overall, with antibiotic prophylaxis we found an infection rate of 2-5% for the TUR of the prostate and of 3% for the TUR of bladder. Primarily infected urine, in this study, did not elevate the risk for infectious complications.

Topics: Amoxicillin; Anti-Bacterial Agents; Bacteriuria; Clavulanic Acid; Clavulanic Acids; Drug Therapy, Combination; Humans; Male; Premedication; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Surgical Wound Infection; Trimethoprim, Sulfamethoxazole Drug Combination