EAU18 – Promising research in urological disease prevention
An ounce of prevention is worth a pound of cure. Cutting-edge prevention research was presented today in “Plenary Session 6 Preventing urological disease: Future prospects” which was chaired by Professors James N’Dow (GB) and Hein Van Poppel (BE).
Systematic review
There is a major risk of infectious complications following a prostate biopsy, according to a systematic review that investigated 165 studies with a total of 162,577 patients and showed a sepsis rate of 0.8% with a 95% confidence interval (CI) and hospitalization rate of 1.1% with a 95% CI.
In his lecture “Prevention of infectious complication after prostate biopsy: A Cochrane analysis”, Dr. Adrian Pilatz (DE) stated that the rate of infection is not significantly influenced by the number of biopsy cores, use of periprostatic nerve block, route of biopsy (transrectal, transperineal), and the type of antibiotic prophylaxis. He added, “There is a significant advantage in using rectal preparation with povidone-iodine and antibiotic prophylaxis for one to three days, and targeted antibiotic prophylaxis in in the future.”
Microbiota
“The investigation of microbiota in urine revealed a new world,” said Prof. Dr. Florian Wagenlehner (DE) in his lecture “Microbiota and Lower Urinary Tract Symptoms (LUTS): The new truth?”. Florian stated, “Soon after the start of the Human Microbiome Project, several groups looked into that in more detail. The paradigm that urine is sterile has shifted.”
Differences in age, gender, and disease enitities of the lower urinary tract are associated with different microbiota. “We don’t have any further evidence beyond that. It’s very difficult to reproduce microbiome studies. Different laboratories get different results. We have no evidence that there’s any causality. There’s no evidence to treat overactive bladder with antibiotics.
Urosepsis
“Early diagnosis of urosepsis is life-saving, decreases morbidity and mortality but the diagnostic tools we have are insufficient by themselves. However, we are not proposing not to use them at all. Diagnostic tools e.g. quick Sequential Organ Failure Assessment (qSOFA ) – EWS, should be used alongside comprehensive clinical evaluation,” stated Dr. Zafer Tandoğdu (GB). Adherence to antibiotic administration within the first hour of diagnosis is crucial and life-saving, and decreases organ failures. Dynamic assessment methods, as opposed to static assessment methods, are more valid and decreases morbidity and mortality.
Lifestyle
Assoc. Prof. Kari Tikkinen (FI) gave advice to prevent the most common urological disease in his lecture “Lifestyle factors and urological diseases”. “Don’t start smoking and if you already do, quit. Do your best to keep a normal, healthy weight. Avoid excessive red meat and processed food, and replace most soft drinks with water,” said Tikkinen. “And keep moving! There’s plenty of benefits in regular physical activity.”