No abstract

No abstract

A functional and well-balanced immune response is required to resist most infections. Slight dysfunctions in innate immunity can turn the 'friendly' host defense into an unpleasant foe and give rise to disease. Beneficial and destructive forces of innate immunity have been discovered in the urinary tract and mechanisms by which they influence the severity of urinary tract infections (UTIs) have been elucidated. By modifying specific aspects of the innate immune response to UTI, genetic variation either exaggerates the severity of acute pyelonephritis to include urosepsis and renal scarring or protects against symptomatic disease by suppressing innate immune signaling, as in asymptomatic bacteriuria (ABU). Different genes are polymorphic in patients prone to acute pyelonephritis or ABU, respectively, and yet discussions of UTI susceptibility in clinical practice still focus mainly on social and behavioral factors or dysfunctional voiding. Is it not time for UTIs to enter the era of molecular medicine? Defining why certain individuals are protected from UTI while others have severe, recurrent infections has long been difficult, but progress is now being made, encouraging new approaches to risk assessment and therapy in this large and important patient group, as well as revealing promising facets of 'good' versus 'bad' inflammation.

Purpose Biofilm infections have a major role in implants or devices placed in the human body. As part of the endourological development, a great variety of foreign bodies have been designed, and with the increasing number of biomaterial devices used in urology, biofilm formation and device infection is an issue of growing importance. Methods A literature search was performed in the Medline database regarding biofilm formation and the role of biofilms in urogenital infections using the following items in different combinations: “biofilm,” “urinary tract infection,” “bacteriuria,” “catheter,” “stent,” and “encrustation.” The studies were graded using the Oxford Centre for Evidence-based Medicine classification. Results The authors present an update on the mechanism of biofilm formation in the urinary tract with special emphasis on the role of biofilms in lower and upper urinary tract infections, as well as on biofilm formation on foreign bodies, such as catheters, ureteral stents, stones, implants, and artificial urinary sphincters. The authors also summarize the different methods developed to prevent biofilm formation on urinary foreign bodies. Conclusions Several different approaches are being investigated for preventing biofilm formation, and some promising results have been obtained. However, an ideal method has not been developed. Future researches have to aim at identifying effective mechanisms for controlling biofilm formation and to develop antimicrobial agents effective against bacteria in biofilms.

What ' s known on the subject? and What does the study add? Clean intermittent catheterization (CIC) is considered the method of choice for bladder emptying when neurological or non-neurological causes make normal voiding impossible or incomplete. The outcome is overall good, also in the long-term. There is neither one best technique nor one best material, as both depend greatly on patients ' individual anatomic, social and economic possibilities. The most frequent complication is urinary tract infection (UTI). Studies differ in the defi nition criteria for UTI, methods for evaluation, CIC techniques, frequency of urine analysis, prophylaxis and patients studied.The study provides a literature review and shows that most studies do not have a high level of evidence. There are various risk factors for UTI and phenotyping them helps to assess prognosis by considering what can happen if treatment is not initiated. The study concludes, that the role of biofi lms in CIC deserves more attention and that diagnosis should be made on urine sample obtained with catheterization, because symptoms are often less reliable. It also concludes that treatment in those who catheterize for a long time is only necessary for symptomatic infections. The study identifi es the following areas for further research: prevention of UTI in patients performing CIC; the use of special catheter types; and the role of frequency of catheterization, prophylactic antibiotics and preservation of natural defence mechanisms in the lower urinary tract. OBJECTIVE• To review the factors related to urinary tract infection (UTI), the most prevalent complication in patients who perform clean intermittent catheterization (CIC). METHODS• We conducted a literature search then a group discussion to gather relevant information on aspects of UTI to guide future research and to help provide clearer recommendations for the prevention of UTI in patients performing CIC. RESULTS• UTI is a major complication of CIC, the incidence of which varies widely in the literature owing to differences in methodology and defi nitions.• Phenotyping the risk factors for UTI helps to assess prognosis by considering what can happen if treatment is not initiated. The role of biofi lms in CIC deserves more attention.• Diagnosis is made using the urine sample obtained by catheterization. Because of neurological or other defi ciencies in patients performing CIC, symptoms are less reliable. Thorough evaluation for the source of signs and symptoms should be made before attributing them to UTI.• There have been many different proposals for the prevention of UTI in patients performing CIC, but most need more research. The role of the type of catheter is unclear but further exploration of special catheter types might be worthwhile.• Treatment in those who perform CIC for a long time is best reserved for symptomatic infections. CONCLUSIONS• Several mechanisms are relevant in UTI related to CIC.• As UTI is prevalent, more research into its prevention is needed.