Practice Policy Statement (BPPS) for Urodynamic Antimicrobial Prophylaxis in high-risk patients. Methods: After institutional review board approval, 489 patients who underwent urodynamics (UDS) in the absence of antibiotic prophylaxis were retrospectively reviewed. Patients were stratified according to the SUFU BPPS risk factors (neurogenic lower urinary tract dysfunction [NLUTD], elevated postvoid residual [PVR], immunosuppression, age over 70, catheter use, and orthopedic implants). χ 2 , Fisher's exact test, Student t test, and univariate and multiple logistic regression analyses were used to assess the associations between these risk factors and postprocedural urinary tract infection (UTI). Results: Twenty-two (4.5%) patients developed symptomatic postprocedural UTI. Univariate analysis revealed statistical differences in the incidence of UTI in patients with elevated PVR and NLUTD groups. The variables that were associated with UTI on multivariate analysis were elevated PVR (odds ratio [OR]: 4.91, 95% confidence interval [CI], 1.92-12.56, P = .001) and NLUTD (OR: 4.84, 95% CI, 1.75-3.37, P = .002). The data analysis for all other high-risk groups failed to show significant correlations with UTI on univariate or multivariate analysis. Patients with three risk factors were more likely to develop UTI than patients with 1 or 2 risk factors. No patient developed pyelonephritis, sepsis, or joint infection. Conclusions: Elevated PVR, NLUTD, and possessing three risk factors were significant predictors for post-UDS UTI. All other risk factors were not associated with postprocedural UTI. Morbidity associated with UTI was low. Antimicrobial prophylaxis for these conditions should be reconsidered.
There is a subset of women presenting with acute pyelonephritis in whom vesicoureteral reflux is a risk factor. When documented, vesicoureteral reflux can be managed effectively with endoscopic treatment.
Objective: To review the recent experience of a busy referral cutaneous-vulvar service. Study Design: 500 randomly chosen charts from the last 5 years of patients seen at the Columbia Presbyterian Medical Center Cutaneous-Vulvar Service were reviewed. Information was entered into a computer data base and analyzed. Results: The most common presenting condition was vulvar vestibulitis (36.2%), followed by lichen sclerosus (19.2%) and vaginitis/vaginosis (14.8%). Most patients had undergone a variety of therapies prior to referral. Many were treated for moniliasis in the absence of clinical evidence prior to our evaluation. Most patients responded well to appropriate therapy. Conclusions: A variety of primary care providers see women with cutaneous-vulvar symptomatology. Awareness of prevalent conditions will lead to correct diagnosis and treatment. We emphasize the importance of interdisciplinary consultation in difficult cases.
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