RISK FACTOR AFFECTING RECURRENCE OFCYSTITIS AFTER UROVAXOM TREATMENT FOR FEMALE PATIENTS WITH RECURRENTCYSTITIS
J. HAN1, C. KIM 2,H. LEE 3;
1Department of Urology, PusanNatl. Univ. Yangsan Hosp., Pusan Natl. Univ. Sch. of Med., Yangsan,Korea, Republic of, 2Department of Urology, Gachon Univ.Gil Med. Ctr., Gachon Univ. Sch. of Med., Incheon, Korea, Republicof, 3Cheil Gen. Hosp. & Women's Hlth.care Ctr., Seoul,Korea, Republic of.
Introduction: In recurrent acutecystitis in women, low dose antibiotic prophylaxis can berecommended1. However, antibiotics can lead to resistanceof the causative microorganisms. The increasing prevalence of E.coliisolates that are resistant to antimicrobial agents has stimulatedinterest in nonantibiotic methods such as the oral immunostimulantOM-89 (Uro-Vaxom®) for the prevention of recurrent acute cystitis.In the meta-analysis the risk ratio for the development of at least 1urinary tract infection (UTI) was significantly lower in theUro-Vaxom® group and mean number of UTI was about half compared toplacebo2. In clinical perspective, however, the recurrenceof acute cystitis is not uncommon after Uro-Vaxom® treatment forseveral months.
Objective: We evaluated the risk factorsaffecting recurrence of cystitis after Uro-vaxom treatment for femalepatients with recurrent cystitis.
Methods: Weretrospectively reviewed and analyzed the medical records of patientswho received Uro-vaxom treatment for at least 6 months. We excludedthe patients with post-voided residual urine volume ≥ 200ml, ahistory of urological condition such as cancer, urinary tractabnormality, indwelling catheter in urinary tract or urologicsurgery. Patients were categorized into two groups: (1) no recurrentcystitis and (2) recurrent cystitis after Uro-vaxom treatment forfemale patients with recurrent cystitis. We compared the risk factorsbetween two groups. The recurrent cystitis was defined as two moreinfections in six months or three or more in one year.
Results:A total 52 of women were included. Group 1 had 35 (67.3%) patientsand group 2 had 17 (32.7%). Before and after Uro-vaxom treatment, themean cystitis episodes for 6 months of patients was 4.19±4.6 (2-24)and 1.17±1.79 (0-6), which were significantly decreased (p<0.001).For the recurrence of cystitis after Uro-vaxom treatment, only riskfactor was uncontrolled diabetes (fasting plasma glucose level>120mg/dL ± casual plasma glucose >180mg/dL) (p=0.002).There were no significant differences in the age, menopause, dailywater intake, hormone replacement therapy or history ofESBL-producing E.coli.
Conclusions: Uro-vaxom treatmentwas effective for management of recurrent cystitis in women. However,the uncontrolled diabetes was a risk factor for failure of Uro-vaxomtreatment.
References: 1. Albert X, Huertas I, Pereir_o IIet al: Antibiotics for preventing recurrent urinary tract infectionin non-pregnant women. Cochrane Database Syst Rev 2004; 3: CD001209.2. Beerepoot MA, Geerlings SE, van Haarst EP et al: Nonantibioticprophylaxis for recurrent urinary tract infections: a systematicreview and meta-analysis of randomized controlled trials. J Urol.2013;190:1981-9.