Infection/Inflammation: A new class of agents for IC shows promise

Christina B. Ching, MDAnalyses of the urinary and gut microbiomes and a quality improvement to standardize use of antibiotics after prostate biopsy were among AUA 2016 highlights in this therapeutic area. The infection/inflammation take-home messages were presented by Christina B. Ching, MD, of Nationwide Children's Hospital, Columbus, OH.

An examination of urine showed increased toxic urinary cations in males with interstitial cystitis (IC), providing potential mechanistic insight for the cause of IC/bladder pain syndrome.

Differential expression of a multi-marker panel of chemokines can distinguish between normal and decreased bladder capacity in IC patients. The finding could allow for phenotypic characterization of IC using a biomarker.

In a study involving a new class of agents for the treatment of IC known as SHIP activators, AQX-1125 decreased visceral pain and bladder inflammation in a rat model. Also, a randomized, double-blind, placebo-controlled phase II trial showed SHIP-1 activation provides significantly improved pain scores and scores on standardized questionnaires.

Agents that improve abdominal pain may be able to improve urologic symptoms through common sensory innervation pathways.

The urinary microbiome differs significantly between patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and controls as well as between patients with different clinical phenotypes, with the urinary microbiome in CP/CPPS patients having significantly increased alpha diversity. An analysis of the gut microbiome also revealed significant difference between men with CP/CPPS and controls, with the gut microbiome in CP/CPPS patients having significantly decreased alpha diversity.

Continue to the next page for more take-home messages.

• A mechanistic association between CP/CPPS and mental health disorders, specifically expression of anxiety and depression, was noted in a study that showed prostate-derived cytokines cross the blood-brain barrier and may lead to altered ERK1/2 signaling in the brain.

• Researchers discovered a mechanism of how usher protein catalyzes the assembly of uropathogenic Escherichia coli (UPEC) pilus, suggesting a potential target for novel pharmaceutical strategies for urinary tract infection (UTI).

• In host-mediated response to infection, urothelial umbrella cells play a critical role as initiators of innate host defenses against UPEC.

• The fungal composition of bladder in healthy women suggests a unique cellular microbiota in the bladder that is distinct and more diverse than surrounding sites.

• Preoperative bacteriuria and positive stone cultures pose significantly higher risk of post-percutaneous nephrolithotomy (PCNL) septic shock, calling for the need to culture stones during PCNL given that 50% of patients with positive stone culture and positive preoperative urine culture harbor different bacteria.

• In a randomized, placebo-controlled, blinded study, long-term use of cranberry juice ≥6 months decreased the rate of incident UTI.

Next: Transurethral catheterization, suprapubic tube, and CIC compared

• In a meta-analysis that compared transurethral catheterization, suprapubic tube (SPT), and clean intermittent catheterization (CIC) and assessed the impact of their duration on the outcome of UTI, no statistical difference in UTI rates was found between methods if the diversion was <5 days, but in the group requiring diversion >5 days, the risk of UTI was decreased with CIC and SPT.

• After transrectal prostate biopsy, long-term use (≥2 years) of dutasteride (Avodart) was associated with a reduced risk of overall and severe UTI.

• A quality improvement initiative was able to standardize use of antibiotics after prostate biopsy according to AUA best practice guidelines without an increased risk of biopsy-related infections, a finding that validates the AUA guidelines and supports their widespread adoption.

• Antimicrobial prophylaxis does not appear to be beneficial during routine cystoscopic stent removal.

• Bacteriuria in patients undergoing onabotulinumtoxinA (Botox) injection for refractory neurogenic detrusor overactivity did not hinder efficacy of onabotulinumtoxinA or the risk of UTI.

• A group reported inconsistency in the definition of UTI in studies of spinal cord injury. Of 80% of articles that reported UTI as the primary outcome, only 44% provided an explicit definition of UTI.

More AUA 2016 take-home messages:

Stone Disease: New AUA guide discusses SWL vs. URS

Prostate Ca: PSA drop, active surveillance are key themes

Infertility/Andrology: Are vasectomy and prostate Ca linked?

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