European Urology Today: June/July 2023

Key articles from international medical journals

(ATG) versus other antirejection strategies in reversing refractory acute graft rejection after living donor renal transplant. A retrospective review of the records of 745 patients who had received living-donor kidney transplants and had experienced acute rejection episodes over the past 20 years was performed. Based on the type of antirejection medication that the patients received, they were divided into two groups, with 80 patients in the ATG group and 665 patients who had other antirejection strategies. By using event-based sequential graft biopsy histopathology analysis, the efficacy of antithymocyte globulins in reversing refractory rejection in terms of graft and patient complications and survival was analysed. Patient survival was comparable in both groups; however, graft survival was better in the ATG group than in the other group; in addition, event-based sequential graft biopsies revealed a lower incidence of acute and chronic rejection episodes after treatment of severe acute rejection in the ATG group compared with the other group. The incidence of post-treatment complications, particularly infection and malignancy, was comparable in both groups. This retrospective analysis of event-based sequential graft biopsy permitted to track graft rejection resolution or worsening. ATG’s were highly effective in reversing acute graft rejection when compared with other approaches, with no increased risk of infection or malignancy. Source: Evaluation of antithymocyte globulin efficacy in reversing refractory graft rejection using retrospective event-based sequential graft biopsy analysis in living related donor renal transplant. Ahmed Akl, Mohamed Elshayeb, Mona Abdel Rahim, Ayman Fathy Refaie, Mohamed A Ghoneim. Exp Clin Transplant 2023, 21(5):428-433. doi: 10.6002/ect.2023.0022.

Investigators performed a multicentre retrospective review of women who were prescribed vaginal oestrogen for the indication of rUTI from January 2009 through December 2019. rUTI was defined as three or more positive urine cultures (separated by at least 14 days) in the 12 months preceding index vaginal oestrogen prescription. Patients were confirmed to fill their prescriptions and continue care within Kaiser Permanente Southern California for at least one year. Exclusion criteria included anatomic abnormalities, malignancy, or mesh erosion of the genitourinary tract. Data on demographics, medical comorbidities, and surgical history were collected. Adherence was captured through refill data after the index prescription. Low adherence was defined as no refills; moderate adherence was defined as one refill; high adherence was defined as two or more refills. Data were abstracted from the electronic medical record using the pharmacy database and diagnosis codes. A paired t-test was used to compare pre- and post-prescription UTI’s over the year preceding and following vaginal oestrogen prescription. Multivariate negative binomial regression was used to evaluate predictors of post-prescription UTI. The cohort included 5,638 women with mean (±standard deviation) age of 70.4 (±11.9) years, body mass index of 28.5 (±6.3) kg/m2, and baseline UTI frequency of 3.9 (±1.3). Most were white (59.9%) or Hispanic (29.7%) and postmenopausal (93.4%). Mean UTI frequency in the year following index prescription decreased to 1.8 (P< 0.001) from 3.9 in the year pre-prescription, a 51.9% reduction. During the 12 months after index prescription, 55.3% of patients experienced one or fewer UTI’s, and 31.4% experienced no UTI’s. Significant predictors of post-prescription UTI included: age 75-84 (incident rate ratio 1.24; 95% CI 1.05-1.46) and 85 plus years (1.41; 1.17-1.68), increased baseline UTI frequency (1.22; 1.19-1.24), urinary incontinence (1.14; 1.07-1.21), urinary retention (1.21; 1.10-1.33), diabetes mellitus (1.14; 1.07-1.21), and moderate (1.32; 1.23-1.42) or high medication adherence (1.33; 1.24-1.42). Surprisingly, highly-adherent

patients demonstrated more frequent post- prescription UTI’s than low-adherence patients (2.2 versus 1.6, P< 0.0001). “Significant predictors of post- prescription urinary tract infection included: age, increased baseline urinary tract infection frequency, urinary incontinence, urinary retention, diabetes mellitus, and moderate or high medication adherence.” The authors conclude that this retrospective review of 5,600 hypoestrogenic women who got prescribed vaginal oestrogen for the prevention of rUTI , the frequency of UTI decreased by over 50% in the following year. The paradoxical finding that women with moderate and high adherence experienced the lowest-magnitude reduction in UTI frequency may represent unobserved selection or unmeasured confounding. Source: Efficacy of vaginal oestrogen for recurrent urinary tract infection prevention in hypoestrogenic women. Tan-Kim J, Shah NM, Do D, Menefee SA. Am J Obstet Gynecol. 2023 May 11; doi. org/10.1016/j.ajog.2023.05.002 PMID: 37178856 Reversing refractory acute graft rejection with ATG The main risk factor for poor graft outcomes is refractory acute rejection and its consequences. In this retrospective study from the Mansoura Urology and Nephrology Centre, the authors compared the efficacy of antithymocyte globulins

Prof. Truls Erik Bjerklund Johansen Section editor Oslo (NO)

Prof. Oliver Hakenberg Section Editor Rostock (DE)


Vaginal oestrogen to hypoestrogenic women reduced the frequency of urinary tract infection by over 50% in the following year Vaginal oestrogen is considered the standard of care for recurrent urinary tract infection (rUTI) prevention in hypoestrogenic women. The primary objective of this study was to assess the association between vaginal oestrogen prescription and the frequency of UTI’s over the following year in a diverse population of hypoestrogenic women. Secondary objectives included evaluation of medication adherence and predictors of post-prescription UTI.

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European Urology Today June/July 2023


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