EURURO Vol. 72 No. 4

652 656

Truls E. [1_TD$DIFF]Bjerklund[3_TD$DIFF] Johansena,*, Tommaso Cai b
aDepartment of Urology, Oslo University Hospital and University of Oslo,
Oslo, Norway
b Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
*Corresponding author. Oslo University Hospital, Department of
Urology, Trondheimsveien 235, Nydalen, Oslo 4959, Norway.
E-mail addresses:
(T.E. [1_TD$DIFF]Bjerklund [3_TD$DIFF] Johansen).
# 2017 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
Re: Treatment Duration of Febrile Urinary Tract
Infection: A Pragmatic Randomized, Double-blind,
Placebo-controlled Non-inferiority Trial in Men and
Women
Van Nieuwkoop C, van der Starre WE, Stalenhoef JE, et al
BMC Med 2017;15:70
Expert’s summary:
The authors compared treatment of febrile urinary tract in-
fection (fUTI) with ciprofloxacin in women and men for 7 or
14 d. The primary endpoint was the clinical cure rate (CCr) at
10–18 d after treatment. The authors demonstrate that a 7-d
course was not inferior to 14-d treatment in women (CCr 94%
vs 93%), but was inferior in men (CCr 86% vs 98%).
Expert’s comments:
The results confirm those of previous trials of fUTI (eg, pyelo-
nephritis) in women who were successfully treated with a 7-d
ciprofloxacin course . By contrast, men seem to require 14 d
of ciprofloxacin to reach the same CCr level. This is consistent
with findings in a Swedish study showing that 2-wk treatment
for fUTI in men was not inferior to 4 wk [2] . In the latter study, [6_TD$DIFF]
transient raised PSA and significant swelling of the prostate on
transrectal ultrasound volumemeasurement [7_TD$DIFF]indicated that the
prostate gland was involved in almost all male fUTIs, regardless
of clinical presentation. This observation is a possible explana-
tion for the longer antimicrobial regimen required in men.
The term fUTI is useful, since elderly patients, men, and
urological patients often lack characteristic symptoms and
signs of acute pyelonephritis. A pragmatic definition of fUTI
is temperature elevation to 38.0 8C accompanying general
symptoms such as shivering, rigor, and nausea, together
with one or several UTI symptoms. Dipstick-positive
nitrite and leukocyte esterase tests support the diagnosis.
Leukocytosis and elevated C-reactive protein in serum
suggest involvement of the kidney and/or prostate.
Consequently, the two statements that 7-d treatment for
women and 14-d treatment for men with ciprofloxacin
directed against a susceptible strain strengthen the
evidence level for guidelines providers. The European
Association of Urology guideline on urological infections
states that all UTIs in men are complicated UTIs, but does
not clearly differentiate between nonfebrile UTI and fUTI
[3]. With the present study and its supporting references in
mind, it would be reasonable to reflect on useful definitions,
terminology, and clinical reality in recommending antimi-
crobial treatment for different UTI presentations.
In view of the scarce number of antibiotics suitable for
the [8_TD$DIFF]urinary [9_TD$DIFF]and genital tracts, especially in men, and the
global increase in resistance against theses antimicrobials,
the threat is obvious. Parsimonious use, adherence to
evidence-based guideline recommendations, and the de-
velopment of new antibiotics and alternative infection
management methods are imperative for future patient
safety. Health authorities have a clear role in promoting this
development.
Conflicts of interest: The author has nothing to disclose.
References
[1]
[2]
[3] European Association of Urology. Guidelines on urological infec-
tions 2017.
Magnus J. Grabe*
Urology Department, [1_TD$DIFF]Ska˚ne [2_TD$DIFF]University [3_TD$DIFF]Hospital, [4_TD$DIFF]Malmo¨, Sweden
*Urology Department, [1_TD$DIFF]Ska˚ ne [2_TD$DIFF]University [3_TD$DIFF]Hospital, [4_TD$DIFF]Malmo¨, Sweden.
E-mail address:
# 2017 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
Re: The Economic Implications of a Reusable Flexible
Digital Ureteroscope: A Cost-Benefit Analysis
Martin CJ, McAdams SB, Abdul-Muhsin H, et al
J Urol 2017;197:730–5
Experts’ summary:
The authors performed a cost-benefit analysis (CBA) and cal-
culated the benefit-to-cost ratio (BCR) to evaluate the potential
economic benefits of a single-use flexible digital ureteroscope
(LithoVue; Boston Scientific, Marlborough, MA, USA) compared
to a conventional reusable flexible digital ureteroscope (Flex
Xc
[2_TD$DIFF]; Karl Storz, Tuttlingen, Germany). The data were collected in
a prospective manner and cases being operated on with a
reusable flexible digital ureteroscope were included. Cost as-
sessment of the reusable digital flexible ureteroscopes per case
was performed using original purchasing and repair/exchange
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