08
September
2015

Prostate biopsy infection - antibiotic resistance

Prostate biopsy infection - antibiotic resistance

Infections associated with prostate biopsy have increased over time, and there is growing evidence of infections that are resistant to the antibiotics used to prevent infection.

Resistant infections after trans-rectal prostate biopsy (TRUS)

About 1-2% of patients who have a TRUS biopsy of the prostate will develop a febrile infection, which can be serious. Antibiotics (usually ciprofloxacin) are used before and after biopsy to keep this infection rate at 1-2%. However, there is increasing evidence that many of us carry bacteria in our gut (and rectum, where the needle is passed through to reach the prostate) that are resistant to ciprofloxacin.

A recent study from the Journal of Urology (Liss et al.) looked at 2673 men from 6 different medical centres undergoing biopsy and discovered cirpofloxacin-resistant bacteria in the rectum in 20.5% of men.

We know that some men are at increased risk of carrying such resistant bacteria (known as ESBL), and these include men who have been treated with ciprofloxacin in the prior six months, and those that have travelled to SE Asia or the Indian subcontinent in the recent past. The bacteria are harmless in the gut, but become dangerous if seeded into the prostate by biopsy.

How can the risk of infection be reduced?

One of the ways to reduce the risk of infection is to consider a transperineal biopsy instead of a transrectal biopsy. In transperineal biopsy, the needles for biopsy are not passed through the rectum, but instead through the skin of the perineum, and the infection risk is greatly reduced. A study from Jeremy Grummet in Melbourne demonstrated a reduction in serious infection, with a greater than 10x reduction in risk compared to transrectal biopsy.

You can read more about this study by following this link to an article by Jeremy Grummet.

Follow this link to read more about transperineal biopsy.



Categories: Updates, Prostate Cancer

05
March
2015

Testosterone replacement statement by FDA

Testosterone replacement statement by FDA

A recent release from the U.S. Food and Drug Administration (FDA) has highlighted that caution is needed with the use of testosterone replacement treatments for men.

US FDA statement on Testosterone Replacement

Their advice suggests that replacement should only be used for men who have low testosterone levels caused by certain medical conditions such a primary hypogonadism (examples are failure of the testes to produce testosterone due to chemotherapy, genetic conditions, damage from infection), or disorders of the brain or pituitary gland that result in decreased testosterone.

Increasingly, testosterone replacement is being used to treat symptoms in men who have low testosterone for no other apparent reason other than due to ageing. The USFDFA state that the benefits and safety of testosterone replacement have not been established for this use.

Some studies suggest there may be an increased risk of cardiovascular problems (heart attack and stroke) with testosterone replacement, although not all studies have demonstrated this.

It is very important that you talk with your doctor about these risks, and the indications for starting testosterone replacement.



Categories: Updates, Other

10
January
2015

Rapid Access Kidney Stone Service

Rapid Access Kidney Stone Service

Kidney stones are a common problem in Australia and can be very painful. Patients with severe pain may need to be seen urgently by a urologist. One option is to present to an emergency department, where the condition can be diagnosed with a consultation and CT scan, and then referral if necessary to a urologist.

From early 2015 we will be offering a rapid access stone assessment service based in the rooms at Calvary Hospital in North Adelaide. You will need a referral from your GP, and can then be seen the same day, with a CT scan organised at Radiology SA (in the same building as our office). CT usually needed to confirm the diagnosis, and show the size and location of the stone.

If necessary, you can be admitted directly to Calvary North Adelaide Hospital, and have the necessary treatment undertaken. Often, it is enough to be admitted with pain killing drugs, anti-inflammatories, and a tablet called an alpha-blocker – many kidney stones will pass on their own with this treatment and this may be sufficient to relieve your kidney stone pain. If the stone is larger or there are complications such as infection, you can have your surgery at the same time.

The aim of this rapid access kidney stone service is to shorten the time from presentation to definitive treatment.


Categories: Updates, Kidney Stones

07
January
2015

Kidney stone infection and surgery

Kidney stone infection and surgery

Patients with kidney stones that need surgical treatment are at risk of urinary tract infection, and sometimes sepsis. Stones often have bacteria attached to them, and these bacteria can be hard to eliminate. A recent study from Tel Aviv University looked at post-operative infection in patients undergoing percutaneous nephrolithotomy (PCNL). Stone samples retrieved during surgery were sent for culture, to see if there were bacteria associated with the kidney stones.

Urinary sepsis (an infection that spreads from urine into the bloodstream and causes a patient to be unwell) occurred in 31% of patients who had a positive stone culture, compared to 5.9% of those patients who had a negative stone culture. E coli (gram negative bacteria) and Enterococcus sp. (gram positive bacteria) were the most common organisms found.

The problem is that it takes a number of days for the culture to come back, and the patient will have developed sepsis by that time. However, what it does highlight is that doing a urine culture 1 to 2 weeks before PCNL surgery can help the situation. If the urine culture is positive, the patient should have a course of antibiotics for 7 days to try to sterilise the urine, and then intravenous antibiotics at the time of surgery. If the urine is sterile pre-operatively, then intravenous antibiotics at the time of surgery are sufficient.

Two other interesting points were raised. First, that resistance to ciprofloxacin and norfloxacin was high, and this is something that is of concern. These antibiotics may be overused in the general population, causing resistance. This is something we are also seeing in patients who need a prostate biopsy for a raised PSA.

Second, we know that some patients cannot reach a point where the urine is sterile (free of bacteria) if they have stones, because the stones themselves are colonised with bacteria, and antibiotics cannot get into stones. These patients pose a specific problem and are at higher risk of infection.

Reference - Ohad Shoshany et al. Percutaneous nephrolithotomy for infection stones: what is the risk for postoperative sepsis? A retrospective cohort study. Urolithiasis (online) 01 Jan 2015

You can read more about kidney stone surgery and the risk of infection by following this link to an article by Michael Wong.


Categories: Updates, Kidney Stones

03
January
2015

Hamlin Fistula Ethiopia break the $6M mark

Hamlin Fistula Ethiopia break the $6M mark

Towards the end of 2014, Hamlin Fistula Ethiopia smashed the $6M mark in income since the charity in Australia was created just over two years ago.


Dr. Hamlin and the whole team at Hamlin Fistula Ethiopia in Australia and Ethiopia have had a huge impact on the lives of the women with obstetric fistula they treat and train.


Our practice will be supporting the work of this charity in 2015 and encourage you to read about the amazing work they do.

Please read more about the work of Hamlin Fistula Ethiopia and stay up to date with latest news from Nick Brook Urology, as we support this work throughout 2015.


Follow this link to a short youtube video

And please pass on the links to Hamlin Fistula Ethiopia, via word of mouth, email and social media - the work they do is so important. You can follow Hamlin Fistula on Twitter.


Categories: Updates

07
December
2014

Nick Brook Urology supporting Hamlin Fistula Ethiopia in 2015

Nick Brook Urology supporting Hamlin Fistula Ethiopia in 2015

In 2015, we will be supporting the incredible work of Australian surgeon Dr Catherine Hamlin and her team. They work in Ethiopa and have been transforming the lives of young women devasted by obstetric fistula.


The work of Hamlin Fistula Ethiopia

During 2015, Nick Brook Urology will be supporting Hamlin Fistula Ethiopia. This incredible organisation has been changing the lives of young women who have been devastated by obstructed labour.

In the 1950s, Australian surgeons Dr Catherine Hamlin AC and her husband Reg visited Ethiopia to help train midwives. But they were struck by the terrible plight of young women who had suffered obstructed labour. More often than not, the baby would die, and the women were left with permanent damage to their bladders (and sometimes rectum). This leads to permanent and constant leakage, and these women are pushed to the edge of their societies, considered too dirty to be part of village life, and considered a curse.

The Hamlins devoted their lives to helping these women; they perfected modern techniques for obstetric fistula surgery and
 have treated more than 40,000 women, more than 90% of them cured. Reg died in 1993 but Catherine continues the work.

The Addis Ababa Fistula Hospital and its five regional hospitals treat obstetric fistula patients at no cost, thanks to the generosity of donors. Not only are these women treated, they are rehabilitated, taught a craft, and re-integrated into society. The Hamlins have also set up the Hamlin College of Midwives to help to support women during childbirth, and reduce the rate of obstetric fistula in Ethiopia. These trained midwives are then deployed back into rural areas where the need is greatest.

The amazing work of the Hamlins has turned around the lives of these women, and is only made possible by the generosity of donors.

Please read more about the work of Hamlin Fistula Ethiopia and stay up to date with latest news from Nick Brook Urology, as we support this work throughout 2015.

And please pass on the links to Hamlin Fistula Ethiopia, via word of mouth, email and social media - the work they do is so important. You can follow Hamlin Fistula on Twitter.


Categories: Updates

Affiliations

Urology Affiliations

Latest Tweets

Contact Us

  • Nick Brook Urology
    Calvary North Adelaide Hospital
    89 Strangways Tce,
    North Adelaide,
    Adelaide SA 5006
  • 08 8267 1424
  • 08 8267 1370