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• Endres, Julian; Terziyska, Yana; Wullich, Bernd; Hakenberg, Oliver W.; Kranz, Jennifer & Leitsmann, Marianne [Show all 15 contributors for this article] (2026). Pilot Survey about the Perspective on Generation Z among European Leaders in Urology: Challenges in Educating Generation Z. Acta Haematologica. ISSN 0001-5792. p. 1–8. doi: 10.1159/000553184.
• Tommaso, Cai; Boeri, Luca; Miacola, Carlos; Palumbo, Fabrizio; Albo, Giancarlo & Ditonno, Pasquale [Show all 10 contributors for this article] (2025). Can nutraceuticals counteract the detrimental effects of the environment on male fertility? A parallel systematic review and expert opinion. Minerva endocrinology. ISSN 2724-6507. 50(1), p. 84–96. doi: 10.23736/S2724-6507.24.04218-0. Full text in Research Archive Show summary

  INTRODUCTION: Male fertility relies on a complex physiology that may be negatively influenced by lifestyle, diet, and environment. The beneficial effect of nutraceuticals on male fertility is a debated claim. The aim of this study was to assess if the positive effect of nutraceuticals can counteract the negative effects of the environment on male fertility. EVIDENCE ACQUISITION: PubMed®/MEDLINE®, Embase and Cochrane Database were searched (September-October 2023), along with crosschecking of references and search for ongoing studies of the effects of the environment and nutraceuticals on male fertility, in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). EVIDENCE SYNTHESIS: Several environmental factors such as microplastic and other endocrine-disrupting chemicals and climate changes may affect the sperm quality in terms of reduction of sperm count number, mobility and altered morphology and thereby reduce male fertility. On the other hand, new evidence demonstrates that a balanced diet rich in antioxidants and essential nutrients, together with minimized exposure to environmental toxins, may improve male fertility and reproductive health. Several nutraceutical compounds proved a protective role against negative environmental effects on male fertility. CONCLUSIONS: Available evidence confirms that the environment may negatively impact male fertility, and this impact is estimated to rise in the forthcoming years. On the other hand, new data indicate that nutraceuticals may have a protective role against the negative impact of environmental factors on male fertility. The need for future studies to monitor and explore these aspects of men’s health cannot be underestimated.

• Stangl, Fabian Peter; Day, Elizabeth; Vallée, Maxime; Bilsen, Manu P.; Grossmann, Nico C. & Falkensammer, Eva [Show all 19 contributors for this article] (2025). Infectious Complications After Transrectal Versus Transperineal Prostate Biopsy: A Systematic Review and Meta-analysis. European Urology Focus. 12(2), p. 275–283. doi: 10.1016/j.euf.2025.07.005. Full text in Research Archive Show summary

  Background and objective Prostate biopsies remain a key step in the diagnosis of prostate cancer and are performed either via a transrectal (TR) or a transperineal (TP) route. In general, the approaches are considered to provide similar diagnostic power. However, infectious complications appear to differ in favour of the TP approach. Furthermore, antibiotic prophylaxis is felt to have limited additional value in a TP biopsy, which aligns with antimicrobial stewardship principles. Urology association guidelines have provided conflicting recommendations on the best approach for a prostate biopsy. This systematic review aims to compare the infectious complications and antibiotic usage of the two approaches. Methods A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines after registration with PROSPERO (CRD42024513309). MEDLINE, Embase, Scopus, and Web of Science were searched for articles published until April 1, 2025. Randomised controlled trials (RCTs) assessing infectious complications (fever, urinary tract infection, and hospitalisation with infectious complications) following a prostate biopsy were included. The risk of bias was assessed with the RoB 2 tool, and statistical analyses included visualisation through funnel and forest plots and assessing the publication bias via Egger’s regression test. Key findings and limitations Ten RCTs were included in the analysis, encompassing 4188 prostate biopsies. Of seven studies reporting hospitalisation for infectious complications, the TP route showed significantly lower odds (odds ratio 0.23, 95% confidence interval [CI] 0.10–0.54; graphical abstract), reducing hospitalisation risk by 77% compared with the TR route. Postinterventional fever occurred less frequently, with an odds ratio of 0.68 (95% CI 0.52–0.89). There was no statistically significant difference in infectious complications after a TP biopsy with or without antibiotics. All TR route biopsies utilised antibiotic prophylaxis. The small number of eligible studies and the high risk of bias, as well as sparse data on bias in most studies, limit the power of our manuscript. . Conclusions and clinical implications TP biopsy is associated with a lower admission risk due to postprocedural infection compared with TR biopsy. TP biopsy seems to be a safe procedure without antibiotics in patients without risk factors, advocating for enhanced antimicrobial stewardship in urology

• Cai, Tommaso; Ceccato, Tommaso; Botti, Simone; Kranz, Jennifer; Verze, Paolo & Bonkat, Gernot [Show all 9 contributors for this article] (2025). Impact of Lifestyle and the Microbiome on Male Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. European Urology Focus. 11(4), p. 557–559. doi: 10.1016/j.euf.2025.04.013. Full text in Research Archive
• Alidjanov, Jakhongir F.; Khudaybergenov, Ulugbek A.; Khudayberdiev, Khurshid B.; Kranz, Jennifer; Schneidewind, Laila & Stangl, Fabian P. [Show all 12 contributors for this article] (2025). Identification of Risk Factors in Patients with Recurrent Cystitis May Improve Individualized Management. Diagnostics (Basel). 15(22). doi: 10.3390/diagnostics15222885. Full text in Research Archive Show summary

  Background/Objectives: Management of acute episodes of lower urinary tract infection (LUTI) depends on whether they are sporadic or recurrent. We aimed to define factors that differentiate patients with acute sporadic cystitis (AC) from those with recurrent cystitis (RC) and thereby improve individualized care. Methods: We performed a post hoc analysis of prospectively collected data from the multinational GPIU.COM study. Female patients with an acute LUTI episode completed the Acute Cystitis Symptom Score (ACSS) and underwent a routine clinical and laboratory evaluation, including a physical examination, ultrasonography, urinalysis, and urine culture and antimicrobial susceptibility testing. Risk factors for recurrence were evaluated using the Lower Urinary Tract Infection Recurrence Risk (LUTIRE) nomogram and the ORENUC classification. Statistical analysis followed a robust stepwise approach. Significant variables were assessed by relative risk (RR), and logistic regression was used to estimate odds ratios (ORs). Model performance was evaluated using the area under the curve (AUC), the Hosmer–Lemeshow test, variance inflation factor (VIF), and bootstrap sampling. Results: A total of 106 women were included (AC n = 50; RC n = 56). Patients with RC more frequently presented with a history of constipation, a severe impact of symptoms on daily activities, multiple uropathogens, and trace proteinuria. Pyuria was inversely associated with RC. Logistic regression identified chronic constipation, severe impact of symptoms on daily activities, and multiple uropathogens as independent predictors of RC. Three predictive models showed consistent discrimination between AC and RC (AUC = 0.80, 0.82, and 0.84). Conclusions: AC and RC showed notable differences in certain symptom profiles, quality of life, urinalysis, and microbiological findings. Combining high-value predictors from LUTIRE and ORENUC into a comprehensive prognostic algorithm could improve assessment of recurrence risk. A refined classification of LUTIs with recurrence grading is warranted to guide decision-making and prevention strategies.

• Botti, Simone; Ceccato, Tommaso; Rizzo, Michele; Liguori, Giovanni; Zucchi, Alessandro & Palmieri, Alessandro [Show all 8 contributors for this article] (2025). Could Urology’s Antimicrobial Stewardship Be Enhanced by the Routine Use of the Meares and Stamey Test? Diagnostics (Basel). 15(8). doi: 10.3390/diagnostics15081002. Full text in Research Archive Show summary

  Background/Objectives: Chronic bacterial prostatitis (CBP) is a prevalent urological condition significantly impacting patients’ quality of life. Accurate diagnosis is essential to differentiate bacterial from non-bacterial prostatitis and to guide appropriate antimicrobial therapy. In the context of antimicrobial resistance (AMR), the Meares and Stamey (M&S) test is a valuable diagnostic tool for targeted antibiotic use and a valuable antimicrobial stewardship (AMS) measure. Despite its clinical relevance, its adoption is limited by practical and logistical challenges. Methods: Relevant databases were searched by using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The keywords used included “Meares and Stamey test,” “antimicrobial stewardship and prostatitis,” and “chronic bacterial prostatitis and Meares.” Results: We enclosed seven studies: one single-center prospective observational comparative study, two national surveys, three cross-sectional studies, and one consensus conference. The M&S test remains the gold standard for diagnosing CBP, offering high specificity in identifying bacterial infections localized within the prostate. The test enables precise pathogen identification and facilitates targeted antimicrobial therapy. Despite its clinical relevance, its adoption is hindered by procedural complexity, patient discomfort, and the apparent need for specialized personnel and facilities. Alternative diagnostic methods, such as the two-glass pre- and post-massage test (PPMT), have demonstrated comparable diagnostic sensitivity while being more practical and time-efficient. Additionally, emerging microbiological techniques are under investigation to increase the M&S test’s sensitivity. Conclusions: The M&S test plays a crucial role in AMS by ensuring targeted antimicrobial therapy in CBP. Overcoming its limitations through patient stratification, clinician education, and the integration of emerging microbiological techniques is essential to enhance its applicability in modern urological practice.

• Zhanel, George; Rossi, Patricia de; Oliva, Cosimo & Johansen, Truls E. Bjerklund (2025). Treatment of asymptomatic bacteriuria during pregnancy: A risk-factor-based approach. Journal of Global Antimicrobial Resistance. ISSN 2213-7165. 46, p. 79–86. doi: 10.1016/j.jgar.2025.11.010. Full text in Research Archive Show summary

  During pregnancy, there is increased risk of ascending urinary tract infection (UTI) resulting in pyelonephritis and associated preterm delivery and low birth weight. It is therefore important that pregnant women who are at high risk of pyelonephritis because of the presence of asymptomatic bacteriuria (ASB) or cystitis receive appropriate antibiotic therapy. The aim of this position paper is to propose a risk-factor-based approach for the treatment of ASB and cystitis in pregnancy to help ensure that antibiotic treatment is prescribed only when necessary, and that the benefits of antibiotic treatment outweigh potential harms for pregnant women and neonates. Rather than advocating ASB screen-and-treat for all pregnant women who have ready access to healthcare, this risk-factor-based approach involves selective screening for ASB in pregnant women with other risk factors for UTI (previous UTI, diabetes mellitus, urinary tract abnormalities, or immunosuppression) and/or a history of preterm birth. Antibiotic treatment is indicated for persistent ASB confirmed with two urine cultures during selective high-risk screening, and for all pregnant women with cystitis confirmed by urine culture, with empiric treatment considered for symptoms of dysuria and urinary frequency. Evidence suggests that such a risk-factor-based approach will prevent progression to pyelonephritis in pregnant women with ASB and cystitis while complying with the principles of antimicrobial stewardship.

• Johansen, Truls E. Bjerklund; Bahrs, Christina; Bruyere, Franck; Cai, Tommaso; Joseph, Amelia & Köves, Béla [Show all 24 contributors for this article] (2025). Consensus position statement on advancing the classification of patients and tests of cure in studies of antibiotic treatment of complicated urinary tract infections. The Lancet Infectious Diseases. ISSN 1473-3099. 25(10), p. e605–e618. doi: 10.1016/S1473-3099(25)00142-2. Full text in Research Archive Show summary

  Complicated urinary tract infections denote an important research field for new antibiotics against Gram-negative pathogens. There is, however, increasing concern that this disease entity is too vaguely defined, leading to heterogeneous study populations and risk of bias. We analysed researchers’ adherence to the US Food and Drug Administration (FDA) guidance on complicated urinary tract infection and assessed risk of bias using a three-step procedure: literature review of full-text articles on complicated urinary tract infection; assessment of the importance of risk factors for treatment failure, including statistical evaluation of how patients with risk factors might skew treatment effects; and a Delphi consensus process in a multidisciplinary group. Our evaluation showed poor adherence to FDA guidance on complicated urinary tract infection and significant heterogeneity in the reporting of study, patient, and pathogen characteristics, leading to a high risk of bias when interpreting and comparing study findings. We therefore question the concept of complicated urinary tract infection as a meaningful entity with its own study guidance.

• Bellankimath, Anurag Basavaraj; Branders, Sverre; Kegel, Isabell; Ali, Jawad; Asadikhoeini, Fatemeh & Johansen, Truls Erik Bjerklund [Show all 10 contributors for this article] (2025). Metagenomic sequencing enables accurate pathogen and antimicrobial susceptibility profiling in complicated UTIs in approximately four hours. Nature Communications. 17. doi: 10.1038/s41467-025-66865-8. Full text in Research Archive Show summary

  Urinary tract infections (UTIs) affect 405 million people worldwide. Current diagnostics rely on cultures, which can take 2 to 4 days. This study evaluates eleven culture-independent methods for sample preparation from 78 complicated UTI patients, followed by real-time nanopore sequencing and data analysis. The metagenomic results are highly consistent with culture-based clinical routines (MALDI-TOF/VITEK-2). The optimized method demonstrated an accuracy score of 99% (100/101) for pathogen identification and 90% (589/653) for antimicrobial susceptibility profiling with 95% specificity. The method’s robustness is highlighted by its ability to accurately identify pathogens with as few as 32 bacterial cells/µL and a low bacterial-to-host cell ratio limit of 0.5. Additionally, mNGS identified 13 pathogens that routine diagnostics missed, which were subsequently confirmed by Vivalytic or PCR. This method is up to 30% more economical than published studies and commercial kits. DNA yield and flow cytometry can be used for pre-screening to reduce costs, which is crucial for clinical adoption. This research highlights the rapid diagnosis of clinical UTIs using a cost-effective and scalable method that requires around four hours from sample collection to informed decision-making. Furthermore, it aims to improve antimicrobial and diagnostic stewardship by reducing empirical treatment and ensuring more judicious antibiotic use.

• Tommaso, Cai; Brugnolli, Anna; Lanzafame, Massimiliano; Dellai, Fabiana; Tascini, Carlo & Scarparo, Claudio [Show all 11 contributors for this article] (2025). A Precision Medicine Model for Targeted Antibiotic Therapy in Urinary Tract Infections: A Valuable Tool to Reduce Hospitalization Stay and the Time to Switch to Oral Treatment. Antibiotics. 14(2). doi: 10.3390/antibiotics14020211. Full text in Research Archive Show summary

  Background/Objectives: The management of urinary tract infections (UTIs) has become an increasingly challenging medical intervention. This study explores whether adoption of a precision medicine model could improve the management of acute uncomplicated pyelonephritis (uAPN) or complicated UTIs (cUTIs) compared with the standard of care approach, in hospitalized patients. Methods: From January 2022 to March 2024, all patients affected by uAPN or cUTIs and attending our urological institution were randomized to receive the following: antibiotic treatment according to guidelines and recommendations (standard of care group) or antibiotic treatment according to the precision medical model (intervention group). The main outcome measures were the rates of clinical success and the length of hospitalization. The time until switching to oral treatment was regarded as a secondary outcome measure. Results: Eighty-three patients were enrolled in the standard of care group, while seventy-nine patients were enrolled in the intervention group. While the overall clinical success rate was similar in the two groups (75 vs. 72; p = 0.97), a statistically significant difference was observed between the two groups in terms of length of hospitalization (8 days vs. 5 days; p = 0.03) and time to switch to oral treatment (96 h vs. 72 h; p = 0.04). A statistically significant difference was found between the two groups regarding the need to change antimicrobial therapy during hospitalization [12 out of 80 vs. 6 out of 77; p = 0.04]. Conclusions: Adoption of the precision medicine model appears as a valuable means to improve the management of patients with uAPN and cUTIs. By reducing the period of hospitalization and the time to switch to oral treatment, the precision medicine model also improves antimicrobial stewardship in the management of UTIs.

• Ceccato, Tommaso; Botti, Simone; Tascini, Carlo; Lanzafame, Massimiliano; Brugnolli, Anna & Ruggera, Lorenzo [Show all 10 contributors for this article] (2024). Emerging strategies in tackling antimicrobial resistance in urology: Narrative review and expert opinion. Urologia. ISSN 0391-5603. 92(2), p. 185–193. doi: 10.1177/03915603241310389. Full text in Research Archive
• Tommaso, Cai; Tamanini, Irene; Odorizzi, Katia; Gallelli, Luca; Lanzafame, Massimiliano & Mazzoli, Sandra [Show all 12 contributors for this article] (2024). The diagnostic yield of the Meares & Stamey test can be significantly improved by symptom-based patient selection and the experience of the test performer. Prostate Cancer and Prostatic Diseases. ISSN 1365-7852. p. 300–304. doi: 10.1038/s41391-024-00824-0. Full text in Research Archive
• Medina-Polo, José; Falkensammer, Eva; Köves, Béla; Kranz, Jennifer; Tandogdu, Zafer & Tapia, Ana María [Show all 10 contributors for this article] (2024). Systematic Review and Meta-Analysis Provide no Guidance on Management of Asymptomatic Bacteriuria within the First Year after Kidney Transplantation. Antibiotics. 13:442(5), p. 1–16. doi: 10.3390/antibiotics13050442. Full text in Research Archive Show summary

  Abstract (1) Background: Urinary tract infections (UTIs) are among the most frequent complications in kidney transplant (KT) recipients. Asymptomatic bacteriuria (ASB) may be a risk factor for UTIs and graft rejection. We aimed to evaluate available evidence regarding the benefit of screening and treatment of ASB within the first year after KT. (2) Evidence acquisition: A systematic literature search was conducted in MEDLINE, the Cochrane Library CENTRAL and Embase. Inclusion criteria were manuscripts in English addressing the management of ASB after KT. The PICO questions concerned Patients (adults receiving a KT), Intervention (screening, diagnosis and treatment of ASB), Control (screening and no antibiotic treatment) and Outcome (UTIs, sepsis, kidney failure and death). (3) Evidence synthesis: The systematic review identified 151 studies, and 16 full-text articles were evaluated. Seven were excluded because they did not evaluate the effect of treatment of ASB. There was no evidence for a higher incidence of lower UTIs, acute pyelonephritis, graft loss, or mortality in patients not treated with antibiotics for ASB. Analysis of comparative non-randomized and observational studies did not provide supplementary evidence to guide clinical recommendations. We believe this lack of evidence is due to confounding risk factors that are not being considered in the stratification of study patients.

• Tandogdu, Zafer; Koves, Bela; Ristovski, Slobodan; Balci, Mustafa Bahadir Can; Rennesund, Kristin & Gravas, Stavros [Show all 41 contributors for this article] (2024). Urosepsis 30-day mortality, morbidity, and their risk factors: SERPENS study, a prospective, observational multi-center study. World Journal of Urology. ISSN 0724-4983. 42:314(1), p. 1–9. doi: 10.1007/s00345-024-04979-2. Full text in Research Archive Show summary

  Purpose To provide a descriptive report of mortality and morbidity in the first 30 days of diagnosis of urosepsis. Secondary aim is to identify risk factors of unfavourable outcomes. Methods Prospective observational multicentre cohort study conducted from September 2014 to November 2018 in European hospitals. Adult patients (≥ 18 years) diagnosed with acute urosepsis according to Sepsis-2 criteria with confirmed microbiological infection were included. Outcomes were classified in one of four health states: death, multiple organ failure, single organ failure, and recovery at day 30 from onset of urosepsis. Descriptive statistics and ordinal logistic regression analysis was performed. Results Three hundred and fifty four patients were recruited, and 30-day mortality rate was 2.8%, rising to 4.6% for severe sepsis. All patients who died had a SOFA score of ≥ 2 at diagnosis. Upon initial diagnosis, 79% (n = 281) of patients presented with OF. Within 30 days, an additional 5% developed OF, resulting in a total of 84% affected. Charlson score (OR 1.14 CI 1.01–1.28), patients with respiratory failure at baseline (OR 2.35, CI 1.32–4.21), ICU admission within the past 12 months (OR 2.05, CI 1.00–4.19), obstruction causative of urosepsis (OR 1.76, CI 1.02–3.05), urosepsis with multi-drug-resistant(MDR) pathogens (OR 2.01, CI 1.15–3.53), and SOFA baseline score ≥ 2 (OR 2.74, CI 1.49–5.07) are significantly associated with day 30 outcomes (OF and death). Conclusions Impact of comorbidities and MDR pathogens on outcomes highlights the existence of a distinct group of patients who are prone to mortality and morbidity. These findings underscore the need for the development of pragmatic classifications to better assess the severity of UTIs and guide management strategies.

• Bellankimath, Anurag Basavaraj; Chapagain, Crystal; Branders, Sverre; Ali, Jawad; Wilson, Robert Charles & Johansen, Truls E. Bjerklund [Show all 7 contributors for this article] (2024). Culture and amplification-free nanopore sequencing for rapid detection of pathogens and antimicrobial resistance genes from urine. European Journal of Clinical Microbiology and Infectious Diseases. ISSN 0934-9723. 43(11), p. 2177–2190. doi: 10.1007/s10096-024-04929-1. Full text in Research Archive Show summary

  Purpose Urinary Tract Infections (UTIs) are among the most prevalent infections globally. Every year, approximately 150 million people are diagnosed with UTIs worldwide. The current state-of-the-art diagnostic methods are culture-based and have a turnaround time of 2–4 days for pathogen identification and susceptibility testing.<p> <p>Methods This study first establishes an optical density culture-based method for spiking healthy urine samples with the six most prevalent uropathogens. Urine samples were spiked at clinically significant concentrations of 10³ -10⁵ CFU/ml. Three DNA extraction kits (BioStic, PowerFood, and Blood and Tissue) were investigated based on the DNA yield, average processing time, elution volume, and the average cost incurred per extraction. After DNA extraction, the samples were sequenced using MinION and Flongle flow cells. <p>Results The Blood and Tissue kit outperformed the other kits based on the investigated parameters. Using nanopore sequencing, all the pathogens and corresponding genes were only identified at a spike concentration of 10<p>5</sup> CFU/ml, achieved after 10 min and 3 hours of sequencing, respectively. However, some pathogens and antibiotic-resistance genes (ARG) could be identified from spikes at 10³ colony formation units (CFU/mL). The overall turnaround time was five hours, from sample preparation to sequencing-based identification of pathogen ID and antimicrobial resistance genes. <p>Conclusion This study demonstrates excellent promise in reducing the time required for informed antibiotic administration from 48 to 72 h to five hours, thereby reducing the number of empirical doses and increasing the chance of saving lives.

• Tommaso, Cai; Tamanini, Irene; Puglisi, Marco; Bizzotto, Leonardo; Rizzo, Michele & Liguori, Giovanni [Show all 9 contributors for this article] (2024). Phytotherapy Might Have a Role in Reducing Unnecessary Prostate Biopsies: Results from an Exploratory, Randomized Controlled Trial of Two Different Phytotherapeutic Agents. Clinics and Practice. 14(1), p. 188–197. doi: 10.3390/clinpract14010016. Full text in Research Archive Show summary

  Background: We aimed to evaluate the impact of two different phytotherapeutic agents on decision making regarding prostate biopsy for patients with higher-than-normal prostate-specific antigen (PSA) levels. Methods: From June 2022 to May 2023, all patients attending two urological institutions due to higher-than-normal PSA levels were randomized to receive either oral capsules of Curcuma Longa, Boswellia, Pinus pinaster and Urtica dioica (Group A) or Serenoa Repens 320 mg (Group B) for 3 months. At the follow-up visit after 3 months, all patients underwent PSA tests and multiparametric magnetic resonance imaging (mpMRI). Results: In the per-protocol analysis, data from 66 patients in Group A and 76 in Group B were analyzed. Fifty patients in Group A (75.7%) showed a significant reduction in total PSA compared to forty-nine in Group B (64.4%) (p < 0.001). Twenty-eight patients had PI-RADS III or higher in mpMRI: twelve in Group A and fourteen in Group B. Twenty-three patients (34.8%) in Group A and fifty-nine (77.6%) in Group B (p < 0.001) underwent prostate biopsy based on the mpMRI findings and PSA values. Three patients in Group A showed a significant reduction in total PSA values while having positive mpMRI findings (6%) compared with nine in Group B (19.5%) (p < 0.001). On the contrary, 7 patients in Group A did not show significant reduction in total PSA values and had negative mpMRI findings (43%) compared to 22 in Group B (81.4%) (p < 0.001). Conclusions: In conclusion, a three-month course of a combination of Curcuma Longa, Boswellia, Pinus pinaster and Urtica dioica seems to be an interesting tool to avoid unnecessary prostate biopsies among men with higher-than-normal PSA levels.

• Cai, Tommaso; Capece, Marco; Grazia, Zorzi Maria; Palmieri, Alessandro; Nesi, Gabriella & Barbareschi, Mattia [Show all 7 contributors for this article] (2023). Prophylactic Lymphadenectomy in Patients with Penile Cancer: Is Sooner Better? Uro. 3(4), p. 251–261. doi: 10.3390/uro3040025. Full text in Research Archive Show summary

  Background: Management of penile cancer patients has its grey zones. In particular, no strong evidence or recommendations exist regarding the timing of prophylactic lymphadenectomy. Here, we aim to review the impact that the timing of inguinal and pelvic prophylactic lymph node dissection has on patient outcome. Methods: All relevant databases were searched following the preferred reporting items for systematic reviews and meta-analysis guidelines. A narrative review of indications for lymph node dissection and pathological considerations precede a systematic review of the impact of prophylactic lymph node dissection timing on prognosis. The primary endpoint is disease-free and overall survival in patients undergoing early or late lymph node dissection after penile cancer diagnosis. Results: Four clinical trials, all focusing on the role of inguinal lymph node dissection, are included. Despite the lack of randomized and controlled trials, this review suggests that lymph node dissection should be performed as soon as possible after diagnosis, with 3 months as a realistic cut-off. Conclusions: Survival of penile cancer patients is strictly related to the timing of prophylactic pelvic lymph node dissection. All patients at high risk of nodal metastasis should be offered lymph node dissection within three months of diagnosis, until new predicting tools are validated.

• Cai, Tommaso; Verze, Paolo; Arcaniolo, Davide; Pandolfo, Savio Domenico; Smarrazzo, Francesco & Manfredi, Celeste [Show all 13 contributors for this article] (2023). Antibiotic Resistance Patterns Among Uropathogens in Female Outpatients Affected by Uncomplicated Cystitis: Focus on Fosfomycin Trometamol. International Journal of Antimicrobial Agents. ISSN 0924-8579. 62(5). doi: 10.1016/j.ijantimicag.2023.106974. Full text in Research Archive
• Tommaso, Cai; Anceschi, Umberto; Prata, Francesco; Collini, Lucia; Brugnolli, Anna & Migno, Serena [Show all 14 contributors for this article] (2023). Artificial intelligence can guide antibiotic choice in recurrent UTIs and become an important aid to improve antimicrobial stewardship. Antibiotics. 12:375(2), p. 1–11. doi: 10.3390/antibiotics12020375. Full text in Research Archive Show summary

  Background: A correct approach to recurrent urinary tract infections (rUTIs) is an important pillar of antimicrobial stewardship. We aim to define an Artificial Neural Network (ANN) for predicting the clinical efficacy of the empiric antimicrobial treatment in women with rUTIs. Methods: We extracted clinical and microbiological data from 1043 women. We trained an ANN on 725 patients and validated it on 318. Results: The ANN showed a sensitivity of 87.8% and specificity of 97.3% in predicting the clinical efficacy of empirical therapy. The previous use of fluoroquinolones (HR = 4.23; p = 0.008) and cephalosporins (HR = 2.81; p = 0.003) as well as the presence of Escherichia coli with resistance against cotrimoxazole (HR = 3.54; p = 0.001) have been identified as the most important variables affecting the ANN output decision predicting the fluoroquinolones-based therapy failure. A previous isolation of Escherichia coli with resistance against fosfomycin (HR = 2.67; p = 0.001) and amoxicillin-clavulanic acid (HR = 1.94; p = 0.001) seems to be the most influential variable affecting the output decision predicting the cephalosporins- and cotrimoxazole-based therapy failure. The previously mentioned Escherichia coli with resistance against cotrimoxazole (HR = 2.35; p &lt; 0.001) and amoxicillin-clavulanic acid (HR = 3.41; p = 0.007) seems to be the most influential variable affecting the output decision predicting the fosfomycin-based therapy failure. Conclusions: ANNs seem to be an interesting tool to guide the antimicrobial choice in the management of rUTIs at the point of care.

• Falkensammer, Eva; Erenler, Ece; Johansen, Truls Erik Bjerklund; Tzelves, Lazaros; Schneidewind, Laila & Yuan, Yuhong [Show all 9 contributors for this article] (2023). Antimicrobial Prophylaxis in Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review. Antibiotics. 12(12). doi: 10.3390/antibiotics12121744. Full text in Research Archive Show summary

  It remains unclear whether antibiotic prophylaxis (AP) should be recommended or discouraged in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). The development of microbial resistance and side effects are risks of antibiotic use. This systematic review (SR) investigates the evidence base for AP in RALP. A systematic literature search was conducted until 12 January 2023, using Embase, MEDLINE, Cochrane CENTRAL, Cochrane CDSR (via Ovid) and CINAHL for studies reporting the effect of AP on postoperative infectious complications in RALP. Of 436 screened publications, 8 studies comprising 6378 RALP procedures met the inclusion criteria. There was no evidence of a difference in the rate and severity of infective complications within 30 days after RALP surgery between different AP protocols. No studies omitted AP. For patients who received AP, the overall occurrence of postoperative infectious complications varied between 0.6% and 6.6%. The reported urinary tract infection (UTI) rates varied from 0.16% (4/2500) to 8.9% (15/169). Wound infections were reported in 0.46% (4/865) to 1.12% (1/89). Sepsis/bacteraemia and hyperpyrexia were registered in 0.1% (1/1084) and 1.6% (5/317), respectively. Infected lymphoceles (iLC) rates were 0.9% (3 of 317) in a RALP cohort that included 88.6% pelvic lymph node dissections (PLND), and 3% (26 of 865) in a RALP cohort where all patients underwent PLND. Our findings underscore that AP is being administered in RALP procedures without scientifically proven evidence. Prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to ensure the comparability of results and guidance on AP in RALP.

• Schneidewind, Laila; Kiss, Bernhard; Stangl, Fabian P.; Tandogdu, Zafer; Wagenlehner, Florian M.E. & Johansen, Truls Erik Bjerklund [Show all 10 contributors for this article] (2023). Practice Patterns in Fournier’s Gangrene in Europe and Implications for a Prospective Registry Study. Antibiotics. 12(2), p. 1–8. doi: 10.3390/antibiotics12020197. Full text in Research Archive Show summary

  Background: Fournier’s gangrene (FG) is a life-threatening, necrotizing infection. Due to the rareness of the disease, it is challenging to plan robust prospective studies. This study aims to describe current practice patterns of FG in Europe and identify implications for planning a prospective FG registry. Methods: Online non-validated 17-items survey among urologists treating FG in in European hospitals. Questionnaires were analyzed with LimeSurvey (LimeSurvey GmbH Hamburg, Germany). Results: 229 responses from ten different European countries were submitted, and 117 (51.1%) urologists completed the questionnaire. The departments treat a mean of 4.2 (SD 3.11) patients per year. The urology department mostly takes the lead in treating FG patients (n = 113; 96.6%). The practice in FG is very heterogenic and mostly case-based all over Europe, e.g., vacuum-assisted wound closure (VAC) is mostly used (n = 50; 42.7%) as adjunct wound. The biggest challenges in FG are the short time to diagnosis and treatment, standardization and establishment of guidelines, and disease awareness. Additionally, participants stated that an international registry is an outstanding initiative, and predictive models are needed. Conclusions: There is no standard of care in the diagnosis, treatment, and long-term care of FG all over Europe. Further research could be conducted with a prospective registry.

• Cai, Tommaso; Privitera, Salvatore; Trovato, Federica; Capogrosso, Paolo; Dehò, Federico & Cimino, Sebastiano [Show all 12 contributors for this article] (2022). A proposal of a new nomogram to predict the need for Testosterone ReplACEment (TRACE): A simple tool for everyday clinical practice. Journal of Personalized Medicine. 12:1654(10), p. 1–10. doi: 10.3390/jpm12101654. Full text in Research Archive Show summary

  International guidelines suggest to use testosterone therapy (TTh) in hypogonadal men presenting symptoms of testosterone deficiency (TD), even if there is no fixed threshold level of T at which TTh should be started. We aimed to develop and validate a nomogram named TRACE (Testosterone ReplACEment) for predicting the need of TTh in patients with “low–normal” total testosterone levels. The following nomogram variables were used: serum T level; serum LH level; BMI; state of nocturnal erections; metabolic comorbidities; and IPSS total score. The nomogram has been tested by calculating concordance probabilities, as well as assaying the calibration of predicted probability of clinical testosterone deficiency and need for TTh, together with the clinical outcome of the TTh. A cohort of 141 patients was used for the development of the nomogram, while a cohort of 123 patients attending another institution was used to externally validate and calibrate it. Sixty-four patients (45.3%) received TTh. Among them, sixty patients (93.7%) reported a significant clinical improvement after TTh. The nomogram had a concordance index of 0.83 [area under the ROC curve 0.81 (95% CI 0.71–0.83)]. In conclusion, the TRACE nomogram accurately predicted the probability of clinical impairment related to TD, and resulted in a simple and reliable method to use to select hypogonadal patients with not clearly pathological testosterone values who will benefit from TTh.

• Tutone, Michaela; Johansen, Truls Erik Bjerklund; Cai, Tommaso; Mushtaq, Shazad & Livermore, David M. (2022). SUsceptibility and Resistance to Fosfomycin and other antimicrobial agents among pathogens causing lower urinary tract infections: findings of the SURF study. International Journal of Antimicrobial Agents. ISSN 0924-8579. p. 1–7. doi: 10.1016/j.ijantimicag.2022.106574. Full text in Research Archive Show summary

  Urinary tract infections (UTIs) are prevalent worldwide, particularly among women. Their incidence increases with age, and treatment is increasingly challenging owing to antibiotic resistance and the lack of new agents. We investigated the susceptibility of current urinary isolates to fosfomycin and other antibiotics across Europe. This cross-sectional study collected consecutive urinary isolates from non-hospitalised women at 20 centres in Belgium, the UK, Italy, Spain and Russia. Bacteria were tested by disk diffusion with relevant antibiotics. As a quality control, a central laboratory re-tested, by agar dilution, (i) isolates found resistant to fosfomycin and (ii) every tenth isolate; all non-Russian sites were included. A total of 2848 isolates were analysed, principally Escherichia coli (2064; 72.5%), Klebsiella spp. (275; 9.7%) and Proteus spp. (103; 3.6%). For E. coli, agents active against >90% of isolates were nitrofurantoin (98.5%), fosfomycin (96.4%) and mecillinam (91.8%). Fosfomycin and nitrofurantoin remained active against >90% of cephalosporin-resistant E. coli. Among 143 E. coli recorded as susceptible locally by disk tests, 138 (96.5%) were confirmed susceptible by minimum inhibitory concentration (MIC) tests, however resistance was only confirmed in 29/58 (50.0%) of those reported resistant by local disk tests. Escherichia coli was found to be the most common uropathogen isolated and was highly susceptible to fosfomycin, nitrofurantoin and mecillinam, all used effectively for more than 30 years. Guidelines advocating fosfomycin for uncomplicated UTIs in women remain microbiologically valid.

• Tommaso, Cai; Gallelli, Luca; Cione, Erika; Verze, Paolo; Palmieri, Alessandro & Mirone, Vincenzo [Show all 9 contributors for this article] (2022). The efficacy and tolerability of pollen extract in combination with hyaluronic acid and vitamins in the management of patients affected by chronic prostatitis/chronic pelvic pain syndrome: a 26 weeks, randomized, controlled, single-blinded, phase III study. Minerva Urology and Nephrology. ISSN 2724-6051. 74(6), p. 780–788. doi: 10.23736/S2724-6051.21.04141-2. Full text in Research Archive
• Cai, Tommaso; Tamanini, Irene; Collini, Lucia; Brugnolli, Anna; Migno, Serena & Mereu, Liliana [Show all 13 contributors for this article] (2022). Management of Recurrent Cystitis in Women: When Prompt Identification of Risk Factors Might Make a Difference. European Urology Focus. 8(5), p. 1476–1482. doi: 10.1016/j.euf.2022.01.014. Full text in Research Archive
• Johansen, Truls E. Bjerklund; Cai, Tommaso; Naber, Kurt; Nicolle, Lindsay E.; Tandogdu, Zafer & Tonjum, Tone [Show all 9 contributors for this article] (2021). Gravide bør screenes for asymptomatisk bakteriuri. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(11), p. 1–5. doi: 10.4045/tidsskr.21.0379. Full text in Research Archive
• Tandogdu, Zafer; Collins, Justin W.; Shaw, Greg; Rohn, Jennifer; Köves, Béla & Sachdeva, Ashwin [Show all 42 contributors for this article] (2021). Management of patients who opt for radical prostatectomy during the coronavirus disease 2019 (COVID-19) pandemic: an international accelerated consensus statement. BJU International. ISSN 1464-4096. 127(6), p. 729–741. doi: 10.1111/bju.15299. Full text in Research Archive
• Gjersvik, Petter; Heikkilä, Reino & Johansen, Truls Erik Bjerklund (2021). Redningsbehandling ved kreft. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(5), p. 1–3. doi: 10.4045/tidsskr.21.0084. Full text in Research Archive
• Alidjanov, Jakhongir F.; Cai, Tommaso; Bartoletti, Riccardo; Bonkat, Gernot; Bruyere, Franck & Köves, Bela [Show all 14 contributors for this article] (2021). The negative aftermath of prostate biopsy: prophylaxis, complications and antimicrobial stewardship: results of the global prevalence study of infections in urology 2010-2019. World Journal of Urology. ISSN 0724-4983. doi: 10.1007/s00345-021-03614-8. Full text in Research Archive Show summary

  Abstract Purpose To evaluate and report the complications, and to analyse antimicrobial stewardship aspects following prostate biopsies (P-Bx) based on the data from a 9-year global study. Methods The primary outcome was to compare complications after P-Bx between patients of two cohorts: 2010–2014 and 2016–2019. Primary outcomes included symptoms of lower and severe/systemic urinary tract infection (LUTIS and SUTIS, respectively), and positive urine culture. Readmission to hospital after P-Bx, need for additional antimicrobial therapy, consumption of different antimicrobial agents for prophylaxis and therapy were evaluated. Students t test and chi-square test were used for comparative analyses. Results Outcome data were available for 1615 men. Fluoroquinolones-based prophylaxis rate increased from 72.0% in 2010–2014 to 78.6% in 2015–2019. Overall rates of complications increased from 6 to 11.7% including an increase in symptomatic complications from 4.7 to 10.2%, mainly due to an increase in LUTIS. Rates of patients seeking additional medical help in primary care after P-Bx increased from 7.4 to 14.4%; cases requiring post P-Bx antibiotic treatment increased from 6.1 to 9.7%, most of which received fluoroquinolones. Transperineal P-Bx was significantly associated with LUTIS. Following transrectal P-Bx, 2.8% developed febrile infections and 4.0% required hospitalisation. Two men (0.12%) died after transrectal P-Bx due to sepsis. Conclusions The rates of complications after P-Bx tended to increase in time, as well as rates of patients seeking additional medical help in the post-P-Bx period. To reduce the risk of infectious complications and to comply with the principles of antibiotic stewardship, clinicians should switch to the transperineal biopsy route.

• Cai, Tommaso; Anceschi, Umberto; Tamanini, Irene; Migno, Serena; Rizzo, Michele & Liguori, Giovanni [Show all 11 contributors for this article] (2021). Xyloglucan, Hibiscus and Propolis in the Management of Uncomplicated Lower Urinary Tract Infections: A Systematic Review and Meta-Analysis. Antibiotics. doi: 10.3390/antibiotics11010014. Full text in Research Archive Show summary

  Background: In the era of antibiotic resistance, an antibiotic-sparing approach presents an interesting alternative treatment of uncomplicated cystitis in women. Our aim is to perform a systematic review and meta-analysis to compare the effectiveness and safety profile of a medical device containing xyloglucan, hibiscus and propolis (XHP) in women with uncomplicated cystitis. Methods: Relevant databases were searched using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary endpoint was clinical or microbiological success, defined as the complete (cure) and/or non-complete (improvement) resolution of symptoms at the end of treatment, or microbiological resolutions. Results: After screening 21 articles, three studies were included, recruiting a total of 178 patients. All three studies used placebo as comparator. A statistically significant difference was found in terms of clinical or microbiological resolution between the medical device and the comparator (3 RCTs, 178 patients, OR: 0.13; 95% CI: 0.05–0.33; p &lt; 0.0001). No clinically significant adverse effects have been reported. Conclusion: A medical device containing xyloglucan, hibiscus and propolis is superior to comparator regimens in terms of clinical effectiveness in adult women with microbiologically confirmed or clinical suspicion of uncomplicated cystitis and is associated with a high patient compliance.

• Cakir, Omer Onur; Castiglione, Fabio; Tandogdu, Zafer; Collins, Justin; Alnajjar, Hussain M. & Akers, Clare [Show all 26 contributors for this article] (2021). Management of penile cancer patients during the COVID-19 pandemic: An eUROGEN accelerated Delphi consensus study. Urologic Oncology. ISSN 1078-1439. 39(3), p. e9–e17. doi: 10.1016/j.urolonc.2020.12.005. Full text in Research Archive
• Cai, Tommaso; Gallelli, Luca; Cione, Erika; Perletti, Giampaolo; Ciarleglio, Francesco & Malossini, Gianni [Show all 11 contributors for this article] (2021). The use of Lactobacillus casei DG® prevents symptomatic episodes and reduces the antibiotic use in patients affected by chronic bacterial prostatitis: results from a phase IV study. World Journal of Urology. ISSN 0724-4983. 39(9), p. 3433–3440. doi: 10.1007/s00345-020-03580-7. Full text in Research Archive Show summary

  Abstract Purpose To evaluate the efficacy of Lactobacillus paracasei CNCM I-1572 (L. casei DG®) in both prevention of symptomatic recurrences and improvement of quality of life in patients with chronic bacterial prostatitis (CBP). Methods Patients with CBP attending a single Urological Institution were enrolled in this phase IV study. At enrollment, all patients were treated with antibiotics in agreement with EAU guidelines and then were treated with L. casei DG® (2 capsules/day for 3 months). Clinical and microbiological analyses were carried out before (enrollment, T0) and 6 months (T2) after the treatment. Both safety and adherence to the treatment were evaluated 3 months (T1) after the enrollment. NIH Chronic Prostatitis Symptom Index (CPSI), International Prostate Symptom Score (IPSS) and Quality of Well-Being (QoL) questionnaires were used. The outcome measures were the rate of symptomatic recurrence, changes in questionnaire symptom scores and the reduction of antibiotic use. Results Eighty-four patients were included. At T2, 61 patients (72.6%) reported a clinical improvement of symptoms with a return to their clinical status before symptoms. A time dependent improvement in clinical symptoms with significant changes in NIH-CPSI, IPSS and QoL (mean difference T2 vs T0: 16.5 ± 3.58; − 11.0 ± 4.32; + 0.3 ± 0.09; p  &lt; 0.001), was reported. We recorded that L. casei DG® treatment induced a statistically significant decrease in both ( p  &lt; 0.001) symptomatic recurrence [1.9/3 months vs 0.5/3 months] and antibiotic use [− 7938 UDD]. No clinically relevant adverse effects were reported. Conclusions L. casei DG® prevents symptomatic recurrences and improves the quality of life in patients with CBP, reducing the antibiotic use.

• Ciarleglio, Francesco A.; Rigoni, Marta; Mereu, Liliana; Cai, Tommaso; Carrara, Alessandro & Malossini, Gianni [Show all 15 contributors for this article] (2021). The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access. World Journal of Emergency Surgery. 16(1), p. 1–9. doi: 10.1186/s13017-021-00382-z. Full text in Research Archive Show summary

  Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89–11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01–63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11). Conclusions This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a “filter effect” induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.

• Johansen, Truls Erik Bjerklund; Kulchavenya, Ekaterina; Lentz, Gretchen M.; Livermore, David M.; Nickel, J. Curtis & Zhanel, George [Show all 7 contributors for this article] (2021). Fosfomycin Trometamol for the Prevention of Infectious Complications After Prostate Biopsy: A Consensus Statement by an International Multidisciplinary Group. European Urology Focus. doi: 10.1016/j.euf.2021.11.007. Full text in Research Archive Show summary

  Context Transrectal ultrasound-guided prostate biopsy (TRPB) has been a standard of care for diagnosing prostate cancer but is associated with a high incidence of infectious complications. Objective To achieve an expert consensus on whether fosfomycin trometamol provides adequate prophylaxis in TRPB and discuss its role as prophylaxis in transperineal prostate biopsy (TPPB). Evidence acquisition An international multidisciplinary group of experts convened remotely to discuss how to best use fosfomycin in various clinical settings and patient situations. Six statements related to prostate biopsy and the role of fosfomycin were developed, based on literature searches and relevant clinical experience. Evidence synthesis Consensus was reached for all six statements. The group of experts was unanimous regarding fosfomycin as a preferred candidate for antimicrobial prophylaxis in TRPB. Fosfomycin potentially also meets the requirements for empiric prophylaxis in TPPB, although further clinical studies are needed to confirm or refute its utility in this setting. There is a risk of bias due to sponsorship by a pharmaceutical company. Conclusions Antimicrobial prophylaxis is mandatory in TRPB, and fosfomycin trometamol is an appropriate candidate due to low rates of resistance, a good safety profile, sufficient prostate concentrations, and demonstrated efficacy in reducing the risk of infectious complications following TRPB.

• Alidjanov, Jakhongir F; Khudaybergenov, Ulugbek A; Ayubov, Bekhzod A; Pilatz, Adrian; Mohr, Stefan & Münst, Julie C [Show all 15 contributors for this article] (2021). Linguistic and clinical validation of the acute cystitis symptom score in German-speaking Swiss women with acute cystitis. International Urogynecology Journal. ISSN 0937-3462. doi: 10.1007/s00192-021-04864-1. Full text in Research Archive Show summary

  Abstract Introduction and hypothesis The Global Prevalence Study of Infections in Urinary tract in Community Setting (GPIU.COM) includes epidemiological aspects of acute cystitis (AC) in women in Germany and Switzerland. The primary study relates to the German version of the Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for self-diagnosis and monitoring the symptomatic course of AC in women. The current study aimed to analyze the validity and reliability of the German ACSS in German-speaking female patients with AC in Switzerland. Methods Anonymized patient data were collected and analyzed from women with AC at the first visit (diagnosis) and follow-up visits as baseline and controls, respectively. Data from 97 patients with a median age of 41 years underwent analysis. Psychometric and diagnostic characteristics of the ACSS were measured and statistically analyzed. Results Average internal consistency of the ACSS resulted in a Cronbach’s alpha (95% CI) of 0.86 (0.83; 0.89) and did not differ significantly between the Swiss and German cohorts. Diagnostic values of the ACSS for the Swiss cohort were relatively lower than for the German cohort, possible due to discrepancies between definitions of UTI in national guidelines. Conclusions The analysis showed that the German version of the ACSS is also suitable for use in the German-speaking female population of Switzerland. Minor differences in definitions of AC between German and Swiss guidelines explain the observed discrepancies in diagnostic values of the ACSS between cohorts.

• Cai, Tommaso; Cocci, Andrea; Maida, Fabrizio Di; Chiodini, Stefano; Ciarleglio, Francesco & Luciani, Lorenzo Giuseppe [Show all 12 contributors for this article] (2021). Visceral adiposity is associated with worse urinary and sexual function recovery after radical prostatectomy: Results from a longitudinal cohort study. Archivio Italiano di Urologia e Andrologia. ISSN 1124-3562. 93(3), p. 285–290. doi: 10.4081/aiua.2021.3.285. Full text in Research Archive Show summary

  Objective: A prospective longitudinal cohort study on the impact of anthropometric measures on the sexual function and continence recovery in patients treated with laparoscopic radical prostatectomy (LRP) is presented.Material and methods: Anthropometric measures, International Index of Erectile Function (IIEF-5) and International Prostatic Symptoms Score questionnaires, were collected before surgery and at the end of follow-up period. All patients were assigned into the following groups: A) non-obese; B) non-obese with central adiposity; C) obese without central adiposity; D) obese with central adiposity. Urinary and sexual functions were the outcome measures. Results: At the end of follow-up, in 29 patients with visceral adiposity (VA) the median IIEF-5 was 14 (IQR 7-18) while in 49 non-VA patients (62.8%) was 22 (IQR 17-24) (p &lt; 0.001). Twenty-three patients (79.3%) with VA reported complete continence, while 6 (20.7%) used ≥ 2 pads per day. Forty-eight patients (97.9%) without VA reported complete continence. VA was confirmed as a strong independent predictor for worse continence (HR 3.67; 2.75-4.51 CI95% p = 0.003) and sexual function recovery (HR: 4.51; 3.09-5.63 CI95% p &lt; 0.001). Conclusion: We truly believe obese with visceral adiposity patients with prostate cancer should receive detailed preoperative counseling before surgery, including higher risk of suboptimal functional outcomes.

• Wagenlehner, Florian M.; Johansen, Truls Erik Bjerklund; Cai, Tommaso; Köves, Béla; Kranz, Jennifer & Pilatz, Adrian [Show all 7 contributors for this article] (2020). Epidemiology, definition and treatment of complicated urinary tract infections. Nature reviews. Urology. ISSN 1759-4812. 17(10), p. 586–600. doi: 10.1038/s41585-020-0362-4. Full text in Research Archive
• Cai, Tommaso; Tamanini, Irene; Mattevi, Daniele; Verze, Paolo; Palmieri, Alessandro & Malossini, Gianni [Show all 10 contributors for this article] (2020). Fosfomycin trometamol and N-acetyl-L-cysteine as combined oral therapy of difficult-to-treat chronic bacterial prostatitis: Results of a pilot study. International Journal of Antimicrobial Agents. ISSN 0924-8579. doi: 10.1016/j.ijantimicag.2020.105935. Full text in Research Archive Show summary

  This paper presents the results of a pilot study of difficult-to-treat patients (exhibiting several previous treatment failures or detection of extended-spectrum beta-lactamase [ESBL] strains) with chronic bacterial prostatitis (CBP) who underwent treatment with fosfomycin trometamol (FT) and N-acetyl-L-cysteine (NAC). Twenty-eight patients with clinically- and microbiologically-confirmed CBP who attended a single urological institution between January 2018 and March 2019 were treated with oral administration of 3 g FT once a day for 2 days, followed by a dose of 3 g every 48 h for 2 weeks, in combination with oral administration of NAC 600 mg once a day for 2 weeks. Clinical and microbiological analyses were carried out at the time of admission (T0) and during follow-up at 1 month (T1) and 6 months (T2) after the end of treatment. Symptoms were assessed by the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostatic Symptom Score (IPSS), and quality of life was assessed by Quality of Well-Being (QoL) questionnaires. Isolated strains were Escherichia coli (23 patients), Enterococcus spp. (3 patients), and Klebsiella oxytoca (2 patients). ESBL strain was found in 19 (67.8%) patients. Microbiological eradication was documented in 21 (75%) patients at the second follow-up visit and clinical cure was achieved in 20 (71.4%) patients. Significant changes on questionnaires were recorded between baseline and follow-up visits. Fifteen of 19 patients (78.9%) with ESBL strains were cured. No significant side effects were reported. FT in combination with NAC is a promising alternative therapy in difficult-to-treat CBP patients.

• Cai, Tommaso; Tiscione, Daniele; Favilla, Vincenzo; Puglisi, Marco; Palumbo, Fabrizio & Zucchi, Alessandro [Show all 9 contributors for this article] (2020). Oral administration and intralesional injection of hyaluronic acid Versus intralesional injection alone in peyronie's disease: Results from a phase III study. The World Journal of Men's Health (WJMH). ISSN 2287-4208. 38. doi: 10.5534/WJMH.200048. Full text in Research Archive
• Cai, Tommaso; Cocci, Andrea; Coccarelli, Franco; Ruggera, Lorenzo; Lanzafame, Paolo & Caciagli, Patrizio [Show all 14 contributors for this article] (2019). Infectious complications after laser vaporization of urinary stones during retrograde intrarenal surgery are not associated with spreading of bacteria into irrigation fluid but with previous use of fluoroquinolones. European Urology Focus. p. 1–8. doi: 10.1016/j.euf.2019.02.018. Full text in Research Archive
• Tandogdu, Zafer; Kakariadis, Evgenios TA; Naber, Kurt; Wagenlehner, Florian & Johansen, Truls Erik Bjerklund (2019). Appropriate empiric antibiotic choices in health care associated urinary tract infections in urology departments in Europe from 2006 to 2015: A Bayesian analytical approach applied in a surveillance study. PLOS ONE. 14(4), p. 1–18. doi: 10.1371/journal.pone.0214710. Full text in Research Archive Show summary

  Background Health care associated urinary tract infections (HAUTI) is a common complicating factor of urological practice. It is unclear what the appropriate empirical antibiotic choices are and how infection control policies (ICP) influence this. The aim of this study is to use probabilistic approaches towards the problem. That is to determine the chances of coverage of empirical antibiotic choices in HAUTIs and their annual trends in Europe. In addition, the impact of departmental self-reported compliance with catheter management and regulated usage of prophylactic antibiotics policies was tested. The estimated chances of coverage of antibiotics and further probabilistic calculations are carried out using the Global Prevalence of Infections in Urology (GPIU) annual surveillance study European data. Methods GPIU is a multi-state annual prevalence study conducted in urology departments to detect patients with HAUTIs, using the Center for Disease Control (CDC) definitions and antimicrobial resistance (AMR). In this analysis; the European cohort from 2005 to 2015 was used. The estimated chance of coverage for each antibiotic choice in HAUTIs was calculated using the Bayesian Weighted Incidence Syndromic Antibiogram (WISCA) approach. Annual trend of the overall cohort and number of appropriate antibiotic choices were estimated. Departments were compared according to their self-reported compliance to ICPs to determine if there was an impact on chances of coverage and appropriate antibiotic choices. Results We estimated that in most study years less than half of the single agent antibiotics and all combination options were appropriate for empirical treatment of HAUTIs. Departments with compliance to both ICPs were estimated to have 66%(2006) to 44% (2015) more antibiotic choices compared to departments with complete lack of compliance to the ICPs. In our estimates departments with adherence to a single policy was not superior to departments with complete lack of adherence to ICPs. Conclusions Most single agent choices had limited coverage for HAUTIs and combination choices had improved chance of coverage. Optimal antibiotic selection decision should be part of decision experiments and tested in local surveillance studies. Departments with self-reported compliance to ICPs have more antibiotic choices and details of the compliance should be evaluated in future studies. The analysis herein showed that over the 10-year course there was no clear time trend in the chances of coverage of antibiotics (Bayesian WISCA) in European urology departments.

• Cai, Tommaso; Tamanini, Irene; Tascini, Carlo; Köves, Bela; Bonkat, Gernot & Gacci, Mauro [Show all 10 contributors for this article] (2019). Fosfomycin Trometamol versus Comparator Antibiotics for the Treatment of Acute Uncomplicated Urinary Tract Infections in Women: A Systematic Review and Meta-Analysis. Journal of Urology. ISSN 0022-5347. 203(3), p. 570–578. doi: 10.1097/JU.0000000000000620. Full text in Research Archive
• Tandogdu, Zafer; Köves, Béla; Cai, Tommaso; Cek, Mete; Tenke, Peter & Naber, Kurt [Show all 8 contributors for this article] (2019). Condition-specific surveillance in health care-associated urinary tract infections as a strategy to improve empirical antibiotic treatment: an epidemiological modelling study. World Journal of Urology. ISSN 0724-4983. p. 1–8. doi: 10.1007/s00345-019-02963-9. Full text in Research Archive Show summary

  Background Health care-associated urinary tract infection (HAUTI) consists of unique conditions (cystitis, pyelonephritis and urosepsis). These conditions could have different pathogen diversity and antibiotic resistance impacting on the empirical antibiotic choices. The aim of this study is to compare the estimated chances of coverage of empirical antibiotics between conditions (cystitis, pyelonephritis and urosepsis) in urology departments from Europe. Methods A mathematical modelling based on antibiotic susceptibility data from a point prevalence study was carried. Data were obtained for HAUTI patients from multiple urology departments in Europe from 2006 to 2017. The primary outcome of the study is the Bayesian weighted incidence syndromic antibiogram (WISCA) and Bayesian factor. Bayesian WISCA is the estimated chance of an antibiotic to cover the causative pathogens when used for first-line empirical treatment. Bayesian factor is used to compare if HAUTI conditions did or did not impact on empirical antibiotic choices. Results Bayesian WISCA of antibiotics in European urology departments from 2006 to 2017 ranged between 0.07 (cystitis, 2006, Amoxicillin) to 0.89 (pyelonephritis, 2009, Imipenem). Bayesian WISCA estimates were lowest in urosepsis. Clinical infective conditions had an impact on the Bayesian WISCA estimates (Bayesian factor > 3 in 81% of studied antibiotics). The main limitation of the study is the lack of local data. Conclusions Our estimates illustrate that antibiotic choices can be different between HAUTI conditions. Findings can improve empirical antibiotic selection towards a personalized approach but should be validated in local surveillance studies.

• Johansen, Truls Erik Bjerklund; Zahl, Per Henrik; Baco, Eduard; Bartoletti, Riccardo; Bonkat, Gernot & Bruyere, Franck [Show all 15 contributors for this article] (2019). Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy: first report from the Norwegian Patient Registry. World Journal of Urology. ISSN 0724-4983. p. 1–10. doi: 10.1007/s00345-019-02837-0. Full text in Research Archive Show summary

  Background A 68-year-old man died of cerebral arterial embolism 6 days after transrectal prostate biopsy with a single p.o. dose of trimethoprim sulfamethoxazole (TMP-SMX) as prophylaxis. The case precipitated analysis of local antibiotic resistance and complication rates. Materials and methods Data on E. coli resistance from Oslo University Hospital and national data on hospitalizations and mortality after biopsy were retrieved from local microbiology files and the Norwegian Patient Registry (NPR) 2011–2017. Results Urine E. coli resistance against TMP-SMX increased from 35% in 2013 to more than 60% in 2015. For ciprofloxacin, the resistance increased from 15% in 2013 to about 45% in 2016. The highest annual E. coli resistance in blood cultures for TMP-SMX and ciprofloxacin was 37% and 28%, respectively. 10% of patients were hospitalized with a diagnosis of infection within the first 60 days after biopsy and there was a relative increase in mortality rate of 261% within the first 30 days. Due to the severity of the figures, the story and the NPR data were published in Norway’s leading newspaper and were succeeded by a series of chronicles and commentaries. Conclusions Several critical points of the biopsy procedure were not performed according to current standards. We believe that the patient might have died of septic embolism after biopsy. As a result of the findings and the debate, local practice was changed from transrectal to transperineal prostate biopsies.

• Cai, Tommaso; Tamanini, Irene; Cocci, Andrea; Maida, Fabrizio di; Caciagli, Patrizio & Migno, Serena [Show all 13 contributors for this article] (2019). Xyloglucan, hibiscus and propolis to reduce symptoms and antibiotics use in recurrent UTIs: A prospective study. Future Microbiology. ISSN 1746-0913. 14(12), p. 1013–1021. doi: 10.2217/fmb-2019-0145. Full text in Research Archive Show summary

  Aim: To evaluate the efficacy of a medical device containing xyloglucan, hibiscus and propolis in the management of recurrent urinary tract infections (rUTIs). Patients &amp; methods: Sixty-one women affected by rUTIs received this medical device, one capsule a day for 15 days (one cycle every month, for 6 months), in an observational, prospective study. Clinical and microbiological evaluations were performed at baseline and 1, 3 and 6 months from enrolment. Results: At first follow-up, 41 reported a clinical improvement and a return to their clinical status before UTI, while 47 and 51 did so at the second and third follow-up evaluations. A statistically significant clinical improvement was reported at each follow-up visit (quality of life [QoL] 94.2 vs 98.6; QoL 94.1 vs 98.7; QoL 94.2 vs 99.1; p &lt; 0.001). A statistically significant reduction in antibiotic use was reported. Conclusion: This medical device is able to improve quality of life in women with rUTIs, reduce recurrences and antibiotic use.

• Cai, Tommaso; Santi, Raffaella; Tamanini, Irene; Galli, Ilaria Camilla; Perletti, Giampaolo & Johansen, Truls Erik Bjerklund [Show all 7 contributors for this article] (2019). Current knowledge of the potential links between inflammation and prostate cancer. International Journal of Molecular Sciences. ISSN 1661-6596. 20:3833(15), p. 1–14. doi: 10.3390/ijms20153833. Full text in Research Archive
• Matthew, Dixon; Stefil, Maria; McDonald, Michael; Johansen, Truls Erik Bjerklund; Naber, Kurt & Wagenlehner, Florian M. [Show all 7 contributors for this article] (2019). Metagenomics in diagnosis and improved targeted treatment of UTI. World Journal of Urology. ISSN 0724-4983. 38, p. 35–43. doi: 10.1007/s00345-019-02731-9. Full text in Research Archive Show summary

  Introduction The genomic revolution has transformed our understanding of urinary tract infection. There has been a paradigm shift from the dogmatic statement that urine is sterile in healthy people, as we are becoming forever more familiar with the knowledge that bacterial communities exist within the urinary tracts of healthy people. Metagenomics can investigate the broad populations of microbial communities, analysing all the DNA present within a sample, providing comprehensive data regarding the state of the microenvironment of a patient’s urinary tract. This permits medical practitioners to more accurately target organisms that may be responsible for disease—a form of ‘precision medicine’. Methods and Results This paper is derived from an extensive review and analysis of the available literature on the topic of metagenomic sequencing in urological science, using the PubMed search engine. The search yielded a total of 406 results, and manual selection of appropriate papers was subsequently performed. Only one randomised clinical trial comparing metagenomic sequencing to standard culture and sensitivity in the arena of urinary tract infection was found. Conclusion Out of this process, this paper explores the limitations of traditional methods of culture and sensitivity and delves into the recent studies involving new high-throughput genomic technologies in urological basic and clinical research, demonstrating the advances made in the urinary microbiome in its entire spectrum of pathogens and the first attempts of clinical implementation in several areas of urology. Finally, this paper discusses the challenges that must be overcome for such technology to become widely used in clinical practice.

• Cai, Tommaso; Cocci, Andrea; Tiscione, Daniele; Puglisi, Marco; Maida, Fabrizio Di & Malossini, Gianni [Show all 10 contributors for this article] (2018). L-Methionine associated with Hibiscus sabdariffa and Boswellia serrata extracts are not inferior to antibiotic treatment for symptoms relief in patients affected by recurrent uncomplicated urinary tract infections: Focus on antibiotic-sparing approach. Archivio Italiano di Urologia e Andrologia. ISSN 1124-3562. 9(2), p. 97–100. doi: 10.4081/aiua.2018.2.97. Full text in Research Archive Show summary

  Objective: To evaluate the efficacy of a phytotherapic combination of L-Methionine associated with Hibiscus sabdariffa and Boswellia serrata for treatment of acute episodes of uncomplicated urinary tract infections (UTI) in women affected by recurrent UTIs. Materials and methods: In this randomized phase III clinical trial, adult females with uncomplicated UTI were enrolled into one of the following treatment groups: Group A: phytotherapic combination 1 tablet in the morning and 1 tablet in the evening for 7 days; Group B: Short term antibiotic treatment according to international guidelines recommendations. At baseline, all patients were evaluated by a urologist and quality of life (QoL) questionnaires and mid-stream urine culture. Same clinical and laboratory investigations were repeated at each follow-up visit. Results: Forty-six patients were enrolled in Group A and 47 in Group B. At the first follow-up (30 days), both groups showed a statistically significant improvement in quality of life scores as compared with baseline assessment [Group A: (QoL 94.3 VS 98.5 p < 0.001); Group B: (QoL 94.5 VS 98.7 p < 0.001)]. An improvement from baseline was also seen at the second followup evaluation after 3 months [Group A: (QoL 94.3 VS 99.1 p < 0.001); Group B: (QoL 94.5 VS 98.1 p < 0.001)]. At the second follow-up visit, a statistically significant difference in QoL was reported between the two groups (99.1 VS 98.1; p < 0.003) and a transition from UTI to asymptomatic bacteriuria (ABU) was observed 12 of 46 (26%) patients in Group A, while no patients in Group B demonstrated ABU (p = 0.007). Conclusions: Here, we demonstrated that this phytotherapic combination is able, in comparison to antibiotic treatment, to improve patients quality of life, reducing symptoms in acute setting and preventing the recurrences. Interestingly, a significantly higher proportion of patients in the phytotherapy group had ABU after three months. Our findings are of great interest in an antibiotic stewardship perspective.

• Bartoletti, Riccardo; Wagenlehner, Florian M.E.; Johansen, Truls Erik Bjerklund; Köves, Béla; Cai, Tommaso & Tandogdu, Zafer [Show all 7 contributors for this article] (2018). Management of Urethritis: Is It Still the Time for Empirical Antibiotic Treatments? European Urology Focus. doi: 10.1016/j.euf.2018.10.006. Full text in Research Archive
• Kløw, Nils-Einar; Grøtta, Ole Jørgen; Bay, Dag; Sandbæk, Gunnar; Johansen, Truls Erik Bjerklund & Hagen, Thijs [Show all 7 contributors for this article] (2018). Outcome after prostatic artery embolization in patients with symptomatic benign prostatic hyperplasia. Acta Radiologica. ISSN 0284-1851. p. 1–6. doi: 10.1177/0284185118813709. Full text in Research Archive
• Bonkat, Gernot; Braissant, Olivier; Cai, Tommaso; Köves, Béla; Johansen, Truls Erik Bjerklund & Pickard, Robert [Show all 7 contributors for this article] (2018). Non-molecular Methods to Detect Bacteriuria Prior to Urological Interventions: A Diagnostic Accuracy Systematic Review. European Urology Focus. 3(6), p. 535–537. doi: 10.1016/j.euf.2018.03.004. Full text in Research Archive
• Choe, Hyun-Sop; Lee, Seung-Ju; Cho, Yong-Hyun; Cek, Mete; Tandogdu, Zafer & Wagenlehner, Florian [Show all 8 contributors for this article] (2018). Aspects of urinary tract infections and antimicrobial resistance in hospitalized urology patients in Asia: 10-Year results of the Global Prevalence Study of Infections in Urology (GPIU). Journal of Infection and Chemotherapy. ISSN 1341-321X. 24(4), p. 278–283. doi: 10.1016/j.jiac.2017.11.013. Full text in Research Archive Show summary

  Objectives: To assess Asian data from Global Prevalence Study on Infections in Urology (GPIU study) which has been performed more than 10 years. Methods: Seventeen Asian countries participated in the GPIU study between 2004 and 2013. Data for these countries were collected from the web-based GPIU database. The point prevalence of urinary tract infections (UTI) and antimicrobial susceptibility of representative pathogens were analysed for Asian geographic regions. Results: A total of 6706 patients (5271 male, 1435 female) were assessed during the study period, and 659 patients were diagnosed with a UTI (9.8%). Of these UTI patients, 436 were male and 223 were female. Mean patient age was 54.9 ± 19.3 years. Pyelonephritis and cystitis were the most common clinical diagnoses, representing 30.7% and 29.9% of patients, respectively. Escherichia coli was the most frequently identified uropathogen (38.7%). For the patients with urinary tract infection, cephalosporins were the most frequently used antibiotics (34.4%), followed by fluoroquinolones (24.1%), aminoglycosides (16.8%). Fluoroquinolone resistance was relatively high (ciprofloxacin 54.9%, levofloxacin 39.0%), and cephalosporin resistance 42% (42.5–49.4%). Of the antibiotics evaluated, uropathogens had maintained the highest level of susceptibility to amikacin and imipenem (24.9% and 11.3% resistance rates, respectively). Conclusion: Uropathogens in many Asian countries had high resistance to broad-spectrum antibiotics. Knowledge of regional and local resistance data and prudent use of antibiotics are important for proper management of UTI in Asian countries.

• Cai, Tommaso; Cocci, Andrea; Verze, Paolo; Rizzo, Michele; Palmieri, Alessandro & Liguori, Giovanni [Show all 15 contributors for this article] (2018). The use of oral fosfomycin-trometamol in patients with catheter-associated urinary tract infections (CAUTI): new indications for an old antibiotic? Journal of chemotherapy. ISSN 1120-009X. 30(5), p. 290–295. doi: 10.1080/1120009X.2018.1500110. Full text in Research Archive
• Cai, Tommaso; Tessarolo, Francesco; Caola, Iole; Piccoli, Federico; Nollo, Giandomenico & Caciagli, Patrizio [Show all 12 contributors for this article] (2018). Prostate calcifications: A case series supporting the microbial biofilm theory. Investigative and Clinical Urology (Investig. clin. urol.). ISSN 2466-0493. 59(3), p. 187–193. doi: 10.4111/icu.2018.59.3.187. Full text in Research Archive
• Köves, Béla; Tenke, Peter; Tandogdu, Zafer; Cai, Tommaso; Bogenhard, Florian & Wullt, Björn [Show all 15 contributors for this article] (2018). Transurethral resection of the prostate: Are we following the guidelines? - Outcomes from the Global Prevalence of Infections in Urology (GPIU) study. Journal of chemotherapy. ISSN 1120-009X. 31(1), p. 15–22. doi: 10.1080/1120009X.2018.1542552. Full text in Research Archive
• Cai, Tommaso; Lanzafame, Paolo; Caciagli, Patrizio; Migno, Serena; Mereu, Liliana & Mattevi, Daniele [Show all 10 contributors for this article] (2018). Role of increasing leukocyturia for detecting the transition from asymptomatic bacteriuria to symptomatic infection in women with recurrent urinary tract infections: A new tool for improving antibiotic stewardship. International journal of urology. ISSN 0919-8172. 25(9), p. 800–806. doi: 10.1111/iju.13723. Full text in Research Archive
• Drejer, Ditte; Beji, Sami; Øzeke, Recep; Nielsen, Anna Munk; Høyer, Søren & Johansen, Truls Erik Bjerklund [Show all 8 contributors for this article] (2017). Comparison of White Light, Photodynamic Diagnosis, and Narrow-band Imaging in Detection of Carcinoma In Situ or Flat Dysplasia at Transurethral Resection of the Bladder: the DaBlaCa-8 Study. Urology. ISSN 0090-4295. 102, p. 138–142. doi: 10.1016/j.urology.2016.11.032. Full text in Research Archive
• Cai, Tommaso; Verze, Paolo; Palmieri, Alessandro; Gacci, Mauro; Lanzafame, Paolo & Malossini, Gianni [Show all 12 contributors for this article] (2017). Is preoperative assessment and treatment of asymptomatic bacteriuria necessary for reducing the risk of postoperative symptomatic urinary tract infections after urologic surgical procedures? Urology. ISSN 0090-4295. 99, p. 100–105. doi: 10.1016/j.urology.2016.10.016. Full text in Research Archive
• Wagenlehner, Florian M.E.; Tandogdu, Zafer & Johansen, Truls Erik Bjerklund (2017). An update on classification and management of urosepsis. Current Opinion in Urology. ISSN 0963-0643. 27(2), p. 133–137. doi: 10.1097/MOU.0000000000000364. Full text in Research Archive
• Cai, Tommaso; Köves, Béla & Johansen, Truls Erik Bjerklund (2017). Asymptomatic bacteriuria, to screen or not to screen - And when to treat? Current Opinion in Urology. ISSN 0963-0643. 27(2), p. 107–111. doi: 10.1097/MOU.0000000000000368. Full text in Research Archive
• Cai, Tommaso; Tamanini, Irene; Kulchavenya, Ekaterina; Perepanova, Tamara; Köves, Béla & Wagenlehner, Florian M.E. [Show all 10 contributors for this article] (2017). Urogenital and extra genital mutilation in gender-affirming surgery: Are we violating primum non nocere? Archivio Italiano di Urologia e Andrologia. ISSN 1124-3562. 97(1), p. 1–6. doi: 10.4081/aiua.2025.13709. Full text in Research Archive
• Bartoletti, Riccardo; Cai, Tommaso; Wagenlehner, Florian M.; Naber, Kurt & Johansen, Truls Erik Bjerklund (2016). Treatment of urinary tract infections and antibiotic stewardship. European Urology. Supplement. ISSN 1569-9056. 15(4), p. 81–87. doi: 10.1016/j.eursup.2016.04.003. Full text in Research Archive
• Tandogdu, Zafer; Johansen, Truls Erik Bjerklund; Bartoletti, Riccardo & Wagenlehner, Florian (2016). Management of the Urologic Sepsis Syndrome. European Urology. Supplement. ISSN 1569-9056. 15(4), p. 102–111. doi: 10.1016/j.eursup.2016.04.004. Full text in Research Archive
• Vahlensieck, Winfried; Perepanova, Tamara; Johansen, Truls Erik Bjerklund; Tenke, Peter; Naber, Kurt G. & Wagenlehner, Florian M.E. (2016). Management of uncomplicated recurrent urinary tract infections. European Urology. Supplement. ISSN 1569-9056. 15(4), p. 95–101. doi: 10.1016/j.eursup.2016.04.007. Full text in Research Archive
• Smelov, Vitaly; Naber, Kurt & Johansen, Truls Erik Bjerklund (2016). Improved Classification of Urinary Tract Infection: Future Considerations. European Urology. Supplement. ISSN 1569-9056. 15(4), p. 71–80. doi: 10.1016/j.eursup.2016.04.002. Full text in Research Archive
• Wagenlehner, Florian; Tandogdu, Zafer; Bartoletti, Riccardo; Cai, Tommaso; Cek, Mete & Kulchavenya, Ekaterina [Show all 13 contributors for this article] (2016). The global prevalence of infections in urology study: A long-term,worldwide surveillance study on urological infections. Pathogens. ISSN 2076-0817. 5(1), p. 1–8. doi: 10.3390/pathogens5010010. Full text in Research Archive
• Cai, Tommaso; Gallelli, Luca; Cocci, Andrea; Tiscione, Daniele; Verze, Paolo & Lanciotti, Michele [Show all 21 contributors for this article] (2016). Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative. World Journal of Urology. ISSN 0724-4983. 35(2), p. 221–228. doi: 10.1007/s00345-016-1867-6. Full text in Research Archive
• Tandogdu, Zafer; Cai, Tommaso; Köves, Béla; Wagenlehner, Florian & Johansen, Truls Erik Bjerklund (2016). Urinary tract infections in immunocompromised patients with diabetes, chronic kidney disease, and kidney transplant. European Urology Focus. 2(4), p. 394–399. doi: 10.1016/j.euf.2016.08.006. Full text in Research Archive
• Cai, Tommaso; Verze, Paolo; Brugnolli, Anna; Tiscione, Daniele; Luciani, Lorenzo Giuseppe & Eccher, Cristina [Show all 13 contributors for this article] (2016). Adherence to European Association of Urology Guidelines on Prophylactic Antibiotics: An Important Step in Antimicrobial Stewardship. European Urology. ISSN 0302-2838. 69(2), p. 276–283. doi: 10.1016/j.eururo.2015.05.010. Full text in Research Archive
• Kulchavenya, Ekaterina; Naber, Kurt & Johansen, Truls Erik Bjerklund (2016). Urogenital tuberculosis: classification, diagnosis, and treatment. European Urology. Supplement. ISSN 1569-9056. 15(4), p. 112–121. doi: 10.1016/j.eursup.2016.04.001. Full text in Research Archive
• Mouraviev, V; Lee, B; Patel, V; Albala, D; Johansen, Truls Erik Bjerklund & Partin, A. [Show all 8 contributors for this article] (2016). Clinical prospects of long noncoding RNAs as novel biomarkers and therapeutic targets in prostate cancer. Prostate Cancer and Prostatic Diseases. ISSN 1365-7852. 19(1), p. 14–20. doi: 10.1038/pcan.2015.48. Full text in Research Archive
• Bartoletti, Riccardo; Cai, Tommaso; Perletti, Giampaolo; Wagenlehner, Florian M.E. & Johansen, Truls E. Bjerklund (2015). Finafloxacin for the treatment of urinary tract infections. Expert Opinion on Investigational Drugs. ISSN 1354-3784. 24(7), p. 957–963. doi: 10.1517/13543784.2015.1052401. Full text in Research Archive
• Cai, Tommaso; Mazzoli, Sandra; Lanzafame, Paolo; Caciagli, Patrizio; Malossini, Gianni & Nesi, Gabriella [Show all 12 contributors for this article] (2015). Asymptomatic bacteriuria in clinical urological practice: preoperative control of bacteriuria and management of recurrent UTI. Pathogens. ISSN 2076-0817. 5(1), p. 1–6. doi: 10.3390/pathogens5010004. Full text in Research Archive
• Rud, Per Erik; Klotz, Dagmar; Rennesund, Kristin; Baco, Eduard; Johansen, Truls Erik B & Diep, Lien My [Show all 9 contributors for this article] (2014). Preoperative magnetic resonance imaging for detecting uni- and bilateral extraprostatic disease in patients with prostate cancer. World Journal of Urology. ISSN 0724-4983. 33(7), p. 1015–1021. doi: 10.1007/s00345-014-1362-x. Full text in Research Archive
• Tenke, Peter; Köves, Béla & Johansen, Truls Erik B (2014). An update on prevention and treatment of catheter-associated urinary tract infections. Current Opinion in Infectious Diseases. ISSN 0951-7375. 27(1), p. 102–107. doi: 10.1097/QCO.0000000000000031. Full text in Research Archive
• Nilsson, Rasmus; Omland, Harald; Dahl, Alv A & Johansen, Truls Erik B (2014). Early outcome of orchiopexy and analysis of predictive factors: A retrospective study from 2001 to 2010 in a Norwegian regional hospital. Scandinavian Journal of Urology. ISSN 2168-1805. 48(5), p. 474–481. doi: 10.3109/21681805.2014.905631. Full text in Research Archive
• Johansen, Truls Erik B; Nilsson, Rasmus; Tandogdu, Zafer & Wagenlehner, Florian (2014). Clinical presentation, risk factors and use of antibiotics in urinary tract infections. Surgery (United Kingdom). ISSN 0263-9319. 32(6), p. 297–303. doi: 10.1016/j.mpsur.2014.04.002. Full text in Research Archive

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• Bellankimath, Anurag Basavaraj; Branders, Sverre; Kegel, Isabell; Ali, Jawad; Asadi, Fatemeh & Johansen, Truls Erik Bjerklund [Show all 10 contributors for this article] (2025). Accurate and rapid turnaround of four hours for the diagnosis of complicated UTIs using metagenomics. Full text in Research Archive
• Bellankimath, Anurag Basavaraj; Branders, Sverre; Kegel, Isabell; Ali, Jawad; Asadi, Fatemeh & Johansen, Truls E. Bjerklund [Show all 10 contributors for this article] (2025). Turnaround time of just four hours from sample collection to informed decision-making for complicated urinary tract infections in a urology ward, using culture-independent metagenomics. Full text in Research Archive
• Branders, Sverre; Kegel, Isabell; Ali, Jawad; Asadi, Fatemeh; Johansen, Truls E. Bjerklund & Imirzalioglu, Can [Show all 9 contributors for this article] (2025). Turnaround time of just four hours from sample collection to informed decision-making for complicated urinary tract infections in a urology ward, using culture-independent metagenomics. Full text in Research Archive
• Bellankimath, Anurag Basavaraj; Chapagain, Crystal; Branders, Sverre; Ali, Jawad; Wilson, Robert Charles & Johansen, Truls E. Bjerklund [Show all 7 contributors for this article] (2024). Rapid Detection of Clinically Relevant Uropathogens and Antimicrobial Resistance Genes in 5 Hours using Nanopore Sequencing. Full text in Research Archive
• Bellankimath, Anurag Basavaraj; Chapagain, Crystal; Branders, Sverre; Ali, Jawad; Wilson, Robert Charles & Johansen, Truls E. Bjerklund [Show all 7 contributors for this article] (2024). Detection of pathogens and antimicrobial resistant genes from urine within 5 hours using Nanopore sequencing. BioRxiv. ISSN 0362-4331. doi: 10.1101/2024.03.04.582689. Full text in Research Archive
• Bellankimath, Anurag Basavaraj; Chapagain, Crystal; Branders, Sverre; Ali, Jawad; Wilson, Robert Charles & Johansen, Truls E. Bjerklund [Show all 7 contributors for this article] (2024). Rapid Detection of Clinically Relevant Uropathogens and Antimicrobial Resistance Genes in 5 Hours using Nanopore Sequencing. Full text in Research Archive
• Stangl, Fabian P.; Schneidewind, Laila; Kiss, Bernhard; Kranz, Jennifer; Wagenlehner, Florian M. & Johansen, Truls Erik Bjerklund [Show all 10 contributors for this article] (2023). Non-Antibiotic Prophylaxis for Recurrent UTIs in Neurogenic Lower Urinary Tract Dysfunction (NAPRUN): Study Protocol for a Prospective, Longitudinal Multi-Arm Observational Study. Methods and Protocols (MP). 6(3). doi: 10.3390/mps6030052. Full text in Research Archive Show summary

  Introduction: Patients with neurogenic lower urinary tract dysfunction (NLUTD) reliant on intermittent self-catheterization for bladder emptying are at an increased risk of recurrent urinary tract infections (rUTI). So far, the most common practice in the prevention of rUTIs is long-term low-dose antibiotic prophylaxis, phytotherapy, and immunomodulation, whereby antibiotic prophylaxis inevitably leads to the emergence of drug-resistant pathogens and difficulty in treating infections. Therefore, non-antibiotic alternatives in the prevention of rUTIs are urgently required. We aim to identify the comparative clinical effectiveness of a non-antibiotic prophylaxis regimen in the prevention of recurrent urinary tract infections in patients with neurogenic bladder dysfunction who practice intermittent self-catheterization. Methods and analysis: In this multi-centre, prospective longitudinal multi-arm observational study, a total of 785 patients practising intermittent self-catheterisation due to NLUTD will be included. After inclusion, non-antibiotic prophylaxis regimens will be instilled with either UroVaxom® (OM-89) standard regimen, StroVac® (bacterial lysate vaccine) standard regimen, Angocin®, D-mannose (oral dose 2 g), bladder irrigation with saline (once per day). The management protocols will be pre-defined, but the selection of the protocol will be at the clinicians’ discretion. Patients will be followed for 12 months from the onset of the prophylaxis protocol. The primary outcome is to identify the incidence of breakthrough infections. The secondary outcomes are adverse events associated with the prophylaxis regimens and the severity of breakthrough infections. Other outcomes include the exploration of change in susceptibility pattern via the optional rectal and perineal swab, as well as health-related quality of life over time (HRQoL), which will be measured in a random subgroup of 30 patients. Ethics and dissemination: Ethical approval for this study has been granted by the ethical review board of the University Medical Centre Rostock (A 2021-0238 from 28 October 2021). The results will be published in a peer-reviewed journal and presented at relevant meetings. Study registration number: German Clinical Trials Register: Number DRKS00029142.

• Johansen, Truls Erik Bjerklund & Zahl, Per Henrik (2023). T.E.B. Johansen og P.H. Zahl svarer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(12). doi: 10.4045/tidsskr.23.0529. Full text in Research Archive
• Johansen, Truls Erik Bjerklund & Zahl, Per Henrik (2023). Er det bedre å ikke utføre PSA-test? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(8), p. 671–671. doi: 10.4045/tidsskr.23.0248. Full text in Research Archive
• Johansen, Truls Erik Bjerklund & Cai, Tommaso (2022). Facing urosepsis- the most deadly of all urological diseases: Editorial comment to ‘Community-onset urosepsis; incidence and risk factors for 30-day mortality- a retrospective cohort study’, by Holmbom M. et al. Scandinavian Journal of Urology. ISSN 2168-1805. 56(5), p. 421–422. doi: 10.1080/21681805.2022.2137230. Full text in Research Archive
• Cai, Tommaso; Caffo, Orazio; Malossini, Gianni & Johansen, Truls Erik Bjerklund (2021). Delaying Cancer Cases in Urology during COVID-19: Review of the Literature. Letter.J Urol 2020; 204: 926. Journal of Urology. ISSN 0022-5347. 205(5), p. 1534–1535. doi: 10.1097/JU.0000000000001643. Full text in Research Archive
• Berger, Ingvild Merete; Berland, Siren; Rivero, Jezabel Rodriguez; Aamodt, Henrik; Sitek, Jan Cezary & Jørgensen, Kjersti [Show all 7 contributors for this article] (2020). Birt-Hogg-Dubé-syndrom. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(6), p. 1–8. doi: 10.4045/tidsskr.18.0848. Full text in Research Archive
• Cai, Tommaso; Verze, Paolo; Luciani, Lorenzo; Malossini, Gianni; Johansen, Truls Erik Bjerklund & Benetollo, Pier P. [Show all 7 contributors for this article] (2020). What do Patients Say about Telephone-based Urological Consultations at the Time of the COVID-19 Pandemic? Minerva Urologica e Nefrologica. ISSN 0393-2249. 72(4), p. 515–516. doi: 10.23736/S0393-2249.20.03940-5. Full text in Research Archive
• Cai, Tommaso; Tamanini, Irene; Tascini, Carlo; Köves, Bela; Bonkat, Gernot & Gacci, Mauro [Show all 10 contributors for this article] (2020). Reply by Authors. Journal of Urology. ISSN 0022-5347. 203(3), p. 578–578. doi: 10.1097/JU.0000000000000620.03. Full text in Research Archive
• Cai, Tommaso; Tandogdu, Zafer; Wagenlehner, Florian M E & Johansen, Truls Erik Bjerklund (2020). Re: COVID-19 Coagulopathy: Considerations for UrologistsJ. S. Jue and M. Alameddine J Urol 2020; 204: Epub ahead of print. doi: 10.1097/JU.0000000000001144. Journal of Urology. ISSN 0022-5347. 204(4), p. 848–849. doi: 10.1097/JU.0000000000001228. Full text in Research Archive
• Johansen, Truls Erik Bjerklund & Cai, Tommaso (2018). Re: Determinants of variable resource use for multidisciplinary team meetings in cancer care. European Urology. ISSN 0302-2838. p. 1–1. doi: 10.1016/j.eururo.2018.10.037. Full text in Research Archive
• Smelov, Vitaly; Naber, Kurt & Johansen, Truls Erik Bjerklund (2016). Letter to the editor: Diagnostic criteria in urological diseases do not always match with findings by extended culture techniques and metagenomic sequencing of 16S rDNA. Open Microbiology Journal. 10, p. 23–26. doi: 10.2174/1874285801610010023. Full text in Research Archive
• Johansen, Truls Erik Bjerklund & Naber, Kurt G. (2016). Working on a Dream. European Urology. Supplement. ISSN 1569-9056. 15(4), p. 69–70. doi: 10.1016/j.eursup.2016.04.006. Full text in Research Archive
• Johansen, Truls Erik Bjerklund (2015). Re: Ulike retningslinjer for behandling av prostatakreft. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(17), p. 1535–1536. doi: 10.4045/tidsskr.15.0928. Full text in Research Archive
• Johansen, Truls Erik Bjerklund (2015). Re: Den vanskelige prostatakreften. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(17), p. 1536–1536. doi: 10.4045/tidsskr.15.0915. Full text in Research Archive
• Johansen, Truls E. Bjerklund (2015). Den vanskelige prostatakreften. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(6), p. 508–508. doi: 10.4045/tidsskr.15.0057. Full text in Research Archive
• Johansen, Truls Erik Bjerklund (2015). Ulike retningslinjer for behandling av prostatakreft :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(10), p. 924–925. doi: 10.4045/tidsskr.15.0317. Full text in Research Archive
• Bellankimath, Anurag Basavaraj; Ahmad, Rafi; Wilson, Robert Charles; Ahluwalia, Balpreet Singh & Johansen, Truls Erik Bjerklund (2026). Transforming urinary tract infection diagnostics: Clinical metagenomics for rapid pathogen identification and antimicrobial resistance profiling. Universitetet i Innlandet. ISSN 9788283806229. Full text in Research Archive Show summary

  Urinary tract infections (UTIs) are among the most common bacterial infections world wide, impacting 405 million people and resulting in significant morbidity and healthcare costs. The routine diagnostic test, urine culture, takes 2-4 days to identify the pathogen and determine an appropriate antibiotic. This approach can lead to suboptimal clinical management, high antibiotic prescription rates, and improper use, which in turn foster antimicrobial resistance (AMR). Clinical metagenomics, which involves DNA sequencing of patient samples, offers a promising opportunity to revolutionize UTI diagnosis and treatment. Using Oxford Nanopore Technology (ONT), sequencing and data analysis can be performed in real-time. However, a crucial step for clinical application is the depletion of abundant human DNA, which dominates microbial DNA, as well as the removal of impurities and inhibitors present in the urine sample. Existing DNA extraction methods are not suitable for real-time sequencing because of their lengthy turnaround times, high costs, and challenges in managing clinical samples. The thesis aimed to develop, evaluate, and optimize DNA extraction methods for rapid pathogen identification and antibiotic susceptibility profiling in UTI diagnostics. We developed a culture-independent DNA extraction method that selectively removes human DNA and enriches microbial DNA. This method is accurate, fast, and cost-effective for clinical samples. In a proof-of-concept (PoC) study, urine samples from 78 patients with complicated UTI (cUTI) were evaluated using 11 different DNA extraction methods. The methods encompassed combinations of HL-SAN and M-SAN endonucleases, enzymatic and mechanical lysis strategies, and column and magnetic bead based DNA extraction techniques. Compared with routine culture-based diagnostic assays, the optimized method yielded the best pathogen identification performance (accuracy 99%, sensitivity 99%, specificity 100%) and antibiotic-susceptibility predictions (accuracy 90%, sensitivity 68%, specificity 95%). The method is also rapid, with a turnaround time of approximately 4 hours and a per sample cost of $36. Following modifications, a prospective validation study was carried out on an additional 296 cUTI samples, confirming pathogen identification performance consistent with the PoC study and slightly improved antibiotic susceptibility predictions. The limit of detection was 9.3 × 103 CFU/mL. The modifications also enabled the detection of Candida species, indicating the potential for comprehensive pathogen identification. The developed method’s usefulness extends beyond cUTI samples, as shown by the PoC study on blood cultures for diagnosing bloodstream infections. In this study, key parameters like saponin, endonucleases, and salt concentrations were fine tuned for the blood cultures. The optimized approach successfully depleted host material in blood cultures. In conclusion, the culture-independent sample preparation methods tackle the crucial challenge of DNA extraction from clinical samples. They provide a comprehensive and practical strategy to improve the diagnosis and management of UTIs and bloodstream infections, and to promote prudent antibiotic use and AMR stewardship. While additional validation is necessary, these findings show strong potential for broad clinical application and the potential to improve patient care.

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