Der Urologe · Suppl 1 · 2017
Urologe 2017 · 56 (Suppl 1):S6–S136
Online publiziert: 10. August 2017
Springer Medizin Verlag GmbH
Abstracts des 69. Kongresses
der Deutschen Gesellschaft
für Urologie e. V.
V01 – Infektiologie
20. 09. 2017, Breslau, 10:30–12:00
Optimal dosage and duration of Pivmecillinam for the treatment
of uncomplicated lower urinary tract infections: a systematic
review and meta-analysis
, J. Kranz
, K. Jensen
, T. Proctor
, K. Naber
, F. Kunath
, S. Schmidt
UroEvidence@DGU, Berlin, Germany,
St. Antonius Hospital, Eschweiler,
Institute of Medical Biometry and Informatics (IMBI), Universität
Heidelberg, Heidelberg, Germany,
Klinik für Urologie, Technische
Universität Munich, Straubing, Germany,
Department of Urology, University
Hospital Erlangen, Erlangen, Germany,
Department of Urology, Pediatric
Urology and Andrology, Justus-Liebig University, Giessen, Germany
Background: Lower urinary tract infections are among the most prevalent
bacterial infections. Pivmecillinam (PIV) has been used for >30 years, al-
though the optimal PIV dosage/duration regime remains unknown. We
conducted a systematic review/meta-analysis to compare ecacy/safety
of dierent PIV Regimes.
Methods: We included RCTs with adults with symptoms of UTI that com-
pared dierent PIV regimes or PIV versus other antibiotics. Meta-analyses
were conducted using xed-eect model to obtain direct/indirect ecacy
estimates for the following outcomes: clinical/bacteriological cure, reinfec-
tion, relapse, failure and adverse events. We categorized PIV regimes into
high-total dosage, moderate-total dosage and low-total dosage regimes.
Results: We included 23 RCTs. No dierence in clinical cure was found in
PIV high versus moderate or high versus low total dosage comparisons.
For bacteriological cure, comparisons of high versus moderate total PIV
dosage as well as high versus low total PIV dosage showed a trend in favour
of the total high dosage treatment. Results for relapse, reinfection and fail-
ure were inconclusive and statistically not signicant. Patients treated with
total high dosages were 40% and 44% more likely to report mild-moder-
ate adverse events than those treated with moderate or low total dosages.
Conclusions: ere is insucient evidence to support the use of an opti-
mal combination of dosage, frequency, duration of PIV therapy. Evidence
is limited due to moderate to high risk of bias of included studies, old study
data and data based on small sample sizes. In order to give clinical advice
and considering current antimicrobial stewardship strategies that favour
higher doses and shorter treatment durations, 3-days treatment durations
can be recommended.
Analysis of ESR1, ESR2 and AR in liquid biopsies of CP/CPPS
patients: ﬁrst steps towards establishment of non-invasive
biomarkers for chronic prostatitis
, H.-C. Schuppe
, A. Pilatz
, E. Berg
, T. Dansranjavin
, J. Wolf
, U. Schagdarsurengin
Klinik für Urologie, Kinderurologie und Andrologie, Epigenetik des
Urogenitalsystems, Gießen, Germany,
Klinik für Urologie, Kinderurologie
und Andrologie, Gießen, Germany
Introduction: Chronic prostatitis/chronic pelvic pain syndrome (CP/
CPPS) has an enigmatic etiology, heterogeneous clinical presentation and
unexplored molecular background. As hormonal and inammatory im-
balances accompany prostate tumors, and chronic inammation is a po-
tent risk factor, we studied estrogen and androgen receptors (ESR1, ESR2
and AR) in CP/CPPS patients’ liquid biopsies.
Materials and methods: Age-matched (< 40 and ≥40 years) CP/CPPS pa-
tients type IIIb (n = 50) and healthy controls (n = 51) were obtained in
Clinic of Urology, Giessen. Patients were characterized according to CPSI,
IPSS and IIEF. Inammatory factors (interleukin 8, testosterone, estradiol,
elastase, fructose, and peroxidase-positive cells) were routinely measured.
Matched liquid biopsies (blood and ejaculates) were used for isolation of
white blood cells (WBCs) by density gradient centrifugation. CpG-pro-
moter methylation and mRNA expression of ESR1, ESR2 and AR were
analyzed by pyrosequencing and RT-qPCR, respectively.
Results: CP/CPPS was associated with elevated levels of IL8, peroxi-
dase-positive cells, elastase and fructose (p < 0.01, Mann-Whitney U test),
whereby elder patients were aected more profoundly. Peripheral WBCs
were inconspicuous, when comparing age-matched patients and controls.
Remarkably, WBCs obtained from ejaculates of CP/CPPS patients exhib-
ited signicantly increased methylation of ESR1 and ESR2 promoters and
down-regulation of respective gene expression (p < 0.01). is dierence
was detectable among young (< 40 y. patients vs. controls) as well as elder
men (>40 y.).
Conclusion: Epigenetic inactivation of ESR1 and ESR2 in ejaculated WBCs
is symptomatic for CP/CPPS and could serve as an age-independent
non-invasive biomarker for chronic prostatitis.
Keimspektrum und Resistenzlage gängiger Harnableitungen –
Implikationen für den klinischen Alltag
S. K. Frees
, J. Rapp
, W. Jäger
, C. Thomas
, A. Haferkamp
, R. Stein
Klinik und Poliklinik für Urologie und Kinderurologie der
Universitätsmedizin Mainz, Mainz, Deutschland,
Zentrums für Kinder-
und Jugendurologie des Universitätsklinikum Mannheim, Mannheim,
Einleitung: Der Anteil multiresistente Keime nimmt in Deutschland zu.
Nach Anlage einer Harnableitung ist die klinische Signikanz einer Bak-
teriurie meist unklar. Ziel der Studie war es die Assoziation von Bakterien
zur Harnableitungsart, relevanten Infektzeichen sowie dem Resistenzspek-
trum dieser Keime zu evaluieren.
Die präsentierenden Autoren sind mit einer Unterstreichung markiert.