Lower urinary tract dysfunction (LUTD) is common and causes a spectrum of morbidity and decreased quality of life (QoL) for patients. LUTD can range from urinary retention to urge incontinence, and includes a variety of syndromes, with the most common and widely recognized being overactive bladder (OAB). The classic treatments of LUTD and OAB comprise different strategies including behavioral therapies, medications and minimally invasive or invasive surgical procedures. Generally, once patients have tried behavioral modifications and oral medical therapy, and have not experienced adequate relief of their symptoms, the next step is to consider minimally invasive therapies. In the last two decades since FDA approval, sacral nerve stimulation (SNS) has become an accepted intervention, with increasing use and evidence of effectiveness for LUTD, specifically OAB and non-obstructive urinary retention. SNS has shown both objective and subjective improvement in voiding symptoms in several randomized controlled trials (RCTs) when compared to sham or standard medical therapy. The main limitations for more extensive use include relatively high cost, implantation of a device and possibly reoperation secondary to adverse events (AE). Percutaneous tibial nerve stimulation (PTNS) is a less invasive, less direct and less expensive method for neuromodulation, which has also shown effectiveness in several randomized and non-randomized trials, including comparable improvement rates to anticholinergics in OAB management. However, the efficacy of PTNS is only maintained for a short period after the stimulation is delivered. This technique has a much lower rate of AE compared to SNS, but with the inconvenience of weekly visits for stimulation, although implantable devices are on the horizon. In this article we review the mechanism of action, indications, effectiveness and complications related to SNS and PTNS therapy for LUTD.

Cite this article as: Şen P, Demirdal T. Current Approaches to Surgical Antimicrobial Prophylaxis and Use of Antimicrobial Prophylaxis in Urological Procedures. J Urol Surg 2017;4:159-166. Surgical site infections (SSIs) are the most common and preventable type of healthcare-associated infections in low and middle-income countries and affect one-third of patients that have undergone surgical procedures. As the number of surgical procedures performed increases, the prevention of SSIs becomes more important. It is considered that, it is possible to prevent approximately half of all SSI cases. However, due to the contribution of many factors to the development of SSIs, it may be difficult to effectively prevent these infections, and there is a need to take various preventive measures before, during and after surgery. This review presents the current recommendations on the use of prophylactic antimicrobial agents for the prevention of SSIs and recommendations about antimicrobial prophylaxis in urological procedures. Keywords: Surgical site infections, antibiotics, prophylaxisCerrahi alan enfeksiyonları (CAE) en sık görülen sağlık bakımıyla ilişkili enfeksiyonlar olup önlenebilir olması nedeniyle önem arz etmektedir. CAE önlenmesi için uygulama çeşitleri gittikçe artmakta ve buna bağlı olarak kanıta dayalı müdahale talepleri gün geçtikçe artmaktadır. Bu nedenle önceden yayınlanan kılavuzlara ek güncelleme ihtiyacı doğmaktadır. Yeni ve güncellenmiş öneriler sadece sağlık mensupları için değil, aynı zamanda profesyonel dernek ve kuruluşlar için de bir kaynak olabilme özelliğini taşımaktadır. Bu derlemede CAE önlemeye yönelik profilaktik antimikrobiyal ajan kullanımıyla ilgili güncel önerileri sunmak amaçlanmıştır.

No abstract

No abstract