The Japanese Nationwide Surveillance for UTIs and the JAID/JSC Guide to Clinical Management of Infectious Diseases 2023: The Usefulness of the Urinary Flow Cytometry Method (uFCM)

17 Aug 2025 12:10 12:30

Shang-Jen ChangTaiwan Moderator Which Surgical Treatment is Best for UPJO in Infants: Open, Laparoscopic, Robotic AssistedAbstract Ureteropelvic junction obstruction (UPJO) in infants is a condition that can significantly impair renal function and requires timely surgical intervention when certain criteria are met, such as decreased split renal function, poor drainage on diuretic renography, or recurrent urinary tract infections. The three main surgical approaches for treating UPJO are open pyeloplasty (OP), laparoscopic pyeloplasty (LP), and robot-assisted laparoscopic pyeloplasty (RALP). Each technique has its own benefits and limitations, especially when applied to infants. Minimally invasive surgery (MIS), including LP and RALP, has gained popularity in pediatric urology due to advantages such as shorter hospital stays, reduced postoperative pain, faster recovery, and better cosmetic outcomes. However, the small working space in infants, the steep learning curve, and higher costs are significant limitations. In particular, the utility of MIS in infants remains controversial due to undefined benefits and technical challenges, including limited space for trocar placement and difficulty in intracorporeal suturing. Current guidelines from the European Association of Urology (EAU) indicate that while RALP is considered the gold standard for older pediatric patients, its role in infants remains less defined due to anatomical and logistical constraints. Open surgery continues to be the mainstay for infantile UPJO due to its well-established success rate and lower cost. Several studies have addressed the learning curve associated with these techniques. Laparoscopic pyeloplasty requires about 30 cases for a surgeon to achieve proficiency, while RALP demands approximately 18–31 cases depending on the metrics used. Simulation-based training, dry labs, and multicenter collaboration are proposed solutions to accelerate skill acquisition and ensure patient safety. Cost is another critical consideration. Although RALP generally incurs higher upfront costs, especially in low-volume centers, innovations such as magnetic stents have helped offset some of these expenses by eliminating the need for anesthesia during stent removal. Moreover, the availability of pediatric-specific robotic instruments remains limited and necessitates ongoing development to fully support MIS in smaller patients. In conclusion, while RALP is increasingly recognized as the standard for pediatric UPJO, its application in infants should be considered selectively, depending on surgeon experience, institutional resources, and patient anatomy. Open pyeloplasty remains a safe and effective option, particularly in very young children. Advances in surgical training, cost reduction strategies, and instrument development will be key to expanding the use of minimally invasive techniques in this population.

Koichiro WadaJapan Speaker Antimicrobial Resistance on Neisseria Gonorrhoeae and Mycoplasma GenitaliumSexually transmitted diseases, in which Neisseria gonorrhoeae and Mycoplasma genitalium are the pathogenic microorganisms, have become a social problem also in Japan. Drug resistance has been increasing, especially among penicillins, macrolides, and fluoroquinolones in Neisseria gonorrhoeae. Mycoplasma genitalium was originally not highly susceptible to tetracyclines, but has recently become resistant to macrolides and fluoroquinolones. N. gonorrhea can be treated with a 1g single-dose of ceftriaxone, but urethritis caused by M. genitalium sometimes requires sequential/combination therapy, and many cases are difficult to treat. In my presentation, I would like to discuss diagnosis and treatment, especially drug resistance in Japan.

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Antimicrobial resistance (AMR) has been major concern worldwide. According to Japanese nationwide surveillance carried out in 2020, progression of AMR was observed not only among complicated urinary tract infections (uUTIs); Among uUTIs, FQ-resistant E. coli and ESBL-producing E. coli accounted for 20.0% and 10.6%, respectively. Additionally, in postmenopausal women with penicillins and first-generation cephalosporins have tended to be recommended at high grade. Recommendations for cases in which ESBL-producing strains are suspected or isolated have been set as an independent item for each infection, and oral and intravenous antimicrobials other than carbapenems are recommended. Moreover, urinary flow cytometry method (<span class="NormalTextRun SpellingErrorV2Themed SCXW166027823 BCX0" style="-webkit-user-drag: none; -webkit-tap-highlight-color: transparent; margin: 0px; padding: 0px; user-select: text; background-position: 0px 100%; background-repeat: repeat-x; background-image: url(" data:image="" svg+xml;base64,phn2zyb4bwxucz0iahr0cdovl3d3dy53my5vcmcvmjawmc9zdmciihdpzhropsi1iibozwlnahq9ijqipjxnigzpbgw9im5vbmuiigzpbgwtcnvszt0izxzlbm9kzci+phbhdgggc3ryb2tlpsijruiwmdawiibkpsjnmcazyzeumjugmcaxlji1ltigmi41ltjtmy43nsazidugmyivpjxwyxroigq9ik0widbonxy0sdb6ii8+pc9npjwvc3znpg="=");" border-bottom:="" 1px="" solid="" transparent;"="">uFCM) is introduced as a useful modality. UF-1500 and UF-5000 (Sysmex Corporation, Kobe, Japan) are fully automated urine sediment analyzer to assess urine components. They can provide significant information for clinicians to diagnose UTIs and identify bacteria. Especially regarding bacterial profile, bacteria can be determined to be gram-positive or negative, and it can provide the results of drug susceptibility testing within only 1 hour.

The presentation will provide an overview of surveillance data, treatment guidelines and advanced examinations, which can help clinicians to select appropriate antimicrobials in the era of highly progressive AMR.