Current Trend of Antibiotic Use for Urological Disease in South Korea

17 Aug 2025 12:30 13:00
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.
Sang-Rak BaeKorea (Republic of) Speaker HPV Vaccination in Men, Asia and the WorldHPV Vaccination in Men: Status in Asia and the World Human papillomavirus (HPV) comprises a group of over 200 virus types, among which certain high-risk types are known to cause genital warts and various cancers. Persistent infection with high-risk HPV types is a leading cause of cervical cancer and is also associated with vulvar, vaginal, oral/oropharyngeal, penile, and anal cancers. Approximately 5.2% of all cancers globally—amounting to around 600,000 new cases annually—are attributed to HPV infection. Prophylactic vaccination remains the most effective method to prevent these HPV-related malignancies. In the case of cervical cancer, HPV screening and treatment of precancerous lesions are also recognized as effective preventive strategies. However, due to the absence of reliable screening methods for HPV-related conditions in men, the burden of male HPV infection has often been overlooked. As of 2025, around 149 countries have implemented national HPV vaccination programs, of which 82 offer gender-neutral vaccination (GNV). In Asia, Mongolia, Bhutan, the UAE, Qatar, and Kuwait have adopted GNV, and Taiwan is scheduled to expand vaccination to males starting September 2025. This study aims to emphasize the necessity of expanding HPV vaccination for males in Asia, based on global comparisons and the rationale for male vaccination. 1. History of HPV and HPV Vaccination In the 1970s, HPV infection was first identified as a cause of female genital malignancies. In 1985, HPV DNA was detected in head and neck cancer tissues, and in 1995, HPV types 16 and 18 were officially classified as carcinogenic for genital cancers. The first HPV vaccine was developed in 2006, and in 2007, HPV-16 was acknowledged as a carcinogen for head and neck cancers. As of July 2025, 37 out of 38 OECD countries (excluding Türkiye) have implemented national vaccination programs. Japan and Korea currently only provide government-supported vaccination for females. In Asia, Mongolia, Bhutan, UAE, Qatar, and Kuwait offer vaccination for both sexes, with Taiwan including males starting in September 2025. 2. Global Status of HPV-Related Cancers To reduce the incidence of cervical cancer to fewer than 4 cases per 100,000 women by 2030, the WHO has launched the "A World Without Cervical Cancer" initiative, targeting 90% vaccination coverage, 70% screening uptake, and 90% treatment rates. Globally, 87–96% of cervical cancers are HPV-related, with 92% in Asia alone. Additionally, head and neck cancers—the fifth most common cancer—are associated with HPV in 20–40% of cases. Penile cancer is linked to HPV in up to 90% of HGSIL cases and approximately 33% of invasive penile cancers. In total, HPV is associated with over 730,000 cancers worldwide, representing over 5% of all malignancies. 3. Rationale for HPV Vaccination in Males HPV vaccination in males is often underprioritized, as the burden of prevention is traditionally placed on females. Unlike cervical cancer in females, there is no organized screening program for HPV-related non-cervical cancers in men, limiting secondary prevention benefits. Men also show lower awareness of HPV-related diseases, increasing their vulnerability to infection. Due to insufficient vaccine coverage, populations such as MSM and unvaccinated females remain inadequately protected despite herd immunity. Males act as a significant reservoir of HPV. Transmission from female to male occurs at a rate of 5.6 per 100 person-months, while male-to-female transmission is also substantial at 3.5. HPV-infected sperm demonstrates reduced motility and increased DNA fragmentation, potentially affecting fertility. In the U.S., the incidence of HPV-related oropharyngeal cancer in men has surpassed that of cervical cancer in women since the mid-2010s. 4. HPV Vaccination for Males in Asia Asia is home to approximately 60% of the global population. However, the two most populous countries—China and India—do not include HPV vaccination in their national immunization programs. Among the Asian countries offering vaccination, only Mongolia, Bhutan, UAE, Qatar, Kuwait, and now Taiwan (from September 2025) provide GNV. There is significant variability in vaccination coverage across nations. According to GLOBOCAN data, 58% of global cervical cancer cases—around 352,000 new diagnoses—occur in Asia. Given Asia’s population size and disease burden, expanding HPV vaccination programs, particularly for males, is a critical public health priority. 5. Recommendations To prevent HPV-related diseases—including cervical cancer, oropharyngeal cancer, and benign HPV-related conditions—HPV vaccination is recommended for both males and females aged 9–26. Individuals aged 9–14 should receive two doses at 0 and 6 months; those aged 15–26 should receive three doses at 0, 1, and 6 months. The optimal age for vaccination is 11–12 years. Women aged 27 and above may receive the vaccine based on individual clinical decision-making. 6. Conclusion HPV affects both sexes, contributing significantly to disease burden in males through cancers and anogenital warts. The lack of organized screening for HPV-related diseases in men makes gender-neutral vaccination (GNV) a fair and effective public health strategy. GNV may also accelerate cervical cancer elimination and increase program resilience against future disruptions. In particular, the high burden of HPV-related diseases in Asia underscores the urgency and importance of expanding vaccination coverage across the region.
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The proportion of antimicrobial-resistant bacteria has been rapidly growing all over the world, especially in Asia. In addition, emergence, spread and persistent of multidrug-resistant bacteria increase the risk of disease spread, severe illness and death, which is recognized as one of the greatest threats to global health. Given these circumstances, the appropriate use of an antimicrobial agent is fundamental for treating UTI, and to select the optimal antibiotics, it should be based on the microbiological characteristics of the community and the corresponding antibiotic susceptibility information. Therefore, continuous investigation and monitoring of AMR are necessary to obtain correct information on the distribution, microbiological characteristics, and antibiotic susceptibility for uropathogen in the community. 

In the World Health Organization's 2014 global surveillance report on antibiotic resistance, the increase in resistance to cephalosporin and fluoroquinolone antibiotics among the major causative bacteria of urinary tract infections was raised as a serious problem for global health, and Korea, also. 

In general, some of the urine sediment test items are used to diagnose urinary tract infections, but the traditional method relies on a microscope. However, even if a standardized test method is used, the microscopic measurement method may show differences depending on the variation and skill level of the operator, and has the disadvantage of low reproducibility due to subjective interpretation of test results and a long time required for testing. 

Recently, various attempts have been made to overcome the shortcomings of the traditional microscopic observation of urine sediment, and in particular, automated urine sediment analyzers have been developed and are being actively used. 

In the case of UF-5000, a fully automatic urine sediment analyzer, sensitivity and specificity have been improved compared to existing microscopic measurement methods in detecting bacteria, and in particular, information on suspected Gram positive and Gram negative bacteria is provided as a flag message for bacterial culture. Provides information that can be used as the basis for empirical treatment until screening and culture results are obtained.