24 THE JOURNAL OF UROLOGY® CONCLUSIONS: Uncomplicated UTis in males may not be as uncommon as current literature suggests. Presentation and diagnostic criteria employed in primary care are greatly variable, which makes criterion-based subsequent investigation in secondary care difficult. Standardisation of upper tract imaging is required; this study indicates that this may not be required in the absence of loin pain, pyrexia or recurrence of infection. Abnormal uroftows and post-void residuals are the commonest abnormality. Source of Funding: None 90 A SYSTEMATIC REVIEW OF URINARY TRACT INFECTIONS FOLLOWING TRANSPOSITION OF BOWEL SEGMENTS INTO URINARY TRACT Nabi Ghulam*, Sze M Yong, Eng Ong, Adrian Grant, Gladys C McPherson, James M 0 N'Dow, Aberdeen, United Kingdom INTRODUCTION AND OBJECTIVE: Recurrent or persistent infections often complicate urinary tract reconstruction using intestine. We carried out a systematic review to find out the prevalence of urinary tract infections following transposition of bowel segments into urinary tract. METHODS: We searched Medline, Pubmed, Embase, CINAHL and ZETOC from 1990 to December 2002. We searched from 1990 onwards principally because bladder reconstruction using transposed intestinal segments began to be used more widely from the mid-1980s, and meaningful long term follow up data would be expected to start appearing in the literature from the 1990s. 3370 abstracts were reviewed including all types of studies from prospective controlled studies to retrospective small series. All relevant articles with at least 10 patients and a mean follow up of at least I year were retrieved. 405 studies were suitable based on these criteria. There were no language restrictions. Data was extracted on urinary tract infection rates, CISC rates and reported incidence of catheter/ urostomy pouch blockage. The quality of study design and data reporting was assessed using checklist. RESULTS: 405 studies were suitable based on the above inclusion criteria. There were I 0 randomised controlled trials, 21 prospective cohort studies, 17 comparative prospective studies, 74 retrospective comparative studies and 279 retrospective case series reporting on 32,795 patients. Urinary tract infection was reported in 6 (60%) randomised trials, 5 (23%) prospective cohort studies, 3 (17.6%) comparative prospective studies, 13 (17.5%) retrospective comparative studies and 81 (29%) retrospective case series. The reported incidence is shown in the Table below with respect to various types of diversions: The mean qualityof various studies was 7/26, with randomised controlled trials scoring 12/26. CONCLUSIONS: Urinary tract remains a significant complication following reconstruction of urinary tract using intestine. Type of urinary diversion, or bowel segment does not have any significant impact on its incidence. The quality of reporting is poor. There is lack of standardisation of reporting and defination of UTis. Very few studies report on catheter/urostomy blockages. Type of UTI Conduit Continent Bladder recon- Bladder replace- diversion diversion And CISC/Urostomy Median% Median% struction Me- ment Me- blockage rates (Range) (Range) dian% (Range) dian'lo(Range) Upper tract 30 (0-52) 14(641) 17 (0-83) 10(4-85) Lower tract 11 (1-20) 10 (1-61) 11 (0-56) 7 (0·36) CISC/Urostomy 2(04) 2(0-12) 1 (04) blockage rate Source of Funding: None 91 KETAMINE-ASSOCIATED ULCERATIVE CYSTITIS: A NEW CLINICAL ENTITY Robert J Stewart*, Rohan Shahani, Robert Hamilton, Toronto, ON, Canada INTRODUCTION AND OBJECTIVE: Ketamine hydrochloride is a NMDA receptor antagonist that is used as a dissociative anesthetic agent in humans and for veterinary procedures. Increasingly however, it is being used as a recreational drug. Users inhale lyophilized ketamine and describe euphoric "out-of-body" experiences. The source of ketamine for such illicit use has been veterinary sources. Recently, ketamine has been produced illicitly, and the supply and use has significantly increased. METHODS: 4 patients, all of whom are daily ketamine users, have been assessed recently with severe irritative voiding symptoms. Specifically, all have had dysuria, frequency, urgency and associated gross hematuria. RESULTS: Urine cultures were sterile in all cases. CT imaging revealed marked thickening of the bladder wall, small capacity as well as peri-vesical stranding, consistent with severe inflammation. At cystoscopy, all of the patients had severe ulcerative cystitis. Biopsy revealed epithelial denudation and inflammation with a mild eosinophilic infiltrate. A sample of the drug was analyzed at a central narcotics laboratory and confirmed to be ketamine hydrochloride. *Presenting author. Vol. 171 , No.4 , Supplement, Saturday, May 8, 2004 Treatment with non-steroidal anti-inflammatories, antibiotics and phenazopyridine was unsuccessful. All 4 patients have had a good response to pentosan polysulfate, although the severity of symptoms appears to correlate with their ketamine use. CONCLUSIONS: We describe a new clinical entity of severe ulcerative cystitis as a result of heavy ketamine use. Although the mechanism of bladder injury is presently unknown, it may be a metabolite of ketamine hydrochloride. The natural history of this disorder is not yet defined. Medical use of ketamine has not been reported to produce these effects on the bladder. As illicit ketamine becomes more easily available, ulcerative cystitis related to its use may be a more prevalent problem confronting urologists. Source of Funding: None 92 A NEW CONCEPT FOR TREATMENT OF URINARY TRACT INFECTIONS CAUSED BY NITRATE- REDUCING BACTERIA: AN IN VITRO EVALUATION Stefan G Carlsson*, Peter Wiklund, Eddie Weitzberg, Jon Lundberg, Stockholm, Sweden INTRODUCTION AND OBJECTIVE: E. coli , a nitrate-reducing gram- negative bacteria, causes the vast majority of lower urinary tract infections. Dietary and endogenous nitrate is excreted in urine and during infection with nitrate- reducing bacteria it is reduced to nitrite. At a low pH nitrite is converted to a variety of nitrogen oxides that are toxic to bacteria. The objective with this study was to investigate the antibacterial effects of urinary nitrate after its sequential reduction to nitrite and other nitrogen oxides. METHODS: An Escherichia coli control strain (ATCC 25922) and a mutant lacking nitrate reductase activity (RK 4353 mutant) were pre-incubated in urine supplemented with sodium nitrate (0-10 mM) at pH 7.0. The nitrite-containing bacterial culture was then transferred (and diluted Ill 0) to slightly acidic urine (pH 5 and 5.5) containing ascorbic acid (10 mM) and growth was monitored continuously in a computerized incubator (optical density) and with a viable count method. Nitrite and nitrate sample concentrations were determined by chemiluminescence after reductive cleavage and subsequent determination of the NO released into the gas phase. RESULTS: The control strain produced nitrite in relation to the amount of nitrate added. This strain was killed when the culture was transferred to acidic urine. In contrast, the mutant that did not produce nitrite retained full viability after transfer to acidic urine. If control bacteria were grown in acidic urine with nitrate and ascorbic acid present from the start of the experiment no inhibition of growth was noted. MICs and minimal bactericidal concentrations, (MBCs) of sodium nitrite/ascorbic acid in acidic urine were comparable to those of conventional antibiotics. CONCLUSIONS: Pre-incubation of nitrate-reducing E. coli in nitrate-rich urine leads to accumulation of nitrite. Subsequent acidification of the urine results in generation of nitrogen oxides that are bactericidal. Killing however requires a sequential procedure where bacteria are allowed to grow in nitrate-rich neutral environment later followed by acidification. We speculate that ingestion of nitrate followed some hours later by acidification of urine could be a new therapeutic strategy for treatment of urinary tract infections. Source of Funding: None defined 93 A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND STUDY COMPARING CIPROFLOXACIN VS CONTROL FOR PEDIATRIC PATIENTS WITH COMPLICATED URINARY TRACT INFECTIONS OR PYELONEPHRITIS Jay M Lieberman*, Long Beach, CA; Luis Huicho, Lima, Peru; Aida Torres, San Miguel de Tucuman, Argentina; Francisco J Cortes Gudino, Jalisco, Mexico; Steven J Skoog, Portland, OR; Martin A Kayle, Denver, CO; Renee Perroncel, Cheryl A Cihon, Pamela Cyrus, Steven F Kowalsky, West Haven, CT INTRODUCTION AND OBJECTIVE: Ciproftoxacin (CIP)'s safety and efficacy in adults with urinary tract infections (UTI) is well-established. Children with complicated UTI (cUT!) or pyelonephritis (PYN) are an acutely ill group where benefits of quinolone administration may outweigh potential risks. This study evaluated the efficacy and musculoskeletal safety of CIP vs a control (CTRL) regimen. METHODS: Patients aged 1-16 years with cUT! or PYN were stratified to initial intravenous (IV) or oral (PO) therapy, then randomized 1:1 to receive CIP or CTRL. In the PO stratum, patients received CIP, cefixime (CFX), or trimethoprim/sulfamethoxazole (TMP/SMX) oral suspension. In the IV stratum, patients received CIP IV or IV to PO, ceftazidime (CZD) IV, IV to CFX PO, or IV to TMP/SMX PO. Duration was 10-21 days, and doses [mg/kg] were: CIP PO 10-20 ql2h ; CIP IV 6-10 q8h; CZD 30-45 q8h; CFX 8/day; TMP/SMX 4/20 ql2h. Primary safety outcome was incidence of arthropathy by 42 days posttherapy (Day 42), assessed by a blinded safety committee. Arthropathy was defined as any condition affecting joints or periarticular tissue with historical or physical evidence