Orally Administered Combination of Hyaluronic Acid, Chondroitin Sulfate, Curcumin, and Quercetin in the Prevention of Postcoital Recurrent Urinary Tract Infections: Analysis of 98 Women in Reproductive Age After 6 Months of Treatment.

OBJECTIVE: The aim of this study is to assess the efficacy of orally administered combination of hyaluronic acid (HA), chondroitin sulfate (CS), curcumin, and quercetin for the prevention of postcoital recurrent urinary tract infection (UTI) in reproductive age women. METHODS: Ninety-eight consecutive patients in reproductive age affected by UTI were considered for the study. All 98 patients received a combination of HA, CS, curcumin, and quercetin two tablets per diem for the first month and one tablet every day for the next 5 months. We investigate recurrence of UTI with the Urinary Tract Infection Symptoms Assessment and the Pelvic Pain and Urinary Urgency Frequency. The quality of life and sexual function were valued using 36-Item Short Form Survey, Female Sexual Function Index, and the Female Sexual Distress Scale questionnaires. The same investigations were performed at the first visit and after 6 months of treatment. RESULTS: The symptoms associated with UTI significantly decreased after 6 months of treatment, in particular dysuria episodes diminished and number of voiding decreased (P < 0.0001). During the treatment period, only seven patients (7.1%) experienced a UTI recurrence, confirmed by positive urine culture with bacteriuria of greater than 10 colony forming units/mL. The Pelvic Pain and Urinary Urgency Frequency, Female Sexual Function Index, Female Sexual Distress Scale, and 36-Item Short Form Survey showed a statistically significant improvement after 6 months. CONCLUSIONS: Oral administration of a combination of HA, CS, curcumin, and quercetin is a valid and well-tolerated nonantibiotic treatment for prevention of postcoital UTI in reproductive age women.

Prevention of recurrent lower urinary tract infections in postmenopausal women with genitourinary syndrome: outcome after 6 months of treatment with ospemifene.

Aim of this study was to evaluate the efficacy of ospemifene in the prevention of recurrent lower urinary tract infections in postmenopausal women with vulvovaginal atrophy. The study have a retrospective design. Thirty-nine patients were enrolled. Patients underwent clinical examination and urine culture. The urinary symptoms and the quality of life were evaluated with UTISA score, PUF and SF-36 questionnaires before and after treatment. All 39 patients received ospemifene 60 mg one tablet/daily for 6 months. Adverse effects and complications were assessed. Thirty-nine patients were enrolled in the study. Two patients experienced one new UTI episode and the mean number of positive urine culture decreased significantly after 6 months (3.65 ± 2.12 vs 0.25 ± 0.17, p < .0001). The mean number of urinary infection symptoms decreased significantly after treatment; dysuria reduced (4.76 ± 2.45 vs 0.89 ± 1.12). PUF score and SF-36 showed a statistically significant change (22.43 ± 5.89 vs 12.14 ± 3.21) and (52.86 ± 9.21 vs 83.43 ± 10.76). No adverse effects were reported and the total success rate was the 92.3% after 6 months at PGI-I. Ospemifene is a valid alternative with excellent tolerability for the UTIS prevention in postmenopausal patients.

Use of trans-labial ultrasound in the diagnosis of female urethral diverticula: A diagnostic option to be strongly considered.

AIM: To demonstrate effectiveness of trans-labial ultrasound (TL-US) in the evaluation of female urethral diverticula (UD). METHODS: In the study period, 20 UD were diagnosed and treated. All data on demographic characteristics, presenting symptoms, physical examination findings, diagnostic and operative procedures, were considered. Patients were referred to TL-US for diverticular evaluation, using a 2D 7.5-MHz endfire probe. For each UD, size, complexity, echogenicity content, and presence of diverticular neck were considered. Follow-up controls were carried out at 1, 6 and 12 months after surgery, to evaluate outcome and need for further intervention. RESULTS: Mean patient age was 46 years (range, 35-55 years) and mean parity was 1 (range, 0-3). The principal symptoms associated with the diverticular mass was dysuria (25%). In all evaluated cases, UD was single (simple in 15 cases and complex in 5). The mean size of the diverticula was 28 mm (range, 8-50 mm). Nineteen diverticula were diagnosed on TL-US, and urethrocystoscopy was carried out for confirmation. Treatment consisted of diverticulectomy. At 1-, 6- and 12-month follow up after surgery, TL-US showed no recurrence of UD in any of the patients. CONCLUSIONS: TL-US is a valid, mini-invasive and reproducible method to diagnose UD.

Clinical curative effect of fuzi-cake-separated moxibustion for preventing dysuria after operation for lower limb fracture.

OBJECTIVE: To assess the clinical curative effect of fuzi-cake-separated moxibustion at Zhongji (CV 3) and Guanyuan (CV 4) for preventing dysuria after internal fixation of lower limb fractures. METHODS: Sixty patients conforming to the inclusion standards were randomly divided into a treatment group (n = 30) and a control group (n = 30). Fuzi-cake-separated moxibustion was performed at Guanyuan (CV 4) and Zhongji (CV 3), 20 min at a time, twice a day, for 3 days before operation in the treatment group. No fuzi-cake-separated moxibustion was performed in the control group. After treatment, the score for symptoms of first urination, urinary time, urinary volume, 24 h remaining urinary volume, incidence of uroschesis, and rate of controlling dysuria were compared to evaluate the curative effect of preventing post-operative dysuria. RESULTS: The score for symptoms of first urination, 24 h remaining urinary volume (maximum 120 mL vs 250 ml, and less than 10 ml in 24 cases vs 15 cases), and the rate of controlling dysuria (83.34% vs 30%) were significantly better (P < 0.05, P < 0.05, and P < 0.001, respectively) in the treatment compared with the control group. There was no statistical difference (P > 0.05) between the two groups in first post-operative urinary time, urinary volume, or incidence of 24 h uroschesis. CONCLUSION: Fuzi-cake-separated moxibustion at Zhongji (CV 3) and Guanyuan (CV 4) can better prevent post-operative dysuria, effectively promote the functional restoration of the urinary bladder, and control the incidence of post-operative dysuria.

Shrinkage of prostate volume in sunitinib-treated patients with renal cell carcinoma.

Sunitinib is widely used to treat patients with advanced renal cell carcinoma; however, its influences on the prostate volume and lower urinary tract symptoms remain unclear. To investigate the influence of sunitinib on clinical findings of urinary tract, we recruited a total of 20 male patients with advanced renal cell carcinoma who are treated with sunitinib. We evaluated clinical findings during clinical visits over 24 weeks: International Prostate Symptom Score, urine flow rate, residual urine volume, serum prostate-specific antigen level and prostate volume. Residual urine and prostate volumes were significantly decreased at Week 24. The residual urine volume was especially decreased in patients with a high residual volume at baseline. No differences were observed in the International Prostate Symptom Score total score, International Prostate Symptom Score quality of life score, maximal urinary flow rate or prostate-specific antigen level. We observed a reduction in prostate volume and an improvement in urinary symptoms through relief from urinary tract obstruction during sunitinib treatment. Careful attention to urinary functions and drug dose adjustment seems to be necessary in patients with comorbid benign prostatic hyperplasia or dysuria.

[A case of Ifosfamide-induced dysuria which could be avoided by changing the regimen of mesna].

A 39-year-old woman with advanced and recurrent cervical carcinoma received chemotherapy with IFM+CDDP(IFM 5, 000mg/m2 by intravenous infusion for 24 hours and CDDP 50 mg/m2 by intravenous infusion for one hour)in September of 2011. Mesna(3, 200mg/body)was administered intravenously for 30min three times a day to prevent IFM-induced hemorrhagic cystitis. She complained of residual urine from the evening of day 2 and felt pain during urination from day 3 (urinary tract pain: Grade 1 CTCAE v4.0 ). Both symptoms continued until day 6. When the infusion rate of mesna was changed to 24 hours of continuous administration, as with IFM on the second course, no symptoms which occurred during the first course were observed. The chemotherapy could be continued without compromising her QOL. The present finding suggests that IFM-induced dysuria could be avoided by changing the regimen to mesna, due to the increase in its binding potency and the metabolite of IFM, acrolein.

[Endovascular treatment of persistent dysuria and chronic pelvic pain in women with pelvic varicose veins].

The results of the examination and treatment of 16 patients aged from 26 to 46 years with persistent urinary disorders and chronic pelvic pain due to severe pelvic varicose veins are presented. Using ultrasound with color Doppler mapping and venography of renal and ovarian vein for evaluation of condition of the venous system of the pelvis, the significant dilation of the internal iliac, ovarian and uterine veins with a pronounced decrease in blood flow in veins up to the stasis of blood, accompanied by flow turbulence and powerful backflow of renal blood through ovarian veins were found in all patients. According to uroflowmetry, there was a decrease in detrusor tone and a violation of evacuation capacity of the bladder. Evaluation of microcirculation using LDF allowed to diagnose congestive hemodynamic type of microcirculation. Scleroembolization for varicose ovarian vein with Gianturco coil and ethoxysclerol was performed in all patients. Positive therapeutic effect in the form of eliminating varicose pelvic veins, pain relieve, disappearance of persistent dysuria, and the remission of chronic cystitis was achieved in 86% of women. This intervention provided the normal outflow of blood from the pelvic veins, contributed to the normalization of uroflowmetry data and restoration of normal microcirculation in the urinary bladder.

Dysuria caused by a partially obstructing urethral membrane in a female dog.

CASE DESCRIPTION: A 3.5-year-old spayed female Labrador Retriever was examined for dysuria of unknown duration. CLINICAL FINDINGS: Urogenital examination revealed a recessed vulva and a persistent hymen. The hymen was broken down digitally. Results of urinalysis at the referral examination were unremarkable, and no clinically relevant abnormalities were detected on clinicopathologic analysis of blood and serum samples or cytologic evaluation of a vaginal smear. After clinical signs persisted, retrograde contrast vaginourethrocystography was performed; results were considered normal. During uroendoscopic examination, a translucent membranous structure was detected that partially obstructed the urethral lumen near the junction of the urethra and bladder. TREATMENT AND OUTCOME: Passage of the endoscope into the urinary bladder ruptured the membranous structure. The dog recovered from the procedure uneventfully and was treated with colchicine (0.03 mg/kg [0.014 mg/lb], PO, q 24 h for 14 days). One month later, the owner reported resolution of clinical signs. Fourteen months later, the patient was evaluated for recurrence of dysuria of several months' duration. Uroendoscopic examination revealed a membranous structure similar to that originally detected; this tissue was also ruptured during endoscopy. The patient was discharged and the owner was instructed to administer colchicine at the same dosage. Recurrence of dysuria was reported again 10 months following the second procedure. CLINICAL RELEVANCE: To the authors' knowledge, this type of membranous urethral obstruction has not been previously described in a dog. Administration of colchicine did not prevent recurrence, but potential effects of drug administration on time to recurrence could not be evaluated.

Litiasis recidivante en cachorro Schnauzer miniatura: reporte de un caso / Recurrent urolithiasis in a miniature Schnauzer puppy: case report

La formación de cálculos urinarios es un problema clínico importante en perros. Existen diferencias en la tendencia de presentar litiasis entre diversas razas. Se presenta un caso de litiasis recidivante en un cachorro, macho,Schnauzer miniatura, que a los dos meses de edad presentó hematuria y disuria por obstrucción de vías urinarias asociada a etiología litiásica. El cachorro expulsó urolitos en dos ocasiones, a los tres y siete meses de edad. El análisis morfológico de estos cálculos mostró que el primero estaba formado por Carbapatita (fosfato de calcio carbonatado cristalizado) correspondiente al tipo morfológico IVa1 y los cálculos del segundo episodio presentaban una combinación del tipo IVa1 + IIa, este último tipo morfológico formado por Weddellita (oxalato de calcio dihidratado). Los análisis de orina mostraron pH 6 a 7,5, con bacterias y cristales de fosfato triple en dos muestras y de oxalato de calcio en una muestra del total de seis analizadas. Se administró antibióticos para controlar infecciones urinarias en ambos episodios litiásicos. El manejo nutricional consistió en alimentación con balanceado especial para perros con litiasis desde los 2 hasta los 7 meses de edad. Luego del segundo episodio litiásico se evitaron los balanceados y se alimentó al cachorro con pollo hervido y verduras. Desde la instauración del nuevo régimen nutricional, hace ya más de un año, no se han observado cristales en las muestras de orina, ni se refieren síntomas urinarios en el cachorro hasta la fecha.

The formation of urinary stones represents an important clinical issue in canines. There are differences in the trend to present urolithiasis among breeds. This is a case of recurrent lithiasis in a Miniature Schnauzermale puppy that presented hematuria and dysuria caused by a urinary tract obstruction associated to lithiasis. The puppy eliminated uroliths at the age of three and seven months old. The morphological analysis of this urinary calculus showed that the first consisted of carbapatite (crystallized carbonated apatite) classified as morphological type IVa1 and the second calculus presented a combination of type IVa1 + IIa. Morphological type IIa is formed by Weddellite (dihydrate calcium oxalate). Urine analysis of six samples showed a pH value from 6 to 7,5 with presence of bacteria and triple phosphate crystals in two samples and calcium oxalate crystals in one sample. Antibiotic therapy was applied to treat urinary infection in both lithiasic episodes. Dietary therapy consisted initially in feeding the puppy with balanced food special for dogs with lithiasis from two to seven months old. After the second lithiasic episode, the puppy was fed with boiled chicken and vegetables avoiding the balanced dog food. Since the implementation of the latter nutritional plan, more than a year ago, nor crystals have been detected in urine samples neither clinical signs of urolithiasis were observed in the puppy up to now.

Semiología renal y genitourinaria en pediatría: primera parte / Nephrologoy and urology semiology in children: first part

A pesar de los avances tecnológicos, la historia clínica y el examen físico continúan y continuarán siendo la base de un buen enfoque y aproximación diagnóstica correcta, por ésto, la semiología sigue siendo un área muy importante en la medicina. En ésta revisión se plantea una guía sistemática e integral para la evaluación del sistema nefro-urológico en el niño desde las herramienta básicas y fundamentales como la historia clínica, el examen físico con sus componentessemiológicos en lo normal y lo patológico, integrando además los métodos diagnósticos de laboratorio e imagen disponibles en la actualidad, para lograr un buen enfoque y aproximación diagnóstica en niños con enfermedad renal.

Despite technological advances, medical history and physical examination remain the foundation of a good approach and correct diagnosis; semiology remains a very important area in medicine. In this review a systematic and comprehensive guide for the evaluation of nephron urological system in children is presented, with emphasis in medical history, physical examination and semiotic aspects, in normal and pathological conditions; additionally laboratory and imaging studies available to achieve a good diagnostic approach in children with renal disease are presented.