Clinical trials of homeopathy in urological disorders: a systematic review.

OBJECTIVES: Homeopathy remains one of the most sought after therapies for urological disorders. The aim of this paper was to systematically review the available clinical researches of homeopathy in the said conditions. CONTENT: Relevant trials published between Jan 1, 1981 and Dec 31, 2016 (with further extension up to Dec 31, 2017) was identified through a comprehensive search. Internal validity of the randomized trials and observational studies was assessed by The Cochrane Collaboration's tool and methodological index for non-randomized studies (MINORS) criteria respectively, homeopathic model validity by Mathie's six judgmental domains, and quality of homeopathic individualization by Saha's criteria. SUMMARY: Four controlled (three randomized and one sequentially allocated controlled trial) trials were reviewed and 14 observational studies alongside - all demonstrated positive effect of homeopathy. Major focus areas were benign prostatic hypertrophy and renal stones. One of the four controlled trials had 'adequate' model validity, but suffered from 'high' risk of bias. None of the non-randomized studies was tagged as 'ideal' as all of those underperformed in the MINORS rating. Nine observational studies had 'adequate' model validity and quality criteria of individualization. Proof supporting individualized homeopathy from the controlled trials remained promising, still inconclusive. OUTLOOK: Although observational studies appeared to produce encouraging effects, lack of adequate quality data from randomized trials hindered to arrive at any conclusion regarding the efficacy or effectiveness of homeopathy in urological disorders. The findings from the RCTs remained scarce, underpowered and heterogeneous, had low reliability overall due to high or uncertain risk of bias and sub-standard model validity. Well-designed trials are warranted with improved methodological robustness. FUNDING: None; Registration web-link: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018081624&ID=CRD42018081624.

Cannabis and multiple sclerosis.

INTRODUCTION: Patients with multiple sclerosis (MS) may suffer from spasticity and pain during their disease course. Baclofen, dantrolene, diazepam and gabapentin have been used as first-line options to treat these conditions, with modest results. Medical use of marijuana smoking has bypassed traditional clinical trials and has been legalized as a therapeutic option for MS-related spasticity and pain in some countries. Cannabis-derived drugs have been tested and approved for medical use. AREAS COVERED: With the development of nabiximols by the pharmaceutical industry, more countries have made it possible for patients with MS to have legal access to cannabis-related therapies. The evidence-based data on nabiximols and MS-related spasticity, pain, and urinary symptoms is consistent. There are over 7,500 patients reported in 33 studies (12 from the United Kingdom and 11 from Italy). EXPERT OPINION: Nabiximols is safe and effective for patients with MS whose spasticity could not be treated with the first-line oral drugs. At present, legislation, bureaucracy and costs involved in prescribing this drug limit the experience of neurologists from many countries. There is no scientific evidence that smoking marijuana can be beneficial to patients with MS.

[Extract of Serenoa repens in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms].

This literature review focuses on the use of Serenoa repens extracts in the treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Extracts of Serenoa repens produce marked anti-inflammatory, anti-androgenic and antiproliferative effects. Various extracts differ in their activity depending on the concentration of free fatty acids and the method of extract preparation. Extracts of Serenoa Repens from different manufacturers vary considerably in composition, effectiveness and supporting evidence. Evaluation of the effectiveness of Serenoa Repens extracts should be carried out for each extract separately, depending on the method of preparation and brand. The most studied and clinically effective is the hexane lipidosterol extract of Serenoa Repens Permixon. This assessment is supported by a report on Serenoa Repens, issued by the European Medicines Agency. In this report, only Serenoa repens hexanic extract Permixon is considered to be a well-established medical use product for the symptomatic treatment of BPH.

Evaluation of three herbal compounds used for the management of lower urinary tract disease in healthy cats: a pilot study.

OBJECTIVES: Lower urinary tract disease (LUTD) occurs commonly in cats, and idiopathic cystitis (FIC) and urolithiasis account for >80% of cases in cats <10 years of age. Although several strategies have been recommended, a common recommendation is to induce dilute urine resulting in more frequent urination and to dilute calculogenic constituents. In addition to conventional therapy using modified diets, traditional Chinese and Western herbs have been recommended, although only one - choreito - has published data available. We evaluated three commonly used herbal treatments recommended for use in cats with LUTD: San Ren Tang, Wei Ling Tang and Alisma. We hypothesized that these three Chinese herbal preparations would induce increased urine volume, decreased urine saturation for calcium oxalate and struvite, and differences in mineral and electrolyte excretions in healthy cats. METHODS: Six healthy spayed female adult cats were evaluated in a placebo-controlled, randomized, crossover design study. Cats were randomized to one of four treatments, including placebo, San Ren Tang, Wei Ling Tang or Alisma. Treatment was for 2 weeks each with a 1 week washout period between treatments. At the end of each treatment period, a 24 h urine sample was collected using modified litter boxes. RESULTS: Body weights were not different between treatments. No differences were found in 24 h urinary analyte excretions, urine volume, urine pH or urinary saturation for calcium oxalate or struvite between treatments. CONCLUSIONS AND RELEVANCE: The results of this study do not support the hypothesis; however, evaluation of longer-term and different dosage studies in cats with LUTD is warranted.

Ethnopharmacological survey of medicinal plants practiced by traditional healers and herbalists for treatment of some urological diseases in the West Bank/Palestine.

BACKGROUND: Throughout history, every civilization in the world used plants or their derivatives for treatment or prevention of diseases. In Palestine as in many other countries, herbal medicines are broadly used in the treatment of wide range of diseases including urological diseases. The main objective of this research is to study the use of herbal remedies by herbalists and traditional healers for treatment of various urological diseases in the West Bank regions of Palestine and to assess their efficacy and safety through the literature review of the most cited plants. METHOD: The study included a survey part, plant identification and a review study. The first part was a cross-sectional descriptive study. Face to face questionnaires were distributed to 150 traditional healers and herbalist in all regions of the West Bank of Palestine. The literature review part was to assess the most cited plants for their efficacy and toxicity. RESULTS: One hundred forty four herbalists and traditional healers accepted to participate in this study which was conducted between March and April, 2016. The results showed that 57 plant species belonging to 30 families were used by herbalists and traditional healers for treatment of various urinary tract diseases in Palestine. Of these, Apiaceae family was the most prevalent. Paronychia argentea, Plantago ovata, Punica granatum, Taraxacum syriacum, Morus alba and Foeniculum vulgare were the most commonly used plant species in the treatment of kidney stones, while Capsella bursa-pastoris, Ammi visnaga and Ammi majus were the most recommended species for treatment of urinary tract infections and Portulaca oleracea used for renal failure. In addition Curcuma longa and Crocus sativus were used for enuresis while Juglans regia, Quercus infectoria, Sambucus ebulus and Zea mays were used for treatment symptoms of benign prostate hyperplasia. Fruits were the most common parts used, and a decoction was the most commonly used method of preparation. Through literature review, it was found that Paronychia argentea has a low hemolytic effect and contains oxalic acid and nitrate. Therefore, it could be harmful to renal failure patients, also Juglans regia, Quercus infectoria and, Sambucus ebulus are harmful plants and cannot be used for treatment of any disease. CONCLUSIONS: Our data provided that ethnopharmacological flora in the West Bank regions of Palestine can be quite wealthy and diverse in the treatments of urinary tract diseases. Clinical trials and pharmacological tests are required evaluate safety and efficacy of these herbal remedies.

Herbal treatment of the urinary system diseases based on 16(th) and 17(th) century herbals in Poland.

The medicinal use of herbs is a principal achievement of human ingenuity. The most renowned doctors of antiquity: Hippocrates, Dioscorides, Theophrastus, Pliny the Elder and Galen mentioned herbs in their works. The first printed herbal was published in Mainz in 1485. Outstanding scientists e.g. Otto Brunfels, Hieronymus Bock, Leonard Fuchs and Andreo Mattiola published herbals in the 16th century. Polish doctors also contributed to the development of herbal treatment. The first work: Of Herbs and their Potency by Stefan Falimirz, published in 1534, triggered other publications in the 16th century, the age of herbals. In 1542, Hieronymus Spiczynski published a herbal: Of Local and Overseas Herbs and their Potency. Then, in 1568, Marcin Siennik published his: Herbal, which is the Description of Local and Overseas Herbs, their Potency and Application. In 1595, Marcin of Urzedow published: The Polish Herbal, the Books of Herbs. Completed in mid-16th century, it was only published 22 years after his death. The last work discussed is Herbal Known in Latin as published in 1613 by Simon Syrenius a graduate of Ingolstadt and Padua universities and lecturer at the Academy of Krakow. The work was Europes most complete elaboration on herbal treatment. The herbs described in the herbals worked as diuretics, demulcents, analgesics, relaxants and preventives of kidney stones. Published in Polish, they are still to be found in Poland. All the works presented herein are held by the Library of the Seminary of Wloclawek, and the Ossolinski National Institute in Wroclaw.

Influence of polyunsaturated fatty acids on urologic inflammation.

PURPOSE: Studies demonstrate that polyunsaturated fatty acids, fish oils, and alpha-linoleic acid are beneficial anti-inflammatory agents, which suppress inflammatory mediators and their activity. METHODS: This review focuses on the effects of omega-3 fatty acids (O-3FAs) on three primary urologic organs (bladder, kidney, and prostate) and associated conditions such as urolithiasis, kidney transplantation, interstitial cystitis/bladder pain syndrome, bladder cancer, prostate cancer (CaP), and chronic prostatitis/chronic pelvic pain syndrome. RESULTS: The following themes emerged: the potential influence of O-3FA in suppressing urologic inflammation; the supportive role of O-3FA in therapeutic interventions; pro-inflammatory mechanisms of omega-6 fatty acids (O-6FAs) associated with disease progression; and the importance of the optimal ratio of O-6FAs/O-3FAs. CONCLUSIONS: The need for further research on the role of PUFAs in suppressing urological inflammation precipitated.

Antioxidant responses of damiana (Turnera diffusa Willd) to exposure to artificial ultraviolet (UV) radiation in an in vitro model; part I; UV-C radiation / Respuesta antioxidante en damiana (turnera diffusa willd) expuesta a radiación ultravioleta (UV) artificial en un modelo in vitro; parte I; radiación UV-C

Introduction: Ultraviolet type C (UV-C) radiation has higher energy than the UV-B radiation and has been less studied because it is completely absorbed by the ozone layer. However, artificial UV-C radiation can generate diverse modifications in the plants. Given that exposure to UV-C for short periods of time increases the antioxidant content, improving the appearance and shelf-life of products, its potential application in postharvest treatments to modify the antioxidant content of medicinal plants, such as damiana (Turnera diffusa), is novel and relevant. Objective: To determine the effects of UV-C radiation on enzymatic and non-enzymatic antioxidant defenses, as well as oxidative damage levels, in damiana (Turnera diffusa) plantsin vitro. Results: UV-C radiation decreased superoxide dismutase (SOD, EC 1.15.1.1) and total peroxidases (POX, EC 1.11.1) activities, the concentration of chlorophylls (a and b), carotenes, vitamin C, and total antioxidant capacity. UV-C radiation increased the phenolic compound levels in damiana. Loss of antioxidant defenses was higher in damiana plants exposed to higher UV-C doses and/or for longer periods. This study suggests that UV-C radiation induces oxidative stress, evidenced as increased protein carbonyls and phenolic compound content, in damiana (T. diffusa). Conclusion: Low dose, short exposure to UV-C stimulates phenolic compound content in damiana. Thus, controlled UV-C treatments could be used as postharvest treatment to increase phenolic compound content in damiana plants (AU)

Introducción: La radiación ultravioleta tipo C (UV-C) presenta mayor energía y es menos estudiada que la radiación UV-B, debido a que se considera que es totalmente absorbida por la capa de ozono. Sin embargo, la radiación UV-C artificial es capaz de generar diversas modificaciones en las plantas. Dado que la exposición a UV-C por intervalos de tiempo cortos incrementa la concentración de compuestos antioxidantes, mejorando la apariencia y vida de anaquel de los productos, su potencial aplicación en tratamientos poscosecha para modificar el contenido antioxidante de plantas medicinales, como la damiana (Turnera diffusa), es novedoso y relevante. Objetivo: Determinar el efecto de la radiación UV-C sobre las defensas antioxidantes enzimáticas y no enzimá- ticas, así como en los niveles de daño oxidativo de damiana (Turnera diffusa) in vitro. Resultados: La radiación UV-C disminuyó la actividad de las enzimas superóxido dismutasa (SOD, EC 1.15.1.1) y peroxidasas totales (POX, CE 1.11.1), la concentración de clorofila (a y b), carotenos, vitamina C y la capacidad antioxidante total, e incrementó el contenido de compuestos fenólicos en damiana. La disminución de las defensas antioxidantes fue mayor en plantas de damiana expuestas a dosis más altas de UV-C o por períodos más largos. Estos resultados sugieren que la radiación UV-C induce estrés oxidativo, evidenciado por el incremento del contenido de carbonilos proteicos y el contenido de compuestos fenólicos en damiana (T. diffusa). Conclusión: Dosis bajas y menor exposición a UV-C estimulan la síntesis de compuestos fenólicos en damiana. Por ello, tratamientos controlados con UV-C podrían emplearse como tratamientos poscosecha para incrementar el contenido de compuestos fenólicos en plantas de damiana (AU)

Antioxidant responses of damiana (Turnera diffusaWilld) to exposure to artificial ultraviolet (UV) radiation in an in vitro model; part II; UV-B radiation / Respuesta antioxidante en damiana (turnera diffusa willd) expuesta a radiación ultravioleta (UV) artificial en un modelo in vitro; parte II; radiación UV-B

Introduction: Ultraviolet type B (UV-B) radiation effects on medicinal plants have been recently investigated in the context of climate change, but the modifications generated by UV-B radiation might be used to increase the content of antioxidants, including phenolic compounds. Objective: To generate information on the effect of exposure to artificial UV-B radiation at different highdoses in the antioxidant content of damiana plants in an in vitro model. Methods: Damiana plantlets (tissue cultures in Murashige-Skoog medium) were irradiated with artificial UV-B at 3 different doses (1) 0.5 ± 0.1 mW cm-2 (high) for 2 h daily, (2) 1 ± 0,1 mW cm-2 (severe) for 2 h daily, or (3) 1 ± 0.1 mW cm-2 for 4 h daily during 3 weeks. The concentration of photosynthetic pigments (chlorophylls a and b, carotenoids), vitamins (C and E) and total phenolic compounds, the enzymatic activity of superoxide dismutase (SOD, EC 1.15.1.1) and total peroxidases (POX, EC 1.11.1), as well as total antioxidant capacity and lipid peroxidation levels were quantified to assess the effect of high artificial UV-B radiation in the antioxidant content of in vitro damiana plants. Results: Severe and high doses of artificial UV-B radiation modified the antioxidant content by increasing the content of vitamin C and decreased the phenolic compound content, as well as modified the oxidative damage of damiana plants in an in vitro model. Conclusion: UV-B radiation modified the antioxidant content in damiana plants in an in vitro model, depending on the intensity and duration of the exposure (AU)

Introducción: Los efectos de la radiación ultravioleta tipo B (UV-B) sobre las plantas medicinales se han investigado recientemente en el contexto del cambio climático, pero las modificaciones que genera la radiación UV-B podrían emplearse para modificar el contenido de compuestos antioxidantes, incluyendo los compuestos fenólicos. Objetivo: Generar información sobre el efecto de una alta exposición a UV-B artificial en el contenido antioxidante de damiana (Turnera diffusa, Willd) en un modelo in vitro. Método: Plántulas de damiana en cultivo de tejidos (medio Murashige-Skoog) fueron irradiadas con UV-B artificial en 3 diferentes dosis: (1) 0,5 ± 0,1 mW cm-2 (alto) por 2 h diarias, (2) 1 ± 0,1 mW cm-2 (severa) por 2 h diarias, o (3) 1 ± 0,1 mW cm-2 durante 4 horas diarias por 3 semanas. Se cuantificó la concentración de pigmentos fotosintéticos (clorofilas a y b, carotenoides), vitaminas (C y E) y compuestos fenólicos totales, la actividad enzimática de la superóxido dismutasa (SOD, EC 1.15.1.1) y las peroxidasas totales (POX, EC 1.11.1), así como la capacidad antioxidante total y la peroxidación de lípidos para evaluar el efecto de la alta radiación UV-B artificial en el contenido antioxidante de damiana in vitro. Resultados: Dosis altas y severas de radiación UV-B artificial modificaron el contenido antioxidante incrementando el contenido de vitamina C y disminuyendo el contenido de compuestos fenólicos totales, además de modificar el daño oxidativo de plantas de damiana en un modelo in vitro. Conclusión: La radiación UV-B modifica el contenido antioxidante en damiana en un modelo in vitro, dependiendo de la intensidad y el tiempo de exposición (AU)

Fitoterapia en Urología. Evidencia científica actual de su aplicación en urolitiasis, dolor pélvico crónico, disfunción eréctil e infecciones urinarias / Phytotherapy in Urology. Current Scientific Evidence of its Application in Urolithiasis, Chronic Pelvic Pain, Erectile Dysfunction and Urinary Tract Infections

Objetivo: Evaluar la utilidad de la fitoterapia en urolitiasis, infecciones urinarias, disfunción eréctil (DE) y prostatitis crónica/dolor pélvico crónico (PC/DPC). Adquisición de la evidencia: Revisión sistemática de la evidencia publicada hasta enero del 2011 empleando los términos científicos: fitoterapia, litiasis urinaria, prostatitis crónica, dolor pélvico crónico, disfunción eréctil, infección urinaria, cistitis y los nombres científicos de los compuestos siguiendo las normas del Código Internacional de Nomenclatura Botánica. Las bases de datos utilizadas fueron Medline y The Cochrane Library. Se incluyeron artículos publicados hasta enero del 2011 en español/inglés. Se incluyeron estudios in vitro/in vivo sobre modelos animales o seres humanos. Los criterios de exclusión fueron literatura no española/inglesa o artículos con graves defectos metodológicos. Síntesis de la evidencia: Se incluyeron 86 artículos y se seleccionaron 40 que cumplieron los criterios de inclusión. En urolitiasis hay pocos trabajos en humanos. El fitato tiene su principal utilidad como prevención y en la disminución del crecimiento de fragmentos residuales tras litotricia extracorpórea por ondas de choque (LEOCH). En PC/DPC el único compuesto que ha demostrado eficacia fue el extracto de polen en un ámbito de tratamiento multimodal. En DE no hay evidencia a favor del uso de la fitoterapia. La mayoría de los trabajos presentan limitaciones en el diseño o escaso tamaño muestral. En infecciones urinarias la mayoría de los productos son diuréticos. Solo existe evidencia para el arándano rojo como prevención en mujeres jóvenes o embarazadas. No debe emplearse como tratamiento de las infecciones urinarias. Conclusiones: La fitoterapia muestra utilidad en las infecciones urinarias de repetición y en la PC/DPC. Tiene cierto papel en la urolitiasis y carece de utilidad en la DE (AU)

Objective: To assess the usefulness of phytotherapy in urolitiasis, urinary tract infections, erectile dysfunction (ED) and chronic prostatitis/chronic pelvic pain (CP/CPP). Acquisition of the evidence: Systematic review of the evidence published until January 2011 using the following scientific terms: phytotherapy, urinary lithiasis, Chronic prostatitis, chronic pelvic pain, erectile dysfunction, urinary tract infection, cystitis and the scientific names of compounds following the rules of the International Code of Botanical Nomenclature. The databases used were Medline and The Cochrane Library. We included articles published until January 2011 written in English and Spanish. We included studies in Vitro/in vivo on animal models or human beings. Exclusion criteria were literature not in English and Spanish or articles with serious methodological flaws. Synthesis of the evidence: We included 86 articles selecting 40 that met the inclusion criteria. In Urolitiasis there are few works in humans. The phytate has its main use as prevention and in reducing the growth of residual fragments after extracorporeal shock wave lithotripsy (ESWL). In CP/CPP the only compound that has shown effectiveness was the extract of pollen in a field of multimodal treatment. In DE ther is no evidence for the use of herbal medicine. Most of the works have limitations in the design or low sample size. In urinary tract infections most of the products are diuretics .There is only evidence for the cranberry as prevention in young or pregnant women. It must not be used as a treatment for urinary tract infections. Conclusions: Phytotherapy is usefull in repeat urinary tract infections and the CP/CPP. It has some role in the urolitiasis and lacks useful in the DE (AU)

Nabiximols in the treatment of spasticity, pain and urinary symptoms due to multiple sclerosis.

INTRODUCTION: Over the last two decades, experimental and clinical data suggest a therapeutic benefit of cannabis-based medicines for a variety of multiple sclerosis (MS) symptoms. Clinical trials, both with synthetic or plant-derived cannabinoids, have demonstrated clinical efficacy of cannabinoids for the treatment of spasticity, neuropathic pain and bladder dysfunction. Nabiximols, a 1:1 mix of delta-9-tetrahydrocanabinol and cannabidiol extract from cloned chemovars, was licensed in the UK in 2010 and has also been approved in other European countries and Canada. The European Federation of Neurological Societies recommends that cannabis should be used only as a second or third line treatment in central neuropathic pain. AREAS COVERED: After a brief discussion of the endocannabinoid system, this review focuses on the use of cannabis to improve MS symptoms. More specifically, the authors have analyzed clinical studies on cannabis-based medicine extract (CBME), in particular nabiximols, in spasticity, as well as pain, and bladder dysfunction in MS. The authors have considered the large randomized controlled trials examining the psychological effects associated with cannabinoids use as well as long-term follow-up studies. EXPERT OPINION: Despite a number of trials with very promising results, there are still concerns related to relative paucity of data on long-term safety. Also, the long-term efficacy information in terms of the control of symptoms of a disease in which the natural history is progression is sparse. Therefore, further studies are required to improve the current knowledge of nabiximols.

Dietary supplements for benign prostatic hyperplasia: an overview of systematic reviews.

Benign prostatic hyperplasia (BPH) is a common chronic condition in older men. The aim of this overview of systematic reviews (SRs) is to summarise the current evidence on the efficacy and adverse effects of dietary supplements for treating BPH with lower urinary tract symptoms. We searched 5 electronic databases and relevant overviews without limitations on language or publication status. Six SRs of 195 articles were included in this overview. Serenoa repens was reviewed in 3 studies and no specific effect on BPH symptoms and urinary flow measures was observed. However, ß-sitosterol, Pygeum africannum and Cernilton were reviewed in one study each, and significant improvement was observed for all three. All the included compounds have mild and infrequent adverse effects. SRs on ß-sitosterol, Pygeum africannum and Cernilton have not been updated since 2000, thus an update of reviews on these compounds will be necessary in the future.

[The antiradical activity of plant extracts and healthful preventive combinations of these exrtacts with the phospholipid complex].

Using the chemiluminescence method, the effective concentration of antioxidants (AO) and its reactivity toward peroxyl radicals (ARA, the k7 constant) have been measured for 13 plant extracts. In fact all extracts demonstrated ARA higher than ionol. Larix dahurica, Hypericum perforatum, Potentilla fruticosa, Aronia melanocarpa and Rhaponticum carthamoides extracts showed the highest values of ARA. The combinations Aronia + Raponticum extracts; Larix + Hibiscus extracts; Schizandra +Aronia extracts were synergistic (the synergism effect beta of 38%, 33% and 22%). Apparently this phenomenon is the result of the synergistic interaction between compounds present in plant extracts. The Phospholipid complex--Lipoid S40, lacting any antioxidant effect alone, showed a potent synergistic effect with Aronia extract (beta3 = 60%), Silybum extract (beta3 = 41%). Clinical trials demonstrated, that combinations "Lipoid + Aronia extract", "Lipoid + Larix extract + Hibiscus extract", "Lipoid + Silybum extract", "Lipoid + Q10 + Rosa majalis extract" may be used as an additional component in the medicinal treatment, or as an individual prophylactic agent.

Efficacy of ozone as a novel treatment option for urovagina in dairy cows.

Urovagina is detrimental to the health and fertility of cows worldwide. Surgery, the only known treatment, is not economically pragmatic to dairy practice, and it has some medical drawbacks. The objective of this study was to determine whether reproductive problems associated with urovagina could be alleviated through more practical and less-invasive treatment options to allow successful conception and term-pregnancy. Cows diagnosed with urovagina (n = 1219) were divided into three treatment groups, each containing an equal number of cows with mild, moderate and severe urovagina. The groups received one of three treatment options: saline (group A, n = 400), streptomycin (group B, n = 400) or ozone (group C, n = 419) flush, regardless of the severity of the urovagina condition within the group. The ozone treatment was found to be the most effective treatment modality, resulting in the shortest period of days open (95, 89 and 79 days in groups A, B and C, respectively; p < 0.05), the fewest number of inseminations until pregnancy (2.38, 1.84 and 1.63 in groups A, B and C, respectively; p < 0.05) and the smallest number of culled cows (20, 23 and 12 in groups A, B and C, respectively; p < 0.05). The ozone flush coupled with intracornual insemination presents an effective treatment option for urovagina that can lead to successful conceptions and pregnancies in dairy cows.

Recruitment of participants to a clinical trial of botanical therapy for benign prostatic hyperplasia.

OBJECTIVES: The timely recruitment of study participants is a critical component of successful trials. Benign prostatic hyperplasia (BPH), a common nonmalignant urologic condition among older men, is characterized by lower urinary tract symptoms (LUTS). Successful recruitment methods for a trial of medical therapy for BPH, Medical Therapy of Prostate Symptoms (MTOPS), were mass mailing and advertising. The Complementary and Alternative Medicines Trial for Urological Symptoms (CAMUS) was designed to evaluate a botanical therapy, saw palmetto, for the treatment of BPH. The objective of this study was to evaluate recruitment strategies for CAMUS and to contrast the baseline characteristics of CAMUS participants with those recruited to a similar trial using conventional medical therapy. DESIGN: CAMUS is a randomized, double-blind, placebo-controlled trial designed to evaluate the effects of saw palmetto given at escalating doses over an 18-month period on relief from LUTS. SUBJECTS: The target enrollment goal was 350 men with LUTS from 11 clinical centers over a 12-month period. The recruitment techniques used and participants contacted, screened, and randomized through each technique were obtained from the clinical centers. Baseline characteristics of the CAMUS participants were compared with participants in the MTOPS trial who met the CAMUS eligibility criteria for LUTS. RESULTS: The target enrollment goal was achieved in 11 months. The overall monthly recruitment rate per site was 3.7 and ranged from 2.4 to 8.0. The most successful recruitment methods were mass mailing and advertising, which accounted for 39% and 35% of the study participants, respectively. In comparison to MTOPS participants, CAMUS participants were younger, more highly educated, more diverse, and had less severe urinary symptoms. CONCLUSIONS: Successful recruitment methods for CAMUS were similar to those in MTOPS. The use of botanical therapy attracted a less symptomatic and more educated study population.

Aportación a la historia de la farmacoterapia urológica / Contribution to the history of urological pharmacotherapy

Introducción: el objetivo de este trabajo es la revisión histórica de la farmacoterapia urológica. Los contenedores utilizados para la conservación y almacenamiento de los medicamentos son una importantísima fuente de información en la investigación histórica. Material y método: se ha acudido al estudio de fuentes escritas como son tratados de materia médica y terapéutica y a fuentes materiales existentes en el Museo-Farmacia de la Farmacia Monástica de la Real Cartuja de Valldemossa, en Mallorca. Se revisan los antiguos contenedores de medicamentos y sus cartelas identificadoras en botes cerámicos, frascos de vidrio y cajas de madera y restos medicamentosos hallados en su interior. Resultados: se describen diferentes medicamentos, tanto simples (de origen vegetal, mineral o animal) como compuestos, más usados a lo largo de los siglos para tratar las enfermedades del aparato urinario: cañafístula, agárico, mechoacán, altramuz, hinojo, goma arábiga, arrayán, bol armeno, Oleum scorpionum, cuerno de ciervo, cantáridas. Se presenta la evidencia de conocimiento disponible para cada uno de estos remedios en las principales fuentes bibliográficas y la prueba de que fueron empleados en Valldemossa. Conclusiones: la base de la farmacoterapia general y urológica se centraba en la naturaleza. Los medicamentos de origen vegetal eran los más utilizados. El arsenal terapéutico que a lo largo de la historia ha reunido la humanidad es el resultado de un largo proceso de mestizaje de prácticas y conocimientos de distintas culturas y sociedades (AU)

Introduction: The aim of this work is to present a historical review of urological pharmacotherapy. The containers used to preserve and store medicines are an important source of information in historical research. Material and methods: I studied written sources such as treaties of Medical and Therapeutical Materials, as well as material sources available at the Pharmacy Museum of the Farmacia Monástica de la Real Cartuja de Valldemossa in Mallorca. I examined the old medicine containers and the labelling on ceramic recipients, glass jars and wooden boxes and other medicines found inside them. Results: Different medicines, the most used over the centuries to treat diseases of the urinary system are described, including both simple (of plant, mineral or animal origin) and compound medicines: drumstick tree, agaricus, mechoacan, lupine, fennel, acacia gum, myrtle, Armenian bole, oleum scorpionum, hartshorn plantain, cantharides. I present evidence of knowledge available for each of these remedies in the main bibliographic sources, as well as proof that they were used in Valldemossa. Conclusions: The basis of general and urological pharmacotherapy was concentrated on nature. Medicines of plant origin were the most used. The therapeutic inventory that mankind has accumulated throughout history is the result of a lengthy process of combining practices and knowledge of different cultures and societies (AU)

Botulinum neurotoxin A for male lower urinary tract symptoms.

PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) affects a large number of male patients from 45 years onward, increasing with age. Routine medical treatment is mainly limited to plant extracts, α-blockers, and 5-α-reductase inhibitors. Although all types of drug have a proven efficacy, they often do not sufficiently treat all aspects of LUTS related to BPH. Thus, there is a need for alternatives. Intraprostatic injections with botulinum neurotoxin type A (BoNT/A) seem to be a promising alternative. The purpose of this review is to summarize the most recent findings from basic science and clinical studies in relation to BoNT/A application in BPH-related LUTS, thereby providing insight into the putative mechanism of action, the rationale for the use of BoNT/A in BPH-related LUTS, and the clinical outcomes. RECENT FINDINGS: There is some evidence that BoNT/A intraprostatic injections affect both, the static and dynamic component of BPH-related LUTS by reducing the prostate volume and by downregulation of α-1A-adrenoreceptors. Clinical trials demonstrated an easy and minimally invasive intraprostatic application of BoNT/A with a favourable safety profile. Efficacy seems to be good with significant improvements for several months in symptoms, urinary flow rate and reduction in postvoid residual, prostate volume, and also prostate-specific antigen in some studies. SUMMARY: BoNT/A seems to be a promising alternative in the treatment of BPH-related LUTS with a good tolerance and safety profile. However, the level of evidence is still low and further randomized controlled studies are mandatory.

Serenoa repens (saw palmetto): a systematic review of adverse events.

Serenoa repens (W. Bartram) Small, also known as saw palmetto, is one of the most widely used herbal preparations for the treatment of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Although a number of randomized controlled trials (RCTs) and systematic reviews of the efficacy of S. repens for the treatment of LUTS and BPH have been published, no systematic review on its drug interactions or adverse events currently exists. This review assesses all available human safety data of S. repens monopreparations. Systematic literature searches were conducted from date of inception to February 2008 in five electronic databases; reference lists and our departmental files were checked for further relevant publications. Information was requested from spontaneous reporting schemes of the WHO and national safety bodies. Twenty-four manufacturers/distributors of S. repens preparations and four herbalist organizations were contacted for additional information. No language restrictions were imposed. Only reports of adverse events in humans from monopreparations of S. repens were included. Data from all articles, regardless of study design, reporting adverse events or interactions were independently extracted by the first author and validated by the second. Forty articles (26 randomized controlled trials, 4 non-randomized controlled trials, 6 uncontrolled trials and 4 case reports/series) were included. They suggest that adverse events associated with the use of S. repens are mild and similar to those with placebo. The most frequently reported adverse events are abdominal pain, diarrhoea, nausea, fatigue, headache, decreased libido and rhinitis. More serious adverse events such as death and cerebral haemorrhage are reported in isolated case reports and data from spontaneous reporting schemes, but causality is questionable. No drug interactions were reported. Currently available data suggest that S. repens is well tolerated by most users and is not associated with serious adverse events. The majority of adverse events are mild, infrequent and reversible, and include abdominal pain, diarrhoea, nausea and fatigue, headache, decreased libido and rhinitis. We found no evidence for drug interactions with S. repens. However, higher quality reporting of adverse events is essential if safety assessments are to be improved in future.