Development and Validation of a Preoperative Nomogram for Endoscopic Management Decision Making in Upper Urinary Tract Urothelial Carcinoma.

OBJECTIVE: We aimed to develop and validate a preoperative nomogram that predicts low-grade, non-muscle invasive upper urinary tract urothelial carcinoma (LG-NMI UTUC), thereby aiding in the accurate selection of endoscopic management (EM) candidates. METHODS: This was a retrospective study that included 454 patients who underwent radical surgery (Cohort 1 and Cohort 2), and 26 patients who received EM (Cohort 3). Utilizing a multivariate logistic regression model, a nomogram predicting LG-NMI UTUC was developed based on data from Cohort 1. The nomogram's accuracy was compared with conventional European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) models. External validation was performed using Cohort 2 data, and the nomogram's prognostic value was evaluated via disease progression metrics in Cohort 3. RESULTS: In Cohort 1, multivariate analyses highlighted the absence of invasive disease on imaging (odds ratio [OR] 7.04; p = 0.011), absence of hydronephrosis (OR 2.06; p = 0.027), papillary architecture (OR 24.9; p < 0.001), and lack of high-grade urine cytology (OR 0.22; p < 0.001) as independent predictive factors for LG-NMI disease. The nomogram outperformed the two conventional models in predictive accuracy (0.869 vs. 0.759-0.821) and exhibited a higher net benefit in decision curve analysis. The model's clinical efficacy was corroborated in Cohort 2. Moreover, the nomogram stratified disease progression-free survival rates in Cohort 3. CONCLUSION: Our nomogram ( https://kmur.shinyapps.io/UTUC_URS/ ) accurately predicts LG-NMI UTUC, thereby identifying suitable candidates for EM. Additionally, the model serves as a useful tool for prognostic stratification in patients undergoing EM.

One-Step Robot-Assisted Complete Urinary Tract Extirpation in Man with End-Stage Renal Disease on Dialysis: The First Case Report.

Urothelial carcinoma (UC) could be observed in urinary bladder (UBUC) and upper urinary tracts (UTUC). In the National Comprehensive Cancer Network guidelines for bladder cancer, extirpative surgery is indicated in certain cases. However, some extreme cases might also need the extirpation of the majority of the urinary tract, which is called complete urinary tract extirpation (CUTE). We present a patient diagnosed with high-grade UBUC and UTUC. He underwent dialysis for end-stage renal disease (ESRD) at the same time. Considering his non-functional kidneys and removing his high-risk urothelium at the same time, we performed robot-assisted CUTE to extirpate both his upper urinary tracts, urinary bladder, and prostate. In our experience, the console time was not significantly elongated, and the perioperative course was uneventful. To our knowledge, this is the first case report adopting a robotic system in such an extreme case. We conclude that robot-assisted CUTE is worth further study regarding its oncological survival outcomes and perioperative safety in patients with ESRD on dialysis.

A Review of Traditional Chinese Medicine in Treating Renal Interstitial Fibrosis via Endoplasmic Reticulum Stress-Mediated Apoptosis.

Renal interstitial fibrosis (RIF) is the main pathological manifestation of end-stage renal disease. Recent studies have shown that endoplasmic reticulum (ER) stress is involved in the pathogenesis and development of RIF. Traditional Chinese medicine (TCM), as an effective treatment for kidney diseases, can improve kidney damage by affecting the apoptotic signaling pathway mediated by ER stress. This article reviews the apoptotic pathways mediated by ER stress, including the three major signaling pathways of unfolded protein response, the main functions of the transcription factor C/EBP homologous protein. We also present current research on TCM treatment of RIF, focusing on medicines that regulate ER stress. A new understanding of using TCM to treat kidney disease by regulating ER stress will promote clinical application of Chinese medicine and discovery of new drugs for the treatment of RIF.

High Consumption of Green Tea Suppresses Urinary Tract Recurrence of Urothelial Cancer via Down-regulation of Human Antigen-R Expression in Never Smokers.

BACKGROUND/AIM: Smoking is a risk factor for carcinogenesis and progression of urothelial cancer (UC). Green tea polyphenol inhibits these malignant behaviors and suppresses human antigen R (HuR) expression, which is associated with malignant aggressiveness. This study aimed to clarify the anti-cancer effects of green tea based on the smoking status of UC patients. PATIENTS AND METHODS: Three hundred and sixty (260 with bladder cancer, BC and 100 with upper tract UC) patients were divided into three groups based on consumption of green tea: low (<1 cup/day, n=119), middle (1-4 cup/day, n=160), and high (>5 cup/day, n=81). HuR immunoreactivity was evaluated immunohistochemically in formalin-fixed specimens. RESULTS: In never smokers, multivariate analysis showed that the frequency of green tea consumption was a significant predictor (middle: hazard ratio, HR, 0.36, p=0.002; high: HR, 0.20, p=0.003) of urinary tract recurrence. A high consumption of green tea was associated with low rates of urinary tract recurrence and up-grading in UC patients. In BC, high consumption was associated with a lower risk of up-grading (p=0.011) and up-staging (p=0.041) in recurrent cancer. HuR expression in the high-consumption group was lower (p=0.019) than that in other groups. These significant findings were not detected in ever smokers. CONCLUSION: High consumption of green tea suppressed urinary tract recurrence and the risks of up-grading and up-staging by recurrence in never smokers. Our results suggested that HuR expression played important roles in such mechanisms.

Percepción del dolor en cistoscopia flexible con el uso de lidocaína intrauretral / Perception of pain in flexible cystoscopy using intraurethral lidocaine

OBJETIVO: La cistoscopia flexible es una técnica utilizada en el diagnóstico de la patología del tracto urinario inferior. El objetivo de este estudio es evaluar la eficacia del anestésico local intrauretral en la percepción del dolor en el paciente. MÉTODOS: Estudio observacional prospectivo no aleatorizado que incluye 142 hombres a los que se realiza cistoscopia flexible. Se dividen en dos grupos en función del uso o no de anestésico local intrauretral (Grupo 1: 70 hombres con anestésico intrauretral [lidocaína 2%]; Grupo 2: 72 hombres sin anestésico intrauretral). Se analiza escala visual analógica y cuestionario del dolor. Análisis estadístico con SPSS 17.0 y significación estadística p≤0,05. RESULTADOS: La edad media del grupo 1 fue de 64,7±10,3 años frente a 66,7±10,8 años en el grupo 2, sin diferencias significativas. La puntuación en la escala visual analógica en el grupo 1 fue 2,23±2,20 frente a 1,69±1,74 en el grupo 2 (p = 0,1). La intensidad del dolor total y actual en el cuestionario del dolor fue de 1,81 ± 0,87 y 1,66 ± 1,65, respectivamente, en el grupo 1 y de 1,72 ± 0,72 y 1,21±1,45, respectivamente, en el grupo 2 (no diferencias significativas). Tras dividir a los pacientes en función de una puntuación en la escala visual analógica ≤ 2, se observa que la causa que motivó la cistoscopia es un factor independiente asociado a la percepción del dolor, incrementando el riesgo de percibir más dolor en 1,89. CONCLUSIÓN: El uso de anestésico local como lubricante previo a cistoscopia flexible no parece disminuir el dolor y consideramos que no está indicado de rutina en esta técnica diagnóstica

OBJECTIVE: The aim of this study is to evaluate the efficacy of a local intraurethral anesthetic on the pain perceived by the patient during flexible cystoscopy. METHODS: An observational, prospective, nonrandomized, study was conducted on 142 males subjected to a flexible cystoscopy. The patients were divided into two groups: Group 1: 70 patients with intraurethral anesthetic (lidocaine 2%), and Group 2:72 patients without intraurethral anesthetic. The results were scored on a visual analog scale and a pain questionnaire and analyzed. The statistical analysis was performed using SPSS 17.0 and with a statistical significance of p ≤ 0.05. RESULTS: The mean age of Group 1 was 64.7 ± 10.3 years compared to 66.7 ± 10.8 years in Group 2, with no significant differences. The score on the visual analog scale in Group 1 was 2.23 ± 2.20 versus 1.69 ± 1.74 in Group 2 (p = 0.1). The overall and current pain intensity in the pain questionnaire was 1.81 ± 0.87 and 1.66 ± 1.65, respectively, in Group 1, and 1.72 ± 0.72 and 1.21 ± 1.45, respectively, in Group 2 (no significant differences). After dividing the patients into groups according to a visual analog scale score ≤ 2, it was observed that the cause that led to cystoscopy was an independent factor associated with the perception of pain, increasing the risk of perceiving more pain by 1.89. CONCLUSIÓN: The use of local anesthetic as a lubricant prior to flexible cystoscopy does not appear to reduce pain, and we consider that its routine use is not indicated

Estrategias terapéuticas para el tratamiento de la prostatitis crónica/síndrome de dolor pélvico crónico / Therapeutic strategies for the treatment of chronic prostatitis / chronic pelvic pain syndrome

La prostatitis crónica/síndrome de dolor pélvico crónico es una enfermedad con una repercusión sobre la calidad de vida que en ocasiones es equiparable a la de los pacientes con infarto de miocardio, diabetes mellitus, etc. Durante años, la terapia médica estándar se ha realizado con antiinflamatorios no esteroideos, alfa-bloqueantes y antibióticos. Con el objetivo de analizar las alternativas terapéuticas existentes en la actualidad se ha llevado a cabo una búsqueda bibliográfica en PubMed de los artículos publicados hasta marzo del 2014, encontrando diversas terapias para el tratamiento de la prostatitis crónica/síndrome de dolor pélvico crónico como modificaciones en los estilos de vida, fitoterapia, extractos bacterianos orales inmunoestimulantes, acupuntura, terapia miofascial y biofeedback, terapias neuromoduladoras, ondas de choque extracorpóreas, fármacos con efecto sobre el sistema nervioso central y periférico, terapias cognitivo-conductuales y terapias térmicas. Aunque muchos de estos estudios muestran a priori unos resultados satisfactorios, son necesarios ensayos clínicos controlados y aleatorizados con el objetivo de determinar la efectividad real así como la durabilidad de estos tratamientos en el tiempo (AU)

The chronic prostatitis/chronic pelvic pain syndrome is a disease with an impact on quality of life which is sometimes comparable to that of patients with myocardial infarction, diabetes mellitus, etc. For years, the standard medical therapy was performed with non steroidal anti-inflammatory, alpha-blockers and antibiotics. In order to analyze existing therapeutic alternatives at the moment, a comprehensive literature search in PubMed database was conducted for articles published up to March 2014 data, founding several therapies for the treatment of chronic prostatitis/chronic pelvic pain syndrome as changes in lifestyle, herbal medicine, oral immunostimulant bacterial extracts, acupuncture, myofascial therapy and biofeedback, neuromodulatory therapies, extracorporeal shockwave, medications known to affect the central and peripheral nervous system, cognitive-behavioral therapies and thermal therapies. Although many of these studies show a priori satisfactory results, controlled randomized clinical trials are necessary to determine the actual effectiveness and durability of these treatments over time (AU)

[The features in preventing recurrent lower urinary tract infection].

This review outlines characteristics of medications most commonly used for preventing recurrent lower urinary tract infection (UTI). It shows that the treatment and prophylaxis of UTI should be comprehensive and include the restoration of the normal urogenital tract anatomy and use in addition to antibacterial and anti-inflammatory drugs, agents, normalizing the function of the lower urinary tract, as well as drugs for local and systemic immunoprophylaxis, protection of the urothelium from recurrent infection, local hormone replacement therapy in menopause, and dietary supplements to acidify the urine.

The effects of resveratrol against trifluralin toxicity in the urinary tract of rats.

The herbicide itself and the degradation products are highly toxic on biological systems. The aim of this study is to investigate the potential toxic effects of trifluralin (TRF) on the urinary system of male rats and to investigate the protective effects of resveratrol (RSV) in TRF-induced urinary system damage. A total of 35 male Wistar rats were randomly divided into: (1) control group, (2) sham group, (3) low dose TRF group (0.8 g/kg/day), (4) high dose TRF group (2 g/kg/day) and (5) high dose TRF + RSV group 10 mg/kg/day. RSV was administered for 21 days by intragastric gavage at a dose of 10 mg/kg/day after induction of TRF. Kidney, ureter and urinary bladder tissue was examined using light microscopy and ultrastructurally. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling was performed to detect apoptosis. Superoxide dismutase (SOD), glutathion peroxidase (GPx) and malondialdehyde (MDA) levels were also evaluated biochemically for oxidative stress parameters. Histological evaluation showed that TRF increases apoptosis and oxidative stress, causes histological tissue damages and biochemical changes in the kidneys but does not cause any damage to the ureter and bladder. Treatment with RSV significantly attenuated tissue damage in the urinary system of rats. Apopitotic cells were significantly decreased in the treatment group. Additionally, treatment with RSV decreased SOD and GPx levels and increased MDA levels in the kidney tissue of animals subjected to TRF. These results show that RSV can significantly minimize histological damage and biochemical differences in treating TRF-induced kidney injury in rats.

Avaliação de extratos de quebra- pedra (Phyllanthus sp) frente à patógenos causadores de infecções no trato urinário / Evaluation of Phyllanthus sp extracts in face of Pathogen Causers of Urinary Treat Infections

RESUMO O trato urinário normalmente é estéril, no entanto, pode ser contaminado por agentes etiológicos provenientes da microbiota intestinal, dentre os mais comuns pode-se destacar a Escherichia coli. Os microrganismos estão se tornando cada vez mais resistentes a múltiplos antimicrobianos. É notória, portanto, a necessidade de encontrar novas substâncias com propriedades antimicrobianas. Portanto, foram avaliados diferentes extratos de Phyllanthus sp, frente a microrganismos causadores de infecções no trato urinário e comparadas as técnicas de hole-plate e disco difusão. Para ambas as técnicas avaliadas, o extrato de 72 horas mostrou melhor atividade antimicrobiana, na técnica de disco difusão, a bactéria mais sensível foi o Staphylococcus saprophyticcus, que apresentou CMI (Concentração Mínima Inibitória) de 15,84 mg/mL. Com a utilização da técnica de hole-plate, a bactéria mais sensível observada foi Staphylococcus aureus, com valor de CMI igual ao reportado anteriormente. Foi observado que os extratos alcoólicos obtiveram maior eficiência em relação às infusões, que a técnica de hole-plate revelou ser mais eficiente que a técnica de disco difusão e que os cocos Gram positivos foram mais susceptíveis quando comparadas aos bacilos Gram negativos e fungos.

ABSTRACT Commonly, the urinary treat is sterile, but it can also be contaminated by etiological agents from the intestinal treat, of which the Escherichiacoli is the most common one. These microorganisms are increasingly becoming more resistant to multiple antibiotics. It became necessary to find new substances with antimicrobial properties, so the purpose of this paper is to evaluate different Phyllanthus sp extracts- in face of microorganisms which cause the urinary treat infections- and compare it to the hole-plate and disk diffusion techniques. The 72 hours extraction showed better antimicrobial activity in both methods. Using disk diffusion, the most sensitive bacterium was the Staphylococcus saprophyticcus, with the MIC of 15,84 mg/mL. While using the technique of hole-plate, the most sensitive bacterium was the Staphylococcus aureus, with the same MIC of the previous cited bacterium. This study showed that the alcoholic extracts were more efficient than the infusions. It can also be observed that the hole-plate technique seems to be more efficient than the disk diffusion one, and the Gram positive cocci bacteria were more sensitive than the Gram negative bacilli and fungi.

[Bacterial culture and drug sensitivity analysis of upper urinary tract calculi complicating with infection].

OBJECTIVE: To investigate the bacteriology and drug sensitivity of upper urinary tract calculi patients, and to provide information for choosing suitable antibiotics. METHODS: In the study, 21 patients who suffered from lithiasis in upper urinary tract and required an emergency drainage for acute obstruction and infection were the "acute group"; 64 patients with calculi in upper urinary tract and accompanied with no infectious symptoms were the "common group". The bacteriology and drug sensitivity of the two groups were investigated. RESULTS: Gram-negative bacteria infected the most common of upper urinary tract calculi patients with infection, accounting for 71.4% in the acute group and 65.7% in the common group, among which Escherichia coli were the predominant ones (35.7% in the acute group and 32.9% in the common group). No difference was found between these two groups in bacterial distribution (P>0.05). Although the average drug resistance rate of Gram-negative bacteria in the acute group was higher than that in the common group, it revealed no significant difference (P>0.05). The drug resistance rate to semisynthetic penicillin, cefuroxime and ceftriaxone were more than 50%, 60%, and 50%, respectively. Quinolones, such as ciprofloxacin and levofloxacin, got a 45% drug resistance. Aminoglycoside, carbapenema were sensitive to Gram-negative bacteria. Cefoperazone/sulbactam and piperacillin/tazobactam were more effective than ceftriaxone and piperacillin, respectively. CONCLUSION: There was no significant difference between upper urinary tract calculi patients with acute infection and common infection in bacteriology and drug sensitivity. Semisynthetic penicillin, the second generation of cephalosporin and quinolone were no longer the good choices of empirical use. Antibiotics combined with ß-lactamase inhibitors would be an ideal empirical therapeutic choice.

Significance of urinary tract involvement in patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

BACKGROUND: Urinary tract involvement in patients with peritoneal surface disease treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) often requires complex urologic resections and reconstruction to achieve optimal cytoreduction. The impact of these combined procedures on surgical outcomes is not well defined. METHODS: A prospective database of CRS/HIPEC procedures was analyzed retrospectively. Type of malignancy, performance status, resection status, hospital and intensive care unit stay, morbidity, mortality, and overall survival were reviewed. RESULTS: A total of 864 patients underwent 933 CRS/HIPEC procedures, while 64 % (550) had preoperative ureteral stent placement. A total of 7.3 % had an additional urologic procedure without an increase in 30-day (p = 0.4) or 90-day (p = 1.0) mortality. Urologic procedures correlated with increased length of operating time (p < 0.001), blood loss (p < 0.001), and length of hospitalization (p = 0.003), yet were not associated with increased overall 30-day major morbidity (grade III/IV, p = 0.14). In multivariate analysis, independent predictors of additional urologic procedures were prior surgical score (p < 0.001), number of resected organs (p = 0.001), and low anterior resection (p = 0.03). Long-term survival was not statistically different between patients with and without urologic resection for low-grade appendiceal primary lesions (p = 0.23), high-grade appendiceal primary lesions (p = 0.40), or colorectal primary lesions (p = 0.14). CONCLUSIONS: Urinary tract involvement in patients with peritoneal surface disease does not increase overall surgical morbidity. Patients with urologic procedures demonstrate survival patterns with meaningful prolongation of life. Urologic involvement should not be considered a contraindication for CRS/HIPEC in patients with resectable peritoneal surface disease.

Un abordaje diferente a la nefrostomía percutánea por urólogos / A Different Approach to the Percutaneous Nephrostomy by Urologists

Introducción: La colocación de un tubo de nefrostomía percutánea (NPC) se realiza generalmente en los Servicios de Radiología de todo el mundo. Sin embargo, hay unos pocos estudios dirigidos a urólogos sobre la NPC realizada con guía ecográfica. La dirección de la aguja utilizando una sonda de ecografía abdominal convexa puede ser difícil en manos inexpertas. Para realizar este procedimiento de manera sencilla proponemos que serían útiles una sonda colocada en el flanco o la región intercostal, y un director de aguja ranurada larga que no permita el movimiento de la aguja. Se consideró que una sonda para ecografía transrectal (ETR) era adecuada para resolver este problema. Material y método: Desde enero de 2007 hasta abril de 2011 se realizaron un total de 113 accesos renales percutáneos (ARP) utilizando una sonda de ETR en 102 pacientes, de 20 a 84 años de edad. Debido a la insuficiente capacidad de imagen de la sonda de ETR en pacientes obesos, con un índice de masa corporal (IMC) mayor de 30kg/m2, estos fueron excluidos. Se realizaron 42 ARP bajo anestesia local, y a este grupo se le llamó grupo de anestesia local (AL). Se realizaron 71 ARP para la inserción de la nefrostomía bajo anestesia local, complementados con sedación profunda, y a este grupo se le denominó grupo de sedación profunda (SP). Resultados: Se llevó a cabo la punción dirigida al cáliz y la colocación de alambre de guía en todos los pacientes (100%), pero la tasa de éxito de la inserción del tubo en cada grupo fue diferente. La tasa de inserción exitosa de la NPC fue del 69,1% (29 de 42 casos) en el grupo de AL y del 95,8% (68 de 71 casos) en el grupo de SP. No se observó lesión vascular mayor y/o lesión de órganos adyacentes al intestino, el hígado, el bazo o el pulmón en ningún paciente. Conclusión: La orientación de la sonda para ETR, la sedación profunda y los dilatadores modificados pueden ofrecer una alta tasa de éxito para los urólogos con poca experiencia en la inserción de la NPC, que de de otro modo les resultaría difícil realizar (AU)

Introduction: Percutaneous nephrostomy (PCN) tube placement is generally performed in radiologic departments worldwide. However, there are a few urologist-directed studies about PCN performed with ultrasound guidance. Needle direction using a convex abdominal ultrasound probe might be difficult in unexperienced hands. In order to perform this procedure easily, we propose that a probe placed on flank or intercostal region and a long grooved needle director that never allows needle movement would be useful. We considered a transrectal ultrasound (TRUS) probe was suitable to resolve this issue. Material and method: From January 2007 to April 2011, a total of 113 percutaneous renal access (PRA) were performed using a TRUS probe in 102 patients, aged 20 to 84 years old. Because of the insufficient imaging capability of the TRUS probe in obese patients whose body mass index (BMI) greater than 30kg/m2 were excluded. Forty two PRA were performed under local anesthesia and this group was named local anesthesia (LA) group. Seventy one PRA were performed for nephrostomy insertion under local anesthesia supplemented by deep sedation and this cluster was named deep sedation (DS) group. Results: Targeted calyx puncture and guide wire placement was performed in all patients (100%) but success rate of tube insertion in each group was different. Successful PCN insertion rate was 69.1% (29 of 42 cases) in LA group and 95.8% (68 of 71 cases) in DS group. No major vascular injury and/or adjacent organ injury to bowel, liver, spleen or lung was seen in any patient. Conclusion: Guidance of TRUS probe, deep sedation, and modified dilators may offer a high success rate to the urologists with little experience in PCN insertion which they would find it difficult to perform (AU)

Utilidad del jugo de sumidad de ortiga en el tratamiento de afecciones urológicas y reumatológicas / Expressed juice of stinging nettle herh: evidence of effectiveness in irrigation therapy and rheumatic compaints

Se llevó a cabo un studio abierto (observacional) de 12 semanas de duración en el que participaron 114 pacientes a los que se les administró jugo de sumidad de ortiga fresca obtenido por expresión, como “terapia de lavado de las vías urinarias” (para el tratamiento de afecciones urinarias leves y prevención de la formación de arenilla en los riñones), y como tratamiento coadyuvante de molestias reumáticas, indicaciones ambas reconocidad en al monografía del Comité de Medicamentes a base de Plantas (HMPC) de la Agencia Europea del Medicamento (EMA). Al cabo de 6 semanas los médicos valoraron la mejoría de dichas indicaciones en un 25-55%, que también fue confirmada por la evaluación de los pacientes (30-85%). La mejoría aumentó a lo largo del estudio, alcanzando en la última visita, a las 12 semanas, un 65 y 50% en opinión de los médicos y un 95 y 50% según los pacientes, respectivamente, en las indicaciones urológicas y reumatológicas. En la visita efectuada al cabo de 6 semanas los pacientes refirieron un importante incremento de la excreción de orina, que se mantenía casi al mismo nivel a las 12 semanas. Dada la excelente tolerabilidad, se concluyó que la administración de este jugo de ortiga resulta adecuado – también a largo plazo – para incrementar la diuresis en la mejora funcional de riñones y vejiga y para prevenir la formación de arenilla en los riñones, además de cómo tratamiento coadyuvante en caso de molestias reumáticas (AU)

In an open study, an expressed juice of fresh nettle herb (Urtica dioica L. and/or Urtica urens L.) was administered for 12 weeks to 114 patients for the irrigation of urinary tract, prevention of kidney gravel and as a supportive therapy of rheumatic compaints. These indications had recently been acknowledge by the European HMP Committee in a monograph. Within 6 weeks of the therapy the physicians rated the improvement in both indications by 30-55% which was confirmed by the patients rating (30-85%). The improvements increased up to the final visit after 12 weeks with at least 65 and 50% in the physician´s rating and with 95 and 50% in the rating by the patients for the indications urology and rheumatism, respectively. A strong increase in urinary flow was noted by the patients within 6 weeks of the therapy and remained constant up to the final visit after 12 weeks. Due to excellent tolerability, the therapeutic use of the expressed juice also for long-term application as a cure in the approve therapy is reasonable (AU)

Tratamiento farmacológico en la hiperplasia prostática benigna / Pharmacological treatment of the benign prostatic hyperplasia

La hiperplasia prostática benigna, enfermedad común en hombres a partir de los 50 años de edad, consiste en el crecimiento benigno e incontrolado de la glándula prostática y produce diversos síntomas del tracto bajo urinario. Su agente causal multifactorial involucra fundamentalmente el incremento de la conversión de testosterona en dihidrotestosterona por acción de la 5 a-reductasa prostática, lo cual desencadena eventos que propician el incremento en el tamaño de la próstata (componente estático) y el aumento del tono del músculo liso de vejiga y próstata (componente dinámico) regulado por los adrenoreceptores (ADR)-a1. El tratamiento farmacológico de la hiperplasia prostática benigna incluye los inhibidores de la 5a-reductasa, antagonistas de ADR-a1, su terapia combinada y la fitoterapia. El objetivo del presente trabajo fue presentar los aspectos más relevantes de la farmacología de los fármacos utilizados en el tratamiento de la hiperplasia prostática benigna y brindar elementos de su eficacia, seguridad y tolerabilidad. Para ello, se realizó una reseña de los diferentes fármacos utilizados en el tratamiento de esta afección, los que fueron clasificados de acuerdo con su mecanismo de acción. Se incluyeron productos de origen natural como los extractos lipídicos del Serenoa repens y Pygeum africanum, así como el D-004, extracto lipídico de los frutos de la Roystonea regia, que ejerce efectos beneficiosos sobre los principales factores causales de la hiperplasia prostática benigna, ya que es un inhibidor de la 5 a-reductasa prostática, un antagonista de los ADR-a1, un inhibidor de la 5-lipooxigenasa y tiene acción antioxidante, lo que evidencia un mecanismo multifactorial. Los resultados hasta el presente indican que el D-004 es seguro y bien tolerado

Benign prostatic hyperplasia is a common disease in over 50 years-old men consisting in uncontrolled and benign growth of prostatic gland that leads to lower urinary tract symptoms. The etiology of benign prostatic hyperplasia is multifactoral involving the increased conversion of testosterone in dihydrotestosterone by the prostatic 5a-reductase action, which brought about events that encourage the prostate growth (static component) and the increase of the bladder and prostate smooth muscle tone (dynamic component) regulated by the a1 -adrenoceptors (ADR). The pharmacological treatment of the benign prostatic hyperplasia includes the prostatic 5a-reductase inhibitors, the a1-adrenoreceptor blockers, their combined therapy and the phytotherapy. This paper was aimed at presenting the most relevant aspects of the pharmacology of drugs used for treating the benign prostatic hyperplasia, and providing elements to analyze their efficacy, safety and tolerability. To this end, a review was made of the different drugs for the treatment of this pathology and they were grouped according to their mechanism of action. Natural products were included as lipid extracts from Serenoa repens and Pygeum africanum as well as D-004, a lipid extract from Roystonea regia fruits, with proved beneficial effects on the main etiological factors of benign prostatic hyperplasia. D-004 is a prostatic 5a-reductase inhibitor, an a1-adrenoceptor antagonist, a 5-lipooxygenase inhibitor and has antioxidant action, all of which reveals a multifactoral mechanism. The results achieved till now indicate that D-004 is a safe and well-tolerated product

Tratamiento farmacológico en la hiperplasia prostática benigna / Pharmacological treatment of the benign prostatic hyperplasia

La hiperplasia prostática benigna, enfermedad común en hombres a partir de los 50 años de edad, consiste en el crecimiento benigno e incontrolado de la glándula prostática y produce diversos síntomas del tracto bajo urinario. Su agente causal multifactorial involucra fundamentalmente el incremento de la conversión de testosterona en dihidrotestosterona por acción de la 5 a-reductasa prostática, lo cual desencadena eventos que propician el incremento en el tamaño de la próstata (componente estático) y el aumento del tono del músculo liso de vejiga y próstata (componente dinámico) regulado por los adrenoreceptores (ADR)-a1. El tratamiento farmacológico de la hiperplasia prostática benigna incluye los inhibidores de la 5a-reductasa, antagonistas de ADR-a1, su terapia combinada y la fitoterapia. El objetivo del presente trabajo fue presentar los aspectos más relevantes de la farmacología de los fármacos utilizados en el tratamiento de la hiperplasia prostática benigna y brindar elementos de su eficacia, seguridad y tolerabilidad. Para ello, se realizó una reseña de los diferentes fármacos utilizados en el tratamiento de esta afección, los que fueron clasificados de acuerdo con su mecanismo de acción. Se incluyeron productos de origen natural como los extractos lipídicos del Serenoa repens y Pygeum africanum, así como el D-004, extracto lipídico de los frutos de la Roystonea regia, que ejerce efectos beneficiosos sobre los principales factores causales de la hiperplasia prostática benigna, ya que es un inhibidor de la 5 a-reductasa prostática, un antagonista de los ADR-a1, un inhibidor de la 5-lipooxigenasa y tiene acción antioxidante, lo que evidencia un mecanismo multifactorial. Los resultados hasta el presente indican que el D-004 es seguro y bien tolerado(AU)

Benign prostatic hyperplasia is a common disease in over 50 years-old men consisting in uncontrolled and benign growth of prostatic gland that leads to lower urinary tract symptoms. The etiology of benign prostatic hyperplasia is multifactoral involving the increased conversion of testosterone in dihydrotestosterone by the prostatic 5a-reductase action, which brought about events that encourage the prostate growth (static component) and the increase of the bladder and prostate smooth muscle tone (dynamic component) regulated by the a1 -adrenoceptors (ADR). The pharmacological treatment of the benign prostatic hyperplasia includes the prostatic 5a-reductase inhibitors, the a1-adrenoreceptor blockers, their combined therapy and the phytotherapy. This paper was aimed at presenting the most relevant aspects of the pharmacology of drugs used for treating the benign prostatic hyperplasia, and providing elements to analyze their efficacy, safety and tolerability. To this end, a review was made of the different drugs for the treatment of this pathology and they were grouped according to their mechanism of action. Natural products were included as lipid extracts from Serenoa repens and Pygeum africanum as well as D-004, a lipid extract from Roystonea regia fruits, with proved beneficial effects on the main etiological factors of benign prostatic hyperplasia. D-004 is a prostatic 5a-reductase inhibitor, an a1-adrenoceptor antagonist, a 5-lipooxygenase inhibitor and has antioxidant action, all of which reveals a multifactoral mechanism. The results achieved till now indicate that D-004 is a safe and well-tolerated product(AU)

[The role of mutation of gene cyp1A1 and benzapilene in cytogenetic changes of urinary tract epitheliocytes in oil industry workers employed in the oil fields of the North of West Siberia].

The examination of 477 oil industry workers and office personnel (control) employed in the oil fields of the North of Tomsk and Tyumen regions has detected increased number of epithelyocytes with micronuclei and an elevated urine level ofbenzapilene in workers employed in oil production. Especially pronounced changes of the above parameters were observed in men with mutant alleles Val of CYP1A1 gene. An enhanced mutation process in oil production workers may be due to a resultant action of different factors on human genome. Involved may be both mutagens and factors of comutagenic nature. The results obtained in this study suggest a conclusion about urgent need of introduction of new scientifically validated criteria of selection of personnel for oil production in the North of the West Siberia. Health examination of the applicants must include genotyping.

Vitamin D induction of the human antimicrobial Peptide cathelicidin in the urinary bladder.

The urinary tract is frequently being exposed to potential pathogens and rapid defence mechanisms are therefore needed. Cathelicidin, a human antimicrobial peptide is expressed and secreted by bladder epithelial cells and protects the urinary tract from infection. Here we show that vitamin D can induce cathelicidin in the urinary bladder. We analyzed bladder tissue from postmenopausal women for expression of cathelicidin, before and after a three-month period of supplementation with 25-hydroxyvitamin D3 (25D3). Cell culture experiments were performed to elucidate the mechanisms for cathelicidin induction. We observed that, vitamin D per se did not up-regulate cathelicidin in serum or in bladder tissue of the women in this study. However, when the bladder biopsies were infected with uropathogenic E. coli (UPEC), a significant increase in cathelicidin expression was observed after 25D3 supplementation. This observation was confirmed in human bladder cell lines, even though here, cathelicidin induction occurred irrespectively of infection. Vitamin D treated bladder cells exerted an increased antibacterial effect against UPEC and colocalization to cathelicidin indicated the relevance of this peptide. In the light of the rapidly growing problem of resistance to common urinary tract antibiotics, we suggest that vitamin D may be a potential complement in the prevention of UTI.

Urinary tract infection caused by Corynebacterium urealyticum in a male dog / Infecção do trato urinário por Corynebacterium urealyticum em um cão

Um cão adulto, com histórico de infecção do trato urinário, foi apresentado aos autores. O cão foisubmetido ao exame físico, ultrassonografia, urinálise e cistocentese para cultura bacteriológica. O exame bacteriológico evidenciou a presença de bastonetes Gram positivo em cultura pura como únicomicrorganismo isolado. Provas bioquímicas do isolado confirmaram tratar-se de Corynebacteriumurealyticum. O patógeno mostrou-se susceptível às quinolonas e aos aminoglicosideos, e resistente àmaioria das penicilinas. O tratamento com ciprofloxacina apresentou sucesso.

Time courses of bacterial density in urine during antibacterial chemotherapy and influential factors in patients having positive bacteriuria with a complicated urinary tract.

A series of consecutive urine cultures was performed to determine the time points of elimination of bacteria from urine and the factors influencing these time points in patients receiving antimicrobial chemotherapy for positive bacteriuria. Between 1988 and 2000, 110 patients who had positive bacteriuria and received a 5-day regimen of parenteral antibacterials were included in this study. Quantitative urine cultures were performed every 24 h throughout the therapy. Bacteria were identified; minimum inhibitory concentrations of antibacterial agents for causative bacteria were determined, and the bacteria were categorized as susceptible or nonsusceptible. The complexity of the urinary tract was graded as high or low. A multivariate Cox proportional hazards model was utilized to identify the factors that determined the time course of bacterial density in urine. Two penicillins, seven cephalosporins, five carbapenems and one fluoroquinolone were administered to 110 patients. The overall bacteriurial elimination rate at the end of treatment was 73% (80/110), and the most frequent day of elimination was day 1 (54%; 43/80), followed by day 2 (20%; 16/80). The significant factors for persistence of bacteriuria after chemotherapy were the presence of an indwelling catheter, a nonsusceptible pathogen, and high complexity of the urinary tract; risk ratios were: 2.398 (P = 0.0009), 2.227 (P = 0.0020), and 2.113 (P = 0.0455), respectively, which also influenced the day of elimination. In conclusion, the efficacy of treatment and the time point of bacteriurial elimination were determined by the presence of a urinary catheter, drug susceptibility, and urinary complexity in patients with positive bacteriuria undergoing antibacterial chemotherapy.