Studies on the protective effect of dietary fish oil on gentamicin-induced nephrotoxicity and oxidative damage in rat kidney.

Gentamicin (GM)-induced nephrotoxicity limits its long-term clinical use. Several agents/strategies were attempted to prevent GM nephrotoxicity but were not found suitable for clinical practice. Dietary fish oil (FO) retard the progression of certain types of cancers, cardiovascular and renal disorders. We aimed to evaluate protective effect of FO on GM-induced renal proximal tubular damage. The rats were pre-fed experimental diets for 10 days and then received GM (80 mg/kg body weight/day) treatment for 10 days while still on diet. Serum/urine parameters, enzymes of carbohydrate metabolism, brush border membrane (BBM), oxidative stress and phosphate transport in rat kidney were analyzed. GM nephrotoxicity was recorded by increased serum creatinine and blood urea nitrogen. GM increased the activities of lactate and glucose-6-phosphate dehydrogenases whereas decreased malate, isocitrate dehydrogenases; glucose-6 and fructose-1,6-bisphosphatases; superoxide dismutase, catalase, glutathione peroxidase and BBM enzymes. In contrast, FO alone increased enzyme activities of carbohydrate metabolism, BBM and oxidative stress. FO feeding to GM treated rats markedly enhanced resistance to GM elicited deleterious effects and prevented GM-induced decrease in 32Pi uptake across BBM. Dietary FO supplementation ameliorated GM-induced specific metabolic alterations and oxidative damage due to its intrinsic biochemical/antioxidant properties.

Biofeedback y electroestimulación como tratamiento de la enuresis no monosintomática / Biofeedback and electrostimulation in the treatment of non monosymptomatic enuresis

Objetivo. Mostrar nuestra experiencia con las técnicas de biofeedbacky electro estimulación en el tratamiento de la enuresis no monosintomática. Material y métodos. Se analizaron los datos de 99 niños atendidos entre 1995 y 2000 por enuresis no monosintomática con edades comprendidas entre 5 y 14 años (65 niñas y 34 niños). Se les realizó estudio urodinámico completo para definir a los pacientes en cinco grupos: disfunción vesicoesfinteriana (47 pacientes), hiperactividad de detrusor (25 pacientes), urgencia sensorial (15 pacientes), hipertonía de esfínter (10 pacientes) y vejiga “retencionista” (2 pacientes). Se consideró como éxito menos de 3 noches húmedas al mes. El biofeedbacky la electroestimulación consistieron en 10 sesiones semanales de20 minutos con el equipo SIGMAX-Biomedical. Se indicó estimulación tibial en patologías en las que fracasaron tratamientos anteriores(12 sesiones de 30 minutos con el equipo SANS de UroSurge).Resultados. El éxito al fin del tratamiento fue del 78,9% en la disfunción vesicoesfinteriana, del 80% en la hiperactividad del detrusor, del 85% en la urgencia sensorial, del 75% en la hipertonía de esfínter y del 100% en la vejiga “retencionista”.Conclusiones. Los llamados “tratamientos alternativos” como el biofeedback y la electro estimulación son eficaces en el tratamiento dela enuresis no monosintomática. Esta eficacia se mantiene en el tiempo y es independiente de la disfunción miccional hallada (AU)

Aim. To show our experience with biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis. Methods. We reviewed biofeedback and electrostimulation techniques in the treatment of complicated enuresis carried out in our institution between 1995 and 2000. We report 99 patients (65 girls and 34boys) with ages ranging from 5 to 14 years old. A complete urodinamy study divided the patients into 5 groups: detrusor-sphincter dysfunction(DSD) (47patients), detrusor over activity (DO) (25 patients), urge syndrome(US) (15 patients), sphincter hypertony (SH) (10 patients) and “retentionist” bladder (RB) (2 patients). Success was defined as less than three wet nights in a month. Biofeedback and electrostimulation program was designed in 10 sessions per week (20minutes each session)with SIGMAX-Biomedical software. Tibial electrostimulation with SANS-UroSurge equipment was indicated when biofeedback and electrostimulation techniques failed (12 sessions per week,30 minute seach session).Results. The success rate has been 78,9% in DSD group, 80% in DO group , 85% in US group, 75% in SH group, 100% in RB group. Conclusions. Effectiveness of biofeedback and electrostimulation echniques in the treatment of non monosymptomatic enuresis has been reported and seems to be permanent in time (AU)

Colonic washout enemas for persistent constipation in children with recurrent urinary tract infections based on dysfunctional voiding.

OBJECTIVES: To describe the use of colonic washout enemas for persistent constipation in children treated for dysfunctional voiding by cognitive and biofeedback training. METHODS: We treated 50 children, who had dysfunctional voiding and persistent dilatation of the rectum notwithstanding adequate oral laxatives, with colonic washout enemas. We performed retrograde filling of the rectum with 20 mL/kg water, starting once daily for 2 weeks, then 3 times per week for 6 to 12 months. RESULTS: During the 6-month follow-up, 30 children were free from urinary tract infections. In 20 children we observed partial relief of complaints. On ultrasound all children showed a normalized diameter of the rectum. In 33 patients washout treatment could be stopped with continuing success. Relapse of a distended rectum triggered the need for chronic intermittent enema therapy in 17 patients. A few patients reported pain during enema treatment; otherwise, we noted no counter-effect. CONCLUSIONS: Dysfunctional voiding combined with constipation in children can be cured by washout enemas if oral laxatives fail.

[Melanosis of the urinary bladder--a case report with 10 years of follow-up and review of literature]. / Melanose der Harnblase--Fallbericht mit Langzeitverlauf über 10 Jahre und Literaturübersicht.

INTRODUCTION: Extradermal melanotic lesions are found predominantly in the oral cavity, colon or conjunctiva, and by far less frequently in other organs. We report for the first time a case of solitary melanosis of the urinary bladder with a follow-up of more than 10 years. CASE REPORT: A 48-year old man presented with symptoms of frequency, urge incontinence, obstructive voiding symptoms and nocturia. On urethrocystoscopy under general anaesthesia, melanosis of the bladder with visibly reduced bladder capacity was diagnosed and confirmed on biopsy. The patient was treated for his micturation problems with alpha-blockers, intravesical electrostimulation and GAG-substitution therapy, without success. The chronic progression of bladder symptoms and shrinkage eventually led to cystoprostatectomy and bladder replacement by an orthotopic ileal neobladder, 10 years after primary diagnosis. CONCLUSION: The very low number of reported cases accounts for the lack of management guidelines for this disease. Symptomatic treatment as well as repeated cystoscopic monitoring are logical therapeutic recommendations. Since the development of malignant disease can only be ruled out microscopically, repeated biopsies or prophylactic cystectomy need to be considered.

Future drugs for the treatment of benign prostatic hyperplasia.

For at least a decade, no new drug principles have been added to the therapeutic armamentarium for the treatment of lower urinary tract symptoms (LUTS) associated with or suggestive of benign prostatic hyperplasia (BPH). Theoretically, there seem to be several possibilities to improve the current treatment, which is based mainly on alpha1-adrenoceptor (AR) antagonists, 5alpha-reductase inhibitors and phytotherapy. It cannot be dismissed that subtype selective alpha1-AR antagonists can further improve treatment, but convincing evidence is still lacking. Muscarinic receptor antagonists are currently evaluated in BPH patients, but their eventual place in therapy, as a single treatment or in combination with alpha1-AR antagonists, has to be established. Endothelin receptor antagonists, alone or together with alpha1-AR antagonists, seem to offer a new attractive approach; however, proof of concept studies are lacking. The L-arginine/NO/cGMP pathway awaits further exploration; nitric oxide (NO) donors or phosphodiesterase (PDE) inhibitors may be clinically useful. Purinoceptors are currently the focus of interest as treatment targets in the lower urinary tract and inhibitors of P2X3 (and P2X1) subtypes may offer new opportunities. If a treatment based on desensitising C-fibres in the bladder and urethra is effective, not only in neurogenic bladders, but also for treating LUTS, it would be a viable option. For new treatments of LUTS, targets within the central nervous system (CNS) may offer exciting opportunities.