The efficacy and safety of intravesical chondroitin sulphate solution in recurrent urinary tract infections.

BACKGROUND: Urinary tract infections are among the most common indications for antibiotic therapy. The emergence of resistant uropathogens indicates the need for treatment alternatives. Replenishment of the glycosaminoglycan layer of the bladder, achieved by intravesical instillation of e.g. chondroitin sulphate (CS), is described to be a cornerstone in the therapy of cystitis. To retrospectively evaluate the efficacy of a therapy with 0.2% CS in patients suffering recurrent urinary tract infections (rUTI) in comparison to a treatment with low-dose long-term antibiotics (LDLTAB) and a combination of both. METHODS: A total of 151 patients with recurrent UTI who underwent intravesical therapy at Diaconesse hospital in Leiden, The Netherlands were included. 50 patients had been treated with CS, 51 patients had received LDLTAB, and 50 patients had received a combination therapy (LDLTABCS). Data recorded for baseline, after 6, and 12 months of treatment were evaluated. Descriptive statistics were calculated. Exploratory comparisons between groups and within groups were performed by using one-tailed and paired t-tests. Patients filled in a standardized quality of life questionnaire (EQ-5D). RESULTS: We found a statistically significant reduction of number of infections from 7.10 ± 0.50 SEM to 0.45 ± 0.07 SEM after 12 months therapy with CS compared to 12 months therapy with LDLTAB (from 7.04 ± 0.47 SEM to 1.8 ± 0.15 SEM). The number of visits to the urologist significantly decreased in the CS group from 7.46 ± 0.80 SEM to 1.28 ± 0.11 SEM and from 4.10 ± 0.29 SEM to 1.35 ± 0.11 SEM in the LDLTABCS group. In addition, a significant increase in Quality of life (QoL) was seen in the CS-group (from 58.2 ± 0.82 SEM to 80.43 ± 0.82 SEM) and in the LDLTABCS group (from 62.4 ± 0.97 SEM to 76.73 ± 1.06 SEM). There was no improvement in QoL with LDLTAB (from 58.24 ± 1.08 SEM to 58.96 ± 1.19 SEM). Evaluation's evidence is limited due to its retrospective character. CONCLUSIONS: Retrospective analysis of data from patients that underwent therapy for rUTIs confirms the safety and efficacy of CS and indicate a superiority to antibiotic treatment of rUTIs.

[Significance of deviations in hearing thresholds in pure-tone audiograms]. / Zur Signifikanz von Abweichungen der Hörschwellen im Tonschwellenaudiogramm.

Variations in tone hearing thresholds can occur with a certain probability at random or due to systematic changes in hearing, the test system or the test methodology. Therefore, a significance analysis is essential for diagnostic statements and expert opinions. The random probability tables published here can be used in a simple way to identify any significant alterations in hearing thresholds with a probability of error of ≤0.05.

Effectiveness of cefetamet pivoxil in the treatment of pyelonephritis in children.

Cefetamet pivoxil was investigated in an open, randomized comparative study involving a total of 37 children with acute pyelonephritis, whose ages ranged from 2 to 14 years. The patients received either 10 mg/kg (n = 18) or 20 mg/kg (n = 8) cefetamet pivoxil twice daily, or 30-50 mg/kg amoxycillin/clavulanic acid three times daily (n = 11) for a period of 7-10 days. Escherichia coli was the main causative agent isolated in 28 (75.7%) of the patients; other pathogens included Proteus mirabilis (three patients). Proteus species (one patient), Klebsiella pneumoniae (two patients), Pseudomonas diminuta (one patient) and mixed infections (three patients). No differences in the overall treatment outcome could be observed between the treatment regimens used and, at the end of treatment, all pathogens were eradicated with neither relapse, nor persistence of the isolated pathogen, nor reinfection occurring. The clinical signs and symptoms had subsided in all patients at treatment end and the tolerability of the trial drugs was found to be satisfactory with no premature treatment withdrawal required. It is concluded that cefetamet pivoxil in the standard twice-daily dose of 10 mg/kg was equally effective and as well tolerated as 20 mg/kg cefetamet pivoxil given twice daily or 30-50 mg/kg amoxycillin/clavulanic acid given three times daily.

[Balloon ureter catheter for temporary endo-drainage (author's transl)]. / Ballon-Ureterkatheter zur temporären Endo-Drainage.

A new balloon ureter catheter (catheter 7-French, balloon 9-French) is described. It offers important advantages over conventional catheters for temporary endo-drainage in the treatment of urinary obstruction as well as renal and ureteral fistulas. An angled whistle-tipped catheter facilitates placement. Sufficiently large drainage openings above and below the balloon and an additional outflow lumen prevent obstructions. The special catheter is held in an optimal position inside the balloon underneath the whistle tip. Thus, no further fixation is necessary, and the patients need not be confined to bed.

[Enuresis--causes, diagnosis and therapy]. / Enuresis--Ursachen, Diagnostik und Therapie.

672 children aged between 4 and 16 years were treated for primary or secondary enuresis between 1980 and 1986. The group included more girls than boys. A systematic diagnostic investigation, consisting of a detailed medical history, physical examination, urinalysis and sonography of the kidneys and bladder, was carried out in all cases. This investigation was followed by urodynamic tests to detect any functional disorders of the lower urinary tract. Finally, a voiding cystogram, urethral calibration and urethrocystoscopy were conducted to screen for morphological changes. Three major groups of causes of enuresis were identified. Functional miction disorders were found in 312 (46.4%) children. In these cases there was an inability to voluntarily control the detrusor, detrusor-sphincter dyssynergia and hyperactivity of the detrusor. 223 (33.2%) of the children had pathological anatomical changes of the urinary tract, such as malformations leading to vesicoureteral reflux, vesicular diverticula, duplication of the upper urinary tract, megaureter, urethral stenosis or urethral valves, with associated infection. Psychogenic disorders were diagnosed in 137 (20.4%) cases. The first group received drug treatment and biofeedback training for reestablishment of conscious control over the vegetative functions of the lower urinary tract. The second group underwent surgery for correction of the pathological anatomical changes. The third group was referred for psychotherapy.

[Indications and results of Politano-Leadbetter antireflux-plasty in 565 cases of ureterorenal surgery]. / Indikation und Ergebnisse der Antireflux-Plastik nach Politano-Leadbetter bei 565 ureterorenalen Einheiten.

The Politano-Leadbetter antireflux procedure is a standardized and safe method for the treatment of primary and secondary reflux persisting after successful therapy of infravesical obstruction. Indications for antireflux surgery depend on reflux classification, age, urethral calibration and evaluation of position and shape of the ureteral orifice, associated malformations and successful antimicrobial therapy. Reflux was cured in 90.4 per cent of 565 ureterorenal units in 361 children and 103 adults. A persisting reflux occurred in 5.1 per cent and a stenosis of the terminal ureter requiring reimplantation occurred in 0.7 per cent. The overall rate of reinterventions was 8.1 per cent. This low complication rate makes surgical correction advisable if urinary tract infection and primary reflux cannot be eradicated by continuous antimicrobial therapy.

[Treatment of female urinary stress incontinence with a Zoedler suspension-plasty and a new, stable, radiopaque polyester sling]. / Die Behandlung der weiblichen Harnstressinkontinenz mit der Suspensionsplastik nach Zoedler und einem neuen, formstabilen, röntgenfähigen Polyesterband.

We report on 183 patients with urinary stress incontinence treated with bladder-neck suspension plasty according to Zoedler from 1972-1982 using the conventional nylon sling. 86.1% of the patients were continent postoperatively. Long term follow-up to 10 years however showed a continuous decrease of success rate in the first 2 postoperative years (74.9% in the 1st, 67.2% in the 2nd year). From the 3rd postoperative year there was a stable continence-rate of 50.7%. As the significant increase of incontinence relapse is due to enzymatic destruction of the nylon sling--first described in ophtalmology--we developed a new form-stable and radiopaque polyester sling. Since 1983 we implanted this new sling in 40 patients. Long term results of the conventional Zoedler procedure and first results of a modified method using the new polyester sling are discussed.

[Results and acceptance of corpus cavernosum autoinjection therapy in organic erectile dysfunction]. / Ergebnisse und Akzeptanz der Schwellkörperautoinjektionstherapie (SKAT) bei organischer erektiler Dysfunktion.

Ambulatory autoinjection therapy of the corpus cavernosum with a vasoactive drug combination for vasculogenic and neurogenic erectile dysfunction was performed in 50 men from 10/85-6/87. Acceptance was excellent by all patients and their wives. Transitory hematomas appeared in 6/50 (12%) cases. Local infections, cavernitis or systemic side effects were not observed. In 3/50 (6%) patients prolonged erections occurred. Treatment included drainage of the intracavernous blood, manual decompression and if necessary additional application of 1 mg metaraminol under extreme caution. Only 1 (2%) patient developed a nodular tunica fibrosis at the injection site which disappeared spontaneously upon cessation of treatment within 4 weeks.

[New trocar housing with an interchangeable cryotherapy sound for after-treatment of bladder outlet tumors]. / Neue Trokarhülse mit auswechselbarer Kryotherapiesonde zur Nachbehandlung von extrem lokalisierten Tumoren am Harnblasenausgang.

The cryotherapy of tumours of the urinary bladder hitherto used by means of transurethrally introduced sounds with or without optics made necessary the development of an irrigation trocar casing with exchangeable cryotherapy sound for the entire therapeutic comprehension of all parts of the wall of the urinary bladder, particularly in the region of the outlet of the urinary bladder from 7 till 17 o'clock. The optic control is performed by means of a simultaneously suprapubically introduced trocar cystoscope. Thus also extremely localised tumorous changes in the region of the outlet of the urinary bladder (dead angle) are optically established and rendered accessible to cryotherapy.

Atraumatic partial nephrectomy. Experience with 112 consecutive patients.

The aim of the described method of partial nephrectomy is to minimize injury to the kidney, if possible without causing unnecessary loss of blood, and without interrupting the arterial or venous blood flow during surgery. Use of a pedicle clamp, compressing forceps for the renal parenchyma or hypothermia is superfluous. Following pre- and intraoperative estimation of the dimensions of the area of the renal parenchyma to be removed, virtual hemostasis is achieved by applying a continuous U-shaped suture distal to the portion of the kidney to be resected, using an atraumatic chromic catgut suture. Total hemostasis in the area to be excised is attained with the aid of a second U-shaped suture, running parallel to the first but entering on the opposite renal margin. Following excision, the raw surfaces are then reapproximated by means of a continuous suture and thus sealed. To conclude the operation a temporary nephrostomy is inserted. The immediate and later follow-up results and the advantages and potential complications of the new technique are described in 112 consecutive patients presenting for treatment during a period of 12 years.

[Surgical removal of cast calculi using extensive longitudinal nephrotomy]. / Operative Entfernung von Korallensteinen durch grosse longitudinale Nephrotomie

The results of the operative treatment of 21 large longitudinal nephrotomies on account of the existence of cast calculi of the renal calyx are reported and discussed. In complete cast calculi with participation of the whole renal pelvis and all renal calyces this operation method leads to satisfactory results. Of the 12 cases (57-1%) with ideal postoperative morphological findings 83-3% became bacteriologically sterile; according to our opinion the lesion of the parenchyma due to operation is to be accounted for. In stone formations which do not fill all the calyces and yet in many cases in literature are called cast calculi, a pyelotomy or resection of the renal pole may by all means be the therapy of choice.

[Primary tumors of the ureter (author's transl)]. / Primäre Harnleitertumoren

13 own cases of primary tumors of the ureter are presented and discussed with reference to the presenting clinical symptoms, diagnostic procedures, and therapy. In our patients, excretory urography was not always of diagnostic value, whereas retrograde pyelography contributed to the correct diagnosis. The radiographic appearance of ureteral tumors has to be differentiated from strictures. In one case with a calcified papilloma, preoperative roentgendiagnosis suggested an ureteral stone.

Correlation between tumour stage, tumour grade, and immunocompetence in patients with carcinoma of the bladder and prostate.

The cellular immunocompetence was examined in 132 patients with transitional cell carcinoma of the bladder and 85 patients with carcinoma of the prostate with reference to the tumour stage and grade. In both groups a significant correlation between tumour stage and grade was found. These two parameters were also correlated with the reduction of immunocompetence. The results are discussed and compared with those in the literature.

Evaluation of the immunocompetance of patients with transitional cell carcinoma of the bladder.

The cellular immunocompetence was examined by means of the quantitative DNCB hypersensitivity reaction in 152 patients with transitional cell carcinomas of the bladder of Broders grades 1-4. Against a control group of 367 normal controls of both sexes, 85 patients with transitional cell carcinomas of grades 1 and 2 showed a normal DNCB reactivity, irrespective of the frequency of tumour recurrence. In 9 patients of this group, an increase of malignancy from grade 2 to grade 3 was observed; the simultaneous deterioration of immunocompetence, however, was not statistically significant. On the other hand, with transitional cell carcinomas of grades 3 and 4, significant impairment of immunocompetence correlating with the tumour stage was noted.

[Urinary tract infection following prostatic surgery (author's transl)]. / Harnwegsinfektionen nach Prostataoperationen

A comparative study was conducted on the severity and course of postoperative urinary infections in prostatic adenoma patients with preoperative bacteriuria and patients without infection. In both groups urinary infections showed a similar tendency to resolve, whereas a significant increase of polyresistant bacterial strains was noted in patients with preoperative bacteriuria. A comparison of 100 patients who had undergone transurethral resection and 100 patients who had undergone prostatectomy showed that severity and course of the postoperative urinary tract infection did not differ.

[Results of the Anderson-Hynes kidney/calix plasty in 102 ureteral efferent stenoses]. / Ergebnisse der Anderson-Hynes-Nierenbeckenplastik bei 102 Ureterabgangsstenosen

In 102 patients with ectasia of the renal calyx from degree I to III a pyelograft after Anderson-Hynes was performed. The leading clinical symptoms were, arranged according to frequency: flank pain, recurrent infections of the urinary tract, macrohaematurias, diffuse abdominal pain, palpable flank tumours. In general the diagnosis was made on the basis of the infusion urogramme; a retrograde pyelography was indicated only in cases of missing or insufficient excretion of the contrast remedy. According to the results of the operation apart from the Anderson-Hynes-graft in a lower pole vessel compressing the ureteral passage a ventral deposition of the anastomosis or resection of the lower pole vessel with or without simultaneous resection of the pole was performed. The results of the Anderson-Hynes pyelograft correlated with the degree of the preoperative ectasia of the renal calyx; with increasing degree of severity the good results decreased from 90% to 38%, whereas the bad results increased from 3% to 46%. Judging the success of the operation, a good correspondence between the clinical and radiological parameters was revealed in the degrees I and II. In degree III the numbers of cases were too slight, to secure a diverging tendency of these criteria.

Biological behavior of N-[4-(5-nitro-2-furyl)-2-thiazolyl]-formamide induced carcinoma of the transitional epithelium in the rat.

30 female Wistar rats weighing between 70 and 90 g were fed for 8 months with 0,188% N-[4-(5-nitro-2-furyl)-2-thiazolyl] Formamide (FANFT). After this period a papillary tumor of the urinary bladder was demonstrable in each animal. Histological examination always revealed a transitional cell carcinoma with prevailing medium tumor stages; no distant metastases were found. The grade of malignancy was classified as medium and high. No significant statistical relationship could be ascertained between tumor stage and grade or between grade and weight, but a correlation was established between tumor stage and weight. After 12 months, 36/60 kidneys were found to be normal, whereas in 20/60 dysplasias and in 2/60 transitional cell carcinomas of the renal pelvis were observed; secondary hydronephrosis due to bladder tumors occured 4 times. Other organ changes were not noticeable.