Oral Acidification with l-Methionine as a Noninvasive Treatment for Encrusted Uropathy.

Background: Encrusted uropathy (EU) is a rare disease caused by urea-splitting bacteria, most commonly Corynebacterium urealyticum, whose incidence is increasing. Standard treatment is based on pathogen-directed antibiotic therapy, urinary diversion, bladder instillations, and surgical resection of urinary calcifications. Case Presentation: We present the case of a 60-year-old man with symptomatic bilateral encrusted pyelitis and cystitis with acute renal failure. We initially treated the patient with antibiotic therapy, urinary diversion, and oral acidification with acetohydroxamic acid, achieving negative urinary cultures. Because of the persistence of encrusted pyelitis, the patient was discharged on oral l-methionine 500 mg bid and 12 months later the encrustations had almost disappeared. Finally, we performed right retrograde intrarenal surgery to remove a persistent small calcification. Conclusion: Oral urinary acidification with l-methionine is a valid treatment for urinary encrustations in EU, with no complications reported. Complete resolution of the calcifications may be achieved without the need for invasive processes and unnecessary manipulation of the urinary system.

[BCG and bladder cancer: Past, present and future.] / BCG y cáncer de vejiga: pasado, presente y futuro.

BCG has been used in the treatment of NMIBC for more than 40 years. Nevertheless, its exact working mechanisms have not been completely discovered. Clinical and basic research done over all these years has generated much information but it could be summarized in a few simple statements. It has been demonstrated the best route of administration is intravesical, BCG is superior than intracavitary chemotherapy to prevent recurrence but its adverse events are worse. Recently, it has been demonstrated that BCG could delay or prevent progression to infiltrative cancer. Nevertheless, to achieve this, maintenance therapy is necessary. Therefore, the recommendation is to treat middle and high risk cases with BCG. No significant differences in efficacy have been found between the various strains but differences in recurrence have been found between standard and reduced doses.Furthermore, the presence or absence of side effects does not seem to be a prognostic factor for the efficacy of BCG and, maintenance therapy is not associated with a significant increase in toxicity. In the future, the optimal schedule and doses must be defined, and it probably will be different for each individual. BCG shortage has led to try alternative therapies through chemo hyperthermia or electrical gradient application the efficacy of which should be evaluated. New strains and immunological treatments are also under research.

Inmunoterapia con BCG BCG y cáncer de vejiga: pasado, presente y futuro / BCG and bladder cancer: Past, present and future

Hace más de 40 años que se utiliza la BCG en el tratamiento del CVNMI. Sin embargo, los mecanismos de trabajo exactos de su funcionamiento aún no han sido totalmente descubiertos. La investigación clínica y básica realizada durante todos estos años ha generado mucha información pero que podría resumirse en unas pocas afirmaciones sencillas. Se ha demostrado que la mejor vía de administración de BCG es la vía intravesical, que la BCG es superior a la quimioterapia intracavitaria para prevenir la recurrencia pero que sus efectos adversos son peores. Recientemente se ha demostrado que BCG podría prevenir o retrasar la progresión a cáncer infiltrante. Sin embargo, para lograr esto, la terapia de mantenimiento es necesaria. Por ello, se recomienda que los tumores de riesgo intermedio y alto se traten con BCG. No se han encontrado diferencias significativas en la eficacia entre las diferentes cepas, pero si diferencia de recurrencia en la utilización de una dosis estándar frente a una reducida. Además, la presencia o ausencia de efectos secundarios no parece ser un factor pronóstico para la eficacia de BCG y la terapia de mantenimiento no se asocia con un aumento significativo de la toxicidad. En el futuro, se debe definir el esquema y la dosis óptimos, y esto probablemente sea diferente para cada individuo. La falta de suministros de BCG ha hecho que se prueben terapias alternativas mediante quimiohipertermia o aplicación de un gradiente eléctrico cuya efectividad debe ser evaluada. Nuevas cepas y tratamientos inmunológicos están también siendo investigados

BCG has been used in the treatment of NMIBC for more than 40 years. Nevertheless, its exact working mechanisms have not been completely discovered. Clinical and basic research done over all these years has generated much information but it could be summarized in a few simple statements. It has been demonstrated the best route of administration is intravesical, BCG is superior than intracavitary chemotherapy to prevent recurrence but its adverse events are worse. Recently, it has been demonstrated that BCG could delay or prevent progression to infiltrative cancer. Nevertheless, to achieve this, maintenance therapy is necessary. Therefore, the recommendation is to treat middle and high risk cases with BCG. No significant differences in efficacy have been found between the various strains but differences in recurrence have been found between standard and reduced doses. Furthermore, the presence or absence of side effects does not seem to be a prognostic factor for the efficacy of BCG and, maintenance therapy is not associated with a significant increase in toxicity. In the future, the optimal schedule and doses must be defined, and it probably will be different for each individual. BCG shortage has led to try alternative therapies through chemo hyperthermia or electrical gradient application the efficacy of which should be evaluated. New strains and immunological treatments are also under research