[Infection of the lower urinary tract: new possibilities of herbal medicine].

The review article is devoted to using modern combined herbal remedies for the treatment and prevention of urinary tract infections. From current point of view, the mechanisms of the pharmacological action of the components of Phytolysin preparations, paste for the preparation of a suspension for oral administration and Phytolysin capsules, are described in detail. The pathogenetic explanations of using herbal preparations in urological patients is given. The results of clinical studies are presented, confirming the efficiency of the use of drugs for the treatment and prevention of lower urinary tract infections. The new dosage form Phytolysin in the form of capsules does not differ in composition from the paste. Pharmacological effects and pathogenetic bases for the use of Fitolizin suggest that the new dosage form (capsules) is identical to the traditional, previously used one (paste).

[Antiadhesive strategy for non-antibacterial prophylaxis of recurrent lower urinary tract infections].

INTRODUCTION: The importance of recurrent lower urinary tract infection (LUTI) is associated with its high frequency, a significant decrease in the quality of life and insufficient efficiency of currently available treatment methods. Due to the high antibiotic resistance of uropathogens, the role of alternative therapeutic strategies increases, including substances with antiadhesive properties. AIM: to evaluate the efficiency of a biologically active additive (BAA) "Ecocystin" containing D-mannose and inulin for the prevention of recurrent LUTI in women. MATERIALS AND METHODS: A total of 74 women aged 21 to 75 years (mean 47.4+/-13.6 years) with recurrent LUTI were included in the study. After the initial treatment of LUTI all the patients were divided into two groups. Patients of the main group (n=44) received BAA "Ecocystin", containing D-mannose with antiadhesive properties and inulin, which is a prebiotic, to prevent recurrence of LUTI. Ecocystin was prescribed 1 sachet packet 2 times a day for the first 3 days, and then 1 sachet packet 1 time a day for 6 months. The Ecocystin sachet contains 1.5 g of D-mannose and 1.5 g of inulin. In the control group (n=30) were not prescribed Ecocystin. Clinical indicators were assessed on the 3rd day, as well as after 3 and 6 months from the beginning of the study. RESULTS: During the first 3 months, recurrent LUTI were diagnosed in 51.7% of patients in the control group and only in 15.9% of patients in the main group (p=0.002). By the 6th month of follow-up, relapses were seen in 75.9% and 29.5% of patients, respectively (p<0.001). In the main group a significant increase in the time interval before the onset of recurrence was found. During the first three months of follow-up, the recurrence of LUTI in the main group developed on average after 43.4+/-14.3 days compared to 28.2+/-13.5 days in the control group (p=0.026). In addition, severity and duration of recurrent LUTI in patients of the main group were less pronounced than in the control group. CONCLUSION: Our results showed that Ecocystin is an effective drug for the prevention of recurrences in patients with recurrent LUTI. Considering antiadhesive properties of D-mannose, which is part of Ecocystin, this drug can be recommended as a pathogenetically justified alternative to the antibacterial drugs.

[Recurrent lower urinary tract infection in women: treatment and prevention].

INTRODUCTION: Antibiotics represent the main drugs for the treatment and prevention of recurrent lower urinary tract infections (UTIs). At the same time, there is no consensus regarding the duration of therapy and the interval between courses. MATERIAL AND METHODS: A total of 50 women aged 18 to 65 years (mean age 44.6+/-13.2 years) with recurrent lower UTIs in the acute stage were treated. All patients were prescribed fosfomycin trometamol (Fosfomycin Esparma, Esparma GmbH, Germany) at a dose of 3 g once every 10 days for 3 months. The changes of clinical and laboratory parameters were evaluated on the 3rd day after the first administration of fosfomycin, and then after 1, 3 and 6 months from the start of treatment. RESULTS: A decrease in the severity of clinical manifestations of cystitis was seen on the next day after first administration of fosfomycin. By the 3rd day, the ACSS score decreased from the initial 9.2+/-2.1 to 1.4+/-1.0 (p<0.001), while the average urinary frequency changed from 12.3+/-2.3 to 7.5+/-1.4 (p<0.05). After 3 months of therapy, the clinical results virtually did not differ from results on the 3rd day. The therapy was well tolerated; adverse events were noted in 10 patients, but they didnt result in discontinuation of the drug. During follow-up for 3 months after the completion of therapy, 47 (94%) women didnt have recurrence of lower UTI. CONCLUSION: the results of the study suggest a high efficiency and good tolerability of fosfomycin when it is prescribed according to specific scheme for the treatment and prevention of recurrent lower UTIs in women.

[D-mannose for prevention and treatment of lower urinary tract infection: pathogenetic basics and clinical results].

Non-antibacterial methods of prevention and treatment of lower urinary tract infection are described in the article. The current view on the mechanism of treatment effect of D-mannose is presented, which contributes to the prevention of bacterial invasion. Pathogenetic concepts for using D-mannose as specific antiadhesin or a competitive blocker of bacterial invasion is provided. In addition, we discussed the results of basic and clinical studies, proving the efficiency of D-mannose for prevention and treatment of lower urinary tract infection.

[Efficiency and safety of phenazopyridine for treatment of uncomplicated urinary tract infection: results of multi-center, randomized, placebo-controlled, clinical study].

AIM: to evaluate the efficiency and safety of phenazopyridine for the treatment of patients with uncomplicated lower urinary tract infection, accompanied by pain. MATERIALS AND METHODS: A multicenter double-blind, randomized, placebo-controlled study with parallel groups to evaluate the efficacy and safety of phenazopyridine in patients with acute uncomplicated cystitis was performed. A total of 60 women were divided into two groups of 30 patients. In the main group (average age 32.6+/-7.4 years) phenazopyridine was prescribed (2 tablets of 100 mg p.o., with a total dose of 200 mg, once). In the control group, patients (mean age 35.53+/-8.79 years) received a placebo according to the same scheme. To evaluate the efficiency of treatment, the severity of the main symptoms 6 hours after taking the drug was analyzed. After that, patients started antibiotic therapy. They were followed-up for the next three days. The tolerance of therapy was evaluated by the presence of adverse events. RESULTS: All 30 patients taking phenazopyridine had an improvement after 6 hours, and the most frequent response was "significant improvement" (43.3%). The responses of patients in the main group significantly (p<0.05) differed from responses of patients in the control group. Six hours after taking phenazopyridine/placebo, the severity of all values according to VAS score, including the degree of general discomfort, pain during urination and increased frequency of urination improved significantly in the main group compared to the control group. The average assessment of general discomfort in the main group decreased by 53.4% in comparison with 28.8% in the control group, while the severity of pain during urination and urination frequency decreased by 57.4 vs. 35.9% and 39.6 vs. 27.6%, respectively. An analysis of the time before the complete absence of the general discomfort was performed. In the main group this period of time was significantly less than in the control group (p<0.05). There were no serious adverse events while taking phenazopyridine. Rate of adverse events was comparable between two groups. CONCLUSION: The results of the study showed that phenazopyridine is an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis and can be recommended in addition to etiological therapy.

[Fosfomycin for treatment of uncomplicated lower urinary tract infection].

In this article the current data on using of antibacterial drug Fosfomycin for treatment of lower urinary tract infection are reviewed. The distinct features of pharmacodynamics and pharmacokinetics of fosfomycin, as well as the spectrum of its antimicrobial activity are thoroughly discussed. The current information on the resistance of uropathogens, including those that produce extended-spectrum -lactamase, are presented.

[Bladder hydrodistension in treating patients with interstytial cystitis/ bladder pain syndrome].

This study aimed to evaluate the effectiveness of bladder hydrodistension in the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), depending on the duration of the procedure. MATERIALS AND METHODS: The study comprised 71 women aged 51.6+/-8.3 years with a 5.2+/-2.3 year history of IC/BPS. All patients underwent bladder hydrodistension (BH). Depending on the duration of BH, patients were divided into 4 groups. The distension time in group 1 (n=10), group 2 (n=20), group 3 (n=20) and group 4 (n=21) was 1 min, 2 min, 4 min and 6 min, respectively. The treatment effectiveness was assessed 1 month after BH by subjective assessment of patients, Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale questionnaire, a visual analog pain scale (VAS), and voiding diaries. RESULTS: At one month after BH, positive effect was observed in 32 (45.1%) patients. In groups 1, 2, 3 and 4 the treatment was effective in 20%, 55%, 45% and 47.6% of patients, respectively. Clinical effectiveness of BH with distension time of 1 min was significantly lower than that of 2, 4, and 6 min. At the same time, we did not find significant differences in the effectiveness of this procedure with distension time of 2, 4 and 6 min. CONCLUSION: The results of this study suggest that BH is an effective treatment in patients suffering from IC/BPS. At the same time, they show that the distension time of 2 min. is optimal from the point of view of clinical effectiveness, since the longer duration of the procedure is excessive, and the shorter time is insufficient.

[NefroCAPS phytolysin in complex management of women with chronic recurrent cystitis].

RELEVANCE: Recurrent lower urinary tract infections (UTI) in women are one of the most challenging problems of modern urology, which is associated both with their high incidence and increasing resistance of uropathogens to antibacterial drugs. Due to this fact, the phytotherapy of infectious and inflammatory diseases of the urinary tract has received increased attention. AIM: To investigate the effectiveness of Phytolysin nefroCAPS in the complex management of women with chronic recurrent cystitis. MATERIALS AND METHODS: 50 women with chronic recurrent cystitis underwent a complex examination. They were divided into two groups depending on the treatment they received. Patients of the 1st group (n=27) received a combination therapy: fosfomycin (monural) 3 g (single dose) and Phytolysin nefroCAPS one capsule three times daily for three months. Patients of the 2nd group (n=23) were administered a single 3-g dose of fosfomycin (monural). RESULTS: Follow-up examinations were performed 1, 3 and six months after initiation of the treatment. In patients of the 1st group, clinical manifestations of the disease disappeared earlier, and they had fewer recurrences than the patients of the 2nd group. Also, bacteriological study of urine showed a more persistent antimicrobial effect among patients of the 1st group. CONCLUSION: In patients with chronic recurrent cystitis, plant-based preparation Phytolysin nefroCAPS administered concurrently with an antibacterial drug is more effective than antibiotic monotherapy.

[Methods of traditional chinese medicine in the treatment of patients with interstitial cystitis/bladder pain syndrome].

In recent years, there has been an increasing interest in alternative (complementary) treatments of interstitial cystitis/bladder pain syndrome (IC/BPS). This is due both to the high incidence of IC/BPS and to a lack of effectiveness of conventional treatments. One of the directions of alternative therapies is a traditional Chinese medicine using a special diet, various animal and plant-derived medicines, breathing exercises and acupuncture. This review analyzes the accumulated experience in using traditional Chinese medicine in the treatment of patients with IC/BPS. The presented data indicate that these methods appear to be promising, since they are effective in a significant number of patients, lead to an improvement in their quality of life, are non-invasive and well tolerated. However, due to the lack of clinical studies, the efficacy of this treatment modalities needs to be confirmed.

[Litholytic therapy for urate nephrolithiasis].

AIM: To evaluate the effectiveness of ESWL combined with litholytic therapy in patients with uric acid kidney stones. MATERIALS AND METHODS: A total of 59 patients with urate nephrolithiasis were observed at the Department of Urology, First Pavlov SMU of St. Peterburg. The patients were divided into two groups according to the treatment regimen. The study group comprised 30 patients who were administered litholytic therapy before ESWL. The comparison group included 29 patients with nephrolithiasis who underwent ESWL without prior litholytic therapy. RESULTS: After 4 weeks of treatment with Blemaren, in 60% of patients of the study group a decrease in the calculus size was noted; in 83.3% of patients according to MSCT there was a decrease in calculus density. Disintegration of kidney stones after a single ESWL session was achieved in 86.7% of patients of the study group and in 65.5% of patients of the control group. CONCLUSION: The results of this study allow us to recommend a 4-week course of Blemaren to treat patients with urate nephrolithiasis to prepare for ESWL.

[Combined treatment of genital human papillomavirus infection in men].

This study aimed to assess the efficacy of treatment of genital human papillomavirus infection in 107 men. Patients in group 1 (n=51) underwent laser ablation of genital warts, patients in group 2 (n=56) were treated with laser ablation in conjunction with the administration of an immune system medication izoprinozin. During the first 9 months post-treatment, human papillomavirus infection relapse rate in group 1 was 23,5% and in group 2 - 5,4%. It was likewise observed that the combined treatment of genital warts resulted in reduced incidence of infective complications and the time of wound epithelialization after laser papilloma ablation.