[Antibacterial therapy for acute cystitis in the age of growing pathogen resistance].

Acute cystitis refers to uncomplicated lower urinary tract infections, with the recurrence rates after the first cystitis episode being 50%. The basic treatment for the above diseases is antibacterial therapy, whose efficiency depends entirely on the right choice of a drug during initial empiric therapy. The paper gives the European Association of Urology guidelines and Russian guidelines, which are based on the results of both international (ARESC) and Russian (DARMIS) studies of urinary tract infection pathogens and their susceptibility to antibacterial drugs. Phosphomycin trometamol and furasidine potassium are the drugs of choice to treat acute cystitis in Russia now.

[Persistent dysuria in women. Current issues in diagnosis and treatment].

The article discusses the causes of persistent dysuria in women and presents detailed algorithm for the examination of patients with recurrent lower urinary tract infections which is one of the most frequent causes of urination disorders in women. The high rate of recurrence of cystitis and urethritis in women suggests the need for careful examination and treatment of patients with account of etiology and pathogenesis of these diseases. In 20 patients who were examined according to the specified algorithm, non-gonococcal urethritis and exacerbation of recurrent cystitis were diagnosed. All patients suffered from urination disorders for a long time, and received different types of antibacterial drugs with temporary effect. Only a careful examination allowed to reveal concomitant gynecological diseases underlying urethritis, and choose appropriate therapy. The complex therapy with safocid, including azithromycin, seknidazol, fluconazole, and immunotropic drug lavomax was administred.

[Cellular changes in the paraurethral zone of the experimental animals in exposure to collost gel].

An experimental trial of the collagen gel collost was made on Wistar white female rats aged 68 and 30-36 months. 7 and 15% collost gel (the first Russian collagen gel produced from cattle skin) was implanted in paraurethral region of the animals. The connective tissue cells in the zone of collost gel injection was studied histologically, immunohistochemically, electron microscopically. The examinations revealed differences in the content of the connective tissue in the injection zone depending on a collagen concentration and the age of the animal. The findings suggest that 15% collost gel implantation in the form of a paraurethral injection may be effective in females suffering from stress urinary incontinence for narrowing urethral lumen and preventing spontaneous voiding in response to a rise of intraabdominal pressure.

[Use of isolated intestinal segments in surgical treatment of radiation-induced lesions of the urinary tract].

Fifteen females with various radiation-induced lesions of the urinary tract (urinary fistulas alone or in combination with uni- or bilateral ureteral strictures) received surgical treatment using isolated intestinal segments. The above surgical intervention reestablished natural urination in 9 patients. They were relieved from continuous urine leakage into the vagina and/or from nephrostomas. Heterotopic urine derivation was performed in 6 patients. Thus, restoration of natural urination in most patients with postradiation lesions can be performed only in usage of isolated intestinal segments. In some cases heterotopic urine derivation is indicated.

[Hyperbaric oxygenation in the treatment of patients with interstitial cystitis: clinical and morphological rationale].

We studied efficacy of hyperbaric oxygenation (HBO) in 8 patients with interstitial cystitis/painful bladder syndrome (IC/PBS). Mean age of the patients was 53 years (35-72 years), mean duration of the disease 7.5 years (6-17 years). Ulcerative IC/PBS was diagnosed in 7 of 8 patients. The patients received combined treatment: surgical (hydrobouginage of the bladder, electrocoagulation of bladder ulcer) and a HBO course in the postoperative period. The efficacy was assessed by clinical and morphological criteria (estimation of histamine level in urethral smears, proliferative activity of bladder mucosa epithelial cells). A HBO course consisted of 10 sessions (40 min, 2 atm). The treatment reduced the number of voidings for 24 hours, increased mean effective bladder volume, lowered a total score by L. Parsons scale, histamine content in urethral smears, stimulated proliferative activity of bladder mucosa epithelium. Thus, HBO proved its safety and effectiveness in combined treatment of IC/PBS.

[Russian results of the international epidemiological study of clinical aspects and resistance to antimicrobial medicines of cystitis uropathogens in females (ARESC): significance of empiric therapy].

A total of 656 female patients from Russia aged between 18 to 65 years with uncomplicated cystitis entered the international ARESC trial, of them 647 were eligible for final analysis. Positive cultural urine tests ( > 10(4) CFU/ml) were in 419 (64.7%) patients, 393 (93.8%) patients had monoinfection. The central laboratory of Genoa (to which the isolated samples were sent) has tested 416 uropathogens from 399 patients. The following pathogens were isolated: E. coli (72.6%), enterococcus (7.0%), Klebsiella pneumoniae (4.6%), Staphylococcus saprophyticus (3.6%), Proteus mirabilis (2.4%) and Staphylococcus aureus (1.7%). E. coli was most sensitive to phosphomycin (99.3%), mecillinam (97.3%), nitrofurantoin (94.7%), ciprofloxacin (87.4%). The lowest sensitivity was to ampicillin (42.1%) and cotrimoxasol (69.4%). As to the whole bacterial spectrum, the highest sensitivity was found to phosphomycin (96.5%), nitrofurantoin (85.6%) and citrofloxacin (82.8%), the less sensitivity--to ampicyllin (44.3%) and co-trimoxasol (70.1%). Phosphomycin, mecillinam (not registered in Russia) and nitrofurantoin showed activity in vitro and can be considered as drugs of choice for empiric therapy of cystitis. Because of high resistance of pathogens, co-trimoxasol (trimetoprim) and fluoroquinalones are not recommended as first-line treatment for uncomplicated cystitis in females.

[Prophylaxis of recurrences of urinary tract infection].

Canephron N, a medicine of plant origin, was tested in outpatient aftertreatment for prophylaxis of recurrent infection of the upper urinary tract, in intravesical therapy for prophylaxis of lower urinary tract infections in sexually transmitted diseases. Canephron N provides an additional anti-inflammatory and symptomatic effect which lasts after active antibacterial therapy, and effective antibacterial protection in invasive manipulations, intravesical instillations, in particular. The drug showed good tolerance.

[Renal function in patients after purulent pyelonephritis].

The kidneys of the patients with purulent pyelonephritis (PP) undergo anatomic and functional alterations. The latter may be irreversible in some cases. The severity of the above alterations depends on PP form, choice and time of treatment. Our study included 84 patients who had PP at the age of 15 to 70 years. Primary PP was detected in 47 (56%) patients, secondary--in 37 (44%) patients. Open surgery was performed in 18 patients (group 1), transcutaneous drainage was used in 38 patients (group 2), conservative treatment was conducted in 28 patients (group 3). Comparison of dynamic nephroscintigraphic findings showed that recovery of renal function in groups 2 and 3 lasted 6-12 months versus 60-84 months in group 1. The degree of the renal function recovery depends on the PP form, age of the patient, duration of the disease, virulence of the causing agent, comorbid pathology, immune status, method of treatment. This was confirmed by the data of complex radionuclide examination. Long term complications, for instance, progress of arterial hypertension (41% cases) and chronic pyelonephritis (44% cases) were observed more frequently and earlier in patients after open operations.

[Microbiological characteristics and clinical efficacy of phosphomycin]. / Microbiologicheskaia kharakteristika i klinicheskaia éffektivnost' fosfomitsina.

E. coli is the most frequent agent causing urinary infection (UI) both in adults and children. E. coli of UI outpatients is often resistant to ampicilline, amoxicilline and co-trimoxasol. The study of phosphomycin in UI outpatients showed its highest efficacy against E. coli. Phosphomycin in a single daily dose of 3 g is a drug of choice in acute uncomplicated cystitis. The results of the study also demonstrate that phosphomycin can be used for prevention of pyoinflammatory complications before endoscopic manipulations and operations as well as open operations on the lower urinary tracts and genital organs.

[Diagnostic errors in purulent pyelonephritis]. / Oshibki v diagnostike gnoinogo pielonefrita.

Most frequent errors in diagnosis of purulent pyelonephritis have been analysed. It is shown that only a total of data obtained on the disease history, clinical symptoms, results of laboratory tests, ultrasound or x-ray symptoms of purulent pyelonephritis enable making an accurate diagnosis and choice of adequate treatment policy.