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1.
Emerg Med Clin North Am ; 37(4): 707-723, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563203

RESUMO

Urinary tract infection (UTI) affects patients of all ages and is a diagnosis that emergency physicians might make multiple times per shift. This article reviews the evaluation and management of patients with infections of the urinary tract. Definitions of asymptomatic bacteriuria, uncomplicated UTI, and complicated UTI are presented, as well as techniques for distinguishing them. The pathophysiology and clinical and laboratory diagnoses of UTI are described. Treatment of UTI is reviewed, with attention to bacteriuria and special populations, including pregnant, elderly/geriatric, and spinal cord injury patients.


Assuntos
Serviço Hospitalar de Emergência , Infecções Urinárias/diagnóstico , Antibacterianos/uso terapêutico , Bacteriúria/diagnóstico , Bacteriúria/terapia , Cistite/diagnóstico , Cistite/terapia , Humanos , Pielonefrite/diagnóstico , Pielonefrite/terapia , Infecções Urinárias/terapia
3.
Int Urol Nephrol ; 51(10): 1715-1720, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31321678

RESUMO

PURPOSE: Haemorrhagic cystitis (HC) after allogeneic transplantation (HSCT) is a condition characterized by diffuse inflammation and bleeding from the bladder mucosa. Treatment of HC is not standardized and clinical Guidelines are elusive. The aim of this study was to evaluate the safety and efficacy of intravesical treatment with platelet-rich plasma (PRP) in patients with HC after allogenic HSCT. METHODS: Data from ten consecutive patients with BK virus-induced HC between 2013 and 2017 were collected. HC was classified into four grades. Inclusion criteria were (a) grade 3 or 4 BKV-induced HC after allogenic HSCT; (b) HC refractory to conservative therapy. All patients underwent transurethral cystoscopy and PRP treatment under general anaesthesia. RESULTS: Mean patients' age was 33.6 years. Four patients (40%) presented a grade 3 BKV-induced HC and six patients (60%) a grade 4. No intraoperative complications occurred. Postoperative complications were recorded in six patients: three patients required blood transfusion while three patients endovenous antibiotic therapy. Median time to catheter removal was 6 days (IQR 2-10). Median length of hospitalization was 35 days (IQR 6-73). At 30 days after surgery, a three-way catheter was repositioned in one patient for grade 4 haematuria, six patients had a complete response, and three a partial response. CONCLUSIONS: Our preliminary experience suggests that intravesical administration of PRP should be considered as a feasible and safe option for the treatment of BK-induced HC after HSCT. Future studies are needed to assess its potential value in other forms of haemorrhagic cystitis.


Assuntos
Cistite/terapia , Transplante de Células-Tronco Hematopoéticas , Hemorragia/terapia , Plasma Rico em Plaquetas , Complicações Pós-Operatórias/terapia , Administração Intravesical , Adolescente , Adulto , Cistite/complicações , Hemorragia/complicações , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Homólogo , Adulto Jovem
4.
Complement Ther Clin Pract ; 34: 13-16, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30712716

RESUMO

BACKGROUND: and purpose: Different in vitro studies have reported the antimicrobial effects of green tea catechins and also their synergistic effects with trimethoprim-sulfamethoxazole against E. coli. The aim of the present study was to evaluate the efficacy of green tea as an adjunctive therapy to standard antimicrobial treatment in women with acute uncomplicated cystitis. MATERIALS AND METHODS: In this blinded randomized trial, 70 patients were assigned to receive four 500 mg capsules of green tea or starch as placebo daily for three days along with trimethoprim-sulfamethoxazole. The presence of acute uncomplicated cystitis symptoms was recorded and urinalysis was performed. RESULTS: Women in the green tea group showed a statistically significant decrease in the prevalence of cystitis symptoms and a statistically significant improvement in the urinalysis results except for hematuria after 3 days of treatment. CONCLUSION: Green tea was an effective adjunct to trimethoprim-sulfamethoxazole to treat acute uncomplicated cystitis in women.


Assuntos
Antibacterianos/administração & dosagem , Cistite/terapia , Chá/química , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Doença Aguda , Adulto , Antibacterianos/farmacologia , Escherichia coli/efeitos dos fármacos , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
5.
Int J Surg ; 63: 34-42, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30711618

RESUMO

BACKGROUND: BK virus is a major cause of late onset haemorrhagic cystitis in patients undergoing Haematopoietic Cell Transplantation (HCT). The evidence for the management of BK Virus Associated Haemorrhagic Cystitis (BKV-HC) is limited. Much of the published data consists of non-randomised case series and case reports. To our knowledge this is the first systematic review for the management of BKV-HC in both paediatric and adult populations. Our primary outcome was to examine the evidence for strategies of 1) prevention and 2) cessation of haematuria associated with BKV. Secondary outcomes were to assess the toxicity of treatment strategies and devise management recommendations for clinicians. MATERIALS AND METHODS: We performed a systematic review of the PubMed and Central databases to evaluate the current evidence. A search protocol was prepared and registered with the PROSPERO database (CRD42017082442). The review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. Results were classified by treatment type. Qualitative analysis of included articles was performed, and grades of recommendations were devised for each treatment. RESULTS: Of 896 titles screened, 44 articles were included for qualitative analysis. The overall quality of evidence was low. There is insufficient evidence to recommend prophylactic quinolones. 40 studies evaluated treatments for established BKV-HC. There are no high-quality comparative studies. Cidofovir is the most studied treatment but quality of evidence is low, and grade of recommendation is weak. Hyperbaric oxygen therapy, Fibrin glue, Leflunomide, Sodium Pentosan Polysulfate, Intravesical Alum and Radiological embolisation have all been described but the effectiveness of these treatments is unclear. CONCLUSION: There remains no clear specific treatment for BKV-HC. An effective multi-disciplinary approach leading to early recognition and initiation of treatment is encouraged. The development of novel therapies followed by well-designed clinical studies are urgently needed.


Assuntos
Vírus BK , Cistite/terapia , Hemorragia/terapia , Infecções por Polyomavirus/complicações , Infecções Tumorais por Vírus/complicações , Adulto , Criança , Cistite/prevenção & controle , Hemorragia/prevenção & controle , Humanos
6.
BJU Int ; 123(4): 585-594, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30113758

RESUMO

INTRODUCTION: Haemorrhage is a frequent complication of radiation cystitis leading to emergency presentations in patients with prior pelvic radiation therapy. Standard initial patient management strategies involve resuscitation, bladder washout with clot evacuation and continuous bladder irrigation. Beyond this, definitive surgical treatment is associated with significant morbidity and mortality. Alternative less invasive management options for non-emergent haemorrhagic cystitis include systemic medical therapies, hyperbaric oxygen (HBO), intravesical therapies and laser ablation. However, evidence to support and compare treatment for haemorrhagic radiation cystitis is limited. METHODS: Herein, a literature search pertaining to the current management of haemorrhagic cystitis was conducted. RESULTS: In total, 23 studies were included in this review with 2 studies reviewing systemic therapy, 7 studies evaluating HBO therapy, 10 studies investigating a variety of intravesical therapies and the remaining 4 were relating to ablative therapies. Across these studies, the patient groups were heterogenous with small numbers and variable follow up periods. CONCLUSION: With evaluation of existing literature, this narrative review also provides a stepwise clinical algorithm to aid the urologist in treating patients presenting with complications associated with radiation cystitis.


Assuntos
Cistite/terapia , Hemorragia/patologia , Oxigenação Hiperbárica , Terapia a Laser , Lesões por Radiação/terapia , Irrigação Terapêutica , Bexiga Urinária/efeitos da radiação , Cistite/etiologia , Cistite/patologia , Hemorragia/etiologia , Humanos , Lesões por Radiação/patologia , Bexiga Urinária/patologia
7.
Neurourol Urodyn ; 38(1): 135-143, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30350879

RESUMO

AIMS: Interstitial cystitis and bladder pain syndrome is a prevalent health concern with inadequate treatments. Neuromodulation has emerged as a therapeutic option to treat patients refractory to standard care. The objective of this study was to determine the efficacy and mechanism(s) of sensory pudendal nerve stimulation on bladder function in cystitis rats. METHODS: Female rats were administered saline (n = 8) or cyclophosphamide (CYP, 150 mg/kg IP, n = 16) and single-trial cystometry experiments were conducted under urethane anesthesia 48 h after injection. Electrical stimulation (0.02-0.22 mA, 10-20 Hz) was delivered to the sensory branch of the pudendal nerve and its effect on the bladder and external urethral sphincter were measured. Stimulation trials were also conducted following bilateral hypogastric nerve transection (HGNT) or pharmacological inhibition of beta-adrenergic receptors (propranolol, 1 mg/kg IV) to determine the mechanisms of bladder inhibition. RESULTS: CYP-induced cystitis decreased bladder capacity (P = 0.0352) and bladder compliance (P = 0.024) by up to 38% of control. Electrical stimulation of the sensory pudendal nerve increased bladder capacity (P < 0.0001) in control and CYP rats by up to 51-52% of their respective baselines. HGNT did not influence bladder inhibition generated by sensory pudendal nerve stimulation in control rats, whereas HGNT and propranolol decreased the efficacy of electrical stimulation in CYP rats. CONCLUSIONS: Sympathetic reflex activity mediates sensory pudendal nerve stimulation in CYP treated but not control rats. These studies demonstrate an alternative approach to neuromodulation in cystitis and establish mechanistic changes during stimulation that may enable the development of novel therapeutics.


Assuntos
Cistite/fisiopatologia , Cistite/terapia , Nervo Pudendo/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Bexiga Urinária/fisiopatologia , Animais , Antineoplásicos Alquilantes , Ciclofosfamida , Cistite/induzido quimicamente , Estimulação Elétrica , Feminino , Ratos , Ratos Wistar , Sensação , Uretra/fisiopatologia , Urodinâmica
8.
Neurourol Urodyn ; 38(1): 116-122, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30411810

RESUMO

AIM: Interstitial cystitis/painful bladder syndrome/(IC/PBS) results in recurring pain in the bladder and surrounding pelvic region caused by abnormal excitability of micturition reflexes. Spinal cord stimulation (SCS) is currently clinically used for the attenuation of neuropathic and visceral pain. The present study examined whether SCS at upper lumbar segments modulates detrusor overactivity and visceral hyperalgesia associated with cystitis in a rat model of cyclophosphamide (CYP)-induced cystitis. METHODS: Cystitis was induced by intraperitoneal injection of CYP (200 mg/kg) in six adult female Sprague Dawley rats 48 h prior to urodynamic recordings. Another six rats served as-controls with saline injection. Cystometry and the external urethral sphincter (EUS) electromyography during bladder infusion were evaluated under urethane anesthesia. The visceromotor reflexes (VMR) obtained from the external abdominal oblique muscle were quantified during bladder infusion and isotonic bladder distension (IBD), respectively. After baseline recordings were taken, SCS was applied on the dorsal surface of L3 for 25 min. Urodynamic recordings and VMR during bladder infusion and IBD were repeated 2 h after SCS. RESULTS: CYP resulted in detrusor overactivity, stronger EUS tonic contractions, and increased VMR. SCS significantly reduced non-voiding contractions, prolonged EUS relaxation, and delayed VMR appearance during bladder infusion as well as significantly decreased VMR during IBD in cystitis rats. CONCLUSION: SCS improved bladder function and EUS relaxation during bladder infusion and significantly attenuated visceral nociceptive-related VMR during IBD in cystitis rats. SCS may have therapeutic potential for patients with hyperalgesia and IC/PBS.


Assuntos
Cistite/terapia , Estimulação da Medula Espinal/métodos , Bexiga Urinária Hiperativa/terapia , Dor Visceral/terapia , Animais , Ciclofosfamida , Cistite/induzido quimicamente , Cistite/complicações , Eletromiografia , Feminino , Contração Muscular , Ratos , Ratos Sprague-Dawley , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/etiologia , Urodinâmica , Dor Visceral/etiologia
9.
Neurourol Urodyn ; 38(1): 97-106, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30411813

RESUMO

AIM: To investigate whether hyperbaric oxygen (HBO) is effective for the pathophysiological findings in an IC/PBS-like mouse model induced by intravesical hydrogen peroxide (H2 O2 ). METHODS: Six-week-old ICR female mice (N = 16) were divided into four experimental groups: (1) sham control with intravesical vehicle instillation twice, and without subsequent treatment (N = 4); (2) H2 O2 instillation twice, followed by HBO (100% O2 , 2 ATA, 30 min per session) (N = 4); (3) H2 O2 instillation twice, followed by dummy hyperbaric treatment (air, 2ATA, 30 min per session) (N = 4); and (4) H2 O2 instillation twice, followed by no treatment (N = 4). Body weight, voiding frequency, tidal voiding volume, and individual bladder pain threshold using the von-Frey test were measured. Whole body uptake of an inflammation-specific fluorescent pan-cathepsin was assessed by an in vivo imaging. Immunohistochemical staining and the mRNA expression of several biomarkers associated with chronic inflammation in resected bladders were evaluated. RESULTS: The HBO-treated group showed significant improvement in voiding frequency, tidal voiding volume, and the individual bladder pain threshold. Moreover, HBO markedly suppressed H2 O2 -induced inflammation, edema, and fibrosis in bladder wall, concomitant with a significant decrease in mRNA expressions of inflammation biomarkers and a significant increase in endothelial nitric oxide synthase expression. HBO also inhibited the expression of transient receptor potential channels induced by H2 O2 instillation. CONCLUSION: These results suggest that HBO contributes to elimination of H2 O2 -induced long-lasting cystitis through the repair of chronically inflamed bladder tissue and inhibition of the bladder sensory system.


Assuntos
Cistite/complicações , Cistite/terapia , Peróxido de Hidrogênio , Hiperalgesia/etiologia , Hiperalgesia/terapia , Oxigenação Hiperbárica , Oxidantes , Transtornos Urinários/etiologia , Transtornos Urinários/terapia , Administração Intravesical , Animais , Cistite/induzido quimicamente , Feminino , Peróxido de Hidrogênio/administração & dosagem , Inflamação/induzido quimicamente , Inflamação/metabolismo , Camundongos , Camundongos Endogâmicos ICR , Limiar da Dor , Urodinâmica/efeitos dos fármacos
10.
Arch Esp Urol ; 71(10): 859-862, 2018 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30560799

RESUMO

OBJECTIVE: Even though there is no established standard therapy for Eosinophilic cystitis (EC), the series of cases guide us in the treatment of patients. We report our therapeutic experience with hydrodistention and complementary methods. In order to establish a standard treatment in patients with EC. METHODS: Retrospective review of the clinical history of a patient diagnosed with eosinophilic cystitis. RESULTS: A 66-year-old woman presented female urethral syndrome 1 year before and was initially treated as a chronic cystitis. After further investigations including cystoscopy and bladder biopsy, she was diagnosed with EC.Urothelial mucosa bleeding was evidenced and cauterization and hydrodistention were performed. After the surgical treatment, corticosteroids and antibiotics were initiated.The maintenance treatment was continued with Vitamin C, Maurita flexuosa and Peumus boldus. The patient's condition has been improving and she is still asymptomatic one year later. CONCLUSION: The efficacy of treatment with hydrodistention, corticosteroids and antibiotics showed positive results in short and long term in this patient. Vitamin C, Maurita flexuosa and Peumus boldus showed favorable results in EC maintenance treatment.


Assuntos
Cistite , Eosinofilia , Idoso , Antibacterianos/uso terapêutico , Cistite/terapia , Cistoscopia , Eosinofilia/terapia , Feminino , Humanos , Estudos Retrospectivos
11.
Arch. esp. urol. (Ed. impr.) ; 71(10): 859-862, dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-178768

RESUMO

Objetivo: A pesar de que no existe una terapia estándar establecida para la cistitis eosinofílica (CE), la serie de casos nos guía en el tratamiento de los pacientes. Presentamos nuestra experiencia terapéutica con hidrodistensión y métodos complementarios. Con el fin de establecer un tratamiento estándar en pacientes con CE. Métodos: Revisión retrospectiva de la historia clínica de un paciente con diagnóstico de cistitis eosinofílica. Resultados: Una mujer de 66 años presentó síndrome uretral femenino hace un año y fue tratada inicialmente como una cistitis crónica. Después de más investigaciones incluyendo una cistoscopia y una biopsia de la vejiga, se le diagnosticó CE. Se evidenció sangrado de la mucosa urotelial y se realizaron cauterización e hidrodistensión. Después del tratamiento quirúrgico, se iniciaron corticosteroides y antibióticos. El tratamiento de mantenimiento se continuó con Vitamina C, Maurita flexuosa y Peumus boldus. La condición del paciente ha mejorado y sigue estando asintomática un año después. Conclusión: La eficacia del tratamiento con hidrodistención, corticosteroides y antibióticos mostró resultados positivos a corto y largo plazo en este paciente. La vitamina C, Maurita flexuosa y Peumus boldus mostraron resultados favorables en el tratamiento de mantenimiento de CE


Objective: Even though there is no established standard therapy for Eosinophilic cystitis (EC), the series of cases guide us in the treatment of patients. We report our therapeutic experience with hydrodistention and complementary methods. In order to establish a standard treatment in patients with EC. Methods: Retrospective review of the clinical history of a patient diagnosed with eosinophilic cystitis. Results: A 66-year-old woman presented female urethral syndrome 1 year before and was initially treated as a chronic cystitis. After further investigations including cystoscopy and bladder biopsy, she was diagnosed with EC. Urothelial mucosa bleeding was evidenced and cauterization and hydrodistention were performed. After the surgical treatment, corticosteroids and antibiotics were initiated. The maintenance treatment was continued with Vitamin C, Maurita flexuosa and Peumus boldus. The patient’s condition has been improving and she is still asymptomatic one year later. Conclusion: The efficacy of treatment with hydrodistention, corticosteroids and antibiotics showed positive results in short and long term in this patient. Vitamin C, Maurita flexuosa and Peumus boldus showed favorable results in EC maintenance treatment


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cistite/terapia , Eosinofilia/terapia , Antibacterianos/uso terapêutico , Cistoscopia , Estudos Retrospectivos
12.
Clin J Oncol Nurs ; 22(6): E146-E151, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30451996

RESUMO

BACKGROUND: Hyperbaric oxygen therapy is a rare treatment modality for hemorrhagic cystitis (HC) following BK virus reactivation in the immunosuppressed population. Clinicians need to be aware of the etiology, preventive measures, complications, and various management techniques in HC while treating patients undergoing bone marrow transplantation. OBJECTIVES: This study details the pathologic progression of HC in a patient with acute lymphoblastic leukemia harboring BK virus after cytotoxic induction chemotherapy and haploidentical marrow transplantation. METHODS: A search of PubMed for literature published from 1973-2018 was conducted using keywords. FINDINGS: Hyperbaric oxygen therapy in chemotherapy-induced and BK virus-associated HC is a viable management option in parallel with tapering of immunosuppressives, bladder irrigation, and IV resuscitation within the post-transplantation acute lymphoblastic leukemia population.


Assuntos
Cistite/epidemiologia , Cistite/terapia , Hematúria/terapia , Oxigenação Hiperbárica/métodos , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Transplante de Medula Óssea/métodos , Comorbidade , Cistite/diagnóstico , Intervalo Livre de Doença , Feminino , Hematúria/diagnóstico , Hematúria/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento
13.
Mol Med ; 24(1): 60, 2018 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-30482157

RESUMO

BACKGROUND: We tested the hypothesis that extracorporeal shockwave treatment (ESWT) can abolish inflammation and restore urothelial barrier integrity in acute interstitial cystitis by upregulating the fatty acid receptor GPR120. METHODS: A total of 30 female Sprague-Dawley rats were categorized into five groups: (1) sham-operated rats (SC); (2) rats treated with ESWT (SC + ESWT); (3) rats with bladder irritation using 150 mg/kg cyclophosphamide through intraperitoneal injection; (4) cyclophosphamide rats treated with ESWT (cyclophosphamide+ESWT); (5) cyclophosphamide rats treated with GPR120 agonist (cyclophosphamide+GW9508). RESULTS: On Day 3, urine and bladder specimens were collected for biochemical, histopathological, immunological, and immunoblotting analysis. Following stimulation with cyclophosphamide, the inhibition of the elevated levels of TAK1/NF-κB and phospho-TAK1/NF-κB by ESWT and GPR120 agonists in RT4 cells was associated with a suppression of NF-κB translocation from the cytosol to the nucleus. Accordingly, this anti-inflammatory effect was abolished by GPR120 antagonist and knockdown of GPR120. Histologically, bladder inflammation in cyclophosphamide-treated rats was suppressed by GW9508 or ESWT. Masson's trichrome and Sirius red staining revealed that cyclophosphamide treatment enhanced synthesis of extracellular matrix in rats that was reversed by GW9508 or ESWT. Upregulated pro-inflammatory mediators and cytokines in the cyclophosphamide-treated rats were also suppressed in the GW9508- or ESWT-treated rats. The significantly increased inflammatory cell infiltration as well as the impaired urothelial integrity of the bladder after cyclophosphamide treatment were reversed by treatment with GW9508 or ESWT. CONCLUSIONS: These findings suggest that GPR120, the sensing receptor for ESWT, may be useful in the treatment of interstitial cystitis by inhibiting inflammatory response in bladder cells.


Assuntos
Cistite/terapia , Tratamento por Ondas de Choque Extracorpóreas , Receptores Acoplados a Proteínas-G/metabolismo , Animais , Linhagem Celular Tumoral , Ciclofosfamida , Cistite/induzido quimicamente , Cistite/metabolismo , Feminino , Inativação Gênica , Ratos Sprague-Dawley , Receptores Acoplados a Proteínas-G/genética
14.
Medicine (Baltimore) ; 97(45): e11272, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30407278

RESUMO

INTRODUCTION: Emphysematous pyelonephritis (EPN) or cystitis (EC) is a severe infection of the urinary tract with high mortality. EPN is uncommon among the patients of end stage of renal failure (ESRD) CASE PRESENTATION:: A 38-year-old male with uremia and anuria who was on hemodialysis was found to have gas formation in the bilateral pelvis, ureters, and urinary bladder by CT scan. The diagnosis was emphysematous pyelonephritis and cystitis. And Foley catheter was placed and bladder irrigation was performed. Escherichia coli infection was identified in urine culture and antibiotic was prescribed accordingly. Gas disappeared completely and the patient recovered uneventfully. CONCLUSION: This is the first case report of asymptomatic EPN and EC in uremic patient, and conservative management was optimistic in this condition. More attention should be paid to EPN and EC happening to ESRD patients.


Assuntos
Anuria/complicações , Cistite/etiologia , Enfisema/etiologia , Infecções por Escherichia coli/complicações , Pielonefrite/etiologia , Uremia/complicações , Adulto , Anuria/terapia , Tratamento Conservador , Cistite/terapia , Enfisema/terapia , Infecções por Escherichia coli/tratamento farmacológico , Humanos , Masculino , Diálise Renal/efeitos adversos , Uremia/terapia
15.
Int Urol Nephrol ; 50(10): 1745-1751, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30132277

RESUMO

PURPOSE: Given that more cancers are being diagnosed earlier and that treatment of cancer is improving, health issues of cancer survivors are becoming more common and apparent. Pelvic radiation therapy for the treatment of gynecological cancers can lead to long-term collateral damage to the bladder, a condition termed radiation cystitis (RC). Late sequelae may take many years to develop and include incontinence and pain as well as hematuria. RC is a rare but potentially life-threatening condition for which there are few management and treatment options. METHODS: There are limited data in the literature regarding the effects of radiation on the bladder after gynecological cancer therapy and we hereby review the literature on cancer survivorship issues of pelvic radiation for gynecology literature. RESULTS: Treatment options are available for patients with radiation-induced hemorrhagic cystitis. However, most treatments are risky or only effective for a short timeframe and no therapy is currently available to reverse the disease progress. Furthermore, no standardized guidelines exist describing preferred management options. Common therapies include hyperbaric oxygen therapy, clot evacuation, fulguration, intravesical instillation of astringent agents, and surgery. Novel developing strategies include Botulinum Toxin injections and liposomal-tacrolimus instillations. These treatments and strategies are discussed. CONCLUSIONS: In this review, we will present current and advanced therapeutic strategies for RC to help cancer survivors deal with long-term bladder health issues.


Assuntos
Cistite/terapia , Neoplasias dos Genitais Femininos/radioterapia , Hematúria/terapia , Lesões por Radiação/terapia , Administração Intravesical , Adstringentes/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Sobreviventes de Câncer , Cistite/etiologia , Cistite/cirurgia , Feminino , Hematúria/etiologia , Hematúria/cirurgia , Humanos , Oxigenação Hiperbárica , Imunossupressores/uso terapêutico , Lesões por Radiação/etiologia , Lesões por Radiação/cirurgia , Sobrevivência , Tacrolimo/uso terapêutico , Bexiga Urinária/efeitos da radiação
16.
Arch Ital Urol Androl ; 90(2): 101-103, 2018 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-29974728

RESUMO

OBJECTIVES: The aim of our study was to explore the effectiveness of the combination of D-mannose, Salicin, and Lactobacillus acidophilus (La-14) in patients complaining recurrent symptomatic cystitis due to E. coli. MATERIALS AND METHODS: From July 2013 to September 2014, 85 consecutive subjects (68 women and 17 men) affected by recurrent symptomatic cystitis were enrolled. Of those, 46 (33 women and 13 men) suffered from neurogenic bladder. Overall 78 patients received an initial 5-days regimen consisting on a tid oral combination of 1000 mg of D-mannose plus 200 mg of dry willow extract (salicin) (attack phase), followed by bid 7-days with 700 mg of D-mannose plus 50 mg (1x109 CFU) of Lactobacillus acidophilus (La-14) (maintenance treatment). The maintenance treatment was repeated every 15 days for the next two months. Patients' symptoms were evaluated through a 3-days bladder diary and a Visual Analogic Scale (VAS). RESULTS: After treatment VAS scores decreased from 8.07 ± 1.70 to 4.74 ± 2.07 (p = 0.001) in non-neurological patients (group A) and from 7.21 ± 1.90 to 3.74 ± 3.12 (p = 0.001) in the neurological patients (group B). A significant reduction of daily frequency was noted in both groups: from 14 ± 3 to 7 ± 3 (p = 0.001) in group A and from 15 ± 3 to 8 ± 3 (p = 0.001) in group B. A reduction of incontinence episodes in Group A patients was observed, as well as in 12/39 Group B. Improvements were maintained during follow-up. CONCLUSION: This therapeutic approach combining D-Mannose with Salicin (acute treatment) and Lactobacillus acidophilus La-14 (maintaining treatment) seems to be effective in symptomatic bacterial UTIs. Further larger and randomized control trials (RCTs) are needed to confirm our results.


Assuntos
Terapia Biológica/métodos , Cistite/terapia , Infecções por Escherichia coli/terapia , Adulto , Idoso , Álcoois Benzílicos/uso terapêutico , Terapia Combinada , Cistite/microbiologia , Infecções por Escherichia coli/microbiologia , Estudos de Viabilidade , Feminino , Glucosídeos/uso terapêutico , Humanos , Lactobacillus acidophilus , Masculino , Manose/uso terapêutico , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Extratos Vegetais/uso terapêutico , Recidiva , Resultado do Tratamento , Bexiga Urinaria Neurogênica/complicações , Infecções Urinárias/tratamento farmacológico , Adulto Jovem
17.
Curr Opin Support Palliat Care ; 12(3): 344-350, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30015689

RESUMO

PURPOSE OF REVIEW: There are various specific therapeutic intervention available to treat hemorrhagic cystitis, once emergency treatment has been carried out. The lack of prospective studies, because of the relative rarity of this condition, makes it difficult to hierarchize the therapeutic sequence. The present review presents and summarizes the literature published on radiation-induced hemorrhagic cystitis from April 2015, date of a precedent exhaustive review, to March 2018. RECENT FINDINGS: During our period of interest, 13 clinical studies and two new clinical trials protocols were published. Most of the clinical studies were retrospective and presented data about hyperbaric oxygen (HBO) therapy, comforting its place as a well tolerated and effective first-line treatment. Other studies reported the outcomes of treatments with alum, formalin, silver nitrate, fulguration with laser or definitive surgery. SUMMARY: Although authors seem to agree that formalin and surgery have their role as effective but potentially morbid last-line treatments, there is no consensus on primary approach to management of radiation-induced hemorrhagic cystitis beyond symptomatic measures. Several treatments have proven excellent response rates and few side effects. The results of on-going prospective studies on mesenchymal stromal cells or tacrolimus instillations are awaited, but the main discriminating factor to choose between treatments remains local availability.


Assuntos
Cistite/terapia , Hemorragia/terapia , Oxigenação Hiperbárica/métodos , Lesões por Radiação/terapia , Compostos de Alúmen/uso terapêutico , Cistite/epidemiologia , Formaldeído/uso terapêutico , Hemorragia/epidemiologia , Humanos , Nitrato de Prata/uso terapêutico
18.
J Int Med Res ; 46(7): 2954-2960, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29916283

RESUMO

This present case report describes a 64-year-old female patient with type 2 diabetes mellitus who also had emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC). Computed tomography revealed well defined emphysematous pyelonephritis and cystitis. Broad-spectrum antibiotic and percutaneous drainage of the right kidney were used as part of a conservative management regimen. The patient achieved clinical recovery and was discharged 12 days after admission. Furthermore, 13 other cases of EPC and EC that were reported between 1962 and 2017 were reviewed and discussed. The overall mortality was 15.4% (two of 13 patients), compared with 25% for EPN alone or 7.4% for EC alone as reported in the literature. The primary pathogen identified in the 13 patients was Escherichia coli (53.8%). All 13 patients were treated with antibiotics.


Assuntos
Cistite/diagnóstico por imagem , Enfisema/diagnóstico por imagem , Infecções por Escherichia coli/microbiologia , Escherichia coli/isolamento & purificação , Pielonefrite/diagnóstico por imagem , Antibacterianos/uso terapêutico , China , Cistite/microbiologia , Cistite/terapia , Diabetes Mellitus Tipo 2/complicações , Drenagem , Enfisema/microbiologia , Enfisema/terapia , Infecções por Escherichia coli/diagnóstico por imagem , Infecções por Escherichia coli/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Pielonefrite/microbiologia , Pielonefrite/terapia
19.
Urologiia ; (2): 9-13, 2018 May.
Artigo em Russo | MEDLINE | ID: mdl-29901288

RESUMO

AIM: To investigate the role of hyperbaric oxygen therapy in the management of patients with radiation induced urinary bladder injury (radiation cystitis). MATERIALS AND METHODS: The study comprised 23 patients with late radiation induced urinary bladder injury who were evaluated and treated using hyperbaric oxygen therapy and bladder instillation. Before and after treatment, all patients underwent cystoscopy with the bladder mucosa biopsy. - RESULTS: In all patients, the treatment resulted in positive outcomes manifested by resolution of hematuria, alleviation of dysuria, decrease in urination frequency to 6.5 +/- 0.5 times a day, increase the bladder capacity, which ultimately improved patients the quality of life. Hyperbaric oxygen therapy was well tolerated, there were no adverse effects. Morphological studies confirmed positive clinical changes following hyperbaric oxygen therapy. CONCLUSION: The study findings support wider use of hyperbaric oxygen therapy in the management of radiation cystitis.


Assuntos
Cistite , Oxigenação Hiperbárica , Lesões por Radiação , Bexiga Urinária , Adulto , Idoso , Cistite/diagnóstico por imagem , Cistite/fisiopatologia , Cistite/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/fisiopatologia , Lesões por Radiação/terapia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia
20.
J Pediatr Urol ; 14(5): 366-373, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29776868

RESUMO

OBJECTIVE: Hemorrhagic cystitis (HC) is a serious event that can occur after hematopoietic stem cell transplantation (HSCT). Treatment goals are primarily to preserve life, and then the functionality of the bladder. There is no standard therapeutic approach for HC. Described treatment options provide low success rates and are related to potential life-threatening side effects. The aim of this study was to describe our experience in treatment of HC following HSCT. PATIENTS AND METHODS: This was a retrospective study of patients with HC treated at our institution between January 2010 and October 2016. We analyzed demographics, underlying diagnosis, and treatment modalities. RESULTS: We treated 39 patients with HC. Mean age was 9.4 years (SD 4.20) and 64% were males. Acute leukemia was the most common underlying diagnosis in 27 (69%). Mean time from HSCT to HC onset was 55.46 days (SD 112.35). HC grades were: I (3), II (21), III (8), and IV (7). BK-viuria was present in 34 patients (87.2%). Non-invasive treatment was performed in 28 patients (71.8%). The remaining 11 (28.2%) required urological intervention (all high-grade), consisting of bladder irrigation in all of these. Additional treatments consisted of: intravesical cidofovir (4), intravesical sodium hyaluronate (5), cystoscopy and clot evacuation (4), selective angioembolization (2), percutaneous nephrostomy (1), and open extraction of bladder clots and cutaneous cystotomy (1). Overall, eight patients (20.5%) died as a result of the malignancy (3 in the urological intervention group), and of these four had active HC at death. Mean follow-up was 36.2 months (SD 24.9). CONCLUSION: HC is associated with high morbidity and mortality. Treatment should be individualized and designed to prioritize survival. However, bladder function should be preserved for the future.


Assuntos
Cistite/terapia , Transplante de Células-Tronco Hematopoéticas , Hemorragia/terapia , Complicações Pós-Operatórias/terapia , Adolescente , Algoritmos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pediatria , Estudos Retrospectivos , Urologia
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