Drug adherence and drug-related problems in pharmacotherapy for lower urinary tract symptoms related to benign prostatic hyperplasia.

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is one of the most common urinary disorders in elderly men. In recent years, pharmacotherapy of BPH has increased the efficacy, including combination treatment mostly with two drug classes, namely, 5-α-reductase inhibitors and α-1-adrenolytics (alpha blockers) with a different pharmacological activity. Although pharmacological treatment of BPH is a success story in urology, daily practice suggests that several medical needs remain unmet. We aimed to evaluate drug adherence in patients receiving pharmacological therapy to treat LUTS/BPH, and to analyze drug adherence among monotherapy and combination therapy. The sample population consisted of 758 men aged > 40 years who had been prescribed medications for LUTS/BPH during the index period between June 2015 and August 2016. Only alpha blockers and 5-α-reductase inhibitors (5ARIs) were considered in the analysis. Among ABs there were doxazosin, tamsulosin, alfuzosin, terazosin and among 5-α-reductase inhibitors it was only finasteride. Drug adherence was assessed in patients who were treated for a minimum of 6 months. Two levels of exposure were evaluated, follow-ups: ≥ 6 months, and ≥ 12 months. In patients who were treated for at least 6 months, the drug adherence rate was 32% and the 12-month drug adherence rate was 23%. We observed an inverse relationship between drug adherence rates and the duration of treatment - longer the duration of pharmacological therapy, lower was the drug adherence rate noted. Our study shows a low rate of overall drug adherence in patients diagnosed with BPH. It was observed that a low adherence rate is closely related to drug-related problems (DRP). Furthermore, this is a correlation between the degree of LUTS/BPH and adherence rate - the higher degree of LUTS/BPH, the higher adherence rate. Further studies are warranted focusing on assessing adherence to pharmacological therapy.

The Assessment of the Risk of Acute Kidney Injury in Patients Undergoing an Urgent Endovascular Treatment Due to Severe Renal Bleeding.

INTRODUCTION: This study was designed to assess the clinical factors associated with the development of acute kidney injury (AKI) in patients undergoing endovascular treatment during the course of severe renal bleeding. METHODS: A retrospective analysis was performed of 36 consecutive patients who were treated endovascularly between January 2006 and December 2016 for anemia caused by iatrogenic (26 pts) or posttraumatic (10 pts) renal bleeding. Typical patient data, baseline, and postprocedural blood parameters were evaluated. As a predictor of AKI occurrence, SCr0 > 1.5 mg/dL, eGFR < 60 ml/min/1.73 m2, and Mehran score were evaluated. RESULTS: Fourteen patients (39%) developed AKI after CM injection. Time of hospitalization (p = 0.02), hypotension (p = 0.005), dialysis (p = 0.05), blood transfusions (p = 0.028), amount of blood received (p = 0.003), red blood units > 3 (RBU) (p = 0.032), and CM > 150 ml (p = 0.014) were related to AKI occurrence. The Mehran score may be used as a predictor of AKI occurrence (p = 0.022). The SCr > 1.5 mg/dL and eGFR < 60 ml/min/1.73 m2 were not statistically significant. Selective renal embolization (mean 34% loss of renal tissue) does not lead to AKI. CONCLUSIONS: Hypotension, anemia requiring blood transfusion, and administration of CM exceeding 150 ml poses higher risk of AKI development, which leads to longer hospital stay and need of dialysis. The Mehran score may be used as predictor of AKI occurrence. Up to one third of the kidney was embolized with no AKI linked to the procedure. The concern of AKI occurrence should not be a cause of delay of endovascular treatment.

[A case of kidney and ureter tuberculosis causing diagnostic difficulties]. / Przypadek gruzlicy nerki i moczowodu sprawiajacy trudnosci diagnostyczne.

A case is presented of tuberculosis of the kidney and ureter with negative bacteriological examination, suspected of malignant tumour. The diagnosis was based on histological examination of ureteral specimen taken intraoperatively.

[The results of treatment of chronic prostatitis on the background of anaerobic bacterial and fungal infections]. / Wyniki leczenia prostatitis chronica na tle zakazen bakteriami beztlenowymi i grzybami.

More than 25% of patients who declare indisposition of the urinary tract suffer from prostate infection. Progress in the medical treatment of this type of infection has been achieved largely due to the introduction of new sorts of antibiotics and development of modern diagnostic methods. The aim of the study is to determine the causes of prostate infections. A bacteriological examination of the prostate secretion in 28 patients after "per rectum" massage were conducted in the Urology Clinic of the Central Clinical Hospital of Military Academy in Warsaw from March 1995 to September 1997. All the patients had previously undergone medical treatment and long-term pharmacotherapy. A high percentage of fungal infections as well as the increased occurrence of Chlamydia trachomatis have been observed.

[Finasteride in the treatment of benign prostatic hyperplasia]. / Finasterid in der Behandlung der benignen Prostatahyperplasie.

BACKGROUND: Benign prostatic hyperplasia (BPH) is one of the most common urinary disorders in elderly men. The symptoms of this disease are increased prostate size, bladder outlet obstruction and lower urinary tract disorders. It influences bladder infections, bladder stone formation and increases the risk of urinary retention which can cause renal failure. It is necessary for the disease to be treated operatively. The number of conducted surgical interventions for pharmacotherapy has been significantly reduced in recent years due to increased efficacy in conservative therapy including combined treatment mostly with two groups of drugs: finasteride and alpha-blockers with different pharmacological activities. The aim of the study was to evaluate finasteride efficacy in the treatment of benign prostatic hyperplasia. MATERIALS AND METHODS: The clinical trial was conducted from October 2008 to November 2009. According to the urologist's recommendation the patients took finasteride at a dose of 5 mg daily. A total of 4,315 patients participated in the clinical trial and were enrolled in 50 urological centres in Poland. The average age of the patients was 66.5 years, the youngest patient was 46 and the oldest was 91 (median 67.00 years, standard deviation SD±8.101). The use of finasteride at least for 2 weeks was the criterion for the patient to be included in the study. The medical trial lasted 12 months and consisted of 6 visits at which data relating to IPSS, QoL, intensification of urinary system symptoms, the results of the additional studies, PSA serum concentrations, the urinary tract USG with evaluation of residual urine and prostate, urine analysis with evaluation of crystalline, uroflowmetry, transrectal ultrasonography (TRUS) and biopsy were recorded. The study did not exclude the combined treatment with finasteride and alpha-adrenergic blocking drugs. RESULTS: Prostatocystitis was diagnosed in 30 men among the patients treated at the first visit after the digital rectal examination (DRE) trial and they qualified for antibiotic therapy. Suspicion of a tumor was diagnosed in 69 (1.59 %) patients of the study group at the first visit after the DRE trial and they qualified for biopsy of the prostate after the PSA trial and TRUS at the second visit. Therefore, 4,216 patients took part in the clinical trial. In the course of 12 months 392 patients were excuded from the study for different reasons: cardiac infarct, apoplexy, resignation without reason and change of address. According to the IPSS scale (International Prostate Symptom Score) a small intensification of symptoms was diagnosed in 676 patients (16%), in 2,830 patients (67%) moderate and in 718 patients (17 %) considerable. Prostate cancer was confirmed histopathologically in 50 (1.15%) out of 69 patients who qualified for biopsy of the prostate. In 2,677 (70%) patients taking both alpha-blocker and finasteride, the progression of disease reduced, the micturation improved considerably and the mass of adenoma of the prostate diminished by 40%. However, in 956 (25%) patients taking only finasteride or finasteride + phytotherapy the mass of adenoma of the prostate diminished by 40%, too. When the medical trial was finished, 212 patients (5.02 %) of the study group who showed intensive symptoms of BPH and the finasteride and alfa-blocker treatment proved not to be effective enough qualified for surgical therapy. A total of 3,824 out of 4,216 (90.7%) patients finished the medical trial and 3,612 (85.6 %) were willing to continue the further therapy.

Assessment of the cytotoxicity of aluminium oxide nanoparticles on selected mammalian cells.

The rapid development of nanotechnology raises both enthusiasm and anxiety among researchers, which is related to the safety use of the manufactured materials. Thus, the aim of this study was to investigate the effect of aluminium oxide nanoparticles on the viability of selected mammalian cells in vitro. The aluminium oxide nanoparticles were characterised using SEM and BET analyses. Based on Zeta (ζ) potential measurements and particle size distribution, the tested suspensions of aluminium oxide nanoparticles in water and nutrient solutions with or without FBS were classified as unstable. Cell viability, the degree of apoptosis induction and nanoparticles internalization into the cells were assessed after 24 h of cell exposure to Al2O3 nanoparticles. Our results confirm the ability of aluminium oxide nanoparticles to penetrate through the membranes of L929 and BJ cells. Despite this, there was no significant increase in apoptosis or decrease in cell viability observed, suggesting that aluminium oxide nanoparticles in the tested range of concentrations has no cytotoxic effects on the selected mammalian cells.