Research progress of immune vaccines in the prevention of recurrent urinary tract infections / 中华泌尿外科杂志

Urinary tract infection (UTI) is one of the most common infectious diseases. It has the characteristics of high recurrence rate and prolonged course. At present, the problem of antibiotic resistance is becoming more and more serious, the incidence of adverse reactions is high, and the disadvantages of long-term administration appear, which brings severe challenges to the treatment of recurrent urinary tract infection. The prevention and treatment of UTI recurrence has become the focus of research. Recurrent urinary tract infection is related to the immune regulation mechanism of the body. Administration of immune regulation can provide new ideas for prevention and treatment. The vaccine based on immune regulation to prevent rUTI has made some progress. It can not only reduce the frequency of recurrences, but also decrease related symptoms. At the same time, the vaccine has good tolerance, high safety and good application prospect. This paper aims to summarize the progress of immune regulation and immune vaccines in vivo and clinical research.

Treatment of Uncomplicated Recurrent Urinary Tract Infection with Chinese Medicine Formula: A Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate Chinese medicine (CM) formula Bazheng Powder () as an alternative therapeutic option for female patients with recurrent urinary tract infection (RUTI).@*METHODS@#A randomized double-blinded trial was performed. Eligible female patients with RUTI were recruited from one hospital and two community health centers. By using a blocked randomization scheme, participants were randomized to receive a CM formula (10 herbs) for 4 weeks or antibiotics for 1 week, followed by 3 weeks of placebo. Clinical cure rate and microbiological cure and recurrence after treatment were evaluated.@*RESULTS@#A total 122 eligible patients were enrolled, with 61 cases in each group. The clinical cure rate by the intentto- treatment approach was 90.2% for the CM group and 82.0% for the antibiotics group (P>0.05). Bacteria were cleared from 88.5% (54/61) of patients in the CM group and 82.0% (50/61) in the antibiotics group. The recurrence rate in recovered patients at the 6-month follow-up was 9.1% (5/61) and 14.0 (7/61) in the CM and antibiotics groups, respectively (P>0.05).@*CONCLUSION@#CM formula Bazheng Powder is a good alternative option for RUTI treatment. (Registration No. NCT01745328).

Successful Treatment with Choreito for Recurrent Urinary Tract Infection Treated with Modern Medicine / 日本東洋医学雑誌

Urinary tract infection (UTI) is a common disease, and administration of antibiotics should be the first choice for UTI. However, it often recurs, and recurrent UTI is generally treated with antibiotics. Many reports describe the use of choreito for the treatment of lower urinary tract symptoms and ureteral stones, but only a few reports are dedicated to the treatment of recurrent UTI with choreito. An 84-year-old woman had a UTI that recurred 4 times, and every time she was hospitalized. Although we treated her condition with an antibiotic and α 1-blocker for neurogenic bladder, and provided her home-care advice, her UTI recurred 4 times. Thus, we gave her choreito, which successfully treated her recurrent UTI. Before the treatment, she was hospitalized 4 times within 2 months. However, in the recent 7 months after the treatment with choreito, she did not need to be hospitalized. She is currently visiting a hospital once every 2 months. The present case indicates that choreito is beneficial in terms of health economics.

Risk factors for recurrent urinary tract infection in children with neurogenic bladders treated by clean intermittent catheterization / 中华实用儿科临床杂志

Objective To identify the risk factors associated with recurrent urinary tract infection (RUTI) in children with neurogenic bladders (NB) who received clean intermittent catheterization (CIC) in order to provide recommendations for reducing the risk of RUTI.Methods Records of 184 children with NB managed by CIC at the Department of Urology Surgery,the First Affiliated Hospital of Zhengzhou University from July 2011 to September 2015 were reviewed and analyzed.According to UTI incidence,they were divided into 2 groups as occasional UTI group (0-1 time/year,OUTI group) and RUTI group (＞ 1 time/year).The clinical and urodynamic data were compared between 2 groups,and the risk factors were identified by regression analysis.Results Of the total patients,147 patients (79.9％) were diagnosed as OUTI and 37 cases (20.1％) as RUTI.Median follow-up lasted for average 27 months (12-39 months).The characteristics of RUTI group was indicated significantly in the study,which included increasing age(7.4 years old vs.5.9 years old),a higher level of spinal lesions,and more vesicoureteral reflux(VUR),and there were significant differences in bladder wall thickness(4.7 cm vs.3.6 cm) and lower bladder compliance compared with RUTI group (all P ＜ 0.05).But there was no statistical significance in gender,antibiotics,hydronephrosis,incontinence,bladder capacity,detrusor overactivity,detrusor sphincter dyssynergia and detrusor leakage point pressure between 2 groups (all P ＞ 0.05).Increasing age,increased bladder wall thickness,lower bladder com-pliance and the presence of VUR were independent risk factors associated with RUTI group (all P ＜ 0.05).Conclusions Increasing age,increasing bladder wall thickness,lower bladder compliance and VUR are the risk factors for RUTI in NB children managed with CIC.It is necessary to follow up video-urodynamic and ultrasound findings in order to identify the high-risk patients and provide the evidence for preventing RUTI.

Voiding pattern of toilet-trained Filipino children with recurrent urinary tract infection and without urinary tract infection

OBJECTIVES@#The objectives of this study were to compare the voiding pattern of toilet-trained patientswith and without recurrent UTI, to describe the voiding pattern of toilet-trained patients withoutUTI aged 2 to 15 years old and to describe the voiding pattern of toilet trained patients with recurrentUTI aged 2 to 15 years old.@*MATERIALS AND METHODS@#A total of 80 toilet-trained Filipino children divided into two groups with 40each were included. R-UTI group consisted of patients aged 2 to 15 years old who presented withrecurrent UTI. The control (No-UTI) group consisted of children aged 2 to 15 years old without anyurinary symptoms and without history of urinary tract infection. Parents completed a 72-hour bladderchart at home. All participants answered Farhat's DVSS. Patients underwent uroflowmetry,uroflowmetry with EMG and post void residual assessment (PVR). Qmax, uroflowmetry pattern,bladder wall thickness and PVR were recorded and analyzed using independent t-test.@*RESULTS@#The mean age of subjects with UTI was 6.32 ± 2.77 years and those in the control group havea mean age 6.67 ± 2.77 years old. Of patients of R-UTI group the following were statisticallysignificant compared to No-UTI : Constipation (48% vs 15%), mean frequency of voiding volumesgreater than 125% of the estimated bladder capacity (EBC) at daytime (0.8 ± 0.22 vs 0.05 ± 1.20p=0.0002), frequency (45% vs 5%), mean average voided volume (126.54 ± 56.05 mL vs 84.34 ±34.26 mL p=0.0001), mean daytime average voided volume (121.33 ± 59.59 mL vs 87.90 ± 36.41mL p =0.0033), mean maximum voided volume (232.25 ± 113.99 mL vs 130.85 ± 49.99 mLp<0.0001), mean bladder thickness (3.83 ± 0.68 mm vs 3.38 ± 0.62 mm p = 0.0030), mean PVR(12.96 ± 10.54 mL vs 5.21 ± 5.68 mL p=0.0001). PVR was significant in 45% of cases compared to3% significant PVR (when 4-6 years old defined as >10ml or >10%of EBC, and if >7 years old >20mlor >15% of EBC). When mean PVR was computed as percentage of EBC, R-UTI group had astatistically higher percentage compared to the no-UTI group (6.27 ± 2.52 % vs 2.52 ± 2.75 %p=0.0001). Mean observed bladder capacity (OBC) was found to be more than the EBC in 35% ofcases in the R-UTI group compared to 12% of No-UTI group (p=0.018). Uroflow-EMG in the R-UTI group were, 85% synergic, 12% dyssynergic and 3% interrupted pattern. EMG in the No-UTIgroup were, 38% synergic, 55% dyssynergic, 2% delayed relaxation, 5% interrupted. The EMGpatterns were statistically significant between the groups (p<0.0001). Uroflow patterns werecomparable between the two groups (p=1.000).@*CONCLUSION@#Constipation was more frequent in the R-UTI group. R-UTI group had a higher meanfrequency of EBC > 125% during daytime, frequency, mean average voided volume, mean averagevoided volume during daytime, mean maximum voided volume, mean bladder thickness, mean PVRcompared to the without UTI group. Mean observed bladder capacity was observed to be greater thanthe EBC in the R-UTI group compared to the No-UTI group. R-UTI group was synergic compared toNo-UTI group which were dyssynergic.

Acupuncture points used in the prophylaxis against recurrent uncomplicated cystitis, patterns identified and their possible relationship to physiological measurements / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the correlation between single acupoints used and the recurrence rate of cystitis among cystitis-prone women receiving acupuncture as a prophylactic treatment.</p><p><b>METHODS</b>In all, 58 cystitis-prone women were included in the analysis. Customised acupuncture treatments were given twice a week, over 4 weeks. The main effect parameter was the number of cystitis episodes during the 6-month observation time. Residual urine was measured at baseline, 2, 4 and 6 months using portable ultrasound equipment. Sympathetic and vagotone nerve activities were measured by using skin conductance and respiratory sinus arrhythmia, respectively.</p><p><b>RESULTS</b>The main acupoints used for patients with Kidney (Shen) qi/yang deficiency were Shenshu (BL23), Taixi (KI3), Zhongji (CV3), Sanyinjiao (SP6) and Pangguangshu (BL28), compared with Taichong (LR3), CV3, BL28, Yinlingquan (SP9) and SP6 for Liver (Gan) qi stagnation, and SP6, CV3, BL28, Zusanli (ST36) and SP9 for Spleen (Pi) qi/yang deficiency patients. The combination BL23 and KI3 were used in 16 women, 13 of which were Kidney pattern related patients. When used, the number of symptomatic episodes were reduced to a third compared with what occurred in the 42 women where this combination was not used (3/16 vs. 28/42, P<0.05). BL23 application correlated to a significant reduction in residual urine measured a few days after treatment. Patients with the pattern of Spleen qi/yang deficiency had an initial increase in residual urine after treatments.</p><p><b>CONCLUSION</b>Treating Kidney pattern related patients with the combination of BL23 and KI3 resulted in far better outcome than other points/combination of points for other Chinese medicine diagnoses. The acupoint SP6 may be less indicated than previously assumed when treating cystitis-prone women prophylactically.</p>

Research on diminishing scheme of cefaclor sustained release tablets in the treatment of recurrent urinary tract infection / 中国感染控制杂志

Objective To explore the efficacy and adverse reactions of diminishing scheme of cefaclor sustained re-lease tablets in the treatment of recurrent urinary tract infection(RUTI).Methods 60 RUTI patients in a hospital were divided into treatment group(n=30)and control group (n=30),patients in treatment group were treated with diminishing scheme of cefaclor sustained release tablets,patients in control group were treated with diminishing scheme of levofloxacin tablets,clinical therapeutic efficacy and adverse reactions of two groups were observed. Results The curative rate in treatment group was higher than control group ([80.00%,n =24]vs [53.33%,n =16])(χ2 =4.80,P =0.028).The incidence of RUTI in treatment group was lower than control group ([6.67%,n=2]vs [26.67%,n=8])(χ2 =4.32,P =0.038).Incidence of adverse reactions in treatment group was lower than control group (16.67% vs 50.00%)(χ2 =7.50,P =0.006).Conclusion The diminishing scheme of cefaclor sus-tained release tablets in the treatment of RUTI has good curative efficacy,low recurrence rate,fewer adverse reac-tions,and can be used for the treatment of recurrence of RUTI.

Infeccion urinaria recurrente y situaciones especiales / Recurrent urinary tract infection and special situation

En el estudio de la infección urinaria inicial y recurrente es fundamental el descarte de malformaciones nefrourológicas. Sin embargo, nuevos paradigmas señalan que deben tomarse en cuenta, en especial en las recurrencias, diversos factores de riesgo, tales como, la virulencia bacteriana, patrones de resistencia a antibióticos, alteraciones metabólicas, trastornos de la eliminación, el papel de la inmunidad innata y la respuesta inflamatoria; todo ello puede conllevar a situaciones particulares como bacteriuria asintomática e infecciones urinarias recurrentes. Estos casos ameritan conductas y tratamientos individualizados a cada situación especial

In patients with initial and recurrent urinary tract infection it is essential to exclude nephrourologic malformations. However, new paradigms consider especially recurrences, several risk factors such as bacterial virulence, antibiotic resistance patterns, metabolic disorders, elimination disorders and the role of innate immunity and inflammatory renponse; all of these factors can lead to situations such as asymptomatic bacteriuria and recurrent urinary tract infections. These cases deserve individualized treatment in each unique situation

Recurrent urinary tract infections: evaluation of the prophylactic efficacy of urinary antiseptics methenamine and methylthioninium chloride / Infecções do trato urinário recorrentes: avaliação da eficácia profilática dos anti-sépticos urinários metenamina e cloreto de metiltionínio

Introduction: Urinary tract infection (UTI) is a very common condition in clinical practice, affecting an estimated 50% of all adult women during a lifetime. The most common causative agent is E. coli UTI may also be caused by S. saprophyticus, Enterobacteria (Klebsiella sp and Serratia sp.), Enterococcus sp., and P. aeruginosa. Recurrent UTIs occur at least twice per semester or three times a year. Prophylactic measures to prevent recurrent UTIs include changes in contraception methods, cranberry products, increased fluid intake, urination after intercourse, vaginal estrogen therapy for post-menopausal women, antibiotics, and urinary tract antiseptic agents. Objectives: To evaluate the use of a combination of methenamine and methylthioninium chloride in the prophylaxis of recurrent uncomplicated lower UTIs, with respect to: · Signs and symptoms of UTI· Etiologic agent(s)· Recurrence rates· Need for antibiotic therapy in case of recurrence · Incidence of adverse events associated with the treatment, including any reported alterations of laboratory testsMaterials & methods: A descriptive, analytic, restrospective study was performed at Hospital Universitário Constantino Otaviano - UNIFESO. Medical charts from patients presenting recurrent uncomplicated lower UTI attended from 2001-present were analyzed, including the following information: Demographic data (age, gender, weight, ethnicity, living conditions) medical history/ signs and symptoms of UTI identification of treatment and dosing regimens treatment duration recurrence rates and need for antibiotic therapy in case of recurrence other medications prescribed and records of adverse events. Results: E. coli was identified as etiologic agent in 80% of the patients. Following antibiotic therapy, all patients received prophylactic treatment with the combination of methenamine and methylthioninium chloride. Treatment duration ranged from three to six months. Adverse events were observed in 13/60 patients...

Introdução: A infecção do trato urinário é bastante comum na prática clínica, afetando aproximadamente 50% de todas as mulheres adultas em algum momento da vida. O agente etiológico mais comum é a E. coli. A ITU pode também ser causada por S. saprophyticus, Enterobactérias (Klebsiella sp. e Serratia sp.), Enterococcus sp. e P. aeruginosa. ITUs recorrentes ocorrem ao menos duas vezes por semestre ou três vezes ao ano. Medidas profiláticas para prevenir a recorrência incluem alterações nos métodos contraceptivos, produtos de oxicoco, aumento da ingestão de fluidos, micção após a relação sexual, e terapia vaginal de estrogênio para mulheres em pós-menopausa, bem como antibióticos e anti-sépticos urinários. Objetivos: Avaliar o uso da combinação de de metentamina e cloreto de metiltionínio na profilaxia de ITUs recorrentes não-complicados, com respeito à: · Sinais e sintomas de ITU · Agente etiológico · Número de recorrências · Necessidade de terapia antibiótica em caso de recorrência · Incidência de efeitos adversos do tratamento, inclusive quaisquer alterações de exames laboratoriais. Materiais e métodos: Foi realizado um estudo descritivo, analítico, retrospectivo no Hospital Universitário Constantino Otaviano – UNIFESO. Prontuários médicos disponíveis de pacientes apresentando ITU recorrente não complicada, atendidos de 2001-presente foram analisados, incluindo-se as seguintes informações: dados demográficos (idade, sexo, peso, etnia, condições habitacionais) histórico médico/ sinais e sintomas de ITU identificação do tratamento e regime de tratamento recorrência necessidade de tratamento antibiótico no caso de recorrência outros medicamentos prescritos e registro de efeitos adversos. Resultados: E. coli foi identificado como agente etiológico em 80% dos pacientes. Após terapia antibiótica, todos os pacientes receberam tratamento profilático com a combinação de metenamina e cloreto de metiltionínio. A duração do tratamento variou entre três a seis meses...

Recurrence and Follow-up after Urinary Tract Infection

PURPOSE: Urinary tract infection(UTI) is the most common bacterial infectious disease that may induce severe renal injury unless early diagnosis and appropriate treatment are performed. If recurrent UTI is prevented, renal injury can be also reduced. Therefore, we studied the risk factors of recurrent UTI in children. METHODS: We performed a retrospective study of 168 children(58 girls and 110 boys) who were treated for UTI in the Department of Pediatrics, Korea University Medical Center, during 2000-2001. Among 168 children, 93 children were followed up for more than six months. For the detection of recurrence of UTI, we performed monthly routine urine cultures and physical examinations. RESULTS: The total rate of recurrence was 32.3%. The recurrent rate in boys and girls were 37.1% and 17.4%, respectively(P<0.05). The most common causative bacteria in the first onset and in recurrence were Escherichia coli. There was a significant difference in the onset age of UTI between boys with recurrence(4.8+/-1.0 months) and without recurrence(16.5+/-3.8 months)(P<0.01). In 77% of cases, urinary tract infection recurred within six months of the first infection. The time of the first recurrence after UTI was 3.7+/-0.6 months in boys and 14+/-8.2 months in girls(P<0.01). The number of recurrences showed a significant difference between the group under the age of one year(0.69+/-0.8/year) and those above the age of one year(0.16+/-0.4/year)(P<0.05). There was no difference in the recurrent rate between those with structural abnormality and those with normal anatomy. CONCLUSION: Monthly routine urine cultures are efficient in detecting recurrent UTI in children. Because the male sex and young age especially less than one year of age are risk factors for increased recurrence rate of UTI, these children should be followed-up with urine cultures.