Alternativas aos antibióticos na profilaxia das infecções urinárias recorrentes não complicadas na mulher / Alternatives to antibiotics in the prophylaxis of recurrent uncomplicated infections in women

A infecção do trato urinário (ITU) é a doença bacteriana mais comum no sexo feminino, e cerca de 25% a 30% das mulheres apresentam ITUs recorrentes ao longo da vida. Os antibióticos são muito utilizados para o tratamento e prevenção dessas infecções. Entretanto, o uso excessivo e indevido desses medicamentos, além dos efeitos adversos, está relacionado ao surgimento de uropatógenos multirresistentes. Há um interesse crescente na comunidade científica para encontrar alternativas ao uso de antibióticos para tratamento e/ou prevenção das infecções bacterianas. Esta revisão tem por objetivo discutir algumas dessas alternativas.(AU)

Urinary tract infection (UTI) is the most common bacterial disease in females, and about 25% to 30% of women experience recurrent UTIs throughout their lives. Antibiotics are widely used standard for treating and preventing these infections. However, the excessive and improper use of these drugs, in addition to the adverse effects, is related to the emergence of multidrug-resistant uropathogens. There is a growing interest in the scientific community to find alternatives to the use of antibiotics for the treatment and/or prevention of bacterial infections. This review aims to discuss some of these alternatives.(AU)

Intrauterine contraceptive device embedded in bladder wall with calculus formation removed successfully with open surgery

@#An Intrauterine contraceptive devices (IUCD) is commonly inserted by the primary health care physician. It can migrate into pelvic or abdominal organs. When a pregnancy occurs following an insertion of an IUCD, there should be a high suspicion of uterine perforation or possible migration. A radiograph can be done in the primary health care clinic to search for a missing IUCD. Early referral to the urology service is warranted when a patient presents with recurrent urinary tract infections. Removal of an intravesical IUCD can be managed with cystoscopy, laparoscopy or open surgery. Herein, we report a case of IUCD migration into the bladder. This case will highlight the importance of proper technique, careful insertion and the role of ultrasound.

Managing Recurrent Urinary Tract Infections in Primary Care - Can We Do Better?

A middle-aged lady was treated and followed up for recurrent urinary tract infections (UTI) with increasingly resistant organisms without documentation of interval resolution of infection by negative urine cultures. We discuss the events following the diagnosis of her fourth urinary tract infection. Referral for further evaluation of her urinary tract in view of recurrent UTI showed she had a bladder cancer. The investigation and management of recurrent UTI is reviewed. The link between bladder cancer and recurrent urinary tract infection is also explored.

Infección urinaria recurrente en la mujer / Recurrent urinary tract infection in women

Recurrent urinary tract infections (R-UTI) are common among women even though they generally have a normal urinary tract. Women with R-UTI have an increased susceptibility to vaginal colonization with uropathogens due to a greater propensity for them to adhere to their epithelial cells. Risk factors include frequent sexual intercourse, spermicide use, first UTI at an early age and maternal history of UTI. Prevention of recurrences can be done with low-dose continuous antimicrobial prophylaxis or with post-coital antimicrobial prophylaxis, a method that may be more efficient and acceptable. Estrogen replacement therapy using a vaginal administration in postmenopausal women is also effective in preventing R-UTI. The vaginal vaccine only diminishes percentage of women with Escherichia coli UTI. The oral vaccine reduces R-UTI with inferior results than antimicrobial prophylaxis; Cranberry intake shows some evidence in favor, although further trials are needed. Finally R-UTI can also be effectively managed with self-start antimicrobial therapy.

La infección urinaria recurrente (ITU-R) es común en mujeres que generalmente no presentan alteraciones del tracto urinario, pero que tienen una mayor predisposición a la colonización vaginal por uropa-tógenos que se adhieren más ávidamente a sus células epiteliales. Las relaciones sexuales frecuentes, el uso de espermicidas, el antecedente de ITU a corta edad y la historia materna de ITU son factores de riesgo. La prevención de la recurrencia puede hacerse con profilaxis antimicrobiana continua a dosis baja o post-coital. La terapia de reemplazo estrogénico en la mujer post-menopáusica es efectiva en prevenir ITU-R, recomendándose su uso vía vaginal. La vacuna vaginal sólo disminuye el porcentaje de pacientes con ITU por Escherichia coli; la vacuna oral disminuye las ITU-R aunque con resultados inferiores a la profilaxis antimicrobiana. La ingesta de arándano rojo muestra alguna evidencia a favor, aunque insuficiente. Finalmente, la ITU-R también puede manejarse con terapia antimicrobiana iniciada por la paciente.

Prospective trial on the effect of circumcision in boys less than 2 years with primary vesicoureteral reflux and recurrent urinary tract infection: A university medical center experience

Rationale: Vesicoureteral reflux (VUR) occurs in 30-50 percent of children with urinary tract infection (UTI). Although it does not cause bacteriuria, it facilitates transport of bacteria from the bladder to the upper tract and increases risk both for UTI and scarring and its sequelae. Antibiotics remain as the mainstay of prevention, yet 40 percent breakthrough infections still occurObjectives: This study was done to determine whether circumcision prevents recurrent UTI in boys less than 2 years old diagnosed with primary vesicoureteral reflux who are on standard prophylactic antibiotic and likewise correlate age, laterality and severity of reflux with UTI recurrenceMethods: This is a prospective cohort of 57 subjects selected by non randomized purposive sampling allocated to either group A (circumcised) or group B (uncirResults: Of 57 males, 25 (44 percent) were circumcised and 32 (56 percent) were uncircumcised. The mean age was 16 months (1 month - 24 months). Twenty-nine had unilateral reflux and 28 had bilateral reflux. Recurrent UTI was observed in 12 subjects in group B (37 percent) while only 2 subjects in group A (8 percent). Chi square analysis showed a significant association between recurrence and circumcision status (x2Conclusion: The role of circumcision seems to protect boys with VUR for it decreases the recurrence of UTI. It maybe considered as part of UTI therapy. (Author)