ABSTRACT
BACKGROUND: Urinary tract infections are among the most common indications for antibiotic therapy. The emergence of resistant uropathogens indicates the need for treatment alternatives. Replenishment of the glycosaminoglycan layer of the bladder, achieved by intravesical instillation of e.g. chondroitin sulphate (CS), is described to be a cornerstone in the therapy of cystitis. To retrospectively evaluate the efficacy of a therapy with 0.2% CS in patients suffering recurrent urinary tract infections (rUTI) in comparison to a treatment with low-dose long-term antibiotics (LDLTAB) and a combination of both. METHODS: A total of 151 patients with recurrent UTI who underwent intravesical therapy at Diaconesse hospital in Leiden, The Netherlands were included. 50 patients had been treated with CS, 51 patients had received LDLTAB, and 50 patients had received a combination therapy (LDLTABCS). Data recorded for baseline, after 6, and 12 months of treatment were evaluated. Descriptive statistics were calculated. Exploratory comparisons between groups and within groups were performed by using one-tailed and paired t-tests. Patients filled in a standardized quality of life questionnaire (EQ-5D). RESULTS: We found a statistically significant reduction of number of infections from 7.10 ± 0.50 SEM to 0.45 ± 0.07 SEM after 12 months therapy with CS compared to 12 months therapy with LDLTAB (from 7.04 ± 0.47 SEM to 1.8 ± 0.15 SEM). The number of visits to the urologist significantly decreased in the CS group from 7.46 ± 0.80 SEM to 1.28 ± 0.11 SEM and from 4.10 ± 0.29 SEM to 1.35 ± 0.11 SEM in the LDLTABCS group. In addition, a significant increase in Quality of life (QoL) was seen in the CS-group (from 58.2 ± 0.82 SEM to 80.43 ± 0.82 SEM) and in the LDLTABCS group (from 62.4 ± 0.97 SEM to 76.73 ± 1.06 SEM). There was no improvement in QoL with LDLTAB (from 58.24 ± 1.08 SEM to 58.96 ± 1.19 SEM). Evaluation's evidence is limited due to its retrospective character. CONCLUSIONS: Retrospective analysis of data from patients that underwent therapy for rUTIs confirms the safety and efficacy of CS and indicate a superiority to antibiotic treatment of rUTIs.
Subject(s)
Cystitis , Urinary Tract Infections , Humans , Chondroitin Sulfates , Quality of Life , Retrospective Studies , Urinary Tract Infections/drug therapy , Anti-Bacterial AgentsABSTRACT
PURPOSE: We evaluated the efficacy and safety of 2 oral doses of desmopressin compared to 20 micrograms. nasal spray and baseline values in the treatment of primary nocturnal enuresis. MATERIALS AND METHODS: A multicenter study was done comparing oral dosages (200 and 400 micrograms.) of desmopressin (4-week, randomized, double-blind phase followed by 12 weeks of open label treatment with 400 micrograms.) to 20 micrograms. nasal spray in 66 adults and adolescents 12 to 45 years old with primary nocturnal enuresis. RESULTS: No significant differences were found between the 2 doses of desmopressin tablets or between the tablets and 20 micrograms. nasal spray during the double-blind phase. However, patients who initially received 200 micrograms. desmopressin tablets experienced fewer wet nights after they completed 12 weeks of open label treatment when the dose was escalated to 400 micrograms. tablets. Those who received 400 micrograms. tablets initially maintained response during this phase. Desmopressin tablets were well tolerated at both dose levels: 96% of patients and 94% of physicians rated the tolerability as excellent. CONCLUSIONS: Desmopressin tablets are an effective and safe alternative for treatment of nocturnal enuresis.
Subject(s)
Deamino Arginine Vasopressin/administration & dosage , Enuresis/drug therapy , Renal Agents/administration & dosage , Administration, Intranasal , Administration, Oral , Adolescent , Adult , Child , Deamino Arginine Vasopressin/adverse effects , Double-Blind Method , Female , Humans , Male , Middle Aged , Renal Agents/adverse effectsABSTRACT
Since the selection criteria for renal transplantation have become less stringent as a consequence of improved graft survival and decreased mortality, patients with severe structural anomalies of the lower urinary tract can now benefit from renal transplantation into an ileal conduit. This is illustrated by two succesful cases. The opertative procedure is discussed, and the possibilities for the future are mentioned.
