Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal women.

PURPOSE: We evaluated and compared the efficacy of post-intercourse and daily oral ciprofloxacin prophylaxis against recurrent lower urinary tract infections in 135 sexually active premenopausal women. MATERIALS AND METHODS: Post-intercourse (group 1, 70 patients) and daily (group 2, 65 patients) prophylactic regimens of 125 mg. ciprofloxacin were started following a curative, conventional treatment of the initial acute urinary tract infection. Prophylaxis was maintained for 12 months and during this period patients were followed clinically and bacteriologically with urine and introital samples. Patients were subsequently followed for an additional year after the end of preventive treatment. RESULTS: While 3.67 urinary tract infections per patient in group 1 and 3.74 in group 2 occurred during an identical mean time of 12.2 months before start of the corresponding prophylactic regimen, only 0.043 infection per patient in group 1 and 0.031 in group 2 developed during prophylaxis (p < 0.0001). Before prophylaxis 86% of the vaginal vestibule cultures yielded gram-negative Enterobacteriaceae, equally distributed between both treatment arms, compared to 5.6% and 2.5% during postcoital and daily prophylaxis, respectively. The overall improvement in the incidence of the urinary infections per patient and the rate of introital colonization with enteric gram-negative bacteria was maintained after the end of prophylaxis, with a mean incidence of infections of 0.44 per patient (occurring in 34% of the total patient population), while 36% of all women had abnormal introital colonization. CONCLUSIONS: Long-term post-intercourse prophylaxis with ciprofloxacin proved to be equally effective as daily prophylaxis, and the major advantage of the former therapy was use of only a third of the amount of drug consumed in daily prophylaxis.

A randomized, dose comparison study of cefodizime in the treatment of lower urinary tract infections in women.

In a prospective randomized study, the efficacy and safety of 1 and 2 g of cefodizime administered as single intramuscular injections were compared in a total of 50 women having either complicated or uncomplicated lower urinary tract infections (LUTI). Bacteriological culture of urine and safety laboratory tests were performed before and after treatment. 18/25 patients in the 1 g cefodizime group and 22/25 in the 2 g cefodizime group showed satisfactory clinical and bacteriological response to treatment. The inadequately treated patients all had complicating factors on entry to the study (residual urine in six cases, a bladder malignancy in two, neurogenic bladder and diabetes mellitus with glucosuria in one case each). Cefodizime proved efficacious in female patients with uncomplicated LUTI, as well as in those aged over 65 years, patients having mild renal insufficiency, mild glucosuria, unsuccessful oral antibiotic pretreatment or recurrent and postoperative infections. In no case were there any systemic adverse reactions to cefodizime or clinically significant changes in laboratory tests.

Single dose oral administration of cefixime 400mg in the treatment of acute uncomplicated cystitis and gonorrhoea.

A placebo-controlled prospective randomised double-blind study was performed in 80 consecutive female outpatients with acute cystitis. Single dose oral antibiotic treatment was successful in 89.4% of patients treated with cefixime 400mg or ofloxacin 200mg and in 84.2% of those receiving cotrimoxazole (160/800mg). Bacteriuria was eradicated in 26.3% of patients in the placebo group. Two noncomparative clinical trials involving a total of 43 male patients with acute gonococcal urethritis reported a 100% cure rate after administration of a single 400mg dose of cefixime. Such single dose regimens offer the advantages of reduced expense, good tolerability, minimal alteration of normal bacterial flora, and the potential for improved patient compliance, compared with multiple dose antibacterial therapy.

Aspects concerning posterior urethral valves.

Twenty-six boys were evaluated and treated for posterior urethral valves. At the time the valves were diagnosed unilateral or bilateral vesicoureteral reflux was present in 58% of the ureters and 69% of the children, while dilatation of the upper urinary tract was present in 88% and 92%, respectively. There was a variety of symptoms and signs, but the most prominent in neonates and infants were vesical urine retention, palpable kidneys and failure to thrive, whereas in the older children voiding dysfunction, incontinence and urinary infection were the most common. Twenty-four out of 26 boys were managed by primary valve ablation and in 62.5% of them this type of treatment was adequate in resolving or sufficiently improving clinical manifestations and roentgenologic findings, requiring no further management. Urinary diversion in the form of vesicostomy and cutaneous ureterostomy was preserved for those patients who did not improve with valve ablation alone. The current aspects concerning posterior urethral valves are also discussed.

Etiology of acute scrotum in 100 boys with regard to age distribution.

A review of 100 boys less than 15 years old who were hospitalized for an acute scrotum revealed that the most common causes of the disorder were testicular torsion, including torsion of the spermatic cord (42 per cent) and torsion of the appendages (32 per cent). The remaining 26 per cent of the cases were owing to idiopathic scrotal edema (8 per cent), epididymitis and orchitis (6 per cent each), and incarcerated hernia and acute hematocele (3 per cent each). The age distribution of these children was biphasic, with the highest frequency in newborns (with exclusively extravaginal torsion) and in boys 13 years old, whereas in boys with appendiceal torsion the single peak frequency was at age 10 years. While idiopathic scrotal edema occurred in children less than 7 years old and orchitis in patients more than 12 years old, epididymitis was observed in young boys and those of pubertal age.

The role of chlamydiae in epididymitis.

In 21 men suffering from acute or chronic epididymitis who underwent scrotal surgical exploration, diagnostic microbiological studies consisting in cultures of the epididymal tissues and mid-stream urine specimens, as well as examination of the urethral swabs--before and after prostatic massage--were performed. Laboratory tests revealed that 55 per cent of the patients younger than 40 years were infected by Chlamydia trachomatis, and 36 per cent by urinary tract bacteria. On the other hand, in only 10 per cent of the patients older than 40 years the causative organisms were Chlamydiae, whereas in 70 per cent the common urinary tract bacteriae were the agents of epididymal infection. The aforementioned microbiological examinations were proved to be reliable in demonstrating the causative bacteria for epididymitis.

Vesical diverticula: etiology, diagnosis, tumorigenesis, and treatment. Analysis of 74 cases.

A thirteen-year review of bladder diverticula was undertaken and 74 cases were identified. In 8 patients primary neoplasms arose in the diverticula, and their treatment included diverticulectomy or partial cystectomy with or without postoperative irradiation, irradiation only, and transurethral resection of the tumor combined with fulguration of the diverticular wall and postoperative bladder instillations with doxorubicin or thiotepa solutions. Early diagnosis with additional visualization of the interior of vesical diverticulum is mandatory, since carcinoma arising in it has a poor prognosis.

Rubinstein-Taybi syndrome.

Rubinstein-Taybi (broad thumb and big toe) syndrome, is characterized by mental and motor retardation and skeletal deformities of which broad thumb and large first toe are the most obvious. In addition, defects of the cardiovascular system and the urinary tract may be present. A case of Rubinstein-Taybi syndrome in a boy is presented.

Epididymitis: aspects concerning etiology and treatment.

Extended microbiological studies were performed on 49 patients with acute or chronic epididymitis, including bacteriology of epididymal specimens in cases of scrotal surgery. In no patient had instrumentation or catheterization resulted in epididymitis. The microbiological data showed a prevalence of Chlamydia trachomatis epididymal infections in men less than 40 years old, whereas common urinary tract pathogens prevailed in older patients. Cultures of urethral swabs and midstream urine provided reliable information on the type of microorganism that caused epididymitis. Ofloxacin, an antibiotic of the new quinolone group, was proved to be highly effective in the treatment of acute and chronic bacterial as well as chlamydial epididymitis.

Penile duplication.

We report on a case of penile duplication in an eight-year-old boy. While diphallia was incomplete, there was a common root of the penis which divided into two shafts of different size, doubling in frontal plane. Only one urethra left the bladder along the lower and smaller penile shaft and ended with a hypospadiac meatus. After surgical plastic repair, the patient had a good functional and cosmetic result. In addition, this patient had a horseshoe kidney.

Clinical evaluation of temocillin in urinary tract infections.

A group of 27 female and 2 male urological patients, aged 19 to 80 years (mean 44 years), were treated with intravenous temocillin 500 mg twice daily for 5 to 7 days. The diagnoses were acute pyelonephritis (n = 20), acute cystitis (n = 6), and acute cystitis and pyelonephritis combined (3). The causative organisms were Escherichia coli (n = 20). Proteus species (n = 9). Klebsiella species (n = 4). Streptococcus faecalis (n = 2). Staphylococcus epidermidis (n = 1), and Providencia stuartii (n = 1). 27 of the 29 patients (93%) were clinically and bacteriologically cured; bacteriuria persisted in 2 patients with prolonged obstructive uropathy. In acute non-obstructive pyelonephritis, the urinary excretion of beta-2-microglobulin rapidly decreased, documenting a prompt renal tubular restitution during therapy. The drug was well tolerated and proved very safe with regard to haematological, hepatic and renal parameters. Also, Candida haemagglutination titres did not increase significantly during therapy. Temocillin therapy should preferably be commenced after the results of the urine culture are available.

Idiopathic gangrene (Fournier) of the male external genitalia, with report of a case and review of the literature.

Fournier's gangrene, originally described by Fournier in 1883, is a rare and unusual ischaemic necrosis of the male external genitalia. Reports on the idiopathic penile and/or scrotal gangrene are relatively rare in newer publications. The aetiology of the disease which is characterized by a sudden onset, most commonly without prodromal symptoms, is still not fully understood. There is strong evidence, however, that Fournier's gangrene is a specific infection due to Streptococcus haemolyticus, group A, and/or anaerobic Streptococci. Presenting a case of our own, we take the opportunity to discuss the pathogenesis, pathomorphology, bacteriology and treatment of the disease.

["Milk-of-calcium" renal cyst (author's transl)]. / Intrarenale "Kalkmilch-Zyste".

In milk-of-calcium renal cysts a suspension of fine calcific sediment is contained in a pyelogenic cyst. This very rare condition may be misinterpreted as solid renal calculi. The true roentgenologic diagnosis is established by films taken with the patient upright or sitting: the calcific material gravitating to the bottom of the cyst results in the characteristic half-moon contour.

[Priapism in childhood (author's transl)]. / Priapismus im Kindesalter. Atiologie, Therapie, Fallbericht.

Priapism is a very rare problem in childhood. Although sickle cell disease and leukemia may produce persistent erection, juvenile priapism is most commonly idiopathic. The physiology and pathology of erection are reviewed, and the pathomechanisms of diseases which may produce priapism are described. If red cell sickling and leukemia are excluded, immediate surgical intervention by either corporosaphenous or corporospongiosum shunts is recommended for resolution of priapism and preservation of potency. A case of juvenile priapism is presented in which HCG medication as underlying factor is discussed.

The effect of in situ isolated perfusion of experimental renal tumors with cytotoxic agents in high concentration.

In animal experiments the possibility of increasing the dosage of anticancer drugs by isolated in situ tumor perfusion without incurring systemic toxicity was studied. Isolated perfusion of normal kidneys with tris-ethylenimino-benzochinon (triaziquon, Trenimon) and amethopterin (Methotrexate) demonstrated that the kidney tolerates far higher antitumor drug concentrations than are achieved by systemic anticancer chemotherapy. Renal function, which was evaluated before and after cytotoxic perfusion by means of renal functional scintigraphy, decreased by less than 15%. Each kidney was examined histologically after perfusion. Isolated cytotoxic perfusion of renal tumors (Walker carcinosarcoma 256) using the combination of Trenimon (0.034 microgram/ml) and Methotrexate (0.034 mg/ml) led to complete tumor regression. Tumor perfusion without cytotoxic agents and systemic intravenous administration of the LD50 of the anticancer drugs did not achieve tumor control.