ABSTRACT
In this review article, the authors describe all relevant aspects of the new S2k guideline from the German Society of Urology (Deutschen Gesellschaft für Urologie, DGU) for the diagnosis and treatment of IC/PBS (interstitial cystitis/painful bladder syndrome). A list of necessary and optional examinations and the necessity of diagnosis of exclusion are summarized and evaluated. The treatment options listed (ranging from conservative, oral drug, and complementary medicine to interventional surgical procedures) also give the reader a good overview of the contents of the guideline and possible therapeutic approaches. Finally, the recommendations including consensus of the guideline group are also summarized in various information boxes.
Subject(s)
Cystitis, Interstitial/diagnosis , Cystitis, Interstitial/therapy , Practice Guidelines as Topic , Urology/standards , Germany , Humans , Pain , Physical Examination , Societies, MedicalABSTRACT
INTRODUCTION: This study aims to compare the efficacy of propiverine hydrochloride immediate release (IR), propiverine hydrochloride extended release (ER) and placebo for the treatment of overactive bladder syndrome. The primary outcome measure is incontinence episode frequency, with secondary outcome measures including mean volume per void and quality of life as assessed on King's Health Questionnaire. MATERIAL AND METHODS: The double-blind, double-dummy, randomized study compared IR 15 mg twice daily, ER 30 mg once daily and placebo in 3 parallel groups. After a run-in period of 7 days, the patients were treated for 32 days. Nine hundred and eighty-eight patients were randomized, and 910 patients completed the protocol without major violations. RESULTS: The number of incontinence episodes/24 h decreased by 2.26 in the IR group (p < 0.001 vs. placebo), by 2.46 in the ER group (p < 0.0001 vs. placebo) and by 1.75 in the placebo group. The most frequent adverse event was dry mouth with 22.8% of the patients in the IR group, 21.7% in the ER group and 6.4% in the placebo group. The overall tolerability was rated 'very good' or 'good' by more than 80% of the investigators and patients in all 3 groups. CONCLUSIONS: Propiverine ER 30 mg once daily and propiverine IR 15 mg twice daily significantly reduce the number of incontinence episodes/24 h within a treatment period of 32 days. Both formulations are safe and well tolerated. The extended release formulation of propiverine is a suitable new option for the treatment of the overactive bladder.
Subject(s)
Benzilates/therapeutic use , Cholinergic Antagonists/therapeutic use , Urinary Bladder, Overactive/drug therapy , Benzilates/administration & dosage , Calcium Channel Blockers , Cholinergic Antagonists/administration & dosage , Delayed-Action Preparations , Dose-Response Relationship, Drug , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Urinary Bladder, Overactive/physiopathology , Urodynamics/drug effectsABSTRACT
Diverticular disease of the female urethra is rare, but not so rare as assumed hitherto. The predominant theory is that diverticula urethrae is secondary to infection of the glandulae paraurethrales, but they can be easily pared out, and this together with their three-dimensional appearance with subdivision in side, undermines this theory. On the other hand, the known fact that urethral diverticula can be observed in female babies and girls of school age and also in urethral moulds of healthy young women, in which widened urethral glands can be found, supports the idea of a congenital origin. The irritability of the female urethra results from the fact that it is made up of two germ layers. Inflammation of paraurethral ducts causes secondary widening of small congenital diverticula of the female urethra. Proximally located diverticula can irritate sphincter function, as does invasive treatment. In some cases endoscopic therapy might be justified rather than plastic surgical removal via the vagina. The history, symptoms, diagnostis, histology and secondary pathology are indicated only very briefly.
Subject(s)
Diverticulum/etiology , Urethral Diseases/etiology , Female , Humans , Urinary Incontinence/etiology , UrographyABSTRACT
In intact rats we studied the influence of low doses of intravenously (i.v.) administered somatostatin (SRIF) on the net absorption and the bidirectional fluxes (lumen-to-plasma, LP; plasma-to-lumen, PL) of calcium in the duodenum, jejunum, ileum and caecum. In the duodenum SRIF inhibited the LP-flux and the net absorption of Ca significantly at infusion rates of 0.75 and 1.0 microgram SRIF . kg-1 . h-1. The PL-flux was not altered by any of the SRIF doses administered. In the other gut segments studied (jejunum, ileum, caecum) neither the net absorption nor the bidirectional Ca fluxes were changed by i.v. SRIF. It is concluded that SRIF in the plasma levels achieved in this study has an influence on the duodenal calcium absorption (CaA) of the rat; questions regarding the mechanisms of this action as well as the physiological significance of our findings are as yet unresolved.
