A prospective multi-center trial of Escherichia coli extract for the prophylactic treatment of patients with chronically recurrent cystitis.

We have assessed the efficacy and safety of Escherichia coli extract (ECE; Uro-Vaxom) which contains active immunostimulating fractions, in the prophylactic treatment of chronically recurrent cystitis. Forty-two patients with more than 2 episodes of cystitis in the proceeding 6 months were treated for 3 months with one capsule daily of ECE and observed for a further 6 months. The primary efficacy criterion was the number of episodes of recurrent cystitis during the 6 months after treatment compared to those during the 6 months before treatment. At the end of the 9-month trial, 34 patients (all women) were eligible for statistical analysis. Their mean age was 56.4 yr (range, 34-75 yr), and they had experienced recurrent urinary tract infections for 7.2+/-5.2 yr. The number of recurrences was significantly lower during the 6-month follow-up period than during the 6 months preceding the trial (0.35 vs. 4.26, P<0.001). During the follow-up, 28 (82.4%) patients had no recurrences and 4 (11.8%) had 1 each. In patients who relapsed, ECE alleviated cystitis symptoms, including painful voiding, frequency and urgency. There were no serious adverse events related to the study drug. Our study demonstrates the efficacy and safety of ECE in the prophylactic treatment of chronically recurrent cystitis.

Treatment for chronic prostatitis/chronic pelvic pain syndrome: levofloxacin, doxazosin and their combination.

INTRODUCTION: We performed a prospective, randomized study to examine the efficacies of levofloxacin and doxazosin alone and as a combination therapy in patients with National Institutes of Health (NIH) category III chronic prostatitis/chronic pelvic pain syndrome. PATIENTS AND METHODS: Men with a NIH diagnosis of category III chronic prostatitis/chronic pelvic pain syndrome and who had experienced pelvic pain for more than 3 months during the last 6 months were enrolled. All patients underwent treatment for 6 weeks. The patients were assessed at baseline and after 2 and 6 weeks by using the NIH Chronic Prostatitis Symptom Index. Eighty-one men (average age 40.1 years) were randomized to either the levofloxacin group (n = 26), the doxazosin group (n = 26), or the combination group (n = 29). RESULTS: The average baseline NIH Chronic Prostatitis Symptom Index total scores were 22.6, 22.4, and 24.1, respectively. At 6 weeks, the total scores were 11.2 (response rate 50.3%), 17.7 (response rate 21.1%), and 13.1 (response rate 45.6%), respectively. The levofloxacin group showed a higher response rate than the doxazosin group, not at 2 weeks but at 6 weeks (p < 0.001). CONCLUSIONS: For a 6-week short-term treatment levofloxacin is more effective than doxazosin for chronic prostatitis/chronic pelvic pain syndrome. In addition, levofloxacin monotherapy was also more effective when compared with the combination therapy.

Laparoscopic nephrectomy for a single-system ectopic ureter draining a small, dysplastic and poorly functioning kidney in children.

PURPOSES: To assess the efficacy of laparoscopic nephrectomy for a single-system ectopic ureter draining a dysplastic kidney in children. PATIENTS AND METHODS: Between February 1999 and September 2005, 16 girls with a mean age of 6.2 years (range: 2-15 years) presented with urinary incontinence accompanied by regular voiding since birth (15 patients) and vaginitis (one patient). Ultrasonography, intravenous urography and a 99mTc-DMSA renal scan showed the presence of only a single kidney in all cases. Computed tomography (CT) showed a dysplastic kidney definitely in nine patients, structures suspicious of dysplastic kidney in three cases, and no dysplastic kidney in four cases. Magnetic resonance imaging was carried out in the four cases with non-visualized dysplastic kidneys by CT, and showed a suspicious lesion in only one case, and no lesion in the other three patients. All patients underwent transperitoneal laparoscopic nephrectomy for a dysplastic kidney. RESULTS: Laparoscopy identifies all dysplastic kidneys easily, even in those cases in which dystrophic kidney could not be identified by preoperative imaging. Dysplastic kidneys and ectopic ureters were removed successfully in all 16 patients. Mean operative time was 109 min (range: 40-155 min) with little intraoperative bleeding. Mean postoperative hospital stay was 2.6 days (range: 2-4 days). No intraoperative complication was encountered, except in one single case, in which a small bowel injury occurred during open Hasson's procedure. All patients became dry soon after the operation. CONCLUSION: Laparoscopic nephrectomy for an ectopic ureter draining into a dysplastic kidney is a safe and effective method, and can be carried out successfully, despite a failure by preoperative imaging studies to localize the dysplastic kidney.

Subjective pain scale and the need for analgesia during shock wave lithotripsy.

OBJECTIVE: To investigate patients' opinions on the degree of pain during shock wave lithotripsy, and the need for analgesics in patients with urinary stone. METHODS: A prospective questionnaire study involving subjective pain assessment during and just after shock wave lithotripsy was performed in consecutive patients with uncomplicated renal or ureteral stones. The patients were given unbiased information on the analgesics prior to the procedure. Ten minutes after beginning shock wave lithotripsy, the degree of pain was rated by the patient using a 10-point visual analog scale. After the procedure, the patients were asked to complete a self-administered questionnaire. Based on the response for the questionnaire, the patients were divided as 'tolerable' or 'non-tolerable' group. RESULTS: The results from 180 patients (males 113, females 67) with a mean age of 50.0 +/- 13.0 were analyzed. The average subjective pain score was 6.6 +/- 2.3 during the procedure, and 70 (38.9%) patients responded that they were able to tolerate the pain without analgesics. A total of 116 (64.4%) patients did not agree that analgesic should be recommended to other patients. Subjective pain score during the procedures was not affected by laterality, size of stone, level of education or socioeconomic status, but was affected by patient age (p = 0.042), sex (p = 0.012) and location of stone (p = 0.014). Right and kidney stones were significantly higher in the 'non-tolerable' group than in the 'tolerable' group (p = 0.003 and p = 0.011, respectively), and the 'non-tolerable' patient group had a significant higher pain score than the 'tolerable' group (p < 0.001). CONCLUSIONS: Our result shows that subjective pain severity during shock wave lithotripsy is high but may be well tolerated in some patients. Our findings raise the question as to whether routine analgesics are required during newer generation shock wave lithotripsy procedures in all patients with a urinary stone.

Effects of local anesthetics on human bladder contractility.

AIMS: We investigated the invitro effects of local anesthetics on the contractility of the human bladder. METHODS: By measuring the invitro isometric contractions of human bladder strips, we determined the effects of tetracaine, bupivacaine, lidocaine, and ropivacaine on the basal spontaneous contractions and contractions induced by various stimuli, namely, KCl (60 mM), carbachol (CCh), and electrical field stimulation (EFS). The effect of local anesthetic agents on Ca(2+)-independent sustained tonic contraction (SuTC) of the detrusor was also investigated. RESULTS: Local anesthetics increased phasic and tonic spontaneous contractile activity dose dependently in the concentration range 1-500 muM, but abolished phasic activity at higher concentrations. Local anesthetic agents inhibited nerve-mediated contraction (EFS, 0.8 msec) in a concentration-dependent manner (ropivacaine > tetracaine = bupivacaine > lidocaine), and inhibited non-nerve mediated contractions induced by KCl, long pulse EFS (direct muscle stimulation, 100 msec), and CCh. Inhibitory potency on non-nerve mediated contraction was for long pulse EFS: ropivacaine = tetracaine > bupivacaine = lidocaine and for KCl- and CCh-induced contractions: ropivacaine > tetracaine > bupivacaine = lidocaine. Higher concentrations of local anesthetics were needed to inhibit non-nerve-mediated bladder contraction than nerve-mediated contraction. SuTC was suppressed by all local anesthetics concentration dependently. CONCLUSIONS: Our study demonstrates that local anesthetics have inhibitory effects on the contraction of human bladder as induced by different stimulants and concentrations. Their effects and differences suggest that they may be considered potentially useful as diagnostic and therapeutic agents for bladder dysfunction.

Voiding diary for the evaluation of urinary incontinence and lower urinary tract symptoms: prospective assessment of patient compliance and burden.

AIMS: Voiding diary duration may be related to patient compliance and burden. To test this hypothesis, we evaluated patient compliance and burden. METHODS: Between January and July 2002, we prospectively evaluated 162 patients (57 males and 105 females, mean age 53.0, range 20-81 years) with stress urinary incontinence or lower urinary tract symptoms. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score (I-PSS) assessment and were randomly requested to complete 2-day, 3-day, or 7-day voiding diaries (the three study groups). At the second visit, a simple self-administered questionnaire was completed by all patients. The questionnaire included 11 items on subject demographics and voiding diary-keeping. RESULTS: No significant differences were found in either the accuracy of diary-keeping or the daily average number of omissions when the three groups were compared. However, as the diary duration increased, the mean burden scores increased (P = 0.005), and the mean preferred duration of the diary in the 7-day group was significantly higher than that of the 2-day or 3-day groups (P < 0.001). After categorizing patients into two groups according to the degree of patient burden, members of the group with a greater perceived burden were found to have a significantly higher I-PSS quality of life score (P = 0.045) and to have kept a diary for a longer time (P = 0.038). CONCLUSIONS: Our results suggest that keeping a diary for 7 days may increase patient burden and thus, we recommend that the 7-day diary should be reduced to cover fewer days.

Nocturia and complementary indices: determination and quantification of the cause of nocturia by frequency-volume charts in women with lower urinary tract symptoms.

We evaluated differences between women with lower urinary tract symptoms (LUTS) with and without nocturia in terms of voiding habits, urine production and voided volumes in order to determine and quantify the cause of nocturia by using frequency-volume (FV) charts. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score assessment, received a thorough explanation from the study coordinators, and were requested to complete a 3-day FV chart. Of the 123 women enrolled, 106 (86.2%) 20-83 years old (median age 55.0) completed the study. Nocturnal urine volume was higher in nocturics than in non-nocturics, but this was not statistically significant. Total daytime voided volume was lower in nocturics than in non-nocturics ( P=0.030) but with no detectable difference in total voided volume. To identify possible risk factors, we examined age and night time parameters including the nocturnal bladder capacity index (NBCI), nocturnal polyuria index (NPI) and nocturia index (NI) by univariate logistic analysis. When nocturia was defined as voiding at least twice per night, age and NI were found to be associated with it by univariate analysis. These two variables were further analyzed using a multivariate logistic model to determine their association with nocturia. In the multivariate analysis, a positive association was observed between age and nocturia. Patients 50 years or older had a 3.9-fold higher risk [odds ratio (OR) 3.86; 95% confidence interval (CI) 1.60-9.31; P=0.003] of voiding at least twice per night than those younger than 50 years. In the same model, patients with NI greater than 1.5 had a 4.5-fold higher risk of voiding at least twice per night (OR 4.59; 95% CI 1.80-11.17; P=0.001). FV charts are valuable for determining the cause of nocturia in women with LUTS. Our findings suggest that age and the NI may be important variables in the evaluation of nocturia in women with LUTS.

Clinical characteristics and outcome of hydronephrosis detected by prenatal ultrasonography.

The widespread use of prenatal ultrasound results in an increased recognition of fetal hydronephrosis. To determine clinical characteristics and postnatal outcome of fetal hydronephrosis, we performed a retrospective study in children diagnosed as having fetal hydronephrosis between 1990 and 2001. 341 children with 427 dilated kidneys were included. Dilatation of the renal pelvis was caused by primary ureteropelvic junction obstruction in 65.6%, multicystic kidney in 9.4%, vesicoureteral reflux in 7.0%, duplex system in 5.4%, ureterovesical junction obstruction in 4.0%, and posterior urethral valves in 3.0%. Hydronephrosis resolved spontaneously in 126 (29.5%) kidneys, with 52.7% of mild hydronephrosis, and 2.6% of severe hydronephrosis. Mean interval to spontaneous resolution was 1.39 (+/- 1.41, SD) yr. Surgery was performed in 174 kidneys, including pyeloplasty in 105, ureteroneocystostomy in 23, transurethral incision in 11 and nephrectomy in 9. Most patients had initially high-grade hydronephrosis (p<0.05). Mild hydronephrosis appears to be relatively benign, and in most cases, dilatation improves with time, and thus surgical intervention is not required. On the other hand, moderate or severe hydronephrosis often results in a significantly poor outcome and requires surgical intervention, and therefore, requires closer follow-up both antenatally and postnatally.