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PubMed2004

Host subversion by formation of intracellular bacterial communities in the urinary tract.

Urinary tract infections pose a serious health threat with respect to antibiotic resistance and high recurrence rates. While the host robustly responds to bacterial infiltration into the bladder, uropathogenic Escherichia coli can survive the onslaught to persist for months after initially infecting. To accomplish this feat, uropathogenic E. coli forms intracellular bacterial communities, with many biofilm-like properties, within the bladder epithelium. These communities may allow bacteria to subvert host defenses and form a persistent reservoir in the bladder.

Biofilms↗
PubMed2000

Do antimicrobials have a role in preventing septicaemia following instrumentation of the urinary tract?

Urinary tract instrumentation is a significant cause of septicaemia. Review of the literature suggests that selective use of antimicrobials would reduce the risk of septicaemia as this varies between patients and with procedures. Antimicrobial prophylaxis is indicated for patients at high risk of endocarditis, or who are neutropenic. For patients without these risk factors, it is indicated for open, transurethral, or certain forms of laser prostatectomy or trans-rectal prostate biopsy. For cystoscopy, antimicrobials are indicated for patients with preoperative bacteriuria or a preoperative indwelling catheter. Single dose aminoglycosides or oral fluoroquinolones are the agents of choice with the exception of the prevention of endocarditis, where combinations active against streptococci are recommended. For other instrumentations, the risk of antimicrobial toxicity probably outweighs the benefits and a risk-reduction strategy is recommended. Further studies are required to provide definitive answers in many of these areas.

Adult↗
PubMed1989

[Urinary tract infection associated with urinary calculi. 1. The significance of urinary tract infection in urinary calculi].

We investigated 158 cases of urinary stones (infection stones 56, metabolic stones 102) with special reference to pyuria, bacteriuria, stone culture and urease activities of isolated bacteria. Abacterial pyuria was noted in 9 out of 49 (18%) infection stones and in 53 of 77 (69%) metabolic stones. Bacteriuria was noted in 79% of the infection stones and 26% of the metabolic stones. Sixty-seven percent of the infection stones were infected with mainly urea splitting bacteria such as Proteus mirabilis and Staphylococcus. Twenty-three percent of metabolic stones were also infected. Though E. coli, a non-urea splitting bacteria, was isolated most frequently from metabolic stones, urease positive Staphylococcus and Pseudomonas were also isolated. Bacteria within stones could be predicted on the basis of urine culture results of only 20 of 41 infection stones and 8 of 24 metabolic stones. These facts are useful for selection of some antibiotics in the treatment of urinary tract infections associated with urinary calculi. Urinary infections of urea splitting bacteria in infection stones are thought to be initial factors of stone formation and those of non-urea splitting bacteria are to be superimposed. However, urea splitting bacteria in metabolic stones may convert them into infection stones in future.

Adult↗
PubMed2006

Absence of Epstein-Barr virus infection in squamous cell carcinoma of upper urinary tract and urinary bladder.

OBJECTIVES: To address whether Epstein-Barr virus (EBV) infection may be involved in the carcinogenesis of squamous cell carcinoma of the upper urinary tract and urinary bladder (SCC-UB). EBV has been implicated in the genesis of a variety of human cancers, including urothelial carcinoma of the urinary bladder. METHODS: Whether EBV infection is related to SCC-UB carcinogenesis was investigated by in situ hybridization for EBV-encoded RNA and immunohistochemistry for latent membrane protein-1 in 26 cases of SCC-UB. RESULTS: EBV-encoded RNA and latent membrane protein-1 were identified in the control case of nasopharyngeal carcinoma. None of the SCC-UB cases had a nuclear signal of EBV-encoded RNA, and the cancer cells, normal urothelial cells, and inflammatory cells were all negative for latent membrane protein-1, irrespective of the site of SCC-UB. CONCLUSIONS: This study is the first to explore the role of EBV infection in SCC-UB. Our results suggest that EBV infection is not involved in the carcinogenesis of SCC of the renal pelvis, ureter, and urinary bladder.

Aged↗
PubMed1987

Coordinated multicenter study of norfloxacin versus trimethoprim-sulfamethoxazole treatment of symptomatic urinary tract infections. The Urinary Tract Infection Study Group.

In a coordinated, double-blind multicenter trial among general practitioners, 2,255 consecutive patients with symptoms suggesting urinary tract infection were screened; 886 were randomized to receive 200 mg of norfloxacin (333 patients), 400 mg of norfloxacin (335), or 160 mg/800 mg of trimethoprim-sulfamethoxazole (TMP-SMZ; 218) twice daily for seven days. We analyzed bacteriologic efficacy for 252, 240, and 141 of the patients receiving 200 mg of norfloxacin, 400 mg of norfloxacin, or TMP-SMZ, respectively. The short-term efficacy was 97.5%-98.6%, and the accumulated efficacy was 87.9%-88.8%. In patients with complicated infections and in men, the efficacy for the group receiving 200 mg of norfloxacin was lower than that for the other groups. In patients with recurrent infection, bacterial elimination was greater for those receiving TMP-SMZ. Significantly fewer adverse reactions occurred in patients receiving norfloxacin than in those treated with TMP-SMZ. The 200-mg dosage of norfloxacin seemed to cause fewer side effects than the 400-mg dosage.

Adult↗
PubMed2006

Lower urinary tract symptoms, urinary incontinence, sexual function and quality of life after radical prostatectomy and external beam radiation therapy: real life experience in Austria.

The objective of this study was to assess lower urinary tract symptoms (LUTS), urinary incontinence (UI), erectile dysfunction (ED) and quality of life after radical prostatectomy (RPE) and external beam radiation therapy (EBRT) in a "real-life" setting. A consecutive series of patients undergoing routine follow-up after RPE and EBRT at 28 Austrian institutions were analyzed. Men who received adjuvant therapy were excluded. All patients completed a questionnaire on (a) LUTS and UI, (b) sexual function and (c) quality of life. A total of 364 patients following RPE and 82 after EBRT entered this study and were compared in a matched pair analysis (1:1) based on age, PSA at diagnosis and follow-up (RPE: n=82; EBRT: n=82). Mean time-interval between treatment and current investigation was 4.6 years for RPE and 4.4 years for EBRT (n.s.). UI was reported by 41.3% after RPE and 18.8% after EBRT (P=0.001). Urgency was more frequent after EBRT, this difference, however, did not reach statistical significance. Moderate to severe ED (IIEF-5, <17) was present in 80.0% after RPE and in 80.8% after EBRT (n.s.). On a ten-point scale, RPE-patients rated their quality of life higher (7.3) than after EBRT (6.7) (P=0.01). In this "real-life" setting, RPE and EBRT had significant, yet divergent effects on LUTS, UI and sexual function. The respective numbers were substantially higher than those usually reported by physician-directed studies and centers of excellence.

Austria↗
PubMed1988

Transvaginal endosonography: a new method to study the anatomy of the lower urinary tract in urinary stress incontinence.

A new method to investigate the anatomy of the lower urinary tract in women is described. Direct ultrasound images of the bladder neck and proximal urethra were obtained using a vaginal endoprobe; the series comprised 100 women with a range of urinary symptoms. The technique was well tolerated by patients and there was no morbidity. Transvaginal endosonography is suitable for the assessment of many aspects of urinary incontinence.

Endoscopy↗
PubMed1980

A controlled trial of different treatment regimens in patients with urinary tract infections after lower urinary tract surgery.

One hundred and four patients who developed urinary tract infections after catheterization for acute retention of urine and surgery of the bladder or urethra were randomly allocated to four treatment groups. Analysis of the results in 65 patients showed that co-trimoxazole and 1 g cephradine administered twice daily for 1 week were successful in eradicating the urinary tract infections in 93% and 88% of the patients, respectively. The same dose of cephradine administered 4-times a day eradicated 64% of the infections. In patients for whom no treatment was given, the original infection did not clear in 65%. Escherichia coli and coagulase-negative staphylococci were the commonest infecting organisms. The in vitro sensitivity testing of antibiotics did not correlate well with the successful eradication of the infecting organism.

Aged↗
PubMed2004

[Effect of treatment of lower urinary tract dysfunction on occurrence of urinary tract infections in children with vesicoureteral reflux].

Correlation between lower urinary tract dysfunction, urinary tract infection (UTI) and vesicoureteral reflux (VUR) is complex and well known. The impact of lower urinary tract dysfunction treatment on frequency of UTI in children with VUR was assessed in our study. Lower urinary tract dysfunction was diagnosed in 32 girls and 4 boys; 19 (53%) of them had VUR in 24 kidney units. All patients were on chemo-prophylaxis and were advised how to restore regular voiding and assume normal posture, in order to reach an optimal relaxation of the pelvic floor during voiding. Eight patients (42%) with signs of hyperactive bladder and/or small bladder capacity were administered anticholinergic-oxybutynin (0.2 mg/kg of body weight). Eleven patients (58%) with sign of bladder-sphincter dysfunction and/or residual urine volume over 20% were treated by alfa-blocker-alfuzosin (0.1 mg/kg of body weight). Four children with constipation were advised to use fiber-rich diet. During 12-mount follow-up, none had febrile UTI, and 7 (37%) had 1 to 3 UTI without temperature. In conclusion, conservative treatment of VUR should include chemo-prophylaxes, lower urinary tract dysfunction treatment, and treatment of constipation, what was confirmed by our study as well.

Child↗
PubMed1995

The management of urinary tract infections in children without urinary tract abnormalities.

Although most urinary tract infections in children with normal urinary tract anatomy pose little threat to renal function, pyelonephritis, particularly in infants, may cause renal scarring when not diagnosed and treated promptly. For most children, however, the problems of urinary tract infection may be related to a biologic predisposition to recurrent infections and the bothersome clinical symptoms associated with them. In these children, infections should be diagnosed carefully and then treated for 3 days with appropriate antimicrobial agents. In children with frequently recurrent infections (more than two in 6 months), a prophylactic antimicrobial agent in the proper low dosage may be useful. Children bothered by infection-associated symptoms of bladder dysfunction with persistent incontinence may improve with treatment with anticholinergic drugs and/or bladder rehabilitation. There may also be a decrease in the rate of urinary tract infections with this treatment. When covert bacteriuria is found and bothersome symptoms are associated with it, symptoms should be treated. If recurrent covert bacteriuria is truly asymptomatic, however, not treating the infection may be the best option.

Anti-Infective Agents, Urinary↗
PubMed1986

Patterns of Schistosoma haematobium egg distribution in the human lower urinary tract. I. Noncancerous lower urinary tracts.

Schistosoma haematobium egg burdens (eggs/g of tissue) of 17 anatomic segments of lower urinary tracts from 32 unselected Egyptian autopsies have been determined by tissue digestion and replicate counts of aliquots of the digestate. There were three anatomic patterns of egg distribution in these lower urinary tracts: apical, basal and diffuse. Regression of egg burdens of each of the anatomic segments as the dependent variable against egg burdens of the entire lower urinary burden yielded a good fit for 15 of 17 of these segments. Statistical analyses revealed that many of these equations for discrete anatomic segments can be combined, generally giving one equation for anatomic regions which are in continuity, indicating that the female worm lives and oviposits in specified venous plexes. These equations also suggest that there are differences in the rates, duration and onset of egg accumulation which may be responsible for schistosomal obstructive uropathy as a cause of death in fairly young individuals.

Adolescent↗
PubMed2000

Cranberries for preventing urinary tract infections.

BACKGROUND: Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of urinary tract infections. The aim of this review is to assess the effectiveness of cranberries in preventing such infections. OBJECTIVES: To assess the effectiveness of cranberry juice and other cranberry products in preventing urinary tract infections in susceptible populations. SEARCH STRATEGY: Electronic databases and the Internet were searched using English and non English language terms; companies involved with the promotion and distribution of cranberry preparations were contacted; reference lists of review articles and relevant trials were searched. SELECTION CRITERIA: All randomised or quasi randomised controlled trials of cranberry juice/products for the prevention of urinary tract infections in susceptible populations. Trials of men, women or children were included. DATA COLLECTION AND ANALYSIS: Reviewers RJ and LM independently assessed and extracted information using specially designed data extraction forms. For each included trial, information was collected on methods of the trial, participants, interventions and outcomes. We were unable to perform statistical analysis due to the nature of the data available for review. MAIN RESULTS: Four trials met the inclusion criteria (three cross-over, one parallel group). Three compared the effectiveness of cranberry juice versus placebo juice or water and one compared the effectiveness of cranberry capsules versus placebo. Two further trials were excluded. The outcomes of interest were number of urinary tract infections in each group (symptomatic and asymptomatic), side effects and adherence to therapy. Data from three out of the four trials indicated that cranberries were effective for at least one of the outcomes of interest. The quality of the four included trials was poor, however, and thus the reliability of the results must be questionable. REVIEWER'S CONCLUSIONS: The small number of poor quality trials gives no reliable evidence of the effectiveness of cranberry juice and other cranberry products. The large number of dropouts/withdrawals from the trials indicates that cranberry juice may not be acceptable over long periods of time. Other cranberry products such as cranberry capsules may be more acceptable. On the basis of the available evidence, cranberry juice cannot be recommended for the prevention of urinary tract infections in susceptible populations. Further properly designed trials with relevant outcomes are needed.

Beverages↗