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Urinary tract infection and dysuria. Cost-conscious evaluation and antibiotic therapy.

Recent research into the pathogenesis and treatment of urinary tract infection (UTI) clearly indicates that our traditional approach has overestimated the need for extensive evaluation and prolonged antibiotic therapy. The great majority of UTIs can be managed adequately with urinalysis and single-dose or three-day antibiotic regimens; only complicated UTIs or those occurring in unusual hosts require cultures and longer courses of treatment.

Anti-Bacterial Agents↗

Topical application of the tricyclic antidepressant doxepin can reduce dysuria and frequency.

The aim of this article is to highlight a novel treatment for the symptoms of chronic urethral and trigonal irritation. A patient with severe urethral hyperaesthesia who derived almost complete alleviation of symptoms with topical application of a tricyclic antidepressant cream is described. The possible modes of action of tricyclics when used via the topical route of administration are described. Topical application of a tricyclic antidepressant cream may alleviate the symptoms of urethral hyperaesthesia.

Administration, Topical↗

Unusual cause of dysuria: migration of a pacemaker generator into the urinary bladder.

Following pacemaker implantation, a 71-year-old female developed infection of the generator pocket. Five years after relocation posterior to the rectus muscle she suffered from cystitis. Cystoscopy revealed the pacemaker generator to be lying within the urinary bladder. Healing was achieved by removing the pacemaker and reutilizing it, after sterilization, in a new pectoral pocket.

Aged↗

Dysuria due to bladder distortion after repeat cesarean section.

Abnormalities of the lower urinary tract resulting from cesarean section are rare. We present a patient who developed urinary frequency, nocturia and acute pains in the late phase of micturition which we think was due to bladder distortion after repeat cesarean section. She was diagnosed cystographically and treated successfully by bladder flap release.

Adult↗

A multicenter, double-blind, placebo-controlled trial of the efficacy of prazosin in the treatment of dysuria associated with benign prostatic hypertrophy.

An 8-center, double-blind, placebo-controlled trial of 39 patients with benign prostatic hypertrophy was conducted to assess the effects of prazosin HCl treatment on functional urologic variables after a treatment period of 4 weeks. The randomized groups were comparable for demographic variables and symptoms, except for the mean residual urinary volume, which was significantly higher in the prazosin HCl group. Prazosin HCl elicited statistically significant improvements in the mean prostatic urethral pressure and prostate area (Mann-Whitney U test: p = 0.001 for both variables as compared with the placebo group). Functional bladder capacity also improved significantly in the group receiving the test drug (Mann-Whitney U test: p = 0.05, as compared with the placebo group). Clinical improvements were also observed in the mean maximum urinary flow, decreased nocturia frequency, and residual urinary volume. Patient preference significantly favored the prazosin HCl treatment (Mann-Whitney U test: p = 0.001). Seven patients on prazosin HCl and 5 receiving placebo reported one or more side effects during the trial phase; these were mild to moderate and disappeared or were tolerated. No statistically significant effects on blood pressure or heart rate were observed.

Double-Blind Method↗