Sexual dysfunction in men with lower urinary tract symptoms

The conventional view that sexual function is not adversely affected by lower urinary tract symptoms (LUTS), assumed to be caused by enlargement secondary to benign prostatic hyperplasia (BPH), was investigated in this study of 423 men aged 40 years and over in a community population in the UK and 1271 urology clinic attenders aged 45 years and over in 12 countries, using the ICSmale and ICSsex questionnaires. Sexual dysfunction was found to be common: in the community, age standardized prevalences of reduced rigidity of erections were 53%, reduced ejaculation 47%, and pain on ejaculation 5%; in clinic men, age standardized prevalences of reduced rigidity of erections were 60%, reduced ejaculation 62%, and pain on ejaculation 17%. Sex lives were reported to be spoiled by LUTS in 8% of community men and 46% in the clinic. There were negative trends for age in the extent to which clinic men were bothered by these symptoms, although older men were still very concerned. Significantly raised odds ratios of sexual dysfunction were found in those with LUTS, especially storage symptoms associated with incontinence. Urinary flow rates were not associated with sexual symptoms. Sexual dysfunction is, therefore, strongly associated with LUTS, is a matter of concern to the men affected, and should be taken into account when managing patients with LUTS.     

Urodynamic pattern in infants with urinary tract infection

PURPOSE: Contemporary chemotherapy has significantly improved the event-free survival (EFS) among patients with T-cell disease. However, myelosuppression has been a significant adverse effect of this approach. In this study, we assessed the impact of r-metHu granulocyte colony-stimulating factor (G-CSF) on the period of neutropenia, number of days of hospitalization, and delays in subsequent administration of chemotherapy in a cohort of patients with T-cell leukemia (T-ALL) or advanced stage lymphoblastic lymphoma (ASLL). PATIENTS AND METHODS: This open-label, randomized trial incorporated r-metHuG-CSF into the induction and two consecutive continuation-therapy cycles of our intensive program for T-cell malignancies. In the induction phase, r-metHuG-CSF was given after two different combinations of chemotherapy, one of which included vincristine, prednisone, cyclophosphamide, and adriamycin and the other a continuous infusion of high-dose ara-C and L-asparaginase. In the two continuation-therapy cycles, r-metHuG-CSF was given following the combination of vincristine, adriamycin, prednisone, and 6-mercaptopurine (MP) and after continuous infusion of high-dose cytarabine (ara-C). RESULTS: Fifty-six patients with T-ALL and 33 with ASLL were enrolled onto study from April 1994 to December 1995. Our data show no significant difference in number of days of absolute neutrophil count (ANC) less than 500/microL, hospitalizations, or delays in therapy in the induction phase. However, in the continuation-therapy phase the number of days of ANC less than 500/microL was significantly shorter (P = .017) on the G-CSF-arm without significantly affecting the number of days of hospitalizations or delays in therapy. CONCLUSION: r-metHuG-CSF did not significantly affect the period of neutropenia, hospitalization, or delays in therapy in the induction phase, whereas in the two cycles of continuation therapy, it significantly shortened the period of neutropenia.     

Prevention of transurethral catheter-induced urinary tract infection

We report on eight patients with diabetic thoracoabdominal neuropathy in whom careful evaluation of peripheral and autonomic nervous system function was performed. All patients had non insulin-dependent diabetes mellitus of 10.5 +/- 6.7 years mean (+/- SD) known duration with poor glycemic control. Thoracic (n = 7) or abdominal (n = 1) pain of sudden onset involved several adjacent dermatomal segments and was bilateral and asymmetrical in 7/8 patients. Four patients had hypoesthesia in the painful zone and six presented with significant weight loss (6.2 +/- 4.3 kg) which reversed after the relief of pain. Truncal electromyogram was abnormal in 7/7 patients. Nerve damage was not limited to thoracic nerves since electrophysiological studies evidenced distal polyneuropathy in all patients. The autonomic nervous system was also involved. Sympathetic skin response was abnormal in 7/7 patients and autonomic cardiovascular function tests demonstrated cardiac denervation in 5/5 patients. In 4/4 patients a marked relief of pain was noted within one week with amitriptyline treatment. This report confirms the characteristic clinical presentation of diabetic thoracoabdominal neuropathy. Moreover, it suggests that this neuropathy is part of a diffuse damage that also involves peripheral nerves of the limbs and autonomic nervous system.     

Measurement of urinary lactoferrin as a marker of urinary tract infection

The usefulness of the measurement of urinary lactoferrin (LF) released from polymorphonuclear leukocytes and of an immunochromatography test strip devised for measuring urinary LF for the simple and rapid diagnosis of urinary tract infections (UTI) was evaluated. Urine specimens were collected from apparently healthy persons and patients diagnosed as suffering from UTI. In the preliminary study, the LF concentrations in 121 normal specimens and 88 specimens from patients (60 with UTI) were quantified by an enzyme-linked immunosorbent assay. The LF concentration was 3,300.0 +/- 646.3 ng/ml (average +/- standard error of the mean) in the specimens from UTI patients, whereas it was 30.4 +/- 2.7 ng/ml and 60.3 +/- 14.9 ng/ml in the specimens from healthy persons and the patients without UTI, respectively. Based on these results, a 200-ng/ml LF concentration was chosen as the cutoff value for negativity. Each urine specimen was reexamined with the newly devised immunochromatography (IC) test strip to calculate the indices of efficacy. Based on the cutoff value, it was calculated that the sensitivity, specificity, and positive and negative predictive values of the IC test were 93.3, 89.3, 86.2, and 94.9%, respectively, compared with the results of the microscopic examination of the urine specimens for the presence of leukocytes. The respective indices for UTI were calculated as 95.0, 92.9, 89.7, and 96.6%. The tests were completed within 10 min. These results indicated that urine LF measurement with the IC test strip provides a useful tool for the simple and rapid diagnosis of UTI.     

Treatment of candidal urinary tract infection with nifuratel

Three patients with candidal urinary tract infections were successfully treated with oral nifuratel, a nitrofuran antimicrobial agent active against yeast and Trichomonas as well as urinary bacterial pathogens. The recommended dose is 400 mg thrice daily for a week. No side effects that could be attributed to the treatment were noted. Minimum ibhibitory concentration determinations for nifuratel against Candida strains of five species showed that 48 out of 59 organisms were inhibited by 50 mg/1 or less, the three strains of Candida species eliminated from our treated patients having MICs of nifuratel in the range of 10-50 mg/1.     

Chronic urinary tract infection due to Candida utilis

An elderly male was seen at an outpatient urology clinic over a period of 3 years with repeat urine specimens containing 10(4) to 10(5) CFU of a "Candida species, not C. albicans." The urine specimens were described as infected due to the presence of pyuria, but no antifungal therapy was administered. On two occasions, the patient presented to the emergency room and urine specimens were sent to the clinical microbiology laboratory. On both occasions, a yeast was isolated at concentrations of >10(5) CFU/ml. The organism was identified as the anamorphic yeast Candida utilis (teleomorph: Pichia jadinii) by conventional methods. Molecular methods, including karyotyping and restriction enzyme analysis, confirmed that the isolates were identical and were C. utilis. The patient developed benign prostatic hypertrophy and chronic obstructive pulmonary disease during the 3-year course. This report is the first demonstration of the isolation of the industrially important yeast C. utilis from a urinary tract infection. In the present case, the organism was associated with chronic, symptomatic disease. The significance of this unusual, low-virulence isolate from a case of urinary tract infection is discussed.     

Controversies in the laboratory diagnosis of community-acquired urinary tract infection

Urine samples constitute the largest single category of specimens examined in most medical microbiology laboratories. The everyday nature and apparent simplicity of urinary tract infection belies the intense debate and controversy regarding the optimal methods of collection, transport and processing of urine specimens and reporting of results. There is considerable variation in the interpretation of quantitative culture results between laboratories and the etiology of abacterial cystitis remains unclear. Microscopy to detect pyuria provides information on an important indicator of inflammation and it has been proposed that detection of urinary antibody may provide similar information. Neither of these indices of host response is suitable for use in a screening test for urinary infection however, although they may usefully contribute to the interpretation of significance of culture results. The development of screening tests and automated systems continues, but at present microscopy and culture remain the most important techniques for laboratory diagnosis. However, these techniques have so far failed to provide an etiological diagnosis for abacterial cystitis and this remains a major area for research.     

Urogenital atrophy and recurrent urinary tract infection in elderly patients

Postmenopausal lower urinary tract atrophy and its relations to recurrent urinary infections in elderly women are studied. Clinical aspects, functional and histological aspects and hypothetic mechanisms of atrophy are reported, epidemiologic data, mechanisms of urinary infections and of estrogen effects are reviewed and reports on the results of local or systemic use of drugs from the literature are presented. Local administration of estrogen seems to be efficient on the urinary tract. Local treatment is less dangerous and cheaper than systemic treatment. Hormonal treatment is one of the preventive measures against recurrent urinary infections in elderly women.     

Amikacin pharmacokinetics in the therapy of childhood urinary tract infection

Amikacin, a new aminoglycoside antibiotic with a spectrum similar to that of gentamicin, has been used mainly in adults. This report summarizes the first use of this drug in children with urinary tract infection. Organisms were eradicated in all cases and recurrent infection occurred in one half after one week. No evidence of ototoxicity or nephrotoxicity was found. Four children developed transient elevation of serum glutamic oxaloacetic transaminase. Serum level (17 mug/ml) of the drug at one hour and its urinary excretion in six hours (60% of the dose) was comparable to those of adults. This antibiotic is potentially valuable and has thus far not shown major toxicity when given for up to 11 days in patients with normal renal and liver functions.     

Eradication of urinary tract infection following spinal cord injury

A prospective study to evaluate the microbiological efficacy of antimicrobial treatment for urinary tract infection (UTI) was performed in 64 catheter-free spinal cord injured (SCI) patients who were visited monthly by a public health nurse who collected urine for culture and urinalysis. Patients also mailed urine dip slides for weekly bacterial counts. UTI was defined as a culture yielding > or = 100,000 colonies/ml. Treatment was given to asymptomatic patients only if pyuria (> or = 10 urinary leukocytes/high powered microscopic field) was present. Initial treatment was for 7-14 days (group 1). When it became apparent during the study that eradication was difficult and relapse or reinfection frequently occurred within a short time after cessation of antibiotic, a second treatment course of > or = 28 days (group 2) was given. By the end of the study, in which all patients were followed for a minimum of 30 days post treatment, 39/42 (93%) cases in group 1 and 11/13 (85%) in group 2 who had initial eradication, had relapsed or become reinfected. The median number of days and standard error for group 1 to relapse or become reinfected was 16 +/- 2.5, and for group 2 it was 27 +/- 6. Development of drug resistance was documented when bacteria isolated prior to any treatment were compared with strains isolated after > or = 28 days of antibiotics. In this study, urine sterility was achieved in a minority of treated UTIs and was relatively short lived.(ABSTRACT TRUNCATED AT 250 WORDS)     

Complicated urinary tract infection: analysis of 179 patients

BACKGROUND: The aim of our study was to investigate the incidence, bacteriology, management and outcome of complicated urinary tract infections (UTIs) at the Veterans General Hospital-Taipei. METHODS: Between June, 1993, and July, 1994, medical records of 2,566 patients admitted to the Division of Urology, Veterans General Hospital-Taipei, were retrospectively reviewed. Of these patient, 1,322 had a diagnosis of benign prostatic hyperplasia (BPH), 607 were admitted for renal stones, 496 for ureteral stones, 75 for transitional cell carcinoma (TCC) of the urinary bladder, 47 for renal tumors and 19 for TCC of the ureter. Among all patients studied, 179 (6.98%) acquired a complicated UTI. Of these, 81 were admitted for BPH, 46 for renal stones, 42 for ureteral stones, five for TCC of the urinary bladder, three for renal tumors and two for TCC of the ureter. RESULTS: Of the 179 patients with complicated UTIs, 155 were men and 24 were women. The urine culture positive rate was 76.0% (136/179) and the most common bacteria were Escherichia coli, Proteus mirabilis and Pseudomonas aeruginosa. The principle mode of treatment included parenteral antibiotics and urinary diversion (percutaneous nephrostomy and Foley catheterization), when necessary. The infection control rate for these complicated UTIs was 96.3% for BPH, 95.5% for renal stone, 97.6% for ureteral stone, 80% for TCC of the urinary bladder, 100% for renal tumor and 100% for TCC of the ureter. Mortality due to complicated UTI was 3.9% (7/179). CONCLUSIONS: We concluded that the prognosis of complicated UTI is good if diagnosis and appropriate treatment are given promptly. Early drainage to relieve obstruction and intravenous antibiotics are initially necessary. Surgical intervention is required to resolve functional or structural abnormalities after the UTI has been controlled.     

Prevalence of lower urinary tract symptoms in Finnish men: a population-based study

The targeting of AMPA- and NMDA-type glutamate receptors to synapses in the central nervous system is essential for efficient excitatory synaptic transmission. Recent studies have indicated that protein-protein interactions of these receptors with synaptic proteins that contain PDZ domains are crucial for receptor targeting. NMDA receptors have been found to bind to the PSD-95 family of proteins, whereas AMPA receptors interact with the PDZ-domain-containing protein GRIP (glutamate receptor interacting protein). PSD-95 and GRIP contain multiple PDZ domains as well as other protein-protein interaction motifs that help to form large macromolecular complexes that may be important for the formation and plasticity of synapses.     

Extracorporeal shock-wave lithotripsy in patients with manifestations of urinary tract infection

The urinary tract infection is very frequent, especially if calculosis of the urinary tract is present. Urinary infection is widespread, and it appears during the year. The people of all ages and both sexes are affected by urinary infection. In the last few years a reliable progress in the understanding and management of urinary tract infection is achieved. Numerous articles published in professional journals are a good proof of it. The urinary tract infection is frequent and is responsible for the use of large quantities of antibiotics which provoke great costs and make other problems. The role of laboratory tests in the diagnosis of infection is predominant. The clinician is completely dependent on his collegue, a bacteriologist, with regard to the results of urine culture. It is known that microorganisms grow better if they have good nourishment. Infections of the urinary tract were always a significant problem. However, over the last few decades, they became, according to some authors, the most frequent bacterial infection in humans, requiring the frequent administration of immunosuppressive agents, corticosteroids and cytostatics; and at the same time a great number of elder people and chronic patients with reduced immunity are involved. Taking into account that significant and insignificant infections of the urinary tract are frequent in nephropathology, particularly in renal and canalicular calculosis, the aim of the study was to point to extracorporeal shock wave lithotripsy without risk of impairment of already existing infections with and without administration of antibiotic and uroantiseptic agents for prophylactic purposes. A group of 5,078 patients with calculosis of the urinary tract was studied. Extracorporeal shock wave lithotripsy was performed in all patients by Siemens lithotriptor Lithostar (Germany). In patients with calculosis of the urinary tract subjected to extracorporeal lithotripsy bacteriuria was regularly followed. A group of 1,836 (36 percent) patients with urinary tract obstruction and 3,242 (64 percent) patients without urinary tract obstruction were treated (Table 1). In 895 (18 percent) patients with urinary tract obstruction infection was serious. In 321 (6 percent) patients without urinary tract infection, serious urinary tract infection was detected (Table 2). The most frequent causes of urinary tract infection are presented in Table 3. Table 4 shows a review of patients to whom antibiotic therapy, prior to extracorporeal lithotripsy, was prescribed. Infection of the urinary tract is responsible for great morbidity. The treatment of any type of urinary tract infection must include the examination of the effect of antibiotic agents. During the treatment of urinary tract infection with calculosis resistant microorganisms are also developed because of repeated administration of antibiotics to patients in health institutions, and especially to patients with ureteral catheters. The treatment of any type of urinary tract infection must include the examination of the effect of antibiotic agents used. The fundamental aims of the treatment of urinary tract infection are: the eradication of causes of infection and concurrent prevention or optimal control of recurrent infection. As long as the patients with urinary tract calculosis are susceptible of permanent infections. It is indispensable to perform sterilization, and thereafter to remove the stone from the urinary tract, because infection of the urinary tract may cause a series of sequelae in the function of the kidney. Frequently the successful urinary sterilization with antibiotic agents cannot be achieved, and consequently, the carrying out of extracorporeal lithotripsy together with administration of antibiotics, is impossible. Good results can be obtained by a combined therapy of antibiotics and extracorporeal lithotripsy in patients with urinary tract calculosis. (ABSTRACT TRUNCATED)     

Bladder malfunction, urinary tract infection and vesicoureteral reflux in children

A correlation between urinary tract infection, vesicoureteral reflux and voiding disorders has increasingly been reported. Voiding dysfunction increases the incidence of recurrent urinary tract infection, induces and perpetuates vesicoureteral reflux, even after surgical antireflux treatment, and may result in permanent renal damage. The resolution of the primary cause with voiding normalization is essential to achieve good results in the treatment of secondary problems such as urinary tract infection and vesicoureteral reflux. Thirty seven children with vesicoureteral reflux secondary to voiding disorders were diagnosed and treated between 1990 and 1995 (five years). Forty-nine ureters were studied. The subjects became symptomatic between 1 month and 13 years of age, with the occurrence of urinary tract infection. All children were neurologically and morphologically normal. Symptoms suggesting bladder instability were detected in 34 (91.9%) and dysfunctional sphincter obstruction in three (8.1%). These patients were all evaluated with a renal/bladder sonogram and voiding cystogram, complemented in 17 (45.9%) with urodynamic testing that confirmed clinical diagnosis. 99mTc-dimercaptosuccinic acid renal scans performed on 29 (78.4%) children revealed renal damage in 26 (89.6%). A treatment program of bladder retraining and bowel habit normalization was encouraged in every child, anti-cholinergic drugs were associated in 23 (62.2%), muscle-relaxant drugs in three (8.1%), phenoxybenzamine and intermittent catheterization were used in one child (2.7%). Urinary tract infection prophylaxis was instituted in 34 (91.9%) children. Urinary tract infection was completely resolved in 35 (94.6%) patients, and its frequency decreased in two (5.4%). Thirty-two children (86.5%) with vesicoureteral reflux were cured and four (10.8%) were improved. Evidence of voiding disfunction ceased in 22 (59.5%) cases and improved in 14 (37.8%) with a reduction in the frequency and intensity of complaints. Urgency syndrome and vesicoureteral reflux remained unchanged in one child (2.7%). These findings imply that detection and treatment of bladder/sphincter disfunction are essential in every child with the complex of recurrent urinary tract infection and vesicoureteral reflux.