Recurrent Cystitis Research Articles

Drinking More Water for Prevention of Recurrent Cystitis

Drinking More Water for Prevention of Recurrent Cystitis

Recurrent Unexplained Cystitis Due to an Ingested Foreign Body–An Extremely Rare Case

We present the images of a 4-year-old male child with history of recurrent unexplained urinary tract infections which was found to be due to an ingested wooden foreign body which had perforated the small bowel into the posterior bladder wall. Such cases are very rare, usually due to domestic abuse or in patients with psychiatric illnesses. The adults usually report early but in children these cases go un-noticed. These patients may present with features of bowel obstruction, perforation, or hematochezia.1 as recurrent urinary tract infections seems to be the first case to be reported.

Clinicopathologic features and immunophenotype of pseudosarcomatous myofibroblastic proliferation of urinary bladder

Objective: To investigate the clinicopathologic features, immunohistochemical phenotypes and biological behavior of pseudosarcomatous myofibroblastic proliferation (PMP) of the urinary bladder which may be misdiagnosed as a malignant neoplasm and undergo extensive treatment. Methods: Six cases of PMP of the urinary bladder were collected from 2001 to 2016 at Beijing Tiantan Hospital, Capital Medical University. The clinicopathologic features and immunophenotypic profile were studied by histopathological and immunohistochemical investigations with clinical follow-up. At the same time, the translocation of ALK gene was detected by fluorescence in situ hybridization (FISH). Immunohistochemistry was carried out using EnVision method for the expression of AE1/AE3, vimentin, EMA, SMA, Caldesmon, Calponin, desmin, ALK, Ki-67, MyoD1, myoglobin, CD34, S-100, CD117, CK7, CK20, GATA3, p63 and CK5/6. The related literature was reviewed. Results: There were two male and four female patients, significantly more common in women. The age of the patients was 27 to 53 years, and the median age was 35 years. The main clinical symptom was painless gross hematuria, one case with dysuria, and one case showed recurrent cystitis. There was no history of surgery and trauma. Follow-up ranged from 4 months to 13 years and showed five cases without recurrence and one case with recurrence. Microscopy showed submucosal lesion with inflammatory exudate and bleeding on the surface, in some cases extending to the superficial muscles of the bladder wall. The lesion was characterized by the proliferation of plump spindle cells, which were loose or dense in arrangement. There were varying degrees of acute and chronic inflammatory cells infiltration in the myxoid matrix. Spindle cells arranged in disorder, or a dense stranding, especially abundant in the cell region. The median mitotic rate was <2/10 HPF cells, but there were no pathological mitotic figures and without nuclear atypia in most spindle cells. Spindle cells with eosinophilic cytoplasm showed long tapering cytoplasmic projections. Oval or short spindle nuclei had vacuolization with prominent nucleoli, looking like ganglionic cells. There were scarce collagen fibers, and a few spindle cells degenerated with chromatin blurred. Some areas showed a granuloma-like pattern and neutrophils within vascular cavity. Immunohistochemically, the spindle cells were diffusely positive for vimentin, SMA and caldesmon. CKpan was strongly and diffusely positive. Desmin and calponin expression was varying. Ki-67 positive cells were about 35% to 55%, but the spindle cells were negative for myoglobin, S-100, CD117, CD34, p63 and CK5/6. FISH test showed that there was no ALK isolated signal in 6 cases of PMP, and so no positive cases were found. Conclusions: PMP of the urinary bladder is a benign non-neoplastic myofibroblastic proliferative lesion. Morphology is extremely easy to be misdiagnosed as malignant tumors, and therefore more attention should be paid to avoid this misdiagnosis.

EPIDEMIOLOGY OF UNCOMPLICATED OUTPATIENT URINARY TRACT INFECTIONS IN THE RUSSIAN FEDERATION

Introduction.Urinary tract infections (UTIs) are one of the most common bacterial infections of practical interest to specialists in different areas. The most common form of UTI is acute uncomplicated cystitis (AUC). To date, there is a limited number of studies devoted to the study of this problem in the Russian Federation.Purpose of research.The aim of this study was to assess the prevalence and clinical features of communitybased UTI in Russia.Materials and methods.The study was conducted in two stages, the first stage was completed in 2005- 2006, the second stage – in 2017, the method of questionnaire was used. During the first stage, young women were surveyed in organized groups (Universities and Colleges) using a paper traditional questionnaire in 20 cities of the Russian Federation, the Republic of Belarus and Kazakhstan. The second stage of the research was carried out using the technology of online surveys. Information about the online questionnaire was shared at specialized events in which mainly young people of 18-25 years participated – lectures at Universities, youth events, social networks, etc. During the second stage of the study, 20 cities of the Russian Federation were covered.Results.At the first stage of the study, 660 women were interviewed, the average age was 20.9 ± 1.6 (median - 18.0) years. At least one episode of dysuria was reported by 19.0% ± 1.5% of the respondents, with 22.9% of the respondents having recurrent cystitis. In the second stage of the study, 525 respondents were interviewed, the average age was 21.1 ± 1.8 years. The occurrence of at least one episode of dysuria during the life о21.1% ± 1.7 of the respondents, while 28.5% of ± 2.0 of the respondents reported the development of 3 or more episodes of the dysuria over the last 12 months.The median duration of cystitis symptoms was 2 days in both the first and second stages of the study. Most often, symptoms of dysuria persisted 1-3 days (64.1%), 4-5 days (23.0%) or 5-7 days (9.5%). The most correlated with the development of cystitis were family history (OR - 2.26-2.42), sexual activity and use of spermicides (OR – 1.69 and 2.43). From 40% to 50.9% of respondents in the case of dysuria do not seek medical care. When reached a medical care, most often consulted a doctor urologist (15.8% - 22.3%), gynecologist (16.7% - 17.7%), rarely a therapist (8.8 – 11.4) or other specialties (1.3% - 14.8%). No pharmacological treatments were used and 20.1% - 23.1% of the respondents, herbal medicine – 24.0% - 23.9%. Antibiotics, spasmolytic drugs and NSAIDs were the most commonly used. Over the past 12 years, there have been significant changes in the structure of antibiotics used in cystitis – the frequency of use of ampicillin, amoxicillin, co-trimoxazole, gentamicin has clearly decreased. On the contrary, increased frequency of use of phosphomycin, norfloxacin, levofloxacin.Conclusions.According to the survey of young women, 19.1%-21.1% of respondents report the occurrence of symptoms of AUC. 22.9% - 28.5% of women report the development of 3 or more episodes of dysuria during the year. Usually clinical symptoms persist for 2 days (median), the duration of dysuria in the range of 1-3 days reported 64.1% - 70.9% of patients. The risk of AUC correlated with the activity of sexual life, family history of UTI, spermicides using – OR – 1.69, 2.42 and 2.43, respectively. 40.3-50.9% patients with AUC did not seek medical care, the main method of treatment of cystitis in an outpatient setting is the use of antibiotics.Disclosure: The study did not have sponsorship. The authors have declared no conflicts of interest.

Неосложненные инфекции мочевыводящих путей у женщин – комплексная терапия

Urinary tract infections are among the most common infectious diseases. Due to high recurrence rates and the increasing resistance of uropathogens to antibacterial drugs, phytotherapy has become an important treatment option in modern urology. Phytotherapeutic medications are characterized by a wide spectrum of pharmacological action, efficacy, and low toxicity, thus allowing for a long term use for treating and preventing many chronic diseases without the risk of adverse effects. Medicinal plants that make up Phytolysin nefroCAPS contain substances that have a wide direct or indirect antimicrobial effect. Plant components of Phytolysin nefroCAPS also have anti-inflammatory and antispasmodic effects. The combination of antibacterial, anti-inflammatory and antispasmodic effect is especially beneficial for the treatment of uncomplicated UTIs. In patients with chronic recurrent cystitis, co-administration of the plant based medication Phytolysin nefroCAPS and an antibacterial drug is more effective than antibacterial therapy alone. Using Phytolysin nefroCAPS, as a part of the comprehensive management of urinary tract infections, can increase the effectiveness of antibiotic therapy, while reducing the treatment duration and the incidence of adverse effects.

Clinical implications of the anatomical position of the urethra meatus in women with recurrent post-coital cystitis: a case-control study.

Recurrent post-coital urinary infection (rUTI)-usually cystitis-is a common entity among otherwise healthy young women. However, little is known about the possible influence of genital anatomical variations. Only a shorter urethral meatus-anus distance has been described as a risk factor. The aim of this study was to evaluate our hypothesis that a shorter urethra-vagina distance is involved in the etiology of post-coital urinary infection. In this prospective case-control study, 61 young women aged between 18 and 40years with an acute post-coital UTI and a history of intercourse-related rUTI were consecutively recruited between January 2013 and February 2018. Fifty-six age-matched, sexually active women with no history of UTI served as controls. Perineal measurements included the distances between the clitoris-urethra (C-U), urethra-vagina (U-V), urethra-anus (U-A) and perineum. Demographic and sexual behavior characteristics and the morphology of the urethral meatus were also noted. Univariate analysis compared variables between groups. ROC analysis was used to define the efficiency of perineal measurements in predicting outcome. Odds ratios and 95% confidence intervals for UTI-predisposing variables were estimated using logistic regression analysis. The U-V and U-A distance was shorter in patients compared with controls [median (interquatile range): 16mm (14-18) vs. 21mm (19-23) and 51mm (47-53) vs. 59mm (55-62), respectively, p < 0.001]. The U-V performed better in ROC analysis than the U-A distance (AUC 0.952 vs. 0.875, p = 0.023). The only statistically significant parameters in multivariate analysis influencing UTI were BMI (OR: 0.702; 0.510-0.967, p = 0.030) and U-V (OR: 0.297; 0.161-0.549, p < 0.001). Our results indicate an association between shorter urethra-vagina distance and post-coital rUTIs.

Recurrent bacterial symptomatic cystitis: A pilot study on a new natural option for treatment.

The aim of our study was to explore the effectiveness of the combination of D-mannose, Salicin, and Lactobacillus acidophilus (La-14) in patients complaining recurrent symptomatic cystitis due to E. coli. From July 2013 to September 2014, 85 consecutive subjects (68 women and 17 men) affected by recurrent symptomatic cystitis were enrolled. Of those, 46 (33 women and 13 men) suffered from neurogenic bladder. Overall 78 patients received an initial 5-days regimen consisting on a tid oral combination of 1000 mg of D-mannose plus 200 mg of dry willow extract (salicin) (attack phase), followed by bid 7-days with 700 mg of D-mannose plus 50 mg (1x109 CFU) of Lactobacillus acidophilus (La-14) (maintenance treatment). The maintenance treatment was repeated every 15 days for the next two months. Patients' symptoms were evaluated through a 3-days bladder diary and a Visual Analogic Scale (VAS). After treatment VAS scores decreased from 8.07 ± 1.70 to 4.74 ± 2.07 (p = 0.001) in non-neurological patients (group A) and from 7.21 ± 1.90 to 3.74 ± 3.12 (p = 0.001) in the neurological patients (group B). A significant reduction of daily frequency was noted in both groups: from 14 ± 3 to 7 ± 3 (p = 0.001) in group A and from 15 ± 3 to 8 ± 3 (p = 0.001) in group B. A reduction of incontinence episodes in Group A patients was observed, as well as in 12/39 Group B. Improvements were maintained during follow-up. This therapeutic approach combining D-Mannose with Salicin (acute treatment) and Lactobacillus acidophilus La-14 (maintaining treatment) seems to be effective in symptomatic bacterial UTIs. Further larger and randomized control trials (RCTs) are needed to confirm our results.

Phylogenetic relationships, biofilm formation, motility, antibiotic resistance and extended virulence genotypes among Escherichia coli strains from women with community-onset primitive acute pyelonephritis

The present work set out to search for a virulence repertoire distinctive for Escherichia coli causing primitive acute pyelonephritis (APN). To this end, the virulence potential of 18 E. coli APN strains was genotypically and phenotypically assessed, comparatively with 19 strains causing recurrent cystitis (RC), and 16 clinically not significant (control, CO) strains. Most of the strains belong to phylogenetic group B1 (69.8%; p<0.01), and APN strains showed unique features, which are the presence of phylogroup A, and the absence of phylogroup B2 and non-typeable strains. Overall, the most dominant virulence factor genes (VFGs) were ecpA and fyuA (92.4 and 86.7%, respectively; p<0.05), and the mean number of VFGs was significantly higher in uropathogenic strains. Particularly, papAH and malX were exclusive for uropathogenic strains. APN and RC strains showed a significantly higher prevalence of fyuA, usp, and malX than of CO strains. Compared to RC strains, APN ones showed a higher prevalence of iha, but a lower prevalence of iroN, cnf1, and kpsMT-II. Hierarchical cluster analysis showed a higher proportion of two gene clusters (malX and usp, and fyuA and ecpA) were detected in the APN and RC groups than in CO, whereas iutA and iha clusters were detected more frequently in APN strains. The motility level did not differ among the study-groups and phylogroups considered, although a higher proportion of swarming strains was observed in APN strains. Antibiotic-resistance rates were generally low except for ampicillin (37.7%), and were not associated with specific study- or phylogenetic groups. APN and RC strains produced more biofilm than CO strains. In APN strains, iha was associated with higher biofilm biomass formation, whereas iroN and KpSMT-K1 were associated with a lower amount of biofilm biomass. Further work is needed to grasp the virulence and fitness mechanisms adopted by E. coli causing APN, and hence develop new therapeutic and prophylactic approaches.

Efficacy of N-acetylcysteine, D-mannose and Morinda citrifolia to Treat Recurrent Cystitis in Breast Cancer Survivals.

Breast cancer survivors in adjuvant therapy, frequently experience the estrogen deficiency with genitourinary symptoms mostly represented by recurrent bacterial cystitis. The objective of the present study was to evaluate the effectiveness of N-acetylcysteine, D-mannose and Morinda citrifolia fruit extract (NDM), when associated to antibiotic therapy, in reducing the persistence of recurrent cystitis in this risk population. Sixty breast cancer survived women with recurrent cystitis were retrospectively examined. Group 1, comprised of 40 patients treated with antibiotic therapy associated with NDM lasting for six months, Group 2 comprised of 20 patients treated with antibiotics alone. The use of NDM in combination with antibiotic therapy showed a significant reduction in positive urine cultures, compared to antibiotics alone. Subjects of Group 1 rather than those of Group 2, showed improvement in symptoms score of urgency, frequency, urge incontinence, recurrent cystitis, bladder and urethral pain. In breast cancer survived women affected by genitourinary discomfort, the combination of NDM and antibiotic therapy showed a greater efficacy in reducing urinary tract infections and urinary discomfort with respect to antibiotic use only.

Long-term efficacy of intravesical instillation of hyaluronic acid/chondroitin sulfate in recurrent bacterial cystitis: 36 months' follow-up

Purpose of Investigation: To compare the efficacy and safety of intravesical instillation of hyaluronic acid/chondroitin sulfate with conventional long-term antibiotic prophylaxis in women with recurrent bacterial cystitis. Materials and Methods: In this analysis of a prospective study, where women with recurrent bacterial cystitis were randomised to intravesical hyaluronic acid 800 mg/chondroitin sulfate 1,000 mg (group 1) or long-term antibiotic prophylaxis (group 2 – control group), patients in group 1 were evaluated 36 months after treatment. Outcomes included cystitis recurrence, subjective pain symptoms based on a visual analogue scale (VAS), three-day voiding, pelvic pain and urgency/frequency symptoms (PUF scale), sexual function questionnaire, quality of life based on King’s Health Questionnaire (KHQ), maximum cystometric capacity (MCC), and adverse events. Results: Twelve women (mean ± standard deviation 59.3 ± 13.9 years old) underwent follow-up at 36 months after treatment. There were improvements in all efficacy evaluations at 36 months’ follow-up, with significantly favourable mean changes from baseline in cystitis frequency (–5.4 episodes/year; p p = 0.002), urinary VAS (–6.7 points; p p p p p Conclusions: Intravesical hyaluronic acid/chondroitin sulfate significantly reduced cystitis recurrence and associated symptoms and was well tolerated in women with recurrent bacterial cystitis at 36 months’ after treatment.

MP23-16 ULTIMATE FATE OF RECURRENT CYSTITIS CAUSED BY ESBL-PRODUCING E.COLI; A PROSPECTIVE LONGITUDINAL STUDY

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-16 ULTIMATE FATE OF RECURRENT CYSTITIS CAUSED BY ESBL-PRODUCING E.COLI; A PROSPECTIVE LONGITUDINAL STUDY Sun Tae Ahn, Hyeong Guk Jeong, Tae Yong Park, Jong Wook Kim, Hong Seok Park, Du Geon Moon, Jeong Gu Lee, and Mi Mi Oh Sun Tae AhnSun Tae Ahn More articles by this author , Hyeong Guk JeongHyeong Guk Jeong More articles by this author , Tae Yong ParkTae Yong Park More articles by this author , Jong Wook KimJong Wook Kim More articles by this author , Hong Seok ParkHong Seok Park More articles by this author , Du Geon MoonDu Geon Moon More articles by this author , Jeong Gu LeeJeong Gu Lee More articles by this author , and Mi Mi OhMi Mi Oh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.748AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E.coli) have become a serious health concern worldwide due to their multidrug-resistance with seriously limiting therapeutic options. There were numerous studies on risk factors for development of ESBL-producing E.coli; however the long-term ultimate fate of UTIs caused by ESBL-producing E.coli remains unknown. Thus, here in we longitudinally monitored female patients with UTIs due to ESBL-producing E.coli and evaluated the recurrence rate and causative organism once UTI recurred during follow up. METHODS Between Jan 2014 and Dec 2014, we enrolled the female patients with UTIs caused by ESBL-producing E.coli, and each patient was followed up 24 months longitudinally. Clinical and microbiological data were collected. During observation period, we investigated the recurrence rate per se and recurrence rate of UTIs due to ESBL producing E.coli. Also we evaluated the risk factors for recurrence of UTIs due to ESBL producing UTIs during follow up. RESULTS Among 127 patients who were enrolled initially, total 106 patients complete the study. Total 45 (45/106, 42.5%) patients experienced UTI recur during observation period and among those patients 34 (34/45, 75.6%) patients recurred with ESBL-producing E.coli. The recurrences with ESBL-producing E.coli were more frequent in patients who had history of cephalosporin use (Table 1). In multivariate analysis, history of cephalosporin use was independent risk factors of recurrence UTIs with ESBL-producing E.coli compared with those who recurred with ESBL negative E.coli (OR 12.92, Cl 1.45-115.6, P=0.022) CONCLUSIONS About 75% of patients initially caused by ESBL producing E.coli recurred with ESBL producing E.coli during follow up. The history of cephalosporin use was identified as the risk factor of UTI recurrence caused by ESBL-producing E.coli in our cohort. Thus, recurrent cystitis patients who have the history of cephalosporin use and UTIs with ESBL-producing E.coli are warranted to be treated base on antibiotic susceptibility profiles of the previous ESBL-producing E.coli. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e287 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Sun Tae Ahn More articles by this author Hyeong Guk Jeong More articles by this author Tae Yong Park More articles by this author Jong Wook Kim More articles by this author Hong Seok Park More articles by this author Du Geon Moon More articles by this author Jeong Gu Lee More articles by this author Mi Mi Oh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Polysaccharide of Escherichia coli in the Prevention of Recurrent Urinary Tract Infection: An Evidence-Based Review

Recurrent urinary tract infection is frequent and it is related to morbidity, costs and growing antibiotic resistance. OM 8930 vaccine is composed by Escherichia coli polysaccharide and it is a possible prophylactic measure, but there is doubt as to its effectiveness. We performed a systematic review in evidence-based medicine databases with rigorous bibliography selection. We found an effective decrease of recurrences in test groups. We recommend the administration of the vaccine as prophylaxis of recurrent cystitis. The vaccine has impact on the recurrent cystitis relapse rate. We suggest that more studies be carried out to evaluate the vaccine cost-benefit and its effectiveness in complicated urinary infections.

Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis: What should we do?

PurposeLower urinary tract symptoms (LUTS) may be associated with chronic urinary tract infection (UTI) undetected by routine diagnostic tests. Antimicrobial therapy might confer benefit for these patients.Materials and methodsOver 10 years, we treated patients with chronic LUTS. Pyuria was adopted as the principal biomarker of infection. Urinary leucocyte counts were recorded from microscopy of fresh midstream urine (MSU) samples. Antibiotics were prescribed and the prescription adjusted to achieve a measurable clinical response and a reduction in pyuria.ResultsWe treated 624 women [mean age = 53.4 years; standard deviation (SD) = 18] with chronic LUTS and pyuria. Mean duration of symptoms prior to presentation was 6.5 years. Only 16% of MSU cultures submitted were positive (≥105 cfu ml-1). Mean treatment length was 383 days [SD = 347; 95% confidence interval (CI) = 337–428]. Treatment was associated with a reduction in total LUTS (F = 98; p = 0.0001), 24-h frequency (F = 75; p = 0.0001), urinary urgency (F = 90; p = 0.0001), lower urinary tract pain (F = 108; p = 0.0001), voiding symptoms (F = 10; p = 0.002), and pyuria (F = 15.4; p = 0.0001). Full-dose first-generation antibiotics for UTI, such as cefalexin, nitrofurantoin, or trimethoprim, were combined with methenamine hippurate. We recorded 475 adverse events (AEs) during 273,762 treatment days. There was only one serious adverse event (SAE). We observed no increase in the proportion of resistant bacterial isolates.ConclusionThis large case series demonstrates that patients with chronic LUTS and pyuria experience symptom regression and a reduction in urinary tract inflammation associated with antimicrobial therapy. Disease regression was achieved with a low frequency of AEs. These results provide preliminary data to inform a future randomized controlled trial (RCT).

Фитолизин nefroCAPS в комплексном лечении женщин с хроническим рецидивирующим циститом

Recurrent lower urinary tract infections (UTI) in women are one of the most challenging problems of modern urology, which is associated both with their high incidence and increasing resistance of uropathogens to antibacterial drugs. Due to this fact, the phytotherapy of infectious and inflammatory diseases of the urinary tract has received increased attention. To investigate the effectiveness of Phytolysin nefroCAPS in the complex management of women with chronic recurrent cystitis. 50 women with chronic recurrent cystitis underwent a complex examination. They were divided into two groups depending on the treatment they received. Patients of the 1st group (n=27) received a combination therapy: fosfomycin (monural) 3 g (single dose) and Phytolysin nefroCAPS one capsule three times daily for three months. Patients of the 2nd group (n=23) were administered a single 3-g dose of fosfomycin (monural). Follow-up examinations were performed 1, 3 and six months after initiation of the treatment. In patients of the 1st group, clinical manifestations of the disease disappeared earlier, and they had fewer recurrences than the patients of the 2nd group. Also, bacteriological study of urine showed a more persistent antimicrobial effect among patients of the 1st group. In patients with chronic recurrent cystitis, plant-based preparation Phytolysin nefroCAPS administered concurrently with an antibacterial drug is more effective than antibiotic monotherapy.

Chronic renal failure in equine due to ascending pyelonephritis predisposed by cauda equina syndrome: case report

ABSTRACT This report describes the case of a mare, of the Campeiro breed, used as an embryo donor, which had recurrent cystitis and urinary incontinence crisis. Clinical signs evolved to progressive weight loss, anorexia, apathy, and isolation from the group. Physical examination showed tail hypotonia, perineal hypalgesia, rectal and bladder sagging compatible with signs related to cauda equina syndrome. Complementary laboratory and sonographic assessment, and necropsy confirmed the diagnosis of chronic renal failure (CRF), which was attributed to the ascending pyelonephritis. The examination of urine culture showed growth of bacteria of the genus Streptococcus sp. This is a rare case in the equine species where the lower motor neuron dysfunction led the development of infectious process in the urinary tract, progressing to renal chronic condition incompatible with life.

The aberrant urethral meatus as a possible aetiological factor of recurrent post-coital urinary infections in young women

Recurrent urinary tract infections (rUTI) in women is a common cause of morbidity worldwide. In young women recurrent cystitis associated with sexual intercourse is quite common; however not all sexually active women will suffer a post-coital UTI episode. A variety of possible predisposing factors has been described, including behavioral risk patterns, genetic factors and increased virulence of certain subtypes of uropathogens. It has long been regarded that anatomical anomalies are rare in this setting of rUTIs. The shorter distance of the urethra to the anus has been the only anatomical risk factor described that is marginally significant in predisposing women for rUTIs. We hereby present a hypothesis that focuses on the shorter distance of the urethral meatus to the vaginal opening as the mainstay of sexually-induced rUTIs. In this theory of “functional hypospadias”, the low misplacement of the urethral opening allows for easier advancement of pathogen-laden mucous by penile thrust and increased friction during intercourse. Our hypothesis suggests that a shorter distance of the urethral meatus to the vaginal opening (and not the anus itself) is an anatomical risk factor for recurrent post-coital cystitis. Verification of this hypothesis might lead to a more patient-oriented approach by alerting clinicians in looking for an aberrant meatus and save the patient from unnecessary imaging and endoscopic examinations often used in these cases. Moreover it may also aid the patient in understanding her anatomy and modify behavioral risk practices.

A case of chronic schistosomiasis four years after infestation

Authors present a case of bilharziosis incidentally diagnosed in a patient undergoing TURB for suspected bladder cancer. The patient, who in 2005 had gone to Malaysia, had been suffering from recurrent hemorrhagic cystitis since 2007, which were treated with antibiotic therapy. In November 2009 he presented to our observation for persistent hematuria, underwent ultrasound examination, fibroscopy and TURB diagnostics for suspicious lesions. The histopathology diagnosis found granulomatous lesions with typical parasites eggs due to schistosomiasis eggs. As a consequence of that, the patient underwent medical therapy. The pathologist's role becomes nullifying not only for the diagnosis of parasitic infections but also for the exclusion or evidence of urothelial squamous neoplasia. The low incidence of this rare parasitic disease in European tourists and the presence of immigrants in our country require to spread the knowledge of these parasites and the most simple tests for early detection.

A Delayed Appearance of the Secondary Bladder Stone 10 Years After Tension-free Vaginal Tape Procedure

The occurrence of bladder calculi in women is uncommon, and the evaluation of bladder stone in women with any history of previous pelvic surgery demands careful attention. Bladder erosion due to previous anti-incontinence surgery formed the nidus for stone formation, and often presented as recurrent cystitis or refractory urinary incontinence since the early postoperative period. We hereby report a rarely delayed appearance of the symptomatic iatrogenic bladder stone occurring 10 years after previous tension-free vaginal tape procedure.

Rehabilitation of reproductive-age patients with recurrent vaginosis, vulvovaginitis and cystitis: the role of contraceptives with bioidentical estrogen

Rehabilitation of reproductive-age patients with recurrent vaginosis, vulvovaginitis and cystitis: the role of contraceptives with bioidentical estrogen

Study results show increased hydration can prevent recurrent cystitis

Study results show increased hydration can prevent recurrent cystitis