Recurrent Cystitis Research Articles

Manual removal of a rare cystic calculus concurrent with recurrent hemorrhagic cystitis in an Arabian mare: A case report

A nine-year-old Arabian mare was presented with symptoms of frequent hematuria, dysuria, pollakiuria and urine dribbling. This report describes a manual removal procedure of a cystic urolith in an Arabian mare. A complete blood count showed a slight reduction in hemoglobin. Renal function tests showed high normal ranges in BUN. The urine sample was very cloudy and had a specific gravity of (1.019) with alkaline pH. The chemical examination showed high hemoglobin concentration with glucose traces. The microscopic examination showed a high number of pus cells and red blood cells with few numbers of rounded epithelial cells. Bacterial culture revealed Klebsiella spp and as a result of the sensitivity test, sensitivity to amoxicillin/ clavulanic acid, amikacin and gentamicin was determined. Cystoscopy revealed a large cystic urolith cranioventrally on the left wall of the urinary bladder. The apex vesicae was inflamed, with blood sludge. The definitive diagnosis was chronic hemorrhagic cystitis caused by a large cystic urolith. As a result, it was concluded that the removal of relatively large calculi through the urethra in the mare, while providing some protection to the bladder neck and urethral mucosa, has been effective with minimal complications.

Results of open prospective study of clinical assessment of efficacy and safety of Nifuratel during exacerbations of recurrent cystitis

The article presents the results of an open prospective study of the clinical assessment of the efficacy and safety of the use of nifuratel during exacerbations of recurrent cystitis. The aim of the program was to assess the change in the duration of the relapse-free course of recurrent cystitis and the effectiveness of the course treatment with Nifuratel-SZ in the treatment of recurrent cystitis. During a non-interventional program, Nifuratel-SZ has been shown to be an effective and well-tolerated drug for the treatment of recurrent uncomplicated lower urinary tract infection.

Results of a clinical study of the drug efficacy and safety for intravesical administration based on bacteriophages in therapy in patients with chronic recurrent cystitis

Background. Urinary tract infections remain one of the urgent problems in the aspect of qualified medical care. The causative agents of nosocomial infections are becoming more and more resistant to the drugs used, while the rate of new drugs synthesis is lower than the rate of development of antibiotic resistance. Routine and empirical prevention of recurrent urinary tract infections is often ineffective.
 Aim. To study the efficacy and safety of intravesical application of the drug based on bacteriophages in therapy in patients with chronic recurrent cystitis.
 Materials and methods. A clinical study was carried out to study the efficacy and safety of the drug for intravesical administration based on bacteriophages in therapy in patients with chronic recurrent cystitis. The study included 75 patients who were divided into 3 groups in a 1: 1: 1 ratio. In the main group, the drug for intravesical administration based on bacteriophages, as well as rectal suppositories with bacteriophages were used; in the control group only a drug for intravesical administration based on bacteriophages or rectal suppositories with bacteriophages. On visits 1-4, all patients underwent a clinical blood test, general urine analysis, bacteriological urine analysis, as well as urine analysis by the polymerase chain reaction method. The analysis of the patients condition in groups was carried out according to the dynamics of main clinical symptoms changes, data from validated scales for assessing pelvic pain and urgency/frequency of urination and assessment of symptoms of acute cystitis (Acute Cystitis Symptom Score ACSS), as well as the dynamics of changes in objective parameters of laboratory studies and possible changes in sensitivity uropathogens to antibacterial drugs.
 Results. The average age of the patients included in the study was 50.6 years. In all 3 groups, bacteriological examination of urine showed a predominant growth of Escherichia coli (3104 CFU/ml). In the course of the study, there was a good tolerance to therapy, a decrease in clinical symptoms, as well as a significant decrease in the total score according to the pelvic pain scale and urgency/frequency of urination and the ACSS scale in all patients.
 Conclusion. The emergence of a large number of microorganisms resistant to various antibiotics and their rapid spread in the environment has led to an increase in scientific interest in bacteriophage therapy as an alternative method of treatment. The overall subjective effectiveness of the therapy in our study was more than 80%, safety - 100%. Further research will allow for a personalized approach to the treatment of infectious diseases of the urinary system.

A multicenter study of antimicrobial prescriptions for cats diagnosed with bacterial urinary tract disease.

ObjectivesThe aim of this study was to evaluate initial antimicrobial therapy in cats diagnosed with upper or lower bacterial urinary tract infections at veterinary practices in the USA and Canada.MethodsElectronic medical records from a veterinary practice corporation with clinics in the USA and Canada were queried between 2 January 2016 and 3 December 2018. Feline patient visits with a diagnosis field entry of urinary tract infection, cystitis and pyelonephritis, as well as variation of those names and more colloquial diagnoses such as kidney and bladder infection, and where an antimicrobial was prescribed, were retrieved.ResultsPrescription data for 5724 visits were identified. Sporadic cystitis was the most common diagnosis (n = 5051 [88%]), with 491 (8.6%) cats diagnosed with pyelonephritis and 182 (3.2%) with chronic or recurrent cystitis. Cefovecin was the most commonly prescribed antimicrobial for all conditions, followed by amoxicillin–clavulanic acid. Significant differences in antimicrobial drug class prescribing were noted between practice types and countries, and over the 3-year study period. For sporadic cystitis, prescription of amoxicillin–clavulanic acid increased significantly and cefovecin decreased between 2016 and 2018, and 2017 and 2018, while fluoroquinolone use increased between 2017 and 2018.Conclusions and relevanceThe results indicate targets for intervention and some encouraging trends. Understanding how antimicrobials are used is a key component of antimicrobial stewardship and is required to establish benchmarks, identify areas for improvement, aid in the development of interventions and evaluate the impact of interventions or other changes.

Специфика психологического функционирования пациентов с интерстициальным циститом

Introduction. The use of psychotherapeutic strategies may be preferable for patients with interstitial cystitis, who do not respond to psychopharmacotherapy and even after somatotropic therapy. therapy, surgical interventions continue to experience uncomfortable sensations. However, many urologists, given the presence of the psychosocial etiology of cystitis in some patients, continue to advocate surgical treatment. Goal. Familiarizing urologists, gynecologists, and mental health professionals with the fact that cystitis consists of heterogeneous subtypes with corresponding pathogenic pathways, comorbid mental disorders, and emotional characteristics. Among these subtypes, the psychosocial phenotype should be distinguished, which has its own specifics, psychodynamics and requires appropriate complex treatment tactics. Materials and methods. 35 women from 25 to 48 years old suffering from recurrent cystitis for 7-12 years and 35 women without urological disorders. The following diagnoses are observed in patients: somatoform autonomic dysfunction of the genitourinary system (F45. 34); psychological factors in chronic recurrent cystitis (F54); recurrent depressive disorder, an episode of moderate severity (F33.1). The patients were examined using the questionnaire of the severity of psychopathological symptoms (SCL-90-R) and the scale of diagnosis of early maladaptive schemes (YSQ S3R). Results. The psychosocial phenotype of cystitis is represented by high somatization, the presence of obsessive-compulsive traits, interpersonal sensitivity, a tendency to develop depression and an anxiety spectrum of disorders. Among the maladaptive cognitive behavioral patterns, the following predominate: negativism/ pessimism, search for approval, feeling of vulnerability, lack of self-control, submission, self-sacrifice, feeling of abandonment and instability, distrust of other people. Conclusion. In addition to psychopharmacotherapy for the treatment of anxiety and depressive symptoms in patients with cystitis, psychotherapy aimed at minimizing difficulties in emotional awareness (alexithymia) and unresolved childhood trauma of relationships should be included in the treatment program. Multimodal psychodynamic psychotherapy and cognitive behavioral therapy can reduce symptoms, affect the immune and nervous systems, and the psychological well-being of patients with cystitis.

Ефективне лікування й профілактика часто рецидивуючої інфекції сечовивідних шляхів препаратом золотарника звичайного (Solidago virgaurea) Цисто-аурин®

Нами проведено дослідження клінічної та лабораторної ефективності, а також оцінка впливу на якість життя інтермітуючої терапії препаратом золотарника звичайного Цисто-аурин у 96 хворих на часто рецидивуючу інфекцію сечовивідних шляхів (ІСШ). Після отримання інформованої згоди хворі були розділені на три статистично однорідні групи. Протягом лікування пацієнтки всіх груп використовували стратегію поведінкової терапії та посткоїтальної профілактики. Пацієнтки групи А додатково отримували Цисто-аурин по 1 табл. 4 рази на день курсами по 15 днів кожного місяця протягом 6 місяців, групи В — той же препарат по 2 табл. 2 рази на день такими ж курсами, пацієнтки групи С (порівняння) спеціальної терапії не отримували. Упродовж дослідження отримані об’єктивні дані, що свідчать про вірогідне зниження числа рецидивів ІСШ на 92,3 і 73,3 % протягом 6 місяців лікування, залежно від кратності прийому препарату. Аналіз впливу досліджуваного препарату на лабораторні прояви часто рецидивуючої інфекції сечової системи показав позитивний ефект інтермітуючого режиму терапії щодо піурії, редукцію прозапальної активності та статистично вірогідне зменшення проявів запалення в сечовій системі. Ефективність редукції лейкоцитурії у хворих, які приймали препарат, становила 73,4 і 44,6 %, тобто лейкоцитурія була в 3,7 і 1,8 раза нижче вихідних значень. У той же час серед хворих групи С статистично значущої динаміки виявлено не було. Дискретна і кількісна оцінка впливу досліджуваного препарату на бактеріурію показала клінічно значущий і статистично вірогідний бактеріо­статичний ефект Цисто-аурину як в процесі лікування препаратом (на 41,0 і 27,6 % відповідно), так і в проспективному 6-місячному періоді спостереження після його прийому (на 30,3 і 18,0 % відповідно), що є важливим підтвердженням впливу препарату на персистенцію мікробів у сечовій системі. Структуризація антибактеріального ефекту щодо клінічно значущих уропатогенів підтвердила редукцію штамів E.сoli на 61,1 і 31,9 %, Klebsiella pneumoniae — на 33,1 і 17,1 %, P.mirabilis — на 19,1 і 12, 9 %, P.aeruginosa — на 21,1 і 14,1 %, Candida spp. — на 19,4 і 14,5 % відповідно. Оцінка впливу досліджуваного препарату на симптоматику рекурентного хронічного циститу (шкала UTISA) показала вірогідне зниження ключових клінічних симптомокомплексів рецидивної ІСШ: полакіурії (на 48,3 % в обох групах), імперативних позивів (59,8 і 30,1 %), болю й печіння (42,6 і 30,2 %), неповного випорожнення сечового міхура (53,8 і 30,9 %), а також інтегрального показника клінічних проявів патології (24,7 і 39,2 % відповідно). Динаміка показників якості життя, що пов’язана із здоров’ям (шкала SF-36), на тлі прийому препарату продемонструвала статистично значущу індукцію ключових доменів якості життя хворих на часто рецидивуючу ІСШ: психічного здоров’я (33,4 % проти 32,5 %) і кумулятивного показника загальної якості життя (19,6 % проти 14,6 % відповідно).

Эффективность применения пробиотиков в профилактике рецидивирующих инфекций нижних мочевыводящих путей и бактериального вагиноза

Introduction The literature data indicate that bacterial vaginosis (BV) increases the risk of development of lower urinary tract infections (LUTI). Thus, it is reasonable to assume that the use of probiotics, in particular Lactoginal, can be effective in preventing relapses of LUTI. Aim To study the efficiency of probiotics, particularly Lactoginal, for the prevention of recurrent LUTI and BV. Materials and methods A total of 120 women with chronic recurrent bacterial cystitis in the acute stage and concomitant bacterial vaginosis were randomized into two groups of 60 patients. In group 1, standard antibacterial therapy was used according to guidelines of professional societies. In group 2, vaginal probiotic Lactoginal was prescribed after standard treatment. Results The results obtained in this study correspond to the literature data. The additional use of probiotics in the complex therapy of chronic lower urinary tract inflammation contributed to the normalization of the lactobacilli concentration in 93% of cases, in contrast to standard antibacterial therapy, after which the normal flora was preserved only in 40% of cases. In addition, a reduction in the number of relapses of BV was seen. Moreover, it was found that in the group of patients treated with Lactoginal, there was 18.3% less recurrence of cystitis within 6 months than in the control group (p Conclusion The use of probiotics, in particular, Lactoginal vaginal capsules, in women with BV after antibacterial therapy contributes to a faster recovery and longer preservation of the normal vaginal flora, which allows to the prolongate the relapse-free period of both chronic bacterial cystitis and BV.

Evaluation of antimicrobial prescriptions in dogs with suspected bacterial urinary tract disease.

BackgroundAntimicrobials are commonly used to treat urinary tract disease in dogs. Understanding antimicrobial use is a critical component of antimicrobial stewardship efforts.Hypothesis/ObjectivesTo evaluate antimicrobial prescriptions for dogs diagnosed with acute cystitis, recurrent cystitis, and pyelonephritis.AnimalsDogs prescribed antimicrobials for urinary tract disease at veterinary practices in the United States and Canada.Materials and MethodsA retrospective review of antimicrobial prescriptions was performed.ResultsThe main clinical concerns were sporadic bacterial cystitis (n = 6582), recurrent cystitis (n = 428), and pyelonephritis (n = 326). Amoxicillin/clavulanic acid (2702, 41%), cefpodoxime (1024, 16%), and amoxicillin (874, 13%) were most commonly prescribed for sporadic bacterial cystitis. The median prescribed duration was 12 days (range, 3‐60 days; interquartile range [IQR], 4 days). Shorter durations were used in 2018 (median, 10 days; IQR, 4 days) compared to both 2016 and 2017 (both median, 14 days; IQR, 4 days; P ≤ .0002).Amoxicillin/clavulanic acid (146, 33%), marbofloxacin (95, 21%), and cefpodoxime (65, 14%) were most commonly used for recurrent cystitis; median duration of 14 days (range, 3‐77 days; IQR, 10.5 days). Amoxicillin/clavulanic acid (86, 26%), marbofloxacin (56, 17%), and enrofloxacin (36, 11%) were most commonly prescribed for pyelonephritis; however, 93 (29%) dogs received drug combinations. The median duration of treatment was 14 days (range, 3‐77 days; IQR, 11 days).Conclusions and Clinical ImportanceDecreases in duration and increased use of recommended first‐line antimicrobials were encouraging. Common drug choices and durations should still be targets for antimicrobial stewardship programs that aim to optimize antimicrobial use, concurrently maximizing patient benefits while minimizing antimicrobial use and use of higher tier antimicrobials.

Efficacy of Lactobacillus vaginal suppositories for the prevention of recurrent cystitis: A phase II clinical trial

To prospectively assess the efficacy and safety of Lactobacillus vaginal suppositories for the prevention of recurrent cystitis. In this single-arm, open-label, phaseII clinical trial, participants used vaginal suppositories containing the GAI 98322 strain of Lactobacillus crispatus for 1year either every 2days or three times per week. The primary end-point was the response rate, as assessed by the number of episodes of recurrent cystitis during the year of administration. The secondary end-points were the response rate, as assessed by episodes of recurrent cystitis during the 1year after completion of the administration period; the total number of episodes of recurrent cystitis before, during and after administration; adverse events; and changes in urine bacteria and the vaginal microbiome. A total of 28 women were enrolled, and 21 completed the study. A total of 18 patients achieved an effective response (86%) during administration. The suppressive effects of Lactobacillus vaginal suppositories on episodes of cystitis continued up to 1year after the last suppository was administered. There was a significant reduction in the mean number of episodes of cystitis, both during and after administration of Lactobacillus vaginal suppositories. No treatment-related adverse events were observed. Amplicon sequencing analysis of the vaginal microbiome showed that Lactobacillus species colonized the vagina during the periods when episodes of cystitis were absent. Vaginal suppositories containing the GAI 98322 strain of Lactobacillus crispatus effectively prevent episodes of recurrent cystitis, both during administration and for at least 1year after administration.

Analysis of Recurrent Urinary Tract Infection Management in Outpatient Settings Reveals Opportunities for Antibiotic Stewards

Background: Studies of antibiotic prescribing choice and duration have typically excluded women with recurrent UTI (rUTI), yet the Infectious Disease Society of America (IDSA) UTI treatment guidelines are applicable to recurrent and sporadic cystitis. We sought to better understand prescribing practices among uncomplicated rUTI patients in terms of choice of drug, duration of therapy, and the risk factors for receiving guideline-discordant therapy. Methods: We performed a retrospective database study by extracting electronic health record data from adults seen at academic primary care, internal medicine, or urology practices between November 2016 and December 2018. Inclusion criteria included having ≥2 or ≥3 International Classification of Diseases Tenth Edition (ICD-10) cystitis codes recorded within a 6- or 12-month period, respectively. We excluded patients with ICD-10 codes indicating any structural or functional genitourinary comorbidities, interstitial cystitis, vaginosis, compromised immune systems, or pregnancy in the prior year. Patients were also excluded if they had signs or symptoms of pyelonephritis at presentation. Results: Overall, 232 patients presented for 597 outpatient visits. Most were married (52.2%), non-Hispanic white (62.9%), and female (92.2%), with a median age of 58 years (IQR, 41–68). Only 21% of visits with an antibiotic prescribed for treatment consisted of a first-line therapy agent prescribed for the recommended duration. In terms of antibiotic choice, these agents were prescribed in 58.4% of scenarios, which primarily included nitrofurantoin (37.8%) and trimethoprim-sulfamethoxazole (TMP-SMX) (20.3%). Guideline-discordant choices of fluoroquinolones (28.8%), and β-lactams (11.2%) were the second and third most commonly prescribed drug categories, respectively. Multinomial logistic regression identified age (OR, 1.02; 95% CI, 1.002–1.04) or having a telephone visit (OR, 3.17; 95% CI, 1.54–6.52) as independent risk factors for receiving a β-lactam. The duration exceeded the 3-day guideline recommendation in 87.6% of fluoroquinolones and 73% of TMP-SMX (73%) prescriptions, and 61% of nitrofurantoin prescriptions exceeded the recommended 5-day duration. Multiple logistic regression analysis revealed that seeking care at a urology clinic (OR, 2.81; 95% CI, 1.59–5.17) served as an independent factor for therapy duration exceeding guideline recommendations. Conclusions: This retrospective study revealed shortcomings in prescribing practices in the type and duration of therapy for rUTI. rUTI as well as sporadic UTI are important targets for outpatient antibiotic stewardship interventions.Funding: This investigator-initiated research study was funded by Rebiotix Inc, a Ferring Company.Disclosures: None

Нетипичные случаи рецидивирующего посткоитального цистита у женщин: приобретенная гипермобильность уретры

Introduction. Recurrent postcoital cystitis is considered as a disease that is a consequence of certain congenital prerequisites in the structure of the lower parts of the urogenital tract in women. Materials and methods. When writing the article, we used data on the surgical treatment of recurrent postcoital cystitis in women, posted in the PubMed databases (https://www.ncbi.nlm.nih.gov/pubmed/) and the Scientific Electronic Library Elibrary.ru (https://elibrary.ru/). When searching the databases, the following keywords were used: postcoital cystitis , honeymoon cystitis , acquired postcoital cystitis , hymenotomy , urethrogenital adhesions ( postcoital cystitis , honeymoon cystitis , acquired postcoital cystitis , transposition of the urethra , hymenotomy , urethro-hymenal fusion ). Results. Patients with recurrent postcoital cystitis represent a heterogeneous group from an etiological point of view. A detailed analysis of complaints and anamnesis of the disease, as well as the causes, conditions and time of recurrence of cystitis helps to clarify the pathogenesis of the disease in each case. The article presents clinical cases of acquired recurrent postcoital cystitis in women who have previously undergone surgery on the lower urinary tract. Conclusion. Recurrent postcoital cystitis can be the result of not only congenital anatomical prerequisites, but also acquired changes in the urogenital area due to surgery or injury.

Treatment of recurrent cystitis during the post-COVID-19 recovery: a case report

In the modern literature on the coronavirus disease 2019 (COVID-19), much attention is paid to patients with a severe clinical course. But no less important is the recovery after disease. The first wave outcomes showed the significance of recovery period in such patients. Intensive drug therapy of COVID-19 increases the risk of iatrogenic complications, while the often long-term healing process is associated with a decrease in immune response, which activates latent infections and opportunistic pathogens. This necessitates an individual therapy selection, especially for elderly patients with comorbidities. The drugs of choice in such a situation should be as effective and safe as possible.The paper presents a case report of managing recurrent cystitis that developed during the post-COVID-19 recovery. The need for an additional search and assessing the significance of the revealed etiology, an integrated approach with the appointment of a broad-spectrum antiviral drug and a bacteriophage therapy is presented.

Эндоскопические и морфологические признаки хронического рецидивирующего папилломавирусного цистита

INTRODUCTION Chronic recurrent cystitis (CRC) is a common disease in the female population and a serious medical problem. There are not enough data about etiology of this desiase and effective treatment. OBJECTIVE To increase the accuracy of the differential diagnosis of bacterial and papillomavirus chronic recurrent cystitis. MATERIALS AND METHODS Analysis of endoscopic and morphological diagnostic methods of 118 patients with CRC, which, depending on the etiological factor, were divided into two groups. Group I (n=65) patients with CRC of HPV etiology and Group II (n=53) - CRC of bacterial etiology (E. coli). All patients were examined according to the EAU and RSU recommendations, and an endoscopic examination of the bladder (cystoscopy) was additionally included, followed by morphological examination of biopsy specimen of the urinary bladder. RESULTS The endoscopic picture of bacterial CRC usually is caused by hyperemia of the mucous membrane of the bladder, hyperemia and injection of vessels with the participation of (small-puncture/diapedesic) hemorrhages without signs of proliferative changes. The endoscopic picture in papillomavirus CRC in all patients presented by focal or diffuse, slightly elevated, exophytic, often polypoid formations of a whitish or whitish-gray color, usually localized in the Leto triangle. Morphological analysis of biopsy tissue of the urinary bladder in patients with bacterial cystitis in the mucous and submucous layer showed edema, thickening of the urothelium, capillary abundance, inflammatory infiltration, represented by lymphocytes, plasma cells and leukocytes, among which neutrophilic macrophage leukocytes were predominant. Morphological analysis of the bladder mucosa in all examined patients with signs of HPV-related lesions showed a thickening of the urothelium, squamous metaplasia of the urothelium, chronic inflammation, microcirculatory vascular reaction and edema. An important distinctive pathomorphological sign of HPV within urinary bladder was the presence of koilocytic transformation of urothelium cells due to the cytopathic effect of the virus. CONCLUSIONS Papillomavirus CR has characterized by an infectious-inflammatory process in the bladder paries, with lymphocytic-plasmatic infiltration and coylocytic transformation of the urothelium.

PUK8 Water: A Prevention Strategy to Decrease the Economic Burden of Recurrent Cystitis Among Women in the United States of America

Urinary tract infections (UTI) are common, highly prevalent in women and represent a substantial economic burden to the healthcare system. In the present study, we estimated the budgetary impact of preventing UTI by increasing water intake in American women with low fluid intake and recurrent cystitis. A Markov model was developed to compare costs and clinical outcomes between usual fluid intake vs. an additional 1.5L/day of water in American women with low fluid intake and recurrent cystitis. Model assumptions included results from a randomized controlled trial reporting increasing water intake by 1.5L/day over usual fluid intake decreased by 48% the risk of developing cystitis in this target population. Outcomes were based on payer perspective and included both direct costs (general practitioner visit, dipstick, urinalysis, antibiotic treatment, pyelonephritis complications and water) and indirect costs (work loss). Costs were adjusted for inflation and updated to 2019 using the country-specific consumer price index and are reported in U.S. dollars ($). A 10-year follow-up period was considered to capture the impact of the prevention strategy on the long-term morbi-mortality resulting from UTI complications. Total UTI cost per person was $1,353, with direct costs of $676. Considering the target population, this corresponded to an annual budget impact of $806 million. Assuming a gradual increase in compliance with high water intake recommendation, from 10% in the first year to 80% after 10 years, 4,170,926 cystitis events and 250,256 pyelonephritis events could be prevented over 10 years, resulting in a cumulative cost saving of $1.5 billion. Even when considering 10% compliance, 89,449 fewer cystitis, 5,367 fewer pyelonephritis and an associated budget saving of $33 million would be expected. Increasing water intake can reduce the economic burden associated to cystitis, resulting in significant cost savings for the US payers.

P0135 - Lactobacillus vaginal suppositories for recurrent cystitis: A phase 2 clinical trial

P0135 - Lactobacillus vaginal suppositories for recurrent cystitis: A phase 2 clinical trial

Nitrofurantoin-induced liver failure: A fatal yet forgotten complication.

Nitrofurantoin is recommended as first-line therapy for uncomplicated cystitis owing to its comparable efficacy to cotrimoxazole, minimal resistance, and reduced risk of inducing resistance.[1][1] It has also been recommended as prophylaxis for recurrent cystitis.[2][2] Most clinicians are familiar

Recurrent UTIs and cystitis symptoms in women

Recurrent urinary tract infections (rUTIs) and recurrent cystitis symptoms without infection occur commonly in women and present frequently in general practice. The aim of this article is to provide amanagement approach to the assessment and treatment of recurrent cystitis symptoms in women with rUTIs as well as women who have negative urine cultures. Five common clinical scenarios are discussed with different approaches to treatment: true rUTIs with positive urine cultures, women with variable urine cultures (some positive and some negative), women with negative urine cultures who have pyuria +/- haematuria, women with completely normal urine cultures and women with ongoing symptoms after a definite UTI. Red flags signalling the need for early referral to aurologist for further assessment are discussed. Both non-antibiotic and antibiotic-related strategies to treat women with rUTIs are available.

Role of D-Mannose in the Prevention of Recurrent Uncomplicated Cystitis: State of the Art and Future Perspectives.

Background: Urinary tract infections (UTI) are highly frequent in women, with a significant impact on healthcare resources. Although antibiotics still represent the standard treatment to manage recurrent UTI (rUTI), D-mannose, an inert monosaccharide that is metabolized and excreted in urine and acts by inhibiting bacterial adhesion to the urothelium, represents a promising nonantibiotic prevention strategy. The aim of this narrative review is to critically analyze clinical studies reporting data concerning the efficacy and safety of D-mannose in the management of rUTIs. Methods: A non-systematic literature search, using the Pubmed, EMBASE, Scopus, Web of science, Cochrane Central Register of Controlled Trials, and Cochrane Central Database of Systematic Reviews databases, was performed for relevant articles published between January 2010 and January 2021. The following Medical Subjects Heading were used: “female/woman”, “urinary tract infection”, and “D-mannose”. Only clinical studies, systematic reviews, and meta-analyses reporting efficacy or safety data on D-mannose versus placebo or other competitors were selected for the present review. Evidence was limited to human data. The selected studies were organized in two categories according to the presence or not of a competitor to D-mannose. Results: After exclusion of non-pertinent studies/articles, 13 studies were analyzed. In detail, six were randomized controlled trials (RCTs), one a randomized cross-over trial, five prospective cohort studies, and one a retrospective analysis. Seven studies compared D-mannose to placebo or others drugs/dietary supplements. Six studies evaluated the efficacy of D-mannose comparing follow-up data with the baseline. D-mannose is well tolerated, with few reported adverse events (diarrhea was reported in about 8% of patients receiving 2 g of D-mannose for at least 6 months). Most of the studies also showed D-mannose can play a role in the prevention or rUTI or urodynamics-associated UTI and can overlap antibiotic treatments in some cases. The possibility to combine D-mannose with polyphenols or Lactobacillus seems another important option for UTI prophylaxis. However, the quality of the collected studies was very low, generating, consequently, a weak grade of recommendations as suggested by international guidelines. Data on D-mannose dose, frequency, and duration of treatment are still lacking. Conclusion: D-mannose alone or in combination with several dietary supplements or Lactobacillus has a potential role in the non antimicrobial prophylaxis or recurrent UTI in women. Despite its frequent prescription in real-life practice, we believe that further well-designed studies are urgently needed to definitively support the role of D-mannose in the management of recurrent UTIs in women.

Посткоитальный цистит: хирургическое лечение

Introduction. Urinary tract infection is one of the most common urological infectious diseases. An important risk factor for uncomplicated urinary tract infection in women is sexual intercourse. Post-coital cystitis is a special form of recurrent cystitis, associated with a low location of the external urethral orifice. This condition is called vestibulo-vaginal dislocation of the urethra. Materials and methods. PubMed and Elibrary (Scientific Electronic Library) databases were searched for studies describing surgical treatment of recurrent post-coital cystitis in women. Based on the relevance and reliability of the sources, 23 articles in peer-reviewed medical journals were selected. All of the selected studies contained data on evolution of surgical treatment approaches for post-coital cystitis. Results. In the middle of the 20th century the interest of medical community in surgical treatment of post-coital cystitis has gradually faded. Such trend was caused by imperfect surgical techniques of existing procedures (O'Donnell and Hirschhorn operations). Subsequent accumulation of experience, over several decades, allowed to establish possible mistakes in diagnosis and operation techniques. Furthermore, a constant search for new techniques and improvement of existing ones minimized potential risk of complications. Great hopes are pinned on the works of B.K. Komyakov et al., who proposed extravaginal transposition of the urethra, that implies the transposition of the urethra and its external orifice as high as possible toward the clitoris. The technique is characterized by high efficacy and a low number of complications, as demonstrated by the treatment results of 228 patients diagnosed with post-coital cystitis. Conclusions. Various curative procedures for post-coital cystitis show the need to determine and standardize the optimal amount of surgical intervention for urethral dystopia in women.

Эпидемиологическое исследование распространенности цистита у женщин Воронежской области

Introduction. The article is devoted to an epidemiological study of the prevalence of cystitis and risk factors for recurrence this disease. Materials and methods. The study is based on the data obtained during the screening survey of 1014 women in the age group of 18-80 years old, permanently residing in the Bobrovsky district of the Voronezh region. Based on the age of the subjects, 3 groups were formed: Group 1 (general group) - 1014 women, Group 2 (fertile age) - 551 women, Group 3 (postmenopausal age) - 463 women. To study the influence of risk factors on the development of cystitis, the following criteria were used: antibiotic therapy, sex life, urinary disorders, gastrointestinal tract (GIT) dysfunction, etc. The obtained material was processed using the computer program Statistics 10.0. 𝛘2 was used as a statistical tool. Results. Of the total number of women surveyed, 15.3% had risk factors according to the ORENUC classification system based on the clinical picture of UTI, anatomical level of UTI, the severity of infection, classification of risk factors and the availability of appropriate antimicrobial therapy. The largest number of risk factors was found in postmenopausal patients (p <0.05). It was found that despite the fact that most of the subjects were sexually active, the absence of sexual activity and the presence of one sexual partner did not affect the presence of a history of cystitis episode (p> 0.05), however, it was revealed that the history of cystitis was significantly associated with functions of the gastrointestinal tract (p<0.05). The use of tactics aimed at active detection of cystitis, by means of questionnaires, can increase the detection rate of cystitis by 10 times. Discussions. In our study, we did not find a large number of cases of recurrent cystitis, in contrast to previously published works, which cited figures from 10 to 30% of the number of women, however, by means of questionnaires, we managed to deduce the prevalence of cystitis in the studied region in women over 18 years old. which amounted to 17.4%. The figure obtained is consistent with data published in previously papers. Conclusions. TThis study has confirmed the previously published works indicating the relationship of cystitis with gastrointestinal diseases. In addition, we found that the prevalence of cystitis (having one or more episodes during a lifetime) in the study group was 17.4%. The annual incidence of cystitis in the study group was 3.2%, while according to official statistics in the region it does not exceed 0.4%. The latter fact indicates the need for further research and strengthening of sanitary and edu- cational work among the population (Internet, TV, radio, newspapers, etc.).