Hungarian Society of Urology
  
  

2018-3 — Summary

Complex treatment of recurrent cystitis

DOI: 10.22591/magyurol.2018.3.magyara.117

Authors:
Magyar András dr., Köves Béla dr.
Jahn Ferenc Dél-pesti Kórház és Rendelőintézet, Urológiai osztály, Budapest (osztályvezető: Tenke Péter dr.)

Summary

About half of the women experience at least one episode of acute cystitis during their lifetime. In acute cystitis the most often isolated causative pathogen is E. coli bacteria. The rapid increase in bacterial resistance to antibiotics is a well-known problem, which results in significant difficulties during the treatment of urinary tract infections, especially recurrent acute cystitis. Recently several international cooperation has been initiated to establish the proper treatment strategies. Treatment of recurrent acute cystitis exclusively with antibiotics, in the long term, results in the increase of resistance and prolonged, recurrent symptoms of cystitis. The main strategies to prevent the increase in bacterial antibiotic resistance are prudent antibiotic use, implementation of non-antibiotical modalities for treatment and prevention of recurrent cystitis, development of new, fast, reliable diagnostic tools, diagnosis of asymptomatic bacteriuria and its treatment performed strictly in accordance with the guidelines.

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Effectiveness of Canephron® combined phytotherapeutic drug for the prevention of recurrent bladder infections

DOI: 10.22591/magyurol.2018.3.magyara.113

Authors:
Magyar András dr., Köves Béla dr.
Jahn Ferenc Dél-pesti Kórház és Rendelőintézet, Urológiai osztály, Budapest (osztályvezető: Tenke Péter dr.)

Summary

Objective: Due to the emergence of bacterial resistance to antibiotics, non-antibiotic prophylaxis and treatment of recurrent cystitis is of utmost importance. Herbal medicine traditionally plays an important role in non-antibiotic prophylaxis. Canephron is a novel combined phytotherapeutic drug, containing three different medicinal plants. Its efficacy for reducing recurrent cystitis episodes was investigated in several studies. Our objective was to review available publications on the phythoterapeuthic drug.
Methods: We performed a PubMed search and further collected references from available systematic reviews. The main outcomes of interest were: (1) the effects of the active components; (2) its efficacy in prevention of recurrent cystitis episodes; (3) evaluation of side effects; (4) evaluation of side effects during pregnancy.
Results: Four relevant publications with a total of 304 included patients were identified and analysed. Due to methodologic limitations, the studies were difficult to interpret and their clinical significance remains unclear. Based on the results of the existing studies Canephron was shown to be effective in the reduction of episodes of recurrent cystitis. Side effects were insignificant and the drug can also safely be used during pregnancy.
Conclusions: Non-antibiotic approaches are of high priority in prevention of recurrent cystitis. The existing studies suggest that Canephron can be effectively and safely used for prevention of recurrent acute cystitis. Its efficiency, however, needs to be confirmed by further well-designed clinical trials.

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Efficacy of cranberry extracts in the reduction of the catheter-associated urinary tract infections

DOI: 10.22591/magyurol.2018.3.magyara.110

Authors:
Magyar András dr., Vinodh Kumar Adithyaa Arthanareeswaran dr., Póth Sándor dr., Köves Béla dr., Tenke Péter dr.
Jahn Ferenc Dél-pesti Kórház és Rendelőintézet, Urológiai osztály, Budapest (osztályvezető: Tenke Péter dr.)

Summary

Introduction: Catheter-associated urinary tract infections result in significant economical and healthcare burden with very few therapeutic options. Our objective is to summarise the latest literature which evaluates the efficacy of cranberry supplements on catheter associated urinary tract infections.
Material and methods: We review a study where patients with long-term indwelling catheters and recurrent catheter associated urinary tract infections were enrolled to take a 36 mg once-daily oral cranberry capsule over a period of 6 months. The primary outcome was to evaluate the efficiency of a cranberry supplement in the reduction of incidence of catheter associated urinary tract infections. Secondary outcomes were to evaluate the change in the bacterial counts and resistance patterns to antibiotics during the 6 months long cranberry supplement treatment.
Results: 22 patients completed the study. Their mean age was 77 years, and 77% of the patients were men. No catheter associated urinary tract infections was observed in the patients during the 6 months long study period. The bacterial resistance to antibiotics was reduced by 28%, while the bacterial count was reduced by 59%. The cranberry supplement treatment did not result in any adverse events or side effects.
Conclusions: The study shows promising data regarding the use of cranberry supplements in the reduction of catheter associated urinary tract infections.

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Therapeutic dilemma of a recurrent urethral stricture and prostate cancer

DOI: 10.2259/magyurol.2018.3.kissz.105

Authors:
Kiss Zoltán dr., Murányi Mihály dr., Flaskó Tibor dr.
Debreceni Egyetem Általános Orvostudományi Kar, Urológiai Tanszék, Debrecen (igazgató: Flaskó Tibor dr.)

Summary

Objective: The authors present a case of a male patient, with recidive urethral stricture of unknown origin, which had an early recurrence of stricture and was diagnosed also with prostate cancer causing therapeutic dilemma to their physicians.
Case report: Urological examination of the 70-year-old male patient due to urinary complaints revealed urethral stricture and elevated PSA. Internal urethrotomy and prostate biopsy was performed, Gleason score 3+3=6 adenocarcinoma was confirmed. The staging examinations revealed organ-localized disease. Meanwhile, recurrent urethral stricture was diagnosed and buccal mucosal graft urethroplasty was performed. Among the therapeutic options, laparoscopic radical prostatectomy was chosen. Three weeks before the planned surgery the patient inserted a silicone tube into the urethra for autoerotic purposes and it could not be removed by the patient. The silicone tube was removed by cystoscope and the surgery was performed. 6 weeks after the operation the PSA was <0.02 ng/ml. They are now reporting about two years of oncologically negative follow-up.
Conclusion: The case demonstrates well that traumatic urethral stricture can be also caused by sexual aberration. Since the prostate cancer was low risk, the authors decided to postpone the operation and the treatment of urethral stricture was performed at first. According to their opinion, radical prostatectomy can also be performed after urethroplasty with adequate functional results.

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Changes in the bacteial spectrum and antibiotic resistance pattern of uropatho­gens at our department between 2004 and 2017

DOI: 10.22591/magyurol.2018.3.magyara.96

Authors:
Magyar András dr.1, Dobák András dr.2, Bálint Péter dr.1, Vinodh Kumar Adithyaa Arthanareeswaran dr.3, Nagy Károly dr.1, Póth Sándor dr.1, Bata Anikó dr.1, Tenke Péter dr.1, Köves Béla dr.1
1Jahn Ferenc Dél-pesti Kórház és Rendelőintézet, Urológiai osztály, Budapest (osztályvezető: Tenke Péter dr.)
2Corden International, Budapest
3Lipcsei Egyetem, Urológiai Klinika, Németország (igazgató: Jens-Uwe Stolzenburg dr.)

Summary

Objective: Since bacterial antibiotic resistance rates may vary with significant differences between countries and regions, as well as change over time, yearly surveillance of the bacterial spectrum and antibiotic-resistance patterns of locally occurring uropathogens is essential to serve as a basis for empirical treatment of urinary tract infections (UTIs). The objective of our study was to investigate the changes in the bacterial spectrum and the antibiotic resistance rates of uropathogens cultured from urine samples collected at our department.
Material and methods: All urine samples taken at our department, from 2004 to 2017 were retrospectively analyzed. The significance rates of the annual changes were calculated using Cochran-Armitage test (p<0.05).
Results: A total of 3513 urine cultures showed significant presence of pathogens. Escherichia coli and Enterococcus faecalis were the most frequently isolated bacteria. Resistance of E. coli to ciprofloxacin has increased significantly, reaching a rate of 25%, while in the case of cephalosporines, resistance of E. coli remained under 20%.
Conclusion: For empirical treatment fluoroquinolones can be no longer recommended in our region. Gram-negative UTIs can be safely treated with cephalosporines, however, they should be avoided if multi-drug resistant bacteria are suspected. Surveillance and monitoring of the bacterial resistance patterns is recommended for all institutions.

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