An uncommon cause of dysuria solved by “boom-boom” radiotherapy

BackgroundChronic lymphocytic leukaemia is a common disease affecting the hematopoietic organs. The disease remains classically indolent for years preceding a blast crisis. However, the disease can affect all parts of the body. We report here an unusual localization.Case presentationA 72-year-old man was followed for 2 years for an indolent chronic lymphocytic leukaemia while he presented a rapidly progressive dysuria. Prostate biopsies were performed concluding to a prostate involvement by the chronic lymphocytic leukaemia. In the absence of progression according to RAI staging system and Binet's classification, he was treated with local low-dose radiotherapy, twice 2 Gy, allowing for a rapid resolution of the symptoms. No systemic treatment was introduced, and 1 year after the completion of his treatment, he is still under watchful waiting strategy for his chronic lymphocytic leukaemia.ConclusionLow-dose radiotherapy is an underused effective strategy in indolent lymphoma. In this case, urinary symptoms from a prostate involvement were relieved non-invasively at low cost.     

芒针治疗前列腺增生排尿困难：随机对照研究

目的:观察芒针疗法与常规针法对良性前列腺增生(benign prostatic hyperplasia,BPH)引起的排尿困难症的临床效应的差异。方法:采用多中心协作随机对照的方法,150例患者随机分为芒针组(72例)和常规针刺组(78例),均取秩边、中极,每天治疗1次,5次为一疗程,疗程间间隔2天,共治疗2个疗程。分别观察治疗前后国际前列腺症状评分(I-PSS)积分、尿流率、残余尿的变化。结果:芒针组有效率为83.3%,常规针刺组有效率为44.9%,芒针组能有效改善I-PSS症状积分、增加尿流率、减少残余尿量,与常规针刺组比较有统计学意义(均P<0.05)。结论:芒针疗法对BPH引起的排尿困难症疗效优于常规针刺,具有较好的可重复性。     

Antibacterial activity of moxifloxacin against periodontal anaerobic pathogens involved in systemic infections

A meta-analysis was performed on five studies conducted over the last decade to demonstrate a positive effect for the drug Uro-Vaxom® compared with Placebo in double-blind studies in patients with urinary tract infection (601 women), with special reference to the prevention of recurrences over an observation period of 6 months, the treatment being given for the first 3 months. The five studies were similar in design. The analysis by means of the Wilcoxon–Mann–Whitney test showed superiority of Uro-Vaxom in all five studies, (P<1%). The summarising Mann–Whitney (MW) statistics also indicated superiority with the Mann–Whitney value being 0.684. In all studies, the Uro-Vaxom group was statistically significant and clinically relevant superior to control with respect to the reduction of the frequency of UTIs and to dysuria, bacteriuria and leucocyturia. The confidence intervals (CI)s were small (0.64–0.72). The drug was well tolerated and compliance of patients was excellent in all studies. Oral immunotherapy with the Uro-Vaxom Escherichia coli (E. coli) extract is an effective prophylactic approach in the prevention of UTIs.     

Prevention of recurrent urinary tract infections with immuno-active E. coli fractions: a meta-analysis of five placebo-controlled double-blind studies

A meta-analysis was performed on five studies conducted over the last decade to demonstrate a positive effect for the drug Uro-Vaxom® compared with Placebo in double-blind studies in patients with urinary tract infection (601 women), with special reference to the prevention of recurrences over an observation period of 6 months, the treatment being given for the first 3 months. The five studies were similar in design. The analysis by means of the Wilcoxon–Mann–Whitney test showed superiority of Uro-Vaxom in all five studies, (P<1%). The summarising Mann–Whitney (MW) statistics also indicated superiority with the Mann–Whitney value being 0.684. In all studies, the Uro-Vaxom group was statistically significant and clinically relevant superior to control with respect to the reduction of the frequency of UTIs and to dysuria, bacteriuria and leucocyturia. The confidence intervals (CI)s were small (0.64–0.72). The drug was well tolerated and compliance of patients was excellent in all studies. Oral immunotherapy with the Uro-Vaxom Escherichia coli (E. coli) extract is an effective prophylactic approach in the prevention of UTIs.     

Clinical presentation and natural course of idiopathic hypercalciuria in children

Idiopathic hypercalciuria (IHC) has been reported mainly in children with hematuria in the 1980s and early 1990s, when renal sonography was just becoming routine. The presence of microcalculi, i.e., of hyperechogenic spots <3 mm in diameter in renal calyces, was not taken into account in those studies. We attempted to outline clinical presentation and natural course of IHC not only in children with hematuria, but also in those with dysuria and/or recurrent abdominal/flank pain and a family history of nephrolithiasis, taking into account the finding of microcalculi. We analyzed retrospectively the data at diagnosis from 74 consecutive children aged 2.4–18 years (mean 8.6) with IHC (calciuria 4.1–15.1 mg kg^–1 24 h^–1, mean 6.1) and the outcome of 30 of them who were followed ≥1 years (mean 3.2) with no specific therapy. At diagnosis, 38 patients (51%) had no hematuria, 42 (57%) had microcalculi and four (5%) had calculi. Of the patients with normal urinalysis, 71% had microcalculi or stones. The subjects with microcalculi and those with stones were significantly older than those without microcalculi and stones (P=0.004 and 0.007). A normal urinalysis at our evaluation and a history of abdominal/flank pain were significantly more frequent in patients with microcalculi than in those without (P=0.02 and 0.0001, respectively). During the follow-up, four of 30 patients formed stones 1–3 years after first diagnosis of IHC. More than half of children with IHC have microcalculi. The risk of formation of microcalculi or stones increases with age. The lack of hematuria does not exclude the presence of microcalculi or calculi. Hypercalciuria has to be suspected in children with dysuria and/or recurrent abdominal/ flank pain and a family history of nephrolithiasis, even when they have no hematuria. Received: 13 December 1999 / Revised: 26 April 2000 / Accepted: 19 May 2000     

The superiority of the analgesic effect of intraurethral Bupivacaine during outpatient flexible cystoscopy in male patients

Objective

Flexible cystoscopy (FC) has become a frequently applied outpatient prosedure. Dysuria with an incidence of 30–54% is the main complaint of patients. As our hypothesis was, lower pain scores during and after cystoscopy would be achieved with bupivacaine application we aimed to compare the analgesic efficacy of intraurethral bupivacaine and lidocaine.

The impact of acute urinary morbidity on late urinary function after permanent prostate brachytherapy

PURPOSE: Acute prostate brachytherapy-related morbidity is dominated by urinary symptomatology. In this study, we evaluated the effect of severe early brachytherapy-related urinary morbidity on late urinary function. METHODS AND MATERIALS: From January 1998 to September 2003, 1029 patients were implanted for clinical stage T1b-T3a (2002 American Joint Committee on Cancer [AJCC] criteria) prostate cancer. Five hundred sixteen (50.1%) received supplemental external beam radiation therapy and 440 (42.8%) received androgen deprivation therapy. Severe acute urinary morbidity (SAUM) was defined as a dysuria frequency score of at least 4 (of 5), a dysuria severity score of at least 8 (of 10), an internation prostate symptom score (IPSS) elevated to at least 30 or 15 above preimplant value for 4 weeks, and/or requirement of a urinary catheter for at least 5 days. Dysuria severity and frequency resolution were defined as a return to within one point of baseline. IPSS resolution was defined as a return to within two points of baseline. RESULTS: Of the 1029 patients, 175 met at least one of the criteria for inclusion. Dysuria frequency resolved in 5.0 vs. 1.3 weeks and dysuria severity in 5.7 vs. 1.4 weeks, for patients with and without SAUM. The mean time for IPSS resolution was 13.8 vs. 6.6 weeks, for patients with and without SAUM. The incidence of transurethral resection (2.3% [4/173] vs. 1.5% [13/841]) and bulbomembranous urethral strictures (2.2% [4/175] vs. 1.8% [15/854]) were comparable among patients with and without SAUM. CONCLUSIONS: Patients experiencing brachytherapy-related SAUM have long-term urinary function and complications comparable to patients who did not develop SAUM.     

创伤性尿道狭窄术后尿道超声研究:对排尿与尿道探杠导入出现矛盾现象的分析

目的　超声观察尿道术后排尿与尿道扩张术出现矛盾时的尿道形态学改变。方法　超声检测 16个病例并监测尿道探杠导入。结果　术后出现的排尿与尿道扩张术之间存在两种情况可分为I型和II型 ,各有 8例。I型声像图表现为尿道活瓣 (5例 )、假道 (2例 ) ,单侧疤痕 (1例 ) ;II型声像图表现为吻合口囊状扩张和S形弯曲 ,各 4例。结论　尿道超声显像可对术后排尿与尿道探杠导入出现的矛盾现象作出病因诊断 ,有助于临床作进一步的合理处理。     

巧用“提壶揭盖法”治癃闭

运用提壶揭盖法的原理、方法,下病上治,宣肺利水,治疗癃闭当知此法。     

前列安治疗肾虚湿热兼瘀型良性前列腺增生症

目的 :观察前列安的临床疗效及安全性。 方法 :将80例肾虚湿热瘀阻型良性前列腺增生症患者随机分为2组,即治疗组(给予前列安浓缩丸口服,每次10 g,每日3次)和对照组(给予癃闭舒胶囊,每次3粒,每日3次),12周为1疗程,设计相关观察表格,1疗程结束后评定疗效和安全性。 结果 :2组总疗效比较无显著性差异,但对改善患者症状如夜尿次数、腰膝酸软、尿线情况以及在提高患者最大尿流率、降低患者泌尿症状困扰评分方面,治疗组均明显优于对照组(P >0.05);且未发现前列安明显毒副反应。 结论 :前列安治疗肾虚湿热瘀阻型前列腺增生症具有良好效果,且有较好的安全性。