Search Results (55)

Background and Objectives: Recurrent urinary tract infection (rUTI) remains common and burdensome, with growing emphasis on antibiotic stewardship and non-antibiotic prevention. We characterized what women with rUTI know, do, and receive in everyday care and identified gaps between patient understanding and guideline-concordant management. Materials and Methods: We conducted a single-center, cross-sectional survey of consecutive adult women presenting with rUTI to a urology clinic in Poland. A structured questionnaire captured demographics, knowledge, symptoms and triggers, diagnostics, treatments and prevention, and satisfaction. Responses were standardized a priori; descriptive statistics and exploratory comparisons were performed (N = 36). Results: The mean age was 53.0 years (SD: 14.8). Only 36.1% identified the correct rUTI definition, while 83.3% recognized bacteria as the common cause. The symptom profile was dominated by frequency and dysuria (each 88.9%); 27.8% reported intercourse as a precipitant, and this was more frequent among sexually active women (43.5% vs. 7.7%; p = 0.031). Over half (55.6%) perceived no seasonality. The median number of episodes in the prior year was five (IQR 4–6). Urine culture was obtained before treatment in 38.9% and after treatment in 13.9%. The overall satisfaction with care was low to moderate (13.9% were very satisfied, 61.1% were moderately satisfied, and 25.0% were dissatisfied). Prior antibiotic exposure included ciprofloxacin (55.6%), furazidin (75.0%), and fosfomycin (47.2%). The uptake of preventive options was uneven: immunoactive vaccines accounted for 19.4%, methenamine hippurate for 16.7%, pelvic floor physiotherapy for 33.3%, and vaginal estrogen for 5.6% overall (9.5% among women ≥ 50 years). Conclusions: In this clinic-referred cohort, rUTI was frequent and disruptive, factual knowledge was limited, urine culture use was inconsistent, and fluoroquinolone exposure remained common. Preventive care was misaligned with guidelines, with underuse of vaginal estrogen and variable adoption of non-antibiotic strategies. Targeted education, stewardship, and structured access to evidence-based prevention may improve outcomes. Full article

(1) Background: The systemic right ventricular (SRV) dysfunction and severe tricuspid regurgitation (TR) remain significant challenges in patients with congenitally corrected transposition of the great arteries (ccTGA) or following atrial switch procedures. Currently, there is no established, evidence-based medical therapy specifically designed for SRV failure, and treatment approaches are largely extrapolated from left ventricular heart failure (HF) guidelines. This therapeutic gap highlights the need for tailored pharmacologic strategies and optimized perioperative management in this unique population. The optimal timing of surgical intervention and the role of modern HF therapy are still under active investigation. (2) Methods: We present a case series of four patients (three adults and one child) with SRV dysfunction and severe TR, who underwent staged treatment consisting of optimized medical therapy followed by surgical tricuspid valve (TV) replacement. Medical therapy included positive inotropes, sacubitril/valsartan, sodium-glucose co-transporter 2 inhibitors (iSGLT2), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and loop diuretics. (3) Results: All patients demonstrated clinical and hemodynamic improvement prior to surgery, with an increase in systemic ventricular ejection fraction (SVEF > 40%) and cardiac index. TV replacement was performed with favorable early postoperative outcomes and preserved ventricular function at mid-term follow-up. No mortality or major adverse events occurred during follow-up. One case of acute cystitis was associated with dapagliflozin. In all patients, postoperative SVEF remained >40%, and no recurrence of significant TR was observed. (4) Conclusions: A stepwise approach combining modern heart failure therapy and elective TV replacement in patients with SRV dysfunction and TR is safe and effective. Preoperative optimization leads to improved ventricular function and may enhance surgical outcomes. These findings support the integration of contemporary pharmacotherapy in the management strategy for SRV failure. Full article

Background/Objectives: Management of acute episodes of lower urinary tract infection (LUTI) depends on whether they are sporadic or recurrent. We aimed to define factors that differentiate patients with acute sporadic cystitis (AC) from those with recurrent cystitis (RC) and thereby improve individualized care. Methods: We performed a post hoc analysis of prospectively collected data from the multinational GPIU.COM study. Female patients with an acute LUTI episode completed the Acute Cystitis Symptom Score (ACSS) and underwent a routine clinical and laboratory evaluation, including a physical examination, ultrasonography, urinalysis, and urine culture and antimicrobial susceptibility testing. Risk factors for recurrence were evaluated using the Lower Urinary Tract Infection Recurrence Risk (LUTIRE) nomogram and the ORENUC classification. Statistical analysis followed a robust stepwise approach. Significant variables were assessed by relative risk (RR), and logistic regression was used to estimate odds ratios (ORs). Model performance was evaluated using the area under the curve (AUC), the Hosmer–Lemeshow test, variance inflation factor (VIF), and bootstrap sampling. Results: A total of 106 women were included (AC n = 50; RC n = 56). Patients with RC more frequently presented with a history of constipation, a severe impact of symptoms on daily activities, multiple uropathogens, and trace proteinuria. Pyuria was inversely associated with RC. Logistic regression identified chronic constipation, severe impact of symptoms on daily activities, and multiple uropathogens as independent predictors of RC. Three predictive models showed consistent discrimination between AC and RC (AUC = 0.80, 0.82, and 0.84). Conclusions: AC and RC showed notable differences in certain symptom profiles, quality of life, urinalysis, and microbiological findings. Combining high-value predictors from LUTIRE and ORENUC into a comprehensive prognostic algorithm could improve assessment of recurrence risk. A refined classification of LUTIs with recurrence grading is warranted to guide decision-making and prevention strategies. Full article

Background/Objectives: To determine long-term patient-reported outcomes for patients undergoing hyperbaric oxygen therapy (HBO2) following external beam radiotherapy. Methods: A retrospective cohort study of all consecutive patients who underwent HBO2 for radiation cystitis in South Australia from September 2017 to March 2023 was performed. Patient-reported symptom severity, anxiety, healthcare use and transfusion requirements pre- and post-treatment were collected through telephone interview. Readmission data and procedural data was collected through both telephone interview and a state-wide electronic medical record. Jamovi was used to perform paired sample t-tests for statistical analysis. Results: There were 89 patients who underwent HBO2 for radiation cystitis with 54 completing the questionnaire. There were 85% of patients alive at the time of follow-up, with 61% of the total cohort and 74% of survivors completing the questionnaire. For those completing the questionnaire, 96% were male with all of them having prostate cancer. Median age was 74 (interquartile range [IQR] 69–78). The mean reduction in patients’ perceived symptom severity after HBO2 on a scale out of 10 was 7.9 to 2 with a difference of 5.9 (95% confidence interval [CI] 5.1–6.7, p < 0.001) and the mean reduction in perceived anxiety was 6.9 to 2.1 with a difference of 4.7 (95% CI 3.6–5.8 p < 0.001). Patients reported a reduction in family doctor visits from 2.7 to 0.76 with a mean reduction of 2 (95% CI 0.8 to 3.2, p = 0.003), emergency department presentations from 3.3 to 0.57 with a mean reduction of 2.7 (95% CI 1.4–4.1, p ≤ 0.001) and blood transfusions from 0.67 to 0.31 with a mean reduction of 0.34 (95% CI −0.44 to 1.1, p = 0.017). Ongoing haematuria was reported in 21 of the 54 patients (39%). Further treatment was required for 20 patients (25%). No patients reported any severe or ongoing adverse effects from HBO2 via the questionnaire. Conclusions: HBO2 is a safe option for recurrent haematuria due to radiation cystitis with high patient satisfaction and reduction in patient-perceived symptom severity, anxiety and healthcare utilisation. Level of evidence: 4. Full article

Recurrent bacterial cystitis in women can lead to interstitial cystitis or bladder pain syndrome (IC/BPS). Activation of Toll-like receptor 4 (TLR4) by LPS can upregulate signaling of the pro-inflammatory receptor p75^NTR. The aim of the presented study was to assess whether p75^NTR antagonist THX-B can modulate LPS-mediated inflammation in bladder cells. In vitro expression and LPS-activation of p75^NTR were confirmed in urothelial (URO) and smooth muscle (SMC) cells. In UROs, p75^NTR antagonism abolished the LPS-elicited rise in membrane-bound and soluble TNF-α. However, it could not prevent LPS-induced rise in phosphorylated ERK nor decrease in phosphorylated p38MAPK, nor the increase in iNOS and nitric oxide (NO) content. On the other hand, in SMCs, LPS increased phosphorylation of JNK, nuclear translocation of NF-κB, and association of TRAF6 to p75^NTR, outcomes prevented by p75^NTR antagonism. In UROs, LPS decreased the expression of tight junction proteins, ZO-1 and occludin, with the latter rescued by p75^NTR antagonism. Intraurethral instillation of LPS increased inflammation in the lamina propria, activation of JNK, and contractile activity of bladder tissue. Alternatively, intraperitoneal THX-B injections prevented LPS-induced inflammation but not enhanced muscle contraction. Our results suggest that inhibition of p75^NTR could help in reducing bladder symptoms during cystitis. Full article

Background/Objectives: Urinary tract infections (UTIs) are the most common bacterial infections and one of the most common diseases worldwide. These infections induce an enormous financial and economic burden. The most frequent pathogen in UTIs is Escherichia coli (E. coli), which is responsible for over 85% of cases of cystitis and over 60% of recurrent cases. Repeated antibiotic prescriptions increase the risk of bacteria developing resistance, reducing treatment efficacy and limiting long-term therapeutic options. When traditional preventive methods fail to provide protection, other strategies may be necessary. To investigate the effectiveness of vaccination with Uro-Vaxom for the prevention of UTIs based on currently available studies. Methods: Systematic literature search. Results: The available studies focus almost exclusively on the female sex. Uro-Vaxom decreased the recurrence of UTIs, was overall well tolerated, and reduced the need for antibiotic therapies. Conclusions: Uro-Vaxom is a potential effective and well-tolerated option for reducing the recurrence of UTIs in patients prone to frequent infections. Nevertheless, the retrospective nature of several studies, combined with methodological limitations and variability in study design, precluded a reliable quantitative estimation of the treatment effect. Full article

Bacterial urinary tract infections (UTIs) are common in small animal practice and their inappropriate treatment contributes to the antimicrobial resistance (AMR) spreading. This study assessed bacterial prevalence, non-susceptibility percentages, antimicrobial prescription and the impact of the application of international guidelines redacted by the International Society for Companion Animals Infectious Disease (ISCAID) in dogs and cats with UTIs evaluated at a European veterinary university hospital, over a 30-month period. A total of 729 bacterial isolates were included. The most frequently isolated bacterial species was Escherichia coli in both dogs (52.8%) and cats (45.7%). Following ISCAID guidelines, almost half of the cases were classified as upper UTIs (24.9%) or recurrent cystitis (24.8%). Multidrug resistance (MDR) percentage was 37.3% (n = 272). Over five semesters, MDR significantly decreased (p = 0.001). Additionally, a significant decrease was recorded for specimens from patients previously treated (p = 0.018) and under treatment at sampling (p < 0.001). Previous treatment with amoxicillin-clavulanate (p = 0.001), marbofloxacin (p < 0.001), enrofloxacin (p < 0.001) and piperacillin-tazobactam (p = 0.016) was linked with higher MDR rates. This study highlighted that companion animals are potential reservoirs for AMR; moreover, international guidelines applied in the daily practice guiding antimicrobial stewardship can lead to a reduction in AMR over time. Full article

Background/Objectives: An 80-year-old man was admitted to our department after a salvage radical cystectomy for actinic cystitis due to radiotherapy for prostate cancer. He presented with a two-month history of feculent debris in the right stoma and deteriorated general conditions, after a long past medical history of recurrent complicated urinary infections. Methods: Computer tomography (CT) of the abdomen revealed a ureterocolic fistula along the right ureteral pelvic tract. A right percutaneous nephrostomy tube was placed. Due to multiple previous surgeries, several lines of intravenous antibiotic therapies and the overall condition of the patient, a conservative management was preferred. Results: A bovine serum albumin-glutaraldehyde (BioGlue^®) adhesive was inoculated into the right ureter through the stoma to close the fistula. After 24 months, the patient remained asymptomatic with negative follow-up imaging. Conclusions: Given the uniqueness of the management of a ureterocolic fistula, this case offers insight into conservative treatment in frail patients not suitable for major surgery. Full article

Women commonly experience urinary tract infection (UTI) recurrence. However, there is no effective tool for predicting recurrent UTI after the first UTI episode. Hence, this study aimed to investigate potential urinary inflammatory biomarkers and specific biomarkers for predicting UTI recurrence or persistence after antibiotic treatment in women. Forty women who had a history of recurrent UTI within 1 year after the initial episode and acute bacterial cystitis were treated with broad-spectrum antibiotics for 1 week. To measure inflammatory biomarker levels, urine samples were collected at the baseline and after 1 week, 1 month, and 3 months. The levels of urinary pro-inflammatory proteins such as neutrophil gelatinase-associated lipocalin (NGAL), nerve growth factor, CXC-motif chemokine ligand (CXCL)-1, interleukin-8, CXCL-10, monocyte chemoattractant protein-1, and tumor necrosis factor-alpha were measured using commercial kits. Seven healthy age-matched women were included as controls. The changes in urinary biomarker levels at the baseline and various time points were compared between women with and without UTI recurrence within 1 month or within 3 months after the initial antibiotic therapy. At the baseline, patients with a higher urinary white blood cell count had a significantly higher NGAL level than the controls and those with a low white blood cell count. Of the 40 patients with a history of recurrent UTI, 12 presented with UTI persistence or recurrence within 1 month and 19 within 3 months after the initial antibiotic treatment. Among the 28 patients without UTI recurrence at 1 month after treatment, 7 had UTI recurrence within 3 months. Compared with patients without UTI recurrence, those with UTI recurrence had significantly higher urinary NGAL levels at 1 week, 1 month, and 3 months after the initial treatment. This study concludes that persistent elevation in urinary NGAL levels after the initial antibiotic treatment indicated persistent bladder inflammation. Further, it could be a predictor of UTI persistence or recurrence within 1 or 3 months after the initial antibiotic treatment. Patients with a history of recurrent UTI and high urinary NGAL levels after antibiotic treatment might require a longer treatment duration to completely eradicate or prevent UTI recurrence. Full article

Objectives: Uncomplicated cystitis is a leading form of bacterial UTI; the most common causative bacterium worldwide is Escherichia coli. This internet-based, prospective, multicenter, and national observational study aimed to report the antimicrobial resistance of E. coli in patients with uncomplicated cystitis through the use of the Korean Antimicrobial Resistance Monitoring System (KARMS) in 2023. Results: Data for a total of 654 patients were retrieved from the KARMS database. The mean (standard deviation) patient age was 55.9 (18.3) years. The numbers of postmenopausal women and patients with recurrent cystitis were 381 (59.4%) and 78 (11.9%), respectively. Regarding antimicrobial susceptibility, 96.8% were susceptible to fosfomycin, 98.9% to nitrofurantoin, 50.9% to ciprofloxacin, and 82.4% to cefotaxime. Extended-spectrum beta-lactamase positivity was 14.4% (89/616), and was significantly higher in tertiary hospitals (24.6%, p < 0.001) and recurrent cystitis (27.6%, p < 0.001). Fluoroquinolone resistance was significantly higher in tertiary hospitals (57.8%, p < 0.001), postmenopausal women (54.2%, p < 0.001), and recurrent cystitis (70.3%, p < 0.001). In addition, postmenopausal status (95% confidence interval [CI]: 1.44–3.17, odds ratio [OR] 2.13, p < 0.001), recurrent cystitis (95% CI: 1.40–4.66, OR 2.56, p = 0.002) and tertiary hospitals (95% CI: 1.00–2.93, OR 1.71, p = 0.049) were associated with significantly increased fluoroquinolone resistance. Methods: Any female patient diagnosed with clinical uncomplicated cystitis and microbiologically proven E. coli infection in 2023 was eligible for this study. Patient data were obtained from the web-based KARMS database. The antimicrobial susceptibility of E. coli was analyzed according to clinical factors, including hospital region, hospital type, menopause status, and recurrence status. Conclusions: The antimicrobial resistance of E. coli in patients with uncomplicated cystitis in the Republic of Korea has reached a serious level, especially in fluoroquinolone resistance. Therefore, major efforts should be made to reduce antimicrobial resistance. Full article

Background: The goal of this study was to evaluate whether the medical recommendation of Angocin^® Anti-Infekt N, compared to standard antibiotic treatment shortly after the diagnosis of a urinary tract infection (UTI) or cystitis, is negatively associated with an early, sporadic, or recurrent UTI, subsequent antibiotic prescriptions, pyelonephritis as a renal complication, or UTI-associated sick leave. Methods: This retrospective cohort study was based on data from the IQVIA^TM Disease Analyzer database and included patients diagnosed with acute UTI or cystitis by physicians in Germany between 2005 and 2021, who were prescribed either Angocin^® or standard antibiotics within 4 days after diagnosis. Patients prescribed antibiotics were matched to those prescribed Angocin^® (5:1) using propensity scores. Univariable logistic and Cox regression models were used to investigate the association between Angocin^® prescription and the defined study outcomes. The effects of Angocin^® were adjusted for age, sex, insurance status, index diagnosis, and physician specialty. Results: A total of 2277 Angocin^® patients and 11,385 antibiotic patients were available for analysis. Compared to antibiotic prescriptions, Angocin^® prescription was associated with significantly lower odds of an early relapse within 1–30 days after the index date (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.62–0.87; p < 0.001), further sporadic UTI within 31–365 days after the index date (OR: 0.68; 95% CI: 0.58–0.78; p < 0.001), and recurrent UTI (OR: 0.63; 95% CI: 0.48–0.82; p < 0.001). This was also accompanied by reduced antibiotic prescriptions (1–30 days: OR: 0.63; 95% CI: 0.53–0.74, p < 0.001; 31–365 days: OR: 0.56; 95% CI: 0.49–0.64, p < 0.001). A strong, but due to the low incidence, not significant, negative association was observed between Angocin^® prescription and the occurrence of pyelonephritis (hazard ratio (HR): 0.67; 95% CI: 0.43–1.06; p = 0.073). Conclusions: The results of this real-world data study demonstrate that Angocin^® can be an effective therapeutic option for managing acute and recurrent UTIs and serves as an alternative therapy to antibiotics. Full article

Background and Objectives: Radiation therapy (RT) plays a crucial role in managing prostate cancer, offering effective disease control and improving survival rates in both localized and recurrent cases. However, RT can lead to hemorrhagic cystitis, a significant late complication resulting in chronic morbidity and other health issues. This study aims to evaluate the real-world incidence of radiation-induced hemorrhagic cystitis requiring surgical intervention. Materials and Methods: This retrospective cohort study analyzed data from prostate cancer survivors treated for hematuria at our center between January 2014 and January 2024. Patients were included if cystoscopy identified radiation cystitis as the cause of hematuria. Descriptive statistics were used, and binomial logistic regression analyses with univariate and multivariate analysis were performed to identify risk factors for worse outcomes. Results: Fifty-two patients met the inclusion criteria. The estimated cumulative incidence at a median follow-up of 5.3 years was 4.5%. Among the participants, 21.2% required more than two transurethral bladder fulguration (TUBF) procedures, and 38.5% needed more than two hospital admissions for hematuria management. The median time to the first fulguration was 64 months. Blood transfusions were necessary in 53.8% of cases, and 38.5% required hyperbaric oxygen therapy. Ultimately, 5.8% of the patients underwent cystectomy. Univariate analysis identified ischemic heart disease (IHD) and antiplatelet therapy as significant risk factors (OR: 5.17 and 5.18, respectively), along with longer time to first fulguration (OR: 5.02). Multivariate analysis confirmed antiplatelet therapy (OR: 2.8, p = 0.05) and time to first TUBF (OR: 1.8, p = 0.02) as significant predictors of multiple procedures. Conclusions: Radiation cystitis remains a significant burden on prostate cancer survivors. Patients on antithrombotic agents, those with delayed initial presentations, and those who received radiation as salvage therapy are more likely to experience higher morbidity. Full article

Objective: To assess the effectiveness of Platelet Concentrates (PCs) in the contest of Hemorrhagic, Actinic, and Radiation Cystitis, plus Urethral Obstruction or Stenosis. Eligibility criteria: Open article in English or Italian regarding in situ applications of PCs for the selected pathologies. Information sources: MEDLINE, Cochrane Library, and ELSEVIER. Risk of bias: High (and discussed). Methods for synthesis of results: Selection of relevant contents, resumed by digital tools, checked by authors and used throughout the manuscript. Included studies: 13 screened articles + 7 personal sources + 37 “extra” articles. Synthesis of results: Pre-clinical and clinical studies demonstrated substantial symptom relief, mucosal restoration, and improved growth factor levels, reducing recurrence rates and complications. However, preparation protocols and results varied among studies. Limitations of evidence: Frequent low-quality studies with mall sample size, plus heterogeneous experimental setups and nomenclature/preparations. Interpretation: PCs demonstrate promise due to their bioactive components, enhancing tissue repair and reducing inflammation with no significant adverse events. Despite positive outcomes in pre-clinical and clinical studies, variability in preparation protocols and small sample sizes, together with inconsistent results, highlight the need for high-quality research to validate PCs’ clinical efficacy and cost-effectiveness. Full article

Recurrent cystitis in women represents an everyday challenge; however, little to no data regarding this population are available. This study aimed to evaluate this collective with respect to a rational calculated antibiotic therapy. Urine cultures and antibiograms from a urological office were retrospectively evaluated from patient data collected between January 2017 and June 2019. The evaluation was conducted using SPSS ©. In total, 84 female patients, who were aged between 18 and 87 years old (median 60 years), suffered from recurrent cystitis. Escherichia coli was found in 53.9% of cases, Staphylococcus aureus and enterococci were each found in 6.7%, and Proteus spp. and Streptococcus agalactiae were each found in 5.6%. The resistance levels to ciprofloxacin (CIP), trimethoprim–sulfamethoxazole (TRS), nitrofurantoin (NIT), and nitroxoline (NOX) were 18.2%, 30.7%, 16.1%, and 12.5% in the tested cases, respectively. Regarding E. coli, resistance to CIP, TRS, and NIT was found in 17.8%, 25%, and 4.2% of the tested cases, and no resistance to NOX was found. The resistance level to CIP was in a tolerable range of <20% in the overall cohort and the E. coli subgroup. More than a quarter of the bacteria were resistant to TRS. The low resistance rates for NIT and NOX are remarkable, promoting the use of these substances if they are not yet used. Full article

(1) Background: Intravesical chemotherapy is the standard of care in intermediate-risk non-muscleinvasive bladder cancer (NMIBC). Different agents are used across the world based on availability, cost, and practice patterns. Epirubicin (EPI), one of these agents, has been used by many centers over many decades. However, its true differential efficacy compared to other agents and its tolerability are still poorly reported. We aimed to assess the differential efficacy and safety of intravesical EPI in NMIBC patients. (2) Methods: This study aimed to systematically review the efficacy and safety profile of Epirubicin (EPI) in the management of non-muscle invasive bladder cancer (NMIBC) compared to other adjuvant therapies. A systematic search of the PUBMED, Web of Science, clinicaltrials.gov, and Google Scholar databases was conducted on 31 December 2023, using relevant terms related to EPI, bladder cancer, and NMIBC. The inclusion criteria targeted studies that evaluated patients treated with EPI following the transurethral resection of bladder tumors (TURBT) for NMIBC and compared oncological outcomes such as recurrence and progression with other adjuvant therapies, including Mitomycin C (MMC), Gemcitabine (GEM), and Bacillus Calmette-Guérin (BCG). Additionally, studies investigating the safety profile of EPI administered intravesically at room temperature and under hyperthermia, as well as oncological outcomes associated with hyperthermic intravesical EPI administration, were included. (3) Results: Eleven studies reported adverse events after adjuvant intravesical instillations with EPI; the most frequently reported adverse events included cystitis (34%), dysuria, pollakiuria, hematuria, bladder irritation/spasms, fever, nausea and vomiting, and generalized skin rash (2.3%). Nine studies compared EPI to BCG in terms of recurrence and progression rates; BCG instillations showed a lower recurrence rate compared to EPI, with limited or non-significant differences in progression rates. Two studies found no significant differences between EPI and MMC regarding progression and recurrence rates. One study showed statistically significant lower recurrence and progression rates with GEM in high-risk NMIBC patients. Another study found no significant differences between EPI and GEM regarding recurrence and progression. (4) Conclusions: EPI exhibits similar oncological performances to Gemcitabine and Mitomycin C currently used for adjuvant therapy in NMIBC. Novel delivery mechanisms such as hyperthermia are interesting newcomers. Full article