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Poletajew S, Brzózka MM, Krajewski W, Kamecki H, Nyk Ł, Kryst P. Glycosaminoglycan Replacement Therapy with Intravesical Instillations of Combined Hyaluronic Acid and Chondroitin Sulfate in Patients with Recurrent Cystitis, Post-radiation Cystitis and Bladder Pain Syndrome: A Narrative Review. Pain Ther 2024; 13:1-22. [PMID: 37917298 PMCID: PMC10796878 DOI: 10.1007/s40122-023-00559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Defects in the glycosaminoglycan layer (GAG) of the bladder mucosa have been identified as a significant contributor to the pathogenesis and clinical progression of chronic inflammatory diseases of the bladder, such as post-radiation cystitis, bladder pain syndrome and recurrent urinary tract infections. This narrative review aims to explore the contemporary evidence on the role of GAG reconstitution with intravesical installations of hyaluronic acid and chondroitin sulfate in the management of those patients, with a goal to provide valuable insights for clinical practice. The reviewed studies consistently demonstrate that GAG reconstitution can result in varying degrees of clinical improvement in patients with post-radiation cystitis, bladder pain syndrome and recurrent urinary tract infections, and is associated with a very favorable safety profile. While the available evidence is growing, its level is still limited, mainly by relatively low number of randomized controlled trials, with small sample sizes. Further research with larger, well-designed trials is needed to solidify the findings and optimize the clinical application of GAG reconstitution.
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Affiliation(s)
- Sławomir Poletajew
- Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland.
| | | | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Hubert Kamecki
- Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Łukasz Nyk
- Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Piotr Kryst
- Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland
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Rahnama’i MS, Javan Balegh Marand A, Röschmann-Doose K, Steffens L, Arendsen HJ. The efficacy and safety of intravesical chondroitin sulphate solution in recurrent urinary tract infections. BMC Urol 2022; 22:188. [PMID: 36424583 PMCID: PMC9685912 DOI: 10.1186/s12894-022-01149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Urinary tract infections are among the most common indications for antibiotic therapy. The emergence of resistant uropathogens indicates the need for treatment alternatives. Replenishment of the glycosaminoglycan layer of the bladder, achieved by intravesical instillation of e.g. chondroitin sulphate (CS), is described to be a cornerstone in the therapy of cystitis. To retrospectively evaluate the efficacy of a therapy with 0.2% CS in patients suffering recurrent urinary tract infections (rUTI) in comparison to a treatment with low-dose long-term antibiotics (LDLTAB) and a combination of both. METHODS A total of 151 patients with recurrent UTI who underwent intravesical therapy at Diaconesse hospital in Leiden, The Netherlands were included. 50 patients had been treated with CS, 51 patients had received LDLTAB, and 50 patients had received a combination therapy (LDLTABCS). Data recorded for baseline, after 6, and 12 months of treatment were evaluated. Descriptive statistics were calculated. Exploratory comparisons between groups and within groups were performed by using one-tailed and paired t-tests. Patients filled in a standardized quality of life questionnaire (EQ-5D). RESULTS We found a statistically significant reduction of number of infections from 7.10 ± 0.50 SEM to 0.45 ± 0.07 SEM after 12 months therapy with CS compared to 12 months therapy with LDLTAB (from 7.04 ± 0.47 SEM to 1.8 ± 0.15 SEM). The number of visits to the urologist significantly decreased in the CS group from 7.46 ± 0.80 SEM to 1.28 ± 0.11 SEM and from 4.10 ± 0.29 SEM to 1.35 ± 0.11 SEM in the LDLTABCS group. In addition, a significant increase in Quality of life (QoL) was seen in the CS-group (from 58.2 ± 0.82 SEM to 80.43 ± 0.82 SEM) and in the LDLTABCS group (from 62.4 ± 0.97 SEM to 76.73 ± 1.06 SEM). There was no improvement in QoL with LDLTAB (from 58.24 ± 1.08 SEM to 58.96 ± 1.19 SEM). Evaluation's evidence is limited due to its retrospective character. CONCLUSIONS Retrospective analysis of data from patients that underwent therapy for rUTIs confirms the safety and efficacy of CS and indicate a superiority to antibiotic treatment of rUTIs.
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Affiliation(s)
- M. S. Rahnama’i
- grid.416373.40000 0004 0472 8381St. Elizabeth- Tweesteden Hospital, Tilburg, The Netherlands ,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - A. Javan Balegh Marand
- Society of Urological Research and Education (SURE), Heerlen, The Netherlands ,grid.412966.e0000 0004 0480 1382Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | | | - L. Steffens
- grid.476374.5G. Pohl-Boskamp GmbH & Co. KG, Hohenlockstedt, Germany
| | - H. J. Arendsen
- Andros Clinics, Bladdercenter, The Hague, The Netherlands
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Dinh A, Duran C, Hamami K, Afif M, Bonnet F, Donay JL, Lafaurie M, Chartier-Kastler E. Hyaluronic acid and chondroitin sulphate treatment for recurrent severe urinary tract infections due to multidrug-resistant gram-negative bacilli in a patient with multiple sclerosis: case report and literature review. Open Forum Infect Dis 2022; 9:ofac245. [PMID: 35855005 PMCID: PMC9280323 DOI: 10.1093/ofid/ofac245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
Abstract
Urinary tract infections (UTIs) are the most common bacterial infections in patients with neurogenic lower urinary tract dysfunction. Antibiotic options for prophylaxis or curative treatment in case of recurrent UTIs, especially due to multidrug-resistant organisms (MDRO), are scarce. We present the case of a 72-year-old man with neurogenic lower urinary tract dysfunction and history of frequent recurrent UTIs due to multiple MDROs who was successfully treated with hyaluronic acid (HA) and chondroitin sulfate (CS) bladder instillations. We also provide a literature review on the efficacy of HA-CS intravesical instillations for prevention of UTI among this population.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique – Hôpitaux de Paris, Garches, France
| | - Clara Duran
- Infectious Disease department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique – Hôpitaux de Paris, Garches, France
| | - Kamel Hamami
- Pharmacy, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique – Hôpitaux de Paris, Garches, France
| | - Muriel Afif
- Pharmacy, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique – Hôpitaux de Paris, Garches, France
| | - Francine Bonnet
- Anesthesiology department, Saint-Louis University Hospital, University of Paris, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Jean-Luc Donay
- Microbiology department, Saint-Louis University Hospital, University of Paris, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Matthieu Lafaurie
- Infectious Disease department, Saint-Louis University Hospital, University of Paris, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Emmanuel Chartier-Kastler
- Urology department, Pitié-Salpétrière University Hospital, Paris Sorbonne University, Assistance Publique – Hôpitaux de Paris, Paris, France
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Reddy M, Zimmern PE. Efficacy of antimicrobial intravesical treatment for uncomplicated recurrent urinary tract infections: a systematic review. Int Urogynecol J 2022; 33:1125-1143. [PMID: 34982189 DOI: 10.1007/s00192-021-05042-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Intravesical antimicrobials (IVA) provide a localized modality of treatment for recurrent urinary tract infections (rUTIs). Owing to the sporadic use of these treatments, we conducted a systematic review on the efficacy of IVA in the management of uncomplicated rUTIs. METHODS A systematic review was conducted for all English language articles from inception to April 2021 utilizing the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards with the following databases: PubMed, OVID Embase, Biomed Central, and Scopus. References were cross-examined for further articles. Risk of bias was assessed in the articles included using the Cochrane and Joanna Briggs Institute tools. RESULTS The initial search resulting in 476 titles led to 15 full-text articles. Of the 13 in the final review (2 RCTs), 3 used gentamicin and 10 used hyaluronic acid IVA. These included 764 participants, mostly women, with a mean age range of 27-80 (median: 53.1). There was a reduction in UTI frequency in 12 out of 13 studies, with 10 studies showing a statistically significant decrease. Dosages of 80 mg of gentamicin per instillation and both 40 mg and 800 mg of hyaluronic acid per instillation were found to be effective in reducing the frequency of UTIs in most studies. Eleven participants reported gentamicin-resistant infections after IVA treatment. Despite high levels of bias in selected categories, the 13 studies were designated to be of high quality for inclusion. CONCLUSIONS The IVAs gentamicin and hyaluronic acid with chondroitin sulphate demonstrated efficacy in the management of uncomplicated rUTIs, mostly in women.
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Affiliation(s)
- Meghana Reddy
- Department of Urology, U.T. Southwestern Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Philippe E Zimmern
- Department of Urology, U.T. Southwestern Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
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Mainini G, Passaro M, Schiattarella A, Franciscis PD, Donna MCD, Trezza G. Prevention and treatment of cystitis during menopause: efficacy of a nutraceutical containing D-mannose, inulin, cranberry, bearberry, Olea europaea, Orthosiphon and Lactobacillus acidophilus. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2020; 19:130-134. [PMID: 33100948 PMCID: PMC7573332 DOI: 10.5114/pm.2020.99567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022]
Abstract
AIM OF THE STUDY To evaluate the efficacy of a nutraceutical compound containing Uticlin® (D-mannose, cranberry, bearberry, Olea europaea), inulin, Orthosiphon and Lactobacillus acidophilus, in preventing recurrent urinary tract infections (UTIs) in menopausal women. MATERIAL AND METHODS This was a prospective cohort study of menopausal women recruited with a history of recurrent UTIs in the previous twelve months and who intended to treat their bladder problem without the use of antibiotics and/or anti-inflammatories. Women were proposed the use of an oral nutraceutical compound. The drug was taken for ten days, every month. Women were assigned to two parallel cohorts: patients using (group 1) or not using (group 2) this nutraceutical compound. The primary objective of the study was to evaluate the number of women with less than two infective episodes in the 6-month follow-up and less than three episodes in the 12-month follow-up. The secondary endpoints were to evaluate the reduction of related symptoms at 12-month follow-up, according to the Visual Analog Scale (VAS). RESULTS At 6 months of therapy, the reduction in the number of patients with ≥ 2 UTIs was statistically significant (p < 0.05) compared to baseline only in group 1. At 12 months, the number of patients who were disease-free was significantly higher (p < 0.05) in group 1 compared to group 2. Moreover, the improvement of related symptoms was statistically significant (p < 0.05) in group 1, as shown by the reduction in the VAS scale value. CONCLUSIONS In menopausal women, the combination of D-mannose, inulin, cranberry, bearberry, Olea europaea, Orthosiphon and Lactobacillus acidophilus SGL 11 per os represents a useful therapy for recurrent UTIs in women wanting a natural approach.
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Affiliation(s)
- Giampaolo Mainini
- Menopausal Center, San Leonardo Hospital, ASL NA3 SUD, Castellammare di Stabia, Naples, Italy
| | | | - Antonio Schiattarella
- Unit of Gynecology and Obstetrics, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pasquale De Franciscis
- Unit of Gynecology and Obstetrics, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mariano C. Di Donna
- Department of Gynecologic Oncology, Arnas Civico, University of Palermo, Palermo, Italy
| | - Gennaro Trezza
- Unit of Gynecology and Obstetrics, Rummo Hospital, Benevento, Italy
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MAJID AK, AHMED Z, KHAN R. Effect of pumpkin seed oil on cholesterol fractions and systolic/diastolic blood pressure. FOOD SCIENCE AND TECHNOLOGY 2020. [DOI: 10.1590/fst.03720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Pigrau C, Escolà-Vergé L. Recurrent urinary tract infections: from pathogenesis to prevention. Med Clin (Barc) 2020; 155:171-177. [PMID: 32561190 DOI: 10.1016/j.medcli.2020.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
Urinary tract infections are highly prevalent among women and when they are recurrent they can lead to patient discomfort and high healthcare costs, and they represent one of the most frequent causes of antibiotic consumption. There are several options to prevent RUTI which include both antibiotic treatment (continuous or postcoital antibiotic prophylaxis) and non-antibiotic measures (hygienic measures, vitamin D, blueberries, D-mannose, probiotics, oestrogens, vaccines, intravesical instillations), but with different levels of evidence, sometimes of poor quality, and therefore new randomized and comparative studies are needed to choose the best strategy.
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Affiliation(s)
- Carlos Pigrau
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016/0003); Consultoría Medicina-Enfermedades-Infecciosas, Clínica Creu Blanca, Barcelona, España.
| | - Laura Escolà-Vergé
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016/0003)
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Cicek N, Yildiz N, Alpay H. Intravesical hyaluronic acid treatment in recurrent urinary tract infections in children with spina bifida and neurogenic bladder. J Pediatr Urol 2020; 16:366.e1-366.e5. [PMID: 32197933 DOI: 10.1016/j.jpurol.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/16/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Damage to the glycosaminoglycan layer of the urothelium, which is composed of hyaluronic acid (HA), may increase the possibility of bacterial adherence and infections. Patients with neurogenic bladder (NB) who perform clean intermittent catheterization (CIC) 4-6 times a day are also under great risk for recurrent urinary tract infections (RUTIs). OBJECTIVE The aim of this study was to assess the efficacy and safety of intravesical HA in reducing the frequency of RUTIs in patients with spina bifida (SB) and NB, who perform CIC. MATERIALS AND METHODS Ten patients (nine girls, one boy) with SB and NB affected by RUTIs received intravesical instillation of HA. Ten patients (seven girls, three boys) with SB and NB who did not accept the intravesical HA therapy were included in the control group. All patients developed symptomatic RUTIs, which occurred at least three times in the previous 12 months. The study group was treated with intravesical 40 mg HA (Hyacyst®) weekly for four weeks, then monthly for the consequent three months. Recurrence of UTIs before and after the treatment was analyzed. RESULTS The mean age of the study group and the controls were 11.1 ± 4.8 (3.2-18.6) and 9.3 ± 5.4 (2.1-16.2) years, respectively. The mean UTIs per patient-month in the study group and the controls were 0.34 ± 0.05 and 0.35 ± 0.06, respectively. The mean follow-up time after the treatment was 16.6 ± 6.9 months in the study group and 16 ± 6.1 months in the controls. The mean UTIs per patient-month significantly decreased in the study group after the treatment (p < 0.001) but showed no significant difference in the control group (p = 0.174). When study and control groups were compared, the mean UTIs per patient-month showed no significant difference before treatment (p = 0.77) but significantly decreased in the study group after the treatment (p < 0.001). DISCUSSION To the best of the authors' knowledge, this study is the first one evaluating the efficacy of intravesical HA in the treatment of RUTIs in children with SB and NB. However, this study has several limitations, such as the small sample size and short follow-up time. CONCLUSION The findings of the present study indicate that intravesical HA is an effective and safe treatment that reduces RUTIs in patients with SB and NB, who perform CIC.
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Affiliation(s)
- Neslihan Cicek
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Nurdan Yildiz
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Harika Alpay
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey
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Harding C, Rantell A, Cardozo L, Jacobson SK, Anding R, Kirschner-Hermanns R, Greenwell T, Swamy S, Malde S, Abrams P. How can we improve investigation, prevention and treatment for recurrent urinary tract infections - ICI-RS 2018. Neurourol Urodyn 2020; 38 Suppl 5:S90-S97. [PMID: 31821632 DOI: 10.1002/nau.24021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/13/2019] [Accepted: 03/04/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recurrent urinary tract infection (rUTI) is a chronic condition and has a significant impact on health-related quality of life. The commonly used definition for rUTI is greater than three episodes in a year or more than two in 6 months. Current diagnostic methods have been used worldwide for over five decades, despite well evidenced criticism. Enhanced culture techniques demonstrate that the microbiome of the bladder is far more complex than previously thought and begs a reappraisal of our current testing. Treatment of rUTI is based on a small number of antibiotic trials with some evidence showing a reduction in the number of positive cultures, but one must be cautious in interpreting the results and weigh against the risk of generation of antimicrobial resistance (AMR). AIM The International Consultation on Incontinence-Research Society think tank reviewed the literature with a view to improving investigation, prevention and treatment of rUTI. METHODS A multidisciplinary team of experts were invited to present evidence regarding the current diagnostic methods, recent advances related to bladder biome mapping and current treatment strategies, including antibiotic and nonantibiotic options. Current guidelines regarding antibiotic stewardship and concerns regarding AMR were discussed. DISCUSSION Outcome of the think tank discussions are summarised with a set of recommendations to inform future research. Particular consideration is given to bacterial survival in the bladder after treatment as well as defects in urothelial barrier function which may play a significant part in the failure to eradicate UTI.
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Affiliation(s)
- Chris Harding
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Angela Rantell
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Susan Kim Jacobson
- Infection Sciences, Severn Pathology, North Bristol NHS Trust, Bristol, UK
| | - Ralf Anding
- Department of Neuro-Urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V, Bonn, Germany
| | - Ruth Kirschner-Hermanns
- Department of Neuro-Urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V, Bonn, Germany
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Sheela Swamy
- Division of Medicine, University College London, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Abrams
- Southmead Hospital, Bristol Urological Institute, Bristol, UK
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Torella M, Bellini G, Punzo F, Argenziano M, Schiattarella A, Labriola D, Schettino MT, Ambrosio D, Ammaturo FP, De Franciscis P. TNF-α effect on human delivery onset by CB1/TRPV1 crosstalk: new insights into endocannabinoid molecular signaling in preterm vs. term labor. Analysis of the EC/EV pathway and predictive biomarkers for early diagnosis of preterm delivery. ACTA ACUST UNITED AC 2020; 71:359-364. [PMID: 31698890 DOI: 10.23736/s0026-4784.19.04405-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Endocannabinoids/endovanilloid (EC/EV) system and inflammation are recognized as key regulators of cell-signaling pathways in female reproduction. The knowledge of predictive biomarkers involved in preterm birth (PTB) represents an important goal to make an early diagnosis. The aim of the study was to investigate the role of EC/EV system and inflammation in human delivery, in placental samples from spontaneous deliveries. METHODS We examined the expression of genes encoding for the components of EC/EV system (CB1, CB2, TRPV1, MAGL, FAAH, DAGL, NAPE-PLD) and for inflammatory cytokines (IL-6, TNF-α) with qRT-PCR techniques, in human placental samples from preterm delivery (at 30 and at 34 weeks) compared to term delivery (40 weeks, control group). RESULTS We found a marked increase of CB1, anandamide, and inflammatory cytokines, mainly TNF-α, together with TRPV1 down-regulation in term delivery group, compared to preterm groups (P<0.05). CONCLUSIONS Our findings highlighted the emergent pivotal role of the EC/EV system and inflammation in spontaneous term delivery and provided the framework for future studies that investigate the CB1/TRPV1 crosstalk in preterm birth. Particularly, we found a link between the stimulation of CB1 receptors and the antagonism of TRPV1 channels, that could be used in PTB prevention, through selected molecules.
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Affiliation(s)
- Marco Torella
- Section of Gynecology and Obstetrics, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Giulia Bellini
- Department of Experimental Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Francesca Punzo
- Section of Pediatrics, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Maura Argenziano
- Department of Experimental Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antonio Schiattarella
- Section of Gynecology and Obstetrics, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Domenico Labriola
- Section of Gynecology and Obstetrics, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Maria T Schettino
- Section of Gynecology and Obstetrics, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Domenico Ambrosio
- Section of Gynecology and Obstetrics, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Franco P Ammaturo
- Section of Gynecology and Obstetrics, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Pasquale De Franciscis
- Section of Gynecology and Obstetrics, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
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Yang B, Blick C, Foley S. Avoiding antibiotics in the management of recurrent UTIs in women: What are our options? JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819854912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Urinary tract infections are one of the most common infections worldwide, accounting in the United Kingdom for 1–3% of all medical consultations. Fifty per cent of women will experience one episode of urinary tract infection in their lifetimes and of these, up to 30% will develop recurrent urinary tract infections. Such women often rely on long-term low dose antibiotics. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Bob Yang
- Department of Urology, Royal Berkshire Hospital, UK
| | | | - Steve Foley
- Department of Urology, Royal Berkshire Hospital, UK
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12
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Kamalifard M, Abbasalizadeh S, Mirghafourvand M, Bastani P, Gholizadeh Shamasbi S, Khodaei L, Gholizadeh G. The effect of Seidlitzia rosmarinus (eshnan) on the prevention of recurrent cystitis in women of reproductive age: A randomized, controlled, clinical trial. Phytother Res 2019; 34:418-427. [PMID: 31680378 DOI: 10.1002/ptr.6534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/03/2019] [Accepted: 10/09/2019] [Indexed: 01/11/2023]
Abstract
The World Health Organization has recommended herbal medicine for treatment and control of recurrent cystitis. This study was conducted to determine effect of eshnan on the prevention of recurrent cystitis. The present triple-blind clinical trial was conducted on 126 women (63 women per group) with recurrent cystitis. The participants were assigned to the intervention and control groups. Three 500-mg eshnan or placebo tablets were taken orally with a glass full of water by the participants half an hour after each meal for 2 months. The study subjects were clinically and paraclinically evaluated by the end of the second, fourth, and sixth months after the intervention and every time they showed clinical symptoms of cystitis. The present findings showed that the incidence rate of cystitis and symptoms of cystitis was significantly lower in the eshnan group compared with the placebo group 2, 4, and 6 months after the intervention (p < .05). The incidence of recurrent was also significantly lower in the intervention group compared with the control group (p < .001). No side effects were observed in the intervention and control groups. The consumption of eshnan can improve the symptoms of cystitis and prevent the incidence of recurrent cystitis in women of reproductive age.
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Affiliation(s)
- Mahin Kamalifard
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shamsi Abbasalizadeh
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Midwifery Department, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Bastani
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sevda Gholizadeh Shamasbi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Laleh Khodaei
- Department of Phytopharmacy, Traditional Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Golchehreh Gholizadeh
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
Urinary tract infections (UTIs) are highly prevalent, lead to considerable patient morbidity, incur large financial costs to health-care systems and are one of the most common reasons for antibiotic use worldwide. The growing problem of antimicrobial resistance means that the search for nonantibiotic alternatives for the treatment and prevention of UTI is of critical importance. Potential nonantibiotic measures and treatments for UTIs include behavioural changes, dietary supplementation (such as Chinese herbal medicines and cranberry products), NSAIDs, probiotics, D-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans, immunostimulants, vaccines and inoculation with less-pathogenic bacteria. Some of the results of trials of these approaches are promising; however, high-level evidence is required before firm recommendations for their use can be made. A combination of these agents might provide the optimal treatment to reduce recurrent UTI, and trials in specific population groups are required.
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Wood MW, Barrett-Wilt GA. Effect of twice-daily oral administration of a chondroitin sulfate-containing supplement on urine chondroitin sulfate concentrations in dogs. Am J Vet Res 2019; 80:799-805. [PMID: 31339761 DOI: 10.2460/ajvr.80.8.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To quantify the magnitude and duration of changes in urine chondroitin sulfate concentration (uCS) as a result of oral administration of a chondroitin sulfate-containing supplement in dogs. ANIMALS 8 healthy privately owned dogs. PROCEDURES A urine sample was collected from each dog via cystocentesis on day 1; free-catch midstream urine samples were collected once daily on days 2 through 5. Pretreatment uCS was established from those samples. Each dog then received a chondroitin sulfate-containing supplement (20 to 30 mg/kg, PO, q 12 h) for 8 days (on days 7 through 14). Urine samples were collected on days 8 through 12 and day 15. For each sample, uCS was quantified by liquid chromatography-tandem mass spectrometry. Variable urine concentration was accounted for by dividing the uCS by urine creatinine concentration (uCrea) to determine the uCS:uCrea ratio. Pretreatment uCS:uCrea ratios were compared with treatment uCS:uCrea ratios to calculate the fold change in uCS after supplement administration. RESULTS Among the study dogs, oral administration of the chondroitin sulfate-containing supplement resulted in a 1.9-fold increase in the median uCS:uCrea ratio. Data obtained on days 8 through 12 and day 15 indicated that the daily increase in uCS remained consistent and was not additive. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that oral administration of supplemental chondroitin sulfate to dogs modestly increased uCS within 24 hours; however, subsequent supplement administration did not have an additive effect. A potential therapeutic benefit of persistently increased uCS in preventing recurrent urinary tract infections in dogs warrants investigation.
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De Franciscis P, La Manna V, Labriola D, Genovese G, Miraglia N, Schiattarella A, Colacurci N, Torella M. Menopausa precoce e metalli pesanti. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Pietropaolo A, Jones P, Moors M, Birch B, Somani BK. Use and Effectiveness of Antimicrobial Intravesical Treatment for Prophylaxis and Treatment of Recurrent Urinary Tract Infections (UTIs): a Systematic Review. Curr Urol Rep 2018; 19:78. [PMID: 30094687 PMCID: PMC6097067 DOI: 10.1007/s11934-018-0834-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of Review Intravesical antibiotics (IVA) has been used for prophylaxis and treatment of recurrent urinary tract infections (rUTIs). However, there is a lack of comprehensive evidence and consensus on its use. We conducted a systematic review to collect all available data about the effectiveness of IVA in prevention and treatment of rUTIs and to give an overview on the outcomes to date. Methods A systematic review was carried out for all English language articles from inception to August 2017, according to the Cochrane and PRISMA standards using MEDLINE, Scopus, Biomed Central, EMBASE, CINAHL, and Web of Science with references cross-checked and individual urology journals hand-searched. Results After an initial identification of 658 studies, we screened 37 abstracts and 18 full-text papers of which 11 were included in our final review. This included 285 patients with a mean age of 52 years and a female:male ratio of 129:117. The IVA used was gentamicin, neomycin/polymyxin, neomycin or colistin and IVA was used for rUTIs as prophylaxis in 5 studies (n = 168) and treatment in 6 studies (n = 117). Overall, a good reduction in symptomatic UTI was seen in 78%, with a short-term success rate and discontinuation rates of 71% (120/168) and 8% (14/168) in the prophylaxis group and 88% (103/117) and 5% (6/117) in the treatment groups respectively. There was a change in the sensitivity of organisms in 30% (50/168) and 23% (27/117) in the treatment and prophylaxis groups respectively. Twenty patients discontinued their IVA instillations which were higher for the non-gentamicin group (11%) compared to the gentamicin group (5%). The side effects were minor and included allergy, suprapubic discomfort, autonomic dysreflexia, urinary tract infections and diarrhoea. Summary Intravesical antimicrobial instillation seems to be a relatively safe and effective method for the prophylaxis and treatment of recurrent UTIs, especially in the short term. It gives clinicians an alternative treatment modality in high-risk patients predisposed to UTIs where all other forms of systemic treatments have failed.
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Affiliation(s)
- Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
| | - Patrick Jones
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
| | - Mike Moors
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Brian Birch
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK. .,Primary Care and Population Sciences, University of Southampton, Southampton, UK.
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17
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Abstract
PURPOSE OF REVIEW To summarize evidence on the efficacy of nonantibiotic treatments in the prevention of recurrent urinary tract infections (UTIs). The need for antibiotic-free regimens seems to be imperative given the worldwide rates of resistance of uropathogens to available antibiotics. RECENT FINDINGS In the recently published literature, cranberry products and probiotics are the focus of research. They both seem to be effective in preventing recurrent UTIs compared with placebo, but their benefit becomes less clear when they are compared with antibiotics. SUMMARY A number of nonantibiotic-containing alternatives are available for the prevention of recurrent UTIs. For the majority of these alternatives, contradictory results have been published. These can be, at least partially, explained by variation in doses administered and duration of treatment. Selection of patients more likely to benefit from these interventions seems to be a realistic approach from a clinical-practice perspective, as well a worthwhile focus for future research.
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18
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Ni Y, Zhao S, Yin X, Wang H, Guang Q, Hu G, Yang Y, Jiao S, Shi B. Intravesicular administration of sodium hyaluronate ameliorates the inflammation and cell proliferation of cystitis cystica et glandularis involving interleukin-6/JAK2/Stat3 signaling pathway. Sci Rep 2017; 7:15892. [PMID: 29162939 PMCID: PMC5698415 DOI: 10.1038/s41598-017-16088-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/06/2017] [Indexed: 01/14/2023] Open
Abstract
Cystitis cystica et glandularis (CCEG) is a chronic cystitis that causes extreme agony in affected patients. However, there are lack of effective conservative treatments. In this study, it is evident that intravesicular sodium hyaluronate (SH) therapy significantly improved the clinical symptoms of CCEG patients and ameliorated the bladder mucosal inflammation and cell proliferation characteristics of the disease. Immunohistochemical staining showed that the staining intensities of hyaluronidase (HYAL 1/2), CD44, IL-6 and phosphorylated signal transducer and activator of transcription 3 (p-Stat3) in bladder mucosal tissue were significantly increased in CCEG patients compared with control patients and that intravesicular SH treatment suppressed these protein expression. We established a CCEG rat model by treating rats with E. coli intravesicularly, and we found that HYAL 1/2 and CD44 expression levels were significantly increased in the E. coli group compared with the NC group. Activation of the IL-6/JAK2/Stat3 pathway and the expression levels of the downstream pro-apoptotic proteins Mcl-1 and Bcl-xL were also significantly increased in the E. coli group compared with the NC group. The above changes were significantly mitigated by intravesicular SH treatment. Therefore, SH may serve as an effective therapy for CCEG by inhibiting bladder mucosal inflammation and proliferation.
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Affiliation(s)
- Yongliang Ni
- Department of Urology, Shandong University Qilu Hospital, Jinan, Shandong, 250012, China.,Department of Urology, Yankuang Group General Hospital, Zoucheng, Shandong, 273500, China
| | - Shaohua Zhao
- Department of Geriatrics, Shandong University Qilu Hospital, Jinan, Shandong, 250012, China
| | - Xiaoxuan Yin
- Department of Traditional Chinese Medicine, Yankuang Group General Hospital, Zoucheng, Shandong, 273500, China
| | - Haixin Wang
- Department of Urology, Yankuang Group General Hospital, Zoucheng, Shandong, 273500, China
| | - Qianqian Guang
- Department of Pathology, Yankuang Group General Hospital, Zoucheng, Shandong, 273500, China
| | - Guangxia Hu
- Department of Pathology, Yankuang Group General Hospital, Zoucheng, Shandong, 273500, China
| | - Yi Yang
- Department of Pathology, Yankuang Group General Hospital, Zoucheng, Shandong, 273500, China
| | - Shoubin Jiao
- Department of Urology, Yankuang Group General Hospital, Zoucheng, Shandong, 273500, China
| | - Benkang Shi
- Department of Urology, Shandong University Qilu Hospital, Jinan, Shandong, 250012, China.
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19
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Abrams P, Hashim H, Tomson C, Macgowan A, Skews R, Warren K. The use of intravesical gentamicin to treat recurrent urinary tract infections in lower urinary tract dysfunction. Neurourol Urodyn 2017; 36:2109-2116. [DOI: 10.1002/nau.23250] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Paul Abrams
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
| | - Hashim Hashim
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
| | | | - Alasdair Macgowan
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
| | - Rachel Skews
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
| | - Katherine Warren
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
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20
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Efficacy of an orally administered combination of hyaluronic acid, chondroitin sulfate, curcumin and quercetin for the prevention of recurrent urinary tract infections in postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2016; 207:125-128. [DOI: 10.1016/j.ejogrb.2016.10.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/07/2016] [Accepted: 10/18/2016] [Indexed: 11/15/2022]
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21
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Abstract
This article briefly summarises data published over the last decade which have investigated the concept that intravesical instillation of glycosaminoglycans (GAGs) hyaluronic acid and chondroitin sulfate is able to restore the GAG layer and provide a beneficial effect in protecting the bladder. In the second half of this article, pre-clinical studies which assess the effectiveness of intravesical instillation of Ialuril® after chemical or electromechanical damage to the rat bladder wall are described.
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22
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Lazzeri M, Hurle R, Casale P, Buffi N, Lughezzani G, Fiorini G, Peschechera R, Pasini L, Zandegiacomo S, Benetti A, Taverna G, Guazzoni G, Barbagli G. Managing chronic bladder diseases with the administration of exogenous glycosaminoglycans: an update on the evidence. Ther Adv Urol 2016; 8:91-9. [PMID: 27034722 PMCID: PMC4772357 DOI: 10.1177/1756287215621234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although the pathophysiology of acute chronic cystitis and other 'sensory' disorders, i.e. painful bladder syndrome (PBS) or interstitial cystitis (IC), often remains multifactorial, there is a wide consensus that such clinical conditions may arise from a primary defective urothelium lining or from damaged glycosaminoglycans (GAGs). A 'cascade' of events starting from GAG injury, which fails to heal, may lead to chronic bladder epithelial damage and neurogenic inflammation. To restore the GAG layer is becoming the main aim of new therapies for the treatment of chronic cystitis and PBS/IC. Preliminary experiences with GAG replenishment for different pathological conditions involving the lower urinary tract have been reported. There is a range of commercially available intravesical formulations of these components, alone or in combination. Literature evidence shows that exogenous intravesical hyaluronic acid markedly reduces recurrences of urinary tract infections (UTIs). Patients treated with exogenous GAGs have fewer UTI recurrences, a longer time to recurrence and a greater improvement in quality of life. Exogenous intravesical GAGs have been used for the treatment of PBS/IC. Despite the limitations of most of the studies, findings confirmed the role of combination therapy with hyaluronic acid and chondroitin sulfate as a safe and effective option for the treatment of PBS/IC. To prevent and/or treat radiotherapy and chemotherapy induced cystitis, GAG replenishment therapy has been used showing preliminary encouraging results. The safety profile of exogenous GAGs has been reported to be very favourable, without adverse events of particular significance.
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Affiliation(s)
- Massimo Lazzeri
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Rodolfo Hurle
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - Paolo Casale
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - NicolòMaria Buffi
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - Giovanni Lughezzani
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - Girolamo Fiorini
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - Roberto Peschechera
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - Luisa Pasini
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - Silvia Zandegiacomo
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - Alessio Benetti
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - Gianluigi Taverna
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy
| | - Giorgio Guazzoni
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Humanitas University, Rozzano, MI, Italy
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23
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García B, Merayo-Lloves J, Martin C, Alcalde I, Quirós LM, Vazquez F. Surface Proteoglycans as Mediators in Bacterial Pathogens Infections. Front Microbiol 2016; 7:220. [PMID: 26941735 PMCID: PMC4764700 DOI: 10.3389/fmicb.2016.00220] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/10/2016] [Indexed: 11/18/2022] Open
Abstract
Infectious diseases remain an important global health problem. The interaction of a wide range of pathogen bacteria with host cells from many different tissues is frequently mediated by proteoglycans. These compounds are ubiquitous complex molecules which are not only involved in adherence and colonization, but can also participate in other steps of pathogenesis. To overcome the problem of microbial resistance to antibiotics new therapeutic agents could be developed based on the characteristics of the interaction of pathogens with proteoglycans.
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Affiliation(s)
- Beatriz García
- Department of Functional Biology, Microbiology, Faculty of Medicine, University of OviedoOviedo, Spain; Instituto Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de OviedoOviedo, Spain
| | - Jesús Merayo-Lloves
- Instituto Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de OviedoOviedo, Spain; Department of Surgery, University of OviedoOviedo, Spain
| | - Carla Martin
- Department of Functional Biology, Microbiology, Faculty of Medicine, University of OviedoOviedo, Spain; Instituto Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de OviedoOviedo, Spain
| | - Ignacio Alcalde
- Instituto Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo Oviedo, Spain
| | - Luis M Quirós
- Department of Functional Biology, Microbiology, Faculty of Medicine, University of OviedoOviedo, Spain; Instituto Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de OviedoOviedo, Spain
| | - Fernando Vazquez
- Department of Functional Biology, Microbiology, Faculty of Medicine, University of OviedoOviedo, Spain; Instituto Oftalmológico Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de OviedoOviedo, Spain; Service of Microbiology, Central University Hospital of AsturiasOviedo, Spain
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24
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Yazawa S. Editorial comment to Restoring the glycosaminoglycans layer in recurrent cystitis: experimental and clinical foundations. Int J Urol 2014; 21:769. [PMID: 24650253 DOI: 10.1111/iju.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Satoshi Yazawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
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