Evolving Role of Silodosin for the Treatment of Urological Disorders – A Narrative Review

Use of α-androgenic receptor blockers remains a mainstay therapeutic approach for the treatment of urological diseases. Silodosin is recommended over other α-blockers for the treatment of lower urinary tract symptoms (LUTS) and benign prostate hyperplasia (BPH), due to its high α_1A uroselectivity. Current research data suggest that silodosin is efficacious in the management of various urological diseases. Thus, we herein review the current evidence of silodosin related to its efficacy and tolerability and appraise the available literature that might ultimately aid in management of various urological conditions at routine clinical practice. Literature reveals that silodosin is beneficial in improving nocturia events related to LUTS/BPH. Silodosin exerts effect on relaxing muscles involved in detrusor obstruction, therefore prolonging the need for patients undergoing invasive surgery. Silodosin treatment, either as a monotherapy or combination, significantly improves International Prostate Symptom Score (IPSS) including both storage and voiding symptoms in patients with BPH/LUTS. Patients on other treatment therapies such as phosphodiesterase 5 inhibitors or other α-blockers are well managed with this drug. Steadily, silodosin has proved beneficial in the treatment of other urological disorders such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), overactive bladder/acute urinary retention (AUR), premature ejaculation (PE), and prostate cancer post brachytherapy-induced progression. In patients with distal ureteral stones, silodosin treatment is beneficial in decreasing stone expulsion time without affecting stone expulsion rate or analgesic need. Moreover, there were significant improvements in intravaginal ejaculation latency time, quality of life scores, and decrease in PE profile among patients with PE. Silodosin has also demonstrated promising results in increasing the likelihood of successful trial without catheter in patients with AUR and those taking antihypertensive drugs. Reports from Phase II studies have shown promising role of silodosin in the treatment of CP/CPPS as well as facilitating ureteral stone passage. From the robust data in this review, further silodosin treatment strategies in the management of different urological conditions need to be focused on.

TRPM8 Channels: Advances in Structural Studies and Pharmacological Modulation

The transient receptor potential melastatin subtype 8 (TRPM8) is a cold sensor in humans, activated by low temperatures (>10, <28 °C), but also a polymodal ion channel, stimulated by voltage, pressure, cooling compounds (menthol, icilin), and hyperosmolarity. An increased number of experimental results indicate the implication of TRPM8 channels in cold thermal transduction and pain detection, transmission, and maintenance in different tissues and organs. These channels also have a repercussion on different kinds of life-threatening tumors and other pathologies, which include urinary and respiratory tract dysfunctions, dry eye disease, and obesity. This compendium firstly covers newly described papers on the expression of TRPM8 channels and their correlation with pathological states. An overview on the structural knowledge, after cryo-electron microscopy success in solving different TRPM8 structures, as well as some insights obtained from mutagenesis studies, will follow. Most recently described families of TRPM8 modulators are also covered, along with a section of molecules that have reached clinical trials. To finalize, authors provide an outline of the potential prospects in the TRPM8 field.

Improving management of the genitourinary syndrome of menopause: evaluation of a health system-based, cluster-randomized intervention

BACKGROUND

Genitourinary symptoms are common in postmenopausal women and adversely affect the quality of life. National surveys and data collected from our healthcare system indicate that postmenopausal women with the genitourinary syndrome of menopause often fail to receive appropriate diagnosis or treatment.

OBJECTIVE

To promote greater detection and treatment of the genitourinary syndrome of menopause, we created and tested a clinician-focused health system intervention that included clinician education sessions and a suite of evidence-based electronic health record tools.

STUDY DESIGN

Using a cluster-randomized design, we allocated primary care (16) and gynecology (6) clinics to the intervention or control group. From September to November 2014, we provided training about the diagnosis and treatment of genitourinary syndrome of menopause in face-to-face presentations at each intervention clinic and in an online video. We developed clinical decision support tools in the electronic health record that contained an evidence-based, point-of-care knowledge resource, a standardized order set, and a checklist of patient education materials for the patient's after visit summary. The tools aimed to facilitate accurate diagnostic coding and prescribing (SmartSet, SmartRx) along with relevant patient information (SmartText). Clinicians who only performed visits at control clinics received no training or notification about the tools. Our primary outcome was vulvovaginal diagnoses made at well visits for women at the age of 55 years and older from November 15, 2014 to November 15, 2015. We also assessed urinary diagnoses, vaginal estrogen prescriptions, and use of the electronic tools. There was departmental support for the intervention but no prioritization within the healthcare system to incentivize change.

RESULTS

In the 1-year period, 386 clinicians performed 14,921 well visits for women at the age of 55 years and older. Among the 190 clinicians who performed well visits in the intervention clinics, 109 (57.4%) completed either in-person or online educational training. The proportion of visits that included a vulvovaginal (7.2% vs 5.8%; odds ratio, 1.27; 95% confidence interval, 0.65-2.51) or urinary diagnosis (2.5% vs 3.1%; odds ratio, 0.79; 95% confidence interval, 0.55-1.13) or vaginal estrogen prescription (4.5% vs 3.7%; odds ratio, 1.24; 95% confidence interval, 0.63-2.46) did not differ between study arms. There was a significant interaction for primary care and gynecology, which revealed more vulvovaginal diagnoses by gynecology but not primary care intervention clinics (odds ratio, 1.63; 95% confidence interval, 1.15-2.31), but there was no significant interaction for prescriptions. Clinicians in the intervention clinics were more likely to use decision support tools than those in control clinics-SmartSet (22.2% vs 1.5%; odds ratio, 18.8; 95% confidence interval, 5.5-63.8) and SmartText for patient information (38.0% vs 24.4%; odds ratio, 1.91; 95% confidence interval, 1.10-3.34). A per-protocol analysis revealed similar findings.

CONCLUSION

Overall, the intervention did not lead to more diagnoses or prescription therapy for postmenopausal genitourinary symptoms but did result in greater distribution of patient information. Gynecology clinicians were more likely to address genitourinary symptoms generally and were more likely to make a vulvovaginal diagnosis after the intervention. Further efforts for improving care should consider ongoing clinician education beginning with enhanced menopause curricula in residency training. Additional interventions to consider include greater access for postmenopausal women to gynecologic care, addressing treatment barriers, and development of national performance metrics.

[Phenotypic and molecular genetic properties of Escherichia coli clinical strains isolated from patients with urological diseases]

OBJECTIVE

Microbiological and molecular genetic characterization resistance profiles of Escherichia coli strains isolated in a pilot single-center clinical study from patients of the urological department in Yaroslavl in 2016-2017.

MATERIALS AND METHODS

Clinical strains of E. coli (n=18) were isolated from the urine of women aged 23-84 years. The mobility of bacteria, colicinogenicity, and sensitivity to lactobacilli antagonism, biofilm formation, and susceptibility to antimicrobials were evaluated. The antibiotic resistance genes were identified.

RESULTS

The E. coli strains had a wide heterogeneity in mobility, colicinogenicity, and biofilm formation. They were sensitive to Lactobacillus acidophilus antagonism, as well as to nitrofurantoin, meropenem, fosfomycin and the main functional classes of disinfectants and antiseptics, but are resistant to beta-lactams, fluoroquinolones and aminoglycosides. The mcr-1 gene providing resistance to colistin was identified in two strains.

CONCLUSIONS

Analysis of genetic antibiotic resistance determinants revealed the genetic diversity of clinical E. coli strains. The obtained data on the strain sensitivity to antibacterials and disinfectants can be used by clinicians in choosing the optimal antibiotic therapy and treatment of abiotic surfaces in urological departments.

Evaluation of three herbal compounds used for the management of lower urinary tract disease in healthy cats: a pilot study

OBJECTIVES

Lower urinary tract disease (LUTD) occurs commonly in cats, and idiopathic cystitis (FIC) and urolithiasis account for >80% of cases in cats <10 years of age. Although several strategies have been recommended, a common recommendation is to induce dilute urine resulting in more frequent urination and to dilute calculogenic constituents. In addition to conventional therapy using modified diets, traditional Chinese and Western herbs have been recommended, although only one - choreito - has published data available. We evaluated three commonly used herbal treatments recommended for use in cats with LUTD: San Ren Tang, Wei Ling Tang and Alisma. We hypothesized that these three Chinese herbal preparations would induce increased urine volume, decreased urine saturation for calcium oxalate and struvite, and differences in mineral and electrolyte excretions in healthy cats.

METHODS

Six healthy spayed female adult cats were evaluated in a placebo-controlled, randomized, crossover design study. Cats were randomized to one of four treatments, including placebo, San Ren Tang, Wei Ling Tang or Alisma. Treatment was for 2 weeks each with a 1 week washout period between treatments. At the end of each treatment period, a 24 h urine sample was collected using modified litter boxes.

RESULTS

Body weights were not different between treatments. No differences were found in 24 h urinary analyte excretions, urine volume, urine pH or urinary saturation for calcium oxalate or struvite between treatments.

CONCLUSIONS AND RELEVANCE

The results of this study do not support the hypothesis; however, evaluation of longer-term and different dosage studies in cats with LUTD is warranted.

[The effectiveness and safety of Omnik OCAS in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia in the routine clinical practice in the Russian Federation (prospective multi-center observing program)]

AIM

To investigate changes in the IPSS after a six-month treatment with Omnic Ocas and its effect on the quality of life of patients in routine urological practice in the Russian Federation in a prospective, multicenter, observational study.

PATIENTS AND METHODS

The study comprised 7000 patients with a verified diagnosis of lower urinary tract symptoms/benign prostatic hyperplasia who received Omnic Ocas (tamsulosin) administered by 700 urologists in various Russian medical institutions. The mean age of the patients was 63 years. The study program involved three visits. At the baseline visit, patients filled out the IPSS and EQ-5D-5L questionnaires, provided a blood sample for PSA, and underwent a digital rectal examination. At visits 2 and 3 scheduled at 3 and 6 months after visit 1 the patients were assessed for the outcomes of the prescribed therapy.

RESULTS

During the 6-month treatment, the patients showed an improvement in the IPSS in the study's age groups. There was a gradual improvement in the storage and voiding symptoms subscale scores of the IPSS. The assessment of the EQ-5D-5L questionnaire results showed significant changes in the quality of life regarding various aspects of life. Adverse events were reported in 0.51% of patients during the study follow-up.

CONCLUSION

The study findings suggest that Omnic Ocas is highly effective in all age groups of patients with LUTS/BPH and has a favorable safety profile.

[Extract of Serenoa repens in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms]

This literature review focuses on the use of Serenoa repens extracts in the treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Extracts of Serenoa repens produce marked anti-inflammatory, anti-androgenic and antiproliferative effects. Various extracts differ in their activity depending on the concentration of free fatty acids and the method of extract preparation. Extracts of Serenoa Repens from different manufacturers vary considerably in composition, effectiveness and supporting evidence. Evaluation of the effectiveness of Serenoa Repens extracts should be carried out for each extract separately, depending on the method of preparation and brand. The most studied and clinically effective is the hexane lipidosterol extract of Serenoa Repens Permixon. This assessment is supported by a report on Serenoa Repens, issued by the European Medicines Agency. In this report, only Serenoa repens hexanic extract Permixon is considered to be a well-established medical use product for the symptomatic treatment of BPH.

Ethnopharmacological survey of medicinal plants practiced by traditional healers and herbalists for treatment of some urological diseases in the West Bank/Palestine

BACKGROUND

Throughout history, every civilization in the world used plants or their derivatives for treatment or prevention of diseases. In Palestine as in many other countries, herbal medicines are broadly used in the treatment of wide range of diseases including urological diseases. The main objective of this research is to study the use of herbal remedies by herbalists and traditional healers for treatment of various urological diseases in the West Bank regions of Palestine and to assess their efficacy and safety through the literature review of the most cited plants.

METHOD

The study included a survey part, plant identification and a review study. The first part was a cross-sectional descriptive study. Face to face questionnaires were distributed to 150 traditional healers and herbalist in all regions of the West Bank of Palestine. The literature review part was to assess the most cited plants for their efficacy and toxicity.

RESULTS

One hundred forty four herbalists and traditional healers accepted to participate in this study which was conducted between March and April, 2016. The results showed that 57 plant species belonging to 30 families were used by herbalists and traditional healers for treatment of various urinary tract diseases in Palestine. Of these, Apiaceae family was the most prevalent. Paronychia argentea, Plantago ovata, Punica granatum, Taraxacum syriacum, Morus alba and Foeniculum vulgare were the most commonly used plant species in the treatment of kidney stones, while Capsella bursa-pastoris, Ammi visnaga and Ammi majus were the most recommended species for treatment of urinary tract infections and Portulaca oleracea used for renal failure. In addition Curcuma longa and Crocus sativus were used for enuresis while Juglans regia, Quercus infectoria, Sambucus ebulus and Zea mays were used for treatment symptoms of benign prostate hyperplasia. Fruits were the most common parts used, and a decoction was the most commonly used method of preparation. Through literature review, it was found that Paronychia argentea has a low hemolytic effect and contains oxalic acid and nitrate. Therefore, it could be harmful to renal failure patients, also Juglans regia, Quercus infectoria and, Sambucus ebulus are harmful plants and cannot be used for treatment of any disease.

CONCLUSIONS

Our data provided that ethnopharmacological flora in the West Bank regions of Palestine can be quite wealthy and diverse in the treatments of urinary tract diseases. Clinical trials and pharmacological tests are required evaluate safety and efficacy of these herbal remedies.

[STUDYING GASTRIC ULCERATION EFFECT OF A NEW DRUG INTENDED FOR TREATMENT OF CHRONIC INFLAMMATORY DISEASES OF KIDNEYS AND URINARY TRACT.]

Gastric ulceration properties (gastrointestinal toxicity) of the sodium salt of 4-(0-β-D-glucopyranosyloxy) benzoic acid, a new nonsteroidal anti-inflammatory drug (NSAID) intended for the treatment of chronic inflammatory diseases of the kidney and urinary tract, have been tested on laboratory animals. Acute NSAID-induced gastropathy was induced in rats by oral administration of indomethacin, nimesulide, diclofenac, acetylsalicylic acid and the new drug. Test animals were killed by instantaneous decapitation 4 h after treatment and their gastrointestinal tracts were studied by pathomorphological methods on micropreparations and histological sections of gastric mucosa. It was established that the new drug, in contrast to reference NSAIDS, did not exhibit gastropathic action on the gastric mucosa.

Herbal treatment of the urinary system diseases based on 16(th) and 17(th) century herbals in Poland

The medicinal use of herbs is a principal achievement of human ingenuity. The most renowned doctors of antiquity: Hippocrates, Dioscorides, Theophrastus, Pliny the Elder and Galen mentioned herbs in their works. The first printed herbal was published in Mainz in 1485. Outstanding scientists e.g. Otto Brunfels, Hieronymus Bock, Leonard Fuchs and Andreo Mattiola published herbals in the 16th century. Polish doctors also contributed to the development of herbal treatment. The first work: Of Herbs and their Potency by Stefan Falimirz, published in 1534, triggered other publications in the 16th century, the age of herbals. In 1542, Hieronymus Spiczynski published a herbal: Of Local and Overseas Herbs and their Potency. Then, in 1568, Marcin Siennik published his: Herbal, which is the Description of Local and Overseas Herbs, their Potency and Application. In 1595, Marcin of Urzedow published: The Polish Herbal, the Books of Herbs. Completed in mid-16th century, it was only published 22 years after his death. The last work discussed is Herbal Known in Latin as published in 1613 by Simon Syrenius a graduate of Ingolstadt and Padua universities and lecturer at the Academy of Krakow. The work was Europes most complete elaboration on herbal treatment. The herbs described in the herbals worked as diuretics, demulcents, analgesics, relaxants and preventives of kidney stones. Published in Polish, they are still to be found in Poland. All the works presented herein are held by the Library of the Seminary of Wloclawek, and the Ossolinski National Institute in Wroclaw.

[VValidation of the combined medical therapy for LUTS using 1-adrenergic blockers and M-cholinoblockers]

In the majority of patients, urination disorders are caused by both mechanical and functional factors. In patients with BPH timely determination of the type and nature of urinary dysfunction, especially bladder outlet obstruction and detrusor overactivity is of great practical importance. Without accounting for this factor, functional results of surgical treatment may be significantly impaired. 1-adrenergic blockers are the first-line therapy for men with moderate to severe lower urinary tract symptoms (LUTS). In selecting the appropriate therapy, more selective 1-adrenergic blockers should be chosen. The selectivity of the 1- adrenergic blockers provides high performance along with a favorable side effect profile especially regarding cardiovascular event rate. Like 1-adrenergic blockers, M-cholinoblockers have varying degrees of selectivity regarding the impact on the bladder. Solifenacin has greater selectivity for the bladder receptors than tolterodine and oxybutynin. The selectivity of this medication regarding the bladder manifests itself in the relatively low incidence of side effects, such as dry mouth, which enables the possibility of long-term therapy. Combined therapy with 1- adrenergic blockers and M-cholinoblockers may be considered as a treatment modality in patients with moderate to severe LUTS with a predominance of filling symptoms, especially if monotherapy proves not effective enough.

[THE MODERN VIEW OF CONSERVATIVE THERAPY OF LOWER URINARY TRACT SYMPTOMS IN MEN]

This literature review summarizes recent evidence on monotherapy and combined treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Particular attention is given to the latest publications on this topic presented at the 30th Congress of the European Association of Urology. α-blockers, 5α-reductase inhibitors, anticholinergics and phosphodiesterase type 5 inhibitors are the main classes of medications for monotherapy. Combination therapy of the above medications is the most promising part of this trend in urology allowing increase the effectiveness of treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. A personalized approach to therapy involves a thorough examination of the patient and the administration of treatment according to his individual needs.

Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection

Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months' duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.

Intestinal and urogenital flagellates

Although the human alimentary and urogenital tracts are parasitized by seven species of flagellate protozoa [115], only two, Giardia lamblia and Trichomonas vaginalis, are generally considered to be pathogens. This review, therefore, concentrates on these organisms and in particular on the experimental and clinical chemotherapy of trichomoniasis and giardiasis. Due to the limited space and the availability of excellent recently published reviews, topics such as life cycles, epidemiology, prevalence and pathology are only briefly discussed in the sections entitled 'Biological Aspects'. The reader seeking comprehensive reference lists and more information on Trichomonas and Giardia and the diseases they cause is referred to these reviews.

Complaints, complainants, and rulings regarding drug promotion in the United Kingdom and Sweden 2004-2012: a quantitative and qualitative study of pharmaceutical industry self-regulation

BACKGROUND

In many European countries, medicines promotion is governed by voluntary codes of practice administered by the pharmaceutical industry under its own system of self-regulation. Involvement of industry organizations in policing promotion has been proposed to deter illicit conduct, but few detailed studies on self-regulation have been carried out to date. The objective of this study was to examine the evidence for promotion and self-regulation in the UK and Sweden, two countries frequently cited as examples of effective self-regulation.

METHODS AND FINDINGS

We performed a qualitative content analysis of documents outlining the constitutions and procedures of these two systems. We also gathered data from self-regulatory bodies on complaints, complainants, and rulings for the period 2004-2012. The qualitative analysis revealed similarities and differences between the countries. For example, self-regulatory bodies in both countries are required to actively monitor promotional items and impose sanctions on violating companies, but the range of sanctions is greater in the UK where companies may, for instance, be audited or publicly reprimanded. In total, Swedish and UK bodies ruled that 536 and 597 cases, respectively, were in breach, equating to an average of more than one case/week for each country. In Sweden, 430 (47%) complaints resulted from active monitoring, compared with only two complaints (0.2%) in the UK. In both countries, a majority of violations concerned misleading promotion. Charges incurred on companies averaged €447,000 and €765,000 per year in Sweden and the UK, respectively, equivalent to about 0.014% and 0.0051% of annual sales revenues, respectively. One hundred cases in the UK (17% of total cases in breach) and 101 (19%) in Sweden were highlighted as particularly serious. A total of 46 companies were ruled in breach of code for a serious offence at least once in the two countries combined (n = 36 in the UK; n = 27 in Sweden); seven companies were in serious violation more than ten times each. A qualitative content analysis of serious violations pertaining to diabetes drugs (UK, n = 15; Sweden, n = 6; 10% of serious violations) and urologics (UK, n = 6; Sweden, n = 13; 9%) revealed various types of violations: misleading claims (n = 23; 58%); failure to comply with undertakings (n = 9; 23%); pre-licensing (n = 7; 18%) or off-label promotion (n = 2; 5%); and promotion of prescription drugs to the public (n = 6; 15%). Violations that go undetected or unpunished by self-regulatory bodies are the main limitation of this study, since they are likely to lead to an underestimate of industry misconduct.

CONCLUSIONS

The prevalence and severity of breaches testifies to a discrepancy between the ethical standard codified in industry Codes of Conduct and the actual conduct of the industry. We discuss regulatory reforms that may improve the quality of medicines information, such as pre-vetting and intensified active monitoring of promotion, along with larger fines, and giving greater publicity to rulings. But despite the importance of improving regulatory arrangements in an attempt to ensure unbiased medicines information, such efforts alone are insufficient because simply improving oversight and increasing penalties fail to address additional layers of industry bias.

Current treatments in familial dysautonomia

INTRODUCTION

Familial dysautonomia (FD) is a rare hereditary sensory and autonomic neuropathy (type III). The disease is caused by a point mutation in the IKBKAP gene that affects the splicing of the elongator-1 protein (ELP-1) (also known as IKAP). Patients have dramatic blood pressure instability due to baroreflex failure, chronic kidney disease, and impaired swallowing leading to recurrent aspiration pneumonia, which results in chronic lung disease. Diminished pain and temperature perception result in neuropathic joints and thermal injuries. Impaired proprioception leads to gait ataxia. Optic neuropathy and corneal opacities lead to progressive visual loss.

AREAS COVERED

This article reviews current therapeutic strategies for the symptomatic treatment of FD, as well as the potential of new gene-modifying agents.

EXPERT OPINION

Therapeutic focus on FD is centered on reducing the catecholamine surges caused by baroreflex failure. Managing neurogenic dysphagia with effective protection of the airway passages and prompt treatment of aspiration pneumonias is necessary to prevent respiratory failure. Sedative medications should be used cautiously due to the risk of respiratory depression. Non-invasive ventilation during sleep effectively manages apneas and prevents hypercapnia. Clinical trials of compounds that increase levels of IKAP (ELP-1) are underway and will determine whether they can reverse or slow disease progression.

Urban schistosomiasis and soil transmitted helminthiases in young school children in Dar es Salaam and Tanga, Tanzania, after a decade of anthelminthic intervention

Rapid urbanization in resource poor countries often results in expansion of unplanned settlements with overcrowding and inadequate sanitation. These conditions potentially support transmission of schistosomiasis and soil transmitted helminths (STH), but knowledge on the occurrence, transmission and control of these infections in urban settings is limited. The present study assessed the status of urinary schistosomiasis and STH across two different-sized cities in Tanzania - Dar es Salaam and Tanga - after a decade of anthelminthic intervention. Primary school children were examined for parasite eggs in urine and stool. Questionnaires were administered to the children, and observations were made on the urban environments. The burden of urinary schistosomiasis and STH was found to be low in both cities (overall 1.2% in Dar es Salaam and 0.3% in Tanga for urinary schistosomiasis; overall <1% in Dar es Salaam and 1-2% in Tanga for each STH infection), and the identified cases showed no clear pattern of spatial distribution. The findings indicated that a marked decrease in prevalence of these infections had occurred in the two cities during recent years. The observed promising developments appeared to have been accomplished by implementation of drug based intervention programs, in combination with environmental change (fewer snail habitats) and generally improved levels of hygiene. Continued efforts, including anthelminthic treatment and health education, are important to maintain these positive achievements.

Is single dose povidone iodine sclerotherapy effective in chyluria?

BACKGROUND

Chyluria is a chronic debilitating condition characterized by formation of pyelo-lymphatic connections. Renal pelvic instillation sclerotherapy is a minimally invasive treatment modality in treatment of chyluria. Various sclerosant with different regimen have been described in literature but there is no single consensus on this regard.

OBJECTIVE

To evaluate the effectiveness and safety of single dose 0.2% povidone iodine renal pelvic instillation sclerotherapy for the treatment of chyluria.

METHODS

In a prospective study from August 2010 till July 2013, forty one patients presenting with milky urine were included. Apart from ether test, presence of lymphocytes in urine and urine triglycerides levels were also done to confirm chyluria. On a day care basis under local anesthesia 5F open ended ureteric catheter was introduced in the ureteric orifice of affected side. Freshly prepared 7-10 ml of 0.2% povidone iodine solution was instilled with the patient in Trendelenburg position.

RESULTS

Total of 41 patients were enrolled ( 27 males and 14 females; mean age 40 years, SD 8.9, range 19-61) with a mean follow up of 20 months. Immediate clearance was seen in all patients and recurrence in 7 (17%). Mean disease free duration was 18 months. Two patients had moderate to severe flank pain.

CONCLUSION

Single dose 0.2% povidone iodine sclerotherapy is safe and effective treatment for chyluria. As it offers treatment on a day care basis, continuous ureteral and urethral catheterizations can be avoided.

[Lower urinary tract symptoms in men]

Lower urinary tract symptoms (LUTS) are frequently encountered in clinical practice, especially in older men. The main focus in the primary treatment of men with complaints of violation of urination should be paid to assessing their severity on the basis of IPSS questionnaire. It is important to identify the predominant symptoms that determine treatment. In the absence of absolute indications for surgical treatment of clinical forms of benign prostatic hyperplasia (BPH), the drug treatment should be used. In cases of the prevalence of obstructive LUTS, first-line treatment is the use of alpha-adrenoblockers. In case of progression of BPH (prostate volume > or = 40 cm3, PSA > 1,5 ng/ml), it is useful to combine the alpha-adrenoblockers with 5alpha-reductase inhibitors. Combined medication in the form of alpha-adrenoblockers and M- cholinergic antagonists is justified in irritative LUTS in men with BPH.

A prospective study of statin drug use and lower urinary tract symptoms in older men

Dyslipidemia and chronic inflammation may play a role in the cause of lower urinary tract symptoms (LUTS) in older men. Use of statin drugs, which are prescribed to lower cholesterol and appear to reduce inflammation, may decrease the incidence or progression of LUTS. The associations of statin drug use with LUTS incidence and progression were prospectively evaluated in the Health Professionals Follow-up Study from 1992 to 2008. Hazard ratios and 95% confidence intervals of incident LUTS (from no or a low International Prostate Symptom Score (IPSS) of 0-7 to a moderate or worse IPSS of ≥15; n = 5,790 cases in 24,715 men) and of LUTS progression (from modest IPSS of 8-14 to severe IPSS of ≥20; n = 2,238 cases in 8,709 men) were calculated comparing current statin use with nonuse. The hazard ratios of LUTS incidence and progression comparing current use to nonuse were greater than 1. However, when comparisons were restricted to participants who used drugs to treat hypertension (a surrogate for uptake of medical care), statin use was not associated with LUTS incidence (hazard ratio = 1.02, 95% confidence interval: 0.94, 1.12) or progression (hazard ratio = 0.98, 95% confidence interval: 0.85, 1.13). Thus, statin use is unlikely to beneficially influence the development or course of LUTS. The present study highlights a methodological issue (confounding) that must be addressed in observational studies on the use of common drugs for indications other than the primary use.

[The antiradical activity of plant extracts and healthful preventive combinations of these exrtacts with the phospholipid complex]

Using the chemiluminescence method, the effective concentration of antioxidants (AO) and its reactivity toward peroxyl radicals (ARA, the k7 constant) have been measured for 13 plant extracts. In fact all extracts demonstrated ARA higher than ionol. Larix dahurica, Hypericum perforatum, Potentilla fruticosa, Aronia melanocarpa and Rhaponticum carthamoides extracts showed the highest values of ARA. The combinations Aronia + Raponticum extracts; Larix + Hibiscus extracts; Schizandra +Aronia extracts were synergistic (the synergism effect beta of 38%, 33% and 22%). Apparently this phenomenon is the result of the synergistic interaction between compounds present in plant extracts. The Phospholipid complex--Lipoid S40, lacting any antioxidant effect alone, showed a potent synergistic effect with Aronia extract (beta3 = 60%), Silybum extract (beta3 = 41%). Clinical trials demonstrated, that combinations "Lipoid + Aronia extract", "Lipoid + Larix extract + Hibiscus extract", "Lipoid + Silybum extract", "Lipoid + Q10 + Rosa majalis extract" may be used as an additional component in the medicinal treatment, or as an individual prophylactic agent.

Emerging therapies: what's new is old and what's old is new

Researchers are constantly seeking ways to improve existing drugs, drug mechanisms of activity, find new indications for old drugs or to develop new drugs to treat urological diseases and conditions. In Canada, tadalafil in a 5 mg daily dosage (old drug), and a new drug, silodosin, have recently become available to treat patients who have benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). In clinical studies, silodosin has shown promise as a treatment for ureteral stones, whereas it has shown conflicting results as a potential treatment for prostatitis. Two new therapies have emerged for treating overactive bladder (OAB): Mirabegron (not yet available in Canada) and fesoterodine (newly introduced in the marketplace). New therapies--denosumab (to prevent skeletal events) and abiraterone acetate and enzalutamide--were recently approved to treat certain patients with advanced prostate cancer. With the advent of new therapies to treat urological diseases, in many cases, primary management of the patient is often shifted from the urologist to the family physician, and sometimes moved from the oncologist to the urologist.

[Afala in the treatment of patients with BPH: efficacy and safety]

The double-blind, placebo-controlled, randomized clinical trial involving 94 patients has evaluated the efficacy and safety of domestic preparation afala in patients with symptoms of I-II stages benign prostatic hyperplasia (BPH). It was shown that a 6-month course of treatment with afala at a dose of 2 tablets 4 times a day resulted in a significant reduction in the severity of urinary disorders, estimated by total IPSS score, relative to baseline values and compared to placebo therapy. The most pronounced therapeutic effects of the drug were registered in respect of irritative symptoms of BPH. According uroflowmetry, peak flow rate after 6 months of treatment was increased by more than 50%. Significant clinical benefit persisted not only within the 6-month course of therapy, but 3 months after. Long-term therapy had no effect on the concentration of total, free and complex PSA, testosterone (total and free), dihydrotestosterone, and prolactin in the blood. Absence of adverse effects, biochemical abnormalities, changes in clinical blood and urine confirmed the safety of 6-month therapy.

[Combined action of levofloxacin and DNAase on biofilms of urogenital infection pathogens]

The effect of antibiotics and DNAase on biofilms of unrelated gram-positive and gram-negative bacteria was studied on strains isolated from patients with infectious and inflammatory urinary diseases. It was found that destruction of extracellular DNA biofilms by DNAase increases sensitivity of the bacteria to environmental factors including antibacterial drugs. DNAase addition to forming and formed biofilms created by unrelated bacteria leads to similar dose-dependent changes This evidences for universal action of the enzyme. A synergetic effect occurs in combined action of antibiotic biofilm and DNAase on bacteria.

Phosphodiesterase type 5 inhibitors in the management of non-neurogenic male lower urinary tract symptoms: critical analysis of current evidence

CONTEXT

A large body of epidemiologic data suggests a causal relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Recently reported studies on phosphodiesterase type 5 inhibitors (PDE5-Is) and LUTS have further contributed to the understanding of mechanisms involved in this relationship and of potential treatment options.

OBJECTIVE

A nonsystematic descriptive review was performed to summarize the literature concerning the role of PDE5-Is in men with LUTS, particularly looking at data derived from clinical trials in relation to the different PDE5-Is or their association with α-blockers.

EVIDENCE ACQUISITION

A comprehensive electronic search was conducted in October 2010 using the Medline database to identify all publications relating to ED and BPH and treatment with sildenafil, vardenafil, tadalafil, udenafil, UK-369003, and combination therapy with alfuzosin and tamsulosin.

EVIDENCE SYNTHESIS

In studies in which either ED or LUTS was the entry criterion, sildenafil appears to improve both erectile function and LUTS in subjects with ED. Placebo-controlled trials of tadalafil and vardenafil showed improvement of LUTS secondary to benign prostatic hyperplasia (BPH), but none of the studies showed a significant effect on urodynamic measures. Exploratory studies with UK-369003 showed improvements in LUTS and ED. Sildenafil or tadalafil associated with alfuzosin or tamsulosin showed greater benefits for the combination therapy for both LUTS and ED. The coadministration of udenafil and an α-blocker in patients with BPH and ED also appeared to improve both LUTS and ED severity.

CONCLUSIONS

Consistent evidence of improvements in LUTS has been shown with PDE5-Is, either alone or in combination with α-blockers. However, effects on urodynamics or objective measures of urinary flow are lacking. Further areas of research include investigation of mechanism of PDE5-Is, urodynamic studies, identification of new efficacy end points, head-to-head comparison with standard of care, potential benefit of add-on treatment, and long-term outcomes.

Pharmacology for common urologic diseases: 2011 review for the primary care physician

Coordination of care between the urologist and primary care physician is critical to effective treatment of a variety of urologic conditions. Medical therapies for benign prostatic hyperplasia, erectile dysfunction, hypogonadism, overactive bladder, and prostate cancer are widely available and a basic understanding of the pathophysiology of these disease states as well as the pharmacology of existing treatment options are necessary to avoid complications and maximize efficacy associated with patient outcomes. Important regulatory decisions have been made concerning the approval and lack of approval of several important urologic medications. Major advances have been made in the therapy of castrate resistant prostate cancer as well as hormonal related skeletal events secondary to advanced carcinoma of the prostate. We provide a 2011 update of the available medications for treatment of several common urologic diseases.

Androgen replacement therapy contributes to improving lower urinary tract symptoms in patients with hypogonadism and benign prostate hypertrophy: a randomised controlled study

PURPOSE

We performed a randomised controlled study regarding the effects of androgen replacement therapy (ART) on lower urinary tract symptoms (LUTS) in hypogonadal men with benign prostate hypertrophy (BPH).

METHODS

Fifty-two patients with hypogonadism and BPH were randomly assigned to receive testosterone (ART group) as 250 mg of testosterone enanthate every 4 weeks or to the untreated control group. We compared International Prostate Symptom Score (IPSS), uroflowmetry data, post-voiding residual volume (PVR) and systemic muscle volume at baseline and 12 months after treatment.

RESULTS

Forty-six patients (ART group, n=23; control, n=23) were included in the analysis. At the 12-month visit, IPSS showed a significant decrease compared with baseline in the ART group (15.7 +/- 8.7 vs. 12.5 +/- 9.5; p<0.05). No significant changes were observed in the control group. The ART group also showed improvement in maximum flow rate and voided volume (p<0.05), whereas no significant improvements were observed in the controls. PVR showed no significant changes in either group. In addition, the ART group showed significant enhancement of mean muscle volume (p<0.05), whereas no significant changes were seen in the controls.

CONCLUSION

ART improved LUTS in hypogonadal men with mild BPH.

ATP and P2X purinoceptors in urinary tract disorders

The pharmacological concept of specifically targeting purinoceptors (receptors for ATP and related nucleotides) has emerged over the last two decades in the quest for novel, differentiated therapeutics. Investigations from many laboratories have established a prominent role for ATP in the functional regulation of most tissue and organ systems, including the urinary tract, under normal and pathophysiological conditions. In the particular case of the urinary tract, ATP signaling via P2X1 receptors participates in the efferent control of detrusor smooth muscle excitability, and this function may be heightened in disease and aging. Perhaps of greater interest, ATP also appears to be involved in bladder sensation, operating via activation of P2X3-containing receptors on sensory afferent neurones, both on peripheral terminals within the urinary tract tissues (e.g., ureters, bladder) and on central synapses in the dorsal horn of the spinal cord. Such findings are based on results from classical pharmacological and localization studies in nonhuman and human tissues, gene knockout mice, and studies using recently identified pharmacological antagonists - some of which have progressed as candidate drug molecules. Based on recent advances in this field, it is apparent that the development of selective antagonists for these receptors will occur that could lead to therapies offering better relief of storage, voiding, and sensory symptoms for patients, while minimizing the systemic side effects that curb the clinical effectiveness of current urologic medicines.

Cyclic nucleotide metabolism including nitric oxide and phosphodiesterase-related targets in the lower urinary tract

The clinical data on the use of the orally active phosphodiesterase (PDE) type 5 inhibitors sildenafil (VIAGRA™), vardenafil (LEVITRA™), and tadalafil (CIALIS™) for the treatment of male erectile dysfunction have boosted research activities on the physiology and pharmacology of the organs of the lower urinary tract (LUT). This includes both intracellular signal transduction in the prostate, urinary bladder (detrusor), and urethra, as well as central brain and spinal cord pathways controlling the function of the LUT. Such efforts provided the basis for the development of new therapeutic modalities into the management of dysfunctions/ syndromes of the LUT, some of which are already offered to the patients. The pharmacological treatment of the overactive bladder and the so-called benign prostatic syndrome, including LUT symptomatology and bladder outlet obstruction secondary to benign prostatic enlargement, has primarily focused on selective, orally available drugs acting by influencing intracellular regulatory mechanisms. These agents are regarded efficacious, have a fast onset of drug action in the target tissue and an improved effect-to-side-effect ratio. Better understanding of the functional significance of proteins related to cyclic nucleotide-dependent pathways, such as nitric oxide synthase, cytosolic and membrane-bound guanylyl cyclases, PDE isoenzymes and cyclic AMP- and cyclic GMP-binding protein kinases, the relative distribution in tissues of the LUT, and the consequences for urogenital function, seems to be of particular interest in order to identify new or more selective pharmacological approaches to manage disorders of the LUT. The present review focuses on cyclic nucleotide-related targets involved in the control of the function of the bladder, prostate, and urethra and the significance of those proteins in the process of evolving new pharmacological options for the treatment of LUT symptoms secondary to benign prostatic hyperplasia as well as dysfunctions of the storage and voiding capability of the urinary bladder.

[Dopaminergic stimulation in the non-motor symptoms of Parkinson's disease]

INTRODUCTION AND DEVELOPMENT

The non-motor symptoms of Parkinson's disease have a great impact in terms of quality of life. They are frequently underdiagnosed and clinical experience suggests that not only is dopamine therapy ineffective but that in many cases it is also responsible for the appearance of some of these symptoms. Different studies have drawn attention to the involvement of the dopaminergic pathways in the pathogenesis of some non-motor symptoms. It has been observed that they can undergo fluctuations in relation to dopaminergic stimulation, generally in wearing off states, while displaying a significant correlation with motor fluctuations and a clinical response with continuous dopaminergic therapy.

CONCLUSIONS

Although recent reviews offer insufficient evidence for treatment of non-motor symptoms with dopaminergic therapy, involvement of the dopaminergic pathways in the aetiopathogenesis of some of these disorders and the clinical observation that such symptoms undergo fluctuations in relation to pulsatile dopaminergic stimulation may lead us to reconsider the possible role of dopaminergic therapy in the treatment of these symptoms.

Uropharmacology in primary care: 2010 update

Many disorders such as erectile dysfunction, overactive bladder, hypogonadism and benign prostatic hypertrophy have traditionally been managed primarily by urologists. The development of newer agents to treat many of these conditions has allowed the primary care provider to manage many of these common conditions. The use of these newer medications has become commonplace in the primary care setting. This article will update some of the most commonly used urologic medications to optimize patient management strategies by the primary care provider or in coordination with the urologist.

[Botulinum toxin useful in urological problems]

Urological and gastroenterological patients may benefit from the therapeutic use of botulinum neurotoxin. Urologic indications include overactive bladder refractory to conventional treatments, painful bladder, chronic pelvic pain syndromes and problems with bladder emptying. Currently, there are no approved therapeutic indications for urologic conditions. In general, botulinum neurotoxin treatment is well tolerated and adverse events are predictable and limited to the urogenital tract, though rare severe and fatal complications have been reported.

Drug treatment of urological symptoms: estimating the magnitude of unmet need in a community-based sample

OBJECTIVE

To examine, in a community-based sample, the use of prescription drugs for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH), overactive bladder, erectile dysfunction, urinary incontinence, and painful bladder syndrome; and to determine whether the use of recommended medications varied by sociodemographics, symptom severity, access to care, and other factors.

SUBJECTS AND METHODS

In a cross-sectional analysis of data obtained from 5503 men and women residents participating in the Boston Area Community Health Survey of Boston, MA, urological symptoms were ascertained by in-person interviews conducted during 2002-2005, using validated symptom scales. Medication use in the past 4 weeks was captured using a combination of drug-inventory methods and self-report.

RESULTS

Compared to the prevalence of symptoms, the prevalence of use of medications for urological conditions was very low among men and women. The highest prevalence of use was among men with moderate-to-severe LUTS/BPH symptoms, where 9.6% used recommended drugs. Use of medications did not vary consistently by race/ethnicity or socioeconomic status, but was often associated with symptom severity. More frequent and more recent use of medical care was also associated with greater use of urological medications.

CONCLUSIONS

Only a small proportion of community-dwelling men and women with urological symptoms are receiving recommended effective drug treatments for urological conditions. While not all persons are candidates for drug treatment, our results suggest that there is a substantial unmet need in the general population.

The use of botulinum toxin type A in urological procedures

Botox is a sterile, vacuum-dried, purified BoNT-A produced from fermentation of Clostridium botulinum. There is an abundance of literature to support the use of Botox in urology, and its off-label use continues to grow. While there are no FDA-approved clinical indications, there are ongoing phase II and III studies to approve Botox for use in some urological conditions. This article will explore the use of Botox in urology and provide a brief review of the literature supporting its use.

Are female lower urinary tract symptoms alleviated by alpha-adrenoreceptor antagonists?

This commentary discusses the article by Low and colleagues, who studied the effect of terazosin in women with lower urinary tract symptoms (LUTS) and an International Prostate Symptom Score (IPSS) > o =8. Terazosin therapy significantly improved IPSS quality-of-life scores and King's Health Questionnaire scores. These findings might seem surprising, because previous studies have shown that alpha-adrenoreceptor antagonists are not effective in women with overactive bladder, which is considered the most common form of LUTS in females. Many women have voiding symptoms, however, and the inclusion criteria in this study resulted in a different population profile compared with those of other studies of female LUTS. The mechanism behind the effect of terazosin is unclear. Without urodynamic characterization, it cannot be established whether patients in the study were obstructed, or whether the effect of terazosin was related to a decrease in bladder outflow resistance.