摘要:

Data are reviewed relating to the safety and efficacy of minimally invasive transurethral microwave thermotherapy and medical management in patients with lower urinary tract symptoms of benign prostatic hyperplasia. Recent evidence is summarized indicating more pronounced long-term beneficial effects of microwave treatment. α-Blockade, however, offers the advantage of more rapid action than microwave treatment. Neoadjuvant and adjuvant α-blocker therapy can accelerate symptom and flow rate improvement in patients receiving microwave treatment. Compared with medical management, microwave treatment possesses greater versatility, allowing patients with severe baseline symptoms and small prostate sizes to be treated with a high probability of success.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Selective α1-adrenergic blockade is now a well accepted and widely used therapeutic treatment for patients presenting with symptomatic bladder outlet obstruction thought to be associated with benign prostatic hyperplasia. This review summarizes the recent developments in this field relating to the subject of receptor subtype selectivity and the potential relevance of this to clinical usefulness of existing drug therapy. Whilst a number of unanswered questions remain as to the exact mechanisms of both drug action and side-effect profile, nevertheless it is clear that existing clinically available α1-antagonists provide a safe, effective and generally well tolerated therapy for patients with lower urinary tract symptoms thought to be associated with benign prostatic obstruction. The implications of the ALLHAT study are discussed.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Medical therapy for lower urinary tract symptoms and benign prostatic hyperplasia with either alpha adrenergic receptor blockers or 5α-reductase inhibitors has become the most common treatment choice over the past 10 years, replacing transurethral resection of the prostate as the standard intervention. Both classes of drugs have demonstrated efficacy and safety in numerous randomized, placebo-controlled clinical trials. Because of the two different mechanisms of action proposed for these two classes of drugs, the idea of utilizing both to enhance efficacy appears logical and promising. However, few well-conducted trials are available to address the issue of combination medical therapy for lower urinary tract symptoms and benign prostatic hyperplasia, the majority of the data available coming from trials with significant design flaws. Two prospective, randomized, placebo-controlled studies have been conducted comparing the safety and efficacy of an alpha blocker-finasteride combination versus placebo in large numbers of patients. Neither one of the two trials suggests superior efficacy of the combination therapy, whereas some of the less well-controlled studies do. Recent evidence suggests superior efficacy of finasteride in men with large glands and higher serum prostate-specific antigen levels in terms of symptoms and outcome prevention. A trial addressing this specific patient population, in whom theoretically the most benefit might be gained from combining both classes of drugs to address symptoms and prevent outcomes, would be a welcome addition to our knowledge base.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The standard medical therapy for symptomatic benign prostatic hyperplasia is still α-blockers and 5α-reductase inhibitors. Ongoing studies demonstrate the long-term safety and efficacy of these two classes of therapeutic approaches. Although there have been no new Food and Drug Administration approved medical therapies for the treatment of benign prostatic hyperplasia over the past year, interest in and the use of phytotherapeutic agents continues to increase. In this review, we will discuss the developments that have occurred over the past year in the medical management of benign prostatic hyperplasia. In addition, we present ongoing efforts at our center to obtain a better understanding of and manipulate the apoptotic pathway as it pertains to the pathophysiology of benign prostatic hyperplasia.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Various minimally invasive modalities that are aimed at alleviating lower urinary tract symptoms employ heat-induced ablation of hyperplastic prostatic tissue. Following extensive studies, most of these modalities were eventually abandoned. High-energy transurethral microwave thermotherapy has survived, however, and has gained a firm position as a therapeutic modality, along with transurethral resection of the prostate. Recent research addressed fundamental issues of mode of action of microwave treatment, and revealed the overall efficacy of this treatment, determined new indications, and rendered high-energy transurethral microwave thermotherapy more acceptable to the patients. Insights into intraprostatic vascularization and treatment monitoring were also gained as a result of these global research efforts.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

With the introduction of the side-firing neodymium:yttrium-aluminum-garnet laser in the early 1990s laser prostatectomy became a widely used treatment for benign prostatic hyperplasia. However, because of prolonged postoperative catheterization times, the lack of immediate effect, and severe postoperative dysuria, many urologists became disinterested in this procedure. Recently, as a result of advances in laser technology, namely, the holmium laser and interstitial laser prostatectomy, interest in lasers for the treatment of benign prostatic hyperplasia has been rekindled. This paper will review published reports over the past year regarding these relatively new treatments.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Uncomplicated urinary tract infections, such as acute uncomplicated cystitis and pyelonephritis, are common infections in otherwise healthy women. Although severe complications are rare, the high prevalence of these infections contributes to significant costs to health care systems. The present review addresses recent publications that concern the epidemiology, pathogenesis, aetiology, diagnosis, treatment and prevention of uncomplicated urinary tract infections and recurrent urinary tract infections in women.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Urinary tract infections are very common during pregnancy.Escherichia coliis the most common pathogen isolated from pregnant women. Ampicillin should not be used because of its high resistance toEscherichia coli. Pyelonephritis can cause morbidity and can be life-threatening to both mother and fetus. Second and third-generation cephalosporins are recommended for treatment, administered initially intravenously during hospitalization. Cultures and the study of virulence factors of uropathogenicEscherichia coliare recommended for the adequate management of pyelonephritis. The lower genital tract infection associated with pyelonephritis is responsible for the failure of antibiotic treatment. Asymptomatic bacteriuria can evolve into cystitis or pyelonephritis. All pregnant women should be routinely screened for bacteriuria using urine culture, and should be treated with nitrofurantoin, sulfixosazole or first-generation cephalosporins. Recurrent urinary infection should be treated with prophylactic antibiotics. Pregnant women who develop urinary tract infections with group B streptococcal infection should be treated with prophylactic antibiotics during labour to prevent neonatal sepsis. Preterm delivery is frequent. Evidence suggests that infection plays a role in the pathogenesis of preterm labour. Experimental models in pregnant mice support the theory thatEscherichia colipropagated by the transplacental route, involving bacterial adhesins, induces preterm delivery, but this has not been demonstrated in humans. Ascending lower genital tract infections are the most probable cause of preterm delivery, but this remains to be proved.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Over the past year, research about urinary tract infections in childhood has yielded new data about methods to detect, treat, and evaluate children who develop urinary tract infection. New imaging modalities have been studied. Long term studies following children with urinary tract infection have also been published over the last year. However, major questions remain to be answered, including the underlying basis of host-pathogen interactions in the urinary tract, as well as the most effective methods for clinical diagnosis and management.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Infection within the abdominal wall and peritonitis are still important causes of morbidity which ultimately limit the use of peritoneal dialysis in end-stage renal failure. Similarly disastrous complications resulting in loss of access can follow infection in venous cannulae and artificial arteriovenous fistulae, particularly in synthetic vascular grafts. Important publications continue to underline the mechanism of reduced resistance to infection by uraemic patients. After renal transplantation bacterial infection is common and predictable. However, immunosuppressed recipients are particularly susceptible to viral and fungal infection. Arguably infection of all types can induce organ rejection.

ISSN:0963-0643    

出版商:OVID    

年代:2001

数据来源: OVID