Comparative Study between Tadalafil versus Tamsulosin versus Halphabarol with Terpenes Mixture as a Medical Expulsive Therapy for Lower Ureteric Stones

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
K A H Teama ◽  
A Y K Abdelsalam ◽  
M E A Elmenyawee
Keyword(s):  
Urinary Tract ◽  
Side Effects ◽  
Comparative Study ◽  
Ureteral Stones ◽  
P Value ◽  
Expulsion Rate ◽  
Once Daily ◽  
Medical Expulsive Therapy ◽  
Tract Infections

Abstract Background urolithiasis is a health problem of worldwide importance. Urolithiasis is the third most common urological disease affecting the urinary tract after urinary tract infections and prostatic diseases. Ureteral stones account for 20% of urolithiasis, and 70% of ureteral stones are located in the lower third of the ureter. Ureteric stones have great bearing on the health as well as quality of life of the patient. Aim of the Study to compare the efficacy of tadalafil (a phosphodiesterase-5 inhibitor), tamsulosin (an alpha-1blocker) and halphabarol (Proximol) with terpenes mixture (Rowatinex) as a medical expulsive therapy for lower ureteric stones. Patients and Methods this was a prospective randomized comparative study conducted on 60 patients between the ages of 20 and 40 years and complaining of unilateral single lower ureteric stone less than or equal to 8 mm presented through the outpatient clinics of Urology in Ain Shams University Hospitals and Damanhour Medical National Institute over a period of 10 months (from November 2017 to August 2018). The patients were randomly divided into 3 equal groups: Group A (20 patients were treated by tadalafil 5 mg once daily), Group B (20 patients were treated by tamsulosin 0.4 mg once daily) and Group C (20 patients were treated by Proximol with Rowatinex three times daily). Therapy was given for a maximum of 3 weeks. The patients were followed-up until stone passage or the end of the study period. Results the results of this study indicate that the stone expulsion rate was significantly higher in tadalafil group and tamsulosin group than Proximol with Rowatinex group (75% vs. 75% vs. 40%, P value = 0.030). Also, the mean stone expulsion time was significantly shorter in tadalafil group and tamsulosin group than Proximol with Rowatinex group (10.20 ± 3.91 days vs. 10.80 ± 3.64 days vs. 14.25 ± 3.28 days, P value = 0.046). The number of patients who experienced renal colic episodes, the number of colic episodes and the number of injectable analgesic uses were significantly lower in tadalafil group and tamsulosin group than Proximol with Rowatinex group (P value < 0.05). The number of follow up ureteroscopic procedures was significantly lower in tadalafil group and tamsulosin group than Proximol with Rowatinex group (25% vs. 25% vs. 60%, P value = 0.030). Also, the drugs are safe with mild few side effects. Conclusion PDE5 inhibitors (tadalafil) are equally efficacious to alpha-1 adrenergic antagonists (tamsulosin) in expulsion of lower ureteric stones less than or equal to 8 mm without any serious side effects. Comparing to Proximol with Rowatinex, both tadalafil and tamsulosin increase significantly the stone expulsion rate, decrease significantly the stone expulsion time and provide significant control of renal colicky pain, significantly less analgesic requirements and significantly lower follow up ureteroscopic procedures.

scholarly journals Efficacy of Tamsulosin and Alfuzosin in Management of Distal Ureteral Stones

Med Phoenix ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 10-13
Author(s):  
Bimochan Piya ◽  
Abhishek Bhattarai
Keyword(s):  
Urinary Tract ◽  
Side Effects ◽  
Diclofenac Sodium ◽  
Study Groups ◽  
Ureteral Stones ◽  
Control Group ◽  
P Value ◽  
Expulsion Rate ◽  
Group A ◽  
Group B

Introduction: Urinary tract calculi are the most frequent condition in urology clinics worldwide. The overall prevalence is about 5 % and lower urinary tract stones account for 70% among them. Medical expulsive therapy has been used to treat distal ureteric stone as it reduces symptoms and facilitates stone expulsion. The aim of this study is to evaluate and compare the efficacy of tamsulosin and alfuzosin as medical therapy in ureteric stones. Materials and Methods: A total of 87 patients with distal ureteral stones of size ≤10 mm were randomly divided into 3 groups. Group A patients (n-30) received 0.4 mg of tamsulosin daily, group B patients (n-29) received 10 mg of alfuzosin daily and group C patients (n-28) received 75 mg of diclofenac sodium. Patients in all groups received diclofenac sodium for one week and then as required. Follow-up was done on a weekly basis for 4 weeks. The stone expulsion rate, time for stone expulsion, and side-effects were recorded in each group. Results: The mean stone size (5.66, 5.79, 5.67) mm and age (29.1, 30.31, 29.4) were comparable in each group. The stone expulsion rate was 83.3%, 79.3%, and 50% in groups A, B, and C respectively.  It showed that both the study groups (Group A and Group B) were effective than the control group (p-value 0.006 and 0.02 respectively) but there was no difference between tamsulosin and alfuzosin (p-value 0.69). The duration of stone expulsion was 11.5 days, 11.8 days, and 17.3 days for Group A, B, and C respectively. The drugs related side effects reported by patients were mild and transient. Conclusion:  The use of tamsulosin and alfuzosin for the medical treatment of ureteric stones proved to be safe and effective and neither did have any significant benefits over the other.

scholarly journals Predictive Risk Factors of Urinary Tract Infection Following Semirigid Ureteroscopic Lithotripsy

2020 ◽  
Author(s):  
Mehmet Çağlar Çakıcı ◽  
Özgür Kazan ◽  
Ayberk İplikçi ◽  
Muhammet Çiçek ◽  
Özgür Efiloğlu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Infectious Complications ◽  
Ureteral Stones ◽  
P Value ◽  
Ureteroscopic Lithotripsy ◽  
Increased Risk ◽  
Predictive Risk ◽  
Tract Infections ◽  
Residual Fragments

INTRODUCTION: The aim of this study is to determine the frequency and predictive factors of postoperative UTI in patients who underwent URS regarding ureteral stones. METHODS: Data from 425 patients undergoing semi-rigid ureteroscopic lithotripsy between December 2015 and December 2019 at a single center were reviewed to detect factors predicting postoperative urinary tract infections. RESULTS: Of the 425 patients, 35 were infective (8.2%). Proximal ureteral stones were the majority in infective group (48.5%); distal ureteral stones were the majority in non-infective group (42.6%)(p=0.026). Stone number and stone size were also higher in the postoperative infective group (p<0.05). UTI history and preoperative DJS insertion were higher in Group 1 (p <0.001, p = 0.001, respectively). Multivariate regression analyses revealed that history of UTI (OR=5.513, 95% CI; 2.622–11.591, p value <0.001) and presence of residual fragments (OR=4.274, 95% CI; 1.892–9.657, p value <0.001) were independent risk factors for infectious complications after URS. DISCUSSION AND CONCLUSION: Even if URS is considered an innocuous procedure, the probability of postoperative infectious complications is far from negligible. Our results showed that the presence of UTI history and residual fragments were associated with an increased risk of subsequent UTI after URS. These infectious complications also have significant morbidity, mortality and expenditure if not treated timely. Therefore, to avoid this preventable complication, all variables should be reviewed and more careful.

scholarly journals Prospective Study on the Efficacy of Tamulosin in Medical Management of Distal Ureteric Stones

2013 ◽  
Vol 3 (1) ◽  
pp. 56-61
Author(s):  
S Basnet ◽  
PM Shrestha ◽  
Rajani Shakya
Keyword(s):  
Side Effects ◽  
Prospective Study ◽  
Economic Value ◽  
Intravenous Urography ◽  
Ureteral Stones ◽  
P Value ◽  
Stone Size ◽  
Expulsion Rate ◽  
Radiographic Images ◽  
Distal Ureteral Stone

A non-interventional prospective study was done in patients having single distal ureteral stone less than 10 mm to find the effectiveness of two weeks course of Tamsulosin 0.4 mg in the stone expulsion; the reduction of occurrence of ureteral, re­duction in rate of use of analgesic agents and the side effects of the drug. Thirty patients, having stone size ≤ 10.0 mm were revealed initially by patient’s symptoms and then confirmed by ultrasonography (USG) followed by Intravenous Urography (IVU) radiographic images. The expulsion rate of distal ureteral stones having size ≤ 10.0 mm was found to be 76.66 % (27 out of 30), with only 26.66 % of analgesic consumption, with decrease in colic episodes by 36.66 % and lesser evidence of side effects. The expulsion rate for stone size less than 7.0 mm is 36.72 % with mean of expulsion days as 5.90±1.92. The expulsion rate for stone size more than 7.0 mm is 63.33 % with mean of expulsion days as 9.33±27. The correlation between the size and expulsion days is statistically significant with p-value of 0.00057 (p = 0.01). The observed side effects were orthostatic hypotension (26.7 %), headache (13.3 %), dizziness (6.7 %), sore throat (6.7 %) followed by fatigue (3.3 %), abnormal ejaculation (3.3 %) and no any side effect was observed in 56.7 % patients. Considering the economic value and its effectiveness, the MET using Tamsulosin 0.4 mg can be the possible intervention for the medical treatment of distal ureteral stones having less than 10 mm stone size. Journal of Chitwan Medical College 2013; 3(1): 56-61 DOI: http://dx.doi.org/10.3126/jcmc.v3i1.8468

scholarly journals Antibiotic Resistance in Urinary Tract Infection in a Tertiary Care Hospital in Bangladesh-A Follow-up Study

2019 ◽  
Vol 31 (1) ◽  
pp. 9-14
Author(s):  
Md Mahabubul Islam Majumder ◽  
Tarek Ahmed ◽  
Saleh Ahmed ◽  
Ashiqur Rahman Khan ◽  
Chinmoy Kumar Saha
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Comparative Study ◽  
Diffusion Method ◽  
Resistance Pattern ◽  
Care Hospital ◽  
E Coli ◽  
Follow Up Study ◽  
Tract Infections

Introduction: Bacterial resistance to antibiotics is one of the most challenging global health threats. Urinary tract infections (UTIs) are a common infection. Regional surveillance programs are necessary to update knowledge on antimicrobial resistance pattern where empirical antibiotic treatment is the mainstay. The aim of this follow up study is to see the changing trends in bacteriology and antibiotic resistance pattern among urological pathogens in comparison to similar study 5 years back. Materials and Methods: We performed a prospective study in Comilla Medical College Hospital, Bangladesh during the period of July 2015- June 2016. Midstream clean-catch urine samples were collected from 658 suspected UTI patients with age more than 12 years and inoculated in MacConkey& Blood agar media for semi quantitative urine culture and sensitivity test. Antibiotic susceptibility pattern was done by Kirby-Bauer disc diffusion method following clinical laboratory science (CLS) program. Results: Culture positive were in 198 samples among 658 inoculated samples. E. coli was isolated from 171(86%) samples which was the most predominant bacteria followed by Klebsiella and Enterococcus. UTI with E. coli was significantly increased in the year 2016 in comparison to 2011. Meropenem, imipenem, amikacin, tazobactum, gentamycin nitrofurantoin, and mecillinum found resistance against 0% to 12% of the urological pathogens. Bacteria offered high degree of resistance against commonly used antibiotics - amoxycillin, amoxiclav, cephradine and cefixime ranging 60% to 86%. Comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, amoxiclav and reduced resistance for nalidexic acid, mecillinum and cefuroxime. Conclusion: E. coli infection is significantly increaseing in follow up study from 2011 to 2016 with no steady increase in resistance to all antibiotics. Imipenem, meropenem, tazobactum, amikacin and nitrofurantoin still remain more sensitive while comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, and amoxiclave and reduced resistance for nalidexic acid, mecillinum, cefixime and cefuroxime. Medicine Today 2019 Vol.31(1): 9-14

scholarly journals Comparative study between Silodosin alone and Silodosin plus Tadalafil for the medical management of lower Ureteric Stone in South-Western part of the Bangladesh

2020 ◽  
Vol 23 (1) ◽  
pp. 67-71
Author(s):  
Masud Ahmed ◽  
Prodyut Kumar Saha ◽  
Kartik Chandra Ghosh ◽  
SK Amirul Islam ◽  
Nirupom Mondal
Keyword(s):  
Treatment Outcome ◽  
Comparative Study ◽  
Medical Management ◽  
Tertiary Hospital ◽  
P Value ◽  
Ureteric Stone ◽  
Expulsion Rate ◽  
Medical Expulsive Therapy

Objective: To compare the treatment outcome of Silodosin alone and Silodosin plusTadalafil as a medical expulsive therapy (MET) of lower ureteric stone in south-westernpart of Bangladesh. Methodology: The study was conducted in a tertiary hospital in Khulna, over a periodof 12 months (January 2019 to December 2019). Out of 108 patients, 100 meet theinclusion criteria who were purposively assigned into 2 groups. 48 patients included inSilodosin alone group and 52 in Silodosin plus Tadalafil group. Result: There was a significant higher stone expulsion rate in Silodosin plus Tadalafilthan Silodosin alone which was 88.46% vs75% respectively (P value 0.02). The meanstone expulsion time of Silodosin alone was14.33 (±3.1) days and Silodosin plus Tadalafilwas 11.48(±2.3) days (P value 0.001). The episodes of pain in Silodosin alone were0.7(±0.06) and 0.6(±0.2) in Silodosin plus Tadalafil group that was statisticallysignificant. Conclusion: The present study concludes that Silodosin plus tadalafil combinationtherapy significantly increases ureteric stone expulsion rate and decreases the expulsiontime and pain episodes than treatment with silodosin alone. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.67-71

scholarly journals Pycnogenol® Supplementation Prevents Recurrent Urinary Tract Infections/Inflammation and Interstitial Cystitis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
A. Ledda ◽  
S. Hu ◽  
M. R. Cesarone ◽  
G. Belcaro ◽  
M. Dugall ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Side Effects ◽  
Interstitial Cystitis ◽  
Urinary Tract Infections ◽  
Recurrent Uti ◽  
Recurrent Urinary Tract Infections ◽  
Standard Management ◽  
Tract Infections ◽  
Open Pilot

This open pilot registry study aimed to evaluate and compare the prophylactic effects of Pycnogenol® or cranberry extract in subjects with previous, recurrent urinary tract infections (UTI) or interstitial cystitis (IC). Methods. Inclusion criteria were recurrent UTI or IC. One subject group was supplemented with 150 mg/day Pycnogenol®, another with 400 mg/day cranberry extract, and a group served as a control in a 2-month open follow-up. Results. 64 subjects with recurrent UTI/IC completed the study. The 3 groups of subjects were comparable at baseline. All subjects had significant symptoms (minor pain, stranguria, repeated need for urination, and lower, anterior abdominal pain) at inclusion. In the course of the study, the subjects reported no tolerability problems or side effects. The incidence of UTI symptoms, in comparison with the period before inclusion in the standard management (SM) group, decreased significantly; there was a more pronounced decrease in the rate of recurrent infections in the Pycnogenol® group ( p < 0.05 ). The improvement in patients supplemented with Pycnogenol® was significantly superior to the effects of cranberry. At the end of the study, all subjects in the Pycnogenol® group were infection-free ( p < 0.05 vs. cranberry). Significantly, more subjects were completely symptom-free after 2 months of management with Pycnogenol® (20/22) than with SM (18/22) and cranberry (16/20). Conclusions. This pilot registry suggests that 60 days of Pycnogenol® supplementation possibly decrease the occurrence of UTIs and IC without side effects and with an efficacy superior to cranberry.

scholarly journals Microbiome recovery in adult females with uncomplicated urinary tract infections in a randomised phase 2A trial of the novel antibiotic gepotidacin (GSK140944)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrea Nuzzo ◽  
Stephanie Van Horn ◽  
Christopher Traini ◽  
Caroline R. Perry ◽  
Etienne F. Dumont ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Human Microbiome ◽  
Time Points ◽  
Pharyngeal Cavity ◽  
Adult Females ◽  
Microbiome Diversity ◽  
Antibiotic Drug ◽  
Tract Infections

Abstract Background With increasing concerns about the impact of frequent antibiotic usage on the human microbiome, it is important to characterize the potential for such effects in early antibiotic drug development clinical trials. In a randomised Phase 2a clinical trial study that evaluated the pharmacokinetics of repeated oral doses of gepotidacin, a first-in-chemical-class triazaacenaphthylene antibiotic with a distinct mechanism of action, in adult females with uncomplicated urinary tract infections for gepotidacin (GSK2140944) we evaluated the potential changes in microbiome composition across multiple time points and body-sites (ClinicalTrials.gov: NCT03568942). Results Samples of gastrointestinal tract (GIT), pharyngeal cavity and vaginal microbiota were collected with consent from 22 patients at three time points relative to the gepotidacin dosing regimen; Day 1 (pre-dose), Day 5 (end of dosing) and Follow-up (Day 28 ± 3 days). Microbiota composition was determined by DNA sequencing of 16S rRNA gene variable region 4 amplicons. By Day 5, significant changes were observed in the microbiome diversity relative to pre-dose across the tested body-sites. However, by the Follow-up visit, microbiome diversity changes were reverted to compositions comparable to Day 1. The greatest range of microbiome changes by body-site were GIT followed by the pharyngeal cavity then vagina. In Follow-up visit samples we found no statistically significant occurrences of pathogenic taxa. Conclusion Our findings suggest that gepotidacin alteration of the human microbiome after 5 days of dosing is temporary and rebound to pre-dosing states is evident within the first month post-treatment. We recommend that future antibiotic drug trials include similar exploratory investigations into the duration and context of microbiome modification and recovery. Trial registration NCT03568942. Registered 26 June 2018.

Ampicillin-Associated Diarrhea: Effect of Dosage and Route of Administration

PEDIATRICS ◽  
1976 ◽  
Vol 58 (6) ◽  
pp. 869-872
Author(s):  
John A. Phillips ◽  
Frederick H. Lovejoy ◽  
Yoichi Matsumiya
Keyword(s):  
Urinary Tract ◽  
Side Effects ◽  
High Dose ◽  
Total Dosage ◽  
Pediatric Practice ◽  
Severe Diarrhea ◽  
Bowel Movements ◽  
Gastrointestinal Side Effects ◽  
Tract Infections ◽  
Mild Diarrhea

Ampicillin is one of the most frequently used antibiotics in pediatric practice.1 Its clinical efficacy has been widely studied, but its gastrointestinal side effects are poorly documented. In adults with urinary tract infections, 11% taking 1 gm/day of ampicillin orally had bowel movements which were at least twice as frequent as normal.2 Another series in adults receiving ampicillin reported an increase in stools with 16% having ≤5 and 5% having ≥5 stools per day. The change in stools increased with total dosage and was equal after oral or intravenous administration.3 In children, ampicillin ranging from 50 to the unusually high dose of 200 mg/kg/day resulted in mild diarrhea (≤5 stools per day) in 18% to 30%, moderate diarrhea (5 to 10 stools per day) in 2% to 11%, and severe diarrhea (≥10 stools per day) in 1% or less of cases.

scholarly journals Infeções do Trato Urinário numa Coorte de Transplantados Renais

2014 ◽  
Vol 27 (3) ◽  
pp. 364 ◽  
Author(s):  
Ana Bispo ◽  
Milene Fernandes ◽  
Cristina Toscano ◽  
Teresa Marques ◽  
Domingos Machado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Hospital Admissions ◽  
Female Gender ◽  
Tract Infections

<strong>Introduction:</strong> Urinary tract infection is the most common infectious complication following renal transplantation and its frequency is insufficiently studied in Portugal. The aim of this study was to characterize the incidence of urinary tract infections and recurrent urinary tract infections in renal transplant recipients.<br /><strong>Material and Methods:</strong> This was a retrospective cohort observational study, obtained from clinical files of all patients who received a renal transplant at the Hospital of Santa Cruz, from January 2004 to December 2005, with a mean follow-up period of five years or until date of graft loss, death or loss of follow-up. After a descriptive analysis of the population, we used bivariate tests to identify risk factors for urinary tract infections.<br /><strong>Results:</strong> A total of 127 patients were included, with a 593 patients.year follow-up. We detected 53 patients (41.7%) presenting with at least one episode of urinary tract infection; 21 patients (16.5%) had recurrent urinary tract infection. Female gender was the only risk factor associated with the occurrence of urinary tract infections (p &lt; 0.001, OR = 7.08, RR = 2.95) and recurrent urinary tract infections (p &lt; 0.001, OR = 4.66, RR = 2.83). Escherichia coli (51.6%), Klebsiella pneumoniae (15.5%) and Enterobacter spp (9.9%) were the<br />most frequently identified pathogens. Patients did not reveal an increased mortality or allograft loss. However, urinary tract infections were the most important cause of hospital admissions.<br /><strong>Discussion:</strong> Female gender was the only risk factor for urinary tract infections in this population. Escherichia coli was the most frequent agent isolated.<br /><strong>Conclusion:</strong> Despite preventive measures, urinary tract infections remain an important cause of morbidity and hospital admissions.<br /><strong>Keywords:</strong> Urinary Tract Infections; Postoperative Complications; Risk Factors; Kidney Transplantation; Portugal.

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