Efficacy of Additional Solifenacin Succinate Therapy for Storage Symptoms in Females with Uncomplicated Lower Urinary Tract Infection: The SOLUTION Randomized Controlled Trial

Background: urinary tract infection (UTI) is often treated in daily practice as overactive bladder (OAB) by giving anticholinergic, the recommended treatment options of OAB. However, anticholinergic application for UTI symptoms relief has never been investigated. To our knowledge, this study was the first randomized trial which investigate anticholinergic use for UTI treatment. This study aimed to evaluate whether additional anticholinergic is beneficial alongside an empiric antibiotic therapy in reducing symptoms and tolerable for females with uncomplicated UTI. Methods: this was a randomized double-blind controlled trial that included female aged >18 y.o with uncomplicated lower UTI. Patients were randomly assigned to either solifenacin succinate 5 mg (group 1) or placebo (group 2) in addition to empiric levofloxacin 500 mg treatment for 3 days. Those with structural and/or functional abnormalities of the urinary tract and allergic reaction history were excluded. We observed changes in overactive bladder symptom score (OABSS), patient perception of bladder condition (PPBC) score, patient-reported symptoms and adverse events. Results: a total of 126 patients, 63 for each group, initiated the trial with median age of 44 (19-67) y.o. There were no differences of age, OABSS, and PPBC score between the 2 groups at baseline. We found significant (p<0.05) reduction of OABSS and PPBC score in both groups at the end of therapy; however the amount of reduction were not different between groups. In group 1 we found 22.2% of patients complained of dry mouth and 25.4%, 4.7%, 3.2% of patients complained of nausea, somnolence and constipation respectively. In group 2 we found 20.0%, 21.7% and 3.3% patients who complained of dry mouth, nausea, and somnolence respectively. One patient in group 2 experienced allergic reaction and was dropped out. Conclusion: we found no significant difference in OABSS and PPBC score reduction by adding anticholinergic to antibiotic therapy for females with uncomplicated UTI. There was no serious adverse event recorded

Management of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia by general practitioners in Jakarta

This study was performed to describe and evaluate the management of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) by general practitioners (GPs) in Jakarta. Methods: This observational cross-sectional study was peformed between January 2013 and August 2013 in Jakarta. We developed a questionnaire consisting of 10 questions describing the management of male LUTS suggestive of BPH by GPs in their daily practice in the previous month. We collected questionnaires from 200 GPs participating in 4 urology symposiums held in Cipto Mangunkusumo Hospital, Jakarta. Results: Most GPs were aged between 25 and 35 years (71.5%) and had worked for more than 1 year (87.5%). One to 5 cases of male LUTS suggestive of BPH were treated by 81% of GPs each month. At diagnosis, the most common symptoms found were urinary retention (55.5%), frequency (48%), and nocturia (45%). The usual diagnostic workup included digital rectal examination (65%), scoring system (44%), measurement of prostate-specific antigen (PSA) level (23.5%), and renal function assessment (20%). Most GPs referred their male patients with LUTS suggestive of BPH to a urologist (59.5%) and 46.5% of GPs prescribed drugs as an initial therapy. Alpha-adrenergic antagonist monotherapy (71.5%) was the most common drug prescribed. Combination therapy with α-adrenergic antagonists and 5α-reductase inhibitors was not routinely prescribed (13%). Thirty-eight percent of GPs referred their patients when recurrent urinary retention was present and 33% when complications were present. Conclusions: Our study provides evidence that the management of male LUTS suggestive of BPH by GPs in Jakarta suggests referral in part to available guidelines in terms of diagnostic methods and initial therapy. However, several aspects of the guidelines, such as PSA level measurement, renal function assessment, urinalysis, ultrasound examination, and prescription of combination therapies, are still infrequently performed

Efficacy of Additional Solifenacin Succinate Therapy for Storage Symptoms in Females with Uncomplicated Lower Urinary Tract Infection: The SOLUTION Randomized Controlled Trial

Background: urinary tract infection (UTI) is often treated in daily practice as overactive bladder (OAB) by giving anticholinergic, the recommended treatment options of OAB. However, anticholinergic application for UTI symptoms relief has never been investigated. To our knowledge, this study was the first randomized trial which investigate anticholinergic use for UTI treatment. This study aimed to evaluate whether additional anticholinergic is beneficial alongside an empiric antibiotic therapy in reducing symptoms and tolerable for females with uncomplicated UTI. Methods: this was a randomized double-blind controlled trial that included female aged >18 y.o with uncomplicated lower UTI. Patients were randomly assigned to either solifenacin succinate 5 mg (group 1) or placebo (group 2) in addition to empiric levofloxacin 500 mg treatment for 3 days. Those with structural and/or functional abnormalities of the urinary tract and allergic reaction history were excluded. We observed changes in overactive bladder symptom score (OABSS), patient perception of bladder condition (PPBC) score, patient-reported symptoms and adverse events. Results: a total of 126 patients, 63 for each group, initiated the trial with median age of 44 (19-67) y.o. There were no differences of age, OABSS, and PPBC score between the 2 groups at baseline. We found significant (p<0.05) reduction of OABSS and PPBC score in both groups at the end of therapy; however the amount of reduction were not different between groups. In group 1 we found 22.2% of patients complained of dry mouth and 25.4%, 4.7%, 3.2% of patients complained of nausea, somnolence and constipation respectively. In group 2 we found 20.0%, 21.7% and 3.3% patients who complained of dry mouth, nausea, and somnolence respectively. One patient in group 2 experienced allergic reaction and was dropped out. Conclusion: we found no significant difference in OABSS and PPBC score reduction by adding anticholinergic to antibiotic therapy for females with uncomplicated UTI. There was no serious adverse event recorded

Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study [version 1; referees: 1 approved, 2 approved with reservations]

Objectives Bleeding is the most common complication of percutaneous nephrolithotomy (PCNL). Injudicious transfusion is frequently performed in current practice, even though it is not always needed. This study aimed to identify the predictive factors of blood loss in the PCNL procedure and evaluate the perioperative transfusion practice.   Methods A prospective study of PCNL was randomly performed by two consultants of endo-urology at our institution. The inclusion criteria were adults with kidney pelvic stones >20 mm or stone in inferior calyx >10 mm or staghorn stone. Those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. A full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, shifting of hematocrit level and amount of blood transfused were analyzed statistically using line regression to identify the predictive factors of total blood loss (TBL).   Results Eighty-five patients were enrolled in this study. Mean TBL was 560.92 ± 428.43 mL for both endo-urology surgeons. Stone burden was the most influential factor for TBL (p=0.037). Our results revealed that TBL (mL) = -153.379 + 0.229 × stone burden (mm2) + 0.203 x baseline serum hematocrit (%); thus considerably predicted the need for blood transfusion. A total of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% received post-operative transfusion, 23% had both intra and post-operative transfusion, resulting in a cross-matched transfusion ratio of 7.72. Mean perioperative blood transfused was 356.00 ± 145.88 mL