Bladder cystitis

This chapter discusses drug s used to treat urinary tract infections (UTIs) and certain miscellaneous drag > used to relieve the symptoms associated with an overactive bladder (involuntary contractions of the detrusor or bladder muscle). Structures of the urinary system that may be affected include the bladder (cystitis), prostate gland (prostatitis), the kidney, or the urethra (see Pig. 47-1). These drug s also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. 

Urinary tract infection (UTI) is an infection caused by pathogenic microorganisms of one or more structures of the urinary tract. The most common structure affected is the bladder, with the urethra, prostate, and kidney also affected (see Pig. 47-1). Display 47-1 identifies the disorder most frequently associated with each of these structures within the urinary system. Clinical manifestations of a UTI of the bladder (cystitis) include urgency, frequency, burning and pain on urination, and pain caused by spasm in the region of the bladder and the suprapubic area. 

Clinical trials showed therapeutic efficacy in a broad spectrum of tumors these include SCLC, testicular tumors, sarcomas, breast cancer, renal cell cancer, pancreatic tumors and lymphomas. Ifosfamide is less myelosuppressive than cyclophosphamide but is more toxic to the bladder. Therefore it is recommended that ifosfamide is coadministered with the thiol compound mesna to avoid hemorrhagic cystitis and to reduce the risk of developing bladder cancer. Other side effects include neurotoxicity and myelosuppression. 

Escherichia coli is a cause of enteritis in young infants and the young of farm animals, where it can cause diarrhoea and fatal dehydration. It is a common infectant ofthe urinary tract and bladder in humans, and is a cause of pyelitis, pyelonephritis and cystitis. 

TRPVl also plays a central role in intercellular pro-inflammatory feedback loops. An important example is mast cells and sensory nerves. Mast cells release tryptase that, in turn, activates the protease-activated receptor PAR-2 activation of PAR-2 then opens TRPVl via PKC [50]. In keeping with this, PAR-2 agonists reduce the heat activation threshold of TRPVl from 42 °C to below body temperature [51]. Excited nerve endings release SP that, as a positive feedback, binds to neurokinin NKl receptors on mast cells. Mast cells also express TRPVl [52]. Consequently, endovanilloids can act in concert to stimulate mast cells and activate capsaicin-sensitive nerve endings. Of relevance is the finding that PAR-2 is up-regulated in the bladder during experimental cystitis [53]. 

Capsaicin-sensitive nerves sense bladder fullness and form the afferent limb of the micturition reflex [132]. In conditions of bladder hypersensitivity, TRPVl is up-regulated on these nerves (presumably via NGL [133, 134]) and deafferentation of the bladder by intravesical capsaicin or RTX was proven beneficial [135-137]. Parenthetically, intravesical RTX is also an effective analgesic agent during experimental cystitis in the rat [138]. By... 

Patients may or may not be in acute distress. In early stages of disease, the patient may complain of obstructive voiding symptoms. If untreated, in late stages of disease the patient may complain of irritative voiding symptoms, or acute urinary retention, which is painful due to maximal distention of the urinary bladder. Also, the patient may be symptomatic of disease complications, including urosepsis, pyelonephritis, cystitis, or overflow urinary incontinence. 

The use of effective prevention strategies can decrease the incidence of hemorrhagic cystitis to less than 5% in patients receiving cyclophosphamide or ifosfamide. There are three methods to reduce the risk administration of mesna, hyperhydration, and bladder irrigation with catheterization. 

If hemorrhagic cystitis occurs, the goals of treatment are to decrease exposure to the offending etiology, establish and maintain urine outflow, avoid obstruction and renal compromise, and maintain blood and plasma volume. Restoration of normal bladder function is the ultimate goal following acute treatment. 

The answer is i. (Katzwng, p 984.) Bacille Calmette-Guerin vaccine is a nonspecific stimulant of the reticuloendothelial system. It is an attenuated strain of Mycobacterium fruvis that appears most effective in small, localized bladder tumors. This agent is approved for intravesicular use in bladder cancer. Adverse reactions are associated with the renal system, such as problems with urination, infection, and cystitis. 

Lower tract infections include cystitis (bladder), urethritis (urethra), prostatitis (prostate gland), and epididymitis. Upper tract infections (such as pyelonephritis) involve the kidney and are referred to as pyelonephritis. 

Cystitis, candidal - Irrigate bladder with a 50 mcg/mL solution, instilled periodically or continuously for 5 to 10 days. 

Uses Hemoixhagic cystitis when saline bladder irrigation fails Action Astringent Dose 1-2% soln w/constant NS bladder irrigation Caution [+/-] Disp Powder for recons SE Encephalopathy possible can precipitate occlude catheters EMS None OD Not expected to produce life-threatening Sxs... 

A toxicity that is unique to cyclophosphamide and ifosfamide is cystitis. Dysuria and decreased urinary frequency are the most common symptoms. Rarely, fibrosis and a permanently decreased bladder capacity may ensue. The risk of development of carcinoma of the bladder also is increased. Large intravenous doses have resulted in impairment of renal water excretion, hyponatremia, and increased urine osmolarity and have been associated with hemorrhagic subendocardial necrosis, arrhythmias, and congestive heart failure. Interstitial pulmonary fibrosis may also result from chronic treatment. Other effects of chronic drug treatment include infertility, amenorrhea, and possible mutagenesis and carcinogenesis. 

Toxic effects due to 4-chloro-ort/20-toluidine result from inhalation or skin contact (Stasik, 1991). The first symptom of 4-chloro-orl/20-toluidine toxicity is macroscopic or microscopic haematuria. Further symptoms include dysuria, reduced bladder capacity and generalized pain in the lower abdomen. Haemorrhagic cystitis is the leading symptom of acute toxicity. 

Cytotoxic Causing disturbance to cellular structure or function often leading to cell death. Cystitis inflammation of the bladder. 

Atropine and other antimuscarinic drugs have been used to provide symptomatic relief in the treatment of urinary urgency caused by minor inflammatory bladder disorders (Table 8-3). However, specific antimicrobial therapy is essential in bacterial cystitis. In the human urinary bladder, M2 and M3 receptors are expressed predominantly with the M3 subtype mediating direct activation of contraction. As in intestinal smooth muscle, the M2 subtype appears to act indirectly by inhibiting relaxation by norepinephrine and epinephrine. 

N.A. Arenaria rubra (Wahlenb.) Sm. Resin.346 Relax muscle walls of the urinary tubules and bladder. Treat kidney stones, acute, and chronic cystitis. 

The main side-effects are urinary tract symptoms such as cystitis and bladder irritation (Mayall et at., 1994). 

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