Urinary tract, lower

France plastic diseases of the lower urinary tract Printing worker (ever) M 7/3 3.0 0.7-13.8 ... 

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. 

O The lower urinary tract symptoms and signs of benign prostatic hyperplasia are due to static, dynamic, or detrusor factors. The static factor refers to anatomic obstruction of the bladder neck caused by an enlarged prostate gland. The dynamic factor refers to excessive stimulation of a-adrenergic receptors in the smooth muscle of the prostate, urethra, and bladder neck. The detrusor factor refers to irritability of hypertrophied detrusor muscle as a result of long-standing bladder outlet obstruction. 

Surgical intervention should be reserved for patients with severe lower urinary tract symptoms of benign prostatic hyperplasia or those with complications of disease (such as recurrent urinary tract infections, renal failure, and bladder calculi). 

Upper and lower urinary tract infection, urosepsis, urinary incontinence refractory urinary retentions chronic, renal failure, bladder diverticuli, bladder stones, or recurrent gross hematuria. 

LUTS lower urinary tract (voiding) symptoms... 

Chappie CR. Pharmacological therapy of benign prostatic hyperplasia/ lower urinary tract symptoms an overview for the practicing clinician. BJU Int 2004 94 738-744. 

Djavan B, Chappie C, Milani S, Marberger M. State of the art on the efficacy and tolerability of alpha, adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 2004 64 1081-1088. 

Milani S, Djavan B. Lower urinary tract symptoms suggestive of benign prostatic hyperplasia latest update on a, adrenoceptor antagonists. BJU Int 2005 95(Suppl 4) 29—36. 

Many medications can influence the lower urinary tract, including those not used for managing genitourinary disorders, and can precipitate new onset or aggravate existing voiding dysfunction and urinary incontinence. 

Urinary incontinence (UI) is defined as the complaint of involuntary leakage of urine.1 It is often associated with other bothersome lower urinary tract symptoms such as urgency, increased daytime frequency, and nocturia. Despite its prevalence across the lifespan and in both sexes, it remains an underdetected and underreported health problem that can have significant negative consequences for the individual s quality of life. Patients with UI may be depressed due to a... 

The patient usually notes Ul during activities like exercise, running, lifting, coughing, or sneezing. This type of Ul is much more common in females (seen only in males with lower urinary tract surgery or injury compromising the sphincter). 

Can have bladder overactivity and Ul without urgency, if sensory input from the lower urinary tract is absent. 

TABLE 50-1. Medications Influencing Lower Urinary Tract Function... 

Describe the signs and symptoms of urinary tract infections (UTIs) and how they differ in upper versus lower urinary tract disease. 

FIGURE 76-1. Anatomy and associated infections of the urinary tract. (From Sprandel KA, Lesch CA, Rodvold KA. Lower urinary tract infection. In SchwinghammerTL, (ed.) Pharmacotherapy Casebook A Patient-Focused Approach. 6th ed. New York McGraw-Hill 2005 319, with permission.)... 

Lower urinary tract infection (UTI) Includes infections of the bladder, urethra, and (in men) prostate and epididymis. 

In an early study in 1971, Cole22 found an association between coffee drinking and lower urinary tract cancer based on a case-control study of 445 cancer patients (345 men, 100 women) and 451 population controls who were matched for age and sex. The analyses had controlled for cigarette smoking and occupation however, there was no consistent dose response relation, and the summary risks were significant only in women,... 

Cole, P, Coffee-drinking and cancer of the lower urinary tract, Lancet, i, 1335, 1971. 

Robinson D, Cardozo LD (2003) The role of estrogens in female lower urinary tract dysfunction. Urology 62 45-51... 

The best statistical parameters were obtained by correlating the in vivo selectivity with the Vdif descriptor defined with respect to the oqa-AR supermolecule. It is worth noting that the oqa is the adrenergic receptor subtype of functional relevance for the urethra tissue (dog model) [8]. Thus, ligands showing high potency and selectivity for the lower urinary tract are those, which better fit the volume of the supermolecule that represents the binding site of the ala-AR subtype. 

Resistance to the drugs has developed over time current uses include treatment of gonorrhea, and upper and lower urinary tract infections in both sexes. 

Pyloric or duodenal obstruction obstructive intestinal lesions or ileus achalasia Gl hemorrhage obstructive uropathies of the lower urinary tract. 

Urinary tract infections - For uncomplicated lower urinary tract infection (eg, cystitis), the usual dosage is 1 or 2 g/day in single or 2 divided doses. For all other urinary tract infections, the usual dosage is 2 g/day in 2 divided doses. 

Echinacea (Echinacea purpurea) Uses immune system stimulant prevention/Rx of colds, flu as supportive th apy for colds chronic infxns of the resp tract lower urinary tract Action Stimulates phagocytosis cytokine production T resp cellular activity topically exerts anesthetic, antimicrobial, anti-inflammatory effects Efficacy Not established may X severity duration of URI Available forms Caps w/ powdered herb equivalent to 300-500 mg, PO, tid pressed juice 6-9 mL, PO, once/d tine 2-4 mL, PO, tid (1 5 dilution) tea 2 tsp (4 g) of powdered herb in 1 cup of boiling water Noles/SE Fever, taste p -version, urticaria, angioedema Contra w/ autoimmune Dz, collagen Dz, progressive systemic Dz (TB, MS, collagen-vascular disorders), HIV, leukemia, may interfere w/ immunosuppressive therapy Interactions t Risk of disulfiram-like reaction W/ disulfiram, metronidazole T risk of exacerbation of HIV or AIDS W/ chinacea amprenavir, other protease inhibitors X effects OF azathioprine, basiliximab, corticosteroids, cyclosporine, daclizumab, econazole vag cream, muromonab-CD3, mycophenolate, prednisone, tacrolimus EMS Possible immunosuppression... 

Adrenergic Alpha lA receptor ADRAIA Agonism Smooth muscle contraction (prostate in particular, effects on the lower urinary tract) and cardiac positive ionotropy, arrhythmia. Antagonism Orthostatic hypotension and other blood pressure related adverse effects and impact on various aspects of sexual function. 

Bladder dysfunction. Two whole-plant extracts of Cannabis sativa were administered to patients with advanced multiple sclerosis (MS) and refractory troublesome lower urinary tract symptoms. The patients... 

Early urodynamic effect. Permixon was administered to 75 patients with lower urinary tract symptoms resulting from mild-to-moderate BPH (mean IPSS 8.2), aged 52-78 years, at a dose of 160 mg twice daily for 9 weeks. Maximum urinary flow rate increased 6% (p < 0.001), and there was a reduction in detrusor pressure at maximum flow (12.8%, p < 0.001), opening detrusor pressure (12.6%, p < 0.001), and residual urine volume (12.6%, p < 0.05). The IPSS... 

Kuzmin, and R. R. Amdiy. Early urodynamic effects of the lipido-ste-rolic extract of Serenoa repens (Permixon ) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 2000 3(3) 195-199. 

Biol Int 2001 25(11) 1117-1124. Gerber, G. S., D. Kuznetsov, B. C. Johnson, and J.D. Burstein. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology 2001 ... 

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