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Intravaginal Suppository Probiotic May Reduce Rate of Recurrent Urinary Tract Infections

The results of a new study suggest that probiotic may reduce the rate of recurrent urinary tract infections in women prone to these infections.

There is a theory that a depletion of vaginal lactobacilli, a type of bacteria, is associated with urinary tract infection risk, which suggests that replenishing this bacteria may be beneficial.

A double blind placebo controlled trial to investigate this theory was conducted.  In the study, young women with a history of recurrent urinary tract infections received antibiotics for acute urinary tract infections. They were then randomized to receive either a Lactobacillus crispatus intravaginal suppository probiotic, called LACTIN-V, or a placebo for five days, then once a week for 10 weeks. Fifty women out of the 100 women who participated in the study received LACTIN-V, and 50 received the placebo.  Seven of the women who received LACTIN-V had at least one urinary tract infection, compared to 13 in the placebo group.

Study author Ann Stapleton, MD, of the University of Washington in Seattle said “Larger efficacy trials of this novel preventive method for recurrent urinary tract infections are warranted to determine if use of vaginal Lactobacillus could replace long term antimicrobial preventive treatments.”

Urinary tract infections are more comment in women which frequently recurs affecting 2 to 3 percent of all women.  In United States alone, cost to treat these infections is estimated at $2.5 billion in year 2000.

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Vitamin D: The Super Vitamin

One of the most underappreciated, yet most crucial, vitamins is the sunshine vitamin:  vitamin D.  Besides protecting our bodies from cancer, obesity, autoimmune diseases, and cardiovascular problems, vitamin D helps build strong bones.  And now scientists have found that this remarkable vitamin has a significant impact on the immune system.  It turns out that vitamin D is necessary for the production of anti-microbial peptides, which are substances that fight off infection-causing bacteria, fungi, and viruses when these pathogens try to move into organs and through mucous membranes.

Previous research has indicated that with adequate amounts of vitamin D, the flu, colds, and serious lung infections, including tuberculosis, may be kept at bay.  Now Swedish researchers from the Karolinska Institute and Karolinska University Hospital in Stockholm have evidence that higher vitamin D levels offer especially strong protection against another common health problem—urinary tract infections (UTIs).

The new study was published in the journal PLoS One.  “In the light of the rapidly growing problem of resistance to common urinary tract antibiotics, we suggest that vitamin D may be a potential complement in the prevention of UTI.  Determining the vitamin D status of individuals with a history of UTI may be of importance to evaluate their ability to fend off intruding bacteria,” stated scientists in PLoS One.

The urinary tract is frequently exposed to infection-causing agents and has a built-in, rapid defense system.  When pathogens threaten, cathelicidin, an antimicrobial peptide, is expressed.  However, the immune system must be healthy in order to do so.  The peptide is actually secreted by bladder epithelial cells and protects the urinary tract from an infection.

Vitamin D plays a very important role in this process.  According to the Swedish study, vitamin D actually induces cathelicidin in the urinary bladder.  This process occurs when a boost in the antimicrobial peptide is needed during an infection.

These findings mean that vitamin D has a huge advantage over many of the antibiotics prescribed today for urinary tract infections.  When antibiotics are used to treat UTIs, the drugs are harmful for the beneficial bacteria in the gut, leading to other problems.  But vitamin D only produces germ-killing peptides at the site of an infection when needed, leaving “friendly bacteria” totally unharmed.

“By inducing and activating cathelicidin with vitamin D, a local rather than a systemic effect can be achieved.  This could offer selective and site-specific treatment of pathogens without perturbing commensal [friendly] microbes elsewhere in the body,” state the scientists.

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Urinary Disease Screening in Children

For many genetic diseases, physicians recommend screening among family members to monitor the disease, ensuring early detection and possible treatment.  But in the case of vesicoureteral reflux, or VUR, it may not be as beneficial to screen siblings of young children who have this urinary reflux disease.

Approximately 1% of children have VUR, and their siblings are at higher risk—more than one-quarter of children whose sibling has VUR also have the disease.  As a result, doctors currently suggest screening all siblings of VUR patients, regardless of whether or not they have symptoms.

But according to a new pediatric study, researchers found that screening siblings of VUR patients before they develop symptoms would prevent only a small number of urinary tract infections (UTI), while costing a significant amount of money and radiation exposure associated with the unpleasant procedure.

“You really have to screen a large number of asymptomatic siblings in order to prevent one infection,” study author Dr. Jonathan Routh of Children’s Hospital Boston explained.

In fact, Routh and his colleagues suggest that in order to prevent just one UTI, hundreds of children must be screened, potentially costing hundreds of thousands of dollars.

In addition, the antibiotics often prescribed for the condition may not be as effective as once believed.  Normally, prophylactic antibiotics are prescribed for UTIs in children with VUR.  If, in fact, prophylactic antibiotics worked, only 30 one-year-old siblings would need to be screened in order to prevent one febrile UTI (or an infection accompanied by fever, which is a sign that the infection may involve the kidneys).  This amounts to $56,000 per averted infection.  But if more conservative estimates of the effectiveness of prophylaxis are used, then 430 siblings would have to be screened to prevent one UTI, costing $820,000 per infection.

“Best case scenario:  You’d still have to screen 30 perfectly normal children in order to prevent one febrile urinary tract infection,” Routh noted.

Not even the American Urological Association is recommending universal screening for siblings of children with VUR.  The AUA has updated guidelines for when screening makes sense for this disease.

Despite the results of this analysis, parents are still going to be concerned about their individual child.  Although Routh acknowledges this concern, he explains that the results do apply to individual children as well.  “It is unlikely that any one child is going to have a direct benefit from that screening.”

Many doctors support Routh’s study, including Dr. Kourosh Afshar, who has studied VUR at the University of British Columbia.  He states that in order to truly test the benefits of screening in real children, many would have to be followed for years, generating an enormous cost.

Universal screening is so costly and prevents so few cases that Dr. Afshar says, “I don’t recommend it as a doctor.”

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Urinary Tract Infection Vaccine

Urinary Tract Infection (UTI) affects more than 8 million people each year.  The cost for treatment is estimated at $3.5 billion each year and it accounts for more than 3 million prescriptions.  If this is not enough to cause concern on UTI, a number of infections are resistant to common antibiotic treatments.

Roughly 80% of UTIs is caused by E. coli.  Studies from the University of Michigan showed that more than half of the E. coli samples they collected were resistant to an antibiotic commonly used to treat UTIs.  In some cases, E. Coli is resistant up to 15% to a class of antibiotics that includes Ciprofloxacin (“cipro”), a second line treatment for UTI.

Last year, the university published a study that showed a vaccine they had developed prevented UTI which are caused by E. coli bacteria and produced key types of immunity in mice. Though developing and testing this vaccine in humans will take several years, this study is a breakthrough in medicine. This will lead to developments that would save billions in health care costs and millions of doctors’ visits and hospitalizations from UTI each year.

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Urinary Tract Infections (UTI) In Men

Urinary tract infections are more common in women than men however men can acquire UTI and it can have some severe complications.  It is important to recognize the symptoms and get treatment quickly.

The urine is normally sterile but under certain circumstances bacteria can move in the urinary system and cause infection.  Just like UTIs in women and children, infections in men are caused by bacteria.

Men with abnormalities of the urinary tract, such as kidney stones or an enlarged prostate, are more prone to urinary infection. This condition can prevent the bladder from emptying completely, which increases the likelihood that bacteria will grow and trigger an infection.

A bladder infection (cystitis) is more common in men who practice anal intercourse and in those who are not circumcised.

Other factors that increase the risk of urinary infections include an obstruction, such as that caused by a partial blockage of the urethra known as a stricture, and non-natural substances, such as rubber catheter tubes (as may be inserted to relieve a blockage in the urethra). Men with diabetes or any disease that suppresses the immune system are more prone to UTI.

Although some men who have a UTI do not have any symptoms, most men will experience some or all of the following symptoms:

  • The urine can look cloudy or milky. If blood is present then the color will be reddish
  • Urine if foul smelling
  • Pain, pressure or tenderness in the area of the bladder (in the middle of the abdomen, below the navel) and/or pain in the upper back or in the side
  • Unusual frequent urge to urinate but often the amount of urine passed is small
  • Painful, burning feeling in the area of the bladder or urethra, during urination
  • Awakening from sleep to urinate
  • Fatigue
  • Fever
  • Nausea and even vomiting may occur

The doctor’s exam will consist of a urine sample that you will give right there at the doctor’s office. A lab test will let them know if you have an infection and how severe the infection is. Once the severity is determined, the doctor will prescribe an antibiotic. If you are in any pain, the doctor will also prescribe a special pain killer that is specifically for UTIs.

You need to be aware that these pain killers may turn your urine a bright blue or orange, but there is no need for alarm, the medicines are quite safe and will leave no lasting effects. You will also need to drink lots of water during your recovery period. This recovery period is usually 7-10 plus days.

In men, a rectal examination will allow your doctor to assess the size and shape of the prostate gland. If you are a young man with no sign of an enlarged prostate, your doctor may order additional tests to search for a urinary tract abnormality that increases the likelihood of infection. This is because urinary tract infections are relatively rare in young men with normal urinary tracts.

If the infection has spread or become severe before your doctor visit, there may be other tests the doctor will require. Further tests such as an IVP (Intravenious pyelogram), ultrasound, or cystoscopy may be required to detect the cause of urinary infections especially is they recur or do not respond to the medication your doctor orders. These types of test are necessary to check your kidneys and/or prostate. The treatment for UTI is somewhat longer for men than for women because of the concern for the prostate.

Once an infection gets into the prostate it is very difficult to get rid of it. This is just one more reason to pay attention to your bodily functions so you can detect a UTI in its earliest stages.  Of course, as with nearly everything else in life, the older a man gets the greater the concern.

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How Cranberry Juice prevents Urinary Tract Infections

It is common knowledge that cranberry juice can help ward off urinary tract infections, but until now, the exact mechanism has remained a mystery. However, a new study by scientists at Worcester Polytechnic Institute has shed light on this mechanism, showing that cranberry juice changes the thermodynamic properties of harmful urinary tract bacteria. This creates an energy barrier that prevents the bacteria from initiating an infection.

Terri Camesano, associate professor of chemical engineering at WPI, elaborated on the findings. “Our results show that, at least for urinary tract infections, cranberry juice targets the right bacteria–those that cause disease–but has no effect on non-pathogenic organisms, suggesting that cranberry juice will not disrupt bacteria that are part of the normal flora in the gut,” Camesano said. “We have also shown that this effect occurs at concentrations of cranberry juice that are comparable to levels we would expect to find in the urinary tract.”

Fortunately for people concerned about their weight, the study has also shown the effects of regular cranberry juice and diet (sugar-free) cranberry juice to be identical.

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