Research - Urinary Tract
Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection
- Kevin C Maki2,3,*,
- Kerrie L Kaspar4,
- Christina Khoo4,
- Linda H Derrig2,
- Arianne L Schild2, and
- Kalpana Gupta5,6
Background: Urinary tract infections (UTIs) are among the most common bacterial infections and are often treated with antibiotics. Concerns about multidrug-resistant uropathogens have pointed to the need for safe and effective UTI-prevention strategies such as cranberry consumption.
Objective: We assessed the effects of the consumption of a cranberry beverage on episodes of clinical UTIs.
Design: In this randomized, double-blind, placebo-controlled, multicenter clinical trial, women with a history of a recent UTI were assigned to consume one 240-mL serving of cranberry beverage/d (n = 185) or a placebo (n = 188) beverage for 24 wk. The primary outcome was the clinical UTI incidence density, which was defined as the total number of clinical UTI events (including multiple events per subject when applicable) per unit of observation time.
Results: The dates of the random assignment of the first subject and the last subject’s final visit were February 2013 and March 2015, respectively. The mean age was 40.9 y, and characteristics were similar in both groups. Compliance with study product consumption was 98%, and 86% of subjects completed the treatment period in both groups. There were 39 investigator-diagnosed episodes of clinical UTI in the cranberry group compared with 67 episodes in the placebo group (antibiotic use–adjusted incidence rate ratio: 0.61; 95% CI: 0.41, 0.91; P = 0.016). Clinical UTI with pyuria was also significantly reduced (incidence rate ratio: 0.63; 95% CI: 0.40, 0.97; P = 0.037). One clinical UTI event was prevented for every 3.2 woman-years (95% CI: 2.0, 13.1 woman-years) of the cranberry intervention. The time to UTI with culture positivity did not differ significantly between groups (HR: 0.97; 95% CI: 0.56, 1.67; P = 0.914).
Conclusion: The consumption of a cranberry juice beverage lowered the number of clinical UTI episodes in women with a recent history of UTI.
Source : American Journal of Clinical Nutrition
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The Effect of Seoritae Extract in Men with Mild to Moderate Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia
Woong Jin Bae,1,2 Hyo Jung Park,2 Hye Cheong Koo,3 Do Ram Kim,3 U-Syn Ha,2 Kang Sup Kim,2 Su Jin Kim,2 Hyuk Jin Cho,2 Sung Hoo Hong,2 Ji Youl Lee,2 Sung Yeoun Hwang,3 and Sae Woong Kim1,2
We evaluated the effects of Seoritae extract (SE) on mild to moderate lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Seventy-six subjects with mild to moderate LUTS suggestive of BPH were prospectively recruited from the urology outpatient clinic and assigned to either SE (4200 mg or 6 tablets 3 times a day) or matching placebo. The primary outcome variable, the International Prostatic Symptom Score (IPSS), was evaluated at baseline and at 4 and 12 weeks. Postvoid residual volume (PVR), maximum urine flow rate (Qmax), and prostate-specific antigen (PSA) levels were evaluated. IPSSs decreased significantly from baseline to 12 weeks within the SE group. Significant improvements in IPSS voiding scores at 4 and 12 weeks were also observed in the SE group compared to the placebo group. IPSS storage and quality of life scores were also significantly decreased at 12 weeks in the SE group. There was no change in Qmax or PVR in both groups after 12 weeks. Administration of SE for 12 weeks led to significant improvements in LUTS, and it can be concerned as a reasonable and safe alternative for men with mild to moderate LUTS.
Source : Evidence Based Complementary and Alternative Medicine
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Cranberry fruit powder (Flowens™) improves lower urinary tract symptoms in men: a double-blind, randomized, placebo-controlled study.
Vidlar A1, Student V Jr, Vostalova J, Fromentin E, Roller M, Simanek V, Student V.
BACKGROUND:Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia increase with age. To date, several medications are available to treat LUTS, including herbal remedies which offer less side effects but lack robust efficacy studies.
METHODS:This 6-month, randomized, double-blind, placebo-controlled study aimed at evaluating the dose effect of 250 or 500 mg cranberry powder (Flowens™) on LUTS and uroflowmetry in men over the age of 45. A total of 124 volunteers with PSA levels <2.5 ng/mL and an international prostate symptoms score (IPSS) score ≥8 were recruited and randomized. The primary outcome measure was the IPSS, evaluated at 3 and 6 months. Secondary outcome measures included quality of life, bladder volume (Vol), maximum urinary flow rate (Q max), average urinary flow rate (Q ave), ultrasound-estimated post-void residual urine volume (PVR), serum prostate-specific antigen, selenium, interleukin 6, and C-reactive protein at 6 months.
RESULTS:After 6 months, subjects in both Flowens™ groups had a lower IPSS (-3.1 and -4.1 in the 250- and 500-mg groups, p = 0.05 and p < 0.001, respectively) versus the placebo group (-1.5), and a dose-response effect was observed. There were significant differences in Q max, Qave, PVR, and Vol in the Flowens™ 500-mg group versus baseline (p < 0.05). A dose-dependent effect on Vol was observed, as well as on PVR, for participants with a nonzero PVR. There was no effect on clinical chemistry or hematology markers.
CONCLUSIONS:Flowens™ showed a clinically relevant, dose-dependent, and significant reduction in LUTS in men over 45.
Source : World J Urol.
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Evaluation of hydro-alcoholic extract of Dolichos biflorus seeds on inhibition of calcium oxalate crystallization
Sarmistha Saha∗, Ramtej J. Verma
Department of Zoology, University School of Sciences, Gujarat University, Ahmedabad 380009, India
To evaluate the effect of an extract obtained from Dolichos biflorus (Fabaceae) on calcium oxalate crystallization in vitro.
Materials and methods
A hydro-methanolic extract of (30:70, v/v) of D. biflorus seeds at different concentrations (1–10 mg/ml) was subjected to in vitro anticrystallization activity using a synthetic urine system. The results were compared with a parallel study conducted with the herbal medicinal product cystone under identical dosage conditions. The nucleation and aggregation of calcium oxalate crystals were measured using spectrophotometric methods and crystals generated in the urine were also analyzed by light microscopy. Statistical differences and percent inhibitions were calculated using GraphPad prism 5 software.
The seed extract was significantly more effective than cystone at inhibiting the nucleation, as well as the aggregation of calcium oxalate monohydrate crystals in a dose-dependent manner. These results were also confirmed by the microscopic analysis.
The results showed that the selected herb, D. biflorus has excellent anticrystallization activity and therefore, might be beneficial if used in formulating a strategy for the dissolution and thereby prevention of urinary stones.
Source : Journal of Herbal Medicine
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Monitoring in vitro antibacterial efficacy of 26 Indian spices against multidrug resistant urinary tract infecting bacteria
Sibanarayan Rath, Rabindra N. Padhy
Central Research Laboratory, Institute of Medical Sciences (IMS) & Sum Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India.
To screen methanolic extracts of 26 commonly used Indian spices against nine species of uropathogenic bacteria (Enterococcus faecalis, Staphylococcus aureus, Acinetobacter baumannii, Citrobacter freundii, Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa), isolated from clinical samples of a tertiary care hospital for antibacterial activity.
Bacterial strains were subjected to antibiotic sensitivity testing by Kirby–Bauer's disc diffusion method. Monitoring antibacterial potentiality of spice extracts was done by the agar-well diffusion method with multidrug resistant (MDR) strains of nine uropathogens.
The Gram-positive (GP) bacteria E. faecalis and S. aureus were resistant to 16 of the 21 antibiotics used. Among the Gram-negative (GN) bacteria, resistant patterns were A. baumannii and E. aerogenes to 12, C. freundii to 14, E. coli to 12, K. pneumoniae to 10, P. mirabilis to 11, and P. aeruginosa to 15 antibiotics of the 18 antibiotics used. The most effective 15 spices, having at least 25–29 mm as the size of the zone of inhibition, were Allium cepa, Brassica juncea, Cinnamomum tamala, Cinnamomum zeylanicum, Coriandrum sativum, Cuminum cyminum, Curcuma longa, Mentha spicata, Murraya koenigii, Nigella sativa, Papaver somniferum, Piper nigrum, S. aromaticum, Trachyspermum ammi, and Trigonella foenum for at least one of the GP or GN MDR bacterial strains used. Moderate control capacity was registered by nine spices, Curcuma amada, Foeniculum vulgare, Illicium verum, Mentha spicata, Papaver somniferum, Syzygium aromaticum, Trachyspermum ammi, Trigonella foenum, and Zingiber officinale. However, the best two spices for controlling all the pathogens used were C. zeylanicum and C. longa, with the highest value of 29 mm as the inhibition zone size.
The most effective and unique 16 spice plants recorded for the in vitro control of MDR uropathogens could further be pursued for the development of complementary and supplementary medicine against MDR bacteria.
Source : Integrative Medicine Research
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Cranberry Products Prevent Urinary Tract Infections in Women: Clinical Evidence
Michael Tempesta and Marilyn Barrett
Conclusion : Further studies are required to establish optimal daily dosing of the cranberry-derived total phenols/PACs for efficient prevention of recurrent UTIs. In vitro and ex vivo studies indicate that these compounds prevent adhesion of E. coli to the epithelium of the urinary tract and thus prevent infection. Although in vitro studies indicate a clear dose- response effect with PACs, the clinical picture may be more complicated. There may be interference by high- and low- molecular- weight sugars naturally present in cranberry, reducing the effect of the PACs in prevention of UTIs via this mechanism. Other phenolics, including the anthocyanins, may also play a role in the clinical benefits observed.
Source : Botanical Medicine from Bench to Bedside
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A randomised, double-blind, placebo-controlled trial of a herbal medicinal product containing Tropaeoli majoris herba (Nasturtium) and Armoraciae rusticanae radix (Horseradish) for the prophylactic treatment of patients with chronically recurrent lower urinary tract infections
Uwe Albrechta, Karl-Heinz Goosb and Berthold Schneiderc
aMediconomics GmbH, Hannover, Germany
bRepha GmbH, Biologische Arzneimittel, Langenhagen, GermanycInstitut für Biometrie, Medizinische Hochschule Hannover, Germany
ABSTRACT Objectives: The aim of this study was to verify the efficacy and safety of a herbal medicinal product containing Tropaeoli majoris herba and Armoraciae rusticanae radix in the prophylactic treatment of chronically recurrent urinary tract infections (UTIs), and to test whether the medicinal product decreases the incidence of relapses over the study period.
Methods: A total of 219 adults aged between 18 and 75 years were screened and 174 patients enrolled. Of these 174 patients, a group of 45 patients were screening failures. Patients were randomised to receive either the study drug or placebo twice daily for 90 days. A UTI is confirmed by defined symptoms together with a laboratory result. The diagnosis of a new episode of a recurrent UTI included urine analysis from a central laboratory. The primary efficacy criterion – the number of recurrent UTIs over the study period – was tested between the treatment groups.
Results: For the per-protocol population, the mean number of recurrent UTIs in the study period was 0.43 versus 0.77 for the placebo group. This result is statistically significant ( p = 0.035). A total of 36 patients in the test group and 37 patients in the placebo group reported adverse events. Two serious adverse events were reported in the placebo group and one serious adverse event in the treatment group (not associated with the study medication).
Conclusion: This randomised, double-blind, placebo-controlled trial demonstrates the efficacy and safety of the herbal medicinal product Angocin Anti-Infekt N* in the prophylactic treatment of chronically recurrent UTIs.
*Angocin Anti-Infekt N is a registered trade name of Repha GmbH, Langenhagen, Germany
Source : Informa Healthcare
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Complementary and Alternative Therapies as Treatment Approaches for Interstitial Cystitis
Kristene E Whitmore, MD
The management of interstitial cystitis (IC) is predominantly the reduction of the symptoms of frequency, urgency, and pain. Multimodal treatment approaches for IC are helpful in customizing therapy for individual patients. Complementary and alternative therapies are a quintessential addition to the therapeutic armamentarium and frequently include dietary modification, nutraceuticals, bladder training, neuromodulation, stress reduction, and sex therapy. Dietary modification involves elimination of bladder irritants, fluid regulation, and a bowel regimen. Nutraceuticals studied for the treatment of IC include calcium glycerophosphate, L-arginine, mucopolysaccharides, bioflavinoids, and Chinese herbs. Bladder training is effective after pain reduction. The neuromodulation of high-tone pelvic-floor muscle dysfunction is achieved with physical therapy and acupuncture. Stress reduction and sex therapy are best administered by a qualified stress manager and sex therapist. Multimodal, nonconventional management may add efficacy to the treatment of IC.
Complementary and alternative medicine therapy for IC is multimodal and individualized to each patient. Studies have described positive outcomes resulting from the use of dietary modification, nutraceuticals, bladder training, neuromodulation with physical therapy and home exercise programs, acupuncture, stress reduction, and sex therapy. There is a need for randomized, controlled trials utilizing CAM to establish the efficacy and reliability of different IC treatments. Optimal control of IC symptoms may also require stress management with a behavioral therapist to assure stable mental health during the early stages of therapy.
Source : Reviews in Urology
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Cranberry for UTI More Than Folk Remedy?
Drinking cranberry juice or taking cranberry capsules or tablets was associated with a protective effect against urinary tract infection, a systematic review found.
The pooled data from 10 studies comparing cranberry-product consumers against nonusers showed cranberry consumption had a risk ratio protective against UTI at 0.62 (95% CI 0.49 to 0.80), according to Chien-Chang Lee, MD, of the National Taiwan University Hospital, and colleagues.
A subgroup analysis found the cranberry products were more effective in women with recurrent UTI, female populations, children, regular cranberry juice drinkers, and those who used cranberry products more than twice daily, Lee and co-authors wrote in the July 9 issue of Archives of Internal Medicine.
"Cranberry-containing products have long been used as a folk remedy to prevent UTIs," the authors explained. Cranberry is thought to interfere with the attachment of bacteria to uroepithelial cells, potentially preventing infection.
The meta-analysis evaluated randomized controlled trials that compared the effectiveness of cranberry containing products, such as juices and pills, with placebo and non-placebo control groups at preventing UTIs. The review included data from 10 trials of 1,494 patients, with 794 in the cranberry group versus 700 in the control group.
In pooled trials, there was an association with protective effects for the cranberry group and significant heterogeneity between the trials (RR 0.68, 95% CI 0.47 to 1.00), but the results were nonsignificant, Lee and colleagues wrote.
They added that sensitivity analyses "showed that the protective effect of cranberry containing products was stronger in nonplacebo-controlled trials" and suggested that expectations of efficacy had an effect on outcomes.
When broken down by subgroup, there was a nonsignificant trend for protection in certain groups consuming cranberries, including:
- Women with recurrent UTI (RR 0.53, 95% CI 0.33 to 0.83)
- Female patients (RR 0.49, 95% CI 0.34 to 0.73)
- Children (RR 0.33, 95% CI 0.16 to 0.69)
- Cranberry juice drinkers (RR 0.47, 95% CI 0.30 to 0.72)
- Patients consuming cranberry products more than twice daily (RR 0.58, 95% CI 0.40 to 0.84)
However, the high sugar content in most cranberry drink products may cause gastrointestinal problems or raise concerns about sugar control in diabetic patients, the authors warned.
They concluded that although their meta-analysis showed an association between cranberry product consumption and protection against UTI, "this conclusion should be interpreted with great caution" due to the "substantial heterogeneity across trials."
The authors said that their review was limited by absent searches for conferences, proceedings, and clinical trial registries; inability to reach some study authors to acquire missing data; and missing proanthocyanidin content for cranberry products in several trials. Proanthocyanidins are compounds that may potentially inhibit the adherence of Escherichia coli to urological mucosa, they wrote.
Primary source: Archives of Internal Medicine
Lee CC, et al "Cranberry-containing products for prevention of urinary tract infections in susceptible populations" Arch Intern Med 2012; 172: 988-996.
Source : Medical News Today
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