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Interventions of acute and chronic pain treatment are associated with risks. Therefore, it is important to know about treatment side effects in order to avoid unnecessary complications and therapy interruption. This knowledge, however, is not to prevent/abandon this treatment altogether. Rather, it is intended to use pain treatment interventions rationally. The following article is to deepen the knowledge of unintended effects of analgetic treatments. Moreover, it will help find an optimal pain therapy in terms of efficacy and tolerable risks as well as limitations. Nonopiates have organ toxic side effects. It is imperative to observe the maximum daily dose and comorbidity. Opioids can have either central or peripheral side effects. Patients suffer, among others, from addiction, breath depression, and tolerance as well as from obstipation, concentration disorders, and an increased risk of falling. Psychiatric drugs, corticosteroids, ketamine, bisphosphonates, and lidocaine are co-analgetics. Besides adverse effects connected to their specific substances, these drugs have partially additive effects on complications of classic analgetics (e. g., gastrointestinal ulceration, renal insufficiency, constipation, and concentration deficits). Invasive procedures (such as epidural catheter) call for an interdisciplinary collaboration. To know about unintended effects helps to avoid dramatic complications (e. g., paraplegia). A sufficient pain therapy, therefore, is more than sufficient analgesia. It also includes the reduction of side effects and complications.

A number of drugs prescribed for the treatment of various diseases can induce urological symptoms as side effects. Antihypertensive drugs (particularly alpha blockers) can result in stress incontinence, whereas selective serotonin reuptake inhibitors (SSRI) can cause urge incontinence and estrogen promotes both forms. A wide range of drugs with anticholinergic activity, among them neuroleptics, tricyclic antidepressants and certain drugs used in airway disorders are associated with urinary retention. Only very few drugs bear a relevant risk for urolithiasis, i. e. the diuretic triamterene and protease inhibitors, such as indinavir; however, the widely used combination of calcium and vitamin D supplementation for prevention of osteoporosis may be an underdiagnosed cause of renal calculi. Drug-induced sexual dysfunction is a frequent side effect of antihypertensive treatment, particularly with beta adrenoceptor blockers and diuretics. The SSRI and some neuroleptics can also impair sexual function.

Despite modern diagnostic investigations, pyogenic infections of the spine are often detected late and are therefore associated with a high lethality. To ensure efficient and adequate therapy, it is necessary to identify and treat the focus of the inflammation. Urogenic spinal infections are often underestimated in their frequency of occurrence and severity of symptoms. From 1994 to 2006, 209 patients suffering a spinal infection were treated in the Department of Orthopedic Surgery. In 13 of them (6.2%), a urogenital inflammation caused the spondylodiscitis. In the context of a retrospective clinical trial, we investigated the risk factors, clinical aspects, and therapeutic consequences of patients with urogenic spinal infections and those with another genesis. The two data sets were compared, and therapeutic differences were extracted.

Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, better known as statins, may be associated with reduced prostate cancer risk. Statins have been reported to demonstrate chemopreventive potentials in prostate cancer cell lines, but the association in observational studies has been inconclusive.Probiotics, defined as live microbial food supplements, have been tested for an impact on a variety of clinical conditions, e.g., urinary tract infections and calcium oxalate stone disease. Furthermore, oral administration of a lactic acid bacterium was effective against experimentally induced bladder tumors. Relationships between cancer and intake of probiotics have mainly been studied in bladder and colon cancer.

Prevention and health promotion are interventions which achieve compression of morbidity. This is well-advised from the viewpoints of both health economics and quality of life in an aging society. Only when preventive and health-promoting strategies have become a matter of course in the health care system can the challenges posed by the altered disease spectrum be met. Because of the frequency of age-associated diseases encountered in urological practice and the considerable influence it wields on quality of life, urology is a focus of attention. Prevention and health counseling will prove to be major tasks in the practice of urology, especially in the private sector. Viewed systematically, primary prevention is more medical and individual in character while health promotion is an aspect of health science geared toward a specific echelon or group. The mission of health policy and medical associations must be to design and evaluate programs for prevention and health promotion. This is uncharted territory for urology. Economic aspects specific to professional groups should not constitute the sole center of attention, even though these interests are legitimate. It is essential that the approach to primary prevention efforts be directed at specific echelons and groups to also reach fringe groups and socially weak groups in the population.

For decades, plant extracts have been amongst to the most popular drugs for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH)/benign prostatic enlargement (BPE). Only a few of the many published studies meet the criteria of the WHO-BPH consensus conference. The few placebo-controlled, long-term (>/=6 months) studies suggest a positive effect of some extracts (saw palmetto, beta-sitosterol, urtica, rye-grass, saw palmetto/urtica combination) on LUTS; an effect on uroflow, post-void residual volume, prostate volume and PSA was not consistently demonstrable. Randomised trials against an active comparator (alpha1-blocker, 5alpha-reductase inhibitors) are difficult to interpret. Due to the lack of prospective studies, several meta-analyses have been published that can not, however, replace prospective studies. None of the BPH-guidelines currently recommend plant extracts, yet universally conclude that this is an interesting approach. Further prospective studies using WHO standards are required to reliably determine the role of such extracts in the management of elderly men with LUTS due to BPH/BPE.

In order to evaluate the preventive efficacy, safety and usefulness of mesna (Sodium 2-mercaptoethane sulfonate) against ifosfamide-induced urinary disorders, a placebo-controlled double-blind comparative study was performed. Ifosfamide was administered by intravenous drip infusion at a daily dose of 2 g/m2 for 5 consecutive days, and mesna was intravenously administered at 20% of the ifosfamide dose, three times daily for 5 consecutive days. The results obtained are as follows. (a) Of 101 accrued patients, 91 patients were evaluated consisting of 45 for the mesna group and 46 for the placebo group. There was no intergroup difference in the number of the evaluated cases and patient characteristics. (b) Micturition pain and feeling of residual urine graded as moderate or severe were not observed for the mesna group, but were observed for the placebo group with incidences of 19.6% (9/46) for micturition pain and 15.2% (7/46) for feeling of residual urine; the intergroup differences in the appearance of these urinary symptoms were statistically significant (P = 0.0003 for micturition pain; P = 0.0009 for feeling of residual urine). The incidence of hematuria graded as moderate or severe was 6.7% (3/45) in the mesna group, which was significantly lower than the 32.6% (15/46) in the placebo group (P = 0.0008). (c) No side-effect attributable to mesna was observed. (d) A judgment of "useful" was obtained in 80.0% (36/45) of the patients treated with mesna, which was significantly higher than the 34.8% (16/46) of the patients treated with placebo (P = near 0). On the basis of the above results, we conclude that the preventive efficacy, safety and usefulness of mesna against ifosfamide-induced urinary disorders have been well demonstrated in this study.