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Introduction and hypothesis This pilot study compares protein expression patterns in the pubocervical fascia of women with pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and asymptomatic women with normal pelvic support methods Samples of pubocervical fascia were collected from four women with POP and SUI and from three asymptomatic (control) women These were analyzed using two-dimensional electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Results The expression levels of transgelin, smooth muscle gamma-actin, myosin light polypeptide 6, and alpha-1 antitrypsin precursor were more than twofold higher in patients than in controls An additional five proteins were overexpressed (more than twofold) in patients, while three proteins were detected only in the patients. Conclusion This pilot study is the first study to estimate changes in protein expression in the pubocervical fascia of human patients with POP. These changes could be related to the pathophysiology of POP

Cystitis is a common infection. The alarmingly high resistance rates exhibited by contemporary uropathogens necessitate the re-evaluation of old antibiotics. To evaluate the effectiveness and safety of fosfomycin compared with other antibiotics for the treatment of patients with cystitis. We performed a meta-analysis of randomized controlled trials (RCTs), generated from searches performed in PubMed, Scopus and Cochrane CENTRAL, which involved patients with cystitis treated with fosfomycin versus other antibiotics. Twenty-seven trials (eight double-blind) were included. Sixteen of these 27 trials involved exclusively non-pregnant female patients, 3 involved adult mixed populations of older age, 5 involved pregnant patients and 3 involved paediatric patients. Regarding clinical success, no difference was found in the comprehensive analysis regarding all comparators combined [10 RCTs, 1657 patients, risk ratio (RR) = 1.00, 95% confidence interval (CI) = 0.98-1.03] in trials involving non-pregnant females and in trials involving mixed populations. Insufficient relevant data were provided from trials involving paediatric and pregnant patients. No difference between fosfomycin and comparators was also found in all comparisons regarding the remaining effectiveness outcomes (namely microbiological success/relapse/re-infection). Fosfomycin had a comparable safety profile with the evaluated comparators in non-pregnant women, mixed and paediatric populations, whereas it was associated with significantly fewer adverse events in pregnant women (4 RCTs, 507 patients, RR = 0.35, 95% CI = 0.12-0.97). In the era of high drug resistance rates, reported even among community-acquired uropathogens, fosfomycin may provide a valuable alternative option for the treatment of cystitis in non-pregnant and pregnant women and in elderly and paediatric patients.

We searched PubMed, Scopus, Web of Science, LILACS, EMBASE, and Cochrane Library databases to assess the effectiveness and safety of 5% imiquimod cream in the treatment of vulvar and vaginal. intraepithetial neoplasia. From the results of the 17 relevant articles identified (1 reported on a randomized controlled trial, 10 reported on case series, and 6 were case reports), 26% to 100% of patients had complete regression, 0% to 60% had partial regression, and 0% to 37% experienced recurrence. The most common adverse events were local burning and soreness, but not severe enough for patients to discontinue treatment. From these reports imiquimod treatment leads to complete response in a considerable percentage of patients, and those who experience partial response will require less extensive excision. Treating vulvar and vaginal intraepithelial neoplasia with 5% imiquimod cream therefore appears to be promising. (C) 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Background: Despite the high incidence of acute pyelonephritis in the community setting, there is no consensus on the optimal duration of treatment. A potential reduction in the duration of the administered antibiotic regimens could contribute to avoiding further development of antimicrobial resistance. Objective: The aim of this meta-analysis was to compare short-course (7- to 14-day) with long-course (14-to 42-day) treatment with the same antibiotic regimens, in terms of the effectiveness and tolerability, in acute pyelonephritis. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials, and SCOPUS (January 1966-March 2008) to identify and extract data from randomized controlled trials (RCTs) comparing the effectiveness and toxicity of short- versus long-course regimens. Additionally, references of studies were searched. A publication was included if: it was an RCT; involved adult and/or adolescent patients with acute pyelonephritis; compared regimens with the same antibiotic, at the same daily dosage, that were administered for differing durations (a short course and a long course [ie, no absolute time cutoff (in days) was employed; rather, the duration of one regimen compared with another defined short- vs long-course]); and reported data regarding clinical success, bacteriologic efficacy, relapses, recurrences, and adverse events and/or patient withdrawals due to adverse events. Trials with a mixed population, including patients with acute pyelonephritis as a subset, were also included in the meta-analysis. Efficacy was assessed by evaluating clinical success, defined as resolution of symptoms and signs at the test-of-cure visit, and bacteriologic efficacy, defined as yielding sterile urine cultures or positive cultures with

Background: Acute pyelonephritis is a common infection with significant morbidity and mortality, particularly in pediatric populations. Early-switch strategies (from intravenous to oral treatment) may be an acceptable or even preferred option in the treatment of patients with acute pyelonephritis in terms of effectiveness and safety and can also reduce the economical burden associated with pyelonephritis. Objective: We sought to evaluate the effectiveness and safety of early-switch strategies in hospitalized patients with acute uncomplicated pyelonephritis. Methods: We searched in PubMed, Cochrane Central Register of Controlled Trials, and Scopus to identify randomized controlled trials (RCTs) that compared intravenous antibiotic regimens to regimens including an early switch to oral (after initial intravenous) treatment. Results: Eight RCTs (6 in children) were eligible for inclusion. In 5 RCTs the intravenous antibiotic treatment arms were not switched to oral treatment until the end of the study while in the remaining 3 RCTs the intravenous arms were switched late to oral treatment (after 5-10 days). Data regarding the incidence of renal scars, microbiological eradication, clinical cure, reinfection, persistence of acute pyelonephritis, and adverse events were provided in 4 (all pediatric trials), 6 (4 pediatric), 4 (2 pediatric), 5 (3 pediatric), 3 (1 pediatric), and 5 RCTs (3 pediatric), respectively. There were no differences regarding the above outcomes between the two compared treatment regimens in either pediatric or adult populations. Conclusion: Early switch to oral antibiotic strategies seem to be as effective and safe as intravenous regimens for the treatment of hospitalized patients with acute pyelonephritis. These findings suggest that there is probably a potential to decrease the duration of intravenous treatment by 4-11 days in hospitalized patients with acute pyelonephritis without compromising their outcomes.

We evaluated the prevalence of urinary tract infection (UTI) after pelvic floor operations for non-malignant etiology and the effectiveness of antibiotic prophylaxis. This was made possible by a review of the evidence from relevant randomized controlled trials (RCTs). Nineteen out of 879 initially identified studies met the criteria for inclusion in our review. Four RCTs compared an antibiotic prophylactic regimen with placebo, 11 two different prophylactic antibiotic regimens, and four had three different treatment arms. Among placebo recipients undergoing pelvic floor surgery, 10-64% developed UTI. In contrast, UTI after pelvic floor gynecological surgery occurred in 0-15% of the patients who received cephalosporins as antibiotic prophylaxis; the likelihood for postoperative UTI was higher for patients receiving cotrimoxazole (28%), ampicillin/sulbactam (13.6%), metronidazole plus ampicillin (20%), metronidazole (10-22.7%), or ciprofloxacin (27.2%). The use of a cephalosporin as perioperative antimicrobial prophylaxis is the optimal regimen in preventing UTIs after pelvic floor surgery.

Objectives: Hyaluronic acid is a protective barrier of the urothelium. A damaged glycosaminoglycan layer may increase the possibility of bacterial adherence and infection. This damage is proposed to be a causative factor in the development of interstitial cystitis, common urinary tract infections, and hemorrhagic cystitis due to posthematopoietic stem cell transplantation. The aim of this article was to review the available data regarding the use of hyaluronic acid as an alternative treatment of the above-mentioned conditions. Methods: Articles relevant to our review that were archived by September 2006 were retrieved from PubMed. Results: Nine relevant studies were identified and evaluated. Hyaluronic acid was administered intravesically at a dose of 40 mg every week for 4-6 wk; patients with noted improvement received two additional monthly doses. Short-term responses of patients with interstitial cystitis, hemorrhagic cystitis, and recurrent urinary tract infections were 30-73% (7 studies), 71% (1 study), and 100% (1 study), respectively. The treatment was well tolerated except for occasional development of bacterial cystitis. The cost of each intravesical installation of hyaluronic acid is 120 UK pounds (excluding the cost of the urinary catheterization). Conclusions: The available clinical data regarding the effectiveness of hyaluronic acid as a potential treatment of patients with interstitial cystitis, recurrent urinary tract infections, and hemorrhagic cystitis are limited. There is need for randomized controlled trials for further investigation of this important therapeutics question; these clinical trials should be disease-specific, blinded, and controlled, and of a sufficient number of patients. Until such studies are available, intravesical instillation of hyaluronic acid cannot be unquestionably endorsed for use for the aforementioned diseases. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Antibiotics, heparin, and several surgical interventions have been used in various combinations for the treatment of septic thrombophlebitis, but the optimal management remains unclear. There are limited data from comparative trials studying this issue. Specifically, only one randomized controlled trial was conducted, while the rest of the evidence comes from case series and case reports. The results of this systematic review of septic thrombophlebitis suggest that the use of heparin in combination with antibiotics is associated with low mortality in patients with this serious type of infection. In addition, adverse effects related to heparin were limited in the reported literature. Although data from comparative trials are required to draw definitive conclusions, the available evidence suggests that the administration of heparin should be considered early in the management of patients with septic thrombophlebitis. (c) 2006 Published by Elsevier B.V.

This review aimed to compare data regarding the effectiveness and safety of azithromycin with alternative regimens in the treatment of pregnant women with Chlamydia trachomatis infection. PubMed and Scopus databases were searched to identify relevant randomised controlled trials (RCTs). The main analysis focused on comparison of azithromycin with erythromycin. In a secondary analysis, azithromycin was compared with erythromycin or amoxicillin. Eight RCTs studying 587 pregnant women with microbiologically documented C. trachomatis infection were included in the meta-analysis. Overall, there was no difference between azithromycin and erythromycin regarding treatment success in intention-to-treat patients (pooled odds ratio (OR)=2.66, 95% confidence interval (CI) 0.69-10.29) or in clinically evaluated patients (OR = 1.46, 95% CI 0.56-3.78). Furthermore, azithromycin was associated with fewer gastrointestinal adverse events (OR = 0.11, 95% CI 0.07-0.18), fewer total adverse events (OR = 0.11, 95% CI 0.07-0.18), a smaller proportion of patients who withdrew from the study (OR = 0.12, 95% CI 0.04-0.37) and better compliance (OR = 23.7, 95% CI 9.34-60.14) than erythromycin. The results of the secondary analysis comparing azithromycin with erythromycin or amoxicillin were similar to those of the main analysis. In conclusion, azithromycin was associated with similar effectiveness but less adverse events compared with erythromycin or amoxicillin in the treatment of pregnant women with C trachomatis infection. (C) 2007 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Objectives. To evaluate the association of various clinical and urodynamic variables with history of urinary tract infections ( UTIs) in women. Methods. A prospective study of 2,081 women referred to a urogynecologic clinic between June 2000 and November 2005 for investigation of lower urinary tract symptoms. Results. 144 women reported history of UTI( s) within the last year from the visit to the clinic, and 91 had recurrent episodes (>= 3 per year). The multivariable analysis showed that urge incontinence ( odds ratio ( OR) = 2.23, 95% confidence interval ( CI): 1.46 - 3.42), suprapubic pain ( OR = 4.12, 95% CI: 2.21 - 7.67), and low maximum flow rate during voiding cystometry ( OR = 0.96, 95% CI: 0.94 - 0.98) were associated with UTIs. Conclusions. Our results suggest that urodynamic testing does not help in identifying specific urogynecologic mechanisms that could improve medical and/or surgical management or prevent recurrent UTI.

The use of vaginal meshes has been an advance in the surgical management of women with pelvic organ prolapse. We reviewed the literature to synthesize the evidence regarding the infectious complications related to this new type of foreign body. We searched PubMed, current contents, and references of initially identified relevant articles and extracted data regarding the incidence, clinical manifestation, and management of vaginal mesh-related infections. The incidence of mesh-related infections and erosion ranged from 0 to 8%, and 0 to 33%, respectively, in the published studies. Various factors influence the development of vaginal mesh-related infectious complications such as the kind of biomedical material (e.g. filament structure, pore size) of the mesh, the type of procedure, the preventive measures taken, and the age and underlying comorbidity of the treated women. Non-specific pelvic pain, persistent vaginal discharge or bleeding, dyspareunia, and urinary or faecal incontinence are the most common manifestation of vaginal mesh-related infection. Clinical examination may reveal induration of the vaginal incision, vaginal granulation tissue, draining sinus tracts, and prosthesis erosion or rejection. Various pathogens have been implicated, including Gram-positive and Gram-negative aerobic and anaerobic bacteria. The management of mesh-related infections in women who underwent pelvic organ reconstruction is combined surgical and medical treatment. Although the use of vaginal meshes has become a new effective method of pelvic organ prolapse surgery clinicians should be aware of the various post-operative complications, including mesh-related infections. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

We present a case of a 29-y-old woman with rectocele, cystocele, and uterine prolapse who developed a vaginal infection after the placement of a macroporous polypropylene vaginal mesh. Bacteroides melaninogenicus was isolated from the area of the infection. The exposed parts of the mesh were removed and she received treatment with metronidazole and doxycycline. No recurrence of the infection was noted during 12 months of follow-up. However, the patient continued to avoid intercourse due to severe dyspareunia. Vaginal mesh-related infections represent an emerging type of infection that may complicate reconstructive surgery in patients with pelvic organ prolapse.

Recurrent urinary tract infections (UTIs) afflict a great number of women around the world. The use of probiotics, especially lactobacilli, has been considered for the prevention of UTIs. Since lactobacilli dominate the urogenital flora of healthy premenopausal women, it has been suggested that restoration of the urogenital flora, which is dominated by uropathogens, with lactobacilli may protect against UTIs. This review is based on a search of PubMed for relevant articles. Many in vitro studies, animal experiments, microbiological studies in healthy women, and clinical trials in women with UTIs have been carried out to assess the effectiveness and safety of probiotics for prophylaxis against uropathogens. Most of them had encouraging findings for some specific strains of lactobacilli. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 (previously called L fermentum RC-14) seemed to be the most effective among the studied lactobacilli for the prevention of UTIs. L. casei shirota and L crispatus CTV-05 have also shown efficacy in some studies. L. rhamnosus GG did not appear to be quite as effective in the prevention of UTIs. The evidence from the available studies suggests that probiotics can be beneficial for preventing recurrent UTIs in women; they also have a good safety profile. However, further research is needed to confirm these results before the widespread use of probiotics for this indication can be recommended.

Vulvovaginal candidiasis (VVC) is a common infection affecting the quality of life of many women. Probiotics havebeen investigated as possible agents for the prevention of recurrences of VVC. We reviewed the available literature. In some studies the development of VVC was associated with either a low number of lactobacilli in the vagina or with the presence of H2O2-non-producing vaginal lactobacilli, although there are a few studies not supporting these statements. In addition, in vitro studies have shown that lactobacilli can inhibit the growth of Candida albicans and/or its adherence on the vaginal epithelium. The results of some clinical trials support the effectiveness of lactobacilli, especially Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14, administered either orally or intravaginally in colonizing the vagina and/or preventing the colonization and infection of the vagina by C. albicans, while the results of a small number of clinical trials do not corroborate these findings. Nevertheless, most of the relevant clinical trials had methodological problems such as small sample size, no control group (placebo) and included women without confirmed recurrent VVC, and thus they are not reliable for drawing definitive conclusions. Thus, the available evidence for the use of probiotics for prevention of recurrent VVC is limited. However, the empirical use of probiotics may be considered in women with frequent recurrence of VVC (more than three episodes per year), especially for those who have adverse effects from or contraindications for the use of antifungal agents, since adverse effects of probiotics are very rare. In any case women should be clearly informed about the unproven usefulness of probiotics for this purpose. In conclusion, despite the promising results of some studies, further research is needed to prove the effectiveness of probiotics in preventing the recurrences of VVC and to allow their wide use for this indication.