Ideal treatment I.

Cystitis

Treatments and drugs Cystitis caused by bacterial infection is generally treated with antibiotics. Treatment for noninfectious cystitis depends on the underlying cause.

Treating bacterial cystitis Antibiotics are the first line of treatment for cystitis caused by bacteria. Which drugs are used and for how long depend on your overall health and the bacteria found in your urine. Usually symptoms improve significantly within a day or so of treatment. However, you'll likely need to take antibiotics for three days to a week, depending on the severity of your infection. No matter what the length of treatment, take the entire course of antibiotics prescribed by your doctor to ensure that the infection is completely eradicated. If you have recurrent UTIs, your doctor may recommend longer antibiotic treatment or refer you to a doctor who specializes in urinary tract disorders (urologist or nephrologist) for an evaluation, to see if urologic abnormalities may be causing the infections. For some women, taking a single dose of an antibiotic after sexual intercourse may be helpful. Hospital-acquired bladder infections can be a challenge to treat because bacteria found in hospitals are often resistant to the common types of antibiotics used to treat communityacquired bladder infections. For that reason, different types of antibiotics and different treatment approaches may be needed.

Treating interstitial cystitis With interstitial cystitis, the cause of inflammation is uncertain, so there's no single treatment that works best for every case. Therapies used to ease the signs and symptoms of interstitial cystitis include:

Medications that are taken orally or instilled directly into your bladder Procedures that manipulate your bladder to improve symptoms, such as bladder distention or, sometimes, surgery Nerve stimulation, which uses mild electrical pulses to relieve pelvic pain and, in some cases, reduce urinary frequency

Treating other forms of noninfectious cystitis If you're hypersensitive to certain chemicals in products such as bubble bath or spermicides, avoiding these products may help ease symptoms and help prevent further episodes of cystitis. Treatment of cystitis that develops as a complication of chemotherapy or radiation therapy focuses on pain management, usually with medications, and hydration to flush out bladder irritants. Most cases of chemotherapy-induced cystitis tend to resolve after the chemotherapy is finished. Cystitis can be painful, but you can take steps to ease your discomfort:

Use a heating pad. Sometimes a heating pad placed over your lower abdomen can help minimize feelings of bladder pressure or pain. Stay hydrated. Drink plenty of fluids, but avoid coffee, alcohol, soft drinks with caffeine, citrus juices and spicy foods until your infection has cleared. These items can irritate your bladder and aggravate your frequent or urgent need to urinate. Take a sitz bath. It may be helpful to soak in a bathtub of warm water (sitz bath) for 15 to 20 minutes.

If you have recurrent bladder infections, let your doctor know. Together, you can develop a strategy to reduce recurrences and the discomfort that cystitis can bring.
Laboratory examination Urinalysis When infection occurs, it shows bacteriuria, WBC (White Blood Cell), RBC (Red Blood Cell) and deposits of white blood cells with renal involvement. Sensitivity tests: a lot of microorganisms sensitive to antibiotics and antiseptic associated with recurrent infections Radiographic assessment Cystitis Diagnosis based on history, medical examination and laboratory, if there is urinary retention and urinary flow obstruction performed IPV (Identivikasi changes and structural abnormalities) Culture: Identifying the bacteria that causes X-ray kidney, ureter and bladder to identify the real structure of the anomaly.

Prevention Cranberry juice or tablets containing proanthocyanidin are the only home remedies proven to reduce your risk of recurrent bladder infections. However, don't drink cranberry juice if you're

taking the blood-thinning medication warfarin (Coumadin). Possible interactions between cranberry juice and warfarin can lead to bleeding. Although other preventive self-care steps have not been well studied, doctors routinely recommend the following for women who've had repeated bladder infections:

Drink plenty of liquids, especially water. Drinking lots of fluids is especially important if you're undergoing chemotherapy or radiation therapy, particularly on treatment days. Urinate frequently. If you feel the urge to urinate, don't delay using the toilet. Wipe from front to back after a bowel movement. This prevents bacteria in the anal region from spreading to the vagina and urethra. Take showers rather than tub baths. If you're susceptible to infections, showering rather than bathing may help prevent them. Gently wash the skin around the vagina and anus. Do this daily, but don't use harsh soaps or wash too vigorously. The delicate skin around these areas can become irritated. Empty your bladder as soon as possible after intercourse. Drink a full glass of water to help flush bacteria. Avoid using deodorant sprays or feminine products in the genital area. These products can irritate the urethra and bladder.

Treatment of Cystitis (UTI, Bladder Infection) Most organisms that cause cystitis are susceptible to commonly used antibiotics. Susceptibility of organisms varies by geographic region and is also based upon having a history of taking antibiotics in the pastBecause antibiotic sensitivities change so frequently, it is important to consult with a physician to determine the best one for any particular infection. Also, experts differ about how long individuals with cystitis need to take antibiotics. In otherwise healthy women with uncomplicated infections, a single-dose or 3-day course of antibiotics is sufficient and associated with far fewer side effects and lower costs than longer courses of treatment. Men may require 7 to 10 days of antibiotics because of involvement with the prostate. Children with uncomplicated cystitis usually receive a 10-day course of antibiotics. Some individuals are not good candidates for single-dose therapy. Patients should not be given single-dose therapy if they are pregnant, diabetic or elderly. Unsuspected upper urinary tract infection may be present in a significant number of these patients, and a 10- to 14-day course of antibiotics should be given. Ampicillin (Amcill, Omnipen, Polycillin, etc.) amoxicillin (Amoxil, Polymox, Trimox, etc.) and trimethoprim-sulfamethoxazole (Bactrim) have been the most extensively evaluated drugs for single-dose regimens. Three-day regimens of trimethoprim-sulfamethoxazole, norfloxacin (Noroxin) and other fluoroquinolones also work and the incidence of side effects is as low as with single-dose treatment. Data on this duration of treatment is not sufficient to permit definite recommendations, but three-day regimens appear promising. As with single-dose therapy, candidates for three-day therapy must be carefully chosen to exclude those with a high probability of an upper tract infection.

Phenazopyridine (Pyridium) can be prescribed for 1-2 days if urination is very painful. Prevention of Cystitis (UTI, Bladder Infection) To help prevent cystitis, a woman should:

Keep the vaginal area clean, including wiping from the front to back after a bowel movement to prevent contamination of the urinary tract. Use tampons and change every three to four hours, instead of sanitary pads. (The pads can act as a culture medium for fecal bacteria, which may then be rubbed against the urinary outlet and invade the bladder.) Wear cotton undergarments, which allow air circulation and discourage the warm, moist environment needed for bacteria growth. Nylon pantyhose should have a cotton crotch. Avoid wearing tight clothes in the genital area, such as control-top pantyhose and skintight jeans, as well as extended wearing of a wet bathing suit. Urinate before and after intercourse and make sure that the partner's hands and penis are clean. Drink plenty of fluids (cranberry juice has been shown to help prevent urinary tract infections.) Urinate "when you see a bathroom" rather than when the urge to urinate becomes strong.

Cystolithiasis Diagnosis The diagnosis of bladder stone includes urinalysis, ultrasonography, x rays or cystoscopy (inserting a small thin camera into the urethra and viewing the bladder). The intravenous pyelogram can also be used to assess the presence of kidney stones. This test involves injecting a radiocontrast agent which is passed into the urinary system. X-ray images are then obtained every few minutes to determine if there is any obstruction to the contrast as it is excreted into the bladder. Today, intravenous pyelogram has been replaced at many health centers by CT scans. CT scans are more sensitive and can identify very small stones not seen by other tests. How are they diagnosed? Many tests can be used to identify what's causing someone's symptoms and whether a stone is present within the bladder. These include urine tests, blood tests, x-rays and ultrasound scans. A special type of test called intravenous urography is often used and provides a picture of the kidneys, ureters and bladder. This allows any stones and their location to be identified. Prevention The best way to prevent bladder stones is to drink plenty of liquids. Juices containing citrates are thought to reduce the risk of stone formation. A study published in the Clinical Journal of the American Society of Nephrology indicate orange juice is more effective at preventing stone formation than other citrus juices.[9] Men who have difficulty with urination due to prostatic hypertrophy should seek treatment.

Management Increasing fluid intake can facilitate the passage of small bladder stones. However, larger stones may require other methods of treatment.[11] Fragmentation of bladder stones can be achieved by use of a cystoscope which is inserted into the bladder. The urologist visualizes the stone and uses ultrasonic energy or laser lithotripsy to to cause fragmentation of the stones into small pieces which are then flushed out of the bladder. This procedure requires anesthesia and may require admission to a hospital. Complications of this treatment include infection and damage to the bladder.[12] Some stones are too large even for cystoscopic treatment and may require open cystotomy, in which an incision is made in the bladder and the stones are removed manually. What's the treatment? Sometimes cystoscopy is performed to examine the inside of the bladder. During this process a fibre-optic camera, called a cystoscope, is inserted into the bladder via the urethra. Any bladder stones can usually be broken up during this procedure, and then washed out. Stones can also be broken up into pieces small enough to allow them to pass out in the urine using a special type of ultrasound called lithotripsy. If the stones are too large to be removed by these methods, surgical removal becomes necessary. Since bladder stones can often recur, it's important to reduce the chances of this happening. This means drinking plenty of fluid every day, and ensuring that any underlying medical conditions, such as gout, are treated appropriately. II. Benign Prostatic Hyperplasia Treatment Options Minor symptoms of BPH usually do not require treatment, while moderate to severe symptoms will interfere with sleep and daily activities. Treatment is then usually recommended. Until recently, the only options were daily drug therapy or major surgery. Both treatments can have undesirable side effects and serious risks to the patient. With the development of minimally invasive therapies, patients now have a selection of treatment choices to better meet their lifestyle and health needs. Treatment choices include:

Drug Therapy Radio frequency (TUNA) Laser coagulation (ILC) Microwave therapy (TUMT) Surgery (TURP)

It is important for you to know your treatment options and the risks and benefits associated with each treatment. An informed patient makes the best decision.

Drug Therapy There are two classifications of drugs which are commonly prescribed: hormone suppressors and alpha blockers. Proscar (finasteride) inhibits production of the hormone that is involved with prostate enlargement. Its use can actually shrink the prostate in some men. Hytrin (terazosin), Cardura (doxazosin), and Flomax (tamsulosin) all act by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and to reduce bladder obstruction. Side effects can include impotence, dizziness, headaches and fatigue. Additionally, the body sometimes becomes resistant to the drugs and they lose effectiveness over time. Most recently herbal (plant) extracts, such as saw palmetto, have been used to relieve BPH symptoms. Although the clinical data is limited, these agents may produce small degrees of improvement, but they do not reduce the size of the prostate. Additionally, these agents may reduce PSA levels, important indicators within the body which may indicate the presence of cancer.

Minimally Invasive Treatments Minimally invasive alternatives provide safe and effective treatment while avoiding the risks and complications associated with surgery. They include radio frequency thermotherapy (TUNA), laser coagulation surgery (ILC), and microwave thermotherapy (TUMT). TUNA - TransUrethral Needle Ablation The TUNA procedure delivers low level radio frequency (RF) energy to the prostate, relieving obstruction without causing damage to the urethra. A small catheter is inserted through the urethra and into the prostate. Two small electrodes are deployed and using a computerized generator to monitor temperature and treatment zones, RF energy is emitted, causing the prostate tissue to shrink, thereby relieving the obstruction while protecting the urethra and surrounding areas. The TUNA procedure can be performed in an office or hospital outpatient center in less than 1 hour using minimal anesthesia. Catheterization is needed in about 40% of the patients--on average less than 2 days. Most patients are able to return to their normal activities within 24 hours. There are minimal side effects, including few reports of sexual dysfunction. The TUNA procedure is reimbursed by Medicare in most states as well as by many private pay and managed care insurance companies. Interstitial Laser Coagulation - ILC ILC uses laser energy to coagulate excess tissue of the prostate. This targeted heating produces coagulative tissue necrosis, with the tissue resorption occurring gradually over time, reducing obstruction. The laser energy is delivered consistently through interstitial tissue with a diffusing tip fiber optic, reducing the risk of damage to adjacent structures. The procedure can be performed in less than 1 hour in a hospital outpatient center using a variety of anesthesia types. In the clinical trials sponsored by Indigo Medical, 83% of the patients required general or spinal anesthesia. Because of the edema caused by the procedure,

catheterization is highly recommended, with most patients averaging 7-14 days. Procedure risks include urinary tract infections, retention, incontinence, and retrograde ejaculation. Transurethral MicrowaveTherapy - TUMT TUMT uses high temperatures to heat and destroy the prostate tissue, with cooling to keep adjacent healthy tissue intact. Microwave energy is delivered through a soft probe, resulting in destruction of diseased tissue and a reduction in BPH symptoms. TUMT can be performed in a hospital outpatient center in over 1 hour and requires minimal anesthesia. Catheterization time ranges from 2-5 days and may result in urinary tract infections. Risks and complications include retrograde ejaculation, urethral strictures, urinary retention, and incontinence. Surgery TransUrethral Resection of the Prostate - TURP TURP is an invasive surgical procedure that has been in practice for more than fifty years. TURP has been considered the "gold standard" of treatment, to which alternative therapies are compared. This procedure usually takes about 1 hour. A cutting loop is used to remove the obstructing tissue. Each year, fewer TURPs are performed, as less invasive technologies emerge. As with any surgery, there is risk involved. Not all patients are surgical candidates, the procedure is costly, and generally requires a patient to remain hospitalized for 1-4 days. General or spinal anesthesia is required, and recovery can take 4-6 weeks. Complications and risks include excessive blood loss, impotence, retrograde ejaculation, incontinence, and infection.

Choosing a Treatment Plan Choosing the right treatment to relieve BPH symptoms is a personal preference. Each treatment may improve symptoms, but each has different risks, complications, and chances of success. It is important to evaluate your symptoms, your treatment choices, and the impact of each on your lifestyle. You should discuss your symptoms and treatment concerns with your doctor.