- Email: [email protected]
Oral urea treatment of hematuria in sickle-cell trait
production of hypertension and cholesterol.
and increased
blood lipids
A Controlled Study of Antimicrobial Prophylaxis of Recurrent Urinary Infection in Women, G. K. M. Harding and A. R. Ronald (291: 597, 1974) - Forty women and girls with frequent documented recurrent urinary tract infections were studied for recurrence during therapy with three different sequential drug regimens as well as during a control period without therapy. Twenty-seven adult women received sulfamethoxazole, 500 mg. daily, methenamine mandelate, 500 mg. four times a day with ascorbic acid, 500 mg. four times a day, and trimethoprim 40 mg. in combination with 200 mg. sulfamethoxazole daily, each drug regimen for a three-month period. Thirteen girls received half the adult doses of each regimen. In addition, a fourth three-month period on no therapy served as a control. Cultures were obtained at monthly intervals and at the onset of symptoms with infection defined as bacteriuria ofgreater than lo5 organisms per milliliter of urine. Sixty-nine infections occurred in the 40 women during the one-year course of study. In sixty-six of the sixty-nine infections the predominant organism isolated from periurethral swab specimens was the same as that in the urine. There was only one infection during low dose trimethoprim-sulfamethoxazole therapy for an over-all incidence of 0.1 infection per patient-year. This comlyared with 3.4 on no drug, 2.5 on sulfa alone, and 1.6 on methenamine mandelate. The trimethoprim-sulfamethoxazole combination prophylasis thus pro\cd significantly better than
UROLOCY
/ MARCH 1975 / VOLUME
V, NUMBER
3
either sulfa or methenamine ma&elate preventing recurrent bacteriuria.
NEW OF
YORK
STATE
alone
in
JOURNAL
MEDICINE
by A. Thomas,
M.D.
Oral Urea Treatment of Hematuria in Sickle-Cell Trait, S. Pariser (74: 2238, 1974) - This preliminary paper and case reports suggesting urea therapy for hematuria associated with sickling traits is of interest to the practicing urologist because of the uncertainty of past therapy. The author administered 160 Gm. of urea in divided doses to 2 patients with hematuria secondary to the sickling disorder, refractory to other therapy, with prompt resolution of the bleeding. Urea therapy was based on earlier favorable therapeutic results reported with SS sickle-cell disease; and although no firm conclusions were reached on the basis of only 2 cases, the cessation of hematuria which followed the administration of oral urea on these occasions suggests the urgent need for a larger controlled study. According to the author, urea in sugar solutions has been shown to block the sickling phenomenon reversibly by means of interference between interacting molecules of hemoglobin S. The major danger is the potential increase of dehydration in individuals already dehydrated because of massive diuresis. Careful monitoring to insure adequate hydration is mandatory if such therapy is to be safe.
and increased
blood lipids
A Controlled Study of Antimicrobial Prophylaxis of Recurrent Urinary Infection in Women, G. K. M. Harding and A. R. Ronald (291: 597, 1974) - Forty women and girls with frequent documented recurrent urinary tract infections were studied for recurrence during therapy with three different sequential drug regimens as well as during a control period without therapy. Twenty-seven adult women received sulfamethoxazole, 500 mg. daily, methenamine mandelate, 500 mg. four times a day with ascorbic acid, 500 mg. four times a day, and trimethoprim 40 mg. in combination with 200 mg. sulfamethoxazole daily, each drug regimen for a three-month period. Thirteen girls received half the adult doses of each regimen. In addition, a fourth three-month period on no therapy served as a control. Cultures were obtained at monthly intervals and at the onset of symptoms with infection defined as bacteriuria ofgreater than lo5 organisms per milliliter of urine. Sixty-nine infections occurred in the 40 women during the one-year course of study. In sixty-six of the sixty-nine infections the predominant organism isolated from periurethral swab specimens was the same as that in the urine. There was only one infection during low dose trimethoprim-sulfamethoxazole therapy for an over-all incidence of 0.1 infection per patient-year. This comlyared with 3.4 on no drug, 2.5 on sulfa alone, and 1.6 on methenamine mandelate. The trimethoprim-sulfamethoxazole combination prophylasis thus pro\cd significantly better than
UROLOCY
/ MARCH 1975 / VOLUME
V, NUMBER
3
either sulfa or methenamine ma&elate preventing recurrent bacteriuria.
NEW OF
YORK
STATE
alone
in
JOURNAL
MEDICINE
by A. Thomas,
M.D.
Oral Urea Treatment of Hematuria in Sickle-Cell Trait, S. Pariser (74: 2238, 1974) - This preliminary paper and case reports suggesting urea therapy for hematuria associated with sickling traits is of interest to the practicing urologist because of the uncertainty of past therapy. The author administered 160 Gm. of urea in divided doses to 2 patients with hematuria secondary to the sickling disorder, refractory to other therapy, with prompt resolution of the bleeding. Urea therapy was based on earlier favorable therapeutic results reported with SS sickle-cell disease; and although no firm conclusions were reached on the basis of only 2 cases, the cessation of hematuria which followed the administration of oral urea on these occasions suggests the urgent need for a larger controlled study. According to the author, urea in sugar solutions has been shown to block the sickling phenomenon reversibly by means of interference between interacting molecules of hemoglobin S. The major danger is the potential increase of dehydration in individuals already dehydrated because of massive diuresis. Careful monitoring to insure adequate hydration is mandatory if such therapy is to be safe.