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Recurrent urinary tract infections - new guidelines

Today I'm at the American Urological Association annual meeting. It happens to be in Chicago at McCormick Place. I'd like to talk to you about a new guideline that relates to the management of recurrent urinary tract infections. How does one know that they have UTI? Most cardinal symptom of UTI is called dysuria which is painful urination. It's not even pain at rest or urinary frequency or urgency – the most important is actually burning with urination. And how can one prove that they have UTI is by doing Urine Culture. So sensation by itself is not enough to make a definitive diagnosis. How can one treat UTI? For somebody who has so-called uncomplicated UTI, which occurs to otherwise healthy women, it's a treatment with as short of a curse of antibiotic as possible. How often does that occur? UTI among otherwise healthy women occurs very –very commonly. In fact, 60 percent of women will experience UTI and 20 to 40 percent of women who already had UTI will have recurrent once. What can we do to decrease the chances of urinary tract infections? One of the things is to consume lots of water. Second – there are some non-pharmacological supplements that can decrease chances of UTI. For example extract of cranberries is proven and actually is a recommended option for women with frequent UTI. The extracts come in different concentrations and forms, so before buying it make sure that it has enough of active ingredient to make it active and successful in your prevention plan. Other things – use of lactobacilli, use of estrogen cream and other supplements to restore age-related changes in a private area, and sometimes even preventative antibiotics are necessary. In any case, if you suspect that you have UTI the most important thing is to obtain the urine culture. For that, you should see your urologist.

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A paradigm change is coming on a horizon of medical management of renal and ureteral stones. Until recently, medical expulsion therapy has been a standard of care for small obstructing ureteral stones. When there is no evidence of infection, initial management of obstructing ureteral stones under 10 mm in diameter included medical expulsion therapy: consumption of fluids, pain control and use of tamsulosin - a common alpha blocker indicated otherwise for treatment of BPH. The strongest evidence for that came from a meta-analysis summarizing observational and prospective trial dating back to 1947. It strongly favored use of alpha blockers for distal ureteral stones measuring less than 10 mm...

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