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EFFECTIVENESS OF ANTIMICROBIAL PROPHYLAXIS IN RECURRENT URINARY TRACT INFECTION (UTI) IN CHILDREN

ALSAYED S. ABDELAZEZ*, MAHMOUD M. ALI**, ABDELAZEZ A EMAI**  AND ABDELRAZAK MANSOUR M ALI***
* Department of urology, Al-Azhar University, Damietta, Egypt.
**Department of urology, Al-Azhar University, Cairo, Egypt.
***Department of Pediatrics, Al-Azhar University, Cairo, Egypt.

 

Objective: To evaluate the effectiveness of trimethoprim–sulfamethoxazole (TMP-SMX) as antimicrobial prophylaxis for recurrent UTI in children.

Materials and Methods: From June 1st 2010 to June 1st 2011, 360 children <12 years with proven UTI were treated and divided into two groups: Study group (n=180) who received daily low doses of TMP-SMX suspension (2 mg of trimethoprim + 10 mg of sulfamethoxazole /kg) as a prophylaxis and Control group (n=180) who received placebo and followed-up for 12 months.

Results: The median age at entry was 44± 7.23 months. UTI developed in 8.1% in study group (n=14/172) and 9.8% in placebo group (n=14/172) and the difference was statistically insignificant (P >0.05). The most serious adverse effect was the development of antibiotic resistance organism to TMP-SMX in antibiotic group in comparison to placebo group [71.4% (n=10/14) Vs 17.7% (n=3/17) respectively] (P <0.05).

Conclusion: Low-dose TMP-SMX was not associated with decreased recurrent UTI in predisposed risk children, whereas the risk for antimicrobial resistance was significantly increased.

Keywords: Children, recurrent UTI, antibiotic prophylaxis.

 

IMPACT OF TAMSULOSIN ON CLEARANCE OF RENAL CALCULI AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

MOHAMED ABO EL-ENEN, MOHAMED GABER, * MOHAMED SAMY
 Urology and *Radiology Departments, Tanta University, Tanta, Egypt.

RENAL STONES “BIOEFFECTS AND FREQUENCIES OF SHOCK WAVE LITHOTRIPSY (SWL)”

MAMDOUH AB. AB.MOHAMID AND ALAYMAN F. HASSEIN
 Urology Department, Minia University Hospital, Minia Egypt

Aim Of The Work: Our primary end point of this prospective study was to evaluate the bioeffects of SWL for treatment of renal stones using different frequencies of shock wave lithotripsy to determine the optimal frequency required, not only for stone fragmentation, but also for safety concerning its bioeffects.

 

Patients And Methods: This prospective study was conducted upon 100 patients (64 male and 36 female) aged 17- 60 years with mean age 35.92 years. All patients had symptomatic renal calculi at the SWL unit, Urology Depart, Minia University Hospital, in the period between July 2008 and Aug. 2009. Extracorporeal shock wave lithotripsy (SWL) was used as primary treatment option for all patients. All patients subjected to complete history taking, clinical examination, laboratory and imaging studies. Patients were randomly classified into 3 groups according to the frequency of shock waves used: Group 1 included 30 patients in whom we used 60 shock waves per minute. Group 2: included forty patients in whom we used 90 shock waves per minute. Group 3: included thirty patients using shock waves 120 shock per minute. All patients were followed up within the first week, 3 months after SWL for the above mentioned laboratory and imaging study to assess the bioeffects of SWL in this group of patients.

 

Results: This study included 100 patients presented with symptomatic renal stones, in those group of patients in this work we noticed some degree of transient renal damage had occurred as a result of stone disintegration by SWL in the first week in the form of a varying degree of intra and peri-renal edema and hemorrhage as well as some degree of impaired renal function,also,there is a decreased in the intra renal blood flow within the first 24 hours after SWL which evidenced by increased renal vascular resistive index. Shock wave lithotripsy (SWL), not only produce renal damage but also has extra renal damaging effects to other organs such as liver (transient rise in the liver enzymes as well as bilirubin), pancreas (rise in the blood glucose level in the first 24 hours following SWL) and cardiovascular system (decrease pulse rate in the first 24 hours after SWL).These bioeffects of ESL not affected by the change in the frequency of shock waves between 60, 90, 120 shock/min except for hematuria which is markedly significant using high frequency shock waves? All of these bio effects produced by SWL disappeared three month after SWL.

 

Conclusion: All the bioeffects produced by SWL either physical and/or chemical are not influenced by changing the frequency of shock waves used for disintegration of renal calculi between 60, 90, 120 shock/min except for heamaturia which was markedly significant with the use of higher frequency shock waves. All the bioeffects produced by SWL disappeared three months after SWL.

 

Key Words: Extracorporeal, Shock waves lithotripsy, bioeffects, frequency, renal calculi, resistive index.


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