We describe a rare case of refractory lower urinary tract symptoms in a young woman caused by human papillomavirus (HPV) infection. Concurrently, vulvar and vaginal warts were present, particularly near the external urethral meatus. Biopsy of the whitish plaque in the trigone of the bladder demonstrated signs of HPV infection and bladder leukoplakia; polymerase chain reaction analysis of this tissue was positive for HPV16. Systemic and local treatments for HPV infection were prescribed. All symptoms resolved. Follow-up examination revealed negative HPV DNA in the bladder tissue.
Introduction. It is known that women are significantly more likely to suffer from lower urinary tract infections (LUTIs) than men. Nowadays, there is growing evidence to demonstrate the impact of vaginal microbiota on the development of recurrent LUTIs.Objectives. To demonstrate the impact of vaginal microbiota disorders on the development of recurrent lower urinary tract infections.Materials & methods. Seventy-five women with recurrent LUTIs 19 – 76 years old were enrolled in this study. The examination was performed according to the algorithm developed in the Department of Urology and Surgical Andrology, Russian Medical Academy of Continuous Professional Education. Real-time PCR of vaginal epithelial cell scrapings (Femoflor 16) was performed to comprehensively evaluate the vaginal microbiota.Results. Vaginal dysbiosis was detected in 47/75 (62.7%) women with recurrent UTIs: moderate vaginal dysbiosis was detected in 25/75 (33.3%) women and severe dysbiosis — in 22/75 (29.3%) women. A moderate correlation between the presence/absence of vaginal dysbiosis and the number of LUTI recurrences over 6 months was found (r = 0.310; p = 0.007). Vaginal dysbiosis was significantly more common among peri- and postmenopausal women with recurrent LUTIs than reproductive women (OR = 4.85; 95% CI = 1.45 – 16.17).Conclusion. Vaginal dysbiosis contributes to the development of recurrent LUTIs with more relapses. Vaginal microbiota disorders and, consequently, recurrent LUTIs are more common in peri- and postmenopausal women than reproductive women.
Introduction. Treatment of urinary tract infections (UTI) is a complex thing to do, due to the difficulties in diagnosing the causes of UTI and identifying risk factors for recurrence of the disease. Objective. To study the causes of hemorrhagic cystitis, develop an algorithm for examining these patients, and select a rational therapy. Materials and methods. A complex examination and treatment of 275 patients with a clinical picture of hemorrhagic cystitis was performed. Patients with the absence of leukocyturia and bacteriuria additionally performed рolymerase chain reaction (PCR) of the first portion of urine (scraping from the urethra) for the presence of herpes simplex viruses of the 1 and 2 types (HSV of the 1 and 2 types), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human papillomavirus of high oncogenic risk (HPV)) in acute period, ELISA with determination of immunoglobulins G and M for HSV types 1 and 2, CMV and EBV, examination of vagina flora pathogens and sensitivity to antibiotics with essential indication of the number of lactobacilli. Results. There is an increase level of hemorrhagic cystitis in young patients, while in 64% of cases, the bacterial agent was not detected. An algorithm for the diagnosis of hemorrhagic cystitis of viral etiology has been developed, including examination of this category of patients for the presence of viral agents. In 37% of cases, the presence of chronic herpes and papillomavirus infection was proven. The use of antiviral therapy significantly reduced the number of recurrent UTI in this category of patients. Conclusions. Examination of patients with recurrent urinary tract infections should include the methods which confirm the viral nature of the disease.
The article presents an analysis of the treatment results of 1122 patients with pyelonephritis in pregnancy at different gestational periods (from 6 to 39-40 weeks of pregnancy). The age of the patients was from 16 to 41 years, the average age was 26.15 ± 7 years. The indications and methods of urinary tract drainage in pregnant women were analyzed depending on the causes of urodynamic disturbances (kidney stone disease, decreased urinary tract tone, ureters compression by the uterus, vesico-urethral reflux) pregnancy term; pyelonephritis in pregnancy stage (serous/ purulent). Errors in the patients’ management after purulent pyelonephritis in pregnancy are considered. The expediency of examining and treating patients with risk factors for urinary tract infections during pregnancy were indicated at the stage of preparing a woman for pregnancy. Antegrade draining of the urinary tract is indicated for pregnant women from the 31st pregnancy week (and even shorter periods with a pronounced violation of urodynamics) with the presence of knee-shaped deviation in the ureter`s upper third and with suspected purulent process. Therefore, nephrostomy draining provides a more adequate outflow of urine from the affected kidney and makes it possible to control daily diuresis. It is necessary to conduct active monitoring of pregnant women with the presence of internal ureteral stents and their timely replacement. It is advisable to remove the drainage 3-4 weeks after birth, depending on the causes of the urodynamics` disorders. Symptom build-up dynamics, severity of intoxication, multi-organ lesion, the possibility of antenatal death of the fetus require urgent choice of the method of urinary tract drainage and the early initiation of intensive therapy in patients with suspected purulent process. Antimicrobial therapy should be carried out in accordance with the Russian guidelines on Urinary tract infections.TThe study did not have sponsorship. The authors have declared no conflicts of interest.
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