Department of Urology "Villa Stuart" Private Hospital, Rome.
Arch Ital Urol Androl. 2020 Apr 6;92(1):34-38. doi: 10.4081/aiua.2020.1.34.
Urinary tract infections (UTIs) are defined as the symptomatic presence of pathogens in the urinary tract that are typically diagnosed by microscopy and culture of urine samples. Over the long-term antibiotic courses, alternative prophylactic methods as probiotics, cranberry juices and D-mannose have been introduced for recurrence prevention. The present study aimed to determine whether a new combination of D-Mannose, Pomegranate extract, Prebiotics and Probiotics is effective in modifying symptoms reported by women with acute uncomplicated acute cystitis.
This is a pilot study, performed between September 2018 and November 2018 at the Department of Urology of Villa Stuart Private Hospital. A dose of a new combination of agents was administered twice daily for 5 days and then once a day for 10 days. Together with the compound, forced hydration (> 2 liters/day) has been strongly suggested. Antibiotics were permitted only in case of clinical worsening. Changes in patients' symptoms, the therapeutic effects and changes in quality of life (QoL) were evaluated clinically and through a validated questionnaire, the Acute Cystitis Symptom Score (ACSS) at the first visit (T0), 15 (T1) and 30 (T2) days later.
Thirty-three patients were enrolled in the study (mean age 38,1 ± 11.2 years) and all completed the treatment protocol. At T1 visit, all symptoms or the majority of symptoms went off in 10 women (30.3%) and at T2 in 30 women (90.9%); some symptoms still remained in 16 women (48.5%) at T1 and in 3 women (9.1%) at T2; the persistence of all symptoms or the worsening of the condition was observed in 7 patients (21.2%) at T1 and in none at T2. The mean score reported at all the ACSS sub-scales significantly decreased between baseline and T1 and T2. Typical symptoms decreased from 11.5 (10.5-12.6) to 4.9 (4.0-5.9) and to 2.7 (2.1-3.3) (p-values < 0.0001); differential symptoms decreased from 3.1 (2.6-3.6) to 0.6 (0.3-0.9) and to 0.3 (0.1-0.5) (p-values 0.009 to < 0.0001); QoL mean score also decrease from 7.2 (6.7- 7.7) to 4.0 (3.3-4.6) and to 1.7 (1.2-2.1) (p-values < 0.0001). Six patients required antibiotics and no adverse events were recorded.
Our study suggests that the action of the compounds, administered in this new combination, could help in an effective management of symptoms of acute cystitis in women, without antibiotics, in a wide majority of the cases. Lack of microbiological assessment is a clear limitation of the study. Moreover, lack of a control group is another important limitation. Finally, hyperhydration could have been a confounding factor in interpretation of results.
尿路感染（UTI）被定义为病原体在尿路中的有症状存在，通常通过尿液样本的显微镜检查和培养来诊断。在长期的抗生素疗程中，已经引入了替代的预防方法，如益生菌、蔓越莓汁和 D-甘露糖，以预防复发。本研究旨在确定 D-甘露糖、石榴提取物、益生元和益生菌的新组合是否能有效改善急性单纯性膀胱炎女性报告的症状。
这是一项于 2018 年 9 月至 2018 年 11 月在 Villa Stuart 私立医院泌尿科进行的试点研究。每天两次给予新组合制剂的剂量，连续 5 天，然后每天一次，持续 10 天。同时，强烈建议使用强制水化（> 2 升/天）。只有在临床恶化的情况下才允许使用抗生素。通过临床评估和经过验证的急性膀胱炎症状评分（ACSS）问卷，在第一次就诊（T0）、15 天（T1）和 30 天（T2）后评估患者症状的变化、治疗效果和生活质量（QoL）的变化。
33 名患者入组（平均年龄 38.1±11.2 岁），均完成了治疗方案。在 T1 就诊时，10 名女性（30.3%）的所有症状或大部分症状消失，30 名女性（90.9%）在 T2 就诊时消失；16 名女性（48.5%）在 T1 就诊时仍有一些症状，3 名女性（9.1%）在 T2 就诊时仍有一些症状；7 名女性（21.2%）在 T1 就诊时出现所有症状或病情恶化，而在 T2 就诊时无一例出现这种情况。所有 ACSS 亚量表的平均评分在基线和 T1 和 T2 之间显著降低。典型症状从 11.5（10.5-12.6）降至 4.9（4.0-5.9）和 2.7（2.1-3.3）（p 值<0.0001）；差异症状从 3.1（2.6-3.6）降至 0.6（0.3-0.9）和 0.3（0.1-0.5）（p 值为 0.009 至<0.0001）；QoL 平均评分也从 7.2（6.7-7.7）降至 4.0（3.3-4.6）和 1.7（1.2-2.1）（p 值<0.0001）。6 名患者需要使用抗生素，没有记录到不良反应。
我们的研究表明，在这种新组合中给予这些化合物的作用可能有助于在大多数情况下，无需抗生素，有效治疗女性急性膀胱炎的症状。缺乏微生物学评估是研究的一个明显局限性。此外，缺乏对照组是另一个重要的局限性。最后，高水化可能是解释结果的一个混杂因素。
