deamino-arginine-vasopressin and Urinary-Retention

Introducing a consensus on pharmacological treatment of male LUTs to be applied to Urology Primary Care. EVIDENCE COMPILATION: The consensus has been created by an expert committee based on the latest recommendations by the European and American Guides for male LUTs treatment. Also, a bibliographic review of the latest advances in the therapeutical approach to these patients has been carried out.. Although the prevalence of both LUTs and overactive bladder is high, and its impact on the quality of life and social cost have been widely described, the number of patients treated is low. On the other hand, current clinical practice doesn't necessarily match the Guides and for this reason false perceptions of the available treatments circulate. For instance, men with storage LUTS are often treated inadequately with α-blockers or 5-α-reductase inhibitors due to underlying obstructive disorders. However, it is known that the incidence of real obstruction tends to be low. Current evidence, though limited, shows that antimuscarinic drugs may be used safely by men with LUTs, and are not associated with an increase in the prevalence of high urinary retention.. We propose an algorithm for the management of male LUTs in which various levels of clinical evaluation are shown for a specific diagnose, as well as for choosing the most appropriate treatment.

Topics: 5-alpha Reductase Inhibitors; Adrenergic alpha-Antagonists; Algorithms; Deamino Arginine Vasopressin; Drug Interactions; Drug Therapy, Combination; Humans; Hyponatremia; Lower Urinary Tract Symptoms; Male; Muscarinic Antagonists; Prostatism; Severity of Illness Index; Sodium Potassium Chloride Symporter Inhibitors; Urinary Retention

We describe an 8 year-old girl with established diabetes insipidus who developed cyclophosphamide-associated antidiuresis. The patient had received cyclophosphamide as part of a high-dose chemotherapy regimen for recurrent suprasellar dysgerminoma prior to autologous bone marrow transplantation. Urinary output decreased and specific gravity increased shortly after a 1 hour i.v. infusion of 50 mg/kg cyclophosphamide and the effect lasted some 5 hours. No other drug could be implicated. This response, occurring in a patient with no ability to secrete vasopressin, suggests a direct tubular effect of one or more cyclophosphamide metabolites. Administering i.v. cyclophosphamide requires careful monitoring of fluid balance in order to avoid water intoxication. Further research is warranted both into the mechanism of this effect and the metabolite responsible for it.

Topics: Antineoplastic Combined Chemotherapy Protocols; Central Nervous System Neoplasms; Child; Cyclophosphamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Dysgerminoma; Female; Humans; Urinary Retention