Epidemiology of interstitial cystitis

This article concerns a survey conducted to determine the origin and history of interstitial cystitis. Information was elicited from 565 patients on demographics, risk factors symptoms, pain, and psychological factors. All those surveyed satisfied the National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases (NIDDK) criteria for interstitial cystitis and have been diagnosed as having the disorder. Comparison of risk factors was made with a control group of 171 individuals, consisting of healthy individuals over 18 years old and of adults attending urology clinics for bladder disorders unrelated to interstitial cystitis.

Clinical evaluation of drug efficacy in UTI in men: the significance of bacterial elimination on day one

With the purpose of assessing whether the effect of a drug at an early stage of administration could serve to predict efficacy at the end of drug treatment, a cephem antibiotic was administered for 5 days (days 0-4) by injection in males with complicated UTI. Results showed that the bacteriological effect on day 1 was reflected in the overall clinical efficacy on day 5. The activity of an antibacterial agent appeared to be reflected in the ability to eliminate bacteria 1 to 2 days after the start of drug administration.

Emphysematous pyelonephritis, ureteritis, and cystitis in a diabetic patient

This paper presents a case of gas-forming infection of the urinary tract in a diabetic patient. Plain film and computed tomography scans of the abdomen greatly facilitated clarification of the entire inflammatory process. The patient was cured by early nephrectomy conducted following unsuccessful treatment by percutaneous drainage.

Secondary psoas abscess twenty-seven years after nephrectomy

Abscesses of the psoas muscle are due to a hematogenous dissemination, to the spread of infection from adjacent intestinal structures, to osteomyelitis of the spine or to tuberculous infection of a disc space. In contrast, psoas abscesses related to the urological tract have only been described on exception. The present report focuses on a right psoas abscess which developed 27 years after a nephrectomy. The infectious process resulted from the spread of an acute vesical infection through the residual ureter. Analysis of 4 other cases reported in the literature allows us to delineate the clinical features of psoas abscesses of urological origin.

Urogynecologic causes of chronic pelvic pain

Many women with CPP undergo lengthy evaluations and sometimes empiric operative procedures only to continue to have pain for which no clear source can be found. Occasionally, a review of urinary symptoms may be the key to initiating a diagnostic and therapeutic course that reveals a urologic cause for their pain. Appropriate treatment directed to the urinary disorder may lead to improvement and potentially obviate gynecologic surgery.

Marital status, indicators of sexual activity and prostatic cancer

STUDY OBJECTIVE

To analyse the relationship between marital status, indicators of sexual activity, history of urological and venereal diseases, and the risk of prostatic cancer.

DESIGN

Case-control study.

SETTING

A network of cooperating hospitals from northern Italy.

PARTICIPANTS

A total of 271 patients with histologically confirmed prostatic cancer and 685 controls in hospital because of acute, non-neoplastic, non-genital or urological conditions.

MEASUREMENTS AND MAIN RESULTS

Relative risks (RR) and the corresponding 95% confidence intervals (CI) derived from multiple logistic regression equations, including terms for age, area of residence, and education were determined. The risk of prostatic cancer was lower in never married than in married men (RR = 0.6), but not significantly so. Cases reported a significantly higher number of marriages than control subjects, and the RR was 3.2 (95% CI = 1.2, 8.9) for two or more marriages compared with never married men. Prostatic cancer patients also reported being significantly older at the time of their first marriage: compared with men who first married under age 25 years, the RR was 1.6 for marriage at age 25 to 29, and 1.8 for age 30 or more. With regard to urological or venereal diseases, only cystitis and nephrolithiasis were more frequently reported by cases, although there was no tendency for the risk to increase with the number of cystitis episodes and the RR decreased for longer periods since the first episode.

CONCLUSIONS

Although these results do not show a totally cohesive picture, they confirm that some aspects of sexual lifestyle are associated with prostatic cancer in Italy.

[Clinical and pathologic characteristics of bladder squamous carcinoma]

From 1973 to 1991, 782 patients with bladder tumor were admitted to this hospital. 23 (2.9%) of them were pathologically confirmed as squamous carcinoma. Clinically, 20 patients showed hematuria, 3 irritation signs of bladder, and 13 both signs. In this group, 82% the tumors belonged to B to D stage and 61% were of grade II. Six of 17 patients showed diffused eosinophil cell infiltration, suggesting a close relationship between bladder squamous carcinoma and inflammation. Bladder polycentric biopsy and exfoliative cytologic urocrisia were emphasized in preoperative diagnosis.

Toxoplasma cystitis associated with acquired immunodeficiency syndrome

Ante-mortem diagnosis of vesical toxoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS), was made by cystoscopic examination and biopsy of the bladder. Vesical biopsies can be helpful in determining appropriate therapy for AIDS patients with urinary tract involvement/disease.

Malignant lymphoma of bladder. Report of three cases and review of the literature

BACKGROUND

The significance of long-standing cystitis has been postulated as a causal factor in malignant lymphoma of bladder.

METHODS

The authors reviewed 3 cases of primary malignant lymphoma of the urinary bladder and an additional 27 cases described in the literature (25 from Western countries and 2 from Japan). Clinical and pathologic findings in the total 30 cases are summarized.

RESULTS

The majority of patients presented with gross hematuria and were between 20 and 85 years of age (median age, 64 years). Marked female preponderance was found (male to female ratio, 1:6.5). Six patients (20%), all of whom were women, out of 30 had a history of chronic cystitis. Macroscopic findings showed a solitary mass (22 cases), multiple masses (6 cases), or a diffuse lesion without nodule formation (2 cases). The vast majority of bladder lymphoma were non-Hodgkin lymphoma (NHL) of B-cell type; among them, 14% were follicular lymphomas. Follow-up indicated that NHL of bladder had a favorable prognosis.

CONCLUSIONS

Malignant lymphoma of bladder is characterized by a preponderance in women, who are occasionally affected by chronic cystitis.

Urinary urgency in women

Urinary urgency is a common unpleasant symptom which may result from a variety of different pathologies. Careful patient assessment and appropriate investigation allow the cause to be elucidated and treated effectively in most cases. However, further research is necessary to increase our understanding of these disorders and to improve the quality of life of the women affected by them.

[Cecovesical fistula of inflammatory origin simulating neoplasm of the cecum]

We describe a case of a caecovesical fistula in a 60-year-old woman caused by an inflammatory tumour of a probably appendicular origin which mimicked cancer of the caecum. The patient, had a history of idiopathic peripheral polineuropathy and chronic constipation. Presented urinary tract infection and fecaluria, without symptoms of appendicitis. At operation, a solid mass including the caecum and the fundus of the bladder was found, and the appendix was not identified. In view of the neoplastic appearance and the impossibility of separating the caecum from the bladder, "en bloc" right hemicolectomy and partial cystectomy were performed. The pathologic study showed the inflammatory nature of the lesion.

Extraordinary urinary frequency syndrome

Thirty-one children with the extraordinary urinary frequency syndrome are presented. Several possible etiologies were identified including viral cystitis-urethritis, stress, and hypercalciuria. A case definition is provided and the literature is reviewed. The authors suggest that this problem is more common than is generally appreciated. The condition is usually self-limited, and invasive diagnostic imaging studies are unnecessary when the presentation is typical.

[Local immunity indices during the chigain treatment of chronic cystitis in children]

A total of 117 children with chronic pyelonephritis (CP) aged 4-14 were examined and treated. 57 of them having attendant cystitis received multimodality treatment comprising local intravesicular instillations of chigain controlled by clinical findings, urinalysis, cystoscopy and urinary secretory immunoglobulins SIg A1, SIg A2 and IgG. The drug chigain capable of immune replacement was found to initiate clinical response, positive trends in urinalysis and cystoscopy data, in the levels of secretory urine immunoglobulins. The findings show the need of immune replacement therapy in the complex of modalities to treat children with CP combined with cystitis.

Percutaneous nephrostomy drainage in the treatment of severe hemorrhagic cystitis

We report on 2 patients who underwent urinary diversion with bilateral percutaneous nephrostomy tube drainage for intractable hemorrhagic cystitis. Both patients received cyclophosphamide-based chemotherapy and 1 also underwent pelvic irradiation for locally advanced prostate adenocarcinoma. In each case the bleeding gradually ceased during a 1-week period. Both patients were alive at 6 months and were voiding spontaneously. We propose that the mechanism of treatment involves diverting endogenous urokinase as well as avoiding overdistention of the bladder.

[Cystitis cystica--a premalignant condition?]

Although cystitis cystica is considered to be a premalignant disease of the urinary bladder, remarkably few reports document the progression from cystitis cystica and glandularis to carcinoma of the bladder. We describe three patients where cystitis cystica was demonstrated 12, three and one month before diagnosis of cancer. We believe cystitis cystica reflects mobilization of the humoral immune defence mechanism in response to various agents, among these a subclinical malignant tumour.

Intravesical formalin for hemorrhagic cystitis following irradiation of cancer of the cervix

OBJECTIVE

To determine the effectiveness of intravesical formalin instillation in hemorrhagic cystitis following irradiation of cancer of the cervix.

METHOD

Records were reviewed for 35 patients with hemorrhagic radiation cystitis who underwent treatment with 1% (n = 22), 2% (n = 10), and 4% formalin (n = 4), using Fair's technique.

RESULT

Complete response was seen in 31 patients (89%) and partial response in 3 patients (8%) after a single instillation. Minor complications were seen in 19 patients (54%). Major complications occurred in 11 patients (31%), with 5 cases requiring subsequent urinary diversion. One patient died of persistent bleeding and probable formalin toxicity. Hematuria recurred in 7 patients achieving complete response at a mean period of 8 months after treatment. A 1% solution was as effective in controlling hematuria as higher concentrations and was associated with significantly less morbidity.

CONCLUSION

Intravesical instillation of 1% formalin is an effective treatment for intractable hematuria secondary to radiation cystitis.

The association of bronchiolitis obliterans organizing pneumonia, systemic lupus erythematosus, and Hunner's cystitis

An 83-year-old woman with histologically confirmed Hunner's cystitis presented with persistent fever, progressive dyspnea, and pulmonary patchy infiltrates. A transbronchial biopsy specimen revealed bronchiolitis obliterans organizing pneumonia. She progressively had development of renal insufficiency, due to systemic lupus erythematosus, proved by renal biopsy specimen. She recovered under corticosteroid treatment, but irreversible renal failure made long-term hemodialysis necessary.

[Hematuria due to polypoid cystitis. Its differential diagnosis from bladder carcinoma]

Polypoid cystitis is not uncommon in patients with a permanent urethral catheter. In some cases difficulties are encountered when making the differential or anatomopathological diagnosis from transitional cell carcinoma of the bladder. We report a case of polypoid cystitis mimicking bladder carcinoma in a patient with a permanent urethral catheter.

Sjögren's syndrome in patients with interstitial cystitis

OBJECTIVE

Patients with interstitial cystitis, a chronic nonbacterial inflammation of the bladder, were investigated for the presence of systemic autoimmune diseases, in particular for Sjögren's syndrome (SS).

METHODS

Ten patients were included in the study on the basis of a diagnosis of interstitial cystitis according to usual criteria. They underwent clinical and laboratory investigations including those for keratoconjunctivitis (KCS) and focal lymphocytic sialoadenitis (FLS).

RESULTS

In 2 patients both KCS and FLS were present allowing the diagnosis of primary SS according to classification criteria. Additionally, in 6 patients one of the 2 hallmarks of primary SS was present, KCS in 3 and FLS in 3.

CONCLUSION

Interstitial cystitis is a new example of a disease that occurs in association with SS, supporting the concept that interstitial cystitis is an autoimmune cystitis. The clinical relevance of the finding is that a high index of suspicion for SS is indicated in patients with interstitial cystitis.

Etiology of asymptomatic microscopic hematuria in adults

Asymptomatic microscopic hematuria is a common finding that demands urologic evaluation. Of the 236 patients over the age of 40, 6.8% were found to have a genitourinary cancer, while 27.5% had other significant urologic disease. However, 52.1% of the patients had unknown etiology of microscopic hematuria and 13.6% had insignificant urologic lesions. Of the 72 patients under the age of 40 a positive diagnosis was made in 16 patients (22.2%). Cystoscopic examination was of diagnostic value in only 1 patient. Therefore, cystoscopy is of little diagnostic value in young patients. Once asymptomatic microscopic hematuria is established and no etiological cause is identified, we follow the patient by urinalysis and cytology every three months and reevaluate the patient in whom urological symptoms develop.

Villous adenoma of the bladder

A case of villous adenoma of the bladder associated with cystitis glandularis of intestinal type is described. Only three villous adenomas have been reported to date, of which two were also accompanied by cystitis glandularis. The lesion can be confused with polypoid hyperplasia in cystitis glandularis. Neutral mucins, acidic sulphomucins, and sialomucins were identified within the villous adenoma and adjacent areas of cystitis glandularis. It is suggested that the villous adenoma may form an intermediary stage in the development of some of the primary adenocarcinomas of the bladder arising in metaplastic intestinal mucosa.

Lumbar epidural blockade for management of pain in interstitial cystitis

Thirteen patients with interstitial cystitis (IC), whose predominant symptom was pelvic or urethral pain, were treated with a series of lumbar epidural local anaesthetic blocks over an 18-month period. Response was evaluated by interview and with voiding diaries and visual analogue scales (VAS) for pain. Of the 55 injections given, immediate pain relief (lasting longer than 24 h) was obtained from 41 (75%). The duration of subsequent pain relief varied considerably, ranging from 2 to 75 days (mean 15.1). Pain relief was accompanied by significant improvement in sleep habit and quality of life. A good correlation was noted between verbally expressed pain and the recorded VAS pain scores. Urinary frequency and average voided volumes were unaffected by treatment. Two patients failed to obtain any relief. Apart from minor transient backache at the injection site, there were no complications from the procedure. Lumbar sympathetic epidural blockade is an excellent means of providing pain relief in interstitial cystitis.