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Abstract
Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis.
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Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Tae Hee Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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102
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Mehdizadehkashi A, Tahermanesh K, Fazel Anvari-Yazdi A, Chaichian S, Azarpira N, Nobakht M, Abed SM, Hashemi N. Ultrastructural Investigation of Pelvic Peritoneum in Patients With Chronic Pelvic Pain and Subtle Endometriosis in Association With Chromoendoscopy. J Minim Invasive Gynecol 2016; 24:114-123. [PMID: 27693809 DOI: 10.1016/j.jmig.2016.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVE To evaluate the pelvic peritoneum under chromoendoscopy by scanning electron microscopy (SEM) as well as light microscopy with hematoxylin and eosin staining and immunohistochemistry (IHC) assays in patients with chronic pelvic pain (CPP) associated with subtle endometriosis. DESIGN Case series study (Canadian Task Force classification II). SETTING A referral academic community tertiary medical center. PATIENTS Three women aged 29 to 37 years were referred to the obstetrics and gynecology clinic of the tertiary university hospital with CPP. They were suspicious for endometriosis, were not responding to medical treatments, and had undergone previous pelvic laparoscopy to determine the stage of endometriosis and preparation of peritoneal samples under the guidance of staining with methylene blue in 0.25% dilution. INTERVENTIONS Comparison of stained and unstained pelvic peritoneal samples after the instillation of 0.25% methylene blue into the pelvic cavity. MEASUREMENTS AND MAIN RESULTS In 3 patients, laparoscopic examination showed minimal endometriosis. A total of 18 samples (9 stained and 9 unstained) from the 3 patients were prepared for SEM. Ten of the samples (55.6%) showed microstructural peritoneal destruction (7 of 9 stained [77.7%] and 3 of 9 [33.4%] unstained). Eighteen samples (9 stained and 9 unstained) from the 3 patients were also prepared for IHC. Six of these samples (33.3%) were S-100-positive, including 4 of 9 (44.4%) stained samples and 2 of 9 (22.2%) unstained samples. CONCLUSIONS In general, in the context of CPP and endometriosis, there is no established relationship between the severity of pain and stage of endometriosis. In the pathophysiology of CPP associated with endometriosis, ultrastructural changes can play a significant role. Under methylene blue staining, some destroyed areas were detected, but the stained areas do not necessarily correlate with increased microstructural peritoneal destruction.
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Affiliation(s)
| | - Kobra Tahermanesh
- Endometriosis and Gynecologic Disorders Research Center, Department of Obstetrics and Gynecology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Shahla Chaichian
- Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maliheh Nobakht
- Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Mehr Abed
- School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Neda Hashemi
- Endometriosis and Gynecologic Disorders Research Center, Department of Obstetrics and Gynecology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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103
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Xu S, Wang X, Wang Y, Lutgendorf S, Bradley C, Schrepf A, Kreder K, O'Donnell M, Luo Y. Transgenic Mice Expressing MCP-1 by the Urothelium Demonstrate Bladder Hypersensitivity, Pelvic Pain and Voiding Dysfunction: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Animal Model Study. PLoS One 2016; 11:e0163829. [PMID: 27684718 PMCID: PMC5042429 DOI: 10.1371/journal.pone.0163829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/14/2016] [Indexed: 01/01/2023] Open
Abstract
Monocyte chemoattractant protein-1 (MCP-1) is one of the key chemokines that play important roles in diverse inflammatory and chronic pain conditions. Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and debilitating inflammatory condition of the urinary bladder characterized by the hallmark symptoms of pelvic pain and voiding dysfunction. To facilitate IC/BPS research, we used transgenic technology to develop a novel urothelial MCP-1 secretion mouse model (URO-MCP-1). A transgene consisting of the uroplakin II gene promoter and the mouse MCP-1 coding sequence with a secretory element was constructed and microinjected. URO-MCP-1 mice were found to express MCP-1 mRNA in the bladder epithelium and MCP-1 protein in the urine, and developed bladder inflammation 24 hours after intravesical administration of a single sub-noxious dose of lipopolysaccharide (LPS). The inflamed bladders of URO-MCP-1 mice exhibited elevated mRNAs for interleukin (IL)-1ß, IL-6, substance P precursor, and nerve growth factor as well as increased macrophage infiltration. In parallel with these phenotypic changes, URO-MCP-1 mice manifested significant functional changes at days 1 and 3 after cystitis induction. These functional changes included pelvic pain as measured by von Frey filament stimulation and voiding dysfunction (increased urinary frequency, reduced average volume voided per micturition, and reduced maximum volume voided per micturition) as measured by micturition cages. Micturition changes remained evident at day 7 after cystitis induction, although these changes were not statistically significant. Control wild-type C57BL/6 mice manifested no clear changes in histological, biochemical and behavioral features after similar cystitis induction with LPS. Taken together, our results indicate that URO-MCP-1 mice are hypersensitive to bladder irritants such as LPS and develop pelvic pain and voiding dysfunction upon cystitis induction, providing a novel model for IC/BPS research.
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Affiliation(s)
- Suming Xu
- Department of Urology, University of Iowa, Iowa City, Iowa, United States of America
| | - Xu Wang
- Department of Urology, University of Iowa, Iowa City, Iowa, United States of America
| | - Yaoqin Wang
- Department of Urology, University of Iowa, Iowa City, Iowa, United States of America
| | - Susan Lutgendorf
- Department of Urology, University of Iowa, Iowa City, Iowa, United States of America
- Department of Psychology, University of Iowa, Iowa City, Iowa, United States of America
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, United States of America
| | - Catherine Bradley
- Department of Urology, University of Iowa, Iowa City, Iowa, United States of America
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, United States of America
| | - Andrew Schrepf
- Department of Psychology, University of Iowa, Iowa City, Iowa, United States of America
| | - Karl Kreder
- Department of Urology, University of Iowa, Iowa City, Iowa, United States of America
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, United States of America
| | - Michael O'Donnell
- Department of Urology, University of Iowa, Iowa City, Iowa, United States of America
| | - Yi Luo
- Department of Urology, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
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104
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Monjotin N, Gillespie J, Farrié M, Le Grand B, Junquero D, Vergnolle N. F16357, a novel protease-activated receptor 1 antagonist, improves urodynamic parameters in a rat model of interstitial cystitis. Br J Pharmacol 2016; 173:2224-36. [PMID: 27111354 PMCID: PMC4919585 DOI: 10.1111/bph.13501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/17/2016] [Accepted: 04/10/2016] [Indexed: 01/15/2023] Open
Abstract
Background and Purpose The aims of the present study were to characterize the role of PAR1 in rat bladder under inflammatory conditions and determine whether a selective PAR1 antagonist, F16357, can prevent the pathophysiological symptoms of cyclophosphamide‐induced interstitial cystitis (IC). Experimental Approach Immunohistochemistry, contractile activity in isolated bladder and urodynamics were determined before and after cyclophosphamide treatment. F16357 was administered intravesically during the acute phase of inflammation, and effects on PAR1 and PAR1‐related bladder contraction evaluated 24 h after cyclophosphamide injection. Urodynamics and associated voided volumes were recorded 7 and 24 h after cyclophosphamide. Key Results In control conditions, PAR1 was present only in some umbrella cells. Cyclophosphamide disrupted the urothelium and expression of PAR1 by all remaining urothelial cells. After F16357 treatment, urothelial damage was absent and PAR1 immunoreactivity similar to control tissues. Thrombin and TFLLR‐NH2 induced bladder contractions. These were increased in inflammatory conditions and antagonized by F16357 in a concentration‐dependent manner. In telemetric experiments, furosemide increased urine production and voiding frequency for 60 min, 7 h after cyclophosphamide injection. Intravesical administration of F16357 blocked these changes with a return to a physiological profile; 24 h after cyclophosphamide, the volume of micturition was still lower with no increase in number of micturitions. F16357 30 μM reduced the number of micturitions and improved bladder capacity, but did not affect diuresis. Under similar experimental conditions, lidocaine 2% induced comparable effects. Conclusions and Implications PAR1 is expressed in rat bladder, overactivated in inflammatory conditions and involved in bladder function and sensation. F16357 could represent an interesting candidate for IC treatment.
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Affiliation(s)
- N Monjotin
- Institut de Recherche Pierre Fabre, Castres, France
| | - J Gillespie
- Newcastle University, Newcastle upon Tyne, England
| | - M Farrié
- Institut de Recherche Pierre Fabre, Castres, France
| | - B Le Grand
- Institut de Recherche Pierre Fabre, Castres, France
| | - D Junquero
- Institut de Recherche Pierre Fabre, Castres, France
| | - N Vergnolle
- IRSD, Université de Toulouse, INSERM, INRA, INP-ENVT, Université de Toulouse-3 Paul Sabatier, Toulouse, France
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105
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Dogishi K, Kodera M, Oyama S, Shirakawa H, Nakagawa T, Kaneko S. Long-lasting pain-related behaviors in mouse chronic cystitis model induced by a single intravesical injection of hydrogen peroxide. J Pharmacol Sci 2015; 129:244-6. [DOI: 10.1016/j.jphs.2015.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022] Open
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106
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Suwabe T, Ubara Y, Mise K, Ueno T, Sumida K, Yamanouchi M, Hayami N, Hoshino J, Kawada M, Imafuku A, Hiramatsu R, Hasegawa E, Sawa N, Takaichi K. Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization. J Am Soc Nephrol 2015; 27:2177-87. [PMID: 26620095 DOI: 10.1681/asn.2015010067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 10/13/2015] [Indexed: 01/18/2023] Open
Abstract
In patients with autosomal dominant polycystic kidney disease (ADPKD), massive renal enlargement is a serious problem. Renal transcatheter arterial embolization (TAE) can reduce renal volume (RV), but effectiveness varies widely, and the reasons remain unclear. We investigated factors affecting renal volume reduction rate (RVRR) after renal TAE in all 449 patients with ADPKD who received renal TAE at Toranomon Hospital from January of 2006 to July of 2013, including 228 men and 221 women (mean age =57.0±9.1 years old). One year after renal TAE, the RVRR ranged from 3.9% to 84.8%, and the least squares mean RVRR calculated using a linear mixed model was 45.5% (95% confidence interval [95% CI], 44.2% to 46.8%). Multivariate analysis using the linear mixed model revealed that RVRR was affected by the presence of large cysts with wall thickening (regression coefficient [RC], -6.10; 95% CI, -9.04 to -3.16; P<0.001), age (RC, -0.82; 95% CI, -1.03 to -0.60; P<0.001), dialysis duration (RC, -0.10; 95% CI, -0.18 to -0.03; P<0.01), systolic BP (RC, 0.39; 95% CI, 0.19 to 0.59; P<0.001), and the number of microcoils used for renal TAE (RC, 1.35; 95% CI, 0.83 to 1.86; P<0.001). Significantly more microcoils were needed to achieve renal TAE in patients with younger age and shorter dialysis duration. In conclusion, cyst wall thickening had an important effect on cyst volume reduction. Renal TAE was more effective in patients who were younger, had shorter dialysis duration, or had hypertension, parameters that might associate with cyst wall stiffness and renal artery blood flow.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | - Koki Mise
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Toshiharu Ueno
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Keiichi Sumida
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | - Noriko Hayami
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Aya Imafuku
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | | | - Eiko Hasegawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
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107
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Tamma SM, Shorter B, Toh KL, Moldwin R, Gordon B. Influence of polyunsaturated fatty acids on urologic inflammation. Int Urol Nephrol 2015; 47:1753-61. [DOI: 10.1007/s11255-015-1108-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/03/2015] [Indexed: 01/03/2023]
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108
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Koeck I, Burkhard FC, Monastyrskaya K. Activation of common signaling pathways during remodeling of the heart and the bladder. Biochem Pharmacol 2015; 102:7-19. [PMID: 26390804 DOI: 10.1016/j.bcp.2015.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/14/2015] [Indexed: 12/12/2022]
Abstract
The heart and the urinary bladder are hollow muscular organs, which can be afflicted by pressure overload injury due to pathological conditions such as hypertension and bladder outlet obstruction. This increased outflow resistance induces hypertrophy, marked by dramatic changes in the organs' phenotype and function. The end result in both the heart and the bladder can be acute organ failure due to advanced fibrosis and the subsequent loss of contractility. There is emerging evidence that microRNAs (miRNAs) play an important role in the pathogenesis of heart failure and bladder dysfunction. MiRNAs are endogenous non-coding single-stranded RNAs, which regulate gene expression and control adaptive and maladaptive organ remodeling processes. This Review summarizes the current knowledge of molecular alterations in the heart and the bladder and highlights common signaling pathways and regulatory events. The miRNA expression analysis and experimental target validation done in the heart provide a valuable source of information for investigators working on the bladder and other organs undergoing the process of fibrotic remodeling. Aberrantly expressed miRNA are amendable to pharmacological manipulation, offering an opportunity for development of new therapies for cardiac and bladder hypertrophy and failure.
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Affiliation(s)
- Ivonne Koeck
- Urology Research Laboratory, Department Clinical Research, University of Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland
| | | | - Katia Monastyrskaya
- Urology Research Laboratory, Department Clinical Research, University of Bern, Switzerland; Department of Urology, University Hospital, Bern, Switzerland.
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109
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Abstract
Several physiopathologic conditions lead to the manifestation of overactive bladder (OAB). These conditions include ageing, diabetes mellitus, bladder outlet obstruction, spinal cord injury, stroke and brain injury, Parkinson's disease, multiple sclerosis, interstitial cystitis, stress and depression. This review has discussed research findings in human and animal studies conducted on the above conditions. Several structural and functional changes under these conditions have not only been observed in the lower urinary tract, but also in the brain and spinal cord. Significant changes were observed in the following areas: neurotransmitters, prostaglandins, nerve growth factor, Rho-kinase, interstitial cells of Cajal, and ion and transient receptor potential channels. Interestingly, alterations in these areas showed great variation in each of the conditions of the OAB, suggesting that the pathophysiology of the OAB might be different in each condition of the disease. It is anticipated that this review will be helpful for further research on new and specific drug development against OAB.
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Affiliation(s)
- Phani B Patra
- King of Prussia, Drexel University College of Medicine, Philadelphia, Pa., USA
| | - Sayani Patra
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pa., USA
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110
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Lin AE, Beasley FC, Olson J, Keller N, Shalwitz RA, Hannan TJ, Hultgren SJ, Nizet V. Role of Hypoxia Inducible Factor-1α (HIF-1α) in Innate Defense against Uropathogenic Escherichia coli Infection. PLoS Pathog 2015; 11:e1004818. [PMID: 25927232 PMCID: PMC4415805 DOI: 10.1371/journal.ppat.1004818] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/18/2015] [Indexed: 02/04/2023] Open
Abstract
Uropathogenic E. coli (UPEC) is the primary cause of urinary tract infections (UTI) affecting approximately 150 million people worldwide. Here, we revealed the importance of transcriptional regulator hypoxia-inducible factor-1 α subunit (HIF-1α) in innate defense against UPEC-mediated UTI. The effects of AKB-4924, a HIF-1α stabilizing agent, were studied using human uroepithelial cells (5637) and a murine UTI model. UPEC adherence and invasion were significantly reduced in 5637 cells when HIF-1α protein was allowed to accumulate. Uroepithelial cells treated with AKB-4924 also experienced reduced cell death and exfoliation upon UPEC challenge. In vivo, fewer UPEC were recovered from the urine, bladders and kidneys of mice treated transurethrally with AKB-4924, whereas increased bacteria were recovered from bladders of mice with a HIF-1α deletion. Bladders and kidneys of AKB-4924 treated mice developed less inflammation as evidenced by decreased pro-inflammatory cytokine release and neutrophil activity. AKB-4924 impairs infection in uroepithelial cells and bladders, and could be correlated with enhanced production of nitric oxide and antimicrobial peptides cathelicidin and β-defensin-2. We conclude that HIF-1α transcriptional regulation plays a key role in defense of the urinary tract against UPEC infection, and that pharmacological HIF-1α boosting could be explored further as an adjunctive therapy strategy for serious or recurrent UTI. Urinary tract infection (UTI), commonly caused by uropathogenic E.coli (UPEC), affects more than 150 million people worldwide, resulting in 14 million hospital visits per year and an estimated total cost of 6 billion dollars in direct health care. Due to the high prevalence of UTI and rapid emergence of antibiotic-resistant bacteria, new effective strategies to prevent and treat UTI are urgently needed. Here, we describe a global regulatory role of transcription factor hypoxia-inducible factor-1 (HIF-1) in innate antimicrobial defense against UPEC. HIF-1 stabilization reduces UPEC attachment to and invasion of uroepithelial cells, and protects bladders from UPEC-mediated cytotoxicity in vivo. In the murine UTI model, we found normal bladder HIF-1 expression is required for efficient UPEC clearance, since HIF-1-deficient mice suffer more severe infection than normal mice. Further studies showed that key elements of host protection provided by HIF-1 regulation are uroepithelial cell nitric oxide and antimicrobial peptide production. This study provides valuable insight into the importance of HIF-1 in supporting host immunity during UTI and its potential as a therapeutic target.
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Affiliation(s)
- Ann E. Lin
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
| | - Federico C. Beasley
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
| | - Joshua Olson
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
| | - Nadia Keller
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
| | | | - Thomas J. Hannan
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Scott J. Hultgren
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Victor Nizet
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, United States of America
- Rady Children’s Hospital, San Diego, California, United States of America
- * E-mail:
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111
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Kiseleva E, Kirillin M, Feldchtein F, Vitkin A, Sergeeva E, Zagaynova E, Streltzova O, Shakhov B, Gubarkova E, Gladkova N. Differential diagnosis of human bladder mucosa pathologies in vivo with cross-polarization optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2015; 6:1464-76. [PMID: 25909028 PMCID: PMC4399683 DOI: 10.1364/boe.6.001464] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/14/2015] [Accepted: 02/24/2015] [Indexed: 05/03/2023]
Abstract
Quantitative image analysis and parameter extraction using a specific implementation of polarization-sensitive optical coherence tomography (OCT) provides differential diagnosis of mucosal pathologies in in-vivo human bladders. We introduce a cross-polarization (CP) OCT image metric called Integral Depolarization Factor (IDF) to enable automatic diagnosis of bladder conditions (assessment the functional state of collagen fibers). IDF-based diagnostic accuracy of identification of the severe fibrosis of normal bladder mucosa is 79%; recurrence of carcinoma on the post-operative scar is 97%; and differentiation between neoplasia and acute inflammation is 75%. The promising potential of CP OCT combined with image analysis in human urology is thus demonstrated in vivo.
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Affiliation(s)
- Elena Kiseleva
- Nizhny Novgorod State Medical Academy, 603000, Minin Square, 10/1, Nizhny Novgorod,
Russia
| | - Mikhail Kirillin
- Institute of Applied Physics RAS, 603950, Ulyanov Street, 46, Nizhny Novgorod,
Russia
- N.I. Lobachevsky State University of Nizhny Novgorod, 603950, 23 Gagarin St., Nizhny Novgorod,
Russia
| | - Felix Feldchtein
- Nizhny Novgorod State Medical Academy, 603000, Minin Square, 10/1, Nizhny Novgorod,
Russia
| | - Alex Vitkin
- Nizhny Novgorod State Medical Academy, 603000, Minin Square, 10/1, Nizhny Novgorod,
Russia
- Department of Medical Biophysics and Radiation Oncology, University of Toronto, Ontario M5G 2M9,
Canada
- Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9,
Canada
| | - Ekaterina Sergeeva
- Institute of Applied Physics RAS, 603950, Ulyanov Street, 46, Nizhny Novgorod,
Russia
- N.I. Lobachevsky State University of Nizhny Novgorod, 603950, 23 Gagarin St., Nizhny Novgorod,
Russia
| | - Elena Zagaynova
- Nizhny Novgorod State Medical Academy, 603000, Minin Square, 10/1, Nizhny Novgorod,
Russia
| | - Olga Streltzova
- Nizhny Novgorod State Medical Academy, 603000, Minin Square, 10/1, Nizhny Novgorod,
Russia
| | - Boris Shakhov
- Nizhny Novgorod State Medical Academy, 603000, Minin Square, 10/1, Nizhny Novgorod,
Russia
| | - Ekaterina Gubarkova
- Nizhny Novgorod State Medical Academy, 603000, Minin Square, 10/1, Nizhny Novgorod,
Russia
| | - Natalia Gladkova
- Nizhny Novgorod State Medical Academy, 603000, Minin Square, 10/1, Nizhny Novgorod,
Russia
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112
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Qiao Z, Xia C, Shen S, Corwin FD, Liu M, Guan R, Grider JR, Qiao LY. Suppression of the PI3K pathway in vivo reduces cystitis-induced bladder hypertrophy and restores bladder capacity examined by magnetic resonance imaging. PLoS One 2014; 9:e114536. [PMID: 25486122 PMCID: PMC4259345 DOI: 10.1371/journal.pone.0114536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/10/2014] [Indexed: 11/18/2022] Open
Abstract
This study utilized magnetic resonance imaging (MRI) to monitor the real-time status of the urinary bladder in normal and diseased states following cyclophosphamide (CYP)-induced cystitis, and also examined the role of the phosphoinositide 3-kinase (PI3K) pathway in the regulation of urinary bladder hypertrophy in vivo. Our results showed that under MRI visualization the urinary bladder wall was significantly thickened at 8 h and 48 h post CYP injection. The intravesical volume of the urinary bladder was also markedly reduced. Treatment of the cystitis animals with a specific PI3K inhibitor LY294002 reduced cystitis-induced bladder wall thickening and enlarged the intravesical volumes. To confirm the MRI results, we performed H&E stain postmortem and examined the levels of type I collagen by real-time PCR and western blot. Inhibition of the PI3K in vivo reduced the levels of type I collagen mRNA and protein in the urinary bladder ultimately attenuating cystitis-induced bladder hypertrophy. The bladder mass calculated according to MRI data was consistent to the bladder weight measured ex vivo under each drug treatment. MRI results also showed that the urinary bladder from animals with cystitis demonstrated high magnetic signal intensity indicating considerable inflammation of the urinary bladder when compared to normal animals. This was confirmed by examination of the pro-inflammatory factors showing that interleukin (IL)-1α, IL-6 and tumor necrosis factor (TNF)α levels in the urinary bladder were increased with cystitis. Our results suggest that MRI can be a useful technique in tracing bladder anatomy and examining bladder hypertrophy in vivo during disease development and the PI3K pathway has a critical role in regulating bladder hypertrophy during cystitis.
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Affiliation(s)
- Zhongwei Qiao
- Children's Hospital of Fudan University, Division of Radiology, Shanghai, China
| | - Chunmei Xia
- Department of Physiology and Pathophysiology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Shanwei Shen
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Frank D. Corwin
- Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Miao Liu
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Ruijuan Guan
- Department of Physiology and Pathophysiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - John R. Grider
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Li-Ya Qiao
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
- * E-mail:
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113
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Flow cytometry analysis using sysmex UF-1000i classifies uropathogens based on bacterial, leukocyte, and erythrocyte counts in urine specimens among patients with urinary tract infections. J Clin Microbiol 2014; 53:539-45. [PMID: 25472486 DOI: 10.1128/jcm.01974-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Urinary tract infections (UTIs) are the second most common bacterial infection. Urine culture is the gold standard for diagnosis, but new techniques, such as flow cytometry analysis (FCA), have been introduced. The aim of the present study was to evaluate FCA characteristics regarding bacteriuria, leukocyturia, and erythrocyturia in relation to cultured uropathogens in specimens from patients with a suspected UTI. We also wanted to evaluate whether the FCA characteristics can identify uropathogens prior to culture. From a prospective study, 1,587 consecutive urine specimens underwent FCA prior to culture during January and February 2012. Outpatients and inpatients (79.6% and 19.4%, respectively) were included, of whom women represented 67.5%. In total, 620 specimens yielded growth, of which Escherichia coli represented 65%, Enterococcus spp. 8%, Klebsiella spp. 7%, and Staphylococcus spp. 5%. For the uropathogens, the outcome of FCA was compared against the results for specimens with E. coli and those with a negative culture. E. coli had high bacterial (median, 17,914/μl), leukocyte (median, 348/μl), and erythrocyte (median, 23/μl) counts. With the exception of Klebsiella spp., the majority of the uropathogens had considerable or significantly lower bacterial counts than that of E. coli. High leukocyte counts were found in specimens with Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, and group C streptococci. Elevated erythrocyte counts were found for P. vulgaris, P. aeruginosa, and group C streptococci, as well as for Staphylococcus saprophyticus. In essence, FCA adds new information about the bacterial, leukocyte, and erythrocyte counts in urine specimens for different uropathogens. Based on FCA characteristics, uropathogens can be classified and identified prior to culture. E. coli and Klebsiella spp. have similar FCA characteristics.
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Bury MI, Fuller NJ, Meisner JW, Hofer MD, Webber MJ, Chow LW, Prasad S, Thaker H, Yue X, Menon VS, Diaz EC, Stupp SI, Cheng EY, Sharma AK. The promotion of functional urinary bladder regeneration using anti-inflammatory nanofibers. Biomaterials 2014; 35:9311-21. [PMID: 25145852 DOI: 10.1016/j.biomaterials.2014.07.057] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/25/2014] [Indexed: 01/06/2023]
Abstract
Current attempts at tissue regeneration utilizing synthetic and decellularized biologic-based materials have typically been met in part by innate immune responses in the form of a robust inflammatory reaction at the site of implantation or grafting. This can ultimately lead to tissue fibrosis with direct negative impact on tissue growth, development, and function. In order to temper the innate inflammatory response, anti-inflammatory signals were incorporated through display on self-assembling peptide nanofibers to promote tissue healing and subsequent graft compliance throughout the regenerative process. Utilizing an established urinary bladder augmentation model, the highly pro-inflammatory biologic scaffold (decellularized small intestinal submucosa) was treated with anti-inflammatory peptide amphiphiles (AIF-PAs) or control peptide amphiphiles and used for augmentation. Significant regenerative advantages of the AIF-PAs were observed including potent angiogenic responses, limited tissue collagen accumulation, and the modulation of macrophage and neutrophil responses in regenerated bladder tissue. Upon further characterization, a reduction in the levels of M2 macrophages was observed, but not in M1 macrophages in control groups, while treatment groups exhibited decreased levels of M1 macrophages and stabilized levels of M2 macrophages. Pro-inflammatory cytokine production was decreased while anti-inflammatory cytokines were up-regulated in treatment groups. This resulted in far fewer incidences of tissue granuloma and bladder stone formation. Finally, functional urinary bladder testing revealed greater bladder compliance and similar capacities in groups treated with AIF-PAs. Data demonstrate that AIF-PAs can alleviate galvanic innate immune responses and provide a highly conducive regenerative milieu that may be applicable in a variety of clinical settings.
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Affiliation(s)
- Matthew I Bury
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL 60614, USA
| | - Natalie J Fuller
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL 60614, USA
| | | | - Matthias D Hofer
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, USA
| | - Matthew J Webber
- Northwestern University, Institute for BioNanotechnology in Medicine (IBNAM), Chicago, IL 60611, USA; Department of Biomedical Engineering, Evanston, IL 60208, USA
| | - Lesley W Chow
- Imperial College London, Royal School of Mines, Department of Materials and Institute for Biomedical Engineering, London, UK
| | - Sheba Prasad
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL 60614, USA
| | - Hatim Thaker
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL 60614, USA
| | - Xuan Yue
- Northwestern University, Institute for BioNanotechnology in Medicine (IBNAM), Chicago, IL 60611, USA
| | - Vani S Menon
- Department of Urology, Loyola University Health System, Maywood, IL 60153, USA
| | - Edward C Diaz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL 60614, USA
| | - Samuel I Stupp
- Northwestern University, Institute for BioNanotechnology in Medicine (IBNAM), Chicago, IL 60611, USA; Northwestern University, Department of Materials Science and Engineering, Evanston, IL 60208, USA; Northwestern University, Department of Chemical and Biological Engineering, Evanston, IL 60208, USA; Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL 60611, USA
| | - Earl Y Cheng
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL 60614, USA; Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, USA; Northwestern University, Institute for BioNanotechnology in Medicine (IBNAM), Chicago, IL 60611, USA
| | - Arun K Sharma
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL 60614, USA; Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, USA; Northwestern University, Institute for BioNanotechnology in Medicine (IBNAM), Chicago, IL 60611, USA; Department of Biomedical Engineering, Evanston, IL 60208, USA.
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115
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Bayrak O, Erturhan S, Seckiner I, Erbagci A, Ustun A, Karakok M. Chemical cystitis developed in experimental animals model: Topical effect of intravesical ozone application to bladder. Urol Ann 2014; 6:122-6. [PMID: 24833822 PMCID: PMC4021650 DOI: 10.4103/0974-7796.130553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 12/31/2012] [Indexed: 11/25/2022] Open
Abstract
Aims: To demonstrate the effects of intravesical ozone treatment on inflammation and epithelial cell damage in chemical cystitis animal model. Materials and Methods: A total of 30 New Zealand rabbits were divided into six groups. Cystitis was conducted with transurethral intravesical hydrochloric acid instillation on the subjects in Groups IA, IB, IIA, and IIB. Then, Group IA-IB subjects were transurethrally administered intravesical ozone therapy twice a week, while Group IIA-IIB subjects were only given intravesical isotonic NaCl instillation. Group IIIA-IIIB subjects were administered intravesical isotonic NaCl instillation without conducting chemical cystitis in order to create the same stress. Treatment schemes of all groups were arranged in the same manner. Following a 3-week (early period) and 6-week (late period) therapy, the rabbits were sacrificed and histopathologic investigations were carried out in order to demonstrate changes in the urinary bladder. Results: In our study, we observed that the basal membrane and mucosal integrity were maintained, inflammatory cells were suppressed in Group IA-IB (Early and late period), which received ozone therapy. However, it was also observed that mucosal integrity was spoiled, numerous inflammatory cells were accumulated in Group IIA-IIB, which was administered isotonic NaCl. Conclusion: Due to its low cost and minimal side effects; ozone therapy could be a new therapeutic approach in the treatment of interstitial cystitis.
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Affiliation(s)
- Omer Bayrak
- Department of Urology, Gaziantep University, Gaziantep, Turkey
| | - Sakip Erturhan
- Department of Urology, Gaziantep University, Gaziantep, Turkey
| | - Ilker Seckiner
- Department of Urology, Gaziantep University, Gaziantep, Turkey
| | - Ahmet Erbagci
- Department of Urology, Gaziantep University, Gaziantep, Turkey
| | | | - Metin Karakok
- Department of Pathology, Gaziantep University, Gaziantep, Turkey
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Akin Y, Bozkurt A, Erol HS, Halici M, Celebi F, Kapakin KAT, Gulmez H, Ates M, Coban A, Nuhoglu B. Impact of Rho-Kinase Inhibitor Hydroxyfasudil in Protamine Sulphate Induced Cystitis Rat Bladder. Low Urin Tract Symptoms 2014; 7:108-14. [PMID: 26663691 DOI: 10.1111/luts.12058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/09/2014] [Accepted: 02/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of the present study was to evaluate anti-inflammatory effects of hydroxyfasudil in a protamine sulfate (PS) induced cystitis rat model. Additionally, we investigated prevention of bladder overactivity (BO), and tissue damage in these experiments. METHODS Animals were divided into four groups. In Groups 1 and 2, chemical induced cystitis model was created by administrating intravesical PS with PE50 catheter by the transurethral route. In Group 1, Rho-kinase inhibitor hydroxyfasudil was administered intaperitoneally, and in Group 2, subjects were administered a corresponding volume of saline in the same way. In Group 3, vehicle was administered intravesically and hydroxyfasudil was administrated intraperitoneally. Group 4 was a control Group, and the vehicle was administered intravesically and intraperitoneally. Micturition frequencies were recorded. Biochemical analyses were performed for oxidative stress, and pathological evaluations were investigated. In vitro contractions of bladder tissue strips were measured in tissue-bath. RESULTS There were significantly lower Lipid peroxidase levels and higher levels of Glutathione in Group 1 than Group 2 (P = 0.016, P = 0.001, respectively). There was generally more inflammation in Group 2 than the other groups as determined by microscopy. There were significantly higher frequencies of micturition, lower volume, and mean voided maximum urine output after PS administration in Groups 1 and 2. In vitro contraction responses of bladder strips to potassium chloride and acetylcholine were statistically higher in Group 2 than Groups 1 and 3. CONCLUSIONS Significant reduction of inflammation by affecting the anti-oxidant defense systems was provided by hydroxyfasudil. Decreased in vitro responses to contractions of bladder smooth muscle strips were obtained. Hydroxyfasudil may be a potential new therapeutic option for inflammation and BO, in rat bladder.
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Affiliation(s)
- Yigit Akin
- Department of Urology, Erzincan University School of Medicine, Erzincan, Turkey
| | - Aliseydi Bozkurt
- Department of Urology, Erzincan University School of Medicine, Erzincan, Turkey
| | - Huseyin S Erol
- Department of Biochemistry, Ataturk University School of Veterinary Medicine, Erzurum, Turkey
| | - Mesut Halici
- Department of Biochemistry, Ataturk University School of Veterinary Medicine, Erzurum, Turkey
| | - Fikret Celebi
- Department of Physiology, Ataturk University School of Veterinary Medicine, Erzurum, Turkey
| | - Kubra A T Kapakin
- Department of Pathology, Ataturk University School of Veterinary Medicine, Erzurum, Turkey
| | - Hakan Gulmez
- Department of Family Medicine, Baskent University School of Medicine, Ankara, Turkey
| | - Mutlu Ates
- Department of Urology, Afyonkocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Abdulkadir Coban
- Department of Biochemistry, Erzincan Universty School of Medicine, Erzincan, Turkey
| | - Baris Nuhoglu
- Department of Urology, Erzincan University School of Medicine, Erzincan, Turkey
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The role(s) of cytokines/chemokines in urinary bladder inflammation and dysfunction. BIOMED RESEARCH INTERNATIONAL 2014; 2014:120525. [PMID: 24738044 PMCID: PMC3971501 DOI: 10.1155/2014/120525] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/26/2014] [Accepted: 02/05/2014] [Indexed: 12/17/2022]
Abstract
Bladder pain syndrome (BPS)/interstitial cystitis (IC) is a chronic pain syndrome characterized by pain, pressure, or discomfort perceived to be bladder related and with at least one urinary symptom. It was recently concluded that 3.3-7.9 million women (>18 years old) in the United States exhibit BPS/IC symptoms. The impact of BPS/IC on quality of life is enormous and the economic burden is significant. Although the etiology and pathogenesis of BPS/IC are unknown, numerous theories including infection, inflammation, autoimmune disorder, toxic urinary agents, urothelial dysfunction, and neurogenic causes have been proposed. Altered visceral sensations from the urinary bladder (i.e., pain at low or moderate bladder filling) that accompany BPS/IC may be mediated by many factors including changes in the properties of peripheral bladder afferent pathways such that bladder afferent neurons respond in an exaggerated manner to normally innocuous stimuli (allodynia). The goals for this review are to describe chemokine/receptor (CXCL12/CXCR4; CCL2/CCR2) signaling and cytokine/receptor (transforming growth factor (TGF-β)/TGF-β type 1 receptor) signaling that may be valuable LUT targets for pharmacologic therapy to improve urinary bladder function and reduce somatic sensitivity associated with urinary bladder inflammation.
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118
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Lv YS, Yao YS, Rong L, Lin ME, Deng BH, Xie Y, Huang H, Lin TX, Xu KW, Huang J. Intravesical hyaluronidase causes chronic cystitis in a rat model: a potential model of bladder pain syndrome/interstitial cystitis. Int J Urol 2013; 21:601-7. [PMID: 24286489 DOI: 10.1111/iju.12358] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/29/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine whether a potential rat model of bladder pain syndrome could be developed through long-term intermittent intravesical hyaluronidase. METHODS A total of 64 female Sprague-Dawley rats were divided into a control group, a low-dose hyaluronidase (1 mg/mL) group, a high-dose hyaluronidase (4 mg/mL) group and a hyaluronic acid-treated group. Hyaluronidase was given intravesically three times a week for 1 month. Hyaluronic acid (0.5 mL, 0.8 mg/mL) was introduced intravesically to hyaluronidase-treated rats' bladders. Histological changes, cystometry, nociceptive behaviors, and messenger ribonucleic acid levels of inflammatory factors were evaluated and compared between groups. RESULTS All hyaluronidase-treated rats showed chronic inflammation and fibrosis, increased and activated mast cells, thinned bladder epithelium with abnormal expressions of uroplakin III and zonula occluden-1, and increased levels of interleukin-6 and intercellular adhesion molecule-1 messenger ribonucleic acid. However, the inflammatory score and levels of interleukin-6 and intercellular adhesion molecule-1 were more significant in the high-dose hyaluronidase group than in the low-dose hyaluronidase group (P < 0.01). Furthermore, hyaluronidase-treated rats showed markedly decreased intercontraction intervals, bladder capacity and increased sensitivity to pain compared with controls (P < 0.01). Hyaluronic acid treatment significantly decreased the inflammatory level, number of mast cells, sensitivity to pain, levels of interleukin-6 and intercellular adhesion molecule-1, and increased intercontraction intervals and bladder capacity (P < 0.01). CONCLUSIONS Long-term intermittent intravesical hyaluronidase could develop a severe chronic cystitis with diffused fibrosis accompanied by altered histology and bladder function. This chronic cystitis rat model can resemble the clinical and histopathological features of human bladder pain syndrome, and might be a potential valuable model for investigation of this troublesome disease.
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Affiliation(s)
- Yi Song Lv
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Department of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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119
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Gheinani AH, Burkhard FC, Monastyrskaya K. Deciphering microRNA code in pain and inflammation: lessons from bladder pain syndrome. Cell Mol Life Sci 2013; 70:3773-89. [PMID: 23463234 PMCID: PMC11113193 DOI: 10.1007/s00018-013-1275-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/22/2013] [Accepted: 01/28/2013] [Indexed: 02/06/2023]
Abstract
MicroRNAs (miRNAs), a novel class of molecules regulating gene expression, have been hailed as modulators of many biological processes and disease states. Recent studies demonstrated an important role of miRNAs in the processes of inflammation and cancer, however, there are little data implicating miRNAs in peripheral pain. Bladder pain syndrome/interstitial cystitis (BPS/IC) is a clinical syndrome of pelvic pain and urinary urgency/frequency in the absence of a specific cause. BPS is a chronic inflammatory condition that might share some of the pathogenetic mechanisms with its common co-morbidities inflammatory bowel disease (IBD), asthma and autoimmune diseases. Using miRNA profiling in BPS and the information about validated miRNA targets, we delineated the signaling pathways activated in this and other inflammatory pain disorders. This review projects the miRNA profiling and functional data originating from the research in bladder cancer and immune-mediated diseases on the BPS-specific miRNAs with the aim to gain new insight into the pathogenesis of this enigmatic disorder, and highlighting the common regulatory mechanisms of pain and inflammation.
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Affiliation(s)
- Ali Hashemi Gheinani
- Department of Clinical Research, Urology Research Laboratory, University of Bern, Murtenstrasse 35, 3010 Bern, Switzerland
| | | | - Katia Monastyrskaya
- Department of Clinical Research, Urology Research Laboratory, University of Bern, Murtenstrasse 35, 3010 Bern, Switzerland
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120
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GAGs and GAGs diseases: when pathophysiology supports the clinic. Urologia 2013; 80:173-8. [PMID: 24526593 DOI: 10.5301/ru.2013.11500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 11/20/2022]
Abstract
The urinary epithelium has been the subject of considerable interest and much research in recent years. What has radically changed in the last decade is the concept of what the bladder epithelium really is. It is currently no longer considered just a simple barrier and a non-specific defence against infections, and it has been recognized as a specialized tissue regulating complex bladder functions and playing a fundamental and active role in the pathogenesis of cystitis. Researchers have been focussing on the receptors and mediators that are active in the sub-epithelial layer, with the hope that understanding the role of the urothelium defect will offer the opportunity for new therapeutic strategies. On the surface of the urothelial umbrella-cells there is a thick layer of glycoproteins and proteoglycans, which together are called Glycosaminoglycans (GAGs). They constitute a hydrophilic mucosal coating and act as a barrier against solutes found in urine. In recent years they have received special attention because injury to Gags, due to different noxae, has been identified as the first step in the genesis of chronic inflammatory bladder diseases, such as recurrent urinary tract infections, chemical or radiation cystitis, interstitial cystitis and/or Bladder Pain Syndrome. Aim of this study is to define the importance of the urothelium starting from the anatomy and physiology of the bladder wall. Furthermore, we will underline the role of glycosaminoglycans, focusing both on their pathophysiological role in the principal bladder diseases and on the therapeutic aspects from the clinical point of view.
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121
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Chung KH, Liu SP, Lin HC, Chung SD. Bladder pain syndrome/interstitial cystitis is associated with anxiety disorder. Neurourol Urodyn 2013; 33:101-5. [PMID: 24038135 DOI: 10.1002/nau.22382] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 01/17/2013] [Indexed: 01/27/2023]
Abstract
AIM Recent research demonstrated that bladder pain syndrome/interstitial cystitis (BPS/IC) is associated with many coexisting physical and psychiatric conditions. In this study, we explored the potential association between anxiety disorder (AD) and BPS/IC using a case-controlled population-based approach in Taiwan. METHODS Data on the sampled subjects analyzed in this study were retrieved from the Longitudinal Health Insurance Database 2000. Our study included 396 female cases with BPS/IC and 1,980 randomly selected female controls. We excluded subjects who had a history of major psychosis (except AD) or a substance-related disorder. A conditional logistic regression was performed to calculate the odds ratio (OR) for the association between a previous diagnosis of AD and IC/BPS. RESULTS Of the 2,376 sampled subjects, 136 (5.72%) had received an AD diagnosis. AD was found in 64 (16.16%) cases and in 72 (3.64%) controls (P < 0.001). The conditional logistic regression analysis (conditioned on age group and the index year) suggested that compared to controls, the OR for prior AD among cases was 4.59 (95% confidence interval (CI) = 2.32-9.08, P < 0.001). After adjusting for chronic pelvic pain, irritable bowel syndrome, fibromyalgia, migraines, sicca syndrome, allergies, asthma, and an overactive bladder, the OR for prior AD among cases was 4.37 (95% CI = 2.16-8.85, P < 0.001) compared to the controls. CONCLUSIONS There was an association between AD and BPS/IC, even after taking demographic characteristics, medical co-morbidities, and substance-related disorders into consideration. Results of this study should alert clinicians to evaluate and monitor the presence of BPS/IC in patients with AD.
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Affiliation(s)
- Kuo-Hsuan Chung
- Departmentof Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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122
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Gonzalez EJ, Girard BM, Vizzard MA. Expression and function of transforming growth factor-β isoforms and cognate receptors in the rat urinary bladder following cyclophosphamide-induced cystitis. Am J Physiol Renal Physiol 2013; 305:F1265-76. [PMID: 23926183 DOI: 10.1152/ajprenal.00042.2013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Numerous proinflammatory cytokines have been implicated in the reorganization of lower urinary tract function following cyclophosphamide (CYP)-induced cystitis. The present study investigated the functional profile of three pleiotropic transforming growth factor-β (TGF-β) isoforms and receptor (TβR) variants in the normal and inflamed (CYP-induced cystitis) rat urinary bladder. Our findings indicate that TGF-β (1, 2, and 3) and TβR (1, 2, and 3) transcript and protein expression were regulated to varying degrees in the urothelium or detrusor smooth muscle following intermediate (48 h; 150 mg/kg ip) or chronic (75 mg/kg ip; once every 3 days for 10 days), but not acute (4 h; 150 mg/kg ip), CYP-induced cystitis. Conscious, open-outlet cystometry was performed to determine whether aberrant TGF-β signaling contributes to urinary bladder dysfunction following intermediate (48 h) CYP-induced cystitis. TβR-1 inhibition with SB505124 (5 μM) significantly (p ≤ 0.001) decreased voiding frequency and increased bladder capacity (2.5-fold), void volume (2.6-fold), and intercontraction intervals (2.5-fold) in CYP-treated (48 h) rats. Taken together, these results provide evidence for 1) the involvement of TGF-β in lower urinary tract neuroplasticity following urinary bladder inflammation, 2) a functional role of TGF-β signaling in the afferent limb of the micturition reflex, and 3) urinary bladder TβR-1 as a viable target to reduce voiding frequency with cystitis.
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Affiliation(s)
- Eric J Gonzalez
- Univ. of Vermont College of Medicine, Dept. of Neurological Sciences, D415A Given Research Bldg., Burlington, VT 05405.
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Chen MC, Meckfessel MH. Autoinflammatory Disorders, Pain, and Neural Regulation of Inflammation. Dermatol Clin 2013; 31:461-70. [DOI: 10.1016/j.det.2013.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Crumley S, Ge Y, Zhou H, Shen SS, Ro JY. Interstitial cystitis: another IgG4-related inflammatory disease? Ann Diagn Pathol 2013; 17:403-7. [PMID: 23732167 DOI: 10.1016/j.anndiagpath.2013.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/01/2013] [Indexed: 01/08/2023]
Abstract
Interstitial cystitis (IC) is a disease of undetermined etiology and pathogenesis. Inflammation is thought to play a key role in many patients, characteristically with an increase in mast cells within the detrusor muscle of the bladder. We observed that some patients with IC had prominent plasma cells in bladder tissue, which elicited our interest in their possible pathogenic role in patients with IC. A total of 44 cases of IC were collected, including 42 bladder biopsies and 2 cystectomies. Patient age ranged from 18 to 92 years (average age of 49.5 years) and included 7 male and 37 female patients. The histology and immunostains for IgG, IgG4 and tryptase were examined, and the results were correlated with clinical and cystoscopic findings. Four cases showed a significant increase in IgG4-positive plasma cells, with greater than 30 IgG4 plasma cells per high-power field and an IgG4/IgG ratio greater than 0.5. In addition, statistically significant differences were found between IC with IgG4-positive plasma cells vs IgG4-negative cases. The IgG4-positive patients were of older age and had increased severe inflammation and decreased bladder capacity as compared with the IgG4-negative patients. We propose that a subset of patients with IC may have an IgG4-related disease, and further study including serum IgG4 measurement is required to better define this relationship.
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Affiliation(s)
- Suzanne Crumley
- Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, TX
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Zhang HP, Li CL, Lu P, Zheng JC, Yu LL, Yang WM, Xiong F, Zeng XY. The function of P2X3 receptor and NK1 receptor antagonists on cyclophosphamide-induced cystitis in rats. World J Urol 2013; 32:91-7. [PMID: 23666265 DOI: 10.1007/s00345-013-1098-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/06/2013] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The purpose of the study is to explore the function of P2X3 and NK1 receptors antagonists on cyclophosphamide (CYP)-induced cystitis in rats. METHODS Sixty female Sprague-Dawley (SD) rats were randomly divided into three groups. The rats in the control group were intraperitoneally (i.p.) injected with 0.9% saline (4 ml/kg); the rats in the model group were i.p. injected with CYP (150 mg/kg); and the rats in the intervention group were i.p. injected with CYP with subsequently perfusion of bladder with P2X3 and NK1 receptors' antagonists, Suramin and GR 82334. Spontaneous pain behaviors following the administration of CYP were observed. Urodynamic parameters, bladder pressure-volume curve, maximum voiding pressure (MVP), and maximum cystometric capacity (MCC), were recorded. Pathological changes in bladder tissue were observed. Immunofluorescence was used to detect the expression of P2X3 and NK1 receptors in bladder. RESULTS Cyclophosphamide treatment increased the spontaneous pain behaviors scores. The incidence of bladder instability during urine storage period of model group was significantly higher than intervention group (χ(2) = 7.619, P = 0.007) and control group (χ(2) = 13.755, P = 0.000). MCC in the model group was lower than the control and intervention groups (P < 0.01). Histological changes evident in model and intervention groups rats' bladder included edema, vasodilation, and infiltration of inflammatory cells. In model group, the expression of P2X3 receptor increased in urothelium and suburothelium, and NK1 receptor increased in suburothelium, while the expression of them in intervention group was lower. CONCLUSIONS In CYP-induced cystitis, the expression of P2X3 and NK1 receptors increased in urothelium and/or suburothelium. Perfusion of bladder with P2X3 and NK1 receptors antagonists ameliorated the bladder function.
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Affiliation(s)
- Hui-ping Zhang
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
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Homan T, Tsuzuki T, Dogishi K, Shirakawa H, Oyama T, Nakagawa T, Kaneko S. Novel mouse model of chronic inflammatory and overactive bladder by a single intravesical injection of hydrogen peroxide. J Pharmacol Sci 2013; 121:327-37. [PMID: 23545478 DOI: 10.1254/jphs.12265fp] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
There is so far no generally accepted animal model of chronic cystitis by which potential therapies can be evaluated. In this study, we aimed to establish a new mouse model of cystitis based on the proinflammatory effects of reactive oxygen species. A single intravesical injection of 1.5% hydrogen peroxide (H2O2) significantly increased the numbers of voids by 1 day after injection in female mice, which lasted up to 7 days. The H2O2 injection rapidly increased the bladder weight by 3 h in parallel with the histological damage and hyperpermeability of urothelial barrier. Although the urothelial dysfunction was recovered to normal by 7 days, increase in bladder weight, edematous thickening of the submucosa, and vascular hyperpermeability were apparent even 7 days after injection. During the time course, massive infiltration of neutrophils and increased expression of inflammatory cytokines were observed in the bladder. An intraperitoneal administration of oxybutynin, amitriptyline, indomethacin, or morphine attenuated the H2O2-induced frequent urination. These findings suggest that an intravesical injection of H2O2 induces relatively long-lasting inflammatory and overactive bladder, compared with existing cystitis models. The intravesical H2O2 injection model may be a simple and useful tool in the pathological study and drug discovery for chronic cystitis.
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Affiliation(s)
- Takashi Homan
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Japan
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127
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An Economic Perspective on Urinary Tract Infection: The “Costs of Resignation”. Clin Drug Investig 2013; 33:255-61. [DOI: 10.1007/s40261-013-0069-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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128
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Lv YS, Yao YS, Lin ME, Rong L, Deng BH, Huang J, Hao WP. Interleukin-6 levels in female rats with protamine sulfate-induced chronic cystitis treated with hyaluronic acid. Int J Urol 2013; 20:1017-22. [PMID: 23379983 DOI: 10.1111/iju.12090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 12/26/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - You-Sheng Yao
- Department of Urology; Sun Yat-sen Memorial Hospital; Sun Yat-sen University; Guangzhou; China
| | | | - Lu Rong
- Department of Urology; Sun Yat-sen Memorial Hospital; Sun Yat-sen University; Guangzhou; China
| | - Bi-Hua Deng
- Department of Urology; Sun Yat-sen Memorial Hospital; Sun Yat-sen University; Guangzhou; China
| | - Jian Huang
- Department of Urology; Sun Yat-sen Memorial Hospital; Sun Yat-sen University; Guangzhou; China
| | - Wei-Ping Hao
- Department of Urology; Sun Yat-sen Memorial Hospital; Sun Yat-sen University; Guangzhou; China
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129
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Keller J, Chen YK, Lin HC. Association of bladder pain syndrome/interstitial cystitis with urinary calculus: a nationwide population-based study. Int Urogynecol J 2012; 24:565-71. [PMID: 22895546 DOI: 10.1007/s00192-012-1917-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/02/2012] [Indexed: 02/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Although one prior study reported an association between bladder pain syndrome/interstitial cystitis (BPS/IC) and urinary calculi (UC), no population-based study to date has been conducted to explore this relationship. Therefore, using a population-based data set in Taiwan, this study set out to investigate the association between BPS/IC and a prior diagnosis of UC. METHODS This study included 9,269 cases who had received their first-time diagnosis of BPS/IC between 2006 and 2007 and 46,345 randomly selected controls. We used conditional logistic regression analysis to compute the odds ratio (OR) and its corresponding 95 % confidence interval (CI) for having been previously diagnosed with UC between cases and controls. RESULTS There was a significant difference in the prevalence of prior UC between cases and controls (8.1 vs 4.3 %, p < 0.001). Conditional logistic regression analysis revealed that cases were more likely to have been previously diagnosed with UC than controls (OR = 1.70; 95 % CI = 1.56-1.84) after adjusting for chronic pelvic pain, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, depression, panic disorder, migraine, sicca syndrome, allergy, endometriosis, and asthma. BPS/IC was found to be significantly associated with prior UC regardless of stone location; the adjusted ORs of kidney calculus, ureter calculus, bladder calculus, and unspecified calculus when compared to controls were 1.58 (95 % CI = 1.38-1.81), 1.73 (95 % CI = 1.45-2.05), 3.80 (95 % CI = 2.18-6.62), and 1.83 (95 % CI = 1.59-2.11), respectively. CONCLUSIONS This work generates the hypothesis that UC may be associated with BPS/IC.
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Affiliation(s)
- Joseph Keller
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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Lv YS, Zhou HL, Mao HP, Gao R, Wang YD, Xue XY. Intravesical hyaluronic acid and alkalinized lidocaine for the treatment of severe painful bladder syndrome/interstitial cystitis. Int Urogynecol J 2012; 23:1715-20. [DOI: 10.1007/s00192-012-1802-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
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