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Porru D, Bobbi V, Di Franco C, Viglio A, Novario M, Tinelli C, Gardella B, Nappi R, Spinillo A, Paulli M, Rovereto B. Clinical and histological findings in bladder pain syndrome/interstitial cystitis: The implication of time of symptoms. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817747474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To find out whether a correlation exists between denudation of urothelium and time of symptom onset in patients with bladder pain syndrome/interstitial cystitis (BPS/IC), and to search for a correlation between the impact of symptoms. Patients and methods: Fifty-seven consecutive patients underwent cystoscopy under anaesthesia to classify those cases suspected of being affected with BPS/IC. The time elapsed between onset of symptoms and diagnosis at the time of bladder biopsy was also defined as BPS/IC duration. Bladder biopsies were taken including detrusor muscle, three deep cold biopsies of posterior, anterior and lateral bladder wall. Results: Statistical analysis showed significant correlation between BPS/IC duration and the presence of Hunner’s lesions ( P<0.023). Hunner’s lesion with cystoscopy and histological evidence of urothelial denudation with bladder biopsy appear to be related to BPS/IC duration. Thus an early diagnosis allows an appropriate therapeutic approach to be started to prevent a more severe evolution of this multifaceted painful syndrome. Conclusions: Our study shows a correlation between the time of symptom onset and evidence of urothelial denudation and with detrusor mast cell count in the whole group of patients. BPS/IC duration did not seem to correlate with the severity of symptoms, but rather with the presence of associated diseases. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Daniele Porru
- Urology Department, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Valentina Bobbi
- Urology Department, Fondazione IRCCS Policlinico San Matteo, Italy
| | | | - Alessandra Viglio
- Molecular Medicine Department, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Mattia Novario
- Molecular Medicine Department, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Barbara Gardella
- Obstetric and Gynecological Clinic, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Rossella Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Arsenio Spinillo
- Obstetric and Gynecological Clinic, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Marco Paulli
- Molecular Medicine Department, Fondazione IRCCS Policlinico San Matteo, Italy
| | - Bruno Rovereto
- Urology Department, Fondazione IRCCS Policlinico San Matteo, Italy
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Yamada Y, Nomiya A, Niimi A, Igawa Y, Ito T, Tomoe H, Takei M, Ueda T, Homma Y. A survey on clinical practice of interstitial cystitis in Japan. Transl Androl Urol 2016; 4:486-90. [PMID: 26816847 PMCID: PMC4708551 DOI: 10.3978/j.issn.2223-4683.2015.08.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background To explore the real-life practice of clinical management of interstitial cystitis (IC) in Japan. Methods A questionnaire on the number of IC patients, cystoscopic findings, diagnostic methods, and the treatment modalities was sent via e-mail to 114 medical institutions belonging to the Society of Interstitial Cystitis of Japan (SICJ). Results Completed questionnaires were returned from 62 institutions (20 university hospitals, 26 general hospitals and 16 clinics), with a response rate of 54%. The median of patient number per institution was 20 and the national number of IC patients was counted as 4,531 in Japan. The number of new patients in 2013 was 7 (median) per institution and calculated as 1,214 in total. The case volume per institution distributed broadly and skewed to a lower volume. The patients were categorized according to cystoscopic findings as either Hunner type IC with Hunner lesions (n=2,066, 45%), non-Hunner type IC with glomerulations on hydrodistension (n=1,720, 38%) or hypersensitive bladder without endoscopic abnormalities (n=304, 7%), excluding unknown (n=441, 10%). The proportion of Hunner type IC was highly variable among the institutions, ranging from 0% to 100% with a median of 29%. As for evaluation, symptom and quality of life (QOL) assessment by questionnaires, frequency volume chart, urinalysis, urine cytology, urine culture, post-void residual measurement, uroflowmetry, ultrasound and cystoscopy were widely adapted. Administration of oral medicines and intravesical instillation therapy were undertaken at 98% and 63% of institutions, respectively. Hydrodistension was commonly performed, totaling in 812 procedures at 53 institutions, while only five cystectomies were reported from four institutions. Conclusions The survey estimated about 4,500 IC patients and 2,000 Hunner type IC patients in Japan. It also revealed a wide range of case volume, acceptable adherence to clinical guidelines, and high variability in the proportion of Hunner type IC. The variable proportions of Hunner type IC despite a high performing rate of endoscopy suggest inconsistency in diagnostic criteria for the Hunner lesion.
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Affiliation(s)
- Yukio Yamada
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Akira Nomiya
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Aya Niimi
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Yasuhiko Igawa
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Takaaki Ito
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Hikaru Tomoe
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Mineo Takei
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Tomohiro Ueda
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Yukio Homma
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
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