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Rahnama’i MS, Marand AJB, Janssen D, Mostafaei H, Gatsos S, Hajebrahimi S, Apostolidis A, Taneja R. Botulinum Toxin Therapy for Bladder Pain Syndrome/Interstitial Cystitis. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Abstract
Purpose of Review
Bladder pain syndrome (BPS)/interstitial cystitis (IC) can also be classified as either non-ulcerative or ulcerative, corresponding to the characteristic cystoscopic findings under hydrodistention. Promising therapeutic effects, including decreased bladder pain, have been reported from recent clinical trials using botulinum toxin A (BoNTA) for the treatment of BPS/IC. This review summarizes the current state of the literature on the underlying mechanisms of BoNTA therapy in BPS/IC as well as new forms of its application.
Recent Findings
BoNTA has its effect in the central nervous system in the afferent nerves as well as in the bladder wall. Besides the well-known effects of BoNTA in the nervous system, pain control as well as reduction of urinary urgency in BPS patients could be achieved by mast cell stabilization effecting histamine release as well as modulation of TRPV and PGE2 pathways, among other systems. In addition, new forms of BoNTA administration have focused on intravesical instillation of the drug in order to circumvent bladder wall injections. Hyperthermia, intravesical hydrogel, and lysosomes have been studied as new ways of BoNTA application in BPS/IC patients. From the available studies, bladder instillation of BoNTA in combination with EMDA is the most promising and effective novel approach.
Summary
The most promising novel application methods for BoNTA in patient with BPS/IC are bladder instillations. Future research needs to point out if bladder instillations with BoNTA with some form of bladder absorption enhancement such as hyperthermia or EMDA would be able to replace BoNTA injections in patients with BPS/IC
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Adelugba I, Siddiqui S, Aziz A, De EJB, Wolff G. Interstitial Cystitis/Bladder Pain Syndrome: What Today’s Urologist Should Know. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-022-00676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Clinical Approach to Recurrent Voiding Dysfunction, Dysuria, and Pelvic Pain Persisting for at Least 3 Months. Int Neurourol J 2022; 26:179-189. [PMID: 36203251 PMCID: PMC9537430 DOI: 10.5213/inj.2244200.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/18/2022] [Indexed: 11/08/2022] Open
Abstract
There are several patients with urination problems and urethral and pelvic discomfort. Usually, these patients’ symptoms are persistent and ambiguous; therefore, it is difficult to find underlying diseases associated with the patient’s symptoms. In addition, there are various conditions such as overactive bladder, cystitis, and interstitial cystitis/bladder pain syndrome (IC/BPS). Sometimes patients with other chronic disorders such as fibromyalgia, inflammatory bowel syndrome, and vulvodynia show urination problems and pelvic pain. Thus, a patient-centered approach is important to find the cause of chronic urination problems and pelvic pain. Moreover, IC/BPS should be considered during the diagnostic process because the clinical characteristics of IC/BPS are diverse. In this narrative review, we suggest an integral approach for the diagnosis and treatment of IC/ BPS.
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Dobberfuhl AD. Pathophysiology, assessment, and treatment of overactive bladder symptoms in patients with interstitial cystitis/bladder pain syndrome. Neurourol Urodyn 2022; 41:1958-1966. [PMID: 35607890 DOI: 10.1002/nau.24958] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/25/2022] [Accepted: 05/05/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Interstitial cystitis/bladder pain syndrome (IC/BPS) is prevalent, difficult to treat, and has close symptom overlap with overactive bladder (OAB). A review of the pathophysiology, assessment, and treatment of IC/BPS patients with overlapping OAB symptoms has not been summarized recently in the published literature. METHODS A review of the published literature on the overlap of IC/BPS and OAB was conducted using MeSH terminology (1992-2022). RESULTS The pathophysiology of IC/BPS is not fully understood. Animal research has found the bladder trigone and base are richly populated by afferent fibers, including many small unmyelinated C-fibers that may be upregulated in IC/BPS. Successful therapies with multimodal effects on OAB symptoms in patients with IC/BPS are likely to exert beneficial effects on both pain and lower urinary tract symptoms. Potentially efficacious therapies for the treatment of OAB in IC/BPS include pelvic floor physical therapy, oral pharmacotherapy (antimuscarinics and beta-3 agonists), sacral neuromodulation, percutaneous tibial nerve stimulation, and botulinum toxin A (BTA). Antimuscarinics and beta-3 agonists have yielded partial efficacy in IC/BPS, although may help differentiate symptoms of OAB from those associated with IC/BPS. The transvaginal trigone treatment (T3) intradetrusor injection approach allows for delivery of therapeutics to the bladder without the need for a cystoscope and appears to be feasible. CONCLUSIONS Further research is needed to understand the pathophysiology of IC/BPS and symptom overlap with OAB, which in turn should enable the development of more personalized therapeutics.
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Affiliation(s)
- Amy D Dobberfuhl
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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Bschleipfer T, Kaftan B. [Interstitial cystitis: interventions and surgery - more than a last resort?]. Aktuelle Urol 2021; 52:561-568. [PMID: 34847608 DOI: 10.1055/a-1668-2975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Interstitial cystitis is an underdiagnosed chronic-relapsing to chronic-progressive urinary bladder disease, whose pathogenesis and aetiology has not been fully elucidated. The disease itself cannot be cured and treatment is symptomatic. Treatment options comprise conservative and medicinal approaches as well as a large number of interventional/surgical procedures. These include intravesical instillation, transurethral procedures such as injections of botulinum toxin A, corticosteroids and local anaesthetics, hydrodistension and neuromodulation as well as (laser) fulguration, resection and cystectomy. Although surgical procedures are considered a late option and are often referred to as last-resort therapy, these interventional options often show good to very good response rates, manageable complications and a favourable risk-benefit evaluation. An overall generalisation of surgery as a last-resort treatment option should therefore be avoided and its use should be discussed based on the individual needs of each patient.
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Affiliation(s)
- Thomas Bschleipfer
- Klinik für Urologie, Andrologie und Kinderurologie, Interdisziplinäres Kontinenz- und Beckenbodenzentrum, Zentrum für Interstitielle Zystitis (IC) und Beckenschmerz, Klinikum Weiden/Klinken Nordoberpfalz AG, Weiden, Germany
| | - Björn Kaftan
- Klinik für Urologe, Interdisziplinäres Kontinenz- und Beckenbodenzentrum, Zentrum für Interstitielle Zystitis (IC) und Beckenschmerz, Städtisches Klinikum Lüneburg gGmbH, Lüneburg, Germany
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Trama F, Illiano E, Marchesi A, Brancorsini S, Crocetto F, Pandolfo SD, Zucchi A, Costantini E. Use of Intravesical Injections of Platelet-Rich Plasma for the Treatment of Bladder Pain Syndrome: A Comprehensive Literature Review. Antibiotics (Basel) 2021; 10:antibiotics10101194. [PMID: 34680774 PMCID: PMC8532598 DOI: 10.3390/antibiotics10101194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Bladder pain syndrome/interstitial cystitis (BPS/IC) or primary bladder pain syndrome (PBPS) is a complex and poorly understood condition. This comprehensive review aimed to discuss the potential application of platelet-rich plasma (PRP) in the treatment of BPS/IC. The pathophysiology of BPS/IC is characterized by urothelial damage that triggers a chain of events leading to chronic inflammation and other conditions. Frequently, in subjects affected by BPS/IC, recurrent urinary tract infection (rUTI) is associated with difficult therapeutic management. For these reasons, many oral and intravesical treatments (e.g., antibiotic therapy and intravesical anesthetic instillations) have been proposed to alleviate the symptoms of IC/BPS. However, the limitation of these treatments is the short duration of improvement. The purpose of this review is to analyze the efficacy of intravesical PRP injections in subjects with PBS/IC and to try to understand the potential therapeutic effects on the pathophysiology of this disease. METHODS A nonsystematic literature search using Pubmed, EMBASE, Scopus, Web of Science, Medline was performed from January 2000 to August 2021. The following terms were combined to capture relevant publications: "platelet-rich plasma", "interstitial cystitis", "PRP", "bladder pain syndrome", and "painful bladder syndrome". RESULTS After exclusion of non-pertinent studies/articles, we have analyzed 5 studies. In detail, 2 articles concerned preclinical studies in which animal models were used. The authors showed an improvement in the histological pattern with less bleeding in treated subjects, a lower presence of inflammatory cytokines and an increase in the mitotic index of urothelial cells in animals treated with intravesical PRP. In the three prospective clinical trials analyzed, patients with BPS/IC who underwent monthly intravesical PRP injections were found to have a statistically significant improvement in symptoms with modulation of growth factors and inflammatory proteins. CONCLUSIONS New evidence suggests that treatment with intravesical PRP could improve urothelial regeneration and reduces chronic inflammation in BPS/IC, modifying the clinical history of its pathology.
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Affiliation(s)
- Francesco Trama
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Umbria, IT Viale Tristano di Joannuccio, 05100 Terni, Italy; (E.I.); (A.M.); (E.C.)
- Correspondence: ; Tel.: +39-0744-20520
| | - Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Umbria, IT Viale Tristano di Joannuccio, 05100 Terni, Italy; (E.I.); (A.M.); (E.C.)
| | - Alessandro Marchesi
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Umbria, IT Viale Tristano di Joannuccio, 05100 Terni, Italy; (E.I.); (A.M.); (E.C.)
| | - Stefano Brancorsini
- Department of Experimental Medicine, University of Perugia, 05100 Terni, Italy;
| | - Felice Crocetto
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Federico II, 80100 Naples, Italy; (F.C.); (S.D.P.)
| | - Savio Domenico Pandolfo
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Federico II, 80100 Naples, Italy; (F.C.); (S.D.P.)
| | - Alessandro Zucchi
- Urology Unit, Department of Translational Research and New Technologies, University of Pisa, 56010 Pisa, Italy;
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Umbria, IT Viale Tristano di Joannuccio, 05100 Terni, Italy; (E.I.); (A.M.); (E.C.)
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Kabay S, Kabay SC, Sevim M. First-line treatment posterior tibial nerve stimulation in patients with interstitial cystitis/bladder pain syndrome. Cent European J Urol 2021; 74:208-214. [PMID: 34336240 PMCID: PMC8318015 DOI: 10.5173/ceju.2021.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to determine the effects of first-line treatment posterior tibial nerve stimulation (PTNS), applied once a week for a 12 week period, as a treatment modality for patients with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). Material and methods A total of 39 female patients with IC/BPS were enrolled in the study. Patients had one 30-minute session of PTNS per week for 12 weeks and symptoms were assessed before and after the treatment sessions by the use of a voiding diary, visual analog scale (VAS) for pain, O'Leary-Sant interstitial cystitis symptom index (ICSI), and O'Leary-Sant interstitial cystitis problem index (ICPI). Results The mean age of the patients was 38.9 ±7.1 years. The improvements in voiding diary parameters after 12 weeks of PTNS treatment were statistically significant compared to baseline but the changes in nocturia, and average voiding volume were not statistically significant. Mean parametric improvements after 12 weeks of PTNS treatment compared to baseline included a daytime frequency decrease by 3.8 voids daily, urgency episodes decrease by 4.7 episodes daily, nocturia decrease by 0.3 voids and voided volume improvement by a mean of 8.4 ml. The difference for ICSI, ICPI and VAS between baseline and the 12th week of PTNS treatment scores demonstrated statistically significant improvements in pain severity, symptom and problem index. Conclusions The findings in this study demonstrated the improvements of voiding diaries, ICSI, ICPI and VAS scores in patients with IC/BPS after 12 weeks PTNS. PTNS treatment is a beneficial firs-line treatment option to IC/BPS symptom amelioration.
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Affiliation(s)
- Sahin Kabay
- Altinbas University Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - Sibel Canbaz Kabay
- Kutahya Health Sciences University, Faculty of Medicine, Department of Neurology, Kutahya, Turkey
| | - Mehmet Sevim
- Kutahya Health Sciences University, Faculty of Medicine, Department of Urology, Kutahya, Turkey
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Mateu Arrom L, Gutierrez Ruiz C, Palou J, Errando-Smet C. Onabotulinumtoxin a injection with or without hydrodistension for treatment of bladder pain syndrome. Int Urogynecol J 2020; 32:1213-1219. [PMID: 32725367 DOI: 10.1007/s00192-020-04451-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Onabotulinumtoxin A (BoNT-A) injection has been used for bladder pain syndrome (BPS) treatment with good results. Our aim was to assess the efficacy and safety of BoNT-A injection with or without hydrodistension (HD). METHODS Retrospective analysis of patients treated with BoNT-A injection with or without HD because of BPS between 2008 and 2014 in our department. One hundred U of Botox® was injected in the trigone and 100 U in the bladder wall. Follow-up included a VAS of pain (0-10), a patient satisfaction scale (0-10) and a treatment benefit scale (1-2: response to treatment; 3-4: non-response to treatment). Complications were classified according to the Clavien-Dindo (CD) classification. BoNT-A retreatment was offered at the patient's request. Reasons for non-retreatment request were collected. Postoperative outcomes were compared between BoNT-A and BoNT-A + HD. RESULTS Forty-one patients were included (39 females, 2 males), median age: 73 years (69-78.5). Reduction in VAS, postoperative VAS = 0, satisfaction with surgery and responders to treatment were significantly higher after BoNT-A + HD (n = 26) than after BoNT-A (n = 15). Eleven (26.8%) complications (CD ≤ 2) were detected, with no differences between treatment groups. Mean follow-up was 153 (± 83) months. Twelve (46.2%) patients in the BoNT-A + HD group and seven (46.7%) patients in the BoNT-A group requested retreatment. Lack of severe pain was a common reason for treatment discontinuation. CONCLUSION BoNT-A injection could represent a safe and effective BPS treatment. BoNT-A + HD seems to be better than BoNT-A alone for pain relief, with no significant additional morbidity.
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Affiliation(s)
- Laura Mateu Arrom
- Functional and Female Urology Department, Fundació Puigvert, C/Cartagena 340-350, 08025, Barcelona, Spain.
| | - Cristina Gutierrez Ruiz
- Functional and Female Urology Department, Fundació Puigvert, C/Cartagena 340-350, 08025, Barcelona, Spain
| | - Joan Palou
- Functional and Female Urology Department, Fundació Puigvert, C/Cartagena 340-350, 08025, Barcelona, Spain
- Chief of the Urology Department, Fundació Puigvert, C/Cartagena 340-350, 08025, Barcelona, Spain
| | - Carlos Errando-Smet
- Functional and Female Urology Department, Fundació Puigvert, C/Cartagena 340-350, 08025, Barcelona, Spain
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Chen YH, Man KM, Chen WC, Liu PL, Tsai KS, Tsai MY, Wu YT, Chen HY. Platelet-Rich Plasma Ameliorates Cyclophosphamide-Induced Acute Interstitial Cystitis/Painful Bladder Syndrome in a Rat Model. Diagnostics (Basel) 2020; 10:diagnostics10060381. [PMID: 32521683 PMCID: PMC7344907 DOI: 10.3390/diagnostics10060381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Interstitial cystitis/painful bladder syndrome (IC/PBS) could be treated to ameliorate urothelial injury. Here, we investigated the efficacy of intravesical instillation with platelet-rich plasma (PRP) and hyaluronic acid for acute IC/PBS. Methods: The effects of PRP and hyaluronic acid on the proliferation of normal human fibroblast cells (HFCs) were assessed. Additionally, thirty virgin female rats were randomized into five groups: group 1, saline-injected control; group 2, cyclophosphamide (CYP) plus intravesical instillation with normal saline; group 3, CYP plus intravesical instillation with hyaluronic acid (1 mg/mL); group 4, CYP plus intravesical instillation with PRP; and group 5, CYP plus intravesical instillation with PRP plus hyaluronic acid. A cystometry and histological assessments were performed. The expression of cell junction-associated protein zonula occludens-2 (ZO-2) and inflammatory cytokine interleukin 6 (IL-6) was also measured. Results: Low dose PRP increased proliferation in HFCs. The acute IC/PBS rats showed significantly lower voiding interval values. Voiding interval values were significantly higher in the CYP plus intravesical instillation with PRP group than in the CYP-induced acute IC/PBS group. Additionally, the expression of ZO-2 was increased and IL-6 was decreased in the CYP plus intravesical instillation with PRP group compared with the CYP-induced acute IC/PBS group. Conclusion: These findings suggest that PRP modulate urothelial repair, which ameliorate the increase in urination frequency in rats treated with CYP. Overall, PRP may confer potential benefits by acting as urothelial repair modulators.
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Affiliation(s)
- Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (Y.-H.C.); (W.-C.C.)
- Departments of Medical Research, Urology and Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Kee-Ming Man
- Department of Life Sciences, National Chung Hsing University, Taichung 40227, Taiwan;
- Department of Anesthesiology, China Medical University Hsinchu Hospital, Hsinchu 30272, Taiwan
- Department of Medicinal Botanicals and Health Applications, Da Yeh University, Changhua 51591, Taiwan
| | - Wen-Chi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (Y.-H.C.); (W.-C.C.)
- Departments of Medical Research, Urology and Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Po-Len Liu
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Kao-Sung Tsai
- Department of Applied Cosmetology, Hungkuang University, Taichung 43302, Taiwan;
| | - Ming-Yen Tsai
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Yu-Tzu Wu
- Department of Neurology, Kuang Tien General Hospital, Taichung 43303, Taiwan;
| | - Huey-Yi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (Y.-H.C.); (W.-C.C.)
- Departments of Medical Research, Urology and Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan
- Correspondence:
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Khullar V, Digesu GA, Veit-Rubin N, Sahai A, Rahnama'i MS, Tarcan T, Chermansky C, Dmochowski R. How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI-RS 2018. Neurourol Urodyn 2020; 38 Suppl 5:S71-S81. [PMID: 31821630 DOI: 10.1002/nau.24245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/21/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND This paper summarises the discussion in a think tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2018 about the treatment of bladder pain syndrome. AIMS To review the treatments of bladder pain syndrome from behavioural treatments to surgical interventions. MATERIALS AND METHODS Review the literature in the light of the think tank discussions. RESULTS All guidelines recommend different levels of treatment starting with conservative behavioral treatments then introducing oral treatments followed by intravesical instillations. If these treatments fail then more invasive treatments such as botulinum toxin injections, neuromodulation, or surgery could be suggested. CONCLUSION Unfortunately for all treatments, the numbers are limited and, therefore, the evidence base is not strong. Further suggestions for research are suggested.
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Affiliation(s)
- Vik Khullar
- Department of Urogynaecology, St Mary's Hospital, Imperial College, London, UK
| | - G Alessandro Digesu
- Department of Urogynaecology, St Mary's Hospital, Imperial College, London, UK
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Arun Sahai
- Department of Urology, Guy's Hospital, MRC Centre for Transplantation, King's College London, London, UK
| | | | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.,School of Medicine, Koc University, Istanbul, Turkey
| | - Christopher Chermansky
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
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Rahnama'i MS, Javan A, Vyas N, Lovasz S, Singh N, Cervigni M, Pandey S, Wyndaele JJ, Taneja R. Bladder Pain Syndrome and Interstitial Cystitis Beyond Horizon: Reports from the Global Interstitial Cystitis/Bladder Pain Society (GIBS) Meeting 2019 Mumbai - India. Anesth Pain Med 2020; 10:e101848. [PMID: 32944561 PMCID: PMC7472163 DOI: 10.5812/aapm.101848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/04/2020] [Accepted: 04/12/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose of the Meeting Bladder pain syndrome/interstitial cystitis is a prevalent but underserved disease. At the Global Interstitial Cystitis/Bladder Pain Syndrome Society (GIBS) meeting, the organization and participants were committed to delivering word-class expertise and collaboration in research and patient care. Under the umbrella of GIBS, leading research scholars from different backgrounds and specialties, as well as clinicians, from across the globe interested in the science and art of practice of Bladder Pain Syndrome (BPS)/Interstitial Cystitis (IC) were invited to deliberate on various dimensions of this disease. The meeting aimed to have global guidelines to establish firm directions to practicing clinicians and patients alike on the diagnosis and treatment of this disease entity. Chronic Pelvic Pain Syndrome (CPPS) is defined by pain in the pelvic area that can have different etiologies. This can be due to urologic, gynecologic, musculoskeletal, gastrointestinal, neurologic, and autoimmune or rheumatologic diseases. At the GIBS meeting held in Mumbai, India, in August 2019, a multidisciplinary expert panel of international urologists, gynecologists, pain specialists, and dietitians took part in a think tank to discuss the development of evidence-based diagnostic and treatment algorithms for BPS/IC. Summary of Presented Findings The diagnosis of BPS/IC is difficult in daily clinical practice. Patients with BPS/IC present with a variety of signs and symptoms and clinical test results. Hence, they might be misdiagnosed or underdiagnosed, and the correct diagnosis might take a long time. A good history and physical examination, along with cystoscopy, is a must for the diagnosis of IC/BPS. For the treatment, besides lifestyle management and dietary advice, oral medication and bladder instillation therapy, botulinum toxin, and sacral neuromodulation were discussed. The innovation in bladder instillation applicators, as well as battery-free neuromodulation through the tibial nerve, was discussed, as well. Recommendation for Future Research As BPS/IC is complex, for many patients, several treatments are necessary at the same time. This was presented at GIBS 2019 as the piano model. In this way, a combination of treatments is tailored to an individual patient depending on the symptoms, age, and patients' characteristics. In the art of medicine, especially when dealing with BPS/IC patients, pressing the right key at the right time makes the difference.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Urology Department, Uniklinik RWTH Aachen, Germany
- Society of Urological Research and Education (SURE), Heerlen, The Netherlands
- Corresponding Author: University Hospital Aachen, Germany Pauwelsstrasse 30 D52074 Aachen, Germany.
| | - Aida Javan
- Society of Urological Research and Education (SURE), Heerlen, The Netherlands
- Urology Department, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Navita Vyas
- Pain and Rehab Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | | | - Sanjay Pandey
- Kokilaben Dhirubhai Ambani Hospital and Research institute, Mumbai, India
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Abstract
Most of us live blissfully unaware of the orchestrated function that our internal organs conduct. When this peace is interrupted, it is often by routine sensations of hunger and urge. However, for >20% of the global population, chronic visceral pain is an unpleasant and often excruciating reminder of the existence of our internal organs. In many cases, there is no obvious underlying pathological cause of the pain. Accordingly, chronic visceral pain is debilitating, reduces the quality of life of sufferers, and has large concomitant socioeconomic costs. In this review, we highlight key mechanisms underlying chronic abdominal and pelvic pain associated with functional and inflammatory disorders of the gastrointestinal and urinary tracts. This includes how the colon and bladder are innervated by specialized subclasses of spinal afferents, how these afferents become sensitized in highly dynamic signaling environments, and the subsequent development of neuroplasticity within visceral pain pathways. We also highlight key contributing factors, including alterations in commensal bacteria, altered mucosal permeability, epithelial interactions with afferent nerves, alterations in immune or stress responses, and cross talk between these two adjacent organs.
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Affiliation(s)
- Luke Grundy
- Visceral Pain Research Group, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia 5042, Australia; .,Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia
| | - Andelain Erickson
- Visceral Pain Research Group, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia 5042, Australia; .,Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia
| | - Stuart M Brierley
- Visceral Pain Research Group, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia 5042, Australia; .,Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia
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Campolo M, Siracusa R, Cordaro M, Filippone A, Gugliandolo E, Peritore AF, Impellizzeri D, Crupi R, Paterniti I, Cuzzocrea S. The association of adelmidrol with sodium hyaluronate displays beneficial properties against bladder changes following spinal cord injury in mice. PLoS One 2019; 14:e0208730. [PMID: 30653511 PMCID: PMC6336272 DOI: 10.1371/journal.pone.0208730] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 11/22/2018] [Indexed: 01/02/2023] Open
Abstract
The disruption of coordinated control between the brain, spinal cord and peripheral nervous system caused by spinal cord injury (SCI) leads to several secondary pathological conditions, including lower urinary tract dysfunction. In fact, urinary tract dysfunction associated with SCI is urinary dysfunction could be a consequence of a lack of neuroregeneration of supraspinal pathways that control bladder function. The object of the current research was to explore the effects of adelmidrol + sodium hyaluronate, on bladder damage generated after SCI in mice. Spinal cord was exposed via laminectomy, and SCI was induced by extradural compression at T6 to T7 level, by an aneurysm clip with a closing force of 24 g. Mice were treated intravesically with adelmidrol + sodium hyaluronate daily for 48 h and 7 days after SCI. Adelmidrol + sodium hyaluronate reduced significantly mast cell degranulation and down-regulated the nuclear factor-κB pathway in the bladder after SCI both at 48 h and 7days. Moreover, adelmidrol + sodium hyaluronate reduced nerve growth factor expression, suggesting an association between neurotrophins and bladder pressure. At 7 days after SCI, the bladder was characterized by a marked bacterial infection and proteinuria; surprisingly, adelmidrol + sodium hyaluronate reduced significantly both parameters. These data show the protective roles of adelmidrol + sodium hyaluronate on bladder following SCI, highlighting a potential therapeutic target for the reduction of bladder changes.
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Affiliation(s)
- Michela Campolo
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
| | - Rosalba Siracusa
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
| | - Marika Cordaro
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
| | - Alessia Filippone
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
| | - Enrico Gugliandolo
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
| | - Alessio F. Peritore
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
| | - Daniela Impellizzeri
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
| | - Rosalia Crupi
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
| | - Irene Paterniti
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
| | - Salvatore Cuzzocrea
- University of Messina, Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Messina, Italy
- Saint Louis University School of Medicine, Department of Pharmacological and Physiological Science, Saint Louis, United States of America
- * E-mail:
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Dellis AE, Papatsoris AG. Bridging pharmacotherapy and minimally invasive surgery in interstitial cystitis/bladder pain syndrome treatment. Expert Opin Pharmacother 2018; 19:1369-1373. [PMID: 30074829 DOI: 10.1080/14656566.2018.1505865] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Interstitial cystitis/bladder pain syndrome (IC/BPS) is a painful and debilitating clinical entity which is challenging to diagnose and even more difficult to treat. Unfortunately, none of the existing oral and intravesical medications have been established as effective and therefore relevant research is ongoing. Areas covered: In this review, the authors present established and emerging treatment options for IC/BPS in terms of medication and minimal invasive procedures. Both American and European Urological Association Guidelines recommend multimodal behavioral techniques alongside oral (e.g. amitriptyline and pentosan polysulfate sodium) or minimally invasive treatments (e.g. dimethyl sulfoxide, botulinum toxin, chondroitin sulfate, triamcinolone, hyaluronic acid, and lidocaine). Novel treatment modalities include immunomodulating drugs, stem cell therapy, nerve growth factor, and ASP6294. Expert opinion: IC/BPS is still a pathophysiological enigma with multifactorial etiopathogenesis that may be controlled but not completely cured. Patient-tailored phenotype-directed multimodal therapy is the most promising treatment strategy. Combined phenotypic categorization with specific biomarkers could help toward better treatment.
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Affiliation(s)
- Athanasios E Dellis
- a 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece.,b 1st Department of Urology, Laikon General Hospital, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Athanasios G Papatsoris
- c 2nd Department of Urology, Sismanogleion General Hospital, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
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