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Yu WR, Jiang YH, Jhang JF, Kuo HC. Cystoscopic characteristic findings of interstitial cystitis and clinical implications. Tzu Chi Med J 2024; 36:30-37. [PMID: 38406570 PMCID: PMC10887339 DOI: 10.4103/tcmj.tcmj_172_23] [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: 07/06/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 02/27/2024] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic inflammatory bladder disease of unknown etiology, characterized by bladder pain and frequency urgency symptoms. Based on the cystoscopic findings after hydrodistention under anesthesia, the phenotype of IC/BPS includes no glamerulation, characteristic glomerulation, and with Hunner's lesion. IC is specifically defined if there are characteristic Hunner's lesion appeared in cystoscopy or after hydrodistention. If there are glomerulations without Hunner's lesion, BPS should be considered. The definition of Hunner's lesion and glomerulations differs based on different definition and observations. Currently, there has been no clear description and grading of the glomerulations and Hunner's lesion. Because the classification of IC/BPS has an impact on the treatment strategy and associated with therapeutic outcome, it is unmet to have a clear definition and consensus on the characteristic cystoscopic findings of IC/BPS. This article reviews the literature and presents the figures of Hunner's lesions and description of different mucosal lesions after cystoscopic hydrodistention.
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Affiliation(s)
- Wan-Ru Yu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Taneja R, Pandey S, Priyadarshi S, Goel A, Jain A, Sharma R, Purohit N, Bandukwalla V, Tanvir, Ragavan M, Agrawal A, Shah A, Girn Z, Ajwani V, Mete U. Diagnostic and therapeutic cystoscopy in bladder pain syndrome/interstitial cystitis: systematic review of literature and consensus on methodology. Int Urogynecol J 2023:10.1007/s00192-023-05449-w. [PMID: 36708406 DOI: 10.1007/s00192-023-05449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/31/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Cystoscopy has been routinely performed in patients suspected to be suffering from bladder pain syndrome/interstitial cystitis (BPS/IC) across the globe. The methodology reported by various guidelines appears to have differences in the techniques and hence there is a need for a review of all those techniques in order to arrive at a consensus. The aim was to review the literature describing the prevalent techniques of cystoscopy for patients of BPS/IC and try to evolve a consensus. METHODS The group the Global Interstitial Cystitis, Bladder Pain Society (GIBS) has worked collectively to systematically review the literature using the key words, "Cystoscopy in Hunner's lesions, bladder pain syndrome, painful bladder syndrome and interstitial cystitis" in the PubMed, COCHRANE, and SCOPUS databases. A total of 3,857 abstracts were studied and 96 articles referring to some part of technique of cystoscopy were short-listed for review as full-length articles. Finally, six articles with a description of a technique of cystoscopy were included for final tabulation and comparison. The group went on to arrive at a consensus for a stepwise technique of diagnostic and therapeutic cystoscopy in cases of BPS/IC. This technique has been compared with the previously described techniques and may serve to be a useful practical guide for treating physicians. CONCLUSION It is important to have a uniform standardized technique for performing a diagnostic and therapeutic cystoscopy in patients with BPS/IC. Consensus on one such a technique has been arrived at and described in the present article.
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Affiliation(s)
- Rajesh Taneja
- Urology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, 110070, India.
| | - Sanjay Pandey
- Urology and Renal Transplant, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | | | - Apul Goel
- Department of Urology, King George Medical University, Lucknow, India
| | - Amita Jain
- Institute of Urology and Robotics, Medanta The Medicity, Gurugram, India
| | - Ranjana Sharma
- Gynecology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Navita Purohit
- Department of Physiatry, Kokilaben Dhitubhai Ambani hospital, Mumbai, India
| | | | - Tanvir
- Tanvir Hospital, Hyderabad, India
| | | | | | - Amit Shah
- Surgery and Urology, Naval Hospital, Mumbai, India
| | | | - Vikky Ajwani
- The Cure Urology Hospital, Vadodara, Gujarat, India
| | - Uttam Mete
- Urology and Robotic Surgery, PGIMER, Chandigarh, India
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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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Quallich SA, Quentin Clemens J, Ronstrom C, James AS, Kreder KJ, Henry Lai H, Naliboff BD, Rodriguez LV, Berry SH, Sutcliffe S. Flares and their impact among male urologic chronic pelvic pain syndrome patients: An in-depth qualitative analysis in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. Neurourol Urodyn 2022; 41:1468-1481. [PMID: 35686553 PMCID: PMC11033701 DOI: 10.1002/nau.24983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/09/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION There has been a sparse exploration of the lived experience of men with urologic chronic pelvic pain syndrome (UCPPS), and none with the goal of Investigating the experience of "flares" as part of this chronic pain syndrome in men. METHODS We conducted three focus groups of male UCPPS patients at two sites of the MAPP Research Network (n = 16 total participants) to explore the full spectrum of flares and their impact on men's lives. RESULTS Flare experiences were common and specific symptom components varied widely. Men reported nonpelvic symptoms (e.g., diarrhea), and variability in symptom intensity (mild to severe), duration (minutes to days), and frequency of flares. Flares episodes, and the threat of flares, were disruptive to their lives, social roles, and relationships. Distinct long-term impacts were reported, such as decreased sexual activity, decreased travel, and potential loss of employment or career. The themes included social isolation and the need for a sense of control and understanding over their unpredictable symptoms. CONCLUSIONS Given their negative impact, future research with men and UCPPS should focus on approaches to prevent flares, and should consider a multimodal approach to reducing the frequency, severity, and/or duration. Quality of life may be improved by providing men with a sense of control over their symptoms and offering them multimodal treatment options, consistent with the recommendations for further research for women with UCPPS.
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Affiliation(s)
- Susanne A Quallich
- Department of Urology, Division of Andrology, General and Community Health, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - J Quentin Clemens
- Department of Urology, Division of Neurology and Pelvic Reconstructive Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Carrie Ronstrom
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Aimee S James
- Department of Surgery, Division of Public Health Sciences and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Karl J Kreder
- Department of Urology, College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - H Henry Lai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bruce D Naliboff
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Larissa V Rodriguez
- Departments of Urology and Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | | | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
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Kono J, Ueda M, Sengiku A, Suadicani SO, Woo JT, Kobayashi T, Ogawa O, Negoro H. Flavonoid Nobiletin Attenuates Cyclophosphamide-Induced Cystitis in Mice through Mechanisms That Involve Inhibition of IL-1β Induced Connexin 43 Upregulation and Gap Junction Communication in Urothelial Cells. Int J Mol Sci 2022; 23:5037. [PMID: 35563427 PMCID: PMC9102543 DOI: 10.3390/ijms23095037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Bladder inflammatory diseases cause various urinary symptoms, such as urinary frequency and painful urination, that impair quality of life. In this study, we used a mouse model of cyclophosphamide (CYP)-induced bladder inflammation and immortalized human urothelial (TRT-HU1) cells to explore the preventive potential of nobiletin (NOB), a polymethoxylated flavone enriched in citrus fruit peel, and investigate its mechanism of action in the bladder. Prophylaxis with PMF90 (60% NOB) attenuated the development of bladder inflammation and urinary symptoms in CYP-treated mice. PMF90 also reduced the upregulation of connexin 43 (Cx43), a major component of gap junction channels, in the bladder mucosa of CYP-treated mice. Stimulation of TRT-HU1 cells with the pro-inflammatory cytokine IL-1β increased Cx43 mRNA and protein expression and enhanced gap junction coupling-responses that were prevented by pre-treatment with NOB. In urothelium-specific Cx43 knockout (uCx43KO) mice, macroscopic signs of bladder inflammation and changes in voiding behavior induced by CYP treatment were significantly attenuated when compared to controls. These findings indicate the participation of urothelial Cx43 in the development of bladder inflammation and urinary symptoms in CYP-treated mice and provide pre-clinical evidence for the preventive potential of NOB through its anti-inflammatory effects on IL-1β signaling and urothelial Cx43 expression.
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Affiliation(s)
- Jin Kono
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (J.K.); (M.U.); (A.S.); (T.K.); (O.O.)
| | - Masakatsu Ueda
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (J.K.); (M.U.); (A.S.); (T.K.); (O.O.)
- Department of Urology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Atsushi Sengiku
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (J.K.); (M.U.); (A.S.); (T.K.); (O.O.)
- Sengiku Urology Clinic, Shiga 524-0045, Japan
| | - Sylvia O. Suadicani
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Je Tae Woo
- Department of Biological Chemistry, College of Bioscience and Biotechnology, Chubu University, Kasugai 487-8501, Japan;
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (J.K.); (M.U.); (A.S.); (T.K.); (O.O.)
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (J.K.); (M.U.); (A.S.); (T.K.); (O.O.)
| | - Hiromitsu Negoro
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (J.K.); (M.U.); (A.S.); (T.K.); (O.O.)
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
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Abelleyra Lastoria DA, Raison N, Aydin A, Khan S, Dasgupta P, Ahmed K. Comparing surgical interventions for interstitial cystitis: A systematic review. Low Urin Tract Symptoms 2022; 14:218-241. [PMID: 35393778 DOI: 10.1111/luts.12441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/10/2022] [Accepted: 03/20/2022] [Indexed: 12/17/2022]
Abstract
The purpose of this review was to summarize and compare the efficacy among surgical interventions in terms of symptomatic relief in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). The review protocol was published on PROSPERO. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was followed. Following database search, a narrative synthesis was performed. Data pertaining symptom scores, pain levels, and voiding frequency following surgery were summarized by calculating percentage change in these parameters. Multiple surgical treatments were identified. These included injections of hyaluronic acid (HA), botulinum toxin A (Botox A), triamcinolone, resiniferatoxin (RTX), platelet-rich plasma, and 50% dimethyl sulfoxide (DMSO) solution, neuromodulation, hydrodistension (HD), resection/fulguration of Hunner lesions, resection of ilioinguinal and iliohypogastric nerves, reconstructive surgery, and cystectomy. This review found no evidence suggesting that HD and RTX injections can ameliorate IC/BPS symptoms. Current evidence suggests that sacral neuromodulation, cystectomy, and transurethral resection/fulguration of Hunner lesions could lead to symptomatic relief in IC/BPS. Further research into the efficacy of Botox A, triamcinolone, 50% DMSO solution, and HA instillations is required. However, the best treatment options cannot be reliably stated due to the low level of evidence of the studies identified. Further research should report outcomes for Hunner-type IC and BPS separately given their differing histopathological characteristics. Performing high-quality randomized controlled trials could be hindered by the low prevalence of the condition and a small proportion of patients progressing to surgery.
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Affiliation(s)
| | - Nicholas Raison
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
| | - Abdullatif Aydin
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
| | - Shamim Khan
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
| | - Prokar Dasgupta
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
| | - Kamran Ahmed
- Simulation Unit, MRC Centre for Transplantation, King's College London, London, UK
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Plair A, Evans RJ, Langefeld CD, Matthews CA, Badlani G, Walker SJ. Anesthetic Bladder Capacity is a Clinical Biomarker for Interstitial Cystitis/Bladder Pain Syndrome Subtypes. Urology 2021; 158:74-80. [PMID: 34303757 DOI: 10.1016/j.urology.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To further examine anesthetic bladder capacity as a biomarker for interstitial cystitis/bladder pain syndrome (IC/BPS) patient subtypes, we evaluated demographic and clinical characteristics in a large and heterogeneous female patient cohort. MATERIAL AND METHODS This is a retrospective review of data from women (n = 257) diagnosed with IC/BPS who were undergoing therapeutic bladder hydrodistention (HOD). Assessments included medical history and physical examination, validated questionnaire scores, and anesthetic BC. Linear regression analyses were computed to model the relationship between anesthetic BC and patient demographic data, symptoms, and diagnoses. Variables exhibiting suggestive correlations (P ≤ .1) were candidates for a multiple linear regression analysis and were retained if significant (P ≤ .05). RESULTS Multiple regression analysis identified a positive correlation between BC and endometriosis (P = .028) as well as negative correlations between BC and both ICSI score (P < .001) and the presence of Hunner's lesions (P < .001). There were higher average numbers of pelvic pain syndrome (PPS) diagnoses (P = .006) and neurologic, autoimmune, or systemic pain (NASP) diagnoses (P = .003) in IC/BPS patients with a non-low BC, but no statistical difference in the duration of diagnosis between patients with low and non-low BC (P = .118). CONCLUSION These data, generated from a large IC/BPS patient cohort, provide additional evidence that higher BC correlates with higher numbers of non-bladder-centric syndromes while lower BC correlates more closely with bladder-specific pathology. Taken together, the results support the concept of clinical subgroups in IC/BPS.
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Affiliation(s)
- Andre Plair
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Robert J Evans
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Catherine A Matthews
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Gopal Badlani
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Stephen J Walker
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC; Wake Forest Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC.
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Homma Y, Akiyama Y, Tomoe H, Furuta A, Ueda T, Maeda D, Lin ATL, Kuo H, Lee M, Oh S, Kim JC, Lee K. Clinical guidelines for interstitial cystitis/bladder pain syndrome. Int J Urol 2020; 27:578-589. [DOI: 10.1111/iju.14234] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Yukio Homma
- Department of Urology Japanese Red Cross Medical Center Tokyo Japan
| | - Yoshiyuki Akiyama
- Department of Urology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hikaru Tomoe
- Department of Urology Tokyo Women’s Medical University Medical Center East Tokyo Japan
| | - Akira Furuta
- Department of Urology Jikei University School of Medicine Tokyo Japan
| | | | - Daichi Maeda
- Department of Clinical Genomics Graduate School of Medicine Osaka University Osaka Japan
| | - Alex TL Lin
- Department of Urology Taipei Veterans General Hospital National Yang Ming University Taipei Taiwan
| | - Hann‐Chorng Kuo
- Department of Urology School of Medicine Buddhist Tzu Chi General Hospital Tzu Chi University Hualien Taiwan
| | - Ming‐Huei Lee
- Department of Urology Feng‐Yuan Hospital Taichung Taiwan
| | - Seung‐June Oh
- Department of Urology Seoul National University Seoul Korea
| | - Joon Chul Kim
- Department of Urology The Catholic University of Korea Seoul Korea
| | - Kyu‐Sung Lee
- Department of Urology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
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Crescenze IM, Gupta P, Adams G, Oldendorf A, Stoffel JT, Romo PGB, Clemens JQ, Cameron AP. Advanced Management of Patients With Ulcerative Interstitial Cystitis/Bladder Pain Syndrome. Urology 2019; 133:78-83. [PMID: 31442473 DOI: 10.1016/j.urology.2019.07.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe a stepwise management of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with Hunner's lesions and present single institution long-term outcomes. METHODS This is a retrospective review of a single tertiary center experience with management of patients with Hunner's lesions from January 2005 to January of 2015. Patients who met the diagnostic criteria for IC/BPS were included. Systematic approach to treatment of patients with Hunner's lesions is proposed based on our results. RESULTS Fifty-five patients with IC/BPS and Hunner's lesions were included. Mean age was 65.0 ±12.7 years, 76.4% (42/55) were female, and median symptom duration was 2 years (interquartile range [IQR] 1.7). All patients had a biopsy to rule out malignancy with therapeutic fulguration which resulted in subjective symptom improvement in 81.8% (45/55) and median time to repeat procedures was 12 months (IQR 621). Triamcinolone injection into the lesion was done in 35 patients and 91.4% (32/35) reported subjective improvement. Repeat injections were done for 74% (26/35) and median time between injections was 8 months (IQR 4, 13). AUA symptom scores and quality of life improved significantly with both treatment modalities. Adjunctive treatment with cyclosporine was used in 47.2% (26/55), and 7.2% (4/55) went on to have a cystectomy. CONCLUSION Patients with Hunner's lesions benefit from early progression from conservative treatments to endoscopic management. Excellent symptom control can be achieved with biopsy/fulguration and triamcinolone injections but recurrence is common and repeat treatments are needed for most patients.
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Walker SJ, Plair A, Hemal K, Langefeld CD, Matthews C, Badlani G, Zambon J, Heath H, Evans RJ. Bladder Hydrodistention Does Not Result in a Significant Change in Bladder Capacity for Interstitial Cystitis/Bladder Pain Syndrome Patients. Urology 2019; 132:81-86. [PMID: 31299328 DOI: 10.1016/j.urology.2019.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/13/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the impact of multiple (2 or more) bladder hydrodistentions (HODs) on anesthetic bladder capacity (BC) in a large cohort of interstitial cystitis/bladder pain syndrome (IC/BPS) patients. Urinary HOD under anesthesia is a third line therapeutic approach used to treat patients with IC/BPS. There is some concern that performing multiple therapeutic HODs may be contraindicated due to the potential for contributing to a diminished BC over time. MATERIALS AND METHODS This is a retrospective chart review of IC/BPS patients from a single institution who had undergone 2 or more bladder HOD procedures. Patient demographic and clinical data, including BC under anesthesia, were retrieved from patient charts for analysis. Least squares regression slopes of BC under anesthesia were calculated and used to estimate within-patient BC changes over time. RESULTS Data from 168 patients (637 HOD procedures) were included for analysis. The average change in BC, 0.52 ± 8.33 mL/mo, was not significantly different from 0 (P= .42). Linear regression analyses did not identify any significant correlation between BC over time with: (1) age, (2) number of HODs, (3) frequency of HODs, (4) average BC, (5) length of time with an IC/BPS diagnosis, or (6) length of time during which the patient's BC was evaluated. Moreover, there was no difference in BC change over time in patients with and without Hunner's lesion (P = .86). CONCLUSION Multiple therapeutic HODs, over several years, do not result in a significant change in BC in IC/BPS patients.
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Affiliation(s)
- Stephen J Walker
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC; Wake Forest Institute for Regenerative Medicinske Forest Baptist Medical Center, Winston-Salem, NC.
| | - Andre Plair
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Kshipra Hemal
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Catherine Matthews
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Gopal Badlani
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Joao Zambon
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Heather Heath
- Wake Forest Institute for Regenerative Medicinske Forest Baptist Medical Center, Winston-Salem, NC
| | - Robert J Evans
- Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, NC
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