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Rutter-Locher Z, Norton S, Denk F, McMahon S, Taams LS, Kirkham BW, Bannister K. A randomised controlled trial of the effect of intra-articular lidocaine on pain scores in inflammatory arthritis. Pain 2024:00006396-990000000-00629. [PMID: 38888846 DOI: 10.1097/j.pain.0000000000003291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/06/2024] [Indexed: 06/20/2024]
Abstract
ABSTRACT Chronic pain in inflammatory arthritis (IA) reflects a complex interplay between active disease in a peripheral joint and central pronociceptive mechanisms. Because intra-articular lidocaine may be used to abolish joint-specific peripheral input to the central nervous system, we aimed to validate its use as a clinical tool to identify those patients with IA whose pain likely incorporates centrally mediated mechanisms. We began by investigating whether there was a placebo response of intra-articular injection in patients with IA 1:1 randomised to receive intra-articular lidocaine or control (0.9% saline). After, in a larger patient cohort not randomized to placebo vs lidocaine groups, we tested whether patients with IA could be stratified into 2 cohorts based on their response to intra-articular lidocaine according to markers of centrally mediated pain. To this end, we evaluated postlidocaine pain numerical rating scale (NRS) scores alongside baseline painDETECT, fibromyalgia criteria fulfillment, and quantitative sensory testing outcomes. Numerical rating scale scores were collected at baseline and 3-, 5-, and 10-minutes postinjection. Firstly, the placebo effect of intra-articular injection was low: compared to baseline, the mean pain NRS score 5-minutes postinjection was reduced by 3.5 points in the lidocaine group vs 1.2 points in the control group. Secondly, postlidocaine NRS scores were significantly higher in those with a high (>18) baseline painDETECT score, fibromyalgia, and low-pressure pain threshold at the trapezius (P = 0.002, P = 0.001, P = 0.005, respectively). Persistent high pain after intra-articular lidocaine injection could be used as an indicator of pronociceptive mechanisms that are centrally mediated, informing centrally targeted analgesic strategies.
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Affiliation(s)
- Zoe Rutter-Locher
- Rheumatology Department, Guy's and St Thomas' NHS Trust, London, United Kingdom
- Department Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College University, London, United Kingdom
| | - Sam Norton
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Franziska Denk
- Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London, London, United Kingdom
| | - Stephen McMahon
- Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London, London, United Kingdom
| | - Leonie S Taams
- Department Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College University, London, United Kingdom
| | - Bruce W Kirkham
- Rheumatology Department, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Kirsty Bannister
- Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London, London, United Kingdom
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Knox S, Offiah I, Hashim H. Evaluation of Central Sensitisation in Bladder Pain Syndrome: A Systematic Review. Int Urogynecol J 2024; 35:1109-1118. [PMID: 38713239 DOI: 10.1007/s00192-024-05793-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/27/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder pain syndrome (BPS) is a debilitating condition characterised by exaggerated bladder sensations and altered bladder function. It is still unknown whether the condition is a peripheral sensory problem or due to abnormal central sensory processing as seen in central sensitisation. This systematic review, which followed a published and Prospective Register of Systematic Reviews-registered protocol (CRD42021229962), is aimed at establishing the scope of central sensitisation in patients with BPS to aid optimal management and treatment. METHODS Four databases were searched, and appraisal of the identified studies was conducted by two independent reviewers based on eligibility criteria: patients with BPS being investigated for central sensitisation with or without comparison of controls, English-language articles, full text and publication in a peer-reviewed journal. The Methodological Index for non-Randomised Studies was used to determine study quality. We identified 763 papers in total, with 15 studies included in the final analysis. All studies were observational and had a low risk of bias. Measures included in the evaluation of CS were questionnaires, urodynamics, and quantitative sensory testing methods. RESULTS There was evidence of central sensitisation in patients with BPS in all papers evaluated (15 out of 15). In addition, more significant central sensitisation correlated with severe disease presentation (3 out of 3 papers) and concomitant chronic pain conditions (5 out of 5 papers). CONCLUSIONS Central sensitisation plays an integral role in BPS patient pathology. Many secondary measures are used to evaluate this condition. Stratification of patients based on their pathology (peripheral, central or a combination of the two) will aid in implementing an individualised management strategy.
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Affiliation(s)
- S Knox
- Department of Obstetrics and Gynaecology, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ, UK.
| | - I Offiah
- North Bristol NHS Trust, Bristol, UK
| | - H Hashim
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
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Tyagi P, Ganguly A, Chermansky C, Tarin TV, Yoshimura N, Maranchie J. Does large volume of distribution of lidocaine masks its systemic uptake from bladder? AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2023; 11:121-135. [PMID: 37168943 PMCID: PMC10165228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/17/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To assess whether therapeutic and toxic effects of intravesical lidocaine are determined by coincident serum levels. MATERIAL AND METHODS Published clinical trials and case studies on instilled lidocaine 1-2% that reported serum lidocaine levels were analyzed using model independent pharmacokinetic equations to compute the absorbed dose fraction (F) for linear regression with the respective dwell times. RESULTS Rapid absorption of intravesical lidocaine is evinced by the serum levels of 0.16±0.3 mg/L at 5 min in bladder cancer patients coinciding with the rapid onset of pain relief (<5 min) and blood pressure drop (≥10 mm Hg) in spinal cord injured patients. Serum levels at 5 min are raised five-fold by alkalinization for a tertiary amine with pKa of 7.8 and a linear rise in F with longer dwell time (r2 = 0.80; P<0.005) conforms to passive, paracellular diffusion of amphiphilic lidocaine (log P of 1.68) around umbrella cell borders with absorption rate at least five times faster than the terminal elimination rate, and therefore the delay in blood sampling after instillation is unwarranted. A rapid resolution of therapeutic and toxic effects is predicated on the extensive dilution of absorbed lidocaine with a rapid distribution half-life of 3.6 min in body weight dependent Vd - 15 times larger than blood volume, 0.13-4.5 L/kg which necessitates dose adjustment in children. CONCLUSION Whether rapid absorption of instilled lidocaine is complicated by an equally rapid and extensive dilution in body weight dependent Vd can be resolved by early blood sampling (<30 min) for: evidence-based medicine, avoidance of lidocaine toxicity in children and to educate the evolution of lidocaine solution to gel and devices.
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Affiliation(s)
- Pradeep Tyagi
- Department of Urology, University of Pittsburgh Pittsburgh, PA 15213, USA
| | - Anirban Ganguly
- Department of Urology, University of Pittsburgh Pittsburgh, PA 15213, USA
| | | | - Tatum V Tarin
- Department of Urology, University of Pittsburgh Pittsburgh, PA 15213, USA
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh Pittsburgh, PA 15213, USA
| | - Jodi Maranchie
- Department of Urology, University of Pittsburgh Pittsburgh, PA 15213, USA
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Li J, Yi X, Ai J. Broaden Horizons: The Advancement of Interstitial Cystitis/Bladder Pain Syndrome. Int J Mol Sci 2022; 23:ijms232314594. [PMID: 36498919 PMCID: PMC9736130 DOI: 10.3390/ijms232314594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/11/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating disease that induces mental stress, lower urinary symptoms, and pelvic pain, therefore resulting in a decline in quality of life. The present diagnoses and treatments still lead to unsatisfactory outcomes, and novel diagnostic and therapeutic modalities are needed. Although our understanding of the etiology and pathophysiology of IC/BPS is growing, the altered permeability of the impaired urothelium, the sensitized nerves on the bladder wall, and the chronic or intermittent sensory pain with inaccurate location, as well as pathologic angiogenesis, fibrosis, and Hunner lesions, all act as barriers to better diagnoses and treatments. This study aimed to summarize the comprehensive information on IC/BPS research, thereby promoting the progress of IC/BPS in the aspects of diagnosis, treatment, and prognosis. According to diverse international guidelines, the etiology of IC/BPS is associated with multiple factors, while the presence of Hunner lesions could largely distinguish the pathology, diagnosis, and treatment of non-Hunner lesions in IC/BPS patients. On the basis of the diagnosis of exclusion, the diverse present diagnostic and therapeutic procedures are undergoing a transition from a single approach to multimodal strategies targeting different potential phenotypes recommended by different guidelines. Investigations into the mechanisms involved in urinary symptoms, pain sensation, and bladder fibrosis indicate the pathophysiology of IC/BPS for further potential strategies, both in diagnosis and treatment. An overview of IC/BPS in terms of epidemiology, etiology, pathology, diagnosis, treatment, and fundamental research is provided with the latest evidence. On the basis of shared decision-making, a multimodal strategy of diagnosis and treatment targeting potential phenotypes for individual patients with IC/BPS would be of great benefit for the entire process of management. The complexity and emerging evidence on IC/BPS elicit more relevant studies and research and could optimize the management of IC/BPS patients.
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Affiliation(s)
- Jin Li
- West China School of Medicine, Sichuan University, Chengdu 610041, China
- Department of Urology, Institute of Urology, Sichuan University, Chengdu 610041, China
| | - Xianyanling Yi
- West China School of Medicine, Sichuan University, Chengdu 610041, China
- Department of Urology, Institute of Urology, Sichuan University, Chengdu 610041, China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, Sichuan University, Chengdu 610041, China
- Correspondence:
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Effect of Stellate Ganglion Block Combined with Lidocaine at Different Concentrations for Preemptive Analgesia on Postoperative Pain Relief and Adverse Reactions of Patients Undergoing Laparoscopic Cholecystectomy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6027093. [PMID: 35450203 PMCID: PMC9017476 DOI: 10.1155/2022/6027093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022]
Abstract
Objective To explore the effect of stellate ganglion block (SGB) combined with lidocaine at different concentrations for preemptive analgesia on postoperative pain relief and adverse reactions of patients undergoing laparoscopic cholecystectomy (LC). Methods Ninety patients undergoing LC in our hospital from June 2019 to June 2020 were selected as the subjects and were randomly divided into group A (30 cases), group B (30 cases), and group C (30 cases), all patients received SGB, and 10 mL of lidocaine at concentrations of 0.25%, 0.5%, and 0.75% was, respectively, administered to patients in groups A, B, and C, so as to compare the analgesic effect, adverse reactions, and clinical indicators among the three groups. Results At T1 and T2, group C obtained obviously lower NRS scores than groups A and B (P < 0.001); compared with groups A and B, group A had obviously higher onset time (P < 0.001) and significantly lower duration (P < 0.001); no obvious differences in the hemodynamic indexes among the groups were observed (P > 0.05); group C obtained obviously higher BCS score than groups A and B; and the total incidence rate of adverse reactions was obviously higher in group C than in groups A and B (P < 0.05). Conclusion Performing SGB combined with 0.5% lidocaine to patients undergoing LC achieves the optimal analgesic effect; such anesthesia plan can effectively stabilize patients' hemodynamics, present higher safety, and promote the regulation of the body internal environment. Further research will be conducive to establishing a better anesthesia plan for such patients.
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SARIKAYA K, ŞENOCAK Ç, İBİŞ MA, SADİOĞLU FE, ÇİFTÇİ M, BOZKURT ÖF. Effectiveness of hydrodistention procedure under local anesthesia in the treatment of bladder pain syndrome/interstitial cystitis. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1032338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Jones P, Hjelle KM, Mohn J, Guðbrandsdottir G, Roth I, Chaudhry AA, Bergesen AK, Beisland C. Current Status of Intravesical Therapies for Bladder Pain Syndrome (BPS): A Narrative Review of Emerging Evidence. Urology 2021; 156:e48-e57. [PMID: 34118230 DOI: 10.1016/j.urology.2021.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/09/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
Bladder pain syndrome (BPS) is a complex condition, which can have debilitating sequelae for patients. Many elements of BPS remain poorly understood including pathophysiology, diagnosis and treatment. Navigating patient care can therefore be challenging for the clinician. Management mandates a multidisciplinary and symptom-based approach. Intravesical treatments such as instillation therapies remain a cornerstone of most treatment algorithms and there are a range of agents that can be selected. This review offers an up-to-date evaluation of the evidence for these intravesical treatments.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.
| | - Karin M Hjelle
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Jannike Mohn
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Gigja Guðbrandsdottir
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Ingunn Roth
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
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Kim CR, Jang EB, Hong SH, Yoon YE, Huh BK, Kim SN, Kim MJ, Moon HS, Choy YB. Indwelling urinary catheter assembled with lidocaine-loaded polymeric strand for local sustained alleviation of bladder discomfort. Bioeng Transl Med 2021; 6:e10218. [PMID: 34027100 PMCID: PMC8126825 DOI: 10.1002/btm2.10218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 01/03/2023] Open
Abstract
Indwelling urinary catheters (IUCs) are used in clinical settings to assist detrusor contraction in hospitalized patients. However, an inserted IUC often causes catheter-related bladder discomfort. To resolve this, we propose an IUC coupled with local, sustained release of an anesthetic drug, lidocaine. For this, a thin strand composed of poly (lactic-co-glycolic acid) and lidocaine was separately prepared as a drug delivery carrier, which was then wound around the surface of the IUC to produce the drug-delivery IUC. Our results revealed that the drug-delivery IUC could exert the pain-relief effects for up to 7 days when placed in the bladder of living rats. Cystometrogram tests indicated that the drug-delivery IUC could significantly relieve bladder discomfort compared with the IUC without lidocaine. Furthermore, the expression of pain-related inflammatory markers, such as nerve growth factor, cyclooxygenase-2, and interleukin-6 in the biopsied bladder tissues was significantly lower when the drug-delivery IUC was used. Therefore, we conclude that an IUC simply assembled with a drug-loaded polymer strand can continuously release lidocaine to allow for the relief of bladder discomfort during the period of IUC insertion.
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Affiliation(s)
- Cho Rim Kim
- Interdisciplinary Program for Bioengineering, College of EngineeringSeoul National UniversitySeoulRepublic of Korea
| | - Eun Bi Jang
- Department of Urology, College of MedicineHanyang UniversitySeoulRepublic of Korea
- Department of Translational Medicine, Graduate School of Biomedical Science & EngineeringHanyang UniversitySeoulRepublic of Korea
| | - Seong Hwi Hong
- Department of Urology, College of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Young Eun Yoon
- Department of Urology, College of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Beom Kang Huh
- Interdisciplinary Program for Bioengineering, College of EngineeringSeoul National UniversitySeoulRepublic of Korea
| | - Se Na Kim
- Institute of Medical & Biological Engineering, Medical Research CenterSeoul National UniversitySeoulRepublic of Korea
| | - Min Ji Kim
- Interdisciplinary Program for Bioengineering, College of EngineeringSeoul National UniversitySeoulRepublic of Korea
| | - Hong Sang Moon
- Department of Urology, College of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Young Bin Choy
- Interdisciplinary Program for Bioengineering, College of EngineeringSeoul National UniversitySeoulRepublic of Korea
- Institute of Medical & Biological Engineering, Medical Research CenterSeoul National UniversitySeoulRepublic of Korea
- Department of Biomedical EngineeringSeoul National University, College of MedicineSeoulRepublic of Korea
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Tailor VK, Morris E, Bhide AA, Fernando R, Digesu GA, Khullar V. Does cystoscopy method affect the investigation of bladder pain syndrome/interstitial cystitis? Int Urogynecol J 2021; 32:1229-1235. [PMID: 32955597 PMCID: PMC8139875 DOI: 10.1007/s00192-020-04512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/19/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Cystoscopic investigation to identify associated histological findings of increased mast cells in the detrusor muscle has been recommended by the European Society for the Study of Bladder Pain Syndrome (ESSIC) in the investigation of bladder pain syndrome/interstitial cystitis (BPS/IC). The aim of this study was to identify if the cystoscopy approach impacts the biopsy results when investigating women presenting with symptoms of BPS/IC. METHODS We performed a single-centre retrospective analysis of 300 bladder biopsy reports from 2015 to 2018 from women undergoing cystoscopy for BPS/IC. Biopsies obtained using closed cup forceps through a flexible (FC) or rigid cystoscope (RC) were compared. RESULTS Fifty-eight FC biopsies were compared with 242 RC biopsies. FC biopsies had a smaller mean diameter (1.6 mm vs 2.9 mm p < 0.01) and volume (4.1 mm3 vs 9.6 mm3 p < 0.001) compared with RC biopsies. There was no significant difference in the histological depth of sampling to the muscularis propria. A total of 292 samples had CD117 immunohistochemical staining for mast cell count (MCC) analysis. The MCC/mm2 was significantly lower in FC biopsies (p < 0.01). Sixteen percent of FC samples compared with 60% of RC samples had a high MCC >28/mm2 (p < 0.01). There was no significant difference in positive microbiology culture between FC (21%) and RC (28%) sampling. CONCLUSION Rigid and flexible cystoscopy can be used to investigate BPS/IC as recommended by international societies. However, the biopsy method impacts the mast cell count analysis, which can influence diagnosis and management. Therefore, RC would be the optimal investigation.
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Affiliation(s)
- Visha K Tailor
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK.
| | - Ellen Morris
- Imperial College School of Medicine, Kensington, London, SW7 2DD, UK
| | - Alka A Bhide
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK
| | - Ruwan Fernando
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK
| | - Guiseppe A Digesu
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK
| | - Vik Khullar
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK
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Vij M, Dua A, Davies A, Freeman R. Do patients with central sensitivity syndromes have poor subjective outcomes despite anatomical cure from pelvic organ prolapse surgery? Int Urogynecol J 2021; 32:1461-1467. [PMID: 33459804 DOI: 10.1007/s00192-020-04655-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pelvic organ prolapse(POP) has an adverse impact on quality of life with lifetime risk of surgery varying from 11 to 20%. Conditions such as fibromyalgia (FMS), chronic fatigue syndrome (CFS/ME) and irritable bowel syndrome (IBS), collectively known as central sensitivity syndromes (CSS), may affect the outcome of POP surgery. The aim of this article is to compare the outcomes of vaginal POP surgery between women with and without CSS. METHOD This was a prospective cohort study. The validated Central Sensitisation Inventory (CSI) was used to identify women with CSS. Subjective and objective outcomes were compared between the two groups using POP-SS, Expectation and satisfaction/"EGGS", pain scores and the POP quantification system (POP-Q). A non-parametric test was used for analysis. RESULT Seventy-eight women were recruited. Complete data were available in 62 patients; 23 patients had evidence of CSS and 39 did not. Women with CSS had significantly higher pre- and post-operative POP-SS scores than those without (p < 0.0005, p = 0.004). Seventeen (73.9%) women with CSS compared to 38 (97.4%) women without CSS demonstrated improvement of a minimum 6 points on the POP-SS scale; however, this was not stastically significant. McGill's pain scores were higher in women with CSS both pre- and post-surgery. Ninety-five per cent of women without CSS achieved their goals and were satisfied with the surgery compared to 69.5% of women with CSS (p < 005). CONCLUSION There is a less favourable outcome of POP surgery in women with CSS compared to those without in terms of persistence of symptoms, pain and overall satisfaction.
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Affiliation(s)
| | - Anu Dua
- Singleton Hospital, Swansea, Wales, UK
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Garzon S, Laganà AS, Casarin J, Raffaelli R, Cromi A, Sturla D, Franchi M, Ghezzi F. An update on treatment options for interstitial cystitis. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2020; 19:35-43. [PMID: 32699542 PMCID: PMC7258371 DOI: 10.5114/pm.2020.95334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/18/2020] [Indexed: 12/22/2022]
Abstract
Interstitial cystitis or bladder pain syndrome (IC/BPS) is a chronic pelvic pain syndrome related to the urinary bladder. The ideal treatment should match as much as possible with the pathophysiologic causes of the IC/BPS, but the scarcely available evidence limits this approach, with the majority of available treatments that are primarily targeted to the control of symptoms. The treatment strategies have traditionally focused on the bladder, which is considered the primary end-organ and source of pain. Nevertheless, the growing body of evidence suggests a multifaceted nature of the disease with systemic components. In general, guidelines recommend the personalized and progressive approach, that starts from the more conservative options and then advances toward more invasive and combined treatments. The behavioral changes represent the first and most conservative steps. They can be combined with oral medications or progressively with intravesical instillation of drugs, up to more invasive techniques in a combined way. Despite the multiple available options, the optimal treatment is not easy to be found. Only further investigation on the etiopathogenetic mechanisms, taking into account the differences among subgroups, and the interaction between central and peripherical factors may allow providing a real improvement in the treatment and management of these patients.
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Affiliation(s)
- Simone Garzon
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Davide Sturla
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
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Taithongchai A. Commentary to: Prospective comparative study on the effects of lidocaine on urodynamic and sensory parameters in bladder-pain syndrome. Int Urogynecol J 2019; 30:1303. [DOI: 10.1007/s00192-019-03922-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/05/2019] [Indexed: 11/24/2022]
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Affiliation(s)
- Apul Goel
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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