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Ke H, Zhu L, Wang Q, Xu K. Neutrophil-to-lymphocyte ratio as a promising non-invasive biomarker for symptom assessment and diagnosis of interstitial cystitis/bladder pain syndrome. BMC Urol 2023; 23:180. [PMID: 37940904 PMCID: PMC10633971 DOI: 10.1186/s12894-023-01353-z] [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: 07/13/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Our study aims to investigate the association between the serum neutrophil-to-lymphocyte ratio (NLR) and interstitial cystitis (IC), as well as to explore whether NLR can serve as a diagnostic marker to distinguish IC from overactive bladder (OAB). We postulate that elevated NLR levels are intricately linked to the onset and clinical presentation of IC, and that the NLR profiles in OAB patients exhibit discernible disparities from those of IC patients. METHODS In a retrospective analysis, we scrutinized the medical records of 70 women diagnosed with IC/BPS, 20 women diagnosed with OAB, and a randomly selected cohort of 150 healthy women who underwent physical examinations during the same temporal frame. A comprehensive panel of blood tests was administered to all participants, and NLR was determined through the calculation of the neutrophil-to-lymphocyte proportion. Additionally, symptom assessment questionnaires and urination diaries were collected from IC/BPS patients. RESULTS NLR levels exhibited significant distinctions among the IC/BPS, Normal, and OAB groups (P < 0.001). Within the IC/BPS group, Hunner type interstitial cystitis (HIC) demonstrated notably divergent NLR levels in comparison to non-Hunner type interstitial cystitis (NHIC) (p = 0.001). Additionally, we observed positive correlations between NLR and Nighttime voids (r = 0.268, p = 0.029), ICPI (r = 0.327, p = 0.007), ICSI (r = 0.369, p = 0.002), PUF Symptom Scale (r = 0.263, p = 0.032), and PUF (r = 0.297, p = 0.015). The receiver operating characteristic (ROC) analysis yielded an area under the curve (AUC) of 0.765 for NLR in distinguishing IC/BPS from the Normal group, and an AUC of 0.707 in discerning IC from OAB. Furthermore, the AUC of NLR was 0.723 for identifying HIC and NHIC patients. CONCLUSIONS Our study unveils the prospective utility of serum NLR as a promising biomarker for both diagnostic and symptom evaluation purposes in IC/BPS patients. It effectively demarcates this condition from OAB, which presents with similar clinical features. Consequently, NLR demonstrates potential as a non-invasive diagnostic instrument to distinguish between the subtypes of IC, particularly HIC and NHIC, which manifest similar symptoms within the IC/BPS spectrum.
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Affiliation(s)
- Hanwei Ke
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
- Peking University Applied Lithotripsy Institute, Peking University People's Hospital, Beijing, 10034, China
| | - Lin Zhu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
- Peking University Applied Lithotripsy Institute, Peking University People's Hospital, Beijing, 10034, China
- Department of Plastic Surgery, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Qi Wang
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
- Peking University Applied Lithotripsy Institute, Peking University People's Hospital, Beijing, 10034, China
| | - Kexin Xu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
- Peking University Applied Lithotripsy Institute, Peking University People's Hospital, Beijing, 10034, China.
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Esen B, Obaid K, Süer E, Gökçe Mİ, Gökmen D, Bedük Y, Gülpınar Ö. Reliability and validity of Turkish versions of the interstitial cystitis symptom index and interstitial cystitis problem index. Neurourol Urodyn 2020; 39:2338-2343. [DOI: 10.1002/nau.24492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/30/2020] [Accepted: 08/15/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Barış Esen
- Department of Urology Ankara University School of Medicine Ankara Turkey
| | - Khaled Obaid
- Department of Urology Ankara University School of Medicine Ankara Turkey
| | - Evren Süer
- Department of Urology Ankara University School of Medicine Ankara Turkey
| | - Mehmet İlker Gökçe
- Department of Urology Ankara University School of Medicine Ankara Turkey
| | - Derya Gökmen
- Department of Biostatistics Ankara University School of Medicine Ankara Turkey
| | - Yaşar Bedük
- Department of Urology Ankara University School of Medicine Ankara Turkey
| | - Ömer Gülpınar
- Department of Urology Ankara University School of Medicine Ankara Turkey
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Gracely A, Cameron AP. Managing Interstitial Cystitis/Bladder Pain Syndrome in Older Adults. Drugs Aging 2020; 38:1-16. [PMID: 33094445 DOI: 10.1007/s40266-020-00810-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
In this review, the current literature regarding pharmacotherapy treatment strategies available for the management of interstitial cystitis/bladder pain syndrome in older adults is addressed. The focus is on those treatments described by the American Urologic Association guidelines, organized according to clinical phenotype. Symptoms at presentation can vary with age, with older adults being more likely to experience nocturia, urinary incontinence, and Hunner's lesions than their younger counterparts. As such, treatment of interstitial cystitis/bladder pain syndrome should follow an individualized multimodal plan based on the patient's unique phenotype(s), starting with the most conservative options and escalating as needed. The side-effect profile and medication interactions should be reviewed, especially when treating older adults, requesting the aid of pharmacists or the primary care physician as needed to safely provide treatment.
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Affiliation(s)
- Alyssa Gracely
- Department of Urology, University of Michigan, 1500 E. Medical Center Drive, TC 3875 SPC 5330, Ann Arbor, MI, 48109, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, 1500 E. Medical Center Drive, TC 3875 SPC 5330, Ann Arbor, MI, 48109, USA.
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Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) and female sexual dysfunction (FSD) are common conditions that substantially reduce women's health. In particular, women with IC/BPS show vulvodynia, a kind of FDS that originates from consistent pain around the vulvar area. There have been many studies attempting to find the underlying mechanisms that induce the chronic pain associated with IC/BPS and vulvodynia and explain why these two conditions often coexist. Proposed theories suggest that pain hypersensitivity is being mediated by peripheral and central sensitization. However, there are still many unknown factors, such as etiologies, that can evoke pain hypersensitivity and may be linking the casual relationship between IC/BPS and vulvodynia. At present, knowledge regarding IC/BPS and vulvodynia are insufficient when considering their clinical importance. Therefore, efforts are necessary to elucidate the issues surrounding IC/BPS and vulvodynia.
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Affiliation(s)
- Su Jin Kim
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.,Current address: Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jayoung Kim
- Departments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. .,Department of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Hana Yoon
- Department of Urology, Medical Research Center, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
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5
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Thu JHL, Vetter J, Lai HH. The Severity and Distribution of Nonurologic Pain and Urogenital Pain in Overactive Bladder are Intermediate Between Interstitial Cystitis and Controls. Urology 2019; 130:59-64. [PMID: 31034917 DOI: 10.1016/j.urology.2019.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES (1) To compare the severity and distribution of nonurologic and urogenital pain between overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS) and controls, and (2) To examine the relationships between the severity of urogenital pain and severity of urinary symptoms among patients with OAB. SUBJECTS AND METHODS Fifty-one OAB patients, 27 IC/BPS patients, and 30 controls were recruited. Nonurologic pain was assessed using a whole body map and Brief Pain Inventory. Urologic pain was assessed using the Interstitial Cystitis Symptom and Problem indexes, Genitourinary Pain Index, and 0-10 pain scale. Urogenital pain was assessed using a genital map, and report of pain related to bladder filling and urination. RESULTS Among OAB patients, 6% reported pelvic pain only while 28% reported pelvic pain and beyond. 18% reported widespread pain. The distribution of nonurologic pain and urogenital pain in OAB patients were intermediate between IC/BPS and controls (IC/BPS>OAB>controls, P all <.05). The intensity of pain reported by OAB patients was intermediate between controls and IC/BPS (average 2.3 vs 0.8 vs 4.3 out of 10, P <.001). Among OAB patients, the pain severity (GUPI-pain, ICSI-pain, ICPI-pain) was positively correlated with urinary severity (UDI-6, IIQ-7, OABq-SS, OABq-QOL, P all < .05). OAB patients with pelvic pain have worse urinary symptoms and psychosocial health (anxiety, depression) compared to OAB patients without pelvic pain. CONCLUSION A subset of OAB patients has pain inside and/or outside the pelvis. The intensity and distribution of pain in OAB was intermediate between IC/BPS and controls. Systemic processes such as central sensitization should be examined in this population.
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Affiliation(s)
- James H L Thu
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO; Department of Anesthesiology, Washington University School of Medicine, St Louis, MO.
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Morales-Solchaga G, Zubiaur-Libano C, Peri-Cusí L, Adot-Zurbano JM, Arlandis-Guzmán S, Franco-de Castro A, Castillejo C. Bladder pain syndrome: Prevalence and routine clinical practice in women attending functional urology and urodynamics units in Spain. Actas Urol Esp 2019; 43:62-70. [PMID: 30262204 DOI: 10.1016/j.acuro.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/07/2018] [Accepted: 06/09/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Bladder pain syndrome (BPS) is classified as a rare chronic debilitating disease and its diagnosis presents a challenge because its symptoms overlap with those associated with overactive bladder syndrome. The aim of the routine study was to estimate the prevalence of BPS and discover to study the profile of symptoms and clinical practice for patients attending functional urology and urodynamics units. MATERIAL AND METHODS An epidemiological study in which 37 functional urology and urodynamics units in Spain participated. The prevalence was studied in both sexes. Clinical practice was evaluated for 319 women with BPS (new diagnosis or under review). Clinical and sociodemographic data were collected retrospectively. The results were studied of urine tests, cystoscopy, biopsy, physical examination, bladder diary, and those of the four available questionnaires: Patient Perception of Bladder Condition; Bladder Pain/Interstitial Cystitis Symptom Score; EuroQoL-5 Dimensions-5L and Patient Global Impression of Severity. RESULTS Five point four percent (503) of the patients who attended these units (9,312) had a diagnosis of BPS (90% [453] females). The tests that were performed most according to the clinical history and anamnesis were: urine test, bladder ultrasound and cystoscopy. The most common symptoms/comorbidities were: pain in the bladder region, increased urinary frequency, nocturia, anxiety and depression. Diagnostic assessment determined pain on hydrodistension (86.9%), positive biopsy (59.2%), myofascial pelvic pain (28.4%), urological phenotype (97.8%), and increased urinary frequency (88.7%). The questionnaires reflected how much the quality of life of these patients was affected. CONCLUSIONS The prevalence of BPS in functional urology and urodynamics units in Spain is low. No homogeneity was observed in terms of diagnosis between the different participating centres. Therefore, a common methodology is required for the management of patients with BPS in these units, with tools specific to this disorder.
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Affiliation(s)
| | | | - L Peri-Cusí
- Servicio de Urología, Hospital Clínic i Provincial, Barcelona, España
| | - J M Adot-Zurbano
- Servicio de Urología, Hospital Universitario de Burgos, Burgos, España
| | - S Arlandis-Guzmán
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
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Kim A, Hoe KO, Shin JH, Choo MS. Evaluation of the incidence and risk factors associated with persistent frequency in interstitial cystitis/bladder pain syndrome and the efficacy of antimuscarinic treatment. Investig Clin Urol 2017; 58:353-358. [PMID: 28868507 PMCID: PMC5577332 DOI: 10.4111/icu.2017.58.5.353] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/21/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the incidence and risk factors associated with persistent urinary frequency, and to evaluate the efficacy of antimuscarinic treatment. MATERIALS AND METHODS Interstitial cystitis/bladder pain syndrome (IC/BPS) patients complaining of persistent urinary frequency despite improved pain were evaluated. Before initial conventional treatment, each patient completed a voiding diary and symptom questionnaires. After conventional treatment, patients were divided according to the presence of pain and frequency. Improved pain was defined as lesser than 3 points in visual analogue scale, and persistent urinary frequency as >10 times/d. Risk factors for persistent frequency were identified through multivariate analysis. The efficacy of antimuscarinic treatment was assessed by the mean change of frequency. RESULTS Of 171 IC/BPS patients treated with conventional therapy, 132 had improved pain after 3 months, but 72 had persistent frequency (72 of 132, 54.5%). Patients with persistent frequency had lower voided volume (p=0.008), lower maximal flow rate (p<0.001), lower maximal bladder capacity (p=0.003), and more frequent micturition (p<0.001) at baseline compared to those with improved frequency. Patients who took antimuscarinic agents showed slightly decreased urinary frequency, from 14.6 times/d to 13.5 times/d (p=0.438) after 3 months of medication. No patients showed more than a 20% decrease in frequency with antimuscarinics. CONCLUSIONS About half of the patients with IC/BPS showed persistent frequency, with poor voiding function identified as a risk factor; antimuscarinic treatment was not effective in these patients.
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Affiliation(s)
- Aram Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyeong-Ok Hoe
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jung Hyun Shin
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Myung-Soo Choo
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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Patnaik SS, Laganà AS, Vitale SG, Butticè S, Noventa M, Gizzo S, Valenti G, Rapisarda AMC, La Rosa VL, Magno C, Triolo O, Dandolu V. Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome. Arch Gynecol Obstet 2017; 295:1341-1359. [DOI: 10.1007/s00404-017-4364-2] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/30/2017] [Indexed: 12/30/2022]
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9
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Efficacy of an orally administered combination of hyaluronic acid, chondroitin sulfate, curcumin and quercetin for the prevention of recurrent urinary tract infections in postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2016; 207:125-128. [DOI: 10.1016/j.ejogrb.2016.10.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/07/2016] [Accepted: 10/18/2016] [Indexed: 11/15/2022]
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Ma E, Vetter J, Bliss L, Lai HH, Mysorekar IU, Jain S. A multiplexed analysis approach identifies new association of inflammatory proteins in patients with overactive bladder. Am J Physiol Renal Physiol 2016; 311:F28-34. [PMID: 27029431 DOI: 10.1152/ajprenal.00580.2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/27/2016] [Indexed: 12/30/2022] Open
Abstract
Overactive bladder (OAB) is a common debilitating bladder condition with unknown etiology and limited diagnostic modalities. Here, we explored a novel high-throughput and unbiased multiplex approach with cellular and molecular components in a well-characterized patient cohort to identify biomarkers that could be reliably used to distinguish OAB from controls or provide insights into underlying etiology. As a secondary analysis, we determined whether this method could discriminate between OAB and other chronic bladder conditions. We analyzed plasma samples from healthy volunteers (n = 19) and patients diagnosed with OAB, interstitial cystitis/bladder pain syndrome (IC/BPS), or urinary tract infections (UTI; n = 51) for proinflammatory, chemokine, cytokine, angiogenesis, and vascular injury factors using Meso Scale Discovery (MSD) analysis and urinary cytological analysis. Wilcoxon rank-sum tests were used to perform univariate and multivariate comparisons between patient groups (controls, OAB, IC/BPS, and UTI). Multivariate logistic regression models were fit for each MSD analyte on 1) OAB patients and controls, 2) OAB and IC/BPS patients, and 3) OAB and UTI patients. Age, race, and sex were included as independent variables in all multivariate analysis. Receiver operating characteristic (ROC) curves were generated to determine the diagnostic potential of a given analyte. Our findings demonstrate that five analytes, i.e., interleukin 4, TNF-α, macrophage inflammatory protein-1β, serum amyloid A, and Tie2 can reliably differentiate OAB relative to controls and can be used to distinguish OAB from the other conditions. Together, our pilot study suggests a molecular imbalance in inflammatory proteins may contribute to OAB pathogenesis.
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Affiliation(s)
- Emily Ma
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Laura Bliss
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; and Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Indira U Mysorekar
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Sanjay Jain
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri; Renal Division, Internal Medicine, Washington University School of Medicine, St. Louis, Missouri;
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11
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Pirt reduces bladder overactivity by inhibiting purinergic receptor P2X3. Nat Commun 2015; 6:7650. [PMID: 26151598 DOI: 10.1038/ncomms8650] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/28/2015] [Indexed: 12/14/2022] Open
Abstract
Pirt is a transmembrane protein predominantly expressed in peripheral neurons. However, the physiological and pathological roles of Pirt in hollow viscus are largely unknown. Here we show that Pirt deficiency in mice causes bladder overactivity. The density of α,β-meATP-induced currents is significantly reinforced in Pirt-deficient dorsal root ganglion (DRG) neurons. Pirt and P2X3 receptor co-localize in bladder nerve fibres and heterologous Pirt expression significantly reduces P2X3-mediated currents. Pirt interacts with P2X3 through the N-terminal 14 amino-acid residues. TAT-conjugated Pirt(N14) peptide (Pirt(N14)) is sufficient to inhibit P2X3 activation in bladder DRG neurons and to alleviate bladder overactivity in Pirt(-/-) mice. Pirt expression is decreased in the bladder of cyclophosphamide (CYP)-treated mice, a commonly used model of bladder overactivity. Importantly, Pirt(N14) administration reduces the frequency of bladder voiding and restores the voided volume of CYP-treated mice. Therefore, our results demonstrate that Pirt is an endogenous regulator of P2X3 in bladder function.
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12
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Kuo HC. Potential urine and serum biomarkers for patients with bladder pain syndrome/interstitial cystitis. Int J Urol 2015; 21 Suppl 1:34-41. [PMID: 24807491 DOI: 10.1111/iju.12311] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Abstract
There is a lack of consensus on the pathophysiology of bladder pain syndrome/interstitial cystitis. The chronic pain symptoms of bladder pain syndrome/interstitial cystitis refractory to local treatment could be a result of central nervous system sensitization and persisting abnormalities in the bladder wall, which activate the afferent sensory system. Evidence also shows that bladder pain syndrome/interstitial cystitis is a heterogeneous syndrome and that the two subtypes, the ulcerative (classic) and non-ulcerative types, represent different disease entities. There is a need for non-invasive markers for the differential diagnoses of the subtypes of bladder pain syndrome/interstitial cystitis, and between bladder pain syndrome/interstitial cystitis and bladder sensory disorders, such as hypersensitive bladder syndrome or overactive bladder. Bladder pain syndrome/interstitial cystitis, but not overactive bladder, involves an aberrant differentiation program in the bladder urothelium that leads to altered synthesis of several proteoglycans, cell adhesion and tight junction proteins, and bacterial defense molecules. These findings have led to the rationale for identifying urinary biomarkers to detect bladder pain syndrome/interstitial cystitis in patients with frequency urgency syndrome. Recently, the markers that have been the focus of the most research are antiproliferative factor, epidermal growth factor, heparin-binding epidermal growth factor, glycosaminoglycans and bladder nitric oxide. In addition, inflammatory proteins in the urine and serum play important roles in the pathogenesis of bladder pain syndrome/interstitial cystitis. The urinary proteome is an easily accessible source of biomarkers for differentiation between inflammatory bladder disorders. Analysis of multiple urinary proteins and serum cytokines could provide a diagnostic basis for bladder pain syndrome/interstitial cystitis, and could be a tool for the differential diagnosis of bladder pain syndrome/interstitial cystitis and other sensory bladder disorders.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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13
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Chennamsetty A, Ehlert MJ, Peters KM, Killinger KA. Advances in Diagnosis and Treatment of Interstitial Cystitis/Painful Bladder Syndrome. Curr Infect Dis Rep 2014; 17:454. [DOI: 10.1007/s11908-014-0454-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lai HH, Vetter J, Jain S, Gereau RW, Andriole GL. The overlap and distinction of self-reported symptoms between interstitial cystitis/bladder pain syndrome and overactive bladder: a questionnaire based analysis. J Urol 2014; 192:1679-85. [PMID: 24907443 DOI: 10.1016/j.juro.2014.05.102] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE We compared symptoms between interstitial cystitis/bladder pain syndrome and overactive bladder based on patient self-reported symptoms on validated questionnaires. MATERIALS AND METHODS We prospectively recruited 26 patients diagnosed with interstitial cystitis/bladder pain syndrome, 53 diagnosed with overactive bladder and 30 healthy controls to participate in a questionnaire based study that inquired about lower urinary tract symptoms. The questionnaires used were GUPI, ICSI, ICPI, ICIQ-OAB, ICIQ-UI, IUSS, numerical rating scales of the severity of bladder pain, pressure or discomfort, and numerical rating scale of the severity of urgency and frequency symptoms. RESULTS On univariate analysis patients with interstitial cystitis/bladder pain syndrome reported significantly more severe pain symptoms than those with overactive bladder. Patients with overactive bladder reported significantly more severe urinary incontinence symptoms than those with interstitial cystitis/bladder pain syndrome. There was no difference in frequency and urgency severity between the groups. Surprisingly, 33% of patients with overactive bladder reported pain or discomfort when the bladder filled and 46% with interstitial cystitis/bladder pain syndrome reported urgency incontinence. On multivariate analysis ICIQ-UI total scores (p = 0.01) and bladder pain severity on the numerical rating scale (p <0.01) distinguished the 2 conditions with 90.6% sensitivity and 96.1% specificity. Overactive bladder had higher ICIQ-UI and lower numerical rating scale pain scores. CONCLUSIONS There is considerable overlap of self-reported symptoms between interstitial cystitis/bladder pain syndrome and overactive bladder. This overlap raises the possibility that the 2 conditions represent a continuum of a bladder hypersensitivity syndrome.
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Affiliation(s)
- H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sanjay Jain
- Renal Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Robert W Gereau
- Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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16
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Thakur SA, Nyska A, White KL, Smith MJ, Auttachoat W, Germolec DR. Immunomodulatory activity of orphan drug Elmiron® in female B6C3F1/N mice. Food Chem Toxicol 2014; 68:196-203. [PMID: 24657363 DOI: 10.1016/j.fct.2014.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/26/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
Interstitial cystitis (IC) is a chronic disorder characterized by bladder discomfort and urinary urgency in the absence of identifiable infection. Despite the expanding use in IC treatment and other chronic conditions, the effects of Elmiron® treatment on immune system remain unknown. Therefore, female B6C3F1/N mice were orally administered Elmiron® daily for 28-days at doses of 63, 125, 250, 500 or 1000mg/kg to evaluate its immunomodulatory effects. Mice treated with Elmiron® had a significant increase in absolute numbers of splenic macrophages (63, 500 and 1000mg/kg) and natural killer (NK) cells (250 and 1000mg/kg). Elmiron® treatment did not affect the humoral immune response or T cell proliferative response. However, innate immune responses such as phagocytosis by liver macrophages (1000mg/kg) and NK cell activity were enhanced (500 and 1000mg/kg). Further analysis using a disease resistance model showed that Elmiron®-treated mice demonstrated significantly increased anti-tumor activity against B16F10 melanoma cells at the 500 and 1000mg/kg doses. Collectively, we conclude that Elmiron® administration stimulates the immune system, increasing numbers of specific cell populations and enhancing macrophage phagocytosis and NK cell activity in female B6C3F1/N mice. This augmentation may have largely contributed to the reduced number of B16F10 melanoma tumors.
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Affiliation(s)
- Sheetal A Thakur
- Toxicology Branch, Division of National Toxicology Program, National Institute of Environmental Health Sciences, NIH, RTP, NC, United States.
| | - Abraham Nyska
- Integrated Laboratory Systems, RTP, NC, United States
| | - Kimber L White
- Virginia Commonwealth University, Richmond, VA, United States
| | - Matthew J Smith
- Virginia Commonwealth University, Richmond, VA, United States
| | | | - Dori R Germolec
- Toxicology Branch, Division of National Toxicology Program, National Institute of Environmental Health Sciences, NIH, RTP, NC, United States.
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Guo C, Yang B, Gu W, Peng B, Xia S, Yang F, Wen D, Geng J, Zhang Y, Zheng J. Intravesical resiniferatoxin for the treatment of storage lower urinary tract symptoms in patients with either interstitial cystitis or detrusor overactivity: a meta-analysis. PLoS One 2013; 8:e82591. [PMID: 24376550 PMCID: PMC3869704 DOI: 10.1371/journal.pone.0082591] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/25/2013] [Indexed: 11/24/2022] Open
Abstract
Background While Resiniferatoxin (RTX) has been widely used for patients with storage lower urinary tract symptoms (LUTS), its clinical efficiency hasn't yet been well evaluated. A meta-analysis was performed to evaluate the exact roles of intravesical RTX for the treatment of storage LUTS in patients with either interstitial cystitis (IC) or detrusor overactivity (DO). Methods A meta-analysis of RTX treatment was performed through a comprehensive search of the literature. In total, 2,332 records were initially recruited, 1,907 from Elsevier, 207 from Medline and 218 from the Web of Science. No records were retrieved from the Embase or Cochrane Library. Seven trials with 355 patients were included and one trial was excluded because of the lack of extractable data. The analyses were all performed using RevMan 5.1 and MIX 2.0. Results Bladder pain was significantly reduced after RTX therapy in patients with either IC or DO. The average decrease of the visual an alogue pain scale was 0.42 after RTX treatment (p = 0.02). The maximum cystometric capacity (MCC) was significantly increased in patients with DO (MCC increase, 53.36 ml, p = 0.006) but not in those with IC (MCC increase, −19.1 ml, p = 0.35). No significant improvement in urinary frequency, nocturia, incontinence or the first involuntary detrusor contraction (FDC) was noted after RTX therapy (p = 0.06, p = 0.52, p = 0.19 and p = 0.41, respectively). Conclusions RTX could significantly reduce bladder pain in patients with either IC or DO, and increase MCC in patients with DO; however, no significant improvement was observed in frequency, nocturia, incontinence or FDC. Given the limitations in the small patient size and risk of bias in the included trials, great caution should be taken when intravesical RTX is used before a large, multicenter, well-designed random control trial with a long-term follow-up is carried out to further assess the clinical efficacy of RTX in in patients with storage LUTS.
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Affiliation(s)
- Changcheng Guo
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Bin Yang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Wenyu Gu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Bo Peng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Shengqiang Xia
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Fengqiang Yang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Deyi Wen
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jiang Geng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Junhua Zheng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
- * E-mail:
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Gamper M, Viereck V, Eberhard J, Binder J, Moll C, Welter J, Moser R. Local immune response in bladder pain syndrome/interstitial cystitis ESSIC type 3C. Int Urogynecol J 2013; 24:2049-57. [PMID: 23670165 PMCID: PMC3838592 DOI: 10.1007/s00192-013-2112-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/06/2013] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder pain syndrome/interstitial cystitis (BPS/IC) is identified based on subjective symptoms which lead to heterogeneous patient populations. Previous studies using gene expression arrays for BPS/IC with Hunner's lesions [European Society for the Study of Interstitial Cystitis (ESSIC) type 3C], a subtype of the condition discernible by cystoscopy, have revealed characteristic immune responses and urothelial abnormalities. This current study aimed to further characterize this subtype using a gene expression panel. We hypothesized that B-cell activation with high levels of urinary antibody concentration would be found. METHODS Cold-cup bladder biopsies, catheterized urine and blood were collected from 15 BPS/IC ESSIC type 3C patients, 11 non-inflammatory overactive bladder (OAB) patients and eight healthy controls. Gene expression in biopsies was quantified by real-time quantitative polymerase chain reaction (RT-qPCR), immunohistochemistry was performed on bladder tissue and urinary immunoglobulins G and A were quantified by enzyme-linked immunosorbent assay. Statistical analyses included the Kruskal-Wallis test for non-parametric data and post hoc tests identified differences between groups. RESULTS High expression of T- and B-cell markers (CTLA4, CD20, CD79A, IGH@), low expression of urothelial markers (KRT20, UPK1B, UPK3A), focal lymphoid aggregates in the submucosa and high immunoglobulin concentration in urine were found exclusively in BPS/IC ESSIC type 3C patients. Results for OAB were in intermediate ranges between the other two groups and UPK1B even reached significantly lower expression when compared to healthy controls. CONCLUSIONS BPS/IC ESSIC type 3C is characterized by a local adaptive immune response with elevated urinary antibody concentrations. Quantification of urinary immunoglobulin levels could be used for a non-invasive diagnosis of BPS/IC ESSIC type 3C.
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Affiliation(s)
- Marianne Gamper
- IKBT, Institut für Klinische Biomedizinische Forschung Thurgau, Lauchefeld 31, 9548, Matzingen, Switzerland,
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Mayer EA. Gut sensations – Not so gut specific after all? Pain 2013; 154:627-628. [DOI: 10.1016/j.pain.2013.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
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