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Taneja R, Singh AK, Sharma A, Taneja N, Raheja A. Validation study of new clinical scoring - "Apollo Clinical Scoring system" for bladder pain syndrome/interstitial cystitis and comparison of outcome with standard "O'Leary-Sant score". Int Urogynecol J 2024; 35:1137-1144. [PMID: 37642668 DOI: 10.1007/s00192-023-05641-y] [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: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 08/31/2023]
Abstract
AIM Validation of the recently published newer clinical scoring system for bladder pain syndrome/interstitial cystitis and comparison of the results with the pre-existing standard O'Leary-Sant score. INTRODUCTION The symptoms are our primary guide to disease severity analysis, treatment, and response monitoring. The combined ICSI/ICPI (O'Leary-Sant Interstitial Cystitis Symptom and Problem Index) consist of a four-item symptom and problem index focusing on urgency, frequency, nocturia, and pain. A new scale, assigning more weight to pain and nocturia and adding the domains of sexual dysfunction and psychological impact, has been published by one of the authors (El Khoudary et al. J Women's Health 2002. 18:1361-1368; 7). MATERIAL AND METHODS This is a prospective study conducted to validate a newer clinical scoring system, namedht e 'Apollo Clinical Scoring' (ACS) system for patients with bladder pain syndrome/ interstitial cystitis (BPS/IC), and to compare its outcome with the simultaneously applied standard O'Leary-Sant (OLS) score. Thirty-five patients of BPS/IC diagnosed using the ESSIC definition were enrolled in the study and followed for 6 months. Intraclass correlation coefficient (ICC) for test-retest reliability, and Cronbach's α for measure of internal consistency, were applied to both scoring systems. RESULTS Intraclass correlation coefficient for ACS was 0.715 and for OLS was 0.689. Cronbach's α for ACS was 0.736 and for OLS was 0.698. CONCLUSION The present study suggests that the recently devised Apollo Clinical Scoring (ACS) system for patients of BPS/IC is internally consistent and a reliable scoring system. When compared with OLS in parallel setting, the newer ACS appeared to be marginally better.
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Affiliation(s)
- Rajesh Taneja
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India.
| | - Ashutosh Kumar Singh
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India
| | - Ankur Sharma
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India
| | - Nilesh Taneja
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India
| | - Apeksha Raheja
- Department of Urology and Robotic Surgery, Indraprastha Apollo Hospitals, Room number 1019, New Delhi, 110070, India
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Nickel JC, Cotechini T, Doiron RC. Secondary Analysis of Interstitial Cystitis/Bladder Pain Syndrome Patients Enrolled in a Recurrent Urinary Tract Infection Prevention Study Provides a Novel Paradigm for Etio-Pathogenesis and Practical Management of This Infection Phenotype. Pathogens 2024; 13:396. [PMID: 38787248 PMCID: PMC11123849 DOI: 10.3390/pathogens13050396] [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: 04/05/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION A subset of interstitial cystitis/bladder pain syndrome (IC/BPS) patients experience recurrent urinary tract infection (rUTI) associated with symptom flares. Recurrent UTI subjects with associated IC/BPS were enrolled in the first North American early clinical experience trial evaluating a new sublingual UTI preventative vaccine, MV140. It has been shown that women with rUTI develop an imbalance in the T helper 1 and 2 (Th2 over-expression) in the bladder mucosa. Our hypothesis-generating secondary analysis will suggest that this infection subcategory of IC/BPS patients develop a similar imbalance of Th1-Th2 response type to bacteria present in their urinary microbiome, leading to a bladder hypersensitivity that responds to mucosal immune modulation. METHODS Female participants with ≥3 documented UTI/year underwent a 3-month vaccination treatment period with a 9-month efficacy period after completion of vaccine treatment (total 12 months). There were no exclusion criteria for subjects in relation to baseline urinary symptoms and/or discomfort/pain. Primary outcome was no UTI following vaccination. Secondary outcomes included change in UTI incidence, overall patient-reported subjective global assessment (SGA responder defined as moderately or markedly improved on 7-point scale), and safety. RESULTS Sixteen subjects with IC/BPS-related symptoms and rUTI (mean age 47; range 23-74 years; mean number of UTI episodes in previous year 6.1 +/- 4.2) were eligible to be included in the Health Canada-approved MV140 vaccine study for prevention of rUTI. All subjects completed the 3-month vaccination period. One subject was lost to follow-up after their 6-month visit. Six subjects were UTI-free, while all 16 subjects had a reduction in UTI episodes compared to the year pre-vaccination. The total post-vaccination reduction in UTI episodes compared to pre-vaccination was 80% (0.1 UTI/subject/month from 0.5 UTI/subject/month, respectively). At 12 months, 13 subjects (81%) were SGA responders (moderately or markedly improved), and the responders reported a reduction in IC/BPS symptoms, with 8 subjects reporting significant or almost complete resolution of their specific long-term bladder discomfort/pain and bothersome urinary frequency or urgency. Four subjects reported mild and self-limited adverse events during vaccination period, but none were related to MV140 vaccine. CONCLUSION Sublingual MV140 vaccine in IC/BPS patients with rUTI not only achieved UTI-free or reduced UTI incidence status but also, after approximately 9 months post vaccination, resolution of patients' long-term treatment-refractory IC/BPS symptoms. This suggests some cases of IC/BPS may be etiologically based on Th2-driven hypersensitivity to bacteria within or entering the urinary microbiome that responds to a vaccine whose mechanism of action is to normalize or balance the bladder Th1/Th2 mucosal immune system.
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Affiliation(s)
- J. Curtis Nickel
- Department of Urology, Queen’s University, Kingston, ON K7L2V7, Canada;
| | - Tiziana Cotechini
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L3N6, Canada
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Yu WR, Jiang YH, Jhang JF, Kuo HC. Urine biomarker could be a useful tool for differential diagnosis of a lower urinary tract dysfunction. Tzu Chi Med J 2024; 36:110-119. [PMID: 38645782 PMCID: PMC11025593 DOI: 10.4103/tcmj.tcmj_221_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: 09/01/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 04/23/2024] Open
Abstract
A precision diagnosis of lower urinary tract dysfunctions (LUTD) such as bladder outlet obstruction, detrusor overactivity (DO), interstitial cystitis/bladder pain syndrome (IC/BPS), dysfunctional voiding (DV), or detrusor underactivity (DU) needs invasive videourodynamic study. Exploring non-invasive tools to help screening LUTD is necessary for clinicians in their daily practice. This article reviews recently clinical studies of using urinary inflammatory proteins and oxidative stress biomarkers in the identification of specific LUTD among men and women with lower urinary tract symptoms (LUTS). Some important findings have been reported: (1) Using urine chemokines CXCL-1 and interleukin-8 (IL-8), we may discriminate overactive bladder (OAB) symptoms in women between DO and urinary tract infection. (2) Urinary levels of oxidative stress biomarkers such as 8-hydroxydeoxyguanosine (8-OHdG) and 8-isoprostane have a potential being used as a tool to identify women with mixed DO and stress urinary incontinence. (3) Urine levels of total antioxidant capacity (TAC), and prostaglandin E2 (PGE2) are positively correlated with voiding detrusor pressure in patients with DU. (4) Urine levels of brain-derived neurotrophic factor (BDNF) and PGE2 were significantly higher in the DU patients with detrusor function recovery. (5) Women with DV had higher urinary levels of tumor necrosis factor-alpha (TNF-α) and 8-OHdG, and urinary IL-2 level was significantly lower. (6) Urine level of 8-isoprostane was higher in the patients with idiopathic DO and neurogenic DO. (7) Higher urine cytokine levels of monocyte chemoattractant protein-1 (MCP-1), regulated on activation, normal T-cell expressed and secreted (RANTES), CXCL-10, IL-7, and eotaxin-1 in patients with IC/BPS than controls. (8) The urine levels of IL-8, CXCL-10, BDNF, IL-6, and RANTES were significantly higher in patients with Hunner's IC than non-Hunner's IC. (9) Male patients with IC/BPS had a significantly higher level of eotaxin, MCP-1, TNF-α, 8-OHdG, and TAC. Combining a higher eotaxin and a higher TNF-α can provide a satisfactory diagnostic value in discriminating IC/BPS from other LUTD in men. These studies provide evidence that measurement of cluster of urine biomarkers could be used as a diagnostic tool to differentiate different LUTD in patients with similar LUTS.
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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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Nettey OS, Gu C, Jackson NJ, Ackerman AL. Validation of Distinct Bladder Pain Phenotypes Utilizing the MAPP Research Network Cohort. Int Urogynecol J 2024; 35:637-648. [PMID: 38300276 PMCID: PMC11023803 DOI: 10.1007/s00192-024-05735-1] [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: 07/26/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION AND HYPOTHESIS As interstitial cystitis/bladder pain syndrome (IC/BPS) likely represents multiple pathophysiologies, we sought to validate three clinical phenotypes of IC/BPS patients in a large, multi-center cohort using unsupervised machine learning (ML) analysis. METHODS Using the female Genitourinary Pain Index and O'Leary-Sant Indices, k-means unsupervised clustering was utilized to define symptomatic phenotypes in 130 premenopausal IC/BPS participants recruited through the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) research network. Patient-reported symptoms were directly compared between MAPP ML-derived phenotypic clusters to previously defined phenotypes from a single center (SC) cohort. RESULTS Unsupervised ML categorized IC/BPS participants into three phenotypes with distinct pain and urinary symptom patterns: myofascial pain, non-urologic pelvic pain, and bladder-specific pain. Defining characteristics included presence of myofascial pain or trigger points on examination for myofascial pain patients (p = 0.003) and bladder pain/burning for bladder-specific pain patients (p < 0.001). The three phenotypes were derived using only 11 features (fGUPI subscales and ICSI/ICPI items), in contrast to 49 items required previously. Despite substantial reduction in classification features, unsupervised ML independently generated similar symptomatic clusters in the MAPP cohort with equivalent symptomatic patterns and physical examination findings as the SC cohort. CONCLUSIONS The reproducible identification of IC/BPS phenotypes, distinguishing bladder-specific pain from myofascial and genital pain, using independent ML analysis of a multicenter database suggests these phenotypes reflect true pathophysiologic differences in IC/BPS patients.
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Affiliation(s)
| | - Cindy Gu
- Department of Urology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Box 951738, Los Angeles, CA, 90095-1738, USA
| | - Nicholas James Jackson
- Department of Internal Medicine and Health Services Research, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - A Lenore Ackerman
- Department of Urology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Box 951738, Los Angeles, CA, 90095-1738, USA.
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Dickson K, Zhou J, Lehmann C. Lower Urinary Tract Inflammation and Infection: Key Microbiological and Immunological Aspects. J Clin Med 2024; 13:315. [PMID: 38256450 PMCID: PMC10816374 DOI: 10.3390/jcm13020315] [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: 11/27/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
The urinary system, primarily responsible for the filtration of blood and waste, is affected by several infectious and inflammatory conditions. Focusing on the lower tract, this review outlines the physiological and immune landscape of the urethra and bladder, addressing key immunological and microbiological aspects of important infectious/inflammatory conditions. The conditions addressed include urethritis, interstitial cystitis/bladder pain syndrome, urinary tract infections, and urosepsis. Key aspects of each condition are addressed, including epidemiology, pathophysiology, and clinical considerations. Finally, therapeutic options are outlined, highlighting gaps in the knowledge and novel therapeutic approaches.
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Affiliation(s)
- Kayle Dickson
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Juan Zhou
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Christian Lehmann
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Yu WR, Kuo HC. Multimodal therapies and strategies for the treatment of interstitial cystitis/bladder pain syndrome in Taiwan. Low Urin Tract Symptoms 2024; 16:e12508. [PMID: 37987028 DOI: 10.1111/luts.12508] [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: 09/21/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disease characterized by bladder pain, frequency, and nocturia. The most common pathologies include chronic inflammation and bladder urothelium dysfunction. According to the bladder condition with or without Hunner's lesions, IC/BPS can be divided into "IC" in patients with Hunner's lesion (HIC) and "BPS" in those without Hunner's lesion (NHIC). Previous studies have reported greater central sensitization and interorgan cross-talk in patients with NHIC. Multimodal treatments have been recommended in clinical guidelines under the biopsychosocial model. The bladder-gut-brain axis has also been speculated, and multimodal therapies are necessary. Unfortunately, currently, no treatment has been reported durable for IC/BPS. Patients with IC/BPS usually experience anxiety, depression, holistic physical responses, and even threats to social support systems. The lack of durable treatment outcomes might result from inadequate diagnostic accuracy and differentiation of clinical phenotypes based on the underlying pathophysiology. Precision assessment and treatment are essential for optimal therapy under definite IC/BPS phenotype. This article reviewed currently available literature and proposed a diagnosis and treatment algorithm. Based on bladder therapy combined with suitable physical and psychological therapies, a well-grounded multimodal therapy and treatment algorithm for IC/BPS following a diagnostic protocol are indispensable.
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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
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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7
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Baars C, van Ginkel C, Heesakkers J, Scholtes M, Martens F, Janssen D. The Burden of Urinary Tract Infections on Quality of Life and Healthcare in Patients with Interstitial Cystitis. Healthcare (Basel) 2023; 11:2761. [PMID: 37893834 PMCID: PMC10606447 DOI: 10.3390/healthcare11202761] [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: 08/10/2023] [Revised: 09/22/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Interstitial cystitis/bladder pain syndrome (IC/BPS) patients are more susceptible to urinary tract infections (UTIs), likely worsening pre-existing symptoms. However, this receives limited attention in guidelines. This study aimed to explore the burden of UTIs on IC/BPS patients' quality of life and their healthcare. METHODS Two quantitative retrospective database studies were conducted in cystoscopically proven IC/BPS patients: one compiled existing patient survey data (n = 217) from July 2021 to examine physical and emotional UTI burden, and the other used a patient file database (n = 100) from January 2020 to May 2022, focusing on UTI prevalence, healthcare use, urine cultures and antibiotic resistance. RESULTS A delay in diagnosis was seen in 70% of patients, due to doctors confusing IC/BPS symptoms with UTIs. The UTI prevalence was over 50%; these patients also report anxiety for new UTIs (70%) and worsening of IC/BPS symptoms (60%). Additionally, for UTI+ patients, healthcare consumption was significantly increased in both studies. Antibiotic resistance (80% of cultures) and prophylactic antibiotic use were common. CONCLUSIONS These findings highlight the burden of UTIs on quality of life in IC/BPS patients and the healthcare system. These results emphasize the need for improved UTI guidelines concerning diagnosis, management and prevention for IC/BPS patients to improve quality of life and care.
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Affiliation(s)
- Cléo Baars
- Department of Urology, Radboudumc, 6525 GA Nijmegen, The Netherlands; (C.B.); (F.M.); (D.J.)
| | - Charlotte van Ginkel
- Department of Urology, Radboudumc, 6525 GA Nijmegen, The Netherlands; (C.B.); (F.M.); (D.J.)
| | - John Heesakkers
- Department of Urology, Maastricht UMC+, 6229 HX Maastricht, The Netherlands;
| | - Mathilde Scholtes
- Interstitial Cystitis Patient Association ICP, 4000 AB Tiel, The Netherlands;
| | - Frank Martens
- Department of Urology, Radboudumc, 6525 GA Nijmegen, The Netherlands; (C.B.); (F.M.); (D.J.)
| | - Dick Janssen
- Department of Urology, Radboudumc, 6525 GA Nijmegen, The Netherlands; (C.B.); (F.M.); (D.J.)
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Ivare AM, Obloza A, Goddard JC. Bladder pain syndrome and pregnancy. Eur J Obstet Gynecol Reprod Biol 2023; 288:29-35. [PMID: 37421744 DOI: 10.1016/j.ejogrb.2023.06.017] [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: 11/21/2022] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
Bladder pain syndrome (BPS) is a poorly understood condition. In pregnancy, lower urinary tract symptoms and pain are common, but the possibility of BPS is rarely considered and almost never explored. The consequences of BPS on pregnancy and vice versa are poorly understood, and management options appear to be limited. This article reviews the current evidence to allow us to better counsel, investigate, diagnose and manage patients with suspected or known BPS who fall pregnant or who are considering pregnancy. MEDLINE, EMBASE and PubMed were searched for a combination of mesh terms of keywords: 'cystitis', 'interstitial', 'bladder', 'pain' and 'pregnancy'. Relevant articles were identified, reviewed and further relevant articles identified from the references. CONCLUSION: BPS symptoms are very common in pregnancy, with limited data suggesting significant negative effects on the woman and pregnancy. There are safe options for investigation, diagnosis and management in pregnancy. There is a need to raise awareness of the impact of BPS symptoms in pregnancy and the available options for diagnoses and management, improving patient experience and outcomes. PATIENT SUMMARY: Patients with BPS or symptoms akin to BPS need not be abandoned in pregnancy. There is data to support them in making decisions around investigation and management in pregnancy.
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Affiliation(s)
- Amy M Ivare
- University Hospitals Leicester, Leicester Royal Informary, Infirmary Square, LE1 5WW, United Kingdom
| | - Aneta Obloza
- University Hospitals Leicester, UK Urogynaecology, United Kingdom
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Nickel JC. Individualized treatment strategy for bladder pain syndrome in female patients provides treatment recipes for successful management. Prog Urol 2023; 33:359-361. [PMID: 36707262 DOI: 10.1016/j.purol.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Affiliation(s)
- J C Nickel
- Department of Urology, Queens University and Kingston Health Sciences Centre, Kingston, Ontario, Canada.
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Neto AC, Santos-Pereira M, Abreu-Mendes P, Neves D, Almeida H, Cruz F, Charrua A. The Unmet Needs for Studying Chronic Pelvic/Visceral Pain Using Animal Models. Biomedicines 2023; 11:biomedicines11030696. [PMID: 36979674 PMCID: PMC10045296 DOI: 10.3390/biomedicines11030696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
The different definitions of chronic pelvic/visceral pain used by international societies have changed over the years. These differences have a great impact on the way researchers study chronic pelvic/visceral pain. Recently, the role of systemic changes, including the role of the central nervous system, in the perpetuation and chronification of pelvic/visceral pain has gained weight. Consequently, researchers are using animal models that resemble those systemic changes rather than using models that are organ- or tissue-specific. In this review, we discuss the advantages and disadvantages of using bladder-centric and systemic models, enumerating some of the central nervous system changes and pain-related behaviors occurring in each model. We also present some drawbacks when using animal models and pain-related behavior tests and raise questions about possible, yet to be demonstrated, investigator-related bias. We also suggest new approaches to study chronic pelvic/visceral pain by refining existing animal models or using new ones.
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Affiliation(s)
- Ana Catarina Neto
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
| | - Mariana Santos-Pereira
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
| | - Pedro Abreu-Mendes
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
- Department of Urology, Centro Hospitalar de São João, 4200-319 Porto, Portugal
- Physiology and Surgery Department, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
| | - Delminda Neves
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
| | - Henrique Almeida
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
- Ginecologia-Obstetrícia, Hospital-CUF Porto, 4100-180 Porto, Portugal
| | - Francisco Cruz
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
- Department of Urology, Centro Hospitalar de São João, 4200-319 Porto, Portugal
- Physiology and Surgery Department, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
| | - Ana Charrua
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
- Correspondence:
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Sensory Receptor, Inflammatory, and Apoptotic Protein Expression in the Bladder Urothelium of Patients with Different Subtypes of Interstitial Cystitis/Bladder Pain Syndrome. Int J Mol Sci 2023; 24:ijms24010820. [PMID: 36614264 PMCID: PMC9821243 DOI: 10.3390/ijms24010820] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to investigate the expression levels of sensory receptors, inflammatory proteins, and pro-apoptotic proteins in the urothelium of non-Hunner's interstitial cystitis (NHIC) bladders of patients with different clinical and cystoscopic phenotypes. The urothelia from the bladders of 52 NHIC patients were harvested. The expression of sensory receptors, including TRPV1, TRPV4, TRPA1, H1-receptors, and sigma-1 receptors; the inflammatory proteins p38 and tryptase; and the pro-apoptotic proteins, such as caspase-3, BAD, and BAX in the urothelium, were investigated using immunohistochemistry and Western blotting. We compared the expression levels of these proteins in NHIC subtypes according to IC symptom scores, visual analog scores of bladder pain, maximal bladder capacity, glomerulation grades, and combined maximal bladder capacity and glomerulations after cystoscopic hydrodistention. The expression levels of TRPV1, TRPV4, sigma-1, P38, tryptase, caspase-3, and BAD were significantly increased in the urothelium of IC/BPS patients compared with the expression levels in the controls. TRPV1 was significantly associated with IC symptom severity. However, no significant differences in sensory receptor expression in the IC/BPS bladders with different bladder conditions were detected. Inflammatory and pro-apoptotic protein expression levels in the urothelium were similar among the IC/BPS subgroups. This study concluded that IC/BPS patients with frequency and bladder pain complaints have higher levels of urothelial sensory receptors, and inflammatory and pro-apoptotic proteins. The expression levels of these sensory receptors, inflammatory proteins, and pro-apoptotic proteins are not significantly different among IC/BPS bladders with different conditions.
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Hung FC, Kuo HC. Liposome-Encapsulated Botulinum Toxin A in Treatment of Functional Bladder Disorders. Toxins (Basel) 2022; 14:toxins14120838. [PMID: 36548734 PMCID: PMC9781836 DOI: 10.3390/toxins14120838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
Botulinum toxin A (BoNT-A) intravesical injections have been used to treat patients with refractory functional bladder disorders such as overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS), but the risk of adverse events and the need for repeated injections continue to prevent widespread application of this treatment. Liposomes are vesicles that comprise concentric phospholipid layers and an aqueous core; their flexible compositions enable them to adsorb and fuse with cell membranes and to deliver drugs or proteins into cells. Therefore, liposomes have been considered as promising vehicles for the less invasive delivery of BoNT-A. In previous placebo-controlled trials including patients with OAB refractory to medical treatment, it was shown that liposomal BoNT-A could significantly decrease the frequency and urgency of urination. In patients with IC/BPS, it was shown that liposomal BoNT-A could also improve bladder pain, but the therapeutic efficacy was not superior to that of the placebo. As the therapeutic mechanisms of BoNT-A include the decreased expression of nerve growth factors, P2X3 receptors, and vanilloid receptors on C-fibers, liposomal BoNT-A might play a more promising role in the treatment of bladder oversensitivity. This article features the contemporary literature regarding BoNT-A, liposomes, and liposomal BoNT-A treatment for functional bladder disorders and potential clinical applications in the future.
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Affiliation(s)
- Fan-Ching Hung
- Department of Urology, National Taiwan University Hospital Yunlin Branch, Douliu 64041, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2113); Fax: +886-3-8560794
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Shi JY, Paredes Mogica JA, De EJB. Non-Surgical Management of Chronic Pelvic Pain in Females. Curr Urol Rep 2022; 23:245-254. [PMID: 36066815 DOI: 10.1007/s11934-022-01110-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to review the most recent literature on non-surgical therapeutic options for chronic pelvic pain in females. RECENT FINDINGS Chronic pelvic pain can arise from virtually any organ system in the human body. If a precise etiology is identified, the management of chronic pelvic pain can be tailored accordingly. In some cases, patients with chronic pelvic pain can remain without a specific diagnosis. In these circumstances, adequate symptom control can still be achieved even if no underlying disorder is found. Although chronic pelvic pain is often a difficult disorder to manage, several non-surgical management options exist. Employing a multidisciplinary approach, most patients can achieve adequate symptom relief, usually without the need for surgical intervention.
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14
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Kuo HC. Clinical Application of Botulinum Neurotoxin in Lower-Urinary-Tract Diseases and Dysfunctions: Where Are We Now and What More Can We Do? Toxins (Basel) 2022; 14:toxins14070498. [PMID: 35878235 PMCID: PMC9324011 DOI: 10.3390/toxins14070498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
Botulinum toxin A (Botox) had been considered a promising drug that has an effect on functional disorders of the lower urinary tract. Because Botox exhibits anti-inflammatory and antispasmodic effects, Botox injection into the bladder can decrease detrusor contractility, reduce bladder hypersensitivity, and eliminate painful sensations. Injecting Botox into the bladder outlet can relax the hyperactivity of the bladder neck, and of the urethral smooth and striated muscles. Based on these therapeutic effects, Botox has been widely applied to treat lower-urinary-tract dysfunctions (LUTDs) such as overactive bladder and neurogenic detrusor overactivity. However, this treatment has not been licensed for use in other LUTDs such as interstitial cystitis, voiding dysfunction due to benign prostatic hyperplasia in men, and dysfunctional voiding in women. Botox has also not been approved for the treatment of children with overactive bladder and dysfunctional voiding; in patients with spinal cord injuries with detrusor sphincter dyssynergia and autonomic dysreflexia; or for poorly relaxed external sphincter in non-neurogenic patients. This article reviews the current knowledge regarding Botox treatment for LUTDs and discusses the potential clinical applications of Botox, as well as work that can be conducted in the future.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 97004, Taiwan
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15
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Mwesigwa PJ, Jackson NJ, Caron AT, Kanji F, Ackerman JE, Webb JR, Scott VCS, Eilber KS, Underhill DM, Anger JT, Ackerman AL. Unsupervised Machine Learning Approaches Reveal Distinct Phenotypes of Perceived Bladder Pain: A Pilot Study. FRONTIERS IN PAIN RESEARCH 2022; 2. [PMID: 35036991 PMCID: PMC8758057 DOI: 10.3389/fpain.2021.757878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is defined as an unpleasant sensation perceived to be related to the bladder with associated urinary symptoms. Due to difficulties discriminating pelvic visceral sensation, IC/BPS likely represents multiple phenotypes with different etiologies that present with overlapping symptomatic manifestations, which complicates clinical management. We hypothesized that unique bladder pain phenotypes or "symptomatic clusters" would be identifiable using machine learning analysis (unsupervised clustering) of validated patient-reported urinary and pain measures. Patients (n = 145) with pelvic pain/discomfort perceived to originate in the bladder and lower urinary tract symptoms answered validated questionnaires [OAB Questionnaire (OAB-q), O'Leary-Sant Indices (ICSI/ICPI), female Genitourinary Pain Index (fGUPI), and Pelvic Floor Disability Index (PFDI)]. In comparison to asymptomatic controls (n = 69), machine learning revealed three bladder pain phenotypes with unique, salient features. The first group chiefly describes urinary frequency and pain with the voiding cycle, in which bladder filling causes pain relieved by bladder emptying. The second group has fluctuating pelvic discomfort and straining to void, urinary frequency and urgency without incontinence, and a sensation of incomplete emptying without urinary retention. Pain in the third group was not associated with voiding, instead being more constant and focused on the urethra and vagina. While not utilized as a feature for clustering, subjects in the second and third groups were significantly younger than subjects in the first group and controls without pain. These phenotypes defined more homogeneous patient subgroups which responded to different therapies on chart review. Current approaches to the management of heterogenous populations of bladder pain patients are often ineffective, discouraging both patients and providers. The granularity of individual phenotypes provided by unsupervised clustering approaches can be exploited to help objectively define more homogeneous patient subgroups. Better differentiation of unique phenotypes within the larger group of pelvic pain patients is needed to move toward improvements in care and a better understanding of the etiologies of these painful symptoms.
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Affiliation(s)
- Patricia J Mwesigwa
- Department of Obstetrics and Gynecology, Center for Women's Pelvic Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Nicholas J Jackson
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Ashley T Caron
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Falisha Kanji
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - James E Ackerman
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jessica R Webb
- Cedars-Sinai Medical Group, Department of Internal Medicine, Los Angeles, CA, United States
| | - Victoria C S Scott
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Karyn S Eilber
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - David M Underhill
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jennifer T Anger
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - A Lenore Ackerman
- Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Naveed M, Changxing L, Ihsan AU, Shumzaid M, Kamboh AA, Mirjat AA, Saeed M, Baig MMFA, Zubair HM, Noreen S, Madni A, Xiaohui Z. Therapeutic interventions to urologic chronic pelvic pain syndrome and UPOINT system for clinical phenotyping: How far are we? Urologia 2022; 89:315-328. [PMID: 34978224 DOI: 10.1177/03915603211065301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The assessment and management of urologic chronic pelvic pain syndrome (UCPPS), is controversial. It is classified by voiding symptoms, pelvic pain, and bladder pain, which is weekly treated, weekly understood, and bothersome. In the aspect of clinical efforts and research to help people with this syndrome have been hampered by the deficiency of a widely reliable, accepted, and a valuable tool to evaluate the patient symptoms and quality of life (QoL) impact. However, the etiology comes into sight is multifactorial, and available treatment options have been imprecise considerably in present years. We compiled the published literature on the assessment of the syndrome, a tentative role of pharmacological and non-pharmacological (conservative, alternative, and invasive therapy) interventions in eradicating the disease as well as improving symptoms. The previously published literature on animal models has established the association of immune systems in the etiology, pathogenesis, and progression of the disease. The UPOINT system for clinical phenotyping of UCPPS patients has six predefined domains that direct multimodal therapy, which would lead to significant symptom improvement in the medical field. The narrative review aims to scrutinize the fluctuating scientist's views on the evaluation of patient and multimodal treatment of the UPOINT system.
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Affiliation(s)
- Muhammad Naveed
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Li Changxing
- Department of Human Anatomy, Medical College of Qinghai University, Xining, China
| | - Awais Ullah Ihsan
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Muhammad Shumzaid
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore, Pakistan
| | | | | | - Muhammad Saeed
- Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | | | | | - Sobia Noreen
- Faculty of Pharmacy. The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Asadullah Madni
- Faculty of Pharmacy. The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Zhou Xiaohui
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
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The effect of intravesical cocktail therapy combined with low-dose amitriptyline on primary bladder pain syndrome. Int Urogynecol J 2022; 33:1225-1230. [PMID: 34977954 DOI: 10.1007/s00192-021-05043-y] [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: 09/28/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We compared the effectiveness of intravesical combination treatment and intravesical treatment plus low-dose amitriptyline in patients with primary bladder pain syndrome (PBPS). METHODS A total of 53 patients were included in the study. Demographic data, voiding frequency, nocturia, visual analog scale (VAS) scores, validated O'Leary-Sant IC Symptom Index (ICSI), and IC Problem Index (ICPI) scores and scores on the Short Form-36 (SF-36) questionnaire were collected from the patients at the beginning of the treatment, and at the 6th week and 6th month of the treatment. The patients were divided into two groups. Group 1 received intravesical treatment for 6 weeks. Group 2 received intravesical treatment plus amitriptyline at a dosage of 10 mg/day. RESULTS The frequencies of voiding and VAS scores were significantly improved in groups 1 and 2 at the 6th week compared with pretreatment (in group 1 p < 0.001, p < 0.001, and in group 2 p < 0.001, p < 0.001 respectively). The median ICSI and ICPI scores also significantly decreased in groups 1 and 2 (in group 1 p < 0.001, p < 0.001, and in group 2 p < 0.001, p < 0.001 respectively). Scores on the dimensions of the SF-36 questionnaire were significantly improved in both groups. There was no significant change in terms of VAS, nocturia, ICSI or ICPI scores when comparing the 6th week and 6th month results in groups 1 and 2 (all p > 0.05). Only role functioning/emotional achieved a significant improvement in group 2 (p = 0.007). CONCLUSIONS Intravesical combination therapies are effective in PBPS treatment. Adding low-dose amitriptyline to intravesical therapy in patients with PBPS improves emotional status.
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Wen C, Xie L, Hu C. Roles of mesenchymal stem cells and exosomes in interstitial cystitis/bladder pain syndrome. J Cell Mol Med 2021; 26:624-635. [PMID: 34953040 PMCID: PMC8817120 DOI: 10.1111/jcmm.17132] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 12/13/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by several symptoms of higher sensitivity of the lower urinary tract, such as bladder pain/discomfort, urgency, urinary frequency, pelvic pain and nocturia. Although the pathophysiology of IC/BPS is not fully understood, the hypothesis suggests that mast cell activation, glycosaminoglycan (GAG) layer defects, urothelium permeability disruption, inflammation, autoimmune disorder and infection are potential mechanisms. Mesenchymal stem cells (MSCs) have been proven to protect against tissue injury in IC/BPS by migrating into bladders, differentiating into key bladder cells, inhibiting mast cell accumulation and cellular apoptosis, inhibiting inflammation and oxidative stress, alleviating collagen fibre accumulation and enhancing tissue regeneration in bladder tissues. In addition, MSCs can protect against tissue injury in IC/BPS by secreting various soluble factors, including exosomes and other soluble factors, with antiapoptotic, anti-inflammatory, angiogenic and immunomodulatory properties in a cell-to-cell independent manner. In this review, we comprehensively summarized the current potential pathophysiological mechanisms and standard treatments of IC/BPS, and we discussed the potential mechanisms and therapeutic effects of MSCs and MSC-derived exosomes in alleviating tissue injury in IC/BPS models.
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Affiliation(s)
- Chao Wen
- Department of Urology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Liping Xie
- Department of Urology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chenxia Hu
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,National Clinical Research Center for Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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Hsu LN, Tsai YS, Tong YC. Low-pressure hydrodistension induces bladder glomerulations in female patients with interstitial cystitis/bladder pain syndrome. Neurourol Urodyn 2021; 41:296-305. [PMID: 34633704 DOI: 10.1002/nau.24818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/04/2021] [Accepted: 09/16/2021] [Indexed: 11/11/2022]
Abstract
AIMS The role of hydrodistension in the diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) is controversial. This study evaluated the effect of low-pressure hydrodistension on glomerulation formation in female patients diagnosed with the disease. METHODS Sixty female patients with the clinical diagnosis of IC/BPS and 30 female controls without the disease underwent cystoscopy and hydrodistension. Cold-cup biopsy was taken from bladder posterior wall at sites with normal cystoscopic appearance before hydrodistension in the IC/BPS group. The tissue samples were processed for histology study. Low-pressure (40 cmH2 O) hydrodistension for 2 min was performed and the appearance of glomerulations was compared between the two groups. High-pressure (80 cmH2 O) hydrodistension for 8 min was then performed as a therapeutic measure for the IC/BPS patients. Further changes to the degree of glomerulations were recorded. RESULTS Histology showed pathological changes in the normal-appearing IC/BPS bladder mucosa including urothelium denudation, inflammatory cell infiltration, stromal edema, fibrosis, and vascular congestion. Low-pressure hydrodistension induced significant glomerulation formation in the patient group (percentage of patients with Grades 0-4: 0%, 8.3%, 40%, 35%, 10%, respectively) while none in the controls. High-pressure hydrodistension further increased the glomerulation grading in the IC/BPS patients. CONCLUSIONS Structural changes are present in prehydrodistension IC/BPS bladder wall, which may not be macroscopically detectable. Hydrodistension at low pressure is adequate to disrupt the integrity of such diseased mucosa and offers a more discriminative test in the diagnosis of IC/BPS.
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Affiliation(s)
- Lin-Nei Hsu
- Department of Urology, An Nan Hospital, China Medical University, Tainan City, Taiwan, ROC
| | - Yuh-Shyan Tsai
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yat-Ching Tong
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Trama F, Illiano E, Marchesi A, Brancorsini S, Crocetto F, Pandolfo SD, Zucchi A, Costantini E. Use of Intravesical Injections of Platelet-Rich Plasma for the Treatment of Bladder Pain Syndrome: A Comprehensive Literature Review. Antibiotics (Basel) 2021; 10:antibiotics10101194. [PMID: 34680774 PMCID: PMC8532598 DOI: 10.3390/antibiotics10101194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Bladder pain syndrome/interstitial cystitis (BPS/IC) or primary bladder pain syndrome (PBPS) is a complex and poorly understood condition. This comprehensive review aimed to discuss the potential application of platelet-rich plasma (PRP) in the treatment of BPS/IC. The pathophysiology of BPS/IC is characterized by urothelial damage that triggers a chain of events leading to chronic inflammation and other conditions. Frequently, in subjects affected by BPS/IC, recurrent urinary tract infection (rUTI) is associated with difficult therapeutic management. For these reasons, many oral and intravesical treatments (e.g., antibiotic therapy and intravesical anesthetic instillations) have been proposed to alleviate the symptoms of IC/BPS. However, the limitation of these treatments is the short duration of improvement. The purpose of this review is to analyze the efficacy of intravesical PRP injections in subjects with PBS/IC and to try to understand the potential therapeutic effects on the pathophysiology of this disease. METHODS A nonsystematic literature search using Pubmed, EMBASE, Scopus, Web of Science, Medline was performed from January 2000 to August 2021. The following terms were combined to capture relevant publications: "platelet-rich plasma", "interstitial cystitis", "PRP", "bladder pain syndrome", and "painful bladder syndrome". RESULTS After exclusion of non-pertinent studies/articles, we have analyzed 5 studies. In detail, 2 articles concerned preclinical studies in which animal models were used. The authors showed an improvement in the histological pattern with less bleeding in treated subjects, a lower presence of inflammatory cytokines and an increase in the mitotic index of urothelial cells in animals treated with intravesical PRP. In the three prospective clinical trials analyzed, patients with BPS/IC who underwent monthly intravesical PRP injections were found to have a statistically significant improvement in symptoms with modulation of growth factors and inflammatory proteins. CONCLUSIONS New evidence suggests that treatment with intravesical PRP could improve urothelial regeneration and reduces chronic inflammation in BPS/IC, modifying the clinical history of its pathology.
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Affiliation(s)
- Francesco Trama
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Umbria, IT Viale Tristano di Joannuccio, 05100 Terni, Italy; (E.I.); (A.M.); (E.C.)
- Correspondence: ; Tel.: +39-0744-20520
| | - Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Umbria, IT Viale Tristano di Joannuccio, 05100 Terni, Italy; (E.I.); (A.M.); (E.C.)
| | - Alessandro Marchesi
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Umbria, IT Viale Tristano di Joannuccio, 05100 Terni, Italy; (E.I.); (A.M.); (E.C.)
| | - Stefano Brancorsini
- Department of Experimental Medicine, University of Perugia, 05100 Terni, Italy;
| | - Felice Crocetto
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Federico II, 80100 Naples, Italy; (F.C.); (S.D.P.)
| | - Savio Domenico Pandolfo
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Federico II, 80100 Naples, Italy; (F.C.); (S.D.P.)
| | - Alessandro Zucchi
- Urology Unit, Department of Translational Research and New Technologies, University of Pisa, 56010 Pisa, Italy;
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Umbria, IT Viale Tristano di Joannuccio, 05100 Terni, Italy; (E.I.); (A.M.); (E.C.)
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21
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Chen Y, Ying Z, Xiao Y, Liu Y, Wu S. The diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies in clinically suspected interstitial cystitis/bladder pain syndrome. Eur J Obstet Gynecol Reprod Biol 2021; 265:156-161. [PMID: 34492610 DOI: 10.1016/j.ejogrb.2021.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/15/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to explore the diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies for clinically suspected interstitial cystitis/bladder pain syndrome (IC/BPS). STUDY DESIGN We reviewed the data of fifty-five clinically suspected IC/BPS patients underwent cystoscopy with hydrodistension and random biopsies. Global Response Assessment was used to evaluate the efficacy. Disease severity was assessed by thorough history, physical examination, 3-day frequency volume chart, visual analog scale of pain, Interstitial Cystitis Symptom Index (ICSI) and clinical phenotype system (UPOINT). RESULTS According to the pathologic outcomes from random biopsies, three out of the 55 clinically suspected IC/BPS were diagnosed as bladder carcinoma. Among the 52 IC/BPS patients, thirty-six patients (69.2%) had initial chief complaints of urinary frequency and urgency. Under cystoscopy, twenty-nine patients and 23 patients were classified as Hunner ulcer type and diffuse global mucosal bleeding (grade III glomerulation). The median functional bladder capacity of the 52 IC/BPS patients was 100 ml. Hydrodistension was effective in 28 patients (53.8%) at postoperative 3 months, which decreased to 25% at post-hydrodistension 6 months and to 13.5% at 12 months. For the 28 hydrodistension-effective patients, the remission degrees of daytime frequency, nocturia, VAS bladder pain and ICSI score were 50.3%, 49.4%, 68.1% and 48%, which were significantly higher than the 16.9% (daytime frequency, P < 0.001), 20.5% (nocturia, P = 0.021), 7.4% (VAS pain score, P < 0.001) and 6.1% (ICSI, P < 0.001) in the hydrodistension-negative group. According to the UPOINT system, the hydrodistension-effective cases had significantly higher rates of symptom remission in U (P = 0.002), P (P = 0.026), O (P < 0.001), and T (P < 0.001) domains than the corresponding negative cases. In effective group, the O domain had the most remission rate (26 out of 28, 92.9%, P < 0.001), followed by the U domain (12 out of 28, 42.9%, P < 0.001) and T domain (12 out of 28, 42.9%, P < 0.001). CONCLUSION Histopathological analysis from random biopsies could distinguish bladder carcinoma from clinically suspected IC/BPS. Hydrodistension is more likely to be effective when chronic pelvic pain is obviously alleviated. The efficacy of hydrodistension could act in a certain period of time.
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Affiliation(s)
- Yuke Chen
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Ziqi Ying
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Yunxiang Xiao
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Yi Liu
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Shiliang Wu
- Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
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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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Volpe KA, Mandelbaum R, Rodriguez LV, Özel BZ, Rolston R, Dancz CE. Does Obtaining a Diagnosis of Interstitial Cystitis/Bladder Pain Syndrome Improve Symptoms or Quality of Life? A Cross-sectional Questionnaire-Based Study. Female Pelvic Med Reconstr Surg 2021; 27:328-333. [PMID: 32304396 DOI: 10.1097/spv.0000000000000840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether receiving a clinical diagnosis of interstitial cystitis (IC) or bladder pain syndrome (BPS) improves patients' symptoms, health-related quality of life (HRQOL), or ability to cope with their symptoms. METHODS In this cross-sectional study, participants with self-reported IC/BPS completed an online questionnaire recalling their perceived change in symptoms after diagnosis and treatment. The questionnaire included demographic information, overall HRQOL measured on a visual analog scale (VAS), O'Leary-Sant Interstitial Cystitis Problem Index, the Urinary Impact Questionnaire, and questions regarding patient beliefs about diagnosis. HRQOL and symptom impact scales were compared before and after diagnosis and treatment. Demographic data, symptom data, and beliefs were examined for correlation with improvement in quality of life after diagnosis. RESULTS A total of 1052 participants initiated the survey and were included in the analysis; most of them identified as female, non-Hispanic, and white (90%). Before symptom onset, median VAS HRQOL score was 87 (interquartile range [IQR], 77-95). Median scores nadired at 34 (IQR, 20-59) after symptom onset before diagnosis, but improved to 61 after diagnosis and treatment (IQR, 38-74; all P < 0.001). Scores remained stable after diagnosis and initiation of treatment with a median score of 65 at the time of survey (IQR, 37-80; P > 0.05). Age, insurance type, and improvement in scores on the symptom impact scale predicted improvement in HRQOL after diagnosis and treatment in the multivariable model. CONCLUSIONS Participants reported improvements on global and symptom-specific quality of life measures after diagnosis and treatment for IC/BPS.
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Affiliation(s)
- Katherine A Volpe
- From the Keck School of Medicine, University of Southern California, Los Angeles, CA
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24
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Cystoscopic hydrodistention characteristics provide clinical and long-term prognostic features of interstitial cystitis after treatment. Sci Rep 2021; 11:455. [PMID: 33432045 PMCID: PMC7801576 DOI: 10.1038/s41598-020-80252-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022] Open
Abstract
To evaluate the correlations of clinical symptoms, urodynamic parameters, and long-term treatment outcomes with different findings of cystoscopic hydrodistention (HD) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). This retrospective analysis of 486 patients with IC/BPS investigated baseline clinical symptoms, disease duration, medical comorbidities, urodynamic findings, cystoscopic characteristics [including maximal bladder capacity (MBC) and the presence of glomerulations and Hunner’s lesions], and outcomes according to the five IC/BPS HD subtypes based on the glomerulation grade, MBC, and the presence of Hunner’s lesions. Receiver operation characteristic analysis identified an optimal cutoff value of MBC ≥ 760 ml as a predictor of satisfactory outcomes. Glomerulation grade and MBC were significantly correlated (r = − 0.403, P < 0.001), and both were significantly associated with IC Symptom Index scores. The rate of satisfactory outcomes was better for the patients with low glomerulation grade and MBC ≥ 760 ml (64.2%), and significantly worse for those with Hunner’s lesions (36.8%); no significant differences were noted among the other groups. The results suggested that IC/BPS patients can be classified into the following three distinct subgroups: (1) those with low glomerulation grade and MBC ≥ 760 ml; (2) those with low glomerulation grade and MBC < 760 ml, or with high glomerulation grade regardless of MBC; and (3) those with Hunner’s lesions. The results showed that three IC/BPS subgroups had distinct bladder characteristics and treatment outcomes. The patients with high MBC and low glomerulation grade after HD had more medical comorbidities but a significantly higher rate of satisfactory treatment outcome. IRB: 105-25-B.
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Lopez SR, Mangır N. Current standard of care in treatment of bladder pain syndrome/interstitial cystitis. Ther Adv Urol 2021; 13:17562872211022478. [PMID: 34178118 PMCID: PMC8202321 DOI: 10.1177/17562872211022478] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/15/2021] [Indexed: 12/30/2022] Open
Abstract
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a debilitating, systemic pain syndrome with a cardinal symptom of bladder related pain with associated systemic symptoms. It is characterized by an inflammation that partially or completely destroys the mucus membrane and can extend into the muscle layer; however, the etiology and pathogenesis is still enigmatic. It has been suggested that mast cell activation, defects in the glycosaminoglycan layer, non-functional proliferation of bladder epithelial cells, neurogenic inflammation, microvascular abnormalities in the submucosal layer, autoimmunity and infectious causes may cause BPS/IC. Available treatment options include general relaxation techniques, patient education, behavioral treatments, physical therapy, multimodal pain therapy, oral (amitriptyline, cimetidine, hydroxyzine) and intravesical treatments (heparin, lidocaine, hyaluronic acid and chondroitin sulfate), hydrodistension and other more invasive treatments. Available treatments are mostly not based on a high level of evidence. Lack of understanding of disease mechanisms has resulted in lack of targeted therapies on this area and a wealth of empirical approaches with usually inadequate efficacy. The aim of this article is to review the available evidence on the pathophysiological mechanisms of BPS/IC as they relate to available treatment options.
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Affiliation(s)
| | - Naşide Mangır
- Department of Urology, Consultant Urologist and Clinical Lecturer in Urology, Hacettepe University School of Medicine, Sıhhiye, Ankara 06100, Turkey
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26
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Watanabe D, Akiyama Y, Niimi A, Nomiya A, Yamada Y, Sato Y, Nakamura M, Kawai T, Yamada D, Suzuki M, Igawa Y, Kume H, Homma Y. Clinical characterization of interstitial cystitis/bladder pain syndrome in women based on the presence or absence of Hunner lesions and glomerulations. Low Urin Tract Symptoms 2020; 13:139-143. [PMID: 32830459 DOI: 10.1111/luts.12344] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare the clinical characteristics of three groups of female patients with interstitial cystitis/bladder pain syndrome (IC/BPS) classified according to the presence or absence of Hunner lesions (HL) and glomerulations. METHODS The clinical records of 100 female patients with IC/BPS who underwent their first bladder hydrodistension at our institution were retrospectively reviewed. They were divided into patients having (HL-IC; n = 57) or lacking (BPS; n = 43) HL. BPS patients were further classified as those with (29) and without (14) glomerulations. Among these three subtypes, demographics, comorbidities, symptom parameters including a visual analog scale for pain scores, O'Leary and Sant Symptom and Problem (OSSI/OSPI) Indices, frequency volume chart variables, and bladder capacity at hydrodistension were compared. RESULTS HL-IC patients were older and had higher OSSI/OSPI scores, greater daytime frequency and nocturia, reduced maximum and average voided volumes, and smaller bladder capacity at hydrodistension compared with BPS patients. Pain intensity and illness duration were comparable among the three groups. HL-IC patients had autoimmune disorders as comorbidities more often, but had psychiatric disorders and irritable bowel syndrome less often compared with BPS patients. No discernible differences in clinical characteristics of symptom severity and comorbid disorders were evident between BPS patients with and without glomerulations. CONCLUSIONS The presence of HL is associated with distinctive clinical characteristics, while glomerulations are not in female patients with IC/BPS. The presence of HL, but not glomerulations, is a robust phenotypic feature of IC/BPS in women.
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Affiliation(s)
- Daiji Watanabe
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, New Tokyo Hospital, Matsudo, Tokyo, Japan
| | - Akira Nomiya
- Department of Urology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaki Nakamura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Nagano Prefectural Shinshu Medical Center, Suzaka, Nagano, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Tokyo, Japan
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Holschneider DP, Wang Z, Chang H, Zhang R, Gao Y, Guo Y, Mao J, Rodriguez LV. Ceftriaxone inhibits stress-induced bladder hyperalgesia and alters cerebral micturition and nociceptive circuits in the rat: A multidisciplinary approach to the study of urologic chronic pelvic pain syndrome research network study. Neurourol Urodyn 2020; 39:1628-1643. [PMID: 32578247 DOI: 10.1002/nau.24424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/11/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022]
Abstract
AIMS Emotional stress plays a role in the exacerbation and development of interstitial cystitis/bladder pain syndrome (IC/BPS). Given the significant overlap of brain circuits involved in stress, anxiety, and micturition, and the documented role of glutamate in their regulation, we examined the effects of an increase in glutamate transport on central amplification of stress-induced bladder hyperalgesia, a core feature of IC/BPS. METHODS Wistar-Kyoto rats were exposed to water avoidance stress (WAS, 1 hour/day x 10 days) or sham stress, with subgroups receiving daily administration of ceftriaxone (CTX), an activator of glutamate transport. Thereafter, cystometrograms were obtained during bladder infusion with visceromotor responses (VMR) recorded simultaneously. Cerebral blood flow (CBF) mapping was performed by intravenous injection of [14 C]-iodoantipyrine during passive bladder distension. Regional CBF was quantified in autoradiographs of brain slices and analyzed in three dimensional reconstructed brains with statistical parametric mapping. RESULTS WAS elicited visceral hypersensitivity during bladder filling as demonstrated by a decreased pressure threshold and VMR threshold triggering the voiding phase. Brain maps revealed stress effects in regions noted to be responsive to bladder filling. CTX diminished visceral hypersensitivity and attenuated many stress-related cerebral activations within the supraspinal micturition circuit and in overlapping limbic and nociceptive regions, including the posterior midline cortex (posterior cingulate/anterior retrosplenium), somatosensory cortex, and anterior thalamus. CONCLUSIONS CTX diminished bladder hyspersensitivity and attenuated regions of the brain that contribute to nociceptive and micturition circuits, show stress effects, and have been reported to demonstrated altered functionality in patients with IC/BPS. Glutamatergic pharmacologic strategies modulating stress-related bladder dysfunction may be a novel approach to the treatment of IC/BPS.
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Affiliation(s)
| | - Zhuo Wang
- Departments of Psychiatry and Behavioral Sciences, Los Angeles, California
| | - Huiyi Chang
- Department of Urology, University of Southern California, Los Angeles, California.,Reeve-Irvine Research Center, University of California, Irvine, California
| | - Rong Zhang
- Department of Urology, University of Southern California, Los Angeles, California
| | - Yunliang Gao
- Department of Urology, University of Southern California, Los Angeles, California.,Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yumei Guo
- Departments of Psychiatry and Behavioral Sciences, Los Angeles, California
| | - Jackie Mao
- Department of Urology, University of Southern California, Los Angeles, California
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, California
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29
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Grinberg K, Sela Y, Nissanholtz-Gannot R. New Insights about Chronic Pelvic Pain Syndrome (CPPS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3005. [PMID: 32357440 PMCID: PMC7246747 DOI: 10.3390/ijerph17093005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. The aim of this article was to present new insight about CPPS in order to raise awareness of nursing and medical staff in the identification and diagnosis of the syndrome and to promote an appropriate treatment for each woman who suffers from CPPS. METHODS A literature review about the factors associated with CPPS and therapeutic interventions for CPPS was conducted. RESULTS CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. CONCLUSIONS The therapeutic interventions in CPPS cases should, consequently, follow a multidisciplinary approach.
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Affiliation(s)
- Keren Grinberg
- Department of Nursing, Faculty of Social and Community Science, Ruppin Academic Center, 40250 Emek-Hefer, Israel
| | - Yael Sela
- Department of Nursing, Faculty of Social and Community Science, Ruppin Academic Center, 40250 Emek-Hefer, Israel
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30
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Rachin SA, Sharov MN, Zaitsev AV, Tynterova AM, Nuvakhova MV, Prokofyeva YS, Parsamyan RR, Maksimova MY, Rachin AP. Chronic pelvic pain: from correct diagnosis to adequate therapy. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2020. [DOI: 10.14412/2074-2711-2020-2-12-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- S. A. Rachin
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - M. N. Sharov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - A. V. Zaitsev
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - A. M. Tynterova
- Immanuel Kant Baltic Federal University, Ministry of Education and Science of Russia
| | - M. V. Nuvakhova
- National Medical Research Center of Rehabilitation and Balneology, Ministry of Health of Russia
| | - Yu. S. Prokofyeva
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
| | - R. R. Parsamyan
- V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia
| | - M. Yu. Maksimova
- Research Center of Neurology, Ministry of Education and Science of Russia
| | - A. P. Rachin
- National Medical Research Center of Rehabilitation and Balneology, Ministry of Health of Russia
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31
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Jiang YH, Jhang JF, Hsu YH, Ho HC, Wu YH, Kuo HC. Urine cytokines as biomarkers for diagnosing interstitial cystitis/bladder pain syndrome and mapping its clinical characteristics. Am J Physiol Renal Physiol 2020; 318:F1391-F1399. [PMID: 32281420 DOI: 10.1152/ajprenal.00051.2020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The objective of the present study was to investigate the diagnostic values of urine cytokines in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) and to identify their correlations with clinical characteristics. Urine samples were collected from 127 patients with IC/BPS [European Society for the Study of Interstitial Cystitis (ESSIC) types 1 and 2] and 28 controls. Commercially available multiplex immunoassays (MILLIPLEX map kits) were used to analyze 31 targeted cytokines. Cytokine levels between patients with IC/BPS and controls were analyzed using ANOVA. Receiver-operating characteristic curves of each cytokine to distinguish IC/BPS from controls were generated for calculation of the area under the curve. Patients with IC/BPS had urine cytokine profiles that differed from those of controls. Between patients with ESSIC type 1 and 2 IC/BPS, urine cytokine profiles were also different. Among cytokines with high diagnostic values (i.e., area under the curve > 0.7) with respect to distinguish patients with ESSIC type 2 IC/BPS from controls, regulated upon activation, normal T cell expressed and presumably secreted (RANTES), macrophage inflammatory protein (MIP)-1β, and IL-8 were of higher sensitivity, whereas macrophage chemoattractant protein (MCP)-1, chemokine (C-X-C motif) ligand 10 (CXCL10), and eotaxin-1 were of higher specificity. In multivariate logistic regression models controlling for age, sex, body mass index, and diabetes mellitus, the urine cytokines with high diagnostic values (MCP-1, RANTES, CXCL10, IL-7, and eotaxin-1) remained statistically significant in differentiating IC/BPS and controls. MCP-1, CXCL10, eotaxin-1, and RANTES were positively correlated with glomerulation grade and negatively correlated with maximal bladder capacity. In conclusion, patients with IC/BPS had urine cytokine profiles that clearly differed from those of controls. Urine cytokines might be useful as biomarkers for diagnosing IC/BPS and mapping its clinical characteristics.
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Affiliation(s)
- 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
| | - Yung-Hsiang Hsu
- Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Han-Chen Ho
- Department of Anatomy, Tzu Chi University, Hualien, Taiwan
| | - Ya-Hui Wu
- 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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32
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OAB and IC/BPS: Two Conditions or a Continuum of One? CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-019-00567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grinberg K, Weissman-Fogel I, Lowenstein L, Abramov L, Granot M. How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome? Pain Res Manag 2019; 2019:6091257. [PMID: 31915499 PMCID: PMC6930783 DOI: 10.1155/2019/6091257] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/05/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Background Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated. Purpose This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients. Methods The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women. Results Along with an improvement in the clinical pain intensity (p = 0.001) and sensitivity to experimental pain tests (p = 0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p = 0.04; p = 0.001; p = 0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p = 0.001). Conclusions The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.
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Affiliation(s)
- Keren Grinberg
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Department of Nursing, Ruppin Academic Center, Emek Hefer, Israel
| | - Irit Weissman-Fogel
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Lior Lowenstein
- The Department of Obstetrics and Gynecology, Rambam Medical Center and Faculty of Medicine, Technion, Haifa, Israel
| | - Liora Abramov
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, The Sex Therapy Clinic, Tel Aviv, Israel
| | - Michal Granot
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion, Haifa, Israel
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Greiman A, Cox L. Pharmacotherapy for Interstitial Cystitis/Bladder Pain Syndrome. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00540-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Khullar V, Chermansky C, Tarcan T, Rahnama'i MS, Digesu A, Sahai A, Veit-Rubin N, Dmochowski R. How can we improve the diagnosis and management of bladder pain syndrome? Part 1: ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S66-S70. [PMID: 31578775 DOI: 10.1002/nau.24166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND This paper summarizes the discussion in a think tank at the ICI-RS 2018 about the diagnosis of bladder pain syndrome (BPS). AIMS To review the guidelines, investigations and subtypes of BPS. MATERIALS AND METHODS Review of literature in the light of the think tank discussion. RESULTS All guidelines recommend completing history, physical examination, urine analysis, urine culture, and urine cytology to define the BPS phenotype but there are differences on further investigations. In those guidelines which recommend cystoscopy, the identification of Hunner's lesions (HLs) is recommended as this changes the treatment plan and outcome. CONCLUSION We propose that the differentiation of Hunner's ulcers is an important step in the assessment of these patients. Further suggestions for research are suggested.
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Affiliation(s)
- Vik Khullar
- Department of Urogynaecology, St. Mary's Hospital, Imperial College, London, UK
| | - Christopher Chermansky
- Department of Female Pelvic Medicine and Reconstructive Urology, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Tufan Tarcan
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.,Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | | | - Alex Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College, London, UK
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK.,Department of Urology, MRC Centre for Transplantation, King's College London, London, UK
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Universitätsklinik für Frauenheilkunde, University of Vienna, Wien, Austria
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
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The negative effect of urologic chronic pelvic pain syndrome on female sexual function: a systematic review and meta-analysis. Int Urogynecol J 2019; 30:1807-1816. [DOI: 10.1007/s00192-019-03984-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/10/2019] [Indexed: 12/11/2022]
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Taneja R, Massand S. A modified clinical scoring system for bladder pain syndrome: Long term experience. Int J Urol 2019; 26 Suppl 1:61-67. [PMID: 31144746 DOI: 10.1111/iju.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To document a modified clinical scoring system in patients with bladder pain syndrome that increases weightage to pain and nocturia and includes measures for sexual dysfunction and psychological impact. The clinical outcome of a set combination of treatment modalities linked to the clinical score at entry was also made. METHODS The new proposed scale was used to assess and treat 190 enrolled patients from January 2009 to September 30, 2017. The patients were evaluated using the new scoring system at the time of induction, after 1, 3 and 6 months after commencement of treatment. Thereafter, they were followed every 6 months. The new scoring system included increased weightage to pain and nocturia and added domains of sexual dysfunction and psychological impact. The patients were treated with a protocol followed by the authors and published in the year 2007. A pictorial linkage of treatment modalities used with the clinical score of the patient was also described. RESULTS A total of 174 evaluable patients had a follow up between 6 and 105 months (mean 64 months). The patients had age distribution between 24 and 76 years and included 19 male patients. 154 out of 174 patients (88.5%) had good or excellent response to treatment using the proposed scale at the end of 6 months. CONCLUSIONS The proposed clinical scale appeared to aid clinical stratification of severity of the disease at the induction and during follow up. The treatment protocol could be linked with the clinical score at the time of induction.
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Affiliation(s)
- Rajesh Taneja
- Urology, Andrology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Sameer Massand
- Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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Doiron RC, Shoskes DA, Nickel JC. Male CP/CPPS: where do we stand? World J Urol 2019; 37:1015-1022. [PMID: 30864007 DOI: 10.1007/s00345-019-02718-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/02/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), commonly encountered in urologic practice, carries with it a stigma of poor understanding, ineffective treatment, and significant financial and quality of life burden. MATERIALS AND METHODS This clinically practical review is based on the authors' personal clinical experience in interpretation and application of currently available evidence. RESULTS Significant progress has been made in terms of classification and evaluation of the disease, leading to encouraging improvements in treatment outcomes. The Chronic Prostatitis Symptom Index (CPSI) is a helpful tool in clinical evaluation and has proven invaluable for research purposes, while UPOINT has demonstrated the heterogeneity of the disease and provides physicians with a uniquely patient-centered approach to treatment. The importance of the microbiome in the evaluation of CP/CPPS patients has yet to be fully appreciated. While personalized, multi-modal therapy appears to be the key to treatment, the addition of pelvic floor physiotherapy (PFPT) with injection of trigger points, and psychosocial therapies to the multi-modal approach armamentarium are promising advances. Innovative interventional approaches are encouraging but require study. CONCLUSIONS While encouraging therapies have been added to personalized, multi-modal treatment strategies, newer innovative therapies appear promising for improved treatment of CP/CPPS patients.
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Affiliation(s)
- R Christopher Doiron
- Department of Urology, Queen's University, Empire 4, Kingston General Hospital, 76 Stuart St, Kingston, ON, K7L 2V7, Canada.
| | - Daniel A Shoskes
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Curtis Nickel
- Department of Urology, Queen's University, Empire 4, Kingston General Hospital, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
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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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Negative Illness Perceptions are Associated With a Pronociceptive Modulation Profile and Augmented Pelvic Pain. Clin J Pain 2018; 34:1141-1148. [DOI: 10.1097/ajp.0000000000000633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Crawford A, Tripp DA, Nickel JC, Carr L, Moldwin R, Katz L, Muere A. Depression and helplessness impact interstitial cystitis/bladder pain syndrome pain over time. Can Urol Assoc J 2018; 13:328-333. [PMID: 31364973 DOI: 10.5489/cuaj.5703] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Interstitial cystitis/bladder pain syndrome (IC/BPS) is a devastating urological chronic pelvic pain condition with an unknown etiology. Evidence-based psychological strategies are becoming more successful for symptom management as we learn more about the targets for intervention. Previous research has established an indirect relationship between depression and pain through catastrophizing, but there have yet to be studies examining the emerging role of emotion regulation in this relationship. METHODS Women with IC/BPS were recruited from tertiary care clinics in Canada and the U.S. between 2013 and 2018. Patients completed questionnaires, including demographics and scores for pain, depression, catastrophizing, and difficulties in emotion regulation at baseline, six months, and one year. Serial mediation was used to test models of pain, catastrophizing, and depression. RESULTS A total of 135 women with IC/BPS completed all three time points. The only significant indirect path was from baseline depression to catastrophizing at six months to pain at one year (b=0.10; confidence interval [CI] 0.0049-0.2520). A followup analysis demonstrated that helplessness was the key factor of catastrophizing driving this relationship (b=0.17; CI 0.0282-0.3826). CONCLUSIONS Reducing feelings of helplessness and increasing patient feelings of control are important ways to limit the effect of low mood on patient pain experience. De-catastrophizing interventions should be part of the referral strategy for IC/BPS symptom management.
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Affiliation(s)
- Alison Crawford
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Dean A Tripp
- Departments of Psychology, Urology, & Anesthesiology, Queen's University, Kingston, ON, Canada
| | - J Curtis Nickel
- Department of Urology Queen's University, Kingston, ON, Canada
| | - Lesley Carr
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Robert Moldwin
- Department of Urology, Hosftra University School of Medicine, New Hyde Park, NY, United States
| | - Laura Katz
- Michael G. DeGroote Pain Clinic, McMaster University Hospital, Hamilton, ON, Canada
| | - Abi Muere
- Department of Psychology, Queen's University, Kingston, ON, Canada
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Acar Ö, Tarcan T. Cystoscopic evaluation and clinical phenotyping in interstitial cystitis/bladder pain syndrome. J Turk Ger Gynecol Assoc 2018; 20:117-122. [PMID: 30457110 PMCID: PMC6558355 DOI: 10.4274/jtgga.galenos.2018.2018.0102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Herein, we aimed to review, report, and discuss the role of cystoscopy and clinical phenotyping in interstitial cystitis/bladder pain syndrome (IC/BPS). For this purpose; a comprehensive nonsystematic review of the relevant literature was conducted. We reviewed articles published in English and indexed in the PubMed, Embase, and Google Scholar databases. Original manuscripts, review articles, case series, and case reports were taken into consideration. Data regarding the indications for, technique, and possible findings of cystoscopy with hydrodistension (HD) and biopsy, as well as clinical implications of cystoscopic information and the concept and use of clinical phenotyping within the context of IC/ BPS were extracted and discussed. IC/BPS is diagnosed based on symptomatic assessment and exclusion of confusable diseases. There is no universal agreement upon the evaluation and diagnostic algorithm of IC/BPS. The majority of the guidelines recommend cystoscopy with HD and biopsy as a diagnostic prerequisite. Various different techniques have been described for cystoscopy with HD. General or epidural anesthesia is more commonly preferred and advocated while assessing endoscopic alterations in patients suspected of having IC/BPS. Cystoscopy with HD and biopsy enables more objective exclusion of confusable diseases. It also provides the basis of the European Society for the Study of Interstitial Cystitis classification. Patients with IC/BPS who demonstrate positive cystoscopic (glomerulations and/or Hunner lesion) and histologic findings have a more severe symptomatology and may benefit from lesion-targeted endoscopic treatments. Clinical phenotyping has been implemented for IC/BPS and may be used for individualized assessment and treatment.
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Affiliation(s)
- Ömer Acar
- Department of Urology, Koç University School of Medicine, İstanbul, Turkey
| | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, İstanbul, Turkey
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Rodríguez LV, Stephens AJ, Clemens JQ, Buchwald D, Yang C, Lai HH, Krieger JN, Newcomb C, Bradley CS, Naliboff B. Symptom Duration in Patients With Urologic Chronic Pelvic Pain Syndrome is not Associated With Pain Severity, Nonurologic Syndromes and Mental Health Symptoms: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Network Study. Urology 2018; 124:14-22. [PMID: 30452963 DOI: 10.1016/j.urology.2018.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate if patients with urologic chronic pelvic pain syndromes (UCPPS) with longer duration of symptoms experience more severe pain and urologic symptoms, higher rates of chronic overlapping pain conditions (COPC) and psychosocial comorbidities than those with a more recent onset of the condition. We evaluated cross-sectional associations between UCPPS symptom duration and (1) symptom severity, (2) presence of COPC, and (3) mental health comorbidities. METHODS We analyzed baseline data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain. Symptom severity, COPC, and mental health comorbidities were compared between patients with symptom duration of < 2 vs ≥ 2 years. Symptom severity was assessed by the Genitourinary Pain Index, the Interstitial Cystitis Symptom and Problem Index, and Likert scales for pelvic pain, urgency, and frequency. Depression and anxiety were evaluated with the Hospital Anxiety and Depression Scale and stress with the Perceived Stress Scale. RESULTS Males (but not females) with UCPPS symptom duration ≥2 years had more severe symptoms than those with <2 years. Participants with short (<2 years) and longer (≥2 years) symptom duration were as likely to experience COPC. CONCLUSION Longer UCPPS symptom duration was associated with more severe symptoms only in limited patient subpopulations. Symptom duration was not associated with risk for COPC or mental health comorbidities. Females with longer UCPPS duration had decreased distress, but the association was largely attributable to age.
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Affiliation(s)
- Larissa V Rodríguez
- Departments of Urology and Obstetrics and Gynecology, Institute of Urology, University of Southern California, Los Angeles, CA.
| | - Alisa J Stephens
- Data Coordinating Core, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - J Quentin Clemens
- Department of Urology, University of Michigan Medical Center, Ann Arbor, MI
| | - Dedra Buchwald
- Department of Urology, University of Washington, Seattle, WA
| | - Claire Yang
- Department of Urology, University of Washington, Seattle, WA
| | - Henry H Lai
- Departments of Surgery (Division of Urologic Surgery) and Anesthesiology, Washington University, St. Louis, MO
| | - John N Krieger
- Department of Urology, University of Washington, Seattle, WA
| | - Craig Newcomb
- Data Coordinating Core, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Cate S Bradley
- Department of Obstetrics and Gynecology, and Urology, College of Medicine and Department of Public Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry, The Geffen School of Medicine at UCLA, Los Angeles, CA
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Ackerman AL, Lai HH, Parameshwar PS, Eilber KS, Anger JT. Symptomatic overlap in overactive bladder and interstitial cystitis/bladder pain syndrome: development of a new algorithm. BJU Int 2018; 123:682-693. [PMID: 30253040 DOI: 10.1111/bju.14568] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To address challenges in the diagnosis and classification of storage lower urinary tract symptoms (LUTS), we sought to define the fundamental features of overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS), two conditions with considerable symptomatic overlap. Through retrospective comparison of self-reported symptoms in women with a range of clinical presentations and symptom severities, we have attempted to refine the diagnostic features of OAB and IC/BPS and to develop a novel clinical nomogram to improve patient screening and classification. MATERIALS AND METHODS We performed a univariate analysis comparing responses to the female Genitourinary Pain Index (fGUPI), the OAB Questionnaire and O'Leary-Sant Indices (the Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index) in an initial cohort of 50 patients with OAB, patients with IC/BPS and control subjects. Only eight questions differed significantly between the IC/BPS and OAB groups; we used five unique questions and three measuring bother to generate a novel composite scoring system and nomogram that included urgency incontinence, bladder pain and symptomatic bother domains to differentiate these populations, which was validated in a second cohort of 150 patients. The addition of a self-reported bother index resulted in the creation of a diagnostic algorithm to identify and classify LUTS clusters across the total population. RESULTS While all validated questionnaires could distinguish between controls and patients with storage LUTS, no combined symptom scores differed significantly between the IC/BPS and OAB groups. These results are reflective of the prevalence of significant bladder pain (35%) in patients with OAB and the presence of urge incontinence (25%) in patients with IC/BPS. Only the fGUPI pain domain scores differed between patients in the OAB and IC/BPS groups, but it was not accurate enough for diagnostic evaluation (68% accuracy). Our composite scores and nomogram gave a much-improved diagnostic accuracy (94%) and demonstrated utility as a screening tool to identify storage LUTS in patients presenting for unrelated complaints, e.g. microhaematuria. CONCLUSIONS There is significant overlap of urinary tract symptoms between OAB and IC/BPS. We present a novel algorithm that provides a binary output capable of guiding clinical diagnosis. Future studies aimed at assessing the diagnostic value of novel classification schemes that address symptoms rather than specific diagnoses may improve patient prognosis.
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Affiliation(s)
- A Lenore Ackerman
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - H Henry Lai
- Departments of Surgery (Urology) and Anesthesiology, Washington University School of Medicine in St Louis, St. Louis, MO, USA
| | - Pooja S Parameshwar
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Karyn S Eilber
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer T Anger
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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McKernan LC, Johnson BN, Reynolds WS, Williams DA, Cheavens JS, Dmochowski RR, Crofford LJ. Posttraumatic stress disorder in interstitial cystitis/bladder pain syndrome: Relationship to patient phenotype and clinical practice implications. Neurourol Urodyn 2018; 38:353-362. [PMID: 30350890 DOI: 10.1002/nau.23861] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/21/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE The relationship between exposure to abuse and interstitial cystitis/bladder pain syndrome (IC/BPS) is well-documented. However, studies have yet to examine posttraumatic stress disorder (PTSD), which develops following exposure to trauma and worsens health outcomes in chronic pain. We aimed to assess the prevalence and impact of PTSD in patients with IC/BPS, including their relation to genitourinary symptom presentation and widespread pain phenotype. MATERIALS AND METHODS We recruited 202 participants with chronic pain from an academic medical center and classified 64 individuals as IC/BPS based on validated epidemiological criteria. Participants completed self-reported questionnaires assessing trauma exposure, PTSD symptoms, emotional distress, pain, and urinary symptoms. Wilcoxon rank-sum tests assessed study aims comparing IC/BPS to other chronic pain. RESULTS Although elevated, IC/BPS trauma exposure rates were equivalent to that of other chronic pain conditions in the sample. Despite this equivalence, in comparison, IC/BPS patients had significantly higher rates of PTSD symptoms, with 42% meeting provisional diagnostic criteria for PTSD. Among IC/BPS, those meeting provisional criteria for PTSD had significantly higher incidence of lifetime sexual abuse, childhood trauma, and presentations consistent with the widespread pain phenotype. In IC/BPS, there was no association between PTSD and genitourinary symptoms, but provisional PTSD was associated with more pain, emotional distress, and poorer quality of life. CONCLUSIONS We recommend that patients with IC/BPS and widespread pain have ongoing screening and monitoring of PTSD. We recommend using trauma-informed care practices with these patients to increase trust and safety, which could improve treatment compliance and follow-up.
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Affiliation(s)
- Lindsey C McKernan
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Benjamin N Johnson
- Department of Psychology, The Pennsylvania State University, State College, Pennsylvania
| | - William S Reynolds
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | | | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Leslie J Crofford
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
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Arlandis S, Franco A, Mora AM, Rebollo P. Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire. A useful tool for the diagnosis of bladder pain syndrome. Actas Urol Esp 2018; 42:457-464. [PMID: 29650471 DOI: 10.1016/j.acuro.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire to evaluate its utility for the diagnosis of Bladder Pain Syndrome (BPS) patients in the Female and Urodynamics Urology Functional Units in Spain. MATERIAL AND METHODS The Spanish adaptation of the BPIC-SS questionnaire was evaluated in 243 BPS patients. EQ-5D-5L, Patient Perception of Bladder Condition (PPBC) and global impression questionnaire (CGI-S) were collected. Consistency, test-retest reliability in patients without clinical changes at 15 days, criterion validity and sensitivity to change were assessed in BPS patients with clinical changes at 6 months. The cut-off point for discriminating BPS patients from other similar pathologies (Hyperactive Bladder or other urinary pathologies) was analysed using ROC curve. RESULTS Mean (SD) BPIC-SS score (0-38) was 16.2 (12.0) points. Cronbach's alpha was 0.92 and intraclass coefficient correlation (ICC) was 0.82, ranging from 0.5-0.9 per item. Convergent validity determined a Spearman correlation of 0.63 with PPBC and -0.40 with EQ-5D-5L Visual Analogue Scale (VAS) and the effect size obtained in patients who improved their clinical status was 1.9. A score greater than or equal to 12 points in the BPIC-SS has been established as the best cut-off point for the diagnosis of BPS (87.5% sensitivity and 91.9% specificity). CONCLUSIONS The Spanish version of the BPIC-SS is a valid and reliable instrument for the diagnosis and follow-up of patients with BPS in Spain.
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Affiliation(s)
- S Arlandis
- Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - A Franco
- Hospital Universitario Clínic, Barcelona, España
| | - A M Mora
- Departamento Médico, Astellas Pharma S.A., Madrid, España
| | - P Rebollo
- Health Economics & Outcomes Research. Real-World Evidence Solutions. QuintilesIMS, Barcelona, España
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Interstitial Cystitis and Sexual Dysfunction: Diagnostic Accuracy Is Essential. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hellman KM, Datta A, Steiner ND, Kane Morlock JN, Garrison EF, Clauw DJ, Tu FF. Identification of experimental bladder sensitivity among dysmenorrhea sufferers. Am J Obstet Gynecol 2018; 219:84.e1-84.e8. [PMID: 29704486 DOI: 10.1016/j.ajog.2018.04.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/09/2018] [Accepted: 04/18/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dysmenorrhea is a common risk factor for chronic pain conditions including bladder pain syndrome. Few studies have formally evaluated asymptomatic bladder pain sensitivity in dysmenorrhea, and whether this largely reflects excess pelvic symptom reporting due to comorbid psychological dysfunction. OBJECTIVE We sought to determine whether bladder hypersensitivity is more common among women reporting moderate or greater dysmenorrhea, without chronic pain elsewhere, after accounting for anxiety and depression. Demonstrating this would suggest that dysmenorrhea might be an early clue for visceral or widespread pain hypersensitivity and improve understanding of potential precursors to bladder pain syndrome. STUDY DESIGN We compared cohorts of regularly menstruating women, without symptoms of chronic pain elsewhere, reporting (1) moderate-to-severe dysmenorrhea (n = 98) and (2) low levels or no menstrual pain (n = 35). Participants underwent rapid bladder filling following a standard water ingestion protocol, serially rating bladder pain and relative urgency during subsequent distension. Potential differences in bladder volumes were controlled for by sonographic measurement at standard cystometric thresholds. Bladder sensitivity was also measured with complementary measures at other times separately including a simplified rapid filling test, palpation of the bladder wall, and through ambulatory self-report. Anxiety and depression were evaluated with the National Institutes of Health Patient-Reported Outcomes Measurement Information System measures. RESULTS Women with moderate-to-severe dysmenorrhea reported more urinary symptoms than controls and had a lower maximum capacity (498 ± 18 mL vs 619 ± 34 mL, P < .001) and more evoked bladder filling pain (0-100 visual analog scale: 25 ± 3 vs 12 ± 3, P < .001). The dysmenorrhea-bladder capacity relationship remained significant irrespective of menstrual pain severity, anxiety, depression, or bladder pain (R2 = 0.13, P = .006). Severity of menstrual pain predicted evoked bladder pain (R2 = 0.10, P = .008) independent of anxiety (P = .21) and depression (P = .21). Women with moderate-to-severe dysmenorrhea exhibiting provoked bladder pain (24/98, 24%) also reported higher pain during the screening rapid bladder test (P < .001), in response to transvaginal bladder palpation (P < .015), and on prospective daily diaries (P < .001) than women with dysmenorrhea without provoked bladder pain. CONCLUSION Women experiencing moderate-to-severe dysmenorrhea also harbor a higher pain response to naturally evoked bladder distension. Noninvasive bladder provocation needs to be tested further longitudinally in those with dysmenorrhea to characterize the course of visceral sensitivity and determine if it may help predict individuals at risk for developing subsequent pain in the bladder or elsewhere.
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Affiliation(s)
- Kevin M Hellman
- Department of Obstetrics/Gynecology, NorthShore University HealthSystem, Evanston, IL; Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Avisek Datta
- Department of Biostatistics, NorthShore University HealthSystem, Evanston, IL
| | - Nicole D Steiner
- Department of Obstetrics/Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Julia N Kane Morlock
- Department of Obstetrics/Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Ellen F Garrison
- Department of Obstetrics/Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Frank F Tu
- Department of Obstetrics/Gynecology, NorthShore University HealthSystem, Evanston, IL; Pritzker School of Medicine, University of Chicago, Chicago, IL. https://www.thegyrl.org
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Cervigni M, Onesti E, Ceccanti M, Gori MC, Tartaglia G, Campagna G, Panico G, Vacca L, Cambieri C, Libonati L, Inghilleri M. Repetitive transcranial magnetic stimulation for chronic neuropathic pain in patients with bladder pain syndrome/interstitial cystitis. Neurourol Urodyn 2018; 37:2678-2687. [DOI: 10.1002/nau.23718] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/06/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Mauro Cervigni
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Emanuela Onesti
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Marco Ceccanti
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Maria C. Gori
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Giorgio Tartaglia
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Giuseppe Campagna
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Giovanni Panico
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Lorenzo Vacca
- Department of Women's Health and Newborns; Interstitial Cystitis Referral Center; University Hospital Foundation A. Gemelli; Rome Italy
| | - Chiara Cambieri
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Laura Libonati
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
| | - Maurizio Inghilleri
- Department of Human Neuroscience; Rare Neuromuscular Diseases Centre; Sapienza University; Rome Italy
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Sub-noxious Intravesical Lipopolysaccharide Triggers Bladder Inflammation and Symptom Onset in A Transgenic Autoimmune Cystitis Model: A MAPP Network Animal Study. Sci Rep 2018; 8:6573. [PMID: 29700406 PMCID: PMC5919907 DOI: 10.1038/s41598-018-24833-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/11/2018] [Indexed: 11/21/2022] Open
Abstract
Patients with interstitial cystitis/bladder pain syndrome (IC/BPS) can potentially develop symptom flares after exposure to minor bladder irritants such as subclinical bacterial infection. To reproduce this symptom onset, we intravesically instilled a sub-noxious dose of uropathogenic E. coli component lipopolysaccharide (LPS) in young URO-OVA/OT-I mice, a transgenic autoimmune cystitis model that spontaneously develops bladder inflammation at ≥10 weeks of age. Female URO-OVA/OT-I mice (6-weeks old) were treated intravesically with phosphate-buffered saline (PBS) or PBS containing a sub-noxious dose (1 μg) of LPS. Mice were evaluated for bladder inflammation, pelvic pain, and voiding dysfunction at days 1, 7, and 14 post-treatment. Mice treated with LPS but not PBS developed early bladder inflammation with increased macrophage infiltration. Accordingly, the inflamed bladders expressed increased levels of mRNA for proinflammatory cytokines (IL-1β and IL-6) and pain mediator (substance P precursor). In addition, LPS-treated mice exhibited pelvic pain and voiding dysfunction such as increased urinary frequency and reduced bladder capacity. These functional changes sustained up to day 14 tested. Our results indicate that a single sub-noxious dose of intravesical LPS triggers early bladder inflammation and symptom onset in URO-OVA/OT-I mice, providing a useful model for IC/BPS symptom flare study.
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