1
|
Urits I, Callan J, Moore WC, Fuller MC, Renschler JS, Fisher P, Jung JW, Hasoon J, Eskander J, Kaye AD, Viswanath O. Cognitive behavioral therapy for the treatment of chronic pelvic pain. Best Pract Res Clin Anaesthesiol 2020; 34:409-426. [PMID: 33004156 DOI: 10.1016/j.bpa.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 01/18/2023]
Abstract
Chronic pelvic pain (CPP) in women is defined as noncyclical and persistent pain lasting more than six months perceived to be related to the pelvis. There are many etiologies that can cause CPP, including gynecologic, urologic, gastrointestinal, musculoskeletal, neurologic, and psychosocial. There is a strong association between psychological factors and CPP. It has been noted that almost half of women being treated for CPP report a history of sexual, physical, or emotional trauma. Women with CPP have been noted to have higher rates of psychological disorders in comparison to their peers. For men, the most common etiology for CPP is chronic prostatitis and there are also correlations with psychological disorders. There are many different treatment options for CPP: surgical, pharmacological, and non-pharmacological (alternative therapies). Cognitive-behavioral therapy may be another option when treating chronic pelvic pain syndrome and should be considered.
Collapse
Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA.
| | - Jessica Callan
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Warner C Moore
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | | | - Jordan S Renschler
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Paul Fisher
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jamal Hasoon
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Jonathan Eskander
- Portsmouth Anesthesia Associates, Anesthesiology and Pain Medicine, Portsmouth, VA, USA
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
| |
Collapse
|
2
|
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.
Collapse
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
| | | |
Collapse
|
3
|
Walter CEJ, Durairajan S, Periyandavan K, C GPD, G DJD, A HRV, Johnson T, Zayed H. Bladder neoplasms and NF-κB: an unfathomed association. Expert Rev Mol Diagn 2020; 20:497-508. [PMID: 32228251 DOI: 10.1080/14737159.2020.1743688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Bladder cancer is the second most common genitourinary tract cancer and is often recurrent and/or chemoresistant after tumor resection. Cigarette smoking, exposure to aromatic amines, and chronic infection/inflammation are bladder cancer risk factors. NF-κB is a transcription factor that plays a critical role in normal physiology and bladder cancer. Bladder cancer patients have constitutively active NF-κB triggered by pro-inflammatory cytokines, chemokines, and hypoxia, augmenting carcinogenesis and progression.Areas covered: NF-κB orchestrates protein interactions (PTEN, survivin, VEGF), regulation (CYLD, USP13) and gene expression (Trp 53) resulting in bladder cancer progression, recurrence and resistance to therapy. This review focuses on NF-κB in bladder inflammation, cancer and resistance to therapy.Expert opinion: NF-κB and bladder cancer necessitate further research to develop better diagnostic and treatment regimens that address progression, recurrence and resistance to therapy. NF-κB is a master regulator that can act with or on minimally one cancer hallmark gene or protein, leading to bladder cancer progression (Tp53, PTEN, VEGF, HMGB1, CYLD, USP13), recurrence (PCNA, BcL-2, JUN) and resistance to therapy (P-gp, twist, SETD6). Thus, an understanding of bladder cancer in relation to NF-κB will offer improved strategies and efficacious targeted therapies resulting in minimal progression, recurrence and resistance to therapy.
Collapse
Affiliation(s)
- Charles Emmanuel Jebaraj Walter
- Department of Biotechnology, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Sankari Durairajan
- Department of Biotechnology, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Kalaiselvi Periyandavan
- Department of Medical Biochemistry, Dr. ALM PG Institute of Basic Medical Science, University of Madras, Chennai, India
| | - George Priya Doss C
- Department of Integrative Biology, School of Biosciences and Technology, VIT University, Vellore, India
| | - Dicky John Davis G
- Department of Biotechnology, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Hannah Rachel Vasanthi A
- Department of Biotechnology, School of Life Sciences, Pondicherry University, Pondicherry, India
| | - Thanka Johnson
- Department of Biotechnology, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Hatem Zayed
- Department of Biomedical Sciences, College of Health Sciences, Qatar University, Doha, Qatar
| |
Collapse
|
4
|
Kullmann FA. A new player in interstitial cystitis/bladder pain syndrome: platelet-activating factor - PAF and its connection to smoking. Physiol Rep 2019; 5:5/7/e13235. [PMID: 28408637 PMCID: PMC5392521 DOI: 10.14814/phy2.13235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Florenta Aura Kullmann
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 15261
| |
Collapse
|
5
|
Kullmann FA, McDonnell BM, Wolf-Johnston AS, Kanai AJ, Shiva S, Chelimsky T, Rodriguez L, Birder LA. Stress-induced autonomic dysregulation of mitochondrial function in the rat urothelium. Neurourol Urodyn 2019; 38:572-581. [PMID: 30575113 PMCID: PMC7528980 DOI: 10.1002/nau.23876] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/10/2018] [Indexed: 12/27/2022]
Abstract
AIM Chronic stress exacerbates the symptoms of most pain disorders including interstitial cystitis/bladder pain syndrome (IC/BPS). Abnormalities in urothelial cells (UTC) occur in this debilitating bladder condition. The sequence of events that might link stress (presumably through increased sympathetic nervous system-SNS activity) to urothelial dysfunction are unknown. Since autonomic dysregulation, mitochondrial dysfunction, and oxidative stress all occur in chronic pain, we investigated whether chronic psychological stress initiated a cascade linking these three dysfunctions. METHODS Adult female Wistar Kyoto rats were exposed to 10 days of water avoidance stress (WAS). Bladders were then harvested for Western blot and single cell imaging in UTC cultures. RESULTS UTC from WAS rats exhibited depolarized mitochondria membrane potential (Ψm ∼30% more depolarized compared to control), activated AMPK and altered UT mitochondria bioenergetics. Expression of the fusion protein mitofusion-2 (MFN-2) was upregulated in the mucosa, suggesting mitochondrial structural changes consistent with altered cellular metabolism. Intracellular calcium levels were elevated in cultured WAS UTC, consistent with impaired cellular function. Stimulation of cultured UTC with alpha-adrenergic (α-AR) receptor agonists increased reactive oxidative species (ROS) production, suggesting a direct action of SNS activity on UTC. Treatment of rats with guanethidine to block SNS activity prevented most of WAS-induced changes. CONCLUSIONS Chronic stress results in persistent sympathetically mediated effects that alter UTC mitochondrial function. This may impact the urothelial barrier and signaling, which contributes to bladder dysfunction and pain. This is the first demonstration, to our knowledge, of a potential autonomic mechanism directly linking stress to mitochondrial dysfunction.
Collapse
Affiliation(s)
- Florenta Aura Kullmann
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bronagh M. McDonnell
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Amanda S. Wolf-Johnston
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anthony J. Kanai
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sruti Shiva
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas Chelimsky
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Larissa Rodriguez
- Departments of Urology and Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Lori A. Birder
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
6
|
Kullmann FA, McDonnell BM, Wolf-Johnston AS, Lynn AM, Giglio D, Getchell SE, Ruiz WG, Zabbarova IV, Ikeda Y, Kanai AJ, Roppolo JR, Bastacky SI, Apodaca G, Buffington CAT, Birder LA. Inflammation and Tissue Remodeling in the Bladder and Urethra in Feline Interstitial Cystitis. Front Syst Neurosci 2018; 12:13. [PMID: 29706873 PMCID: PMC5908978 DOI: 10.3389/fnsys.2018.00013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/28/2018] [Indexed: 01/21/2023] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic disease of unknown etiology. A naturally occurring disease termed feline interstitial cystitis (FIC) reproduces many features of IC/BPS patients. To gain insights into mechanisms underlying IC/BPS, we investigated pathological changes in the lamina propria (LP) of the bladder and proximal urethra in cats with FIC, using histological and molecular methods. Compared to control cat tissue, we found an increased number of de-granulated mast cells, accumulation of leukocytes, increased cyclooxygenase (COX)-1 expression in the bladder LP, and increased COX-2 expression in the urethra LP from cats with FIC. We also found increased suburothelial proliferation, evidenced by mucosal von Brunn’s nests, neovascularization and alterations in elastin content. Scanning electron microscopy revealed normal appearance of the superficial urethral epithelium, including the neuroendocrine cells (termed paraneurons), in FIC urethrae. Together, these histological findings suggest the presence of chronic inflammation of unknown origin leading to tissue remodeling. Since the mucosa functions as part of a “sensory network” and urothelial cells, nerves and other cells in the LP are influenced by the composition of the underlying tissues including the vasculature, the changes observed in the present study may alter the communication of sensory information between different cellular components. This type of mucosal signaling can also extend to the urethra, where recent evidence has revealed that the urethral epithelium is likely to be part of a signaling system involving paraneurons and sensory nerves. Taken together, our data suggest a more prominent role for chronic inflammation and tissue remodeling than previously thought, which may result in alterations in mucosal signaling within the urinary bladder and proximal urethra that may contribute to altered sensations and pain in cats and humans with this syndrome.
Collapse
Affiliation(s)
- F Aura Kullmann
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bronagh M McDonnell
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amanda S Wolf-Johnston
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew M Lynn
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Daniel Giglio
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Samuel E Getchell
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Wily G Ruiz
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Irina V Zabbarova
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Youko Ikeda
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony J Kanai
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sheldon I Bastacky
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gerard Apodaca
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - C A Tony Buffington
- Department of Medicine and Epidemiology, University of California, Davis, Davis, CA, United States.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Lori A Birder
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
7
|
Tutolo M, Ammirati E, Castagna G, Klockaerts K, Plancke H, Ost D, Van der Aa F, De Ridder D. A prospective randomized controlled multicentre trial comparing intravesical DMSO and chondroïtin sulphate 2% for painful bladder syndrome/interstitial cystitis. Int Braz J Urol 2017; 43:134-141. [PMID: 28124536 PMCID: PMC5293394 DOI: 10.1590/s1677-5538.ibju.2016.0302] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/31/2016] [Indexed: 12/04/2022] Open
Abstract
Objective To compare effectiveness of intravesical chondroïtin sulphate (CS) 2% and dimethyl sulphoxide (DMSO) 50% in patients with painful bladder syndrome/interstitial cystitis (PBS/IC). Materials and methods Patients were randomized to receive either 6 weekly instillations of CS 2% or 50% DMSO. Primary endpoint was difference in proportion of patients achieving score 6 (moderately improved) or 7 (markedly improved) in both groups using the Global Response Assessment (GRA) scale. Secondary parameters were mean 24-hours frequency and nocturia on a 3-day micturition dairy, changes from baseline in O’Leary-Sant questionnaire score and visual analog scale (VAS) for suprapubic pain. Results Thirty-six patients were the intention to treat population (22 in CS and 14 in DMSO group). In DMSO group, 57% withdrew consent and only 6 concluded the trial. Major reasons were pain during and after instillation, intolerable garlic odor and lack of efficacy. In CS group, 27% withdrew consent. Compared with DMSO group, more patients in CS group (72.7% vs. 14%) reported moderate or marked improvement (P=0.002, 95% CI 0.05-0.72) and achieved a reduction in VAS scores (20% vs. 8.3%). CS group performed significantly better in pain reduction (-1.2 vs. -0.6) and nocturia (-2.4 vs. -0.7) and better in total O’Leary reduction (-9.8 vs. -7.2). CS was better tolerated. The trial was stopped due to high number of drop-outs with DMSO. Conclusions Intravesical CS 2% is viable treatment for PBS/IC with minimal side effects. DMSO should be used with caution and with active monitoring of side effects. More randomized controlled studies on intravesical treatments are needed.
Collapse
Affiliation(s)
- Manuela Tutolo
- Department of Urology, University Hospitals, KU Leuven, Belgium
| | - Enrico Ammirati
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital Hospital, University of Studies of Turin, Turin, Italy
| | - Giulia Castagna
- Department of Urological Research Institute, IRCCS Ospedale San Raffaele, Division of Oncology/Unit of Urology, Milan, Italy
| | | | | | - Dieter Ost
- Urology, St. Blasius Hospital, Dendermonde, Belgium
| | | | - Dirk De Ridder
- Department of Urology, University Hospitals, KU Leuven, Belgium
| |
Collapse
|
8
|
Mohammadi E, Prusator DK, Healing E, Hurst R, Towner RA, Wisniewski AB, Greenwood-Van Meerveld B. Sexually dimorphic effects of early life stress in rat pups on urinary bladder detrusor muscle contractility in adulthood. Biol Sex Differ 2016; 7:8. [PMID: 26823967 PMCID: PMC4730611 DOI: 10.1186/s13293-016-0062-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Painful bladder syndrome/interstitial cystitis (PBS/IC) is a chronic disorder that is commonly seen in women who report a history of adversity in early life. Here, we test the hypothesis that early life stress (ELS) induces sexually dimorphic abnormalities in urinary bladder smooth muscle function in adulthood. Methods Male and female rat pups were conditioned on postnatal (PN) days 8–12 with either a “predictable or “unpredictable” odor-shock, or odor only control treatment. In adulthood, urinary bladder function was assessed in vivo via urine spot analysis and in vitro via contractile responses to electrical field stimulation (EFS) and membrane depolarization with potassium chloride (KCl). Results In adulthood, we found that female rats exposed to unpredictable ELS showed a significant (p < 0.05) increase in urine voiding volume compared to predictable ELS or controls. We also found that detrusor muscle contractile responses to EFS were significantly (p < 0.001) decreased following unpredictable ELS in adult female rats compared to the predictable ELS or controls. In male rats exposed to ELS, there was no difference in voiding volume or EFS-induced contractility between groups. In adulthood, the myogenic smooth muscle response to KCl was not significantly different between groups. Histological analysis from adult female and male rats revealed no differences in the appearance of the urinary bladder in rats exposed to ELS. Conclusions In summary, our findings provide evidence to support abnormalities in the nerve-mediated contractile responses of the detrusor smooth muscle in adult female rats following ELS. We speculate that these sexually dimorphic alterations in urinary bladder function may account, at least in part, for the female predominance of PBS/IC.
Collapse
Affiliation(s)
- Ehsan Mohammadi
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Dawn K Prusator
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Eleanor Healing
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Robert Hurst
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA ; Department of Urology, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Rheal A Towner
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA ; Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK USA
| | - Amy B Wisniewski
- Department of Urology, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| | - Beverley Greenwood-Van Meerveld
- VA Medical Center, Oklahoma City, OK USA ; Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK USA ; Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, OK USA
| |
Collapse
|
9
|
Abstract
Overactive bladder syndrome is highly prevalent, and increasingly so with aging. It is characterized by the presence of urinary urgency, and can be associated with incontinence, increased voiding frequency, and nocturia. Assessment needs to exclude serious medical disorders that might present with similar symptoms, and a bladder diary is an invaluable part of understanding the presentation. Initial management is conservative, comprising education, bladder training, and advice on fluid intake. Drug therapy options include antimuscarinic medications and beta-3 adrenergic receptor agonists. Persistent overactive bladder syndrome, despite initial therapy, requires a review of the patient’s understanding of conservative management and compliance, and adjustment of medications. For refractory cases, specialist review and urodynamic testing should be considered; this may identify detrusor overactivity or increased filling sensation, and needs to exclude additional factors, such as stress incontinence and voiding dysfunction. Botulinum neurotoxin-A bladder injections can be used in severe overactivity, provided the patient is able and willing to do intermittent self-catheterisation, which is necessary in about 5% of treated patients. Sacral nerve stimulation and tibial nerve stimulation are other approaches. Major reconstructive surgery, such as augmentation cystoplasty, is rarely undertaken in modern practice but remains a possibility in extreme cases.
Collapse
Affiliation(s)
- Karen M Wallace
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| |
Collapse
|
10
|
An Anatomical and Functional Perspective of the Pelvic Floor and Urogenital Organ Support System. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/jwh.0000000000000033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Kairys AE, Schmidt-Wilcke T, Puiu T, Ichesco E, Labus JS, Martucci K, Farmer MA, Ness TJ, Deutsch G, Mayer EA, Mackey S, Apkarian AV, Maravilla K, Clauw DJ, Harris RE. Increased brain gray matter in the primary somatosensory cortex is associated with increased pain and mood disturbance in patients with interstitial cystitis/painful bladder syndrome. J Urol 2015; 193:131-7. [PMID: 25132239 PMCID: PMC4435781 DOI: 10.1016/j.juro.2014.08.042] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Interstitial cystitis is a highly prevalent pain condition estimated to affect 3% to 6% of women in the United States. Emerging data suggest there are central neurobiological components to the etiology of this disease. We report the first brain structural imaging findings from the MAPP network with data on more than 300 participants. MATERIALS AND METHODS We used voxel based morphometry to determine whether human patients with chronic interstitial cystitis display changes in brain morphology compared to healthy controls. A total of 33 female patients with interstitial cystitis without comorbidities and 33 age and gender matched controls taken from the larger sample underwent structural magnetic resonance imaging at 5 MAPP sites across the United States. RESULTS Compared to controls, females with interstitial cystitis displayed significant increased gray matter volume in several regions of the brain including the right primary somatosensory cortex, the superior parietal lobule bilaterally and the right supplementary motor area. Gray matter volume in the right primary somatosensory cortex was associated with greater pain, mood (anxiety) and urological symptoms. We explored these correlations in a linear regression model, and found independent effects of these 3 measures on primary somatosensory cortex gray matter volume, namely clinical pain (McGill pain sensory total), a measure of urgency and anxiety (HADS). CONCLUSIONS These data support the notion that changes in somatosensory gray matter may have an important role in pain sensitivity as well as affective and sensory aspects of interstitial cystitis. Further studies are needed to confirm the generalizability of these findings to other pain conditions.
Collapse
Affiliation(s)
- Anson E Kairys
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | | | - Tudor Puiu
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Eric Ichesco
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan.
| | - Jennifer S Labus
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Katherine Martucci
- Department of Anesthesiology, Division of Pain Medicine, Stanford University Medical Center, Stanford, California
| | - Melissa A Farmer
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Timothy J Ness
- Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, Alabama
| | - Georg Deutsch
- Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, Alabama
| | - Emeran A Mayer
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sean Mackey
- Department of Anesthesiology, Division of Pain Medicine, Stanford University Medical Center, Stanford, California
| | - A Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Kenneth Maravilla
- Department of Radiology, University of Washington, Seattle, Washington
| | - Daniel J Clauw
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Richard E Harris
- Department of Anesthesiology, and the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
12
|
Hanna-Mitchell AT, Wolf-Johnston A, Roppolo JR, Buffington TCA, Birder LA. Corticotropin-releasing factor family peptide signaling in feline bladder urothelial cells. J Endocrinol 2014; 222:113-21. [PMID: 24829219 PMCID: PMC4137776 DOI: 10.1530/joe-13-0422] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Corticotropin-releasing factor (CRF) plays a central role in the orchestration of behavioral and neuroendocrine responses to stress. The family of CRF-related peptides (CRF and paralogs: urocortin (Ucn)-I, -II, and -III) and associated receptors (CRFR1 and CRFR2) are also expressed in peripheral tissues such as the skin and gastrointestinal tract. Local signaling may exert multiple effects of stress-induced exacerbation of many complex syndromes, including psoriasis and visceral hypersensitivity. Interstitial cystitis/painful bladder syndrome (IC/PBS), a chronic visceral pain syndrome characterized by urinary frequency, urgency, and pelvic pain, is reported to be exacerbated by stress. Functional changes in the epithelial lining of the bladder, a vital blood-urine barrier called the urothelium, may play a role in IC/PBS. This study investigated the expression and functional activity of CRF-related peptides in the urothelium of normal cats and cats with feline interstitial cystitis (FIC), a chronic idiopathic cystitis exhibiting similarities to humans diagnosed with IC/PBS. Western blots analysis showed urothelial (UT) expression of CRFR1 and CRFR2. Enzyme immunoassay revealed release of endogenous ligands (CRF and Ucn) by UT cells in culture. Evidence of functional activation of CRFR1 and CRFR2 by receptor-selective agonists (CRF and UCN3 respectively) was shown by i) the measurement of ATP release using the luciferin-luciferase assay and ii) the use of membrane-impermeant fluorescent dyes (FM dyes) for fluorescence microscopy to assess membrane exocytotic responses in real time. Our findings show evidence of CRF-related peptide signaling in the urothelium. Differences in functional responses between FIC and normal UT indicate that this system is altered in IC/PBS.
Collapse
Affiliation(s)
- Ann T Hanna-Mitchell
- Departments of Medicine-Renal Electrolyte DivisionPharmacology and Chemical BiologyUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USADepartment of Veterinary Clinical SciencesThe Ohio State University, Columbus, Ohio, USA
| | - Amanda Wolf-Johnston
- Departments of Medicine-Renal Electrolyte DivisionPharmacology and Chemical BiologyUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USADepartment of Veterinary Clinical SciencesThe Ohio State University, Columbus, Ohio, USA
| | - James R Roppolo
- Departments of Medicine-Renal Electrolyte DivisionPharmacology and Chemical BiologyUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USADepartment of Veterinary Clinical SciencesThe Ohio State University, Columbus, Ohio, USA
| | - Tony C A Buffington
- Departments of Medicine-Renal Electrolyte DivisionPharmacology and Chemical BiologyUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USADepartment of Veterinary Clinical SciencesThe Ohio State University, Columbus, Ohio, USA
| | - Lori A Birder
- Departments of Medicine-Renal Electrolyte DivisionPharmacology and Chemical BiologyUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USADepartment of Veterinary Clinical SciencesThe Ohio State University, Columbus, Ohio, USADepartments of Medicine-Renal Electrolyte DivisionPharmacology and Chemical BiologyUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USADepartment of Veterinary Clinical SciencesThe Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
13
|
Liang D, Lu J, Guo A. Sjögren’s syndrome accompanied with interstitial cystitis: a case report and review of the literature. Clin Rheumatol 2014; 33:1189-93. [DOI: 10.1007/s10067-013-2480-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 12/25/2013] [Indexed: 10/25/2022]
|
14
|
Chrysanthopoulou EL, Doumouchtsis SK. Challenges and current evidence on the management of bladder pain syndrome. Neurourol Urodyn 2013; 33:1193-201. [DOI: 10.1002/nau.22475] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/09/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Eleftheria L. Chrysanthopoulou
- Department of Obstetrics and Gynaecology; St George's Healthcare NHS Trust/St George's University of London; London United Kingdom
| | | |
Collapse
|
15
|
Hague DW, Stella JL, Buffington CAT. Effects of interstitial cystitis on the acoustic startle reflex in cats. Am J Vet Res 2013; 74:144-7. [PMID: 23270359 DOI: 10.2460/ajvr.74.1.144] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare acoustic startle reflexes (ASRs) of healthy cats and cats with interstitial cystitis (IC). ANIMALS 28 healthy cats (11 males and 17 females) and 20 cats with IC (13 males and 7 females). PROCEDURES To evaluate the effect of neutering on ASRs, ASRs in neutered and unneutered healthy cats were measured. To evaluate the effect of housing facility acclimation on ASRs in cats with IC, ASRs were measured in cats with IC within 1 month after arrival at the housing facility and again 2 to 3 months after arrival. To evaluate the effect of the environment on ASRs, ASRs were evaluated in all cats with and without IC after acclimation but before and then after environmental enrichment. RESULTS Neutering led to a significant decrease in overall ASR in the healthy cats. Habituation to the housing facility resulted in a significant decrease in overall ASR of female but not male cats with IC. Environmental enrichment led to a significant decrease in ASR in cats with IC but not in healthy cats. CONCLUSIONS AND CLINICAL RELEVANCE The magnitude of the ASR appeared to be sensitive to environmental conditions and affected by sex, both in healthy cats and cats with IC. It was also higher in cats with IC versus healthy cats, except when cats were housed in a highly enriched environment. IMPACT FOR HUMAN MEDICINE Treatment approaches that include reduction of a patient's perception of environmental unpredictability may benefit humans with IC.
Collapse
Affiliation(s)
- Devon W Hague
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA
| | | | | |
Collapse
|
16
|
Arms L, Girard BM, Malley SE, Vizzard MA. Expression and function of CCL2/CCR2 in rat micturition reflexes and somatic sensitivity with urinary bladder inflammation. Am J Physiol Renal Physiol 2013; 305:F111-22. [PMID: 23594826 DOI: 10.1152/ajprenal.00139.2013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Chemokines are proinflammatory mediators of the immune response, and there is growing evidence for chemokine/receptor signaling involvement in pronociception. Bladder pain syndrome (BPS)/interstitial cystitis (IC) is a chronic pain syndrome characterized by pain, pressure, or discomfort perceived to be bladder-related with at least one urinary symptom. We have explored the expression and functional roles of CCL2 (monocyte chemoattractant protein-1) and its high-affinity receptor, CCR2, in micturition reflex function and somatic sensitivity in rats with urinary bladder inflammation induced by cyclophosphamide (CYP) treatment of varying duration (4 h, 48 h, chronic). Real-time quantitative RT-PCR, ELISAs, and immunohistochemistry demonstrated significant (P ≤ 0.01) increases in CCL2 and CCR2 expression in the urothelium and in Fast Blue-labeled bladder afferent neurons in lumbosacral dorsal root ganglia with CYP-induced cystitis. Intravesical infusion of RS504393 (5 μM), a specific CCR2 antagonist, reduced voiding frequency and increased bladder capacity and void volume in rats with CYP-induced cystitis (4 h), as determined with open outlet, conscious cystometry. In addition, CCR2 blockade, at the level of the urinary bladder, reduced referred somatic sensitivity of the hindpaw and pelvic region in rats with CYP treatment, as determined with von Frey filament testing. We provide evidence of functional roles for CCL2/CCR2 signaling at the level of the urinary bladder in reducing voiding frequency and somatic sensitivity following CYP-induced cystitis (4 h). These studies suggest that chemokines/receptors may be novel targets with therapeutic potential in the context of urinary bladder inflammation.
Collapse
Affiliation(s)
- Lauren Arms
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | | | | | | |
Collapse
|
17
|
Pinto R, Lopes T, Silva J, Silva C, Dinis P, Cruz F. Persistent Therapeutic Effect of Repeated Injections of Onabotulinum Toxin A in Refractory Bladder Pain Syndrome/Interstitial Cystitis. J Urol 2013; 189:548-53. [DOI: 10.1016/j.juro.2012.09.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Rui Pinto
- Department of Urology, Hospital de São João, Porto, Portugal
- Faculty of Medicine of Porto, Porto, Portugal
| | - Tiago Lopes
- Department of Urology, Hospital de São João, Porto, Portugal
- Faculty of Medicine of Porto, Porto, Portugal
| | - João Silva
- Department of Urology, Hospital de São João, Porto, Portugal
- Faculty of Medicine of Porto, Porto, Portugal
| | - Carlos Silva
- Department of Urology, Hospital de São João, Porto, Portugal
- Faculty of Medicine of Porto, Porto, Portugal
| | - Paulo Dinis
- Department of Urology, Hospital de São João, Porto, Portugal
- Faculty of Medicine of Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal
| | - Francisco Cruz
- Department of Urology, Hospital de São João, Porto, Portugal
- Faculty of Medicine of Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal
| |
Collapse
|
18
|
Reeder JE, Byler TK, Foster DC, Landas SK, Okafor H, Stearns G, Wood RW, Zhang Y, Mayer RD. Polymorphism in the SCN9A voltage-gated sodium channel gene associated with interstitial cystitis/bladder pain syndrome. Urology 2012; 81:210.e1-4. [PMID: 23102778 DOI: 10.1016/j.urology.2012.07.072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/10/2012] [Accepted: 07/11/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether an association exists between interstitial cystitis/bladder pain syndrome (IC/BPS) and a nonsynonymous single nucleotide polymorphism in the SCN9A voltage-gated sodium channel gene previously associated with other chronic pain syndromes. MATERIALS AND METHODS Germline deoxyribonucleic acid was sampled from archived bladder biopsy specimens from patients with a documented diagnosis of IC/BPS. Deoxyribonucleic acid from hysterectomy specimens was obtained as a control population. The genotype of single nucleotide polymorphism rs6746030 was determined by deoxyribonucleic acid sequencing after polymerase chain reaction amplification. Contingency analysis of genotypes was performed using Pearson's chi-square test and Fisher's exact test. RESULTS Polymerase chain reaction product was obtained from 26 of 31 control specimens and from 53 of 57 IC/BPS biopsy specimens. Of the 26 control subjects, 3 (11.5%) were genotype AG and 23 were GG. In contrast, AA or AG genotypes were present in 21 of 53 (39.6%) patients with IC/BPS, a statistically significant difference compared with the controls (Pearson's chi-square, P=.036). Similarly, the A allele was at a greater frequency in the IC/BPS group using Fisher's exact test (P=.009). CONCLUSION These data strongly suggest that pain perception in at least a subset of patients with IC/BPS is influenced by this polymorphism in the SCN9A voltage-gated sodium channel.
Collapse
Affiliation(s)
- Jay E Reeder
- Department of Urology, State University of New York Upstate Medical University, Syracuse, New York 13210, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Chelimsky G, Heller E, Buffington CAT, Rackley R, Zhang D, Chelimsky T. Co-morbidities of interstitial cystitis. Front Neurosci 2012; 6:114. [PMID: 22907988 PMCID: PMC3415690 DOI: 10.3389/fnins.2012.00114] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/10/2012] [Indexed: 12/30/2022] Open
Abstract
Introduction: This study aimed to estimate the proportion of patients with interstitial cystitis/painful bladder syndrome (IC/BPS) with systemic dysfunction associated co-morbidities such as irritable bowel syndrome (IBS) and fibromyalgia (FM). Materials and Methods: Two groups of subjects with IC/BPS were included: (1) physician diagnosed patients with IC/BPS and (2) subjects meeting NIDDK IC/PBS criteria based on a questionnaire (ODYSA). These groups were compared to healthy controls matched for age and socio-economic status. NIDDK criteria required: pain with bladder filling that improves with emptying, urinary urgency due to discomfort or pain, polyuria >11 times/24 h, and nocturia >2 times/night. The ODYSA instrument evaluates symptoms pertaining to a range of disorders including chronic fatigue, orthostatic intolerance, syncope, IBS, dyspepsia, cyclic vomiting syndrome, headaches and migraines, sleep, Raynaud’s syndrome, and chronic aches and pains. Results: IC/BPS was diagnosed in 26 subjects (mean age 47 ± 16 years, 92% females), 58 had symptoms of IC/BPS by NIDDK criteria (mean age 40 ± 17 years, 79% females) and 48 were healthy controls (mean age 31 ± 14 years, mean age 77%). Co-morbid complaints in the IC/BPS groups included gastrointestinal symptoms suggestive of IBS and dyspepsia, sleep abnormalities with delayed onset of sleep, feeling poorly refreshed in the morning, waking up before needed, snoring, severe chronic fatigue and chronic generalized pain, migraines, and syncope. Discussion: Patients with IC/BPS had co-morbid central and autonomic nervous system disorders. Our findings mirror those of others in regard to IBS, symptoms suggestive of FM, chronic pain, and migraine. High rates of syncope and functional dyspepsia found in the IC/BPS groups merit further study to determine if IC/BPS is part of a diffuse disorder of central, autonomic, and sensory processing affecting multiple organs outside the bladder.
Collapse
Affiliation(s)
- Gisela Chelimsky
- Department of Pediatric Gastroenterology, Medical College of Wisconsin Milwaukee, WI, USA
| | | | | | | | | | | |
Collapse
|
20
|
Logadottir Y, Fall M, Kåbjörn-Gustafsson C, Peeker R. Clinical characteristics differ considerably between phenotypes of bladder pain syndrome/interstitial cystitis. ACTA ACUST UNITED AC 2012; 46:365-70. [PMID: 22607036 DOI: 10.3109/00365599.2012.689008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Bladder pain syndrome/interstitial cystitis (BPS/IC) is one of the most bothersome conditions in urological practice. This syndrome includes a heterogeneous collection of underlying pathological conditions. Compared to the classic IC with a Hunner lesion, now denominated European Society for the Study of Interstitial Cystitis (ESSIC) type 3C, the non-Hunner type of BPS/IC appears different concerning demographic, endoscopic and histological findings, as well as the response to all forms of treatment. The objective of this study was to determine whether there are additional dissimilarities in clinical presentation between the main phenotypes of BPS/IC. MATERIAL AND METHODS In total, 393 BPS/IC patients (210 type 3C and 183 non-Hunner), diagnosed according to National Institute of Diabetes and Digestive and Kidney Diseases and ESSIC criteria, were studied by surveying the clinical records including micturition diaries. RESULTS In this clinical material, BPS/IC ESSIC type 3C accounted for 55% of cases. Patients with non-Hunner disease were on average 20 years younger at the time of diagnosis. Furthermore, there was a marked and significant difference in bladder capacity under general anaesthesia (p < 0.0001). CONCLUSIONS The findings in the present series, together with previously published reports by this group and by others, confirm the striking differences between the main forms of BPS/IC and underline the indispensability of adequate subtyping in clinical studies.
Collapse
Affiliation(s)
- Yr Logadottir
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.
| | | | | | | |
Collapse
|
21
|
Nordling J, Fall M, Hanno P. Global concepts of bladder pain syndrome (interstitial cystitis). World J Urol 2011; 30:457-64. [DOI: 10.1007/s00345-011-0785-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 10/12/2011] [Indexed: 11/24/2022] Open
|
22
|
Arms L, Vizzard MA. Role for pAKT in rat urinary bladder with cyclophosphamide (CYP)-induced cystitis. Am J Physiol Renal Physiol 2011; 301:F252-62. [PMID: 21632956 PMCID: PMC3154590 DOI: 10.1152/ajprenal.00556.2010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 05/31/2011] [Indexed: 12/20/2022] Open
Abstract
AKT phosphorylation following peripheral nerve injury or inflammation may play a role in somatic pain processes and visceral inflammation. To examine such a role in micturition reflexes with bladder inflammation, we induced bladder inflammation in adult female Wistar rats (200-300 g) by injecting cyclophosphamide (CYP) intraperitoneally at acute (150 mg/kg; 4 h), intermediate (150 mg/kg; 48 h), and chronic (75 mg/kg; every third day for 10 days) time points. Western blot analyses of whole urinary bladders showed significant increases (P ≤ 0.01) in phosphorylated (p) AKT at all time points; however, the magnitude of AKT phosphorylation varied with duration of CYP treatment. Immunohistochemical analyses of pAKT immunoreactivity (pAKT-IR) in cryostat bladder sections demonstrated duration-dependent, significant (P ≤ 0.01) increases in pAKT-IR in both the urothelium and detrusor smooth muscle of CYP-inflamed bladders. Additionally, a suburothelial population of pAKT-IR macrophages (CD68-, MAC2-, and F4/80-positive) was present in chronic CYP-treated bladders. The functional role of pAKT in micturition was evaluated using open, conscious cystometry with continuous instillation of saline in conjunction with administration of an inhibitor of AKT phosphorylation, deguelin (1.0 μg/10 μl), or vehicle (1% DMSO in saline) in control (no inflammation) and CYP (48 h)-treated rats. Bladder capacity, void volume, and intercontraction void interval increased significantly (P ≤ 0.05) following intravesical instillation of deguelin in CYP (48 h)-treated rats. These results demonstrate increased AKT phosphorylation in the urinary bladder with urinary bladder inflammation and that blockade of AKT phosphorylation in the urothelium improves overall bladder function.
Collapse
Affiliation(s)
- Lauren Arms
- Department of Anatomy and Neurobiology, University of Vermont College of Medicine, Burlington, Vermont 05405, USA
| | | |
Collapse
|
23
|
Bladder Pain Syndrome, Interstitial Cystitis, Painful Bladder Syndrome, and Hypersensitive Bladder Syndrome: New Nomenclature/New Guidelines. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0098-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|