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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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Mishra NN. Interstitial cystitis/bladder pain syndrome (IC/BPS): Single-center 20 year experience and treatment results in India. Neurourol Urodyn 2022; 41:1390-1398. [PMID: 35598079 DOI: 10.1002/nau.24959] [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: 04/16/2022] [Accepted: 05/07/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Interstitial cystitis/bladder pain syndrome (IC/BPS) is an enigmatic disease that is difficult to treat. Even among physicians, the prevalent belief is that patients do not improve over time. In this study, we retrospectively reviewed our experience and treatment results for patients diagnosed with IC/BPS at our clinic in India over the past 20 years. MATERIALS AND METHODS Three hundred and eighty IC/BPS patients diagnosed between January 2001 and December 2020 were included. Patients underwent cystoscopy and hydrodistension and were treated with oral drugs, intravesical instillations, and surgery as needed. From January 2021 to June 2021, all patients were contacted by telephone. RESULTS The study had 380 participants, but only 231 could be contacted for analysis. Follow-up averaged 6.37 years and the median was 14 years. Eighteen percent showed no improvement, 2% showed a slight improvement on Global Response Assessment (GRA) questionnaire and were considered nonresponders (NR). Yet, 67% reported notable improvements, and 13% moderate improvements, all of which make up 80% responders (R). In 11 patients who were operated on for ileocystoplasty, 9 showed significant improvements. In addition, three patients developed Urothelial Malignancy. Pregnancy did not affect the disease in any way. CONCLUSIONS Long-term results have been encouraging for IC/BPS patients. Unfortunately, Hunner's lesions patients need a more intensive treatment regimen. Re-evaluation with cystoscopy is recommended in NR. In spite of good results of surgery in our series, it is best to perform surgery only as a last resort.
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Affiliation(s)
- Nagendra N Mishra
- Pramukh Swami Medical College, Bhaikaka University, Anand, Gujarat, India
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Argüelles Rojas S, Oviedo Ortega JG, Velasco Sordo R. Interstitial Cystitis: Diagnosis and Treatment in a Pregnant Patient. Cureus 2021; 13:e14549. [PMID: 34017664 PMCID: PMC8130645 DOI: 10.7759/cureus.14549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Interstitial cystitis or painful bladder syndrome is a chronic condition characterized by severe and acyclic pelvic pain lasting for a period of at least six weeks. Although this condition is not accompanied by urinary infection, the patient's daily activities are impeded. The most common symptoms are urinary frequency, dysuria, suprapubic pain, nycturia, and dyspareunia. The etiology of interstitial cystitis is unclear, and its diagnosis is infrequent because of the low number of cases. A definitive diagnosis is based on cystoscopic findings and typical histopathological evidence, such as Hunner's ulcers. Herein, we describe the diagnosis and treatment of a clinical case of interstitial cystitis in a patient who started presenting symptoms during pregnancy. A 42-year-old woman at 27.2 weeks of pregnancy began showing symptoms at 10 weeks of gestation. She presented with dysuria and hypogastric pain with an intensity of 9/10, which hindered her daily activities. Physical examination revealed tenderness to deep and superficial hypogastric palpation. Routine urinalysis and urine culture test yielded negative results. She was started on symptomatic treatment from 10 weeks of gestation, but it did not result in any improvement. Therefore, intraoperative diagnostic cystoscopy was performed to obtain biopsy samples. Histopathological analysis of the samples showed evidence of interstitial cystitis. Accordingly, she was started on intravesical instillation of hyaluronic acid, which improved her condition. On the basis of the case findings, we recommend that interstitial cystitis should be considered a differential diagnosis in patients with pelvic pain and urinary symptoms unrelated to a urinary infection.
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Affiliation(s)
- Sofía Argüelles Rojas
- Obstetrics and Gynecology, Centro Médico ABC (American British Cowdray), Mexico City, MEX
| | - José G Oviedo Ortega
- Obstetrics and Gynecology, Centro Médico ABC (American British Cowdray), Mexico City, MEX
| | - Roberto Velasco Sordo
- Obstetrics and Gynecology, Centro Médico ABC (American British Cowdray), Mexico City, MEX
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Abstract
Overactive bladder (OAB) is characterized by the storage symptoms of urgency with or without urgency incontinence. Although there is no clear cause of this idiopathic disease, overall prevalence of OAB symptoms in individuals aged 40 years old is more than 15%. Oxytocin, which is one of the most powerful contracting neuropeptide, was also shown to exhibit high intrinsic contractile activity on detrusor muscle. Oxytocin receptor antagonists that inhibit of bladder activity might offer new insights into the treatment of OAB.
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Affiliation(s)
- Onder Canguven
- Hamad General Hospital, Doha, Qatar
- Weill Cornell Medicine, Urology, USA
| | - Raidh Talib
- Department of Urology & Andrology, Hamad General Hospital, Doha, Qatar
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Pape J, Falconi G, De Mattos Lourenco TR, Doumouchtsis SK, Betschart C. Variations in bladder pain syndrome/interstitial cystitis (IC) definitions, pathogenesis, diagnostics and treatment: a systematic review and evaluation of national and international guidelines. Int Urogynecol J 2019; 30:1795-1805. [PMID: 31073635 DOI: 10.1007/s00192-019-03970-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/22/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Interstitial cystitis (IC) and bladder pain syndrome (BPS) are challenging and encompassing hypersensitivity disorders of the lower urinary tract. A variety of national and international guidelines have been published including guidance on nomenclature, definitions, etiopathology, diagnostics and treatment. A lack of universally established clinical guidance is apparent. The aim of this review is to evaluate key guidelines on this area of practice, identify variations, compare their recommendations and grade them using AGREE II. METHODS Literature searches were performed using the PUBMED and CINAHL database from January 1, 1983, to December 1, 2018, referring to the search strategy of AUA. Ten national and international guidelines were included into the analysis. We assessed the guidelines with the updated AGREE II. RESULTS Symptoms congruent in all guidelines are: pain, pressure, discomfort and frequency, urgency and nocturia. Urinalysis is a prerequisite for diagnostics, cystoscopy for most and urodynamics not part of the routine assessment. Treatment options are recommended stepwise. The highest level of evidence and consensus was identified for oral therapies. Nine guidelines had an overall quality score ≥ 50% and three scored ≥ 70% (AUA, GG, RCOG). CONCLUSIONS The guidelines are congruent in symptom reporting, quite congruent in diagnostics and vary to a high degree on treatment recommendations. The complexity of BPS and emerging evidence indicate the need for regular updating of the guidelines and a wider consensus.
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Affiliation(s)
- Janna Pape
- Department of Gynecology, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Gabriele Falconi
- Department of Obstetrics and Gynecology, "San Bortolo" Hospital, Vicenza, Italy
| | | | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK.,St George's University of London, London, UK
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Rao CV. Therapeutic Potential of Human Chorionic Gonadotropin Against Painful Bladder Syndrome/Interstitial Cystitis. Reprod Sci 2016; 23:1451-1458. [PMID: 27004802 DOI: 10.1177/1933719116639139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Painful bladder syndrome/interstitial cystitis is a debilitating chronic bladder disease that primarily affects women. The disease is due to a damage of urothelial cell lining. As a result, potassium particles and other toxic substances in urine can leak into bladder mucosa, causing the symptoms of lower abdominal/pelvic discomfort, pain, increased urination frequency, urgency, nocturia, and so on, all of which can substantially reduce the quality of daily life. There are multiple symptom reliving therapies. Among them, only pentosan polysulfate sodium, sold under the brand name of Elmiron, has been approved for oral use by US Food and Drug Administration. It provides the relief after several months of use. Based on the scientific leads presented in this article, we propose that human chorionic gonadotropin has a therapeutic potential that is worth investigating for the treatment of this disease.
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Affiliation(s)
- C V Rao
- Departments of Cellular Biology and Pharmacology, Molecular and Human Genetics and Obstetrics and Gynecology, Reproduction and Development Program, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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Mishra NN. Clinical presentation and treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) in India. Transl Androl Urol 2016; 4:512-23. [PMID: 26816851 PMCID: PMC4708552 DOI: 10.3978/j.issn.2223-4683.2015.10.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease characterized by pelvic pain urgency and frequency. Patients with severe symptoms lead a very miserable life. North American, European and Asian guidelines have been recently promulgated but they differ on many important issues. There is no consensus on its name, definition, investigations and management. Indian guidelines have also been developed and they give more importance to the symptoms in relation to micturition. Though initially believed to be rare or non-existent in India the situation has changed. In Indian patients the presentation is more or less same as the rest of the world but a large percentage have obstructive symptoms and unusual urinary symptoms. Anal discomfort is also common. In India the commonest investigation in all cases of lower urinary tract (LUT) dysfunction is ultrasonography of kidney ureter and bladder with measurement of the post void residual urine volume. Cystoscopy is also done in all the cases to rule out presence of tuberculosis or carcinoma in situ. Bladder pain syndrome/interstitial cystitis (BPS/IC) is not considered to be a clinical disease as it is difficult to rule out all differential diagnosis only from history. Hunner’s lesion is very rare. Cystoscopy with hydro distension, oral therapy, intravesical therapy and surgical therapy form the back bone of management. It is difficult to know which treatment is best for a given patient. A staged protocol is followed and all the treatment modalities are applied to the patients in a sequential fashion—starting from the non-invasive to more invasive. Intravesical botox has not been found to be effective and there is no experience with interstim neuromodulation.
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Abstract
Overactive bladder (OAB) is a common form of urinary incontinence, resulting from spontaneous and random contractions of the urinary bladder. The affected individuals have an uncontrollable urge to urinate and experience incontinence and nocturia, which can greatly reduce the quality of daily life. There are several drugs for the treatment, and all of them have serious side effects. The following findings suggested that human chorionic gonadotropin (hCG) has a therapeutic potential that is worth investigating for the treatment of OAB. The finding are (1) human detrusor muscle contains hCG receptors, (2) detrusor muscle becomes quiescent during pregnancy, (3) hCG can inhibit detrusor muscle contractions induced by cholinergic stimulation in rats, and (4) hCG can mimic the anticholinergic drug on detrusor muscle contractions.
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Affiliation(s)
- C V Rao
- Departments of Cellular Biology and Pharmacology, Molecular and Human Genetics, and Obstetrics and Gynecology, Reproduction and Development Program, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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Ogawa T, Ishizuka O, Ueda T, Tyagi P, Chancellor MB, Yoshimura N. Current and emerging drugs for interstitial cystitis/bladder pain syndrome (IC/BPS). Expert Opin Emerg Drugs 2015; 20:555-70. [DOI: 10.1517/14728214.2015.1105216] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
The majority of urogynaecological problems can manifest during pregnancy or as a direct result of pregnancy and delivery. Those most commonly occurring during pregnancy are urinary tract infection, filling and voiding disorders, urinary incontinence, pelvic organ prolapse and faecal incontinence. The development of these may be as a result of physiological changes that occur in pregnancy or as a result of previous pregnancies. There may also be urogynaecological sequelae that occur as a result of trauma sustained during delivery. These include perineal and anal sphincter trauma, bladder or ureteric injuries during caesarean section or operative deliveries, and the development of vesico-vaginal or recto-vaginal fistulae.
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Affiliation(s)
- H Law
- Department of Obstetrics and Gynaecology, Mid-Essex Hospital NHS Trust, Chelmsford, UK.
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Schwalenberg T, Stolzenburg JU, Ho TP, Mallock T, Hartenstein S, Alexander H, Zimmermann G, Hohenfellner R, Denzinger S, Burger M, Horn LC, Neuhaus J. Enhanced urothelial expression of human chorionic gonadotropin beta (hCGβ) in bladder pain syndrome/interstitial cystitis (BPS/IC). World J Urol 2011; 30:411-7. [PMID: 21877171 DOI: 10.1007/s00345-011-0755-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/16/2011] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Bladder pain syndrome/interstitial cystitis (BPS/IC) is associated with urothelial lesions. Pathomechanisms of urothelial damage and factors for urothelial restoration are unknown. hCG is a factor for cellular differentiation, angiogenesis and immune competence of the endometrium during pregnancy. Clinical observations demonstrate improvement of BPS/IC symptoms during pregnancy or during infertility treatment with hCG. Our research aims were to examine the expression of hCG and luteinizing hormone receptor (LHR) in the urothelium of BPS/IC patients and compare the levels of hCGβ with healthy controls. METHODS Bladder biopsies of BPS/IC (CLSM: n = 10; qPCR: n = 15); Tumour-free control tissue from cystectomies (n = 12). hCGα, hCGβ and LHR expression were examined by confocal laser scanning microscopy (CLSM), and hCGβ expression was quantified. hCGβ5 and hCGβ7 mRNA splice variants were quantified in real-time polymerase chain reaction. RESULTS We found constitutive expression of hCGα, hCGβ and LHR in healthy controls. HCGβ was significantly upregulated in BPS/IC patients in CLSM. PCR analysis revealed higher levels of hCGβ7 than hCGβ5 in controls and BPS/IC patients. CONCLUSIONS The constitutive expression of hCG and LHR speaks in favour for a functional signalling in urothelial cells without any association with either pregnancy or tumour. We show for the first time that hCGβ is upregulated in BPS/IC urothelium and that hCGβ7 is the dominant splice variant in those cells. Our findings imply a major role of hCG for urothelial integrity and a disturbance of hCG signalling in case of BPS/IC. We conclude that hCG could gain therapeutical relevance in the future.
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Affiliation(s)
- Thilo Schwalenberg
- Department of Urology, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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Warren JW, Clauw DJ, Wesselmann U, Langenberg PW, Howard FM, Morozov V. Sexuality and Reproductive Risk Factors for Interstitial Cystitis/Painful Bladder Syndrome in Women. Urology 2011; 77:570-5. [DOI: 10.1016/j.urology.2010.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/14/2010] [Accepted: 10/14/2010] [Indexed: 01/01/2023]
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Black LV, Ness TJ, Robbins MT. Effects of oxytocin and prolactin on stress-induced bladder hypersensitivity in female rats. THE JOURNAL OF PAIN 2010; 10:1065-72. [PMID: 19595642 DOI: 10.1016/j.jpain.2009.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 03/20/2009] [Accepted: 04/08/2009] [Indexed: 01/10/2023]
Abstract
UNLABELLED Anecdotal evidence suggests that chronic bladder pain improves while breastfeeding. The present study sought to identify potential mechanisms for such a phenomenon by investigating the effects of the lactogenic hormones prolactin (PL) and oxytocin (OXY) in a rat model of bladder nociception. Lactating rats were less sensitive to urinary bladder distension (UBD) than controls. In investigating potential antinociceptive and anxiolytic roles for these hormones, we found exposure to a footshock paradigm (STRESS groups) produced bladder hypersensitivity in saline-treated rats, manifested as significantly higher electromyographical (EMG) responses to UBD, compared to rats exposed to a nonfootshock paradigm (SHAM groups). This hypersensitivity was attenuated by the intraperitoneal administration of OXY prior to footshock in the STRESS-OXY group. The administration of PL augmented EMG responses in the SHAM-PL group but had no effect on the responses of the STRESS-PL group. In the absence of behavioral pretreatment, OXY attenuated UBD-evoked responses while PL had no effect. Moreover, OXY-treated rats spent more time in the open arm of an elevated plus maze compared to saline-treated rats suggesting anxiolysis. These studies suggest the potential for systemic OXY, but not PL, as an analgesic and anxiolytic treatment for painful bladder disorders such as interstitial cystitis. PERSPECTIVE This study presents evidence that systemic oxytocin has both analgesic and anxiolytic properties which may make it a potentially useful agent for patients with stress-exacerbated chronic-pain syndromes such as interstitial cystitis. These studies do not suggest a similar role for prolactin.
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Affiliation(s)
- L Vandy Black
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
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Characterization of a Clinical Cohort of 87 Women with Interstitial Cystitis/Painful Bladder Syndrome. Urology 2008; 71:634-40. [DOI: 10.1016/j.urology.2007.11.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 10/11/2007] [Accepted: 11/07/2007] [Indexed: 11/22/2022]
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