1
|
Hu J, Xiao Y, Jiang G, Hu X. Research Trends of Acupuncture Therapy on Chronic Pelvic Pain Syndrome from 2000 to 2022: A Bibliometric Analysis. J Pain Res 2023; 16:4049-4069. [PMID: 38054110 PMCID: PMC10695139 DOI: 10.2147/jpr.s434333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023] Open
Abstract
Background Acupuncture is considered an important means of analgesic, which has been widely used in chronic pelvic pain syndrome (CPPS) management and treatment in recent years, published a large number of related documents. However, the relevant literature in this field has not been summarized and quantitatively analyzed. Therefore, this study aims to analyze the hotspots and predicting future research trends of acupuncture on pelvic pain syndrome. Methods Search for the relevant publications of the web of science database from 2000 to 2022 about the treatment of acupuncture on chronic pelvic pain syndrome. The Citespace software and VosViewer software are used to analyze the visualization of the countries, institutions, authors, keywords and references and references in the literature. Results A total of 173 publications were included. The annual number of essays gradually showed an overall growth trend over time. Medicine magazine is the most published journal in this field. J UROLOGY and Acupunct Med are the most cited journals and the most influential magazines; The most active and influential country is China, and the most produced institutions are Beijing University of Chinese Medicine; The most produced authors are Liu Zhishun. The most cited and most influential authors are Nickel JC and Armour M; keywords and cited reference analysis show that the quality of life, mechanism research, alternative medicine and electro-acupuncture will be the scientific hotspot of acupuncture treatment for chronic pelvic pain syndrome. Conclusion This study shows that acupuncture on CPPS is increasingly valued and recognized. The future research hotspots will focus on the effects and mechanisms. In the future, more high-quality animal basic research will be required to explore the exact mechanism of acupuncture on CPPS. In addition, different parameters of acupuncture such as electric-acupuncture, stimulating frequency, duration and strength are also the focus of future research. More clinical trials are required to verify its safety and effectiveness.
Collapse
Affiliation(s)
- Jinyu Hu
- School of Graduate and Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang City, People’s Republic of China
| | - Yuanyi Xiao
- School of Graduate and Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang City, People’s Republic of China
| | - Guilin Jiang
- Department of Clinical Medicine, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang City, People’s Republic of China
| | - Xiaorong Hu
- Department of Clinical Medicine, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang City, People’s Republic of China
| |
Collapse
|
2
|
Muacevic A, Adler JR, Gambacciani M. Is Erbium/Neodymium Laser Combination Therapy an Effective Treatment Option for Interstitial Cystitis/Bladder Pain Syndrome With Vulvodynia? Cureus 2022; 14:e31228. [PMID: 36505169 PMCID: PMC9730432 DOI: 10.7759/cureus.31228] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/10/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is often associated with vulvodynia and poor vaginal health. IC/BPS causes pelvic and bladder pain and urinary symptoms, which considerably reduce the quality of life. To date, this condition has no definitive cure. Local estrogen therapy (LET) has been proposed as a treatment for vulvodynia and poor vaginal health to improve the symptoms of IC/BPS. However, chronic LET could be contraindicated or not desired in some patients. The present study reports the case of a 55-year-old postmenopausal woman with IC/BPS who was successfully treated with combined vaginal erbium (VEL)/neodymium (Nd:YAG) laser (VEL+Nd:YAG) therapy. The patient presented with a five-year history of pelvic pain and urinary frequency. Direct approaches for the bladder (such as hydrodistension, anticholinergic drugs, and transurethral Hunner lesion ablation/cauterization) were conducted with inconsistent results. Immediately prior to the patient's presentation, LET was administered for 12 weeks; however, this therapy resulted in mild improvement and poor patient satisfaction. After presentation, VEL+Nd:YAG therapy was conducted once a month for three months. The patient reported considerable decrease in pain during urination. The improved symptoms were maintained for six months after the last therapy session. These results suggest that VEL+Nd:YAG therapy is an effective method for improving symptoms in patients with IC/BPS.
Collapse
|
3
|
Muacevic A, Adler JR. Chronic Pelvic Pain: A Comprehensive Review. Cureus 2022; 14:e30691. [PMID: 36465795 PMCID: PMC9709590 DOI: 10.7759/cureus.30691] [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: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 01/25/2023] Open
Abstract
Chronic pelvic pain (CPP) is explained as a complaint of cyclic or non-cyclic pelvic pain lasting for at least six months with or without dysmenorrhea, dyspareunia, dysuria, and dyschezia. The etiology of symptoms can be categorized according to organ system involvement. Gynecological causes typically involve endometriosis-related pain, pelvic congestion syndrome, pelvic inflammatory disease, adenomyosis, hydrosalpinx, etc. Endometriosis-related pain is seldom non-cyclic and may present due to recurrent bleeding in endometriotic implants. Engorgement of veins leads to inadequate venous washout and presents chronic pelvic pain in pelvic congestion syndrome. The pressure effect of benign lesions of the uterus and cervix may lead to cyclic pain, as in uterine fibroids. Often presentation of diseases like hydrosalpinx may not present until it has overdistended or may at times present as acute pelvic pain if it undergoes torsion. Long-standing untreated pelvic inflammatory diseases in sexually active females is another cause of pelvic pain. The complaint of CPP is also shared due to the involvement of the gastrointestinal system in conditions like irritable bowel syndrome, inflammatory bowel diseases, long-standing abdominal hernias, colorectal cancer, etc. Alteration of the gut biome and dysregulated brain-gut associations lead to typical manifestations of chronic lower back pain and pelvic pain in irritable bowel syndrome. Colorectal tumors, when in the advanced stage, may spread to nearby tissues creating fistulas and affecting nearby nerves, causing pelvic, perineal, and sacral pain. Abdominal hernias with small bowel prolapse are always related to pelvic pain symptoms. Infections in the urinary tract like urethral syndrome, chronic prostatitis, and chronic recurrent cystitis present with CPP and voiding problems. Musculoskeletal etiologies, though varying in degrees, are responsible for isolated complaints of CPP. Examples include pelvic girdle pain, levator syndrome, coccygodynia, and pelvic floor prolapse.
Collapse
|
4
|
Hacad CR, Lucon M, Milhomem SAR, Bruschini H, Tanaka C. Association of physical therapy techniques can improve pain and urinary symptoms outcomes in women with bladder pain syndrome. A randomized controlled trial. Int Braz J Urol 2022; 48:807-816. [PMID: 35838507 PMCID: PMC9388188 DOI: 10.1590/s1677-5538.ibju.2022.0056] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose: to verify the effects of biofeedback (BF) and manual therapy (MT) associated with transcutaneous electrical nerve stimulation (TENS) or postural exercises (PE) in the treatment of bladder pain syndrome (BPS) in women regarding pain and urinary symptoms. Materials and Methods: a parallel-randomized controlled trial was conducted in BPS patients diagnosed according to NIH clinical criteria. Two specialized physiotherapists applied demographic and validated questionnaires of perineal and suprapubic pain (VAS), urinary symptoms and problems (ICSI and ICPI) and sexual function (FSFI) and a physical assessment was made to identify myofascial trigger points. Thirty-one women, mean age 51.8 ± 10.9 were randomized in three groups of treatment consisting of ten weekly sessions of BF and MT (Conventional group); BF, MT, and TENS (TENS group); and BF, MT, and PE (Postural group). Results: Postural group improved perineal and suprapubic pain after treatment (p<0.001 and p=0.001, respectively), and the suprapubic pain improvement remained persistent at 3 months of follow up (p=0.001). Postural group improved urinary symptoms and problems after treatment (p<0.001 and p=0.005, respectively) and during follow up (p<0.001 and p=0.001). Conclusions: Biofeedback and manual therapy associated with postural exercises showed a significant improvement in perineal and suprapubic pain and urinary symptoms after treatment and during follow-up. Both results suggest a possible role for the use of this physiotherapy technique to treat BPS patients. Longer follow-up and a larger number of patients are necessary to confirm these conclusions.
Collapse
Affiliation(s)
- Claudia Rosenblatt Hacad
- Divisão de Fisioterapia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Marcos Lucon
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | | | - Homero Bruschini
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Clarice Tanaka
- Divisão de Fisioterapia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| |
Collapse
|
5
|
Mosca L, Riemma G, Braga A, Frigerio M, Ruffolo AF, Dominoni M, Munno GM, Uccella S, Serati M, Raffone A, Salvatore S, Torella M. Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:981. [PMID: 35893096 PMCID: PMC9331312 DOI: 10.3390/medicina58080981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Female sexual dysfunctions represent a real widespread problem, usually faced from a psychological point of view; however, millions of women worldwide are impacted by pelvic floor dysfunction, personal shame and social taboos, however, continue to inhibit free conversation on the subject. Women's quality of life is considerably improved by screening, diagnosing, and controlling urogenital and sexual issues. This review aims to provide a critical perspective of urogenital conditions and common disturbances in female sexual function associated with these issues. It also includes a discussion of postpartum pelvic dysfunction.
Collapse
Affiliation(s)
- Lavinia Mosca
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, 20900 Monza, Italy;
| | - Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gaetano Maria Munno
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37100 Verona, Italy;
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy;
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy;
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80100 Naples, Italy
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| |
Collapse
|
6
|
Dothan D, Raisin G, Malchi N, Gordon A, Touitou D, Chertin B. Intravesical sustained release system of lidocaine and oxybutynin results from in vitro and animal study. Int Urol Nephrol 2022; 54:2167-2174. [PMID: 35780464 DOI: 10.1007/s11255-022-03280-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating condition of unknown etiology. Intravesical lidocaine demonstrated pain relief in patients with IC/BPS. Intravesical oxybutynin has shown therapeutic efficacy in patients with urinary bladder disorders. However, loss of drug with urination requiring multiple administrations and immediate dilution of drug concentration by residual urine in the bladder mitigated intravesical use of both drugs in clinical practice. The aim of this study was to evaluate the efficacy and safety of fixed-dose combination of lidocaine and oxybutynin, forming in the urine a sustained delivery system named TRG-042. MATERIAL AND METHODS In-vitro, we have quantitatively tested the concentration of lidocaine and oxybutynin released from TRG-042 in artificial urine. Following the successful in-vitro study weekly formulation of TRG-042 was instilled intravesically to six pigs. All pigs were followed with cystoscopy to assess the gradual degradation of the delivery system and to evaluate bladder response over 7 days. Daily blood samples were tested for drug quantization. RESULTS In-vitro studies have demonstrated oxybutynin and lidocaine sustained release over 1-week period coupled with full degradation of the matrix. None of the animals demonstrated any side effects following instillation. Cystoscopy examination observed gradual disintegration of TRG-042 over 1-week with no adverse reaction to the mucosa. Plasma concentrations of oxybutynin and lidocaine were uniformly stable over the 1-week period [1.46 ± 0.176 ng/ml and 4.29 ± 2.48 ng/ml respectively(mean ± SEM)] with almost undetectable concentration of N-desethyloxybutynin (NDO)[0.032 ± 0.068 ng/ml]. CONCLUSIONS The in-vitro and animal data demonstrated that TRG-042 can safely be used for intravesical sustained release of lidocaine and oxybutynin in the treatment of BPS/IC.
Collapse
Affiliation(s)
- David Dothan
- The Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, 91031, Jerusalem, Israel
| | - Galiya Raisin
- The Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, 91031, Jerusalem, Israel
| | - Nadav Malchi
- The Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, 91031, Jerusalem, Israel
| | - Avi Gordon
- The Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, 91031, Jerusalem, Israel
| | - Dan Touitou
- The Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, 91031, Jerusalem, Israel
| | - Boris Chertin
- The Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, 91031, Jerusalem, Israel.
| |
Collapse
|
7
|
Effects of Acupuncture Combined with Rehabilitation on Chronic Pelvic Pain Syndrome in Females: A Meta-Analysis Running Head—Acupuncture Combined with Rehabilitation on Chronic Pelvic Pain. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8770510. [PMID: 35340243 PMCID: PMC8941541 DOI: 10.1155/2022/8770510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/17/2022]
Abstract
Objective To investigate the clinical efficacy of this combined treatment for chronic pelvic pain syndrome (CPPS) by meta-analysis. Methods Relevant articles were retrieved from PubMed, CNKI, Wanfang Data, Web of Science, and Embase, including randomized controlled trials on acupuncture combined with rehabilitation for CPPS in females. Results A total of 224 articles were retrieved in this study, and 14 studies were finally identified for inclusion. Among them, the treatment group was treated with acupuncture combined with pelvic floor rehabilitation therapy, while the control group was treated with acupuncture or pelvic floor rehabilitation therapy. Meta-analysis showed that the treatment effective rate in the treatment group was significantly higher than that in the control group (OR = 6.54; 95% CI: 4.20, 10.21; P < 0.05). After treatment, compared with the control group, the treatment group showed lower incidences of adverse reactions (OR = 0.16; 95% CI: 0.09, 0.27; P < 0.05), bladder prolapse (OR = 0.36; 95% CI: 0.18, 0.73; P < 0.05), cervical prolapse (OR = 0.22; 95% CI: 0.10, 0.49; P < 0.05), and pelvic peritoneal hernia (OR = 0.14; 95% CI: 0.05, 0.38; P < 0.05); in addition, the treatment group was also associated with lower pain score (SMD = −4.05; 95% CI: −6.75, −1.34; P < 0.05) and pelvic dysfunction score (SMD = -4.35; 95% CI: -5.37, -3.34; P < 0.05). Conclusion Acupuncture combined with rehabilitation is effective for CPPS in females, which can significantly reduce the pain intensity and improve pelvic dysfunction of patients.
Collapse
|
8
|
Al-Shaiji TF, Alshammaa DH, Al-Mansouri MM, Al-Terki AE. Association of endometriosis with interstitial cystitis in chronic pelvic pain syndrome: Short narrative on prevalence, diagnostic limitations, and clinical implications. Qatar Med J 2021; 2021:50. [PMID: 34660218 PMCID: PMC8497779 DOI: 10.5339/qmj.2021.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/27/2021] [Indexed: 11/03/2022] Open
Abstract
Introduction: Chronic pelvic pain (CPP) is a diagnostic and therapeutic challenge affecting women of all ages globally. The syndrome is not well understood, but the association of interstitial cystitis (IC) with endometriosis in causing CPP should not be overlooked in managing this cohort. Herein, we present a mini review of this association to evaluate the literature in determining the prevalence of endometriosis and IC concomitantly in patients with CPP, diagnostic limitations, and clinical implications. Methods: A Medline search of the key words “evil twins’ syndrome,” “interstitial cystitis,” “bladder pain syndrome,” and “endometriosis” was conducted for full-text articles published in English over the past 20 years. The search yielded 40 articles, of which 21 were selected. Cross-referencing bibliographies of each publication yielded an additional 25 references. Results: Both endometriosis and IC share a similar array of symptoms that are often exacerbated during the perimenstrual period. Multiple authors have reported the frequent coexistence of these two conditions. Over 80% of patients with CPP were found to have both conditions. The prevalence of endometriosis and IC coexistence was greater than that of each condition separately. Conclusions: It is crucial to look beyond the traditionally diagnosed endometriosis as the cause of CPP. This is true especially in patients whose previous treatment was ineffective. Simultaneous assessment for both conditions is essential to avoid the frequently delayed diagnosis and prevent unsuccessful medical and surgical therapies.
Collapse
Affiliation(s)
- Tariq F Al-Shaiji
- Urology Unit, Department of Surgery, Amiri Hospital, Kuwait City, Kuwait E-mail:
| | - Dalal H Alshammaa
- Department of Obstetrics and Gynecology, Maternity Hospital, Kuwait City, Kuwait
| | - Mariam M Al-Mansouri
- Department of Obstetrics and Gynecology, Maternity Hospital, Kuwait City, Kuwait
| | | |
Collapse
|
9
|
Relationship of Bladder Pain With Clinical and Urinary Markers of Neuroinflammation in Women With Urinary Urgency Without Urinary Incontinence. Female Pelvic Med Reconstr Surg 2021; 27:e418-e422. [PMID: 33009262 DOI: 10.1097/spv.0000000000000951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The pathogenesis of bladder pain is poorly understood. Our hypothesis is that in women with urinary urgency without incontinence, bladder pain is associated with the presence of neurogenic inflammation in the bladder wall and neuroinflammatory biomarkers in the urine. METHODS We conducted a prospective cross-sectional study of women with urinary urgency without incontinence. Urinary symptoms were measured using Female Genitourinary Pain Index. Neuropathic pain, a clinical biomarker of neuroinflammation, was measured using the PainDETECT questionnaire. Inflammatory neuropeptides measured in the urine included nerve growth factor (NGF), brain-derived neurotrophic factor, vascular endothelial growth factor, and osteopontin. Neuropathic pain scores and urinary neuropeptide levels were compared between patients with and without bladder pain using univariable and multivariable analyses. RESULTS In 101 women with urinary urgency without incontinence, 62 (61%) were in the bladder pain group (visual analog scale score, ≤ 3), whereas 39 (39%) were in the no bladder pain group. Urinary symptom scores (5.0 ± 3.1 versus 3.5 ± 2.4, P < 0.001) and neuropathic pain scores (13.3 ± 8.6 vs 5.1 ± 4.8, P < 0.001) were significantly higher for the bladder pain group than for the no bladder pain group. On multivariable analysis after controlling for age, body mass index, and severity of urinary urgency, bladder pain score was significantly associated with elevated urinary levels of vascular endothelial growth factor (P = 0.04) and osteopontin (P = 0.02), whereas the neuropathic pain score was significantly associated with an increased NGF level (P = 0.03). CONCLUSIONS In women with urinary urgency without incontinence, bladder pain is associated with the presence of clinical and urinary biomarkers of neuroinflammation.
Collapse
|
10
|
Liu Y, Zhang P, Liu M, Liu X, Liu R, Yu X, Deng S, Si H, Sun B. The clinical effect of traditional chinese medicine on middle-aged women with Interstitial Cystitis: Protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e19673. [PMID: 32243402 PMCID: PMC7440324 DOI: 10.1097/md.0000000000019673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Interstitial cystitis (IC), as a common disease in urology, is prolonged and repeated. IC has caused great harm to the patient's physical and psychological. Traditional Chinese medicine (TCM) is characterized by overall concepts and dialectical treatment. It provides clinicians with safer and more reliable alternatives in terms of clinical prescriptions and prepared medicines, and also improves the quality of life of patients with IC. Therefore, in this study, we will use the research method of randomized controlled trials to explore the effects of TCM combined with western medicine on renal function and urine metabolism on middle-aged women with IC. METHODS/DESIGN Use randomized controlled trials. According to the proposed diagnostic, inclusion, and exclusion criteria. Sixty patients with interstitial bladder inflammation that met the criteria were randomized into a treatment group and a control group of 30 cases each. The intervention group was treated with integrated traditional Chinese and western medicine. The control group was given conventional Western medicine treatment. The course of treatment is 8 weeks. Interstitial bladder inflammation symptoms score (ICS worker), problem score (worker CPI), pelvic pain and urinary urgency symptoms, and urodynamics were used as the evaluation criteria. DISCUSSION This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of TCM for patients with IC. TRIAL REGISTRATION ClinicalTrials.gov, ChiCTR2000029971, Registered on 17 February 2020.
Collapse
Affiliation(s)
- Yahong Liu
- The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, P.R. China
| | - Pingan Zhang
- The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, P.R. China
| | - Mengyu Liu
- Chengde Medical University, Chengde, Hebei, China
| | - Xiaohe Liu
- Chengde Medical University, Chengde, Hebei, China
| | - Ruijia Liu
- Graduate School of Beijing University of Chinese Medicine
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijng
| | - Xudong Yu
- Graduate School of Beijing University of Chinese Medicine
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijng
| | - Sheng Deng
- Graduate School of Beijing University of Chinese Medicine
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijng
| | - Hongmei Si
- Graduate School of Beijing University of Chinese Medicine
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijng
| | - Bei Sun
- The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, P.R. China
| |
Collapse
|
11
|
Padoa A, McLean L, Morin M, Vandyken C. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med Rev 2020; 9:64-75. [PMID: 32238325 DOI: 10.1016/j.sxmr.2020.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/30/2019] [Accepted: 02/02/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and psychosocial elements can lead to the persistence of OPF symptoms along with psychological and emotional distress. OBJECTIVES (1) To review and contextualize, from a pathophysiologic perspective, the evidence for OPF, (2) to provide an overview of common clinical presentations and comorbidities of OPF, and (3) to discuss the effect of OPF on sexual function in men and women. METHODS Review of the updated literature on the pathophysiology of OPF was carried out. OPF-associated conditions were overviewed, with special emphasis on the impact on sexual function in men and women. RESULTS Individuals with suspected OPF often present with a combination of gastrointestinal, gynecological, musculoskeletal, sexual, and urological comorbidities, mostly accompanied by psychoemotional distress. In both women and men, sexual function is significantly impaired by OPF and genitopelvic pain penetration disorders are often the primary manifestation of this condition. Women with OPF report less sexual desire, arousal, and satisfaction; more difficulty reaching orgasm; lower frequencies of intercourse; more negative attitudes toward sexuality; and more sexual distress than women without sexual pain. The most frequently reported sexual dysfunctions in men with OPF include erectile dysfunction, premature ejaculation, and ejaculatory pain. CONCLUSION The complex pathophysiology of OPF involving multisystemic comorbidities and psychosocial factors emphasize the importance of a biopsychosocial assessment for guiding effective and personalized management. Padoa A, McLean L, Morin M, et al. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med 2021;9:64-75.
Collapse
Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Yitzhak Shamir (formerly Assaf Harofe) Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Melanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | | |
Collapse
|
12
|
Aerts L, Grangier L, Dallenbach P, Wenger JM, Streuli I, Bianchi-Demicheli F, Pluchino N. Understanding sexual pain in endometriosis. ACTA ACUST UNITED AC 2019; 71:224-234. [DOI: 10.23736/s0026-4784.19.04379-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
13
|
Ojala J, Tooke K, Hsiang H, Girard BM, May V, Vizzard MA. PACAP/PAC1 Expression and Function in Micturition Pathways. J Mol Neurosci 2018; 68:357-367. [PMID: 30259317 DOI: 10.1007/s12031-018-1170-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022]
Abstract
Neural injury, inflammation, or diseases commonly and adversely affect micturition reflex function that is organized by neural circuits in the CNS and PNS. One neuropeptide receptor system, pituitary adenylate cyclase-activating polypeptide (PACAP; Adcyap1), and its cognate receptor, PAC1 (Adcyap1r1), have tissue-specific distributions in the lower urinary tract. PACAP and associated receptors are expressed in the LUT and exhibit changes in expression, distribution, and function in preclinical animal models of bladder pain syndrome (BPS)/interstitial cystitis (IC), a chronic, visceral pain syndrome characterized by pain, and LUT dysfunction. Blockade of the PACAP/PAC1 receptor system reduces voiding frequency and somatic (e.g., hindpaw, pelvic) sensitivity in preclinical animal models and a transgenic mouse model that mirrors some clinical symptoms of BPS/IC. The PACAP/receptor system in micturition pathways may represent a potential target for therapeutic intervention to reduce LUT dysfunction following urinary bladder inflammation.
Collapse
Affiliation(s)
- Jacqueline Ojala
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine at The University of Vermont, Given Building, D405A, Burlington, VT, 05405, USA
| | - Katharine Tooke
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine at The University of Vermont, Given Building, D405A, Burlington, VT, 05405, USA
| | - Harrison Hsiang
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine at The University of Vermont, Given Building, D405A, Burlington, VT, 05405, USA
| | - Beatrice M Girard
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine at The University of Vermont, Given Building, D405A, Burlington, VT, 05405, USA
| | - Victor May
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine at The University of Vermont, Given Building, D405A, Burlington, VT, 05405, USA
| | - Margaret A Vizzard
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine at The University of Vermont, Given Building, D405A, Burlington, VT, 05405, USA.
| |
Collapse
|
14
|
Di Tucci C, Di Feliciantonio M, Vena F, Capone C, Schiavi MC, Pietrangeli D, Muzii L, Benedetti Panici P. Alpha lipoic acid in obstetrics and gynecology. Gynecol Endocrinol 2018; 34:729-733. [PMID: 29726290 DOI: 10.1080/09513590.2018.1462320] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Alpha-Lipoic acid (ALA) is a natural antioxidant synthetized by plants and animals, identified as a catalytic agent for oxidative decarboxylation of pyruvate and α-ketoglutarate. In this review, we analyzed the action of ALA in gynecology and obstetrics focusing in particular on neuropathic pain and antioxidant and anti-inflammatory action. A comprehensive literature search was performed in PubMed and Cochrane Library for retrieving articles in English language on the antioxidant and anti-inflammatory effects of ALA in gynecological and obstetrical conditions. ALA reduces oxidative stress and insulin resistance in women with polycystic ovary syndrome (PCOS). The association of N-acetyl cysteine (NAC), alpha-lipoic acid (ALA), and bromelain (Br) is used for prevention and treatment of endometriosis. In association with omega-3 polyunsaturated fatty acids (n-3 PUFAs) with amitriptyline is used for treatment of vestibulodynia/painful bladder syndrome (VBD/PBS). A promising area of research is ALA supplementation in patients with threatened miscarriage to improve the subchorionic hematoma resorption. Furthermore, ALA could be used in prevention of diabetic embryopathy and premature rupture of fetal membranes induced by inflamation. In conclusion, ALA can be safely used for treatment of neuropatic pain and as a dietary support during pregnancy.
Collapse
Affiliation(s)
- Chiara Di Tucci
- a Department of Gynecological, Obstetrical and Urological Sciences , ''Sapienza'' University of Rome , Rome , Italy
| | - Mara Di Feliciantonio
- a Department of Gynecological, Obstetrical and Urological Sciences , ''Sapienza'' University of Rome , Rome , Italy
| | - Flaminia Vena
- a Department of Gynecological, Obstetrical and Urological Sciences , ''Sapienza'' University of Rome , Rome , Italy
| | - Carmela Capone
- a Department of Gynecological, Obstetrical and Urological Sciences , ''Sapienza'' University of Rome , Rome , Italy
| | - Michele Carlo Schiavi
- a Department of Gynecological, Obstetrical and Urological Sciences , ''Sapienza'' University of Rome , Rome , Italy
| | - Daniela Pietrangeli
- a Department of Gynecological, Obstetrical and Urological Sciences , ''Sapienza'' University of Rome , Rome , Italy
| | - Ludovico Muzii
- a Department of Gynecological, Obstetrical and Urological Sciences , ''Sapienza'' University of Rome , Rome , Italy
| | - Pierluigi Benedetti Panici
- a Department of Gynecological, Obstetrical and Urological Sciences , ''Sapienza'' University of Rome , Rome , Italy
| |
Collapse
|
15
|
Transvaginal Trigger Point Injections Improve Pain Scores in Women with Pelvic Floor Hypertonicity and Pelvic Pain Conditions. Female Pelvic Med Reconstr Surg 2018; 25:392-396. [DOI: 10.1097/spv.0000000000000581] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Rahnama'i MS, Marcelissen T, Apostolidis A, Veit-Rubin N, Schurch B, Cardozo L, Dmochowski R. The efficacy of botulinum toxin A and sacral neuromodulation in the management of interstitial cystitis (IC)/bladder pain syndrome (BPS), what do we know? ICI-RS 2017 think thank, Bristol. Neurourol Urodyn 2018; 37:S99-S107. [PMID: 29363792 DOI: 10.1002/nau.23493] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
Abstract
AIMS This manuscript aims to address the evidence availale in the literature on the efficacy of Botulinum Toxin A (BoNT-A) and sacral neuromodulation (SNM) in patients suffering from Interstitial Cystitis (IC)/BPS and propose further research to identify mechanisms of action and establish the clinical efficacy of either therapy. METHODS At the International Consultation on Incontinence-Research Society (ICI-RS) in 2017, a panel of Functional Urologists and Urogynaecologists participated in a Think Tank (TT) discussing the management of IC/BPS by BoNT-A and SNM, using available data from both PubMed and Medicine literature searches. RESULTS The role of BoNT-A and SNM in the treatment of IC/BPS are discussed and mechanisms of actions are proposed. Despite the available randomized trial data on the effect of intravesical BoNT-A treatment on symptoms of IC/BPS, a consistent conclusion of a positive effect cannot be drawn at the moment, as the published studies are small and heterogeneous in design. There is substantive evidence for the positive effects of SNM on symptoms of IC/BPS patients however, during patient selection, it is important to distinguish the degree and the location of pain in order to tailor the best therapy to the right patients. CONCLUSIONS Both intravesical BoNT-A treatment and SNM have been shown to have positive effects in patients with IC/BPS. However, firm conclusions cannot yet be drawn. Patient-reported outcomes and quality of life should be assessed in addition to urinary and pain symptoms. Since current treatments mainly focus on symptomatic relief, future research should also focus on clarifying the pathogenic mechanisms involved in IC/BPS.
Collapse
Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Brigitte Schurch
- Department of Clinical Neuroscience, Neuropsychology & Neurorehabilitation Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Linda Cardozo
- Department of Urogynaecology, Kings College Hospital, London, United Kingdom
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennesse
| |
Collapse
|
17
|
Mitidieri AMDS, Gurian MBF, da Silva APM, Poli-Neto OB, Nogueira AA, Candido-Dos-Reis FJ, Rosa-E-Silva JC. Effect of Acupuncture on Chronic Pelvic Pain Secondary to Abdominal Myofascial Syndrome Not Responsive to Local Anesthetic Block: A Pilot Study. Med Acupunct 2017; 29:397-404. [PMID: 29279735 DOI: 10.1089/acu.2017.1248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Strong evidence shows that 85% of women with chronic pelvic pain (CPP) have musculoskeletal disorders, such as abdominal myofascial pain syndrome (AMPS). The aim of this research was to assess the efficacy of local acupuncture treatment for women with CPP secondary to AMPS unresponsive to treatment with trigger-point injection. Materials and Methods: This pilot study involved 17 women with moderate-to-severe AMPS-related CPP. Acupuncture treatments were given at abdominal-wall trigger points once per week for 10 consecutive weeks. Pain relief was assessed with a visual analogue scale (VAS), the McGill questionnaire, and pressure dynamometer. Quality of life and psychosocial function (risk for anxiety and depression) were evaluated using the Short-Form-36 questionnaire and the Hospital Anxiety and Depression scale. Assessments were performed at baseline and after 1, 3, and 6 months of treatment. Results: Both the VAS and McGill pain questionnaire showed significantly decreased pain intensity (VAS, P < 0.001; and McGill, P 0.049), and the effects were sustained even at 6 months after treatment. Conclusions: Acupuncture treatment was effective for the women who participated in this study, and the current authors believe that these preliminary results suffice to recommend performing randomized controlled trials.
Collapse
Affiliation(s)
| | - Maria Beatriz Ferreira Gurian
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
| | - Ana Paula Moreira da Silva
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
| | - Omero Benedicto Poli-Neto
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
| | - Antônio Alberto Nogueira
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
| | | | - Júlio César Rosa-E-Silva
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brasil
| |
Collapse
|
18
|
BARROS-NETO JA, SANTOS TMDM, CORTES ML, JESUS RPD, FREITAS MC, KRAYCHETE DC. Constipation in patients with myofascial pain syndrome as important aspect for clinical and nutritional treatment: A case-control study. REV NUTR 2017. [DOI: 10.1590/1678-98652017000500003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT Objective To identify the occurrence of constipation in patients with myofascial pain syndrome and to correlate these disorders with the clinical and nutritional variables. Methods This report describes a case-control study performed with 98 adults of both sexs, including 49 patients and 49 individuals without pain. The intensity of the reported pain was evaluated using the Pain Visual Analog Scale, which provided a simple and efficient measurement of pain intensity consisting of a 10cm horizontal line with the ends marked “absence of pain” and “worst possible pain”. The occurrence of constipation was evaluated using the Rome III criteria. A multivariate linear regression was proposed to investigate risk factors between the frequency of bowel movements per week and independent variables this study. Results The mean ages of the patients and controls were 45.9 (7.6) years and 41.2 (12.2) years, respectively. The intensity of the reported pain showed a mean of 7.3 (1.6) points. The likelihood of exhibiting constipation was 4.5 times higher in the patients than in the controls (p=0.001). The number of stools per week was negatively correlated with the intensity of the reported pain (r=-0.613, p<0.001). The use of benzodiazepines was negatively correlated with the frequency of bowel movements per week, while the use of muscle relaxants appeared to increase the frequency of defecation when combined with the use of benzodiazepines and adjusted for the intake of fiber, water and sexs (p=0.037). Conclusion Constipation was a frequent nosological entity in this patient population and the persistence of a change in intestinal motility showed a significant correlation with the pain intensity and low water intake. The reduction of the number of stools per week seems to be associated with the use of benzodiazepines.
Collapse
|
19
|
Murina F, Graziottin A, Felice R, Gambini D. Alpha Lipoic Acid Plus Omega-3 Fatty Acids for Vestibulodynia Associated With Painful Bladder Syndrome. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:131-137. [DOI: 10.1016/j.jogc.2016.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/04/2016] [Accepted: 12/23/2016] [Indexed: 11/16/2022]
|
20
|
Vasudevan V, Moldwin R. Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome. Asian J Urol 2017; 4:50-54. [PMID: 29264207 PMCID: PMC5730899 DOI: 10.1016/j.ajur.2016.08.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 01/22/2023] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating, chronic condition characterized by chronic pelvic pain, urinary urgency, and frequency and is well-known to be associated with a decrease in work productivity, emotional changes, sleep, sexual dysfunction, and mobility. Many metrics of quality of life (QoL) in this patient population have been developed; however, a unified, standardized approach to QoL in these patients has not been determined. The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics. Next, data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed. While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS, addressing QoL in this patient population remains a significant challenge, as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL, including depression, poor sleep, and inability to work. Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics, and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.
Collapse
Affiliation(s)
- Vinaya Vasudevan
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | | |
Collapse
|
21
|
Shim JS, Kang SG, Park JY, Bae JH, Kang SH, Park HS, Moon DG, Cheon J, Lee JG, Kim JJ, Oh MM. Differences in Urodynamic Parameters Between Women With Interstitial Cystitis and/or Bladder Pain Syndrome and Severe Overactive Bladder. Urology 2016; 94:64-9. [PMID: 27130264 DOI: 10.1016/j.urology.2016.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Ji Sung Shim
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Jae Young Park
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Jae Hyun Bae
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Hong Seok Park
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Du Geon Moon
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Jun Cheon
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Je Jong Kim
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea
| | - Mi Mi Oh
- Department of Urology, Korea University Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
22
|
Kuo YC, Kuo HC. Adverse Events of Intravesical OnabotulinumtoxinA Injection between Patients with Overactive Bladder and Interstitial Cystitis--Different Mechanisms of Action of Botox on Bladder Dysfunction? Toxins (Basel) 2016; 8:toxins8030075. [PMID: 26999201 PMCID: PMC4810220 DOI: 10.3390/toxins8030075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 02/29/2016] [Accepted: 03/07/2016] [Indexed: 11/27/2022] Open
Abstract
Intravesical onabotulinumtoxinA (BoNT-A) injections have been proposed to treat both overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) in patients with refractory conditions. We compared adverse events (AEs) after BoNT-A treatment between IC/BPS and OAB in women. IC/BPS patients who failed conventional treatments were enrolled to receive suburothelial injections of BoNT-A (100 U) followed by hydrodistention. Age matched OAB female patients refractory to antimuscarinic agents underwent BoNT-A (100 U) injections. The bladder capacity, maximum flow rate (Qmax), post-void residual (PVR), and voiding efficiency (VE) at baseline, 3 and 6 months, and the post-treatment AEs were analyzed between groups. Finally, 89 IC/BPS and 72 OAB women were included. In the OAB group, the bladder capacity and PVR increased, and VE decreased significantly at three and six months after BoNT-A treatment. In the IC/BPS group, the Qmax increased significantly at six months. There were significant differences in changes of capacity, Qmax, PVR and VE between the two groups. Moreover, OAB patients suffered more frequently from events of hematuria, UTI, and large PVR (>200 mL), but less frequently from events of straining to void. In conclusion, OAB women had higher PVR volume and lower VE than those in IC/BPS after BoNT-A injections. These results imply that the bladder contractility of OAB patients are more susceptible to BoNT-A, which might reflect the different mechanisms of action of Botox on bladder dysfunction. Further investigations to confirm this hypothesis are warranted.
Collapse
Affiliation(s)
- Yuh-Chen Kuo
- Department of Urology, Yangming Branch of Taipei City Hospital, Taipei 11146, Taiwan.
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Taipei 11146, Taiwan.
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Taipei 11146, Taiwan.
| |
Collapse
|
23
|
Gupta P, Gaines N, Sirls LT, Peters KM. A multidisciplinary approach to the evaluation and management of interstitial cystitis/bladder pain syndrome: an ideal model of care. Transl Androl Urol 2016; 4:611-9. [PMID: 26816861 PMCID: PMC4708537 DOI: 10.3978/j.issn.2223-4683.2015.10.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a complex syndrome that has long been treated with bladder directed therapies, which often fail to address the multiple underlying etiologies that can contribute to this disease process. This disease often involves symptoms that extend beyond the bladder and involve the pelvic floor making it crucial for clinicians to approach the patient using a multidisciplinary team. This article will discuss the underlying etiologies for IC/BPS and describe the multidisciplinary approach which we have found to be extremely successful in managing this patient population.
Collapse
Affiliation(s)
- Priyanka Gupta
- 1 Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Beaumont Health System, Royal Oak, Michigan 48073, USA ; 2 Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309, USA
| | - Natalie Gaines
- 1 Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Beaumont Health System, Royal Oak, Michigan 48073, USA ; 2 Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309, USA
| | - Larry T Sirls
- 1 Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Beaumont Health System, Royal Oak, Michigan 48073, USA ; 2 Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309, USA
| | - Kenneth M Peters
- 1 Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Beaumont Health System, Royal Oak, Michigan 48073, USA ; 2 Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309, USA
| |
Collapse
|
24
|
Wennevik GE, Meijlink JM, Hanno P, Nordling J. The Role of Glomerulations in Bladder Pain Syndrome: A Review. J Urol 2016; 195:19-25. [DOI: 10.1016/j.juro.2015.06.112] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Jane M. Meijlink
- International Painful Bladder Foundation, Rotterdam, The Netherlands
| | - Philip Hanno
- Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jørgen Nordling
- Department of Urology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
25
|
Gardella B, Iacobone AD, Porru D, Musacchi V, Dominoni M, Tinelli C, Spinillo A, Nappi RE. Effect of local estrogen therapy (LET) on urinary and sexual symptoms in premenopausal women with interstitial cystitis/bladder pain syndrome (IC/BPS). Gynecol Endocrinol 2015; 31:828-32. [PMID: 26291799 DOI: 10.3109/09513590.2015.1063119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The association between vulvodynia and interstitial cystitis/bladder pain syndrome (IC/BPS), a chronic, debilitating disease of unknown etiology, may involve sex hormone-dependent mechanisms regulating vulvo-vaginal health. We aimed to prospectively investigate the effects of 12 weeks of local estrogen therapy (LET) on urinary/bladder and sexual symptoms in premenopausal women with IC/BPS. Thirty-four women (mean age: 36.1 ± 8.4) diagnosed with IC/BPS were treated vulvo-vaginally three-times/week with estriol 0.5 mg cream and tested by validated questionnaires (ICSI/ICPI, pain urgency frequency [PUF], female sexual function index [FSFI]) and by cotton swab testing, vaginal health index (VHI) and maturation index (MI) before and after treatment. Vulvodynia was present in 94.1% of IC/BPS women. A significant positive effect of LET was evident on urinary and sexual function (p < 0.001, for both) following 12 weeks, as well as an improvement of the VHI (p < 0.001) and the MI (p < 0.04). The results of this open study indicate that 12 weeks of local estriol cream at vaginal and vestibular level may ameliorate urinary/bladder pain symptoms, as well as may improve domains of sexual function. The association between vulvar pain and bladder pain could, therefore, be related to a vaginal environment carrying signs of hypoestrogenism, but further studies are needed to clarify this issue.
Collapse
Affiliation(s)
- Barbara Gardella
- a Research Centre for Reproductive Medicine, Section of Obstetrics and Gynecology, IRCCS Policlinico San Matteo , Pavia , Italy
- b Department of Clinical, Surgical, Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy
| | - Anna Daniela Iacobone
- a Research Centre for Reproductive Medicine, Section of Obstetrics and Gynecology, IRCCS Policlinico San Matteo , Pavia , Italy
| | - Daniele Porru
- c Unit of Urology, Fondazione IRCCS San Matteo , Pavia , Italy , and
| | - Valentina Musacchi
- a Research Centre for Reproductive Medicine, Section of Obstetrics and Gynecology, IRCCS Policlinico San Matteo , Pavia , Italy
| | - Mattia Dominoni
- a Research Centre for Reproductive Medicine, Section of Obstetrics and Gynecology, IRCCS Policlinico San Matteo , Pavia , Italy
| | - Carmine Tinelli
- d Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Arsenio Spinillo
- a Research Centre for Reproductive Medicine, Section of Obstetrics and Gynecology, IRCCS Policlinico San Matteo , Pavia , Italy
- b Department of Clinical, Surgical, Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy
| | - Rossella E Nappi
- a Research Centre for Reproductive Medicine, Section of Obstetrics and Gynecology, IRCCS Policlinico San Matteo , Pavia , Italy
- b Department of Clinical, Surgical, Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy
| |
Collapse
|
26
|
Ackerman AL, Lee UJ, Jellison FC, Tan N, Patel M, Raman SS, Rodriguez LV. MRI suggests increased tonicity of the levator ani in women with interstitial cystitis/bladder pain syndrome. Int Urogynecol J 2015; 27:77-83. [PMID: 26231233 DOI: 10.1007/s00192-015-2794-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/02/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In interstitial cystitis/bladder pain syndrome (IC/BPS), pelvic floor dysfunction may contribute significantly to pelvic pain. To determine if pelvic floor hypertonicity manifests alterations on magnetic resonance imaging (MRI) in patients with IC/BPS, we retrospectively compared pelvic measurements between patients and controls. METHODS Fifteen women with IC/BPS and 15 age-matched controls underwent pelvic MRI. Two blinded radiologists measured the pelvic musculature, including the H- and M lines, vaginal length, urethral length and cross-sectional area, levator width and length, and posterior puborectalis angle. MRI measures and clinical factors, such as age, parity, and duration of symptoms, were compared using a paired, two-tailed t test. RESULTS There were no significant differences in age, parity, or symptom duration between groups. Patients with IC/BPS exhibited shorter levator muscles (right: 5.0 ± 0.7 vs. 5.6 ± 0.8, left: 5.0 ± 0.8 vs. 5.7 ± 0.8 cm, P < 0.002) and a wider posterior puborectalis angle (35.0 ± 8.6 vs. 26.7 ± 7.9°, P < 0.01) compared with controls. The H line was shorter in patients with IC/BPS (7.8 ± 0.8 vs. 8.6 ± 0.9 cm, P < 0.02), while M line did not differ. Total urethral length was similar, but vaginal cuff and bladder neck distances to the H line were longer in patients with IC/BPS (5.7 ± 0.6 vs. 5.1 ± 0.9 cm, P < 0.02; 1.9 ± 0.4 vs. 1.4 ± 0.2 cm, P < 0.001, respectively). CONCLUSIONS Patients with IC/BPS have pelvic floor hypertonicity on MRI, which manifests as shortened levator, increased posterior puborectalis angles, and decreased puborectal distances. We identified evidence of pelvic floor hypertonicity in patients with IC/BPS, which may contribute to or amplify pelvic pain. Future studies are necessary to determine the MRI utility in understanding pelvic floor hypertonicity in patients with IC/BPS.
Collapse
Affiliation(s)
- A Lenore Ackerman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- University of California, Los Angeles, 200 Medical Plaza, Suite 140, Los Angeles, CA, 90095, USA.
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Forrest C Jellison
- Department of Urology, San Antonio Military Medical Center (SAMMC), Fort Sam Houston, TX, USA
| | - Nelly Tan
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maitraya Patel
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Larissa V Rodriguez
- Departments of Urology and Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
27
|
Gurian MBF, Mitidieri AMDS, Rosa E Silva JC, Poli Neto OB, Nogueira AA, Candido dos Reis FJ. Measures used to assess chronic pelvic pain in randomized controlled clinical trials: a systematic review. J Eval Clin Pract 2015; 21:749-56. [PMID: 25809923 DOI: 10.1111/jep.12340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2015] [Indexed: 01/16/2023]
Abstract
RATIONALE Many types of pain assessment are available to researchers carrying out clinical trials in chronic pelvic pain (CPP), ranging from a single-item scale to multidimensional inventories. AIM Our objective was to investigate which assessments of pain are more commonly used in clinical trials on CPP. METHOD We have reviewed articles published between 1991 and 2014. A total of 74 studies out of 1299 original research articles reviewed met the selection criteria by containing at least one method of pain assessment. The selected studies were classified according to the dimensions of pain evaluated, the type of scale and the descriptors used. RESULTS The instruments most frequently used were single-item VAS and Biberoglu and Behrman pain score, while multidimensional inventories were used in few studies. The results of clinical studies in CPP are more frequently based on one-dimensional measurements. Valuable results from clinical studies in CPP might have been omitted because of incomplete outcome measurements. CONCLUSION We believe the authors of clinical studies should report their results in a comprehensive way including in the outcomes of the measurement of one-dimensional and multidimensional pain characteristics.
Collapse
Affiliation(s)
| | - Andréia M D S Mitidieri
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Júlio C Rosa E Silva
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Omero B Poli Neto
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Antônio A Nogueira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | | |
Collapse
|
28
|
Fenton BW, Shih E, Zolton J. The neurobiology of pain perception in normal and persistent pain. Pain Manag 2015; 5:297-317. [DOI: 10.2217/pmt.15.27] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
SUMMARY Pain is a significant national burden in terms of patient suffering, expenditure and lost productivity. Understanding pain is fundamental to improving evaluation, treatment and innovation in the management of acute and persistent pain syndromes. Pain perception begins in the periphery, and then ascends in several tracts, relaying at different levels. Pain signals arrive in the thalamus and midbrain structures which form the pain neuromatrix, a constantly shifting set of networks and connections that determine conscious perception. Several cortical regions become active simultaneously during pain perception; activity in the cortical pain matrix evolves over time to produce a complex pain perception network. Dysfunction at any level has the potential to produce unregulated, persistent pain.
Collapse
Affiliation(s)
- Bradford W Fenton
- Summa Health System, Department of Obstetrics & Gynecology, 75 Arch St Ste 102, Akron, OH 44304, USA
| | - Elim Shih
- Women's Health Fellow, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A10, Cleveland, OH 44195, USA
| | - Jessica Zolton
- Summa Health System, Department of Obstetrics & Gynecology, 75 Arch St Ste 102, Akron, OH 44304, USA
| |
Collapse
|
29
|
Lee CL, Peng CH, Kuo HC. Therapeutic effects and predictive factors for successful intravesical hyaluronic acid instillation in patients with interstitial cystitis/bladder pain syndrome. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2014.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
30
|
Quality of life and changes in symptom relief in patients with acute uncomplicated cystitis treated with antibiotics: a prospective, open-label, multicenter, observational study. Eur J Clin Microbiol Infect Dis 2015; 34:1119-24. [PMID: 25655756 DOI: 10.1007/s10096-015-2329-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/15/2015] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to investigate the effect of ciprofloxacin treatment on quality of life and symptom improvement in patients with simple cystitis. Between January 2010 and December 2010, ciprofloxacin was administered twice daily for 5 days, and changes in the patients' symptoms, the therapeutic effects, and changes in the Korean version of the Urinary Tract Infection Symptoms Assessment (UTISA) score were evaluated. Patients were classified into two groups according to the self-reported degree of symptom improvement. Significant improvement was noted in symptoms such as frequency, urgency, dysuria, tenesmus, lower abdominal discomfort, back pain, and gross hematuria. The treatment success group comprised 249 patients and the treatment failure group comprised 45 patients. Baseline frequency and urgency, tenesmus, and lower abdominal discomfort were worse in the treatment failure group, although the difference was significant only for frequency (p = 0.029) and urgency (p = 0.028). All UTISA subcategory scores showed improvement in the treatment success group, and the median time to symptom improvement was 2.40 days. In the treatment failure group, some UTISA subcategory scores showed significant improvement, including those for dysuria (1.67 to 0.89), tenesmus (1.76 to 1.08), and gross hematuria (0.80 to 0.21), although significant improvement in frequency, urgency, lower abdominal discomfort, and back pain was not observed. The UTISA questionnaire was useful in reflecting the severity of simple cystitis symptoms. Frequency, urgency, lower abdominal discomfort, and back pain were not adequately improved in the treatment failure group, with frequency and urgency being predisposing factors for treatment failure.
Collapse
|
31
|
Adding a Sexual Dysfunction Domain to UPOINT System Improves Association With Symptoms in Women With Interstitial Cystitis and Bladder Pain Syndrome. Urology 2014; 84:1308-13. [DOI: 10.1016/j.urology.2014.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/10/2014] [Accepted: 08/18/2014] [Indexed: 11/19/2022]
|
32
|
Pretreatment features to influence effectiveness of intravesical hyaluronic Acid instillation in refractory interstitial cystitis/painful bladder syndrome. Int Neurourol J 2014; 18:163-7. [PMID: 25279245 PMCID: PMC4180168 DOI: 10.5213/inj.2014.18.3.163] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/17/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the efficacy of intravesical hyaluronic acid (HA) instillation in treating patients with refractory interstitial cystitis/painful bladder syndrome (IC/PBS) and to identify any related factors that influence its therapeutic effect. Methods Thirty-three female IC/PBS patients who demonstrated poor or unsatisfactory responses to previous treatments between December 2010 and October 2012 were enrolled. Despite previous treatments, the enrolled patients had visual analogue scale (VAS) pain scores ≥4 and total scores (symptom and bother scores) ≥13 on the pelvic pain and urgency/frequency (PUF) questionnaire and ≥12 on the O'Leary-Sant interstitial cystitis symptoms index (ICSI)/problems index (ICPI). All patients received once weekly intravesical instillations of 40-mg HA diluted in 50-mL saline for 4 weeks. The efficacy of the HA instillation was evaluated by comparing the mean changes in the scores of the VAS and questionnaires from baseline to 4 weeks after treatment. Improvement was defined as a ≥2 decrease in the VAS. Moreover, we investigated the effects of the presence of Hunner's ulcer and previous treatment modalities on the therapeutic outcome of HA instillation. Results The mean age was 57.0±1.8 years (range, 28-75 years). The VAS score significantly decreased from baseline to 4 weeks after treatment (-2.5, P<0.001). The mean changes in the PUF, ICSI, and ICPI from baseline to 4 weeks after the treatment were -3.8 (P<0.001), -2.3 (P<0.001), and -2.7 (P<0.001), respectively. Twenty patients (61%) showed improvements. Previous treatment modalities did not affect the efficacy of HA instillation and the presence of Hunner's ulcer was unrelated to outcomes. No complications were observed. Conclusions These results show that intravesical HA instillation is an effective and safe treatment for patients with refractory IC/PBS. Previous treatment modalities and presence of Hunner's ulcer do not affect the efficacy of HA instillation.
Collapse
|
33
|
Bagarinao E, Johnson KA, Martucci KT, Ichesco E, Farmer MA, Labus J, Ness TJ, Harris R, Deutsch G, Apkarian VA, Mayer EA, Clauw DJ, Mackey S. Preliminary structural MRI based brain classification of chronic pelvic pain: A MAPP network study. Pain 2014; 155:2502-2509. [PMID: 25242566 DOI: 10.1016/j.pain.2014.09.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 08/19/2014] [Accepted: 09/03/2014] [Indexed: 12/28/2022]
Abstract
Neuroimaging studies have shown that changes in brain morphology often accompany chronic pain conditions. However, brain biomarkers that are sensitive and specific to chronic pelvic pain (CPP) have not yet been adequately identified. Using data from the Trans-MAPP Research Network, we examined the changes in brain morphology associated with CPP. We used a multivariate pattern classification approach to detect these changes and to identify patterns that could be used to distinguish participants with CPP from age-matched healthy controls. In particular, we used a linear support vector machine (SVM) algorithm to differentiate gray matter images from the 2 groups. Regions of positive SVM weight included several regions within the primary somatosensory cortex, pre-supplementary motor area, hippocampus, and amygdala were identified as important drivers of the classification with 73% overall accuracy. Thus, we have identified a preliminary classifier based on brain structure that is able to predict the presence of CPP with a good degree of predictive power. Our regional findings suggest that in individuals with CPP, greater gray matter density may be found in the identified distributed brain regions, which are consistent with some previous investigations in visceral pain syndromes. Future studies are needed to improve upon our identified preliminary classifier with integration of additional variables and to assess whether the observed differences in brain structure are unique to CPP or generalizable to other chronic pain conditions.
Collapse
Affiliation(s)
- Epifanio Bagarinao
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University Medical Center, Stanford, CA, USA Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Department of Radiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USA Department of Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Cervigni M, Natale F. Gynecological disorders in bladder pain syndrome/interstitial cystitis patients. Int J Urol 2014; 21 Suppl 1:85-8. [DOI: 10.1111/iju.12379] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/19/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Mauro Cervigni
- Obstetrics and Gynecology Department; Catholic University; Rome Italy
- Urogynecologic Department; S.Carlo-IDI; Rome Italy
| | | |
Collapse
|
35
|
Pan XQ, Malykhina AP. Estrous cycle dependent fluctuations of regulatory neuropeptides in the lower urinary tract of female rats upon colon-bladder cross-sensitization. PLoS One 2014; 9:e94872. [PMID: 24788240 PMCID: PMC4006778 DOI: 10.1371/journal.pone.0094872] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/20/2014] [Indexed: 12/30/2022] Open
Abstract
Co-morbidity of bladder, bowel, and non-specific pelvic pain symptoms is highly prevalent in women. Little evidence is present on modulation of pelvic pain syndromes by sex hormones, therefore, the objective of this study was to clarify the effects of hormonal fluctuations within the estrous cycle on regulatory neuropeptides in female rats using a model of neurogenic bladder dysfunction. The estrous cycle in female rats (Sprague-Dawley, 230-250 g) was assessed by vaginal smears and weight of uterine horns. Neurogenic bladder dysfunction was induced by a single inflammatory insult to the distal colon. Protein expression of calcitonin gene related peptide (CGRP), substance P (SP), nerve growth factor (NGF), and brain derived neurotrophic factor (BDNF) in the pelvic organs, sensory ganglia and lumbosacral spinal cord was compared in rats in proestrus (high estrogen) vs diestrus (low estrogen). Under normal physiological conditions, concentration of SP and CGRP was similar in the distal colon and urinary bladder during all phases of the estrous cycle, however, acute colitis induced a significant up-regulation of CGRP content in the colon (by 63%) and urinary bladder (by 54%, p≤0.05 to control) of rats in proestrus. These changes were accompanied by a significant diminution of CGRP content in L6-S2 DRG after colonic treatment, likely associated with its release in the periphery. In rats with high estrogen at the time of testing (proestrus), experimental colitis caused a significant up-regulation of BDNF colonic content from 26.1±8.5 pg/ml to 83.4±32.5 pg/ml (N = 7, p≤0.05 to control) and also induced similar effects on BDNF in the urinary bladder which was also up-regulated by 5-fold in rats in proestrus (p≤0.05 to respective control). Our results demonstrate estrous cycle dependent fluctuations of regulatory neuropeptides in the lower urinary tract upon colon-bladder cross-sensitization, which may contribute to pain fluctuations in female patients with neurogenic bladder pain.
Collapse
Affiliation(s)
- Xiao-Qing Pan
- Division of Urology, Department of Surgery, University of Pennsylvania, Glenolden, Pennsylvania, United States of America
| | - Anna P. Malykhina
- Division of Urology, Department of Surgery, University of Pennsylvania, Glenolden, Pennsylvania, United States of America
- * E-mail:
| |
Collapse
|
36
|
Tirlapur SA, Priest L, Wojdyla D, Khan KS. Bladder pain syndrome: validation of simple tests for diagnosis in women with chronic pelvic pain: BRaVADO study protocol. Reprod Health 2013; 10:61. [PMID: 24304546 PMCID: PMC4176137 DOI: 10.1186/1742-4755-10-61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 11/15/2013] [Indexed: 11/22/2022] Open
Abstract
Background Bladder pain syndrome (BPS), a condition with no gold standard diagnosis, comprises of a cluster of signs and symptoms. Bladder filling pain and bladder wall tenderness are two basic clinical features, present in a high number of sufferers. This study will validate the performance of these simple tests for BPS in women with chronic pelvic pain (CPP). Methods/design We will conduct a prospective test validation study amongst women with unexplained CPP presenting to gynaecology outpatient clinics. Two index tests will be performed: patient reported bladder filling pain and bladder wall tenderness on internal pelvic bimanual examination. A final diagnosis of BPS will be made by expert consensus panel. We will assess the rates of index tests in women with CPP; evaluate the correlation between index tests and Pelvic Pain Urgency/ Frequency (PUF) questionnaire results; and determine index test sensitivity and specificity using a range of analytical methods. Assuming a 50% prevalence of BPS and an 80% power approximately 152 subjects will be required exclude sensitivity of < 55% at 70% sensitivity. Discussion The results of this test validation study will be used to identify whether a certain combination of signs and symptoms can accurately diagnose BPS. Trial registration ISRCTN13028601
Collapse
Affiliation(s)
- Seema A Tirlapur
- Women's Health Research Unit, Barts and the London School of Medicine, Queen Mary, University of London, 58 Turner Street, London E1 2AB, UK.
| | | | | | | | | |
Collapse
|
37
|
Kuo YC, Kuo HC. The role of urodynamic study in evaluation of interstitial cystitis/painful bladder syndrome. Tzu Chi Med J 2013. [DOI: 10.1016/j.tcmj.2013.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
38
|
Tirlapur SA, Vlismas A, Ball E, Khan KS. Nerve stimulation for chronic pelvic pain and bladder pain syndrome: a systematic review. Acta Obstet Gynecol Scand 2013; 92:881-7. [PMID: 23710833 DOI: 10.1111/aogs.12184] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/19/2013] [Indexed: 01/14/2023]
Abstract
Chronic pelvic pain (CPP) and bladder pain syndrome (BPS) can have a negative impact on quality of life. Neuromodulation has been suggested as a possible treatment for refractory pain. To assess the effectiveness of tibial and sacral nerve stimulation in the treatment of BPS and CPP. We searched until July 2012: the Cochrane Library, EMBASE (1980-2012), Medline (1950-2012), Web of knowledge (1900-2012), LILACS (1982-2012) and SIGLE (1990-2012) with no language restrictions. We manually searched through bibliographies and conference proceedings of the International Continence Society. Randomized and prospective quasi-randomized controlled studies vs. sham nerve stimulation treatment or usual care of patients with CPP and BPS who underwent sacral or tibial nerve stimulation were included. Any studies involving transcutaneous stimulation were excluded. The outcome was a cure or improvement in symptoms. Three studies with 169 patients treated with tibial nerve stimulation were included; two for CPP and one for BPS. There were improvements in pain, urinary and quality of life scores. There were no reported data for sacral nerve stimulation. There is scanty literature reporting variable success of posterior tibial nerve stimulation in improving pain, urinary symptoms and quality of life in CPP and BPS. In view of the dearth of quality literature, a large multi-centered clinical trial investigating the effectiveness of electrical nerve stimulation to treat BPS and CPP along with the cost-analysis of this treatment is recommended.
Collapse
Affiliation(s)
- Seema A Tirlapur
- Women's Health Research Unit, Queen Mary, University of London, London, UK.
| | | | | | | |
Collapse
|
39
|
Tirlapur S, Kuhrt K, Chaliha C, Ball E, Meads C, Khan K. The ‘evil twin syndrome’ in chronic pelvic pain: A systematic review of prevalence studies of bladder pain syndrome and endometriosis. Int J Surg 2013; 11:233-7. [DOI: 10.1016/j.ijsu.2013.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 01/11/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
|
40
|
George SE, Clinton SC, Borello-France DF. Physical therapy management of female chronic pelvic pain: Anatomic considerations. Clin Anat 2012; 26:77-88. [DOI: 10.1002/ca.22187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/21/2012] [Indexed: 12/20/2022]
|
41
|
Butrick CW. Interstitial cystitis/bladder pain syndrome: management of the pain disorder: a urogynecology perspective. Urol Clin North Am 2012; 39:377-87. [PMID: 22877721 DOI: 10.1016/j.ucl.2012.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Our understanding of interstitial cystitis/painful bladder syndrome (IC/BPS) has evolved with the advancements in our understanding of visceral pain syndromes. The concept of IC/BPS as a visceral pain disorder is used as a model to base a targeted approach to the management of patients with IC/BPS. Guidelines for the treatment of both the bladder and nonbladder pain disorders are reviewed.
Collapse
|
42
|
Arya LA, Harvie HS, Andy UU, Cory L, Propert KJ, Whitmore K. Construct validity of an instrument to measure neuropathic pain in women with bladder pain syndrome. Neurourol Urodyn 2012; 32:424-7. [PMID: 22972593 DOI: 10.1002/nau.22314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/21/2012] [Indexed: 11/11/2022]
Abstract
AIMS To determine the construct validity of an instrument to measure neuropathic pain in women with bladder pain syndrome (BPS). Our hypothesis is that neuropathic, bladder, and bowel pain represent different constructs in women with BPS. METHODS Secondary planned analysis of a prospective cross-sectional study of 150 women with BPS. The relationship between neuropathic pain, urinary, and bowel symptoms was assessed. RESULTS The correlation of the total neuropathic pain score with total urinary and bowel symptom scores was low to moderate (r = 0.28-0.49). The correlation of specific neuropathic pain items with bladder and bowel pain was also low to moderate (r = 0.12-0.36). Women with neuropathic pain had significantly higher scores for urinary urgency, bladder pain, abdominal pain, diarrhea, and constipation than women with non-neuropathic pain (all P < 0.0001). CONCLUSION Somatosensory neuropathic pain and "visceral" bladder and bowel pain represent separate but related constructs in women with BPS.
Collapse
Affiliation(s)
- Lily A Arya
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | | | | | | | | | | |
Collapse
|
43
|
Urogynecological Causes of Pain and the Effect of Pain on Sexual Function in Women. Female Pelvic Med Reconstr Surg 2012; 18:259-67. [DOI: 10.1097/spv.0b013e3182686631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
44
|
Lai MC, Kuo YC, Kuo HC. Intravesical hyaluronic acid for interstitial cystitis/painful bladder syndrome: a comparative randomized assessment of different regimens. Int J Urol 2012; 20:203-7. [PMID: 22925498 DOI: 10.1111/j.1442-2042.2012.03135.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the clinical effectiveness of different regimens of intravesical hyaluronic acid instillation for patients with interstitial cystitis/painful bladder syndrome. METHODS A total of 60 patients (age 16-77 years) diagnosed with interstitial cystitis/painful bladder syndrome were enrolled in this prospective, randomized study. A total of 30 patients were assigned to receive four weekly intravesical instillations of 40 mg of hyaluronic acid followed by five monthly instillations (hyaluronic acid-9 group). Another 30 patients received 12 intravesical instillations of 40 mg hyaluronic acid every 2 weeks (hyaluronic acid-12 group). Symptomatic changes after hyaluronic acid treatments were assessed using Interstitial Cystitis Symptom and Problem Indexes, pain visual analog scale, functional bladder capacity, frequency and nocturia in voiding diary, maximum flow rate, voided volume, postvoid residual volume, and Quality of Life Index at 1, 3 and 6 months. RESULTS Of the 60 patients, 59 were evaluable at the end of the study. The Interstitial Cystitis Symptom Index, Interstitial Cystitis Problem Index and total score, pain visual analog scale, functional bladder capacity, maximum flow rate, and Quality of Life Index improved significantly after 6 months in both groups. The frequency and voided volume improved significantly only in the hyaluronic acid-12 group. However, patients with moderate and marked improvement were clinically similar in both groups. The measured variables did not differ between the two groups over the course of the study. CONCLUSION No significant difference was noted in the therapeutic effect between two hyaluronic acid instillation regimens for treatment of interstitial cystitis/painful bladder syndrome patients. Both groups showed significant improvement in symptom scores and Quality of Life Index.
Collapse
Affiliation(s)
- Ming-Chih Lai
- Department of Urology, Taipei City Hospital, Taipei, Taiwan
| | | | | |
Collapse
|
45
|
Wu WC, Chung SD, Kuo HC. Onabotulinumtoin-A for the treatment of interstitial cystitis refractory to conventional therapy. Tzu Chi Med J 2012. [DOI: 10.1016/j.tcmj.2012.05.006] [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] Open
|
46
|
Zezza L, Reusch CE, Gerber B. Intravesical application of lidocaine and sodium bicarbonate in the treatment of obstructive idiopathic lower urinary tract disease in cats. J Vet Intern Med 2012; 26:526-31. [PMID: 22435459 DOI: 10.1111/j.1939-1676.2012.00911.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 01/14/2012] [Accepted: 02/08/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In human patients with interstitial cystitis, intravesical instillation of alkalinized lidocaine sometimes is associated with sustained amelioration of symptoms beyond the acute treatment phase. Interstitial cystitis shares many features in common with feline idiopathic cystitis. OBJECTIVE To evaluate whether intravesical instillation of alkalinized lidocaine decreases recurrence of urethral obstruction and severity of clinical signs in cats with obstructive idiopathic LUTD. ANIMALS Twenty-six cats with obstructive idiopathic LUTD. Twelve cats in case group (treatment with alkalinized lidocaine) and 14 control cats (treatment with placebo or standard treatment). METHODS Cats were randomly assigned to treatment (2 or 4 mg/kg lidocaine and sodium bicarbonate) or placebo groups (0.2 mL/kg saline solution and sodium bicarbonate). The intravesical instillation was done once a day for 3 days. Some cats underwent standard treatment only (indwelling urinary catheter for 3 days without intravesical instillations). A 2-week, 1-month, and 2-month follow-up after treatment was made using a questionnaire. The recurrence rate and amelioration scores of clinical signs were assessed and compared. RESULTS Recurrence of urethral obstruction was 58% (7/12) in the case group and 57% (8/14) in the control group. Amelioration scores were similar between the 2 groups. CONCLUSION AND CLINICAL IMPORTANCE Intravesical administration of lidocaine for up to 3 consecutive days had no apparent beneficial effect on decreasing recurrence rate and severity of clinical signs in cats with obstructive idiopathic LUTD.
Collapse
Affiliation(s)
- L Zezza
- Clinic of Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland
| | | | | |
Collapse
|
47
|
Cory L, Harvie HS, Northington G, Malykhina A, Whitmore K, Arya L. Association of neuropathic pain with bladder, bowel and catastrophizing symptoms in women with bladder pain syndrome. J Urol 2011; 187:503-7. [PMID: 22177143 DOI: 10.1016/j.juro.2011.10.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE In this study we determined if there is an association of neuropathic pain with urinary, bowel and catastrophizing symptoms in women with bladder pain syndrome. MATERIALS AND METHODS Female patients with a diagnosis of bladder pain syndrome completed validated questionnaires to assess neuropathic pain, urinary and bowel symptoms, quality of life and pain catastrophizing. Women were dichotomized into neuropathic pain and nonneuropathic pain groups. Urinary and bowel symptoms, pain catastrophizing and quality of life scores were compared between the 2 groups using parametric and nonparametric tests. RESULTS Of 150 women with bladder pain syndrome 40 (27%) had features of neuropathic pain while 110 (73%) did not. Women with features of neuropathic pain had significantly worse urinary urgency (mean ± SD 3.1 ± 3.1 vs 2.1 ± 1.7, p <0.001), bladder pain (3.0 ± 1.1 vs 2.0 ± 1.3, p <0.001), bowel pain (8.8 ± 4.0 vs 5.3 ± 3.6, p <0.001), diarrhea (7.8 ± 6.1 vs 4.1 ± 4.3, p <0.001), quality of life (12.2 ± 5.5 vs 9.8 ± 3.8, p <0.001) and higher pain catastrophizing (32.2 ± 12.4 vs 23.1 ± 14.3, p <0.001) scores than those without neuropathic pain. CONCLUSIONS In women with bladder pain syndrome the presence of neuropathic pain is significantly associated with the severity of bladder and bowel pain, urinary urgency and diarrhea. Women with features of neuropathic pain also have worse pain catastrophizing and quality of life than those without features of neuropathic pain.
Collapse
Affiliation(s)
- Lori Cory
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Arya LA, Northington GM, Asfaw T, Harvie H, Malykhina A. Evidence of bladder oversensitivity in the absence of an infection in premenopausal women with a history of recurrent urinary tract infections. BJU Int 2011; 110:247-51. [PMID: 22129305 DOI: 10.1111/j.1464-410x.2011.10766.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Study Type - Prevalence (case control) Level of Evidence 4. What's known on the subject? and What does the study add? Urinary tract infections (UTIs) have been implicated in the aetiology of interstitial cystitis/painful bladder syndrome (IC/PBS). Prior studies have described symptoms and laboratory tests suggestive of UTI at the onset of IC/PBS as well as a significant history of childhood recurrent UTIs. However, the mechanism by which recurrent UTIs contribute to the development of IC/PBS is not clear. Our study shows that women with recurrent UTI suffer from bladder oversensitivity. Our findings have useful clinical implications. Women with bladder oversensitivity complain of urinary frequency which is often misdiagnosed as an infection and treated with unnecessary antibiotics. Additionally, there are no effective therapies for bladder oversensitivity. Therefore, women with recurrent UTI should undergo prompt evaluation and treatment of episodes of infection to prevent the development of bladder oversensitivity. Our findings also provide a possible mechanism for the development of IC/PBS. Whether women with recurrent UTI are at increased risk for developing IC/PBS in the future will need to be confirmed in future studies. OBJECTIVE • To compare the mean voided volume and bladder sensation during filling cystometry in women with a history of recurrent urinary tract infection (UTI) and controls. PATIENTS AND METHODS • This was a case-control study including adult women seen in the urogynaecology clinic. • The cases were 49 women with at least three documented positive urine cultures >105 colonies/mL in the previous 12 months and no active infection at the time of data collection. • Controls were 53 women with stress urinary incontinence and no history of recurrent UTI or coexistent urge urinary incontinence. • We compared bladder diary variables and filling cystometry data in the absence of an active infection. RESULTS • There was no significant difference in the median age, parity and body mass index of women with a history of recurrent UTI and controls. • The median number of voids per day and median number of voids per litre of fluid intake was significantly greater in women with recurrent UTI than controls (12 vs 7 voids/day and 6 vs 4 voids/L, P= 0.005 and P= 0.004 respectively). • The median average voided volume was significantly lower in women with recurrent UTI than controls (155 vs 195 mL, P= 0.008). • On filling cystometry, median volumes of strong desire to void and maximum cystometric capacity were significantly lower in women with recurrent UTI than controls (all P < 0.05). CONCLUSION • In the absence of an infection, premenopausal women with a history of recurrent UTI have significantly greater urinary frequency, lower average voided volume and a lower threshold of bladder sensitivity than controls.
Collapse
Affiliation(s)
- Lily A Arya
- Division of Urogynecology and Reconstructive Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
| | | | | | | | | |
Collapse
|
49
|
Grover S, Srivastava A, Lee R, Tewari AK, Te AE. Role of inflammation in bladder function and interstitial cystitis. Ther Adv Urol 2011; 3:19-33. [PMID: 21789096 DOI: 10.1177/1756287211398255] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Cystitis, or inflammation of the bladder, has a direct effect on bladder function. Interstitial cystitis is a syndrome characterized by urinary bladder pain and irritative symptoms of more than 6 months duration. It commonly occurs in young to middle-aged women with no known cause and in fact represents a diagnosis of exclusion. Many factors have been suggested, including chronic or subclinical infection, autoimmunity and genetic susceptibility, which could be responsible for initiating the inflammatory response. However, a central role of inflammation has been confirmed in the pathogenesis of interstitial cystitis. Patients with interstitial cystitis are usually managed with multimodal therapy to break the vicious cycle of chronic inflammation at every step. Patients who develop irreversible pathologies such as fibrosis are managed surgically, which is usually reserved for refractory cases.
Collapse
Affiliation(s)
- Sonal Grover
- James Buchanan Brady Foundation Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, USA
| | | | | | | | | |
Collapse
|
50
|
Clinton SC, George SE, Mehnert M, Fitzgerald CM, Chimes GP. Pelvic floor pain: physical therapy versus injections. PM R 2011; 3:762-70. [PMID: 21871421 DOI: 10.1016/j.pmrj.2011.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 07/18/2011] [Indexed: 10/22/2022]
|