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Ganguly A, Tyagi S, Chermansky C, Kanai A, Beckel J, Hashimoto M, Cho KJ, Chancellor M, Kaufman J, Yoshimura N, Tyagi P. Treating Lower Urinary Tract Symptoms in Older Adults: Intravesical Options. Drugs Aging 2023; 40:241-261. [PMID: 36879156 PMCID: PMC11167658 DOI: 10.1007/s40266-023-01009-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 03/08/2023]
Abstract
This article provides an overview of the diagnosis and the treatment of lower urinary tract symptoms in older adults complicated by the neurodegenerative changes in the micturition reflex and further confounded by age-related decline in hepatic and renal clearance raising the propensity of adverse drug reactions. The first-line drug treatment for lower urinary tract symptoms, orally administered antimuscarinics, fails to reach the equilibrium dissociation constant of muscarinic receptors even at their maximum plasma concentration and tends to evoke a half-maximal response at a muscarinic receptor occupancy of just 0.206% in the bladder with a minimal difference from exocrine glands, which raises the adverse drug reaction risk. On the contrary, intravesical antimuscarinics are instilled at concentrations 1000-fold higher than the oral maximum plasma concentration and the equilibrium dissociation constant erects a downhill concentration gradient that drives passive diffusion and achieves a mucosal concentration around ten-fold lower than the instilled concentration for a long-lasting occupation of muscarinic receptors in mucosa and sensory nerves. A high local concentration of antimuscarinics in the bladder triggers alternative mechanisms of action and is supposed to engage retrograde transport to nerve cell bodies for neuroplastic changes that underlie a long-lasting therapeutic effect, while an intrinsically lower systemic uptake of the intravesical route lowers the muscarinic receptor occupancy of exocrine glands to lower the adverse drug reaction relative to the oral route. Thus, the traditional pharmacokinetics and pharmacodynamics of oral treatment are upended by intravesical antimuscarinics to generate a dramatic improvement (~ 76%) noted in a meta-analysis of studies enrolling children with neurogenic lower urinary tract symptoms on the primary endpoint of maximum cystometric bladder capacity as well as the secondary endpoints of filling compliance and uninhibited detrusor contractions. The therapeutic success of intravesical multidose oxybutynin solution or oxybutynin entrapped in the polymer for sustained release in the pediatric population bodes well for patients with lower urinary tract symptoms at the other extreme of the age spectrum. Though generally used to predict oral drug absorption, Lipinski's rule of five can also explain the ten-fold lower systemic uptake from the bladder of positively charged trospium over oxybutynin, a tertiary amine. Chemodenervation by an intradetrusor injection of onabotulinumtoxinA is merited for patients with idiopathic overactive bladder discontinuing oral treatment because of a lack of efficacy. However, age-related peripheral neurodegeneration potentiates the adverse drug reaction risk of urinary retention that motivates the quest of liquid instillation, delivering larger fraction of onabotulinumtoxinA to the mucosa as opposed to muscle by an intradetrusor injection can also probe the neurogenic and myogenic predominance of idiopathic overactive bladder. Overall, the treatment paradigm of lower urinary tract symptoms in older adults should be tailored to individual's overall health status and the risk tolerance for adverse drug reactions.
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Affiliation(s)
- Anirban Ganguly
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Shachi Tyagi
- Department of Medicine, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Christopher Chermansky
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Anthony Kanai
- Department of Medicine, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Jonathan Beckel
- Department of Pharmacology, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Mamoru Hashimoto
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Kang Jun Cho
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | | | | | - Naoki Yoshimura
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Pradeep Tyagi
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA.
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Foresti A, Schultz-Lampel D. [Diagnosis of interstitial cystitis: practice-orientated diagnostic work-up]. Aktuelle Urol 2021; 52:547-555. [PMID: 34734396 DOI: 10.1055/a-1645-0987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Interstitial cystitis is a chronic orphan disease of the urinary bladder characterised by its main symptoms of bladder pain, persistent urge to void and urinary frequency. Due to a variety of confusable diseases and different pathophysiologies, the diagnosis of IC is still a diagnosis of exclusion and remains a challenge for doctors and patients alike. Patients often experience misdiagnosis and unsuccessful treatment for years. Therefore, the primary goal for these patients with chronic pain must be a rapid diagnosis and initiation of adequate treatment. This article focuses on transferring the consensus-based recommendations of the current German S2k guideline "Diagnosis and Treatment of Interstitial Cystitis" (IC/BPS) (2018 AWMF register No.: 043/050) into a practice-orientated and structured diagnostic work-up process.
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Affiliation(s)
- Antje Foresti
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
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Scarneciu I, Bungau S, Lupu AM, Scarneciu CC, Bratu OG, Martha O, Tit DM, Aleya L, Lupu S. Efficacy of instillation treatment with hyaluronic acid in relieving symptoms in patients with BPS/IC and uncomplicated recurrent urinary tract infections - Long-term results of a multicenter study. Eur J Pharm Sci 2019; 139:105067. [DOI: 10.1016/j.ejps.2019.105067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 12/27/2022]
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[Diagnosis and treatment of interstitial cystitis (IC/PBS) : S2k guideline of the German Society of Urology]. Urologe A 2019. [PMID: 31659368 DOI: 10.1007/s00120-019-01054-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
In this review article, the authors describe all relevant aspects of the new S2k guideline from the German Society of Urology (Deutschen Gesellschaft für Urologie, DGU) for the diagnosis and treatment of IC/PBS (interstitial cystitis/painful bladder syndrome). A list of necessary and optional examinations and the necessity of diagnosis of exclusion are summarized and evaluated. The treatment options listed (ranging from conservative, oral drug, and complementary medicine to interventional surgical procedures) also give the reader a good overview of the contents of the guideline and possible therapeutic approaches. Finally, the recommendations including consensus of the guideline group are also summarized in various information boxes.
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[Diagnosis and treatment of interstitial cystitis (IC/PBS) : S2k guideline of the German Society of Urology]. Urologe A 2019; 58:1313-1323. [PMID: 31659368 DOI: 10.1007/s00120-019-01054-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this review article, the authors describe all relevant aspects of the new S2k guideline from the German Society of Urology (Deutschen Gesellschaft für Urologie, DGU) for the diagnosis and treatment of IC/PBS (interstitial cystitis/painful bladder syndrome). A list of necessary and optional examinations and the necessity of diagnosis of exclusion are summarized and evaluated. The treatment options listed (ranging from conservative, oral drug, and complementary medicine to interventional surgical procedures) also give the reader a good overview of the contents of the guideline and possible therapeutic approaches. Finally, the recommendations including consensus of the guideline group are also summarized in various information boxes.
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Barua JM, Arance I, Angulo JC, Riedl CR. A systematic review and meta-analysis on the efficacy of intravesical therapy for bladder pain syndrome/interstitial cystitis. Int Urogynecol J 2016; 27:1137-47. [PMID: 26590137 PMCID: PMC4947101 DOI: 10.1007/s00192-015-2890-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/02/2015] [Indexed: 11/26/2022]
Abstract
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease characterised by persistent irritating micturition symptoms and pain. The objective was to compare the clinical efficacy of currently available products for intravesical therapy of BPS/IC and to assess their pharmacoeconomic impact. A Pubmed/Medline database search was performed for articles on intravesical therapy for BPS/IC. A total of 345 publications were identified, from which 326 were excluded. Statistical evaluation was performed with effect size (ES) assessment of symptom reduction and response rates. The final set of 19 articles on intravesical BPS/IC therapy included 5 prospective controlled trials (CTs), the remaining were classified as uncontrolled clinical studies. The total number of patients included was 801, 228 of whom had been evaluated in a CT. For CTs, the largest ES for symptom reduction as well as response rate was observed for high molecular weight hyaluronic acid (HMW-HA), with similar findings in two uncontrolled studies with HMW-HA. The number needed to treat to achieve a response to intravesical therapy was 2.67 for intravesical pentosan polysulphate and 1.31 for HMW-HA which were superior to all other instillates. HMW-HA was significantly superior in cost effectiveness and cost efficacy to all other instillation regimes. The present meta-analysis combined medical and pharmacoeconomic aspects and demonstrated an advantage of HMW-HA over other instillation agents; however, direct comparisons between the different products have not been performed to date in properly designed controlled studies.
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Affiliation(s)
- Jayanta M Barua
- King George Hospital (BHRUT), Ilford, UK
- Barts and the London School of Medicine & Dentistry, QMUL, London, UK
| | - Ignacio Arance
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
| | - Javier C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
| | - Claus R Riedl
- Department of Urology, Landesklinikum Thermenregion, Wimmergasse 19, 2500, Baden, Austria.
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Cox A, Golda N, Nadeau G, Curtis Nickel J, Carr L, Corcos J, Teichman J. CUA guideline: Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Can Urol Assoc J 2016; 10:E136-E155. [PMID: 27790294 PMCID: PMC5065402 DOI: 10.5489/cuaj.3786] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Nicole Golda
- Department of Urology, North York General Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | | | - Lesley Carr
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Joel Teichman
- University of British Columbia, Vancouver, BC, Canada
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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.
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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
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Esteban M, Adot J, Arlandis S, Peri L, Prieto L, Salinas J, Cozar J. Recommendations for the Diagnosis and Management of Bladder Pain Syndrome. Spanish Urological Association Consensus Document. Actas Urol Esp 2015; 39:465-72. [PMID: 26026254 DOI: 10.1016/j.acuro.2015.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) and other bladder pathologies share common manifestations, such as the presence of mictional symptoms and a negative impact on the patient's quality of life. To be properly diagnosed and clinically managed, it is important to distinguish between its clinical modalities and diagnostic criteria for adequate exclusion. OBJECTIVE The purpose of this study was to standardize criteria for making decisions in BPS management, for its diagnosis, initial treatment and follow-up. MATERIAL AND METHOD A nominal group methodology was employed, using scientific evidence on BPS taken from a systematic (non-exhaustive) literature review for developing recommendations along with specialist expert opinions. RESULTS The diagnosis of BPS should be made based on the patient's clinical history, with emphasis on pain and mictional symptoms as well as excluding other pathologies with similar symptomatology. BPS treatment should be directed towards restoring normal bladder function, preventing symptom relapse and improving patients' quality of life. It is therefore advisable to start with conservative treatment and to adopt less conservative treatments as the level of clinical severity increases. It is also recommended to abandon ineffective treatments and reconsider other therapeutic options. CONCLUSIONS Quickly identifying the pathology is important when trying to positively influence morbidity and care quality for these patients.
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Huang W, Wang F, Wu C, Hu W. Efficacy and safety of pirarubicin combined with hyaluronic acid for non-muscle invasive bladder cancer after transurethral resection: a prospective, randomized study. Int Urol Nephrol 2015; 47:631-6. [PMID: 25761743 DOI: 10.1007/s11255-015-0940-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/25/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To verify the efficacy and safety of intravesical instillation of pirarubicin combined with hyaluronic acid after TURBT in non-muscle invasive bladder cancer patients. METHODS We conducted a prospective study recruiting 127 eligible patients from 2008 to 2010. Patients were randomly assigned to Group A (pirarubicin combined with hyaluronic acid) and Group B (pirarubicin alone). Patients' demographics, treatment efficacy on recurrence, visual analog scale score, and postoperative complications were evaluated and analyzed during observation. RESULTS After the first month of intravesical chemotherapy, a perceptible relief of pelvic pain and urinary symptoms was detectable in Group A when compared with Group B (Fig. 2; P = 0.04). From objective analysis, the clinicians observed a consistent better improvement in Group A than in Group B on clinical conditions (P = 0.02). Frequency, urgency, and odynuria are relieved effectively in Group A (21/64 32.9%) and in Group B (41/63 65.1%), with significant difference observed (P = 0.001). No statistical evidence of benefit was observed in terms of recurrence. No obvious hyaluronic acid-related adverse event was observed. CONCLUSIONS As compared to intravesical instillation of pirarubicin alone, the administration of pirarubicin combined with HA for prevention from postoperative recurrence was satisfactory and safe. The relief of pelvic pain and urinary symptoms is more rapid and more durable.
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Affiliation(s)
- Weiping Huang
- Graduate School, Southern Medical University, 1023 Shatainan Road, Guangzhou, 510515, Guangdong, People's Republic of China
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Parsons CL. Diagnosing the bladder as the source of pelvic pain: successful treatment for adults and children. Pain Manag 2014; 4:293-301. [PMID: 25300387 DOI: 10.2217/pmt.14.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The key to successful therapy of interstitial cystitis (IC) is to correctly diagnose it. The significant majority of patients with IC have a dysfunctional bladder epithelium that allows urinary solutes (primarily potassium) to leak into the bladder wall, causing symptoms and tissue damage. Drugs that correct this dysfunction and suppress symptoms are important to achieve successful outcomes in patients. Today over 95% of females with IC are misdiagnosed as having gynecologic chronic pelvic pain, vulvodynia, vaginitis, endometriosis, overactive bladder or urinary tract infection. Men are misdiagnosed as having prostatitis. Often children are not diagnosed at all. Multimodal drug therapy may be required and can achieve successful resolution of IC in over 90% of patients. IC in children can be treated successfully with pentosan polysulfate.
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Biers S, Thiruchelvam N. Bladder pain syndrome: contemporary management and future strategies. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415813515810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Suzanne Biers
- Department of Urology, Addenbrooke's Hospital, Cambridge
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Effectiveness of intravesical hyaluronic acid with or without chondroitin sulfate for recurrent bacterial cystitis in adult women: a meta-analysis. Int Urogynecol J 2012; 24:545-52. [PMID: 23129247 DOI: 10.1007/s00192-012-1957-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/25/2012] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Glycosaminoglycan hyaluronic acid (HA) and chondroitin sulphate (CS) protect the urothelium. Damage to the urothelium may increase bacterial adherence and infection risk. This meta-analysis evaluated the effect of intravesical HA and HA and CS (HA-CS) combination therapy in recurrent bacterial cystitis (RBC) in adult women. METHODS A systematic literature search was performed. Primary outcomes were urinary tract infection (UTI) rate per patient-year, and UTI recurrence time (days). Secondary outcomes were 3-day voids and Pelvic Pain and Urgency/Frequency (PUF) symptom scale total score. RESULTS Four studies involving a total of 143 patients were retrieved and assessed in this analysis. Two were randomized, and two were nonrandomized. A significantly decreased UTI rate per patient-year [mean difference (MD) -3.41, 95 % confidence interval (CI) -4.33 to -2.49, p < 0.00001) was found. Similarly, pooled analysis showed a significantly longer mean UTI recurrence time (days) using either HA or HA-CS therapy (MD 187.35, 95 % CI 94.33-280.37, p < 0.0001). Two studies using HA and HA-CS therapy reported outcomes on 3-day voids, which were not significantly improved after therapy (MD -3.59, 95 % CI -8.43-1.25, p = 0.15), but a significantly better PUF total score (MD -7.17, 95 % CI -9.86 to -4.48, p < 0.00001) was detected in HA-CS groups. CONCLUSIONS Intravesical HA and HA-CS in combination significantly reduced cystitis recurrence, mean UTI recurrence time, and PUF total score. Study limitations include the small number of patients and possible bias. Further studies are needed to validate this promising treatment modality.
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Raymond I, Vasdev N, Ferguson J, Haskin M, Davis L, Hasan TS. The clinical effectiveness of intravesical sodium hyaluronate (cystistat®) in patients with interstitial cystitis/painful bladder syndrome and recurrent urinary tract infections. Curr Urol 2012; 6:93-8. [PMID: 24917721 DOI: 10.1159/000343517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/10/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Painful bladder syndrome/interstitial cystitis (PBS/IC) and recurrent urinary tract infections (UTI) are clinically challenging conditions to manage in patients. We evaluate the clinical use of intravesical sodium hyaluronate (Cystistat®) in both these patient groups who have completed treatment. PATIENTS AND METHODS Thirteen patients with recurrent UTIs (Group I) and 8 patients with PBS/IC (Group II) received intravesical sodium hyaluronate (Cystistat®). Preinstallation demographic parameters were statically comparable in both groups. The mean age of presentation was 54.6 years in Group I and 57.5 years in Group II (p = 0.9). All 13 patients in Group I were on low dose antibiotics. The mean number of installations completed in both groups was 9 (range 4-21). RESULTS Data was collected prospectively using a standard pre- and post-treatment questioner with the pelvic pain and urinary/frequency patient symptom scale. At a mean follow-up of 21 months a significant improvement in bladder pain (p = 0.05), daytime frequency (p = 0.03) and quality of life (p = 0.02) was noted in patients in Group I. Two patients had breakthrough UTIs during treatment. Within Group I, 7 (53%) patients responded well to treatment. Patients in Group II had a significant improvement in bladder pain (p = 0.02), urgency (p = 0.01), nocturia (p = 0.01) and quality of life (p = 0.04). Within Group II, 6 patients (75%) responded to treatment. CONCLUSION Intravesical sodium hyaluronate (Cystistat®) can be used with minimal side effects and good compliance in both groups of patients with PBS and recurrent UTIs. Longer follow-up and larger patient numbers in both groups will be required to confirm the long-term efficacy of these two clinically challenging groups of patients.
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Affiliation(s)
- Ijabla Raymond
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Nikhil Vasdev
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jill Ferguson
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Marion Haskin
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Liz Davis
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Tahseen S Hasan
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
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Tasdemir S, Tasdemir C, Vardi N, Yakupogullari Y, Duman Y, Parlakpinar H, Sagir M, Acet A. Intravesical hyaluronic acid and chondroitin sulfate alone and in combination for urinary tract infection: Assessment of protective effects in a rat model. Int J Urol 2012; 19:1108-12. [DOI: 10.1111/j.1442-2042.2012.03109.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Vita D, Giordano S. Effectiveness of intravesical hyaluronic acid/chondroitin sulfate in recurrent bacterial cystitis: a randomized study. Int Urogynecol J 2012; 23:1707-13. [PMID: 22614285 DOI: 10.1007/s00192-012-1794-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The glycosaminoglycan hyaluronic acid (HA) protects the urothelium; damage may increase bacterial adherence and infection risk. This study evaluated the effect of intravesical HA in recurrent bacterial cystitis (RBC). METHODS Women with RBC were randomized to intravesical HA 800 mg and chondroitin sulfate (CS) 1 g (IALURIL, IBSA) in 50 mL of saline solution once weekly for 4 weeks then once every 2 weeks twice more (group 1) or long term antibiotic prophylaxis using sulfamethoxazole 200 mg and trimethoprim 40 mg once weekly for 6 weeks (group 2; control). Evaluations included: cystitis recurrence at 2 and 12 months; subjective pain symptoms (visual analog scale [VAS]); 3 day voiding; sexual function; quality of life (King's Health Questionnaire [KHQ]); frequency symptoms/frequency symptoms (PUF symptom scale); and maximum cystometric capacity (MCC). Means ± standard deviations were reported, with Mann-Whitney test for between-group comparison (significance P < .05). RESULTS Of 28 women (mean age 60 ± 13 y) randomized, 26 completed follow-up (mean follow-up 11.5 mo). Group 1 showed a significant improvement in all evaluations; cystitis recurrence (1 ± 1.2 versus 2.3 ± 1.4, P = .02); 3-day voiding (mean 17.8 ± 3.5 vs 24.2 ± 8.3, P = .04); symptom VAS (1.6 ± 0.8 vs 7.8 ± 1.6, P < .001); PUF score (11.2 ± 2.7 vs 19.6 ± 2.2, P < .001), KHQ score (18.4 ± 7.2 vs 47.3 ± 13.6, P < .001), and MCC (380 ± 78 vs 229 ± 51 mL, P < .001) vs group 2 at 12 mo. No adverse effects were recorded. CONCLUSIONS Intravesical HA and CS in combination significantly reduced cystitis recurrence and improved urinary symptoms, quality of life, and cystometric capacity in RBC patients at 12 mo follow-up versus antibiotic prophylaxis. Study limitations include a small sample and relatively short follow-up.
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Affiliation(s)
- Davide De Vita
- Department of Obstetrics and Gynaecology, Battipaglia Hospital, Battipaglia, SA, Italy
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Carr LK, Corcos J, Nickel JC, Teichman J. Diagnosis of interstitial cystitis June 2007. Can Urol Assoc J 2011; 3:81-6. [PMID: 19293986 DOI: 10.5489/cuaj.1030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lesley K Carr
- Chair; Assistant Professor, Department of Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont
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Parsons CL, Proctor J, Teichman JS, Nickel JC, Davis E, Evans R, Zupkas P, Phillips C, Shaw T, Naidu N, Argade S. A Multi-Site Study Confirms Abnormal Glycosylation in the Tamm-Horsfall Protein of Patients With Interstitial Cystitis. J Urol 2011; 186:112-6. [DOI: 10.1016/j.juro.2011.02.2699] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Joel S. Teichman
- Department of Urologic Sciences, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia
| | | | - Edward Davis
- Citrus Valley Urologic Medical Group, Glendora, California
| | - Robert Evans
- Wake Forest University, Winston-Salem, North Carolina
| | - Paul Zupkas
- Division of Urology, University of California-San Diego San Diego
| | - Cody Phillips
- Division of Urology, University of California-San Diego San Diego
| | - Timothy Shaw
- Division of Urology, University of California-San Diego San Diego
| | - Natasha Naidu
- Glycotechnology Core Resource, University of California-San Diego San Diego
| | - Sulabha Argade
- Division of Urology, University of California-San Diego San Diego
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Figueiredo A, Palma P, Riccetto C, Herrmann V, Dambros M, Capmartin R. [Clinical and urodynamic experience with intravesical hyaluronic acid in painful bladder syndrome associated with interstitial cystitis]. Actas Urol Esp 2011; 35:184-7. [PMID: 21397161 DOI: 10.1016/j.acuro.2010.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 08/30/2010] [Accepted: 09/01/2010] [Indexed: 11/24/2022]
Abstract
INTRODUCTION few studies have been carried out on therapeutic options in patients with painful bladder syndrome associated with interstitial cystitis. The aim is to verify the safety and effectiveness of treatment with sodium hyaluronate through intravesical instillation in patients with painful bladder syndrome. MATERIALS AND METHODS a series of 18 female patients is presented, with a mean age of 51 years and prior diagnosis of painful bladder syndrome, who were treated by means of the weekly infusion of an intravesical solution of 40mg of sodium hyaluronate in sterile solution, over a period of eight weeks. The patients were examined clinically and urodynamically prior to their inclusion in the study and eight months after the instillations had concluded. RESULTS there was a statistically significant improvement in the urodynamic parameters and in the symptoms measured quantitatively by means of the questionnaire "Pelvic Pain and Urgency/Frequency" between the baseline situation and after the vesical instillation of sodium hyaluronate in patients with painful bladder syndrome. There was no toxicity arising from the treatment, given that no adverse effects were recorded in relation to it. CONCLUSION the clinical use of intravesical hyaluronic acid in patients with painful bladder syndrome possibly associated with interstitial cystitis has been demonstrated. The clinical improvement is also associated both with increased bladder capacity and improved bladder sensitivity. Tolerance was excellent. Clinical tests that more profoundly evaluate the therapeutic potential of this drug in this type of patients are required.
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Parsons CL. The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain. BJU Int 2010; 107:370-5. [DOI: 10.1111/j.1464-410x.2010.09843.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Engelhardt PF, Morakis N, Daha LK, Esterbauer B, Riedl CR. Long-term results of intravesical hyaluronan therapy in bladder pain syndrome/interstitial cystitis. Int Urogynecol J 2010; 22:401-5. [PMID: 20938644 DOI: 10.1007/s00192-010-1294-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 09/20/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS While the short-term efficacy of intravesical hyaluronan for bladder pain syndrome/interstitial cystitis (BPS/IC) has been demonstrated, no data exist on the long-term outcome of this therapy. METHODS Seventy BPS/IC patients treated with intravesical hyaluronan therapy from 2001 to 2003 were asked to rate their present status of bladder symptoms on a visual analog scale. RESULTS Forty-eight of 70 patients responded after a mean follow-up of 4.9 years. The average initial VAS score of 8.15 had been reduced to 2.71 after therapy and further to 2.14 5 years later. Fifty percent of patients (24/48) reported complete bladder symptom remission at 5 years follow-up without any additional therapy; 41.7% (20/48) with symptom recurrence was improved with hyaluronan maintenance therapy. No improvement was reported by four patients. CONCLUSIONS Besides a high rate of acute symptom remission, intravesical hyaluronan also shows long-term efficacy in a considerable number of BPS/IC patients.
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Affiliation(s)
- Paul F Engelhardt
- Department of Urology, Landesklinikum Thermenregion Baden, Wimmergasse 19, 2500 Baden, Austria.
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22
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Galosi AB, Montironi R, Mazzucchelli R, Lacetera V, Muzzonigro G. Interstitial Cystitis: Minimal Diagnostic Criteria. Urologia 2010. [DOI: 10.1177/039156031007700302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Any article reporting on Interstitial Cystitis (IC) will list numerous investigations. This paper presents a review of the minimum investigations needed and their significance for the initial evaluation and diagnosis of patients with Interstitial Cystitis. To optimize patient's early diagnosis and disease monitoring, a comprehensive algorithm for the diagnosis of IC has been proposed. The paper defines interstitial cystitis (IC) as a disease of the urinary bladder diagnosed by at least one of the following 3 requirements: 1) endoscopic criteria (cystoscopy findings); 2) pathologic criteria of bladder biopsy; and 3) clinical criteria including pain and lower urinary tract symptoms evaluation. Furthermore, the exclusion of confusable diseases is mandatory in all cases. These are recommendations, mostly based on expert opinions and literature review. Where possible, a level of recommendation was developed according to a 3–grade scale: mandatory (grade 1), recommended (grade 2), and optional (grade 3). By using a stepwise approach and an evidence-based thought process, the diagnosis of IC is made easier and reliable.
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Affiliation(s)
- Andrea Benedetto Galosi
- Gruppo Lavoro del Centro di Riferimento per le Malattie Rare, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona
- Clinica Urologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona
| | - Rodolfo Montironi
- Anatomia Patologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona
| | - Roberta Mazzucchelli
- Anatomia Patologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona
| | - Vito Lacetera
- Clinica Urologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona
| | - Giovanni Muzzonigro
- Clinica Urologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona
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Abstract
Chronic pelvic pain in women can be caused by a host of gynecological, gastrointestinal, musculoskeletal, neurologic, as well as urologic disorders. An initial broad differential diagnosis is essential. At times, overlapping symptoms and vague physical findings necessitate a multidisciplinary diagnostic approach. A thorough history, which is careful to characterize all aspects of the patient's symptoms, can usually direct the differential toward the bladder when this organ is the source of the pain. Interstitial cystitis/painful bladder syndrome (IC/PBS) should be included in the differential diagnosis, but it should not be used as an expeditious diagnosis when pain coexists with frequency and urgency. Multiple other urologic conditions such as overactive bladder, urinary tract infection, urethral diverticulum, periurethral masses (Skene gland cyst or abscess), and even urethral stricture disease, have overlapping symptom complexes with IC/PBS, and they must not be overlooked as they are much more easily diagnosed and treated. By using a stepwise approach and an evidence-based thought process, the obscurity of chronic bladder and urethral pain can evolve into a progressively narrowing differential.
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Siracusano S, Cucchi A, Ciciliato S, Lampropoulou N, Vittur F. Urinary levels of glycosaminoglycans in patients with idiopathic detrusor overactivity. Int Urogynecol J 2009; 20:1477-80. [DOI: 10.1007/s00192-009-0973-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 07/20/2009] [Indexed: 11/24/2022]
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Kallestrup EB, Jorgensen SS, Nordling J, Hald T. Treatment of interstitial cystitis with Cystistat®, A hyaluronic acid product. ACTA ACUST UNITED AC 2009; 39:143-7. [PMID: 16032779 DOI: 10.1080/00365590410015876-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether intravesical hyaluronic acid id effective in reducing the urinary frequency and pain associated with interstitial cystitis/painful bladder syndrome (IC/PBS). MATERIAL AND METHODS In a prospective, unblinded, uncontrolled pilot study, 20 patients (age range 34-80 years), all suffering from IC/PBS, received weekly bladder instillations of hyaluronic acid for 1 month and monthly instillations for a further 2 months. Patients were then offered further monthly instillations and all were subsequently evaluated after 3 years. Patient outcomes assessed were urinary frequency, use of analgesics and pain. RESULTS All patients completed the 3 months of hyaluronic acid treatment with mean decreases in nocturia and pain of 40% and 30%, respectively, and decrease in analgesic use. Thirteen patients (65%) responded to treatment (responders) and continued therapy, while seven patents withdrew, six because of a lack of response and one due to cystectomy. In the 13 patients who continued hyaluronic acid instillations, four complete responders(30%) ceased therapy after a strong positive response (36%, 60% and 81% decreases compared to baseline in day-time voids, night-time voids and scores, respectively) which was maintained in the absence of continuous therapy, while after 3 years seven partial responders (35%) were still on therapy (25% and 43% decreases compared to baseline in day-time voids and pain scores, respectively). Two patients developed other diseases during follow-up and showed no response to long-term therapy. Hyaluronic acid was will tolerated by all patients. CONCLUSION Hyaluronic acid safely reduced the pain and, to lesser degree, the urinary frequency associated with IC.
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26
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Hanno P. Potassium sensitivity test for painful bladder syndrome/interstitial cystitis: con. J Urol 2009; 182:431-2, 434. [PMID: 19524950 DOI: 10.1016/j.juro.2009.05.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Philip Hanno
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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27
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Kim SH, Kim TB, Kim SW, Oh SJ. Urodynamic Findings of the Painful Bladder Syndrome/Interstitial Cystitis: A Comparison With Idiopathic Overactive Bladder. J Urol 2009; 181:2550-4. [DOI: 10.1016/j.juro.2009.01.106] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Sung Han Kim
- Department of Urology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Korea
| | - Tae Beom Kim
- Department of Urology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Korea
| | - Soo Woong Kim
- Department of Urology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Korea
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Argade SP, Vanichsarn C, Chenoweth M, Parsons CL. Abnormal glycosylation of Tamm-Horsfall protein in patients with interstitial cystitis. BJU Int 2009; 103:1085-9. [DOI: 10.1111/j.1464-410x.2008.08163.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Hanno P, Dmochowski R. Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot. Neurourol Urodyn 2009; 28:274-86. [DOI: 10.1002/nau.20687] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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30
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Daha LK, Riedl CR, Lazar D, Simak R, Pflüger H. Effect of intravesical glycosaminoglycan substitution therapy on bladder pain syndrome/interstitial cystitis, bladder capacity and potassium sensitivity. ACTA ACUST UNITED AC 2009; 42:369-72. [PMID: 19230170 DOI: 10.1080/00365590701871518] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate changes in bladder capacity and potassium sensitivity after glycosaminoglycan (GAG) substitution therapy. MATERIAL AND METHODS The study population comprised two groups of female patients with bladder pain syndrome/interstitial cystitis (BPS/IC): responders (those with symptom improvement) and non-responders (those without symptom improvement) after a 10-week period of intravesical, episodic, weekly, GAG substitution therapy. A total of 27 volunteers with increased pre-therapeutic potassium sensitivity were enrolled in the study and re-evaluated using the modified comparative potassium test (maximal bladder capacity with a saline solution versus a 0.2 M KCl solution) following intravesical GAG substitution therapy. RESULTS In the 13 responders, the average maximal bladder capacity increased by 17% with the saline solution and by 101.5% with the 0.2 M KCl solution. In the 14 non-responders, post-therapeutic average maximal bladder capacity was decreased by 35% with the saline solution and remained relatively unchanged after instillation with a 0.2 M KCl solution. CONCLUSION These data demonstrate that in patients who respond symptomatically to intravesical GAG substitution therapy, cystometric bladder capacity is increased, whereas non-responders experience a decrease in bladder capacity.
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Affiliation(s)
- Lukas K Daha
- Department of Urology, Municipal Hospital Hietzing, Vienna, Austria.
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31
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Seth A, Teichman JMH. What’s new in the diagnosis and management of painful bladder syndrome/interstitial cystitis? Curr Urol Rep 2008; 9:349-57. [DOI: 10.1007/s11934-008-0061-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mouracade P, Saussine C. [Interstitial cystitis in 2008]. Prog Urol 2008; 18:418-25. [PMID: 18602600 DOI: 10.1016/j.purol.2008.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 04/01/2008] [Indexed: 11/18/2022]
Abstract
Interstitial cystitis (IC) is a chronic, debilitating condition that is often associated with late diagnosis and a delay in initiation of appropriate IC-specific therapy. The typical patient with interstitial cystitis (IC) is symptomatic for many years and consults multiple physicians before IC is diagnosed. These observations suggest that the clinical presentation of IC is not widely recognized. The resultant underdiagnosis may be explained in part by the nonspecific nature of IC symptoms, such as urinary urgency, frequency, nocturia and pain, as well as by the lack of an objective diagnostic test. Pelvic pain of bladder origin may refer to pain in any location in the pelvis, is affected by the menstrual cycle and flares with sexual intercourse. As a result of variations in disease definition and diagnostic criteria for interstitial cystitis (IC), the performance of epidemiologic studies has been challenging. The true prevalence of IC is much greater than the early studies suggested. Over the last decade, the recognized prevalence of IC has increased and it is consistently greater among women as compared to men.
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Affiliation(s)
- P Mouracade
- Service d'Urologie, Hôpitaux Universitaires de Strasbourg, Place de l'Hôpital, Strasbourg, France
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Welk BK, Teichman JM. Dyspareunia Response in Patients with Interstitial Cystitis Treated with Intravesical Lidocaine, Bicarbonate, and Heparin. Urology 2008; 71:67-70. [PMID: 18242367 DOI: 10.1016/j.urology.2007.09.067] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 07/24/2007] [Accepted: 09/28/2007] [Indexed: 01/23/2023]
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Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. Int Urogynecol J 2007; 19:717-21. [PMID: 18097627 DOI: 10.1007/s00192-007-0515-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 11/11/2007] [Indexed: 02/01/2023]
Abstract
The aim of this study is to evaluate the efficacy of intravesical hyaluronan therapy in interstitial cystitis/painful bladder syndrome (IC/PBS). One hundred twenty-six patients with IC/PBS and an average disease duration of 6.1 years were treated with weekly instillations of a 50-cm3 phosphate-buffered saline solution containing 40 mg sodium hyaluronate. To be eligible for hyaluronan treatment, a positive modified potassium test was requested as a sign of a urine-tissue barrier disorder. Data were obtained by a visual analogue scale (VAS) questionnaire rating from 0 to 10 that asked for global bladder symptoms before and after therapy. Additional questions evaluated the therapeutic impact on quality of life. A positive and durable impact of hyaluronan therapy on IC/PBS symptoms was observed--103 (85%) of the patients reported symptom improvement (> or =2 VAS units). The mean initial VAS score of 8.5 decreased to 3.5 after therapy (p < 0.0001). Out of 121 patients, 67 (55%) remained with no or minimal bladder symptoms after therapy (VAS 0-2). The majority (101, 84%) reported significant improvement of their quality of life. Intravesical therapy had to be initiated again with good success in 43 patients (34.5%) as symptoms recurred after discontinuation of treatment, while the rest stayed free of symptoms for up to 5 years. In general, hyaluronan therapy was well tolerated and, with the exception of mild irritative symptoms, no adverse reactions were reported for a total of 1,521 instillations. Timely hyaluronan instillation therapy may lead to complete symptom remission or even cure in part of the IC/PBS patients, while some responders need continuous intravesical therapy. The present results suggest that selection of patients for hyaluronan therapy by potassium testing improves the outcome of intravesical therapy with a response rate of >80%.
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Parsons CL, Stein P, Zupkas P, Chenoweth M, Argade SP, Proctor JG, Datta A, Trotter RN. Defective Tamm-Horsfall Protein in Patients With Interstitial Cystitis. J Urol 2007; 178:2665-70. [DOI: 10.1016/j.juro.2007.07.125] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Indexed: 11/27/2022]
Affiliation(s)
- C. Lowell Parsons
- Division of Urology, University of California-San Diego Medical Center, San Diego and Glycotechnology Core Resource, University of California-San Diego (AD), La Jolla, California, and Georgia Urology (JGP), Cartersville, Georgia
| | - Paul Stein
- Division of Urology, University of California-San Diego Medical Center, San Diego and Glycotechnology Core Resource, University of California-San Diego (AD), La Jolla, California, and Georgia Urology (JGP), Cartersville, Georgia
| | - Paul Zupkas
- Division of Urology, University of California-San Diego Medical Center, San Diego and Glycotechnology Core Resource, University of California-San Diego (AD), La Jolla, California, and Georgia Urology (JGP), Cartersville, Georgia
| | - Marianne Chenoweth
- Division of Urology, University of California-San Diego Medical Center, San Diego and Glycotechnology Core Resource, University of California-San Diego (AD), La Jolla, California, and Georgia Urology (JGP), Cartersville, Georgia
| | - Sulabha P. Argade
- Division of Urology, University of California-San Diego Medical Center, San Diego and Glycotechnology Core Resource, University of California-San Diego (AD), La Jolla, California, and Georgia Urology (JGP), Cartersville, Georgia
| | - Jeffrey G. Proctor
- Division of Urology, University of California-San Diego Medical Center, San Diego and Glycotechnology Core Resource, University of California-San Diego (AD), La Jolla, California, and Georgia Urology (JGP), Cartersville, Georgia
| | - Anup Datta
- Division of Urology, University of California-San Diego Medical Center, San Diego and Glycotechnology Core Resource, University of California-San Diego (AD), La Jolla, California, and Georgia Urology (JGP), Cartersville, Georgia
| | - R. Nicholas Trotter
- Division of Urology, University of California-San Diego Medical Center, San Diego and Glycotechnology Core Resource, University of California-San Diego (AD), La Jolla, California, and Georgia Urology (JGP), Cartersville, Georgia
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Akkad T, Pelzer A, Mitterberger M, Rehder P, Leonhartsberger N, Bartsch G, Pinggera GM, Strasser H. Influence of intravesical potassium on pelvic floor activity in women with overactive bladder syndrome: comparative urodynamics might provide better detection of dysfunctional voiding. BJU Int 2007; 100:830-4; discussion 834. [PMID: 17578465 DOI: 10.1111/j.1464-410x.2007.07047.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the influence of intravesical potassium on pelvic floor activity (PFA) during voiding in women with symptoms of overactive bladder (OAB), by using comparative urodynamics (CUD). PATIENTS AND METHODS The study included 175 women who met the criteria of OAB (mean age 52.7 years, range 18-87). CUD included two sessions of pressure-flow studies (0.9% saline vs 0.2 m KCl) with simultaneous measurement of PFA using perineal electromyography (EMG) with surface electrodes. Dysfunctional voiding (DV) was diagnosed if significant PFA was measured by EMG during voiding. RESULTS In 44 patients (25%) there was increased EMG activity only in the presence of KCL; in 58 (33%) there was DV with increased PFA during filling with saline. In all these patients PFA was significantly greater in the presence of KCl (P < 0.001). In patients with DV, filling with KCl prompted a statistically significant difference in maximum bladder capacity, maximum flow rate, mean flow rate and postvoid residual urine volume (P < 0.05). In summary, 102 patients (58%) had DV. CONCLUSION These findings suggest that DV is associated with epithelial dysfunction of the bladder mucosa, which clinically leads to OAB syndrome and can be revealed by CUD. The detection of DV might elude conventional urodynamics, but can be significantly enhanced by CUD (0.9% saline vs 0.2 m KCl).
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Affiliation(s)
- Thomas Akkad
- Department of Urology, Medical University Innsbruck, Austria
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37
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Akkad T, Pelzer AE, Mitterberger M, Rehder P, Leonhartsberger N, Bartsch G, Strasser H. Influence of intravesical potassium on pelvic floor activity in women with recurrent urinary tract infections: comparative urodynamics might lead to enhanced detection of dysfunctional voiding. BJU Int 2007; 100:1071-4. [PMID: 17784889 DOI: 10.1111/j.1464-410x.2007.07120.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the influence of intravesical potassium on pelvic floor activity (PFA) during voiding in women with recurrent urinary tract infections (rUTIs) by using comparative urodynamics (CUD). PATIENTS AND METHODS CUD was conducted in 49 women (mean age 34.6 years, range 15-82) with rUTI. Every patient had two sessions of pressure-flow studies with simultaneous measurement of PFA by perineal surface electromyography (EMG); the first was with 0.9% saline and in the second the bladder was filled with 0.2 m KCl solution. All patients had voiding cysto-urethrography, and dysfunctional voiding (DV) was diagnosed when significant PFA was measured by EMG during voiding. RESULTS Overall, DV was diagnosed in 37 patients (76%) using CUD; 16 (32%) had DV with saline on the pelvic floor EMG. In all these patients there were significantly greater EMG signals in the presence of KCL. In 21 patients (43%) DV was only detected using KCL; this improvement in the detection rate of DV was statistically significant (P = 0.006). Filling with KCl also prompted a statistically significant difference (P < 0.05) in maximum bladder capacity, maximum and average flow rates and in postvoid residual urine volume. CONCLUSION The present data show that DV is present in most women with rUTI but cannot sufficiently be diagnosed by conventional urodynamics with standard 0.9% saline. The present study suggests that CUD might enhance the detection rates of DV.
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Affiliation(s)
- Thomas Akkad
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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38
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Forrest JB, Dell JR. Successful management of interstitial cystitis in clinical practice. Urology 2007; 69:82-6. [PMID: 17462485 DOI: 10.1016/j.urology.2006.08.1110] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 06/03/2006] [Accepted: 08/24/2006] [Indexed: 11/28/2022]
Abstract
Primary care physicians, urologists, and gynecologists have the opportunity to detect interstitial cystitis (IC) in its early stages in symptomatic patients and provide effective treatment before the disease progresses. In this article, we present guidelines for clinical practice management and coding for reimbursement for the care of patients with IC. Important issues in the management of IC are presented, including appropriate Current Procedural Terminology (CPT) coding for office visits and procedures associated with diagnosis and treatment of the disease. Excellent IC care can be integrated into a successful clinical practice with appropriate clinical management and coding for reimbursement.
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Affiliation(s)
- John B Forrest
- University of Oklahoma Health Science Center-Tulsa, Tulsa, Oklahoma, USA.
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39
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Parsons CL. The Role of the Urinary Epithelium in the Pathogenesis of Interstitial Cystitis/Prostatitis/Urethritis. Urology 2007; 69:9-16. [PMID: 17462486 DOI: 10.1016/j.urology.2006.03.084] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 03/28/2006] [Indexed: 11/20/2022]
Abstract
The urothelium plays a pivotal role as a barrier between urine and its solutes and the underlying bladder. Bladder surface mucus is a critical component of this function. The biologic activity of mucus that imparts this barrier function is generated by the highly anionic polysaccharide components (eg, glycosaminoglycans), which are extremely hydrophilic and trap water at the outer layer of the umbrella cell. This trapped water forms a barrier at the critical interface between urine and the bladder. The result is a highly impermeable urothelium that serves as a key protective barrier for the bladder interstitium. In interstitial cystitis (IC), disruption of the urothelial barrier may initiate a cascade of events in the bladder, leading to symptoms and disease. Specifically, epithelial dysfunction leads to the migration of urinary solutes, in particular, potassium, that depolarize nerves and muscles and cause tissue injury. Exogenous heparinoids can restore the barrier function of the urothelium and thus successfully treat patients with IC. Groups of patients who have been given a diagnosis of IC, chronic prostatitis, and urethritis have been shown to have IC by virtue of their shared potassium sensitivity. It would seem, therefore, that mucous deficiency may be present throughout the lower urinary tract. If one is to rename these diseases, perhaps it is best to do so in reference to a shared loss of epithelial barrier function. A name such as lower urinary dysfunctional epithelium would incorporate all of these diseases under a single pathophysiologic process. As a result of these discoveries, a new paradigm for diagnosis and treatment is emerging.
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Affiliation(s)
- C Lowell Parsons
- Division of Urology, Department of Surgery, University of California, San Diego Medical Center, University of California, San Diego, San Diego, California 92103-8897, USA.
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Daha LK, Lazar D, Simak R, Pflüger H. Is there a relation between urinary interleukin-6 levels and symptoms before and after intra-vesical glycosaminoglycan substitution therapy in patients with bladder pain syndrome/interstitial cystitis? Int Urogynecol J 2007; 18:1449-52. [PMID: 17982709 DOI: 10.1007/s00192-007-0354-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 03/04/2007] [Indexed: 10/23/2022]
Abstract
Urinary interleukin-6 (IL-6) has been proposed as a sensitive and specific inflammatory marker in bladder pain syndrome/interstitial cystitis (BPS/IC). We therefore investigated the presence of urinary IL-6 in patients with BPS/IC to find a possible correlation with the symptoms before and after glycosaminoglycan substitution therapy. Urinary IL-6 levels of 25 BPS/IC patients were assessed semi-quantitavely (Milenia Quickline) before and after intra-vesical glycosaminoglycan substitution therapy. Patients received therapy twice weekly with 300 mg pentosanpolysulphate for 5 weeks. Responders were treated for another 5 weeks, whilst non-responders received 40 mg hyaluronic acid weekly for another 10 weeks instead. Treatment response was assessed by the visual analogue scale (VAS) for quality of life and O'Leary-Saint Symptom and Problem Index (OSPI) before, during the 5th week of the treatment and 1 week after the treatment. Before treatment, measurable IL-6 was found in urine samples from 9 out of 25 patients. After treatment, urinary IL-6 was detected in two patients only. The average VAS and OSPI scores before the treatment were 7.9 (4-10) and 25.4 (12-37), respectively. After the treatment, the average VAS and OSPI scores dropped to 5.5 (0-10) and 14.7 (1-29), respectively. No statistically significant difference was found between patients with and without urinary IL-6 and the VAS and OSPI scores before and after the treatment. The urinary IL-6 level in BPS/IC patients is neither suited as a diagnostic marker nor as a predictor of responses to therapies. For the future, it would be important to clarify whether there are subsets of patients with diseases of different aetiologies.
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Affiliation(s)
- Lukas K Daha
- Department of Urology and Ludwig Boltzmann Institute of Urology and Andrology, Municipal Hospital Hietzing, Wolkersbergenstrasse 1, Vienna 1130, Austria.
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Lipovac M, Kurz C, Reithmayr F, Verhoeven HC, Huber JC, Imhof M. Prevention of recurrent bacterial urinary tract infections by intravesical instillation of hyaluronic acid. Int J Gynaecol Obstet 2007; 96:192-5. [PMID: 17280667 DOI: 10.1016/j.ijgo.2006.11.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 11/19/2006] [Accepted: 11/29/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy of vesical instillation of hyaluronic acid against recurrent urinary tract infections. METHODS Twenty women with a history of recurrent urinary tract infections each received 9 intravesical instillations of hyaluronic acid over 6 months. Their status was assessed prospectively over 47.6 weeks and compared with a retrospective review of patient charts covering 36.2+/-6.2 weeks. RESULTS The total numbers of urinary tract infections were 67 before and 10 after treatment (p<0.001). Thirteen patients (65%) were free of recurrences until the end of the study. One had a recurrence during treatment, and 6 (30%) during follow-up. The number of infections per year per patient was reduced from 4.99+/-0.92 to 0.56+/-0.82 (p<0.001). In women with recurrences, time to recurrence was 178.3+/-25.5 days, compared with 76.7+/-24.6 days before treatment (p<0.001). CONCLUSION Intravesical instillation of hyaluronic acid is effective in preventing recurrent urinary tract infections.
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Affiliation(s)
- M Lipovac
- Medical University of Vienna, Department of Obstetrics and Gynecology, AKH, Vienna, Austria.
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Chen MC, Keshavan P, Gregory GD, Klumpp DJ. RANTES mediates TNF-dependent lamina propria mast cell accumulation and barrier dysfunction in neurogenic cystitis. Am J Physiol Renal Physiol 2007; 292:F1372-9. [PMID: 17244892 DOI: 10.1152/ajprenal.00472.2006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Barrier dysfunction of the urinary bladder is postulated to contribute to patient morbidity in the bladder inflammatory disease interstitial cystitis (IC). IC is often considered a neurogenic cystitis, but the mechanisms underlying barrier dysfunction are unclear. In murine neurogenic cystitis induced by pseudorabies virus (PRV), we previously observed formation of urothelial lesions characterized by urothelial apoptosis and urothelial discontinuities. Lesion formation was preceded by mast cell trafficking to the lamina propria, and trafficking was mediated by tumor necrosis factor-alpha (TNF). Here, we found that supernatants of TNF-treated urothelial cultures promoted chemotaxis of bone marrow-derived mast cells in vitro that was blocked by anti-RANTES antibodies but unaffected by anti-TNF antibodies. In vivo, PRV infection of wild-type mice induced RANTES expression in the urothelium that was temporally coincident with lamina propria mast cell accumulation (maximum at days 3-4 following infection) and was not induced in TNF(-/-) mice, TNFR1/2(-/-) mice, or mice treated with anti-TNF antibodies. Anti-RANTES antibodies blocked PRV-induced lamina propria mast cell accumulation 56% and reduced the prevalence of animals with detectable lesions 42%, relative to isotype control antibodies. Bladder barrier function was quantified by measuring transepithelial resistance (TER). PRV induced a 49% loss of TER in the presence of control antibodies, but mice treated with anti-RANTES antibodies exhibited reduced TER loss (16%, P < 0.01). These data demonstrate that RANTES plays a key role in the pathogenesis of neurogenic cystitis and suggest that chemokines may represent novel therapeutic targets for IC patients with mast cell-associated disease.
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Affiliation(s)
- Michael C Chen
- Departments of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Sairanen J, Tammela TLJ, Leppilahti M, Onali M, Forsell T, Ruutu M. Potassium sensitivity test (PST) as a measurement of treatment efficacy of painful bladder syndrome/interstitial cystitis: A prospective study with cyclosporine A and pentosan polysulfate sodium. Neurourol Urodyn 2007; 26:267-70. [PMID: 17078084 DOI: 10.1002/nau.20350] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS Potassium sensitivity test (PST) has been used as an optional tool in diagnosing painful bladder syndrome/interstitial cystitis (PBS/IC). The role of PST in the follow-up of patients with PBS/IC is elusive. We performed PST before and after treatment of PBS/IC with cyclosporine A (CyA) or pentosan polysulfate sodium (PPS), to test whether the result of repeated PST correlates with alleviation of PBS/IC-related symptoms. MATERIALS AND METHODS Sixty-four patients who participated in a randomized clinical study comparing CyA and PPS in the treatment of PBS/IC were recruited to the present study. Patients underwent 0.4 M PST before and after 6 months of treatment. The primary end point was a change from positive PST to negative among patients who responded to both treatments determined by global response assessment (GRA). RESULTS Potassium sensitivity test (PST) was more likely to change from positive to negative among patients who responded to their treatment according to GRA (P < 0.001). The PST change follows the clinical course (ICSI score, voiding frequency, VAS score), which was more beneficial in the CyA-treated patients. CONCLUSIONS Potassium sensitivity test (PST) reflects symptom severity of PBS/IC patients. Change of pre-treatment positive PST to negative correlates well with clinical alleviation of PBS/IC-related symptoms. In patients with persistent symptoms it may be painful and does not offer additional information. Thus, we do not recommend PST to be used as a routine clinical test in monitoring of PBS/IC treatment efficacy.
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Affiliation(s)
- Jukka Sairanen
- Department of Urology, Helsinki University Hospital, PL 580, 00029 HUS, Helsinki, Finland.
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Abstract
Sensory bladder disorders include disorders involving abnormal sensations resulting from many diseases of the urinary bladder. In a proportion of patients no cause can be found and if pain or pelvic pressure is a part of the symptomatology, they are labelled as having painful bladder syndrome (PBS). In a subgroup of these patients abnormal findings can be demonstrated at cystoscopy and/or by histological examination of bladder biopsies. These patients are categorised as having interstitial cystitis (IC). This paper looks into the differential diagnosis, evaluation and treatment of patients with PBS.
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Affiliation(s)
- J Nordling
- Department of Urology, Copenhagen University Hospital in Herlev, DK 2730 Herlev, Denmark.
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Brookoff D, Bennett DS. Neuromodulation in Intractable Interstitial Cystitis and Related Pelvic Pain Syndromes. PAIN MEDICINE 2006. [DOI: 10.1111/j.1526-4637.2006.00132.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Philip J, Willmott S, Irwin P. Interstitial Cystitis Versus Detrusor Overactivity: A Comparative, Randomized, Controlled Study of Cystometry Using Saline and 0.3 M Potassium Chloride. J Urol 2006; 175:566-70; discussion 570-1. [PMID: 16406997 DOI: 10.1016/s0022-5347(05)00238-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Indexed: 11/23/2022]
Abstract
PURPOSE We compared cystometric findings in interstitial cystitis and detrusor overactivity using 0.3 M KCl and 0.9% normal saline. MATERIALS AND METHODS Female patients with established diagnoses of IC (7 patients according to NIDDK criteria) and urodynamically proven DO (10 patients) underwent consecutive cystometrograms using 0.9% normal saline and 0.3 M KCl, the order of which was randomized for each patient. Individual CMGs were performed by separate investigators, and patients and investigators were blinded to the order in which the solutions were used and to the results of the other CMG. The results were analyzed on a comparative basis using a 2-tailed t test for comparison of the means and a Kolmogorov-Smirnov z test was used for group comparison. A ROC curve was used to plot sensitivity to the false-positive rate. RESULTS Irrespective of the diagnosis or the type of infusion used, the volume at FDV was slightly lower with the first CMG compared to the second (mean 76.1 vs 94.2 ml) but did not reach statistical significance (p = 0.20). However, Cmax was similar for first and second CMGs (mean 214 vs 213.2 ml, p = 0.98). Although lower with KCl, there was no significant difference in FDVs obtained with either solution (mean 78.2 vs 92.2 ml for KCl and NS, respectively, p = 0.33). However, KCl produced a significant reduction in Cmax across the whole group (mean 244.5 vs 182.7 ml, p = 0.008). This was most marked in the DO group in which there was a 23% reduction in Cmax with KCl compared to NS, while the IC group showed only a 15% reduction in mean Cmax. The ROC curve, comparing Cmax values for NS with KCl cutoff values of 15% and 30%, resulted in poor positive predictive values (51% and 66%, respectively) for comparative cystometry in distinguishing IC from DO. CONCLUSIONS The 0.3 M KCl reduces Cmax in IC and DO, the effect being more pronounced in DO. Urothelial hyperpermeability is not specific to IC. Comparative cystometry using NS and 0.3 M KCl does not help to differentiate IC from DO.
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Affiliation(s)
- Joe Philip
- Michael Heal Department of Urology, Leighton Hospital, Crewe, Cheshire, United Kingdom
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Philip J, Willmott S, Owen D, Samsudin C, Irwin PP. A double-blind, randomized controlled trial of cystometry using saline versus 0.3 M potassium chloride infusion in women with overactive bladder syndrome. Neurourol Urodyn 2006; 26:110-4. [PMID: 17009304 DOI: 10.1002/nau.20216] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM To evaluate the effect of 0.3 M potassium chloride on cystometric parameters by comparing it with normal saline as a filling solution in women with overactive bladder (OAB). PATIENTS AND METHODS Twenty-three women with significant OAB symptoms underwent consecutive cystometrograms (CMGs) using 0.9% normal saline (NS) and 0.3 M potassium chloride (KCl), the order of which was randomized for each patient. Individual CMGs were performed by separate investigators and both patients and investigators were blinded to the order in which each solution was given and to the results of the other CMG. RESULTS Regardless of the nature of the filling solution, the order in which the CMGs were performed had little influence on either first desire to void (FDV, mean 83.5 ml vs. 117.8 ml for first and second CMGs respectively, P = 0.10) or on maximum cystometric capacity (Cmax, mean 265.0 ml vs. 264.4 ml, P = 0.98). KCl produced a significant (24%) reduction in mean Cmax compared to NS (mean 228.6 ml vs. 300.8 ml, P = 0.001), irrespective of the order of infusion. CONCLUSION This comparative study using 0.3 M KCl versus NS as filling solutions suggests that intravesical potassium may not simply act on urothelial sensory nerve endings; it may also stimulate detrusor muscle contraction. These findings may influence the interpretation of the potassium sensitivity test in patients with OAB symptoms, particularly in those suspected of having interstitial cystitis.
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Affiliation(s)
- Joe Philip
- Michael Heal Department of Urology, Leighton Hospital, Crewe, Cheshire, United Kingdom
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000185331.32574.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Porru D, Tinelli C, Gerardini M, Giliberto GL, Stancati S, Rovereto B. Evaluation of urinary and general symptoms and correlation with other clinical parameters in interstitial cystitis patients. Neurourol Urodyn 2005; 24:69-73. [PMID: 15573384 DOI: 10.1002/nau.20084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS Interstitial cystitis (IC) has been deemed by some authors as a local manifestation of a systemic disease, particularly one of the autoimmune disorders. In order to provide an answer to the question whether IC patients do or do not indiscriminately report high scores for various somatic symptoms, we compared University of Wisconsin scores (U-W scores), including both urinary and non-urinary symptoms, for 30 IC female patients and 30 female controls. MATERIALS AND METHODS A total of 30 female patients with IC and 30 healthy female controls were recruited for the study. All patients had to meet the symptom criteria established by the National Institute for Diabetes and Digestive and Kidney Diseases. Each patient completed a University of Wisconsin symptom scale, after translation (WICS). RESULTS In the IC group median score was zero for all, but two of the reference symptoms: abdominal cramps and dizziness. All urinary symptoms were significantly increased in IC patients compared to controls. In the control group, the median value of urinary symptoms was zero. The duration of the disease was then related to IC symptoms in the patient group. Among the bladder-related symptoms, a good correlation was found for several specific symptoms and urinary symptoms as a whole. An association could be found between a positive potassium sensitivity test (PST) and burning bladder sensation, as well as pelvic discomfort. CONCLUSIONS IC patients had significantly higher scores for the seven urinary symptoms compared to controls. The duration of disease was found to be correlated with the group of seven urinary symptoms.
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Affiliation(s)
- Daniele Porru
- Divisione Urologia, IRCCS Policlinico S. Matteo, Pavia, Italy.
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Daha LK, Riedl CR, Lazar D, Hohlbrugger G, Pflüger H. Do cystometric findings predict the results of intravesical hyaluronic acid in women with interstitial cystitis? Eur Urol 2004; 47:393-7; discussion 397. [PMID: 15716206 DOI: 10.1016/j.eururo.2004.10.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 10/26/2004] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES According to National Institute of Health (NIH) criteria, a bladder capacity of less than 350 cc is an automatic exclusion for a diagnosis of Interstitial Cystitis (IC). In the present study, patients, showing symptoms of IC and with bladder capacities of <350 and >/=350 cc were tested as to their response to a intravesical hyaluronic acid therapy. METHODS The study included 48 patients with clinical symptoms of IC and a positive 0.4 M potassium sensitivity test. Maximum bladder capacity (C(max)) was assessed for the 0.9% NaCl solution first and then for the 0.2 M KCl solution. After the NaCl cystometry, patients were separated into two groups: Group I with a C(max) of <350 cc and Group II with a C(max) of >/=350 cc. Both groups were again separated in two further groups as to the respective percentage reduction of C(max) with the 0.2 M KCl solution: Group Ia/IIa (>/=30%) and Group Ib/IIb (<30%). Patients were treated with weekly instillations of 40 mg hyaluronic acid for 10 consecutive weeks. Pre- and post-treatment bladder symptoms were evaluated through their visual analog scale (VAS) scores. RESULTS With the saline solution, 32 patients had a C(max) of <350 cc (Group I), while 16 patients had a C(max) of >/=350 cc (Group II). Evaluation of VAS scores confirmed a positive response, i.e. symptom relief, to hyaluronic acid therapy, irrespective of bladder capacity. The improvement was particularly evident in patients with a C(max) reduction of >/=30% versus those with a reduction of <30% with the 0.2 M KCl solution (p=0.003). CONCLUSION The present study demonstrates that patients with typical IC symptoms and a cystometric bladder capacity of >/=350 cc, may have increased potassium sensitivity as a sign of IC and show symptom improvement after hyaluronic acid instillation therapy.
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Affiliation(s)
- Lukas K Daha
- Department of Urology and Ludwig Boltzmann Institute of Urology and Andrology, Municipal Hospital Lainz, Wolkersbergenstrasse 1, A - 1130, Vienna, Austria.
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