1
|
Yu J, Lee CU, Lee KS, Ko KJ. Optimal endoscopic treatment and partial cystectomy with or without bladder augmentation for Hunner-type interstitial cystitis. Low Urin Tract Symptoms 2023; 15:216-224. [PMID: 37750459 DOI: 10.1111/luts.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) presents a significant challenge for urologists in terms of management, owing to its chronic nature and adverse impact on patient quality of life. Given the potential distinction between two disease entities within IC/BPS, namely Hunner-type IC and BPS without Hunner lesion, there is a need for an optimal therapeutic approach that focuses on the bladder lesions in Hunner-type IC. In cases where Hunner lesions are observed, complete transurethral ablation of these lesions should be prioritized as the initial intervention, as it has demonstrated effectiveness in symptom control. However, recurrence remains a limitation of this intervention. The techniques of resection and coagulation are equally effective in terms of symptom relief and recurrence prevention. Reconstructive surgery becomes necessary in cases of end-stage IC/BPS where various therapeutic approaches have failed. Patient selection is crucial in reconstructive surgery, particularly for patients with clear Hunner lesions and small bladder capacity who have not responded to previous treatments. Furthermore, it is vital to consider the patients' expectations and preferences adequately. Based on a comprehensive review of the literature and our own clinical experiences, subtotal cystectomy followed by bladder augmentation is considered a safe and effective surgical option. This stepwise and tailored therapeutic approach aims to optimize patients' quality of life by specifically targeting Hunner-type IC.
Collapse
Affiliation(s)
- Jiwoong Yu
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Research Institute for Future Medicine Samsung Medical Center, Seoul, Republic of Korea
| | - Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
2
|
Pathophysiology and Clinical Biomarkers in Interstitial Cystitis. Urol Clin North Am 2023; 50:39-52. [DOI: 10.1016/j.ucl.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
3
|
Osman NI, Bratt DG, Downey AP, Esperto F, Inman RD, Chapple CR. A Systematic Review of Surgical interventions for the Treatment of Bladder Pain Syndrome/Interstitial Cystitis. Eur Urol Focus 2021; 7:877-885. [DOI: 10.1016/j.euf.2020.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/04/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
|
4
|
Abstract
PURPOSE OF REVIEW With recent advances in sequencing technologies and increasing research into the gut microbiome (GMB), studies have revealed associations between the GMB and urinary stone disease (USD). We sought to determine whether the evidence pointed towards a few specific gut bacteria or the broader GMB network is seemingly responsible for this relationship. RECENT FINDINGS Initially, Oxalobacter formigenes (OF) was pursued as the main link between GMB and USD given its ability to degrade oxalate in the gut. However, the latest studies consistently suggest that the entire GMB is much more likely to be involved in handling oxalate absorption and other risk factors for urinary stone formation, rather than just a few microbiota. The GMB has complex networks that are likely involved in the pathophysiology of USD, although the causal mechanisms remain unclear. With increasing interest and research, potential modalities that act on the GMB may help to prevent incidence of USD.
Collapse
Affiliation(s)
- Justin A Lee
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Joshua M Stern
- Department of Urology, Montefiore Medical Center, 1250 Waters Place - Tower 2 - 9th floor, Bronx, NY, 10461, USA.
| |
Collapse
|
5
|
Tudrej KB, Piecha T, Kozłowska-Wojciechowska M. Role of NLRP3 inflammasome in the development of bladder pain syndrome interstitial cystitis. Ther Adv Urol 2019; 11:1756287218818030. [PMID: 30671141 PMCID: PMC6329030 DOI: 10.1177/1756287218818030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/17/2018] [Indexed: 12/20/2022] Open
Abstract
Although it has been proposed that NOD-like receptor protein 3 (NLRP3) inflammasome activation may have an important contribution to the onset of bladder pain syndrome/interstitial cystitis (BPS/IC), as of today there is still insufficient evidence to accept or to reject this hypothesis. However, taking into consideration that inflammasomes have been already shown as important mediators of cyclophosphamide-induced bladder inflammation and that some studies have also revealed human bladder epithelium expresses high levels of NLRP3, such a hypothesis seems to be reasonable. The purpose of this review is to discuss a scenario that NLRP3 inflammasome is a crucial player in the development of this disease. Identification of a novel mediator of bladder inflammation and pain could lead to emerging new therapeutic strategy and the first causative therapy.
Collapse
Affiliation(s)
- Karol Borys Tudrej
- Medical University of Warsaw, Banacha 1, Warszawa, Mazowieckie, 02-097, Poland
| | - Tomasz Piecha
- Medical University of Warsaw, Warszawa, Mazowieckie, Poland
| | | |
Collapse
|
6
|
Antunes-Lopes T, Vale L, Coelho AM, Silva C, Rieken M, Geavlete B, Rashid T, Rahnama'i SM, Cornu JN, Marcelissen T. The Role of Urinary Microbiota in Lower Urinary Tract Dysfunction: A Systematic Review. Eur Urol Focus 2018; 6:361-369. [PMID: 30270128 DOI: 10.1016/j.euf.2018.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/30/2018] [Accepted: 09/16/2018] [Indexed: 01/01/2023]
Abstract
CONTEXT Until 2012, the urinary tract of healthy individuals was considered to be sterile. The advent of metagenomic sequencing revealed a unique urinary microbiota (UM). This paradigm shift appears to have prolific implications in the etiology of several functional lower urinary tract (LUT) disorders. OBJECTIVE To systematically summarize recent data on the role of UM in LUT dysfunction. EVIDENCE ACQUISITION We performed a critical review according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. We conducted a search on PubMed/MEDLINE and SCOPUS with the following MESH terms/keywords: "Microbiome OR Microbiota AND (urinary disorder OR urinary tract symptom OR overactive bladder OR urinary incontinence OR interstitial cystitis OR chronic prostatitis)." The range of search was placed between January 2010 and April 2018, and articles with no full text available or those not written in English were excluded. All retrieved papers were first reviewed by title and abstract, yielding a total of 303 papers. Additional manuscripts, such as those referenced by reviews, were further included. Thirty-six publications were included. EVIDENCE SYNTHESIS Analysis by 16S rRNA sequence and expanded quantitative urine culture provided evidence for the presence of live bacteria in urine, nondetectable by standard culture protocols. Moreover, differences in the UM between healthy individuals and patients with LUT dysfunction were demonstrated. CONCLUSIONS In the near future, urologists must consider urinary dysbiosis as a possible cause of different functional LUT disorders, with potential clinical implications in their diagnosis and treatment. PATIENT SUMMARY Development of metagenomic sequencing revealed a unique urinary microbiota nondetectable by standard culture protocols. This systematic review summarizing recent data on the role of urinary microbiota in lower urinary tract (LUT) dysfunction supports urinary dysbiosis as a possible cause of different functional LUT disorders.
Collapse
Affiliation(s)
- Tiago Antunes-Lopes
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Hospital S. João, Porto, Portugal.
| | - Luis Vale
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Hospital S. João, Porto, Portugal
| | | | - Carlos Silva
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Hospital S. João, Porto, Portugal
| | - Malte Rieken
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Bogdan Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - Tina Rashid
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sajjad M Rahnama'i
- Maastricht University, Maastricht, The Netherlands; Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | | | - Tom Marcelissen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | |
Collapse
|
7
|
Dinis S, de Oliveira JT, Pinto R, Cruz F, Buffington CT, Dinis P. From bladder to systemic syndrome: concept and treatment evolution of interstitial cystitis. Int J Womens Health 2015; 7:735-44. [PMID: 26229509 PMCID: PMC4516339 DOI: 10.2147/ijwh.s60798] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Interstitial cystitis, presently known as bladder pain syndrome, has been recognized for over a century but is still far from being understood. Its etiology is unknown and the syndrome probably harbors different diseases. Autoimmune dysfunction, urothelial leakage, infection, central and peripheral nervous system dysfunction, genetic disease, childhood trauma/abuse, and subsequent stress response system dysregulation might be implicated. Management is slowly evolving from a solo act by the end-organ specialist to a team approach based on new typing and phenotyping of the disease. However, oral and invasive treatments are still largely aimed at the bladder and are based on currently proposed pathophysiologic mechanisms. Future research will better define the disease, permitting individualization of treatment.
Collapse
Affiliation(s)
- Sara Dinis
- Faculty of Medicine, University of Porto, Porto, Portugal ; Department of Obstetrics and Gynecology, Hospital de São João, Porto, Portugal
| | - Joana Tavares de Oliveira
- Faculty of Veterinary Medicine, ULHT, Lisbon, Portugal ; Institute of Molecular Pathology and Immunology (IPATIMUP), University of Porto, Porto, Portugal
| | - Rui Pinto
- Faculty of Medicine, University of Porto, Porto, Portugal ; Department of Urology, Hospital de São João, Porto, Portugal
| | - Francisco Cruz
- Faculty of Medicine, University of Porto, Porto, Portugal ; Department of Urology, Hospital de São João, Porto, Portugal
| | - Ca Tony Buffington
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, OH, USA
| | - Paulo Dinis
- Faculty of Medicine, University of Porto, Porto, Portugal ; Department of Urology, Hospital de São João, Porto, Portugal
| |
Collapse
|
8
|
Kuo HC, Jiang YH, Tsai YC, Kuo YC. Intravesical botulinum toxin-A injections reduce bladder pain of interstitial cystitis/bladder pain syndrome refractory to conventional treatment - A prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial. Neurourol Urodyn 2015; 35:609-14. [DOI: 10.1002/nau.22760] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/12/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
- School of Medicine; Tzu Chi University; Hualien Taiwan
| | - Yuan-Hong Jiang
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
- School of Medicine; Tzu Chi University; Hualien Taiwan
| | - Yao-Chou Tsai
- School of Medicine; Tzu Chi University; Hualien Taiwan
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; New Taipei Taiwan
| | - Yuh-Chen Kuo
- School of Medicine; Tzu Chi University; Hualien Taiwan
- Department of Urology; Yangming Branch of Taipei City Hospital; Taipei Taiwan
| |
Collapse
|
9
|
Jhang JF, Jiang YH, Kuo HC. Potential therapeutic effect of intravesical botulinum toxin type A on bladder pain syndrome/interstitial cystitis. Int J Urol 2014; 21 Suppl 1:49-55. [DOI: 10.1111/iju.12317] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/14/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Jia-Fong Jhang
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
| | - Yuan-Hong Jiang
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
| | - Hann-Chorng Kuo
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
| |
Collapse
|
10
|
Cashley MAP, Cashley MA. Chiropractic care of interstitial cystitis/painful bladder syndrome associated with pelvic lumbar spine dysfunction: a case series. J Chiropr Med 2013; 11:260-6. [PMID: 23843758 DOI: 10.1016/j.jcm.2011.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/22/2011] [Accepted: 10/28/2011] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this case series is to describe findings for patients with bladder pain syndrome (BPS) or interstitial cystitis (IC) who responded positively under chiropractic care. CLINICAL FEATURES Eight cases were selected retrospectively reviewed from 2 independent chiropractic clinics in Scotland. Cases were selected if patients reported bladder dysfunction problems and responded positively to chiropractic care. The cases in this report describe the range of patients affected by this condition. Each patient was treated using chiropractic methods that were specific to the individual case. INTERVENTION AND OUTCOMES The patients selected for this case series showed positive response to chiropractic care over various lengths of time and numbers of treatments. Some of the chiropractic patients who had chronic spinal conditions had reoccurrence of bladder symptoms during an exacerbation of mechanical spinal problems. CONCLUSION This case series highlights that bladder and urinary problems may be associated with spinal dysfunction for some patients.
Collapse
|
11
|
Siddiqui H, Lagesen K, Nederbragt AJ, Jeansson SL, Jakobsen KS. Alterations of microbiota in urine from women with interstitial cystitis. BMC Microbiol 2012; 12:205. [PMID: 22974186 PMCID: PMC3538702 DOI: 10.1186/1471-2180-12-205] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/05/2012] [Indexed: 02/07/2023] Open
Abstract
Background Interstitial Cystitis (IC) is a chronic inflammatory condition of the bladder with unknown etiology. The aim of this study was to characterize the microbial community present in the urine from IC female patients by 454 high throughput sequencing of the 16S variable regions V1V2 and V6. The taxonomical composition, richness and diversity of the IC microbiota were determined and compared to the microbial profile of asymptomatic healthy female (HF) urine. Results The composition and distribution of bacterial sequences differed between the urine microbiota of IC patients and HFs. Reduced sequence richness and diversity were found in IC patient urine, and a significant difference in the community structure of IC urine in relation to HF urine was observed. More than 90% of the IC sequence reads were identified as belonging to the bacterial genus Lactobacillus, a marked increase compared to 60% in HF urine. Conclusion The 16S rDNA sequence data demonstrates a shift in the composition of the bacterial community in IC urine. The reduced microbial diversity and richness is accompanied by a higher abundance of the bacterial genus Lactobacillus, compared to HF urine. This study demonstrates that high throughput sequencing analysis of urine microbiota in IC patients is a powerful tool towards a better understanding of this enigmatic disease.
Collapse
Affiliation(s)
- Huma Siddiqui
- Department of Biology, Centre for Ecological and Evolutionary Synthesis (CEES), University of Oslo, P,O, Box 1066, Blindern, 0316, Oslo, Norway
| | | | | | | | | |
Collapse
|
12
|
Friedlander JI, Shorter B, Moldwin RM. Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU Int 2012; 109:1584-91. [PMID: 22233286 DOI: 10.1111/j.1464-410x.2011.10860.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
What's known on the subject? and What does the study add? Nearly 90% of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) report sensitivities to a wide variety of dietary comestibles. Current questionnaire-based literature suggests that citrus fruits, tomatoes, vitamin C, artificial sweeteners, coffee, tea, carbonated and alcoholic beverages, and spicy foods tend to exacerbate symptoms, while calcium glycerophosphate and sodium bicarbonate tend to improve symptoms. At present we recommend employing a controlled method to determine dietary sensitivities, such as an elimination diet, in order to identify sensitivities while at the same time maintain optimal nutritional intake. We review current literature with regard to diet's effect upon IC/BPS and common comorbidities (irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, neuropathic pain, vulvodynia, and headache) with a focus upon questionnaire-based investigations. We discuss the pathologic mechanisms that may link diet and IC/BPS related-pain, concentrating upon specific comestibles such as acidic foods, foods high in potassium, caffeine, and alcohol. Up to 90% of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) report sensitivities to a wide variety of comestibles. Pathological mechanisms suggested to be responsible for the relationship between dietary intake and symptom exacerbation include peripheral and/or central neural upregulation, bladder epithelial dysfunction, and organ 'cross-talk', amongst others. Current questionnaire-based data suggests that citrus fruits, tomatoes, vitamin C, artificial sweeteners, coffee, tea, carbonated and alcoholic beverages, and spicy foods tend to exacerbate symptoms, while calcium glycerophosphate and sodium bicarbonate tend to improve symptoms. Specific comestible sensitivities varied between patients and may have been influenced by comorbid conditions. This suggests that a controlled method to determine dietary sensitivities, such as an elimination diet, may play an important role in patient management.
Collapse
Affiliation(s)
- Justin I Friedlander
- The Arthur Smith Institute for Urology, Department of Nutrition, New Hyde Park, NY, USA.
| | | | | |
Collapse
|
13
|
Nosseir SB, Lind LR, Winkler HA. Recurrent uncomplicated urinary tract infections in women: a review. J Womens Health (Larchmt) 2011; 21:347-54. [PMID: 22136339 DOI: 10.1089/jwh.2011.3056] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recurrent urinary tract infections most often present with symptoms of irritative voiding. In most cases, they are caused by reinfection with a previously isolated organism. Patients with one or more symptoms of uncomplicated recurrent urinary tract infection should undergo thorough examination and screening for underlying comorbidities that increase susceptibility. When frequent reinfections, empiric treatment relapse, persistent infections, or risk factors for complicated infections are encountered, patients may benefit from urodynamics, cystoscopy, renal ultrasound, intravenous urogram, or voiding cystourethrogram to evaluate for anatomic, functional, or metabolic abnormalities affecting the urinary tract (e.g., stones, stricture, obstruction, vesicoureteral reflux, lesions, detrusor underactivity). These patients may benefit from culture-guided empiric treatment and further evaluation by urology, nephrology, or infectious disease specialists. In patients with a history of uncomplicated urinary tract infections, empiric treatment guided by local antimicrobial resistance may efficiently treat a suspected recurrence. After successful treatment of the acute infection, postcoital prophylaxis, continuous prophylaxis, or self-start empiric treatment may be selected based on frequency of recurrent infections, temporal relation to intercourse, and patient characteristics. Ancillary measures such as probiotics, cranberry products, or local estrogen replacement may also be considered. This article will review the current definition, epidemiology, pathogenesis, diagnosis, work-up, treatment, treatment side effects, and prevention of recurrent urinary tract infections in women. A suggested algorithm for evaluation and treatment based on current literature is provided.
Collapse
Affiliation(s)
- Sandy B Nosseir
- Division of Urogynecology, Female Pelvic Medicine and Reconstructive Surgery Department of Obstetrics and Gynecology, North Shore-Long Island Jewish Health System, Great Neck, New York 11021, USA.
| | | | | |
Collapse
|
14
|
Acid-sensing channels in human bladder: expression, function and alterations during bladder pain syndrome. J Urol 2011; 186:1509-16. [PMID: 21855903 DOI: 10.1016/j.juro.2011.05.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Indexed: 12/27/2022]
Abstract
PURPOSE We examined the possible role of H(+) activated acid-sensing ion channels in pain perception. We characterized expression in bladder dome biopsies from patients with bladder pain syndrome and controls, in cultured human urothelium and in urothelial TEU-2 cells. MATERIALS AND METHODS Cold cut biopsies from the bladder dome were obtained in 8 asymptomatic controls and 28 patients with bladder pain syndrome symptoms. Acid-sensing ion channel expression was analyzed by quantitative real-time polymerase chain reaction and immunofluorescence. Channel function was measured by electrophysiology. RESULTS Acid-sensing ion channel 1a, 2a and 3 mRNA was detected in the human bladder. Similar amounts of acid-sensing ion channel 1a and 3 were detected in detrusor smooth muscle while in urothelium acid-sensing ion channel 3 levels were higher than levels of acid-sensing ion channel 1a. Acid-sensing ion channel 2a mRNA levels were lower than acid-sensing ion channel 1a and 3 levels in each layer. Acid-sensing ion channel currents were measured in TEU-2 cells and in primary cultures of human urothelium. Activated acid-sensing ion channel expression was confirmed by quantitative real-time polymerase chain reaction. TEU-2 cell differentiation caused acid-sensing ion channel 2a and 3 mRNA up-regulation, and acid-sensing ion channel 1a mRNA down-regulation. Patients with bladder pain syndrome showed up-regulation of acid-sensing ion channel 2a and 3 mRNA but acid-sensing ion channel 1a remained unchanged. In contrast, transient receptor potential vanilloid 1 mRNA was down-regulated during bladder pain syndrome. All differences were statistically significant (p <0.05). CONCLUSIONS Several acid-sensing ion channel subunits are expressed in human bladder and TEU-2 cells, in which levels are regulated during urothelial differentiation. Up-regulation of acid-sensing ion channel 2a and 3 in patients with bladder pain syndrome suggests involvement in increased pain and hyperalgesia. Down-regulation of transient receptor potential vanilloid 1 mRNA might indicate that a different regulatory mechanism controls its expression in the human bladder.
Collapse
|
15
|
Abstract
Painful bladder syndrome or urologic chronic pelvic pain syndrome is a chronic condition that presents with lower urinary tract symptoms that include dysuria, urgency, frequent urination, and chronic pelvic pain. Diagnoses included in the painful bladder syndrome are interstitial cystitis and prostatodynia. The history, physical examination, and laboratory evaluation of patients with lower urinary tract symptoms are important in ruling out other diagnoses. Treatment options that are US Food and Drug Administration approved and evidence based are limited; however, many symptom-based treatment options can reduce symptoms and improve quality of life.
Collapse
Affiliation(s)
- Viviana Martinez-Bianchi
- Duke Family Medicine Residency Program, Division of Family Medicine, Department of Community and Family Medicine, Duke University, DUMC 3886, Durham, NC 27710, USA.
| | | |
Collapse
|
16
|
Lewis M, Snyder P, Pietrzak R, Darby D, Feldman R, Maruff P. The effect of acute increase in urge to void on cognitive function in healthy adults. Neurourol Urodyn 2010; 30:183-7. [DOI: 10.1002/nau.20963] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
17
|
Marinkovic SP, Gillen LM, Marinkovic CM. Minimum 6-year outcomes for interstitial cystitis treated with sacral neuromodulation. Int Urogynecol J 2010; 22:407-12. [PMID: 20848271 DOI: 10.1007/s00192-010-1235-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 07/25/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Interstitial cystitis is a multifaceted medical condition consisting of pelvic pain, urgency, and frequency. Can sacral neuromodulation be successfully utilized for the medium term of ≥ 6 years in interstitial cystitis patients for whom standard drug therapies have failed? METHODS In our observational, retrospective, case-controlled review (January 2002-March 2004), we sought to discern whether neuromodulation could be successfully implemented with acceptable morbidity rates in interstitial cystitis patients. Thirty-four female patients underwent stage 1 and 2 InterStim placements under a general anesthetic. Simple means and medians were analyzed. RESULTS Mean pre-op/post-op pelvic pain and urgency/frequency scores were 21.61 ± 8.6/9.22 ± 6.6 (p < 0.01), and mean pre-op/post-op visual analog pain scale (VAPS) were 6.5 ± 2.9/2.4 ± 1.1 (p < 0.01). Median age was 41 ± 14.8 years with a mean follow-up of 86 ± 9.8 months. CONCLUSIONS With a minimum 6-year follow-up we determined that sacral neuromodulation provides adequate improvement for the symptoms of recalcitrant interstitial cystitis.
Collapse
Affiliation(s)
- Serge P Marinkovic
- Department of Urology and Urogynecology, Women's and Children's Hospital, Lafayette, LA 70508, USA.
| | | | | |
Collapse
|
18
|
Abstract
Fibromyalgia (FM) is a challenging condition, but the management of patients with FM is becoming facilitated by new medications that act in what are thought to be some of most important pathophysiological features in this syndrome. However, it is of pivotal importance that an interdisciplinary approach is used to improve pain, fatigue, sleep and other domains to improve quality of life. Here, we present elements of management that the solo practitioner can tackle, focussing in the formally approved drugs for FM and other drugs commonly used in this condition. Further, the elements of an ideal multidisciplinary team are presented, and on how to incorporate their recommendations for the treatment of FM.
Collapse
Affiliation(s)
- Eduardo S Paiva
- Universidade Federal do Parana, Hospital de Clinicas -Rua General Carneiro, 181 Curitiba, PR 80060-900, Brazil.
| | | |
Collapse
|
19
|
Maskell RM. The natural history of urinary tract infection in women. Med Hypotheses 2010; 74:802-6. [PMID: 20064694 DOI: 10.1016/j.mehy.2009.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 12/09/2009] [Indexed: 11/17/2022]
Abstract
Many women who suffer from the symptoms of urinary tract infection have a negative urine culture when conventional methods are used. Their condition is described as 'urethral' (or 'dysuria/frequency') syndrome' (US). As they may be indistinguishable clinically from those with positive cultures antibiotics are often prescribed. Their symptoms are usually recurrent and they may receive many courses of treatment. Some women are said to have 'interstitial cystitis' (IC); they have a long history of symptoms and antibacterial treatment. The urine contains white blood cells (pyuria) and biopsy of the bladder wall shows the histological changes of chronic inflammation. Additional culture techniques applied to urine from these two groups of patients consistently yield bacteria, most commonly lactobacilli in those with US. From the urine of women with IC, lactobacilli and some other 'fastidious' bacteria are isolated from catheter specimens and also from bladder wall biopsies. These bacteria are known to be constituents of the mixed commensal flora of the distal one-third of the urethra. It is proposed that these two syndromes are different stages in the natural history of UTI, and that antibacterial agents, by selection of resistant bacteria in the urethral commensal flora, are an important aetiological factor. It is possible that these bacteria may invade the paraurethral glands via their ducts - a situation analogous to invasion of the prostate in men. There is a considerable body of evidence supporting this hypothesis, but as it all emanates from one centre it needs to be confirmed elsewhere. Acceptance would bring great clinical benefit and considerable financial savings. A laboratory protocol which requires only small additional expenditure, and a clinical management regimen are proposed. At present, much antibacterial treatment is prescribed and many patients undergo radiological and invasive investigations such as cystoscopy and urethral dilatation, the latter incurring the risk of post-instrumentation UTI. There is evidence that 'US' responds gradually if antibiotics are withheld. 'IC' is a more difficult problem because bacteria may have invaded the bladder wall. Carefully targeted antibacterial treatment given for at least 10-14 days might be effective, but there are no data on this. Rational management of 'US' might prevent the development of 'IC'. A recent thorough review of published work on this condition states that the aetiology is still unknown. It appears, however, that no attempt has been made in any recent studies to use urine culture techniques capable of detecting bacteria other than the recognised aerobic pathogens.
Collapse
|