Interstitial cystitis/painful bladder syndrome: diagnostic evaluation and therapeutic response in a private urogynecology unit

Background

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a spectrum of pelvic, bladder or urethral pain, as well as irritative voiding symptoms. The term interstitial cystitis (IC) is reserved for patients with typical cystoscopic features. Diagnosis and management of this syndrome may be difficult. The aim of this study was to describe endoscopic features and our experience on the treatment of this syndrome in Urodifem de Occidente S.C., a private urogynecology unit.

Methods

Observational, retrospective analytic study of 25 treated patients from 33 with diagnosis of IC/PBS between January 2001 and March 2015. The diagnosis was done by clinical, cystoscopic and urodynamic approach. Treatment was based on bladder instillation of dymetilsulfoxido (DMSO), dexamethasone and heparin. Oral pentosan polysulphate was prescribed for at least 1 year.

Results

Cystoscopic findings showed petechial hemorrhages in 32%, Hunner’s lesions in 28%, glomerulations in 28% and bladder pain in absence of lesions in 12%. The basic treatment included one instillation once a week for 6 weeks, twice a month for 2 months and four monthly instillations. Three cases had complete remission of their symptoms, 21 had significant improvement and we have only one failure.

Conclusions

We recommend the combined use of DMSO instillation and pentosan polysulphate (PPS) in cases of IC/PBS.

[Experience in the treatment of interstitial cystitis: review of 17 cases]

BACKGROUND

The Interstitial Cystitis (IC) has been considered in the past an uncommon pathology, however it has received a special attention during the last 20 years, (1678 scientific articles published since 1984 to 2009). There are many therapeutic options not at all satisfactory because there isn't consensus about diagnostic and treatment.

OBJECTIVE

To share our experiences in the treatment of interstitial cystitis, additionally, to comment on the therapeutic response of treatment used.

MATERIAL AND METHOD

Observational, retrospective an analytic study of 17 treated patients from 22 with diagnosis of IC and Bladder Painful Syndrome (IC/BPS) were managed in Urodifem de Occidente, S.C. a private Urogynecologic unit between January 2001 and April 2010. The diagnosis was done in agreement with the concepts of Interstitial Cystitis group from clinical and cystoscopic characteristics. The treatment was: Dimethyl sulfoxide (DIMSO) and Pentosan Polysulfate.

RESULTS

The evaluation was measured by Interstitial Cystitis Symptomatic Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) both validated evaluation instruments, 82% of the patients had a significative improvement of symptomatology and quality of live The ICSI pre and post treatment was of 17.0 and 4.5 and the ICPI was of 14.8 and 4.1 respectively.

CONCLUSION

We recommend the use of combine treatment of DIMSO and PPS in cases of I.C.

[Clinical and diagnostic evaluation in patients with interstitial cystitis]

BACKGROUND

Interstitial cystitis is a disease of unknown origin; in the last twenty years several epidemiological studies reported an increase in frequency.

OBJECTIVE

To describe the symptoms, cystoscopic and histologic findings of 18 cases of interstitial cystitis.

PATIENTS AND METHOD

A descriptive, retrospective and analytical study of 331 women with lower urinary tract symptoms studied in Urodifem de Occidente, (private Urogynecology Clinic), between January 2001 and April 2008. The diagnostic criterion was in agreement with the NIDDK and the Interstitial Cystitis DataBase Study. The statistical analysis was in interval scale means, standard deviations and ranges. Indeed Spearman's rank correlation coefficient.

RESULTS

The most common symptoms were: urinary frequency (100%) nocturia (94.4%), urgency (72%), pain (66.6%), urgency-incontinence (16.7%). Endoscopic lesions were glomerular in 55% and Hunner ulcers in 44.5%. The severity of quality of life resulted in average of 16.7 +/- 2.9 and 15 +/- 2, p < 0.001.

CONCLUSIONS

Urogynecologists must considerer interstitial cystitis when patients show symptoms of bladder irritability and associate pain with the bladder filling. The association of hematuria accompanied by long-term irritability and pain associated with the desire of urination suggests this disease. Cystoscopy is sufficient to confirm the diagnosis.

[Contribution of bladder biopsy to the study of urogynaecological patient]

BACKGROUND

One of the characteristics of urinary symptoms in women is their lack of specificity. Patients with stress incontinence or urgency, local irritation, infection, distal stenosis or a neoplastic process have very similar symptoms.

OBJECTIVE

Determine the frequency of bladder structural lesions detected by urethrocistoscopy in which we performed bladder biopsies.

MATERIAL AND METHOD

Descriptive, retrospective, analytical study of files and videos of 331 patients treated in Urodifem de Occidente (private Urogynecology Center). Thirty-five biopsies were taken. The statistical analysis was expressed as means standard deviations, ranges, percentages and Fishers test.

RESULTS

Patients ages range 30-90 years average 60+13.76. Predominant symptoms were: irritative vesical syndrome 62.8%; pelvic pain 45.71%; urge incontinence 31.4%; hematuria 31.4%; vesical voiding dysfunction 11.4%. Principal endoscopic findings: Urethrotrigonitis; glomerular lesions or Hunner ulcers; vesical trabeculations; tumor or suspect lesions. Histopathologic findings were: Interstitial Cystitis 42.9%; chronic Cystitis 11.4%; Cystitis glandularis 8.6%; Cystitis follicular 11.4%; bladder cancer 5.7%; Vesical Papilloma 5.7%.

CONCLUSIONS

This study supports the practice of vesical biopsy when lesions other than those from chronic infection are observes in the presence of tumors or suspect lesions.