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Wolf-Johnston A, Ikeda Y, Zabbarova I, Kanai AJ, Bastacky S, Moldwin R, Stern JN, Jackson EK, Birder LA. Purine nucleoside phosphorylase inhibition is an effective approach for the treatment of chemical hemorrhagic cystitis. JCI Insight 2024; 9:e176103. [PMID: 38271096 PMCID: PMC10972598 DOI: 10.1172/jci.insight.176103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/22/2024] [Indexed: 01/27/2024] Open
Abstract
Hemorrhagic cystitis may be induced by infection, radiation therapy, or medications or may be idiopathic. Along with hemorrhagic features, symptoms include urinary urgency and frequency, dysuria (painful urination), and visceral pain. Cystitis-induced visceral pain is one of the most challenging types of pain to treat, and an effective treatment would address a major unmet medical need. We assessed the efficacy of a purine nucleoside phosphorylase inhibitor, 8-aminoguanine (8-AG), for the treatment of hemorrhagic/ulcerative cystitis. Lower urinary tract (LUT) function and structure were assessed in adult Sprague-Dawley rats, treated chronically with cyclophosphamide (CYP; sacrificed day 8) and randomized to daily oral treatment with 8-AG (begun 14 days prior to CYP induction) or its vehicle. CYP-treated rats exhibited multiple abnormalities, including increased urinary frequency and neural mechanosensitivity, reduced bladder levels of inosine, urothelial inflammation/damage, and activation of spinal cord microglia, which is associated with pain hypersensitivity. 8-AG treatment of CYP-treated rats normalized all observed histological, structural, biochemical, and physiological abnormalities. In cystitis 8-AG improved function and reduced both pain and inflammation likely by increasing inosine, a tissue-protective purine metabolite. These findings demonstrate that 8-AG has translational potential for reducing pain and preventing bladder damage in cystitis-associated LUT dysfunctions.
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Affiliation(s)
| | - Youko Ikeda
- Renal-Electrolyte Division, Department of Medicine
| | | | - Anthony J Kanai
- Renal-Electrolyte Division, Department of Medicine
- Department of Pharmacology and Chemical Biology; and
| | - Sheldon Bastacky
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert Moldwin
- Arthur Smith Institute for Urology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Joel Nh Stern
- Arthur Smith Institute for Urology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | | | - Lori A Birder
- Renal-Electrolyte Division, Department of Medicine
- Department of Pharmacology and Chemical Biology; and
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Barker ES, Chiu K, Brown VL, Morsy H, Yaeger LH, Catna A, Pakpahan R, Moldwin R, Shorter B, Lowder JL, Lai HH, Sutcliffe S. Urologic Chronic Pelvic Pain Syndrome Flares: A Comprehensive, Systematic Review and Meta-Analysis of the Peer-Reviewed Flare Literature. J Urol 2024; 211:341-353. [PMID: 38109700 PMCID: PMC11037930 DOI: 10.1097/ju.0000000000003820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE We sought to systematically review and summarize the peer-reviewed literature on urologic chronic pelvic pain syndrome flares, including their terminology, manifestation, perceived triggers, management and prevention strategies, impact on quality of life, and insights into pathophysiologic mechanisms, as a foundation for future empirical research. MATERIALS AND METHODS We searched 6 medical databases for articles related to any aspect of symptom exacerbations for interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. A total of 1486 abstracts and 398 full-text articles were reviewed, and data were extracted by at least 2 individuals. RESULTS Overall, we identified 59 articles, including 36 qualitative, cross-sectional, or case-control; 15 cohort-based; and 8 experimental articles. The majority of studies described North American patients with confirmed diagnoses. "Flare" was a commonly used term, but additional terminology (eg, exacerbation) was also used. Most flares involved significant increases in pain intensity, but less data were available on flare frequency and duration. Painful, frequent, long-lasting, and unpredictable flares were highly impactful, even over and above participants' nonflare symptoms. A large number of perceived triggers (eg, diet, stress) and management/prevention strategies (eg, analgesics, thermal therapy, rest) were proposed by participants, but few had empirical support. In addition, few studies explored underlying biologic mechanisms. CONCLUSIONS Overall, we found that flares are painful and impactful, but otherwise poorly understood in terms of manifestation (frequency and duration), triggers, treatment, prevention, and pathophysiology. These summary findings provide a foundation for future flare-related research and highlight gaps that warrant additional empirical studies.
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Affiliation(s)
- Emily S Barker
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Kimberley Chiu
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Victoria L Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Haidy Morsy
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
- Geisinger, Wilkes Barre, Pennsylvania
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University School of Medicine, St Louis, Missouri
| | - Arya Catna
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Ratna Pakpahan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Robert Moldwin
- The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Lake Success, New York
| | | | - Jerry L Lowder
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - H Henry Lai
- Division of Urological Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri
| | - Siobhan Sutcliffe
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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Kelly AA, Jones K, Pineau O, Nickel JC, Rose J, Moldwin R, Doiron C, Riedl C, Cervigni M, Wyndaele J, Tripp DA. Understanding the sleep-pain relationship in patients with interstitial cystitis/bladder pain syndrome. Can Urol Assoc J 2024; 18:cuaj.8686. [PMID: 38381928 DOI: 10.5489/cuaj.8686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pelvic pain condition with critical symptoms of urinary urgency and frequency, persistent bladder-related pain, and reduced quality of life. Poor quality sleep can lead to significant disturbances in daily life and increased pain in IC/BPS patients. Resilience, depressive symptoms, and pain catastrophizing have univariate associations with sleep and pain in IC/BPS, suggesting they may be mechanisms in this sleep and pain relationship. METHODS This online study recruited patients self-reporting a diagnosis of IC/BPS through support groups, social media posts (Facebook, Reddit, and Instagram), and urology clinic advertisements. Participants completed questionnaires on demographics, urologic symptoms, pain, pain catastrophizing, depressive symptoms, and resilience. Only those participants who met the RICE criteria for IC/BPS diagnosis were included. A multiple mediation model was first examined, followed by a serial mediation model. RESULTS Seventy-four participants (Mage= 47.0, standard deviation [SD] 16.7, range 18-83 years) met inclusion criteria. A multiple mediation model showed greater sleep disturbance was associated with greater pain severity through depressive symptoms and pain catastrophizing, but not resilience (b=0.79, bootSE=0.26, bootCI [0.33, 1.35]). A serial mediation showed that the sleep-to-pain relationship had a significant indirect effect through pain catastrophizing and depressive symptoms (b=0.78, bootSE=0.26, bootCI [0.35, 1.32]). CONCLUSIONS Findings suggest depressive symptoms and pain catastrophizing may be important psychosocial mechanisms in the sleep-to-pain relationship. These results help guide future sleep and pain research in IC/BPS and aid in developing and refining treatments.
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Affiliation(s)
| | - Krista Jones
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Olivia Pineau
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Jessica Rose
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Robert Moldwin
- Department of Urology, Zucker School of Medicine, New York, NY, United States
| | | | - Claus Riedl
- Department of Urology, Landesklinikum Baden, Baden, Austria
| | - Mauro Cervigni
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | | | - Dean A Tripp
- Departments of Psychology, Anesthesia, and Urology, Queen's University, ON, Canada
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Brown VL, James A, Hunleth J, Bradley CS, Farrar JT, Gupta P, Lai HH, Lowder JL, Moldwin R, Rodriguez LV, Yang CC, Sutcliffe S. Believing women: a qualitative exploration of provider disbelief and pain dismissal among women with interstitial cystitis/bladder pain syndrome from the MAPP research network. Int Urogynecol J 2024; 35:139-148. [PMID: 37991567 PMCID: PMC11019919 DOI: 10.1007/s00192-023-05677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/10/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Although allusions to the importance of a good physician-patient relationship are present throughout the interstitial cystitis/bladder pain syndrome (IC/BPS) literature, qualitative analysis of patients' perspectives on the clinical encounter is lacking, particularly among women who are most commonly affected by IC/BPS. Therefore, we adopted a patient-centered experiential approach to understanding female patients' perception of clinical encounters. METHODS We re-analyzed previously collected data from a qualitative study on patient flare experiences including eight focus groups of female IC/BPS patients (n = 57, mean = 7/group). Qualitative analysis applied grounded theory to index all physician-patient interactions, then thematically coded these interactions to elucidate common experiences of clinical encounters. RESULTS Women with IC/BPS shared common experiences of provider disbelief and pain dismissal. Discussions with participants demonstrated the extent to which these negative encounters shape patients' health care-seeking behavior, outlook, and psychosocial well-being. Appearing in more than one guise, provider disbelief and dismissal occurred as tacit insinuations, explicit statements, silence, oversimplification, and an unwillingness to listen and discuss alternative treatment. As a result, women adopted several strategies including: rotating specialists; "testing" physicians; self-advocacy; self-management; avoiding the stigma of chronic pain; crying; and opting for alternative medicine over biomedicine. CONCLUSIONS The prevalence of provider disbelief and pain dismissal among women with IC/BPS indicates a need to improve physician-patient communication, informed by the struggles, anxieties, and gendered inequities that female patients with chronic pain experience in their diagnostic journey. Results suggest that further investigation into the power dynamics of clinical encounters might be required.
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Affiliation(s)
- Victoria L Brown
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Aimee James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean Hunleth
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - John T Farrar
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jerry L Lowder
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert Moldwin
- The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Lake Success, NY, USA
| | | | - Claire C Yang
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
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Raisin G, Dothan D, Perez D, Ala-Adin N, Kafka I, Shenfeld O, Hatumi S, Malchi N, Gordon A, Touitou D, Moldwin R, Nassar T, Chertin B. Open Label, Pilot Evaluation of the Safety and Efficacy of Intravesical Sustained Release System of Lidocaine and Oxybutynin (TRG-100) for Patients With Interstitial Cystitis/Bladder Pain Syndrome, Overactive Bladder and Patients With Retained Ureteral Stents Following Endourological Interventions. Urology 2023; 178:42-47. [PMID: 37268171 DOI: 10.1016/j.urology.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Intravesical instillation of analgesic and anticholinergic drugs have shown efficacy in the treatment of pain and voiding symptoms. Unfortunately, drug loss with urination and dilution in the bladder limit their durability and clinical usefulness. We have recently developed and tested in vitro, a sustained delivery system (TRG-100) of fixed-dose combination of lidocaine and oxybutynin designed to allow for a longer exposure of the urinary bladder to the drugs. OBJECTIVE To asses the safety and efficacy of TRG-100 in Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS), overactive bladder (OAB), and endourological intervention stented (EUI) patients in an open-label, prospective study. METHODS Thirty-six patients were enrolled: 10 IC/BPS, 10 OAB, and 16 EUI. EUI patients received a once-weekly installation until stent removal, OAB and IC/BPS patient received weekly installations for 4 consecutive weeks. Treatment effect was assessed by visual analog scale (VAS) score for the EUI group, voiding diaries for OAB group and VAS score, voiding diaries and O'Leary Sant Questionnaires for the IC/BPS group. RESULTS The EUI group showed a mean 4-point improvement in their VAS score. The OAB group showed 33.54% reduction in frequency of urination and IC/PBS group showed a mean of 3.2-point improvement in their VAS score, 25.43% reduction in frequency of urination, and a mean 8.1-point reduction in O'Leary Sant Questionnaires score. All changes were statistically significant. CONCLUSION Intravesical instillation of TRG-100 was found to be safe and efficient in reducing pain and irritative bladder symptoms in our study population. TRG-100 efficacy and safety should be further assessed in a large, randomized control trial.
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Affiliation(s)
- Galiya Raisin
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel.
| | - David Dothan
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Dolev Perez
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Natshe Ala-Adin
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Ilan Kafka
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Ofer Shenfeld
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | | | | | | | | | - Robert Moldwin
- The Smith Institute for Urology at Northwell Health, Lake Success, NY; Department of Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY
| | - Taher Nassar
- The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
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Stephens-Shields AJ, Lai HH, Landis JR, Kreder K, Rodriguez LV, Naliboff BD, Afari N, Sutcliffe S, Moldwin R, Griffith JW, Clemens JQ, Bradley CS, Quallich S, Gupta P, Harte SE, Farrar JT. Clinically Important Differences for Pain and Urinary Symptoms in Urological Chronic Pelvic Pain Syndrome: A MAPP Network Study. J Urol 2023; 209:1132-1140. [PMID: 36848118 PMCID: PMC11062515 DOI: 10.1097/ju.0000000000003394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 02/21/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Symptom heterogeneity in interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, collectively termed urological chronic pelvic pain syndrome, has resulted in difficulty in defining appropriate clinical trial endpoints. We determine clinically important differences for 2 primary symptom measures, pelvic pain severity and urinary symptom severity, and evaluate subgroup differences. MATERIALS AND METHODS The Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns Study enrolled individuals with urological chronic pelvic pain syndrome. We defined clinically important differences by associating changes in pelvic pain severity and urinary symptom severity over 3 to 6 months with marked improvement on a global response assessment using regression and receiver operating characteristic curves. We evaluated clinically important differences for absolute and percent change and examined differences in clinically important differences by sex-diagnosis, presence of Hunner lesions, pain type, pain widespreadness, and baseline symptom severity. RESULTS An absolute change of -4 was clinically important in pelvic pain severity among all patients, but clinically important difference estimates differed by pain type, presence of Hunner lesions, and baseline severity. Pelvic pain severity clinically important difference estimates for percent change were more consistent across subgroups and ranged from 30% to 57%. The absolute change urinary symptom severity clinically important difference was -3 for female participants and -2 for male participants with chronic prostatitis/chronic pelvic pain syndrome only. Patients with greater baseline severity required larger decreases in symptoms to feel improved. Estimated clinically important differences had lower accuracy among participants with low baseline symptoms. CONCLUSIONS A reduction of 30%-50% in pelvic pain severity is a clinically meaningful endpoint for future therapeutic trials in urological chronic pelvic pain syndrome. Urinary symptom severity clinically important differences are more appropriately defined separately for male and female participants.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Robert Moldwin
- Zucker School of Medicine at Hofstra-Northwell, Lake Success, NY
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Aibel K, Choi S, Moldwin R. Pelvic mapping to explore patterns of chronic pelvic pain. Neurourol Urodyn 2023; 42:837-844. [PMID: 36840909 DOI: 10.1002/nau.25145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Chronic pelvic pain syndromes (CPPS) are commonly encountered by urologists and urogynecologists and pose diagnostic and therapeutic challenges. Body maps have been helpful adjuncts to verbal descriptions of pain and may serve a role in phenotyping what is known to be a heterogeneous patient population. The aim of this study was to assess whether patterns of pain as marked on a body map of the pelvis exist among common CPPS diagnoses. The secondary aim was to investigate the association between the total number of pain locations marked on the map and clinical indices in patients with 1 to 3 CPPS diagnoses. MATERIALS AND METHODS Data was collected on patients who visited the Northwell Health Pelvic Pain Treatment Center (PPTC) from January to May 2022 and were diagnosed with at least one of four major CPPS diagnoses: interstitial cystitis/bladder pain syndrome (IC/BPS), pelvic floor myalgia (PFM), chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and vulvodynia. Demographic data as well as survey data from pelvic pain maps, Genitourinary Pain Index (GUPI) forms, and the short form-6 of the Pain Catastrophizing Scale (PCS-6) were recorded. Descriptive statistics among CPPS groups and Pearson correlations among the number of CPPS diagnoses were computed. RESULTS One hundred seventy females and 125 males with CPPS were included in the study. Significant cross-over in mapping patterns was notable between IC/BPS and PFM groups, both most commonly marking "abdomen" and "genital" regions. The most distinct pattern of pain was seen in patients with CP/CPPS and in patients with vulvodynia. Among the total sample, as the mean number of pain locations marked within the pelvis increased, GUPI and PCS scores increased (p < 0.05). As the number of CPPS diagnoses increased, the strength of the relationship independently increased. CONCLUSIONS Pelvic body mapping demonstrated that different forms of CPPS displayed different distributions of pain, but mapping was not predictive of any diagnostic group. Nevertheless, the pelvic body map proved useful in identifying precise locations of pain and may help uncover regions of pain that cannot be easily communicated. The total number of pain sites marked appeared to correlate with worse clinical features.
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Affiliation(s)
- Kelli Aibel
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Sharon Choi
- The Smith Institute for Urology at Northwell Health, Lake Success, New York, USA
| | - Robert Moldwin
- The Smith Institute for Urology at Northwell Health, Lake Success, New York, USA
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Farrar J, Locke K, Clemens J, Griffith J, Harte S, Kirkali Z, Kreder K, Krieger J, Lai HH, Moldwin R, Mullins C, Naliboff B, Pontari M, Rodríguez L, Schaeffer A, Stephens-Shields A, Sutcliffe S, Taple B, Williams D, Landis J. Widespread Pain Phenotypes Impact Treatment Efficacy Results in Randomized Clinical Trials for Interstitial Cystitis/Bladder Pain Syndrome: A MAPP Network Study. Res Sq 2023:rs.3.rs-2441086. [PMID: 36865104 PMCID: PMC9980200 DOI: 10.21203/rs.3.rs-2441086/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Clinical trials of pain are notoriously difficult and inefficient in demonstrating efficacy even for known efficacious treatments. Determining the appropriate pain phenotype to study can be problematic. Recent work has identified the extend of widespread pain as an important factor in the likelihood of response to therapy, but has not been tested in clinical trials. Using data from three previously published negative studies of the treatment of interstitial cystitis/ bladder pain with data on the extent of widespread pain, we examined the response of patients to different therapies base on the amount of pain beyond the pelvis. Participants with predominately local but not widespread pain responded to therapy targeting local symptoms. Participants with widespread and local pain responded to therapy targeting widespread pain. Differentiating patients with and without widespread pain phenotypes may be a key feature of designing future pain clinical trials to demonstrate treatments that are effective versus not.
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Affiliation(s)
- John Farrar
- University of Pennsylvania Perelman School of Medicine
| | - Kenneth Locke
- University of Pennsylvania, Perelman School of Medicine
| | - J Clemens
- University of Michigan Medical School
| | | | | | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
| | - Karl Kreder
- University of Iowa Carver College of Medicine
| | | | | | | | - Chris Mullins
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
| | | | | | | | | | | | | | - Bayley Taple
- Northwestern University Feinberg School of Medicine
| | | | - J Landis
- University of Pennsylvania Perelman School of Medicine
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Aibel K, Moldwin R. Validation of the 'Pelvic Pain Map': a new self-assessment tool for chronic pelvic pain localisation. BJU Int 2023; 131:763-769. [PMID: 36722397 DOI: 10.1111/bju.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop and validate the Pelvic Pain Map to fill a gap in the need for a localised body map of the pelvic region. PATIENTS AND METHODS The Pelvic Pain Map incorporated input from 12 chronic pelvic pain experts across the United States, as well as patient feedback to assess face validity. Finalised diagrams are single, front-facing images of the male and female pelvis that incorporate both abdominal and perineal views. Assessment of test-retest reliability and construct (convergent and discriminant) validity was carried out on a retrospective cohort of patients with chronic pelvic pain syndrome (CPPS) who completed the maps from January 2022 to May 2022. Other measures used in the validation process consisted of the male and female forms of the Genitourinary Pain Index (GUPI) and the short form (six item) of the Pain Catastrophising Scale (PCS-6). RESULTS Test-retest for individual map zones demonstrated moderate to excellent reliability (Cohen's kappa coefficients ranging from 0.28 to 0.64) and for total map zones demonstrated excellent reliability (intraclass correlation coefficient = 0.90). Convergent validity for individual map zones with location descriptors from the GUPI was strong (phi coefficients ranging from 0.26 to 0.79) and for total map zones was moderate (Spearman's correlation coefficient = 0.56). Discriminant validity for total map zones with separate, but related constructs from the GUPI and PCS-6 was weakly positive (Spearman's correlation coefficients ranging from 0.27 to 0.32). CONCLUSION This study suggests that the Pelvic Pain Map is a valid and reliable tool for assessing location of pain in patients with CPPS. Our findings highlight the potential utility of the Pelvic Pain Map in guiding treatment selection and monitoring therapeutic response in patients with chronic pelvic pain.
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Affiliation(s)
- Kelli Aibel
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Robert Moldwin
- The Smith Institute for Urology at Northwell Health, Lake Success, NY, USA
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10
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Jarman A, Janes JL, Shorter B, Moldwin R, De Hoedt AM, Barbour KE, Kim J, Freedland SJ, Anger JT. Food Sensitivities in a Diverse Nationwide Cohort of Veterans With Interstitial Cystitis/Bladder Pain Syndrome. J Urol 2023; 209:216-224. [PMID: 36001744 PMCID: PMC10542818 DOI: 10.1097/ju.0000000000002938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/28/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Prior studies suggest that certain foods exacerbate interstitial cystitis/bladder pain syndrome symptoms. However, these studies were limited in size and demographics. We assessed the presence of diet sensitivities among patients with interstitial cystitis/bladder pain syndrome and compared them with patients with other pelvic pain conditions and healthy controls. MATERIALS AND METHODS We identified Veterans Affairs patients nationwide by querying ICD-9/10 codes for interstitial cystitis/bladder pain syndrome. Patients were assigned to interstitial cystitis, other pelvic pain, or healthy control cohorts after chart review. We mailed all patients the Shorter-Moldwin Food Sensitivity Questionnaire to evaluate the self-perceived effects of specific foods/beverages on urinary symptoms and/or bladder pain. RESULTS In the interstitial cystitis/bladder pain syndrome cohort, 70% had ≥1 food sensitivity vs 37% of the other pelvic pain cohort and 32% of healthy controls (P < .001). The average number of sensitivities were similar between other pelvic pain conditions and healthy control cohorts, which were significantly less than in interstitial cystitis/bladder pain syndrome patients. Interstitial cystitis/bladder pain syndrome patients were more sensitive to acidic, spicy foods, and certain beverages vs other cohorts (all P < .001). Within the interstitial cystitis/bladder pain syndrome cohort, Black patients had significantly higher sensitivity to alcoholic and noncaffeinated beverages than Whites. Black patients did report significantly worsened urinary urgency than Whites (P < .05). CONCLUSIONS In a diverse population of veterans, interstitial cystitis/bladder pain syndrome patients had significantly more food sensitivities than those without interstitial cystitis/bladder pain syndrome. This suggests that food sensitivities could be suggestive of interstitial cystitis/bladder pain syndrome, which could make the Shorter-Moldwin Food Sensitivity Questionnaire a helpful diagnostic tool and aid in distinguishing interstitial cystitis/bladder pain syndrome from conditions often confused with interstitial cystitis/bladder pain syndrome.
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Affiliation(s)
- Aubrey Jarman
- Urology Section, Department of Surgery, Veterans Affairs Health Care System, Durham, NC
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jessica L. Janes
- Urology Section, Department of Surgery, Veterans Affairs Health Care System, Durham, NC
| | - Barbara Shorter
- Long Island University, Professor of Nutrition Emeritus, Brookville, NY
| | - Robert Moldwin
- The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Lake Success, NY
| | - Amanda M. De Hoedt
- Urology Section, Department of Surgery, Veterans Affairs Health Care System, Durham, NC
| | - Kamil E. Barbour
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jayoung Kim
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Stephen J. Freedland
- Urology Section, Department of Surgery, Veterans Affairs Health Care System, Durham, NC
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
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11
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Naliboff BD, Locke K, Schrepf AD, Griffith JW, Moldwin R, Krieger JN, Rodriguez LV, Stephens-Shields AJ, Clemens JQ, Lai HH, Sutcliffe S, Taple BJ, Williams D, Pontari MA, Mullins C, Landis JR. Reliability and Validity of Pain and Urinary Symptom Severity Assessment in Urological Chronic Pelvic Pain: A MAPP Network Analysis. J Urol 2022; 207:1246-1255. [PMID: 35060778 PMCID: PMC10494963 DOI: 10.1097/ju.0000000000002438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We assessed the reliability and validity of an efficient severity assessment for pelvic pain and urinary symptoms in urological chronic pelvic pain syndrome, which consists of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS A total of 578 patients were assessed using brief, empirically derived self-report scales for pelvic pain severity (PPS) and urinary symptom severity (USS) 4 times during a 1-month period and baseline clinic visit that included urological, pain and illness-impact measures. Mild, moderate and severe categories on each dimension were examined for measurement stability and construct validity. RESULTS PPS and USS severity categories had adequate reliability and both discriminant validity (differential relationships with specific clinical and self-report measures) and convergent validity (common association with nonurological somatic symptoms). For example, increasing PPS was associated with pelvic tenderness and widespread pelvic pain, whereas USS was associated with urgency during a bladder filling test and increased sensory sensitivity. PPS and USS categories were independently associated with nonurological pain and emotional distress. A descriptive analysis identified higher likelihood characteristics associated with having moderate to severe PPS or USS or both. Lack of sex interactions indicated that the measures are comparable in interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. CONCLUSIONS Women and men with urological chronic pelvic pain syndrome can be reliably subgrouped using brief self-report measures of mild, moderate or severe pelvic pain and urinary symptoms. Comparisons with a broad range of clinical variables demonstrate the validity and potential clinical utility of these classifications, including use in clinical trials, health services and biological research.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chris Mullins
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
| | - J. Richard Landis
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
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12
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Evans R, Kohan A, Moldwin R, Radecki D, Geib T, Peters KM. Safety, tolerability, and efficacy of LiRIS 400 mg in women with interstitial cystitis/bladder pain syndrome with or without Hunner lesions. Neurourol Urodyn 2021; 40:1730-1739. [PMID: 34288094 DOI: 10.1002/nau.24702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/01/2021] [Indexed: 01/23/2023]
Abstract
AIMS Two phase 2 studies were conducted to assess the efficacy and safety of lidocaine-releasing intravesical system (LiRIS) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with (Study 001; NCT02395042) or without, (Study 002; NCT02411110) Hunner lesions (HL). METHODS Both were multicenter, randomized, double-blind, placebo-controlled, and enrolled women aged ≥18 years. In Study 001, patients were randomized 2:1:1 to LiRIS 400 mg/LiRIS 400 mg, placebo/LiRIS 400 mg, or placebo/placebo for a continuous 28 (2 × 14)-day period. In Study 002, patients were randomized 1:1 to LiRIS 400 mg or placebo for a continuous (single treatment) 14-day period. RESULTS In total, 59 and 131 patients received treatment in Studies 001 and 002, respectively. There was no statistically significant difference in the primary endpoint, the change from baseline to Week 4 of follow-up post-removal in mean daily average bladder numeric rating scale (NRS) pain score in either study (Study 001: placebo/placebo, -1.6; LiRIS/LiRIS, -2.7, p = 0.142; placebo/LiRIS, -2.5, p = 0.319; Study 002: LiRIS -1.2; placebo, -1.5, p = 0.505). There was no statistically significant difference between groups in daily worst NRS pain score, number of micturitions/day or urgency episodes/day. There was no clear trend for reduction in number of HL for LiRIS vs placebo. The frequency of treatment-emergent adverse events was similar between treatment groups in both studies; most were mild or moderate intensity. CONCLUSION These studies did not demonstrate a treatment effect of LiRIS 400 mg compared with placebo, either in patients with IC/BPS with HL, or in those without HL.
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Affiliation(s)
- Robert Evans
- Urology, Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Alfred Kohan
- Bethpage Division, Advanced Urology Centers of New York, Bethpage, New York, USA
| | - Robert Moldwin
- Urologic Infectious/Inflammatory Diseases, The Arthur Smith Institute for Urology, Lake Success, New York, USA
| | | | - Till Geib
- Specialty Development, AbbVie, Irvine, California, USA
| | - Kenneth M Peters
- Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.,Urology, Beaumont Health, Royal Oak, Michigan, USA
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13
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Crawford A, Muere A, Tripp DA, Nickel JC, Doiron RC, Moldwin R, Katz L. The chicken or the egg: Longitudinal changes in pain and catastrophizing in women with interstitial cystitis/bladder pain syndrome. Can Urol Assoc J 2021; 15:326-331. [PMID: 33750522 DOI: 10.5489/cuaj.7106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Evidence-based psychological strategies are being used as clinicians look for helpful interventions for patients diagnosed with the enigmatic chronic urological pelvic pain condition of interstitial cystitis/bladder pain syndrome (IC/BPS). Pain and pain catastrophizing are associated with chronic pelvic pain outcomes but the longitudinal role of catastrophizing on patient pain in IC/BPS remains unknown. METHODS Women with IC/BPS were recruited from tertiary care clinics across North America and completed a battery of questionnaires, including demographics, pain, depression, catastrophizing at baseline, six months, and one year. RESULTS A total of 226 patients completed baseline, 183 completed the six-month survey, and 151 completed the one-year survey. Using a cross-lagged analysis, early changes in pain catastrophizing predicted later changes in pain, but not vice versa. Followup subscale analyses revealed that early changes in magnification predicted later changes in pain, early changes in pain predicted later changes in rumination, and that there was a recursive relationship between changes in helplessness and changes in pain across the study. CONCLUSIONS Pain catastrophizing should be considered a prime target in psychological treatment for chronic pain in patients with IC/BPS, particularly those thinking styles associated with pain onset and maintenance. Future research should be conducted with constructs such as pain catastrophizing in samples prioritizing diversity of patients with IC/BPS and mechanisms as to how to effectively decrease catastrophizing.
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Affiliation(s)
- Alison Crawford
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Abi Muere
- Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Dean A Tripp
- Departments of Psychology, Urology & Anesthesiology, Queen's University, Kingston, ON, Canada
| | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
| | | | - Robert Moldwin
- Zucker School of Medicine at Hofstra-Northwell, New Hyde Park, NY, United States
| | - Laura Katz
- Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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14
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Fall M, Nordling J, Cervigni M, Oliveira PD, Fariello J, Hanno P, Kabjörn-Gustafsson C, Logadottir Y, Meijlink J, Moldwin R, Nasta L, Quaghebeur J, Sairanen J, Taneja R, Tomoe H, Ueda T, Wennevik GE, Wyndaele JJ, Zaitcev A. Comments to Editorial by J. Curtis Nickel. It is premature to categorize Hunner lesion interstitial cystitis as a distinct disease entity. Scandinavian Journal of Urology 2020, Vol. 54, No. 2, 99-100; https://doi.org/10.1080/21681805.2020.1744714. Scand J Urol 2020; 54:355-356. [PMID: 32588705 DOI: 10.1080/21681805.2020.1784269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Magnus Fall
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Jørgen Nordling
- Department of Urology, Herlev University Hospital, Herlev, Denmark
| | - Mauro Cervigni
- Department of Urogynecology, San Carlo Hospital, Rome, Italy
| | - Paulo Dinis Oliveira
- Department of Urology, Hospital de Sao Joao, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jennifer Fariello
- The Arthur Smith Institute for Urology, Pelvic Pain Treatmemt Center, Garden City, NY, USA
| | - Philip Hanno
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yr Logadottir
- Department of Urology, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Jane Meijlink
- International Painful Bladder Foundation, Narden, The Netherlands
| | - Robert Moldwin
- Zucker School of Medicine at Hofstra-Northwell, The Arthur Smith Institute for Urology, Lake Success, NY, USA
| | | | | | - Jukka Sairanen
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
| | - Rajesh Taneja
- Department of Urology Andrology and Robotic Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East Tokyo, Japan, Tokyo, Japan
| | | | | | | | - Andrew Zaitcev
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
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15
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Fall M, Nordling J, Cervigni M, Dinis Oliveira P, Fariello J, Hanno P, Kåbjörn-Gustafsson C, Logadottir Y, Meijlink J, Mishra N, Moldwin R, Nasta L, Quaghebeur J, Ratner V, Sairanen J, Taneja R, Tomoe H, Ueda T, Wennevik G, Whitmore K, Wyndaele JJ, Zaitcev A. Hunner lesion disease differs in diagnosis, treatment and outcome from bladder pain syndrome: an ESSIC working group report. Scand J Urol 2020; 54:91-98. [PMID: 32107957 DOI: 10.1080/21681805.2020.1730948] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives: There is confusion about the terms of bladder pain syndrome (BPS) and Interstitial Cystitis (IC). The European Society for the Study of IC (ESSIC) classified these according to objective findings [9]. One phenotype, Hunner lesion disease (HLD or ESSIC 3C) differs markedly from other presentations. Therefore, the question was raised as to whether this is a separate condition or BPS subtype.Methods: An evaluation was made to explore if HLD differs from other BPS presentations regarding symptomatology, physical examination findings, laboratory tests, endoscopy, histopathology, natural history, epidemiology, prognosis and treatment outcomes.Results: Cystoscopy is the method of choice to identify Hunner lesions, histopathology the method to confirm it. You cannot distinguish between main forms of BPS by means of symptoms, physical examination or laboratory tests. Epidemiologic data are incomplete. HLD seems relatively uncommon, although more frequent in older patients than non-HLD. No indication has been presented of BPS and HLD as a continuum of conditions, one developing into the other.Conclusions: A paradigm shift in the understanding of BPS/IC is urgent. A highly topical issue is to separate HLD and BPS: treatment results and prognoses differ substantially. Since historically, IC was tantamount to Hunner lesions and interstitial inflammation in the bladder wall, still, a valid definition, the term IC should preferably be reserved for HLD patients. BPS is a symptom syndrome without specific objective findings and should be used for other patients fulfilling the ESSIC definitions.
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Affiliation(s)
- Magnus Fall
- Department of Urology, Sahlgrenska Academy at the University Gothenburg, Institute of Clinical Sciences, Göteborg, Sweden
| | - Jørgen Nordling
- Department of Urology, Herlev University Hospital, Copenhagen, Denmark
| | - Mauro Cervigni
- Female Pelvic Medicine & Reconstructive Surgery Center, Catholic University, Rome, Italy
| | - Paulo Dinis Oliveira
- Department of Urology, Hospital de Sao Joao, University of Porto Faculty of Medicine, Porto, Portugal
| | - Jennifer Fariello
- The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
| | - Philip Hanno
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yr Logadottir
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Jane Meijlink
- International Painful Bladder Foundation, Naarden, The Netherlands
| | - Nagendra Mishra
- Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad, India
| | - Robert Moldwin
- The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
| | | | - Jorgen Quaghebeur
- Department of Urology, Small Pelvis Clinic, University Hospital Antwerpen, Antwerp, Belgium
| | - Vicki Ratner
- Interstitial Cystitis Association of America, San Jose, CA, USA
| | - Jukka Sairanen
- Department of Urology, Helsinki University Central Hospital, Helsinki, Finland
| | - Rajesh Taneja
- Department of Urology and Andrology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tomohiro Ueda
- Comfortable Urology Network, Ueda Clinic, Kyoto, Japan
| | - Gjertrud Wennevik
- Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Kristene Whitmore
- Department of Urology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jean Jacques Wyndaele
- Department of Urology, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - Andrew Zaitcev
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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16
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Muere A, Katz L, Crawford A, Nickel JC, Carr L, Moldwin R, Mayer R, Tripp DA. The Temporal Relationship between Catastrophizing and Chronic Pain. Can J Pain 2019. [DOI: 10.1080/24740527.2019.1591865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Abi Muere
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Laura Katz
- Michael G DeGroote Pain Clinic, McMaster University Hospital, Hamilton, Ontario, Canada
| | - Alison Crawford
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - J Curtis Nickel
- Urology & Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Lesley Carr
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert Moldwin
- Department of Medicine, Hofstra University, New Hyde Park, New York, USA
| | | | - Dean A Tripp
- Department of Psychology, Urology & Anesthesiology, Queen’s University, Kingston, Ontario, Canada
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17
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Crawford A, Tripp DA, Nickel JC, Carr L, Moldwin R, Katz L, Muere A. Depression and helplessness impact interstitial cystitis/bladder pain syndrome pain over time. Can Urol Assoc J 2018; 13:328-333. [PMID: 31364973 DOI: 10.5489/cuaj.5703] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Interstitial cystitis/bladder pain syndrome (IC/BPS) is a devastating urological chronic pelvic pain condition with an unknown etiology. Evidence-based psychological strategies are becoming more successful for symptom management as we learn more about the targets for intervention. Previous research has established an indirect relationship between depression and pain through catastrophizing, but there have yet to be studies examining the emerging role of emotion regulation in this relationship. METHODS Women with IC/BPS were recruited from tertiary care clinics in Canada and the U.S. between 2013 and 2018. Patients completed questionnaires, including demographics and scores for pain, depression, catastrophizing, and difficulties in emotion regulation at baseline, six months, and one year. Serial mediation was used to test models of pain, catastrophizing, and depression. RESULTS A total of 135 women with IC/BPS completed all three time points. The only significant indirect path was from baseline depression to catastrophizing at six months to pain at one year (b=0.10; confidence interval [CI] 0.0049-0.2520). A followup analysis demonstrated that helplessness was the key factor of catastrophizing driving this relationship (b=0.17; CI 0.0282-0.3826). CONCLUSIONS Reducing feelings of helplessness and increasing patient feelings of control are important ways to limit the effect of low mood on patient pain experience. De-catastrophizing interventions should be part of the referral strategy for IC/BPS symptom management.
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Affiliation(s)
- Alison Crawford
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Dean A Tripp
- Departments of Psychology, Urology, & Anesthesiology, Queen's University, Kingston, ON, Canada
| | - J Curtis Nickel
- Department of Urology Queen's University, Kingston, ON, Canada
| | - Lesley Carr
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Robert Moldwin
- Department of Urology, Hosftra University School of Medicine, New Hyde Park, NY, United States
| | - Laura Katz
- Michael G. DeGroote Pain Clinic, McMaster University Hospital, Hamilton, ON, Canada
| | - Abi Muere
- Department of Psychology, Queen's University, Kingston, ON, Canada
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18
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Affiliation(s)
- Robert Moldwin
- Arthur Smith Institute for Urology, Northwell Health, Lake Success, New York
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19
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Duh K, Funaro MG, DeGouveia W, Bahlani S, Pappas D, Najjar S, Tabansky I, Moldwin R, Stern JNH. Crosstalk between the immune system and neural pathways in interstitial cystitis/bladder pain syndrome. Discov Med 2018; 25:243-250. [PMID: 29906407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a condition causing intense pelvic pain and urinary symptoms. While it is thought to affect millions of people and significantly impair quality of life, difficulty with diagnosis and a lack of reliably effective treatment options leave much progress to be made in managing this condition. We describe what is currently known about the immunological and neurological basis of this disease, focusing on the interactions between the immune and nervous system. Evidence for immune involvement in IC/BPS comes from its high co-occurrence with known autoimmune diseases, altered cytokine profiles, and immune cell infiltration in patients. These cytokines have the ability to cross-talk with the nervous system via NGF signaling, resulting in hyper-sensitization of pain receptors, causing them to release substance P and creating a positive feedback loop of neuroinflammation. While it seems that the crosstalk between the immune and nervous system in IC is understood, much of the information comes from studying other diseases or from animal models, and it remains to be confirmed in patients with the disease. Identifying biomarkers and confirming the mechanism of IC/BPS are ultimately important for selecting drug targets and for improving the lives of patients with this disease.
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Affiliation(s)
- Kevin Duh
- Departments of Neurology, Surgery, Molecular Medicine, and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Autoimmunity, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY 11030, USA
| | - Michael G Funaro
- Departments of Neurology, Surgery, Molecular Medicine, and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Autoimmunity, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY 11030, USA
| | - William DeGouveia
- Departments of Neurology, Surgery, Molecular Medicine, and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Autoimmunity, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY 11030, USA
| | - Sonia Bahlani
- Department of Urology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- The Arthur Smith Institute for Urology, Northwell Health, Lake Success, NY 11042, USA
| | - Dominic Pappas
- Departments of Neurology, Surgery, Molecular Medicine, and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Autoimmunity, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY 11030, USA
| | - Souhel Najjar
- Department of Neurology, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA
| | - Inna Tabansky
- Department of Neurobiology and Behavior, The Rockefeller University, New York, NY 10065, USA
- These authors share co-senior authorship
| | - Robert Moldwin
- Department of Urology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- The Arthur Smith Institute for Urology, Northwell Health, Lake Success, NY 11042, USA
- These authors share co-senior authorship
| | - Joel N H Stern
- Departments of Neurology, Surgery, Molecular Medicine, and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Autoimmunity, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY 11030, USA
- Department of Neurology, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA
- These authors share co-senior authorship
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20
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Locke, Jr. K, Clemens JQ, Kreder KJ, Lai HH, Krieger JN, Andriole GL, Rodríguez LV, Anger J, Moldwin R, Pontari MA, Mullins C, Landis JR. MP39-01 SUBGROUP DISCOVERY IN UROLOGIC CHRONIC PELVIC PAIN SYNDROME (UCPPS): CONSENSUS CLUSTERING FINDINGS FROM THE MAPP RESEARCH NETWORK. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Tripp D, Crawford A, Nickel JC, Moldwin R, Carr L, Mayer R, Katz L. MP39-20 THE LONGITUDINAL ROLE OF CATASTROPHIZING AND EMOTION REGULATION IN THE RELATIONSHIP BETWEEN DEPRESSION AND PAIN IN WOMEN WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Muere A, Tripp DA, Nickel JC, Kelly KL, Mayer R, Pontari M, Moldwin R, Carr LK, Yang CC, Nordling J. Depression and Coping Behaviors Are Key Factors in Understanding Pain in Interstitial Cystitis/Bladder Pain Syndrome. Pain Manag Nurs 2018; 19:497-505. [PMID: 29501360 DOI: 10.1016/j.pmn.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 10/17/2017] [Accepted: 11/05/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a urologic chronic pelvic pain syndrome with suboptimal treatment outcomes. Catastrophizing is an empirically supported risk factor for greater IC/BPS pain. AIMS In this study, a moderated multiple mediation model is tested in which several additional psychosocial risk factors (depression, illness and wellness-focused behavioral coping strategies) are proposed as mediators or moderators in the existing relationship between catastrophizing and IC/BPS pain. DESIGN The present questionnaire study employed a cross-sectional design. SETTINGS AND PARTICIPANTS Female patients with an IC/BPS diagnosis (n = 341) were recruited at tertiary care sites. METHODS Participants completed questionnaires assessing pain, catastrophizing, behavioral coping strategies, and depressive symptoms. Aggregate factor scores were calculated following exploratory factor analyses. RESULTS It was found that patients with a greater tendency to catastrophize were more likely to engage in illness-focused coping strategies, which contributed to the reporting of greater sensory and affective pain. Furthermore, this mediating effect of illness-focused coping on affective pain was more likely to occur in those patients reporting greater depressive symptoms. CONCLUSIONS Illness-focused behavioral coping is an important mechanism between maladaptive pain cognition and aspects of patient pain, with patients reporting greater depressive symptoms at increased risk for elevated pain. Patient management techniques, including screening for catastrophizing, coping, and depression, are recommended to enrich IC/BPS management.
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Affiliation(s)
- Abi Muere
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.
| | - Dean A Tripp
- Department of Psychology, Queen's University, Kingston, Ontario, Canada; Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada; Department of Urology, Queen's University, Kingston, Ontario, Canada
| | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kerri-Lynn Kelly
- Department of Urology, Queen's University, Kingston, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Michel Pontari
- Department of Urology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Robert Moldwin
- Hofstra Northwell School of Medicine, Hofstra University, Hempstead, New York
| | - Lesley K Carr
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Claire C Yang
- University of Washington School of Medicine, Seattle, Washington
| | - Jorgen Nordling
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Vasudevan V, Moldwin R. Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome. Asian J Urol 2017; 4:50-54. [PMID: 29264207 PMCID: PMC5730899 DOI: 10.1016/j.ajur.2016.08.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 01/22/2023] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating, chronic condition characterized by chronic pelvic pain, urinary urgency, and frequency and is well-known to be associated with a decrease in work productivity, emotional changes, sleep, sexual dysfunction, and mobility. Many metrics of quality of life (QoL) in this patient population have been developed; however, a unified, standardized approach to QoL in these patients has not been determined. The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics. Next, data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed. While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS, addressing QoL in this patient population remains a significant challenge, as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL, including depression, poor sleep, and inability to work. Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics, and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.
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Affiliation(s)
- Vinaya Vasudevan
- Department of Urology, The Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
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Tripp DA, Nickel JC, Krsmanovic A, Pontari M, Moldwin R, Mayer R, Carr LK, Yang CC, Nordling J. Depression and catastrophizing predict suicidal ideation in tertiary care patients with interstitial cystitis/bladder pain syndrome. Can Urol Assoc J 2016; 10:383-388. [PMID: 28096911 PMCID: PMC5167592 DOI: 10.5489/cuaj.3892] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to evaluate psychosocial factors as predictors of suicidal ideation (SI) in a tertiary care outpatient sample of women suffering from interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS The patients are women managed at tertiary care centres (n=190). Controls were recruited from the community (n=117). Both groups completed questionnaires on demographics, pain (McGill Pain Questionnaire), IC/BPS symptoms, and psychological variables. Univariate and multivariate hierarchical regression modelling was conducted to examine the strength of associations and unique effects of psychosocial variables on patient SI. RESULTS Compared to 6% in healthy controls, 23% of patients endorsed SI in the past two weeks. Correlations between SI, depression, and catastrophizing across controls and cases show that for controls, SI is associated with greater pain (0.31; p<0.01) and depression only (0.59; p<0.01). For tertiary care centre cases, SI is associated with pain (0.24; p<0.01), depression (0.64; p<0.01), and catastrophizing (0.35; p<0.01). Regression analyses indicated that psychosocial variables accounted for a significant amount of variance over and above IC/BPS symptoms. Catastrophizing (i.e., helplessness) about pain and depression were significant univariate predictors of SI, but only depression predicted SI in multivariable analyses. CONCLUSIONS Limitations of this study include its cross-sectional design and primarily correlation-based statistics. The present study is the first to implicate multiple psychosocial risk factors over and above IC/BPS-specific symptoms and patient pain experience in SI in women with IC/BPS. Depression in particular is uniquely important in predicting suicidality. These results support a multidisciplinary, proactive approach to IC/BPS involving not only treatment of disease symptoms, but also early detection/treatment of associated psychosocial problems.
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Affiliation(s)
| | | | | | | | - Robert Moldwin
- Hofstra University School of Medicine, New Hyde Park, NY, United States
| | - Robert Mayer
- Asante Physician Partners, Grants Pass, OR, United States
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Funaro M, King A, Moldwin R, Bahlani S. MP72-18 ENDOSCOPIC INJECTION OF TRIAMCINOLONE: A SIMPLE, MINIMALLY INVASIVE AND EFFECTIVE THERAPY FOR HUNNER’S LESIONS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Tamma SM, Shorter B, Toh KL, Moldwin R, Gordon B. Influence of polyunsaturated fatty acids on urologic inflammation. Int Urol Nephrol 2015; 47:1753-61. [DOI: 10.1007/s11255-015-1108-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/03/2015] [Indexed: 01/03/2023]
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Bahlani S, Mehta S, King A, Moldwin R. I-STOP/PMP: A tool for monitoring prescription drug abuse in patients with chronic pain syndromes. Journal of Clinical Urology 2015. [DOI: 10.1177/2051415815575219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Patients with chronic pain syndromes often require analgesics and muscle relaxants for symptom management. Unfortunately, many of these agents have abuse potential, and specific concerns have been raised with regard to drug-seeking behaviours that involve multiple clinicians dispensing similar, if not identical, agents. The Internet System for Tracking Over-Prescribing (I-STOP) is a newly implemented law targeted at monitoring the abuse and diversion of controlled substances in New York State. The purpose of this study is to describe the use and the potential for abuse of agents commonly used in the treatment of a variety of urological pelvic pain patients. Materials and methods: Clinical data from 397 patients with interstitial cystitis/bladder pain syndrome (IC/BPS), chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and pelvic floor dysfunction (PFD) were identified through medical record review over a consecutive 6-month period. These names were entered into the Prescription Monitoring Program (PMP) database to which all prescribers have access. I-STOP monitors prescription use over a prior 6-month interval from the date of access. Categoric data were compared with Fisher’s exact test and the chi-square test. Kaplan–Meier product limit curves were stratified by group and compared using the log-rank test. Results: In total, 397 patients with IC/BPS, CP/CPPS, and PFD were included; 14 patients (3.5%) had been prescribed duplicate medications by more than one practitioner. Of those patients who received duplicate prescriptions, 4 of 14 (29%) were for benzodiazepines, and 10 of 14 (71%) of duplicate medications prescribed were opioids. Conclusions: The implementation of the I-STOP/PMP registry provides an innovative way for practitioners to monitor prescribed controlled substances while allowing patients to receive necessary medications for symptom control.
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Affiliation(s)
- Sonia Bahlani
- The Smith Institute for Urology, North Shore-LIJ Health System, USA
| | - Sandeep Mehta
- The Smith Institute for Urology, North Shore-LIJ Health System, USA
| | - Alexandra King
- Hofstra North Shore-LIJ, School of Medicine, 500 Hofstra University, USA
| | - Robert Moldwin
- The Smith Institute for Urology, North Shore-LIJ Health System, USA
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Bahlani S, King A, Moldwin R. PD20-11 ENDOSCOPIC INJECTION OF TRIAMCINOLONE – A SIMPLE, MINIMALLY INVASIVE, AND EFFECTIVE THERAPY FOR HUNNER'S LESIONS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hanno PM, Erickson D, Moldwin R, Faraday MM. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol 2015; 193:1545-53. [PMID: 25623737 DOI: 10.1016/j.juro.2015.01.086] [Citation(s) in RCA: 421] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this amendment is to provide an updated clinical framework for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome based upon data received since the publication of original guideline in 2011. MATERIALS AND METHODS A systematic literature review using the MEDLINE(®) database (search dates 1/1/83-7/22/09) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of IC/BPS. This initial review yielded an evidence base of 86 treatment articles after application of inclusion/exclusion criteria. The AUA update literature review process, in which an additional systematic review is conducted periodically to maintain guideline currency with newly published relevant literature, was conducted in July 2013. This review identified an additional 31 articles, which were added to the evidence base of this Guideline. RESULTS Newly incorporated literature describing the treatment of IC/BPS was integrated into the Guideline with additional treatment information provided as Clinical Principles and Expert Opinions when insufficient evidence existed. The diagnostic portion of the Guideline remains unchanged from the original publication and is still based on Expert Opinions and Clinical Principles. CONCLUSIONS The management of IC/BPS continues to evolve as can be seen by an expanding literature on the topic. This document constitutes a clinical strategy and is not intended to be interpreted rigidly. The most effective approach for a particular patient is best determined by the individual clinician and patient. As the science relevant to IC/BPS evolves and improves, the strategies presented will require amendment to remain consistent with the highest standards of care.
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Affiliation(s)
- Philip M Hanno
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Deborah Erickson
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Robert Moldwin
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Martha M Faraday
- American Urological Association Education and Research, Inc., Linthicum, Maryland
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Bahlani S, Moldwin R. Endoscopic lysis of bladder scar associated with Hunner's lesions: A new technique. Asian J Urol 2015; 2:59-62. [PMID: 29264121 PMCID: PMC5730693 DOI: 10.1016/j.ajur.2015.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/22/2014] [Accepted: 09/01/2014] [Indexed: 11/16/2022] Open
Abstract
Objective Five to ten percent of interstitial cystitis/bladder pain syndrome (IC/BPS) patients have Hunner's lesions (HL), areas of non-specific inflammation and scarring. The poor quality of life of patients with HL is entwined in associated pain and loss of bladder capacity. Although the decrease in bladder capacity is usually dependent on pain, it may also be dependent upon scarring and associated compliance changes produced by the inflammatory process. This report reviews the potential role of endoscopic scar lysis using the holmium laser in the management of these patients whose only other therapeutic option is urinary diversion. Methods Two patients with HL and "end stage" bladders who underwent holmium laser division of bladder wall scar/tethering were identified. Clinical data were reviewed with emphasis on safety and efficacy. Results Both patients selected for this procedure underwent holmium laser lysis of known scar tissue in an effort to increase bladder capacity and improve symptoms of urinary frequency and pain with bladder filling. The median age of patients who underwent the procedure was 63 (59-67) years. Incisions were made with the holmium laser at frequencies of 3-10 Hz of 300-700 J along the region of scarring. All procedures were performed by the same practitioner. There was an increase in bladder capacity by 58.3% (50.0%-66.7%). During a mean follow-up of 4.2 years, there appeared to be a significant improvement with an increase in interval time between voids and a decrease in pain with bladder filling. Conclusion Patients with IC/BPS may be severely debilitated by a clinically significant decrease in their bladder capacity, especially in the face of HL. The use of the holmium laser to incise regions of scar and bladder wall tethering may produce a clinically significant and durable increase in bladder capacity. The use of this technique as a means of treating bladder scarring poses an excellent adjunct to existing treatment strategies.
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Affiliation(s)
- Sonia Bahlani
- The Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Robert Moldwin
- The Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA
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Bahlani S, Moldwin R. WITHDRAWN: Endoscopic lysis of bladder scar associated with Hunner's lesions: A new technique. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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32
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Bahlani S, Moldwin R. Endoscopic Lysis of Bladder Scar Associated with Hunner’s Lesions: A New Technique. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bahlani S, Mehta S, Akerman M, Moldwin R. PD9-09 I-STOP/PMP: A TOOL FOR MONITORING PRESCRIPTION DRUG ABUSE IN PATIENTS WITH CHRONIC PAIN SYNDROMES. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wu WJ, Kreshover JE, Moldwin R, Kavoussi LR. Strange Vibes - Novel Presentation of Prostatitis. Urol Case Rep 2014; 2:25-6. [PMID: 26955537 PMCID: PMC4732995 DOI: 10.1016/j.eucr.2013.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 11/30/2022] Open
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has significant variability in its presentation. In this study, we present 2 novel cases of prostatitis in which “buzz” is described as the primary pain symptom. These cases describe patients with the primary complaint of “cell phone–like buzzing” within the perineum, with accompanying urinary symptoms consistent with prostatitis. CP/CPPS is a multifactorial disease within which psychological, inflammatory, neurologic, and neuromuscular etiologies are at play. As in other disease descriptions, a buzzing sensation represents the interaction of multiple pathways that have significant overlay with CP/CPPS. As such, we believe buzzing might represent a new symptom of CP/CPPS.
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Affiliation(s)
- Wayland J Wu
- Drexel University College of Medicine, Philadelphia, PA
| | - Jessica E Kreshover
- Arthur Smith Institute for Urology, North Shore - Long Island Jewish Health System, The Hofstra-North Shore LIJ School of Medicine, Lake Success, NY
| | - Robert Moldwin
- Arthur Smith Institute for Urology, North Shore - Long Island Jewish Health System, The Hofstra-North Shore LIJ School of Medicine, Lake Success, NY
| | - Louis R Kavoussi
- Arthur Smith Institute for Urology, North Shore - Long Island Jewish Health System, The Hofstra-North Shore LIJ School of Medicine, Lake Success, NY
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Nickel JC, Tripp DA, Pontari M, Moldwin R, Mayer R, Carr LK, Doggweiler R, Yang CC, Mishra N, Nordling J. Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome: a case control study. Can Urol Assoc J 2013. [DOI: 10.5489/cuaj.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: The impact of early lifetime trauma on symptomseverity and quality of life of patients with interstitial cystitis/bladderpain syndrome (IC/BPS) has not been fully elucidated. Wewanted to determine and compare the prevalence and impact ofchildhood traumatic events, with an emphasis on childhood sexualabuse, on patient symptoms, quality of life and other biopsychosocialparameters.Methods: Subjects (female patients with IC/BPS and controls withoutIC/BPS) completed psychosocial phenotyping questionnaires,including a demographics/history form, and validated questionnairesfocused on presenting symptoms (IC symptom indices, pain),psychosocial parameters (depression, anxiety, pain catastrophizing,sexual functioning, social support) and quality of life. Participantsalso completed the Childhood Traumatic Events Scale.Results: Questionnaires were completed by 207 IC/BPS patientsand 117 controls matched for age, partner status and education. Itwas found that before 17 years of age, the IC/BPS cases reportedhigher prevalence of “raped or molested” compared to controls(24.0% vs. 14.7%; p = 0.047). Within the IC/BPS group, casesreporting previous sexual abuse endorsed greater sensory pain,depression and poorer physical quality of life at the present timecompared to IC cases without a sexual abuse history. In the controlsonly, those reporting previous sexual abuse endorsed more depression,anxiety, stress, social maladjustment poorer mental qualityof life in the present time. When the analysis was corrected forpotential multiple comparison error, none of the findings remainedsignificant in either the IC/BPS or control groups.Interpretation: Childhood traumatic events, in particular sexualabuse and extreme illness, are reported as more common in IC/BPS patients than controls. Early trauma, such as the occurrenceof sexual abuse, is associated with some differences in patientadjustment (e.g., pain, quality of life, depression) but this impactappears to be, at most, very modest.
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Hillelsohn JH, Duty B, Blute ML, Okhunov Z, Kashan M, Moldwin R, Ashley RN. Variability of transrectal ultrasound-guided prostate biopsy prophylactic measures. Can J Urol 2012; 19:6573-6577. [PMID: 23228295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION To assess the variability of pre-prostate biopsy prophylaxis among American urologists. MATERIALS AND METHODS A survey was electronically mailed to 3355 urologists around the country. Urologists were surveyed on their antibiotic prophylaxis choice, the route and duration of antimicrobial prophylaxis. Additionally they were questioned about their knowledge of local antimicrobial resistance and if rectal enemas were routinely used. RESULTS There were 679 (21%) responses to the survey. The survey revealed differences in pre-prostate biopsy prophylaxis among urologists. Ten different classes of antibiotics were used orally, 4 classes intramuscular, 5 classes intravenous, and there was also 14 different duration regimens. CONCLUSION Despite the initiation of the 2008 American Urological Association Guidelines on this topic, there still is a lack of uniformity in prostate biopsy prophylaxis.
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MESH Headings
- Administration, Oral
- Anti-Bacterial Agents/administration & dosage
- Antibiotic Prophylaxis
- Attitude of Health Personnel
- Biopsy, Needle/adverse effects
- Biopsy, Needle/methods
- Cross-Sectional Studies
- Dose-Response Relationship, Drug
- Health Care Surveys
- Humans
- Infusions, Intravenous
- Male
- Observer Variation
- Practice Patterns, Physicians'
- Prostatic Neoplasms/diagnostic imaging
- Prostatic Neoplasms/pathology
- Risk Assessment
- Ultrasonography
- Ultrasound, High-Intensity Focused, Transrectal/adverse effects
- Ultrasound, High-Intensity Focused, Transrectal/methods
- United States
- Urinary Tract Infections/etiology
- Urinary Tract Infections/prevention & control
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Affiliation(s)
- Joel H Hillelsohn
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York 11040, USA
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Nickel JC, Tripp DA, Pontari M, Moldwin R, Mayer R, Carr LK, Doggweiler R, Yang CC, Mishra N, Nordling J. Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome: a case control study. Can Urol Assoc J 2012; 5:410-5. [PMID: 22154637 DOI: 10.5489/cuaj.11110] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of early lifetime trauma on symptom severity and quality of life of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) has not been fully elucidated. We wanted to determine and compare the prevalence and impact of childhood traumatic events, with an emphasis on childhood sexual abuse, on patient symptoms, quality of life and other biopsychosocial parameters. METHODS Subjects (female patients with IC/BPS and controls without IC/BPS) completed psychosocial phenotyping questionnaires, including a demographics/history form, and validated questionnaires focused on presenting symptoms (IC symptom indices, pain), psychosocial parameters (depression, anxiety, pain catastrophizing, sexual functioning, social support) and quality of life. Participants also completed the Childhood Traumatic Events Scale. RESULTS Questionnaires were completed by 207 IC/BPS patients and 117 controls matched for age, partner status and education. It was found that before 17 years of age, the IC/BPS cases reported higher prevalence of "raped or molested" compared to controls (24.0% vs. 14.7%; p = 0.047). Within the IC/BPS group, cases reporting previous sexual abuse endorsed greater sensory pain, depression and poorer physical quality of life at the present time compared to IC cases without a sexual abuse history. In the controls only, those reporting previous sexual abuse endorsed more depression, anxiety, stress, social maladjustment poorer mental quality of life in the present time. When the analysis was corrected for potential multiple comparison error, none of the findings remained significant in either the IC/BPS or control groups. INTERPRETATION Childhood traumatic events, in particular sexual abuse and extreme illness, are reported as more common in IC/BPS patients than controls. Early trauma, such as the occurrence of sexual abuse, is associated with some differences in patient adjustment (e.g., pain, quality of life, depression) but this impact appears to be, at most, very modest.
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Tripp DA, Nickel JC, Wong J, Pontari M, Moldwin R, Mayer R, Carr LK, Doggweiler R, Yang CC, Mishra N, Nordling J. Mapping of pain phenotypes in female patients with bladder pain syndrome/interstitial cystitis and controls. Eur Urol 2012; 62:1188-94. [PMID: 22633363 DOI: 10.1016/j.eururo.2012.05.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/09/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Many bladder pain syndrome/interstitial cystitis (BPS/IC) patients report multiple pain locations outside the pelvis. No research has examined pain using a whole-body diagram, pain-associated adjustment factors, or the impact of pain in multiple body areas on patients' quality of life (QoL). OBJECTIVE Compare and contrast pain in BPS/IC patients and controls using a whole-body diagram (visible body areas). Examine the association between patient adjustment factors and greater number of body pain areas (pain phenotypes). DESIGN, SETTING, AND PARTICIPANTS Validated questionnaires were collected from diagnosed, tertiary-care, outpatient, female BPS/IC patients (n=193) and age-matched controls (n=115). Scales included a body pain area diagram, demographics/history, pain severity, BPS/IC symptoms, pain, depression, catastrophizing, and QoL. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cross-tabulation and analysis of variance models addressed the patient and control differences. RESULTS AND LIMITATIONS Patients reported more pain than controls in all reported body areas. Four pain phenotypes were created based on increasing counts of body locations (BPS/IC only, BPS/IC+plus 1-3 additional locations, BPS/IC plus 4-9, BPS/IC ≥ 10). Patients reported more body pain locations, pain, urinary symptoms, depression, catastrophizing, and diminished QoL than controls. The increased-pain phenotype was associated with poorer psychosocial adjustment and diminished physical QoL, but catastrophizing and low scores for mental QoL remained stable across all patient groups. This study was cross-sectional, relying on correlation-based analyses, thus causality cannot be established. CONCLUSIONS Patients reported numerous systemic pain symptoms outside the areas associated with the bladder/pelvic region, and increased numbers of body pain sites were associated with poorer patient outcomes (ie, pain severity, depression). This study illustrates the significant negative impact of pain on patient adjustment in BPS/IC. These findings suggest that clinicians carefully consider pain location distributions and the potential impact of body pain phenotypes during patient evaluation and treatment planning.
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Affiliation(s)
- Dean A Tripp
- Department of Psychology, Queen's University, Kingston, ON, Canada.
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Shorter B, Akerman M, Varvara M, Patino E, Moldwin R. 819 STATISTICAL VALIDATION OF A SHORT FORM FOOD SENSITIVITY QUESTIONNAIRE FOR INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS). J Urol 2012. [DOI: 10.1016/j.juro.2012.02.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Herati A, Shorter B, Sadek M, Levey H, Okhunov Z, Moldwin R. 808 THE EFFECTS OF CAFFEINE ON THE SYMPTOMS OF INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME: A RANDOMIZED, PLACEBO-CONTROLLED DOUBLE BLIND STUDY. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Evans R, Moldwin R, Cossons N, Darekar A, Scholfield D, Mills I. 1508 TANEZUMAB REDUCES PAIN AND URGENCY IN INTERSTITIAL CYSTITIS: RESULTS OF A PHASE 2 TRIAL. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nickel JC, Tripp DA, Pontari M, Moldwin R, Mayer R, Carr LK, Doggweiler R, Yang CC, Mishra N, Nordling J. Psychosocial phenotyping in women with interstitial cystitis/painful bladder syndrome: a case control study. J Urol 2010; 183:167-72. [PMID: 19913812 DOI: 10.1016/j.juro.2009.08.133] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE We characterized and compared psychosocial phenotypes in a female interstitial cystitis/painful bladder syndrome cohort and an age matched cohort without that diagnosis. MATERIALS AND METHODS Female patients with interstitial cystitis/painful bladder syndrome and controls without the condition completed a psychosocial phenotyping questionnaire battery, including a demographics/history form and validated questionnaires focused on a range of presenting symptoms, psychosocial parameters and quality of life. Specific measures included interstitial cystitis symptom and problem index, McGill Pain Questionnaire, Medical Outcomes Study Sleep Scale, Center for Epidemiological Studies Depression Scale, State-Trait Anxiety Inventory, Pain Catastrophizing Scale, Female Sexual Functioning Index and Multidimensional Scale of Perceived Social Support and Medical Outcomes Study Short Form-12 quality of life. Direct comparisons and correlations were made to establish group differences and the strength of associations for psychosocial parameters in patients with interstitial cystitis/painful bladder syndrome. RESULTS Questionnaires completed by 207 patients with interstitial cystitis/painful bladder syndrome were compared to those of 117 controls matched for age, partner status and education. Compared to controls patients reported significantly more pain (total, sensory and affective), worse physical quality of life, increased sleep dysfunction, depression, catastrophizing, anxiety, stress and moderately more sexual/social function problems. These suffering, coping and social parameters correlated with the degree of general pain but stress, anxiety, depression and catastrophizing further correlated with IC specific symptoms and strongly with decreased quality of life. Pain was strongly associated with physical quality of life, while depression, catastrophizing and stress, and to a lesser extent social support were associated with poor mental quality of life. CONCLUSIONS Patients with interstitial cystitis/painful bladder syndrome have significant cognitive and psychosocial alterations compared to controls.
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Nickel JC, Moldwin R, Lee S, Davis EL, Henry RA, Wyllie MG. Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome. BJU Int 2009; 103:910-8. [PMID: 19021619 DOI: 10.1111/j.1464-410x.2008.08162.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J Curtis Nickel
- Queens University, Kingston General Hospital, Kingston, ON, Canada
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Abstract
BACKGROUND Interstitial cystitis is characterized by over 6 months of chronic pain, pressure and discomfort felt in the lower pelvis or bladder. It is often relieved with voiding, along with daytime frequency and nocturia in the absence of a urinary tract infection. Interstitial cystitis occurs primarily in females including adolescents and its diagnosis is still one of exclusion. It is now recognized as a serious medical condition associated with significant disability. OBJECTIVE The aim of this paper was to review the pathogenesis and treatment of interstitial cystitis with emphasis on new pathogenetic trends and therapeutic modalities. METHODS About 713 mostly original papers were reviewed in Medline from 1990 to August. 2008. All authors independently reviewed the literature. Large, double-blind, placebo-controlled, clinical trials were few and the medical histories of the patients used varied considerably making conclusions difficult. Promising pilot trials turned out mostly negative on follow-up. RESULTS Increasing evidence of co-morbid diseases, neurogenic inflammation and the effect of stress are promising as new targets for pathophysiology. No new effective treatments have emerged. Oral pentosanpolysulfate, amitriptyline, hydroxyzine and quercetin, as well as intravesical heparin/bicarbonate/lidocaine solutions, are still used with variable success. Some pilot open-label trials presented encouraging findings. CONCLUSION Interstitial cystitis contributes substantially to chronic pelvic pain and to poor quality of life. Oral or intravesical administration of solutions containing sodium hyaluronate, chondroitin sulfate and quercetin to both reduce bladder inflammation and 'replenish' the glycosaminoglycan layer should be tried. There is a clear need for therapeutic modalities. New potential translational research areas are suggested.
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Affiliation(s)
- Theoharis C Theoharides
- Tufts University School of Medicine, Department of Pharmacology and Experimental Therapeutics, Experimental Therapeutics 136 Harrison Avenue, Boston, MA 02111, USA.
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Abstract
AIMS The aims of this article were to discuss options for diagnosing interstitial cystitis (IC), to compare approaches and to encourage early diagnosis of this disorder in the primary care setting. METHODS Experts discussed the tools available to diagnose IC and the advantages and disadvantages of each approach. Treatment options, both pharmacological and non-pharmacological, were also discussed. The importance of patient follow-up was emphasised. RESULTS Diagnostic options for IC include a thorough history and physical examination, laboratory evaluations, symptom screening tools, cystoscopy with hydrodistention, bladder biopsy, potassium sensitivity testing, intravesical anaesthetic challenges, urodynamics and urinary markers. Treatment options include oral and intravesical medications, dietary modification and physical therapy. Patient follow-up can be an opportunity to educate and empower patients to participate in their treatment. DISCUSSION A thorough patient history, physical examination and laboratory evaluations are keys to the diagnosis of IC. Optional diagnostic approaches may help increase physician confidence in prescribing therapy for this disorder. Multimodal therapy with an emphasis on patient education can help ensure success in treating IC. CONCLUSION Understanding the options available to diagnose IC may result in earlier identification and treatment for some patients.
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Affiliation(s)
- J B Forrest
- University of Oklahoma Health Science Center, Urologic Specialists of Oklahoma, Inc., Tulsa, OK 74146, USA.
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Affiliation(s)
- Rebecca Braunstein
- Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Edan Shapiro
- Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Jonathan Kaye
- Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
| | - Robert Moldwin
- Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Abstract
Myofascial pain as a cause of chronic pelvic pain with or without pelvic organ pathology is well-documented in the literature. Causes of this pain are multifactorial, including specific pelvic organ pathologies, neuromuscular disorders, and psychologic causes. Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians, physical therapists, neurologists, and psychiatrists. Treatment strategies, including behavioral management, medications, physical therapy, trigger point injections, neuromodulation, botulinum toxin injection, and other lesser known treatment modalities, are discussed in detail in this article.
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Affiliation(s)
- Arun K Srinivasan
- The Arthur Smith Institute of Urology, North Shore and Long Island Jewish Health System, 425 Lakeville Road, New Hyde Park, New York, NY 11040, USA.
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Teichman JMH, Moldwin R. The role of the bladder surface in interstitial cystitis/painful bladder syndrome. Can J Urol 2007; 14:3599-607. [PMID: 17784979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Interstitial cystitis (IC) is a potentially severe and debilitating condition of the bladder. Numerous factors have been implicated in its pathogenesis. MATERIALS AND METHODS A literature review was conducted on the following topics: urothelium, mucosal lining, interstitial cystitis, bladder, and glycosaminoglycans. RESULTS A commonly proposed cause for IC is a defect or alteration in the bladder surface leading to increased permeability to noxious urinary solutes and ultimately to tissue inflammation and neurogenic upregulation. Support for this concept is drawn from studies of the structure, function, and composition of the bladder surface. The cause(s) of this alteration is not known, although recent research has implicated changes in the levels of growth factors and/or compounds that protect against irritants and potentially "toxic" factors. The etiology of IC is likely multifactorial. CONCLUSIONS Alterations of the bladder surface are observed in IC, and may play an important role in the etiology of this condition.
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Affiliation(s)
- Joel M H Teichman
- Division of Urology, St. Paul's Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg 2006; 20:120-9. [PMID: 16374539 DOI: 10.1007/s10016-005-5016-8] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Compression of the left renal vein between the aorta and the superior mesenteric artery has been termed the nutcracker syndrome. Obstruction of left renal vein outflow results in venous hypertension with the formation of intra- and extrarenal collaterals and/or the development of gonadal vein reflux. To date, a variety of clinical symptoms due to mesoaortic compression of the left renal vein (nutcracker syndrome) have been described. It is not known what pathophysiological variables play a role in the different clinical manifestations of nutcracker syndrome. We report two patients representing the two different forms of the condition. In the first, hematuria and left flank pain resolved in a young man after successful renocaval reimplantation. In the second, symptoms of pelvic congestion due to pelvic varices improved in a middle-aged woman after successful embolization of the gonadal vein and pelvic collaterals. This report reviews the pathophysiology, presentation, diagnosis including radiographic findings, management options, as well as the current literature on nutcracker syndrome.
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Affiliation(s)
- Udo Rudloff
- Department of Surgery, Division of Vascular Surgery, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York, USA.
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