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PubMed2006

Tacrolimus treatment for refractory lupus cystitis.

A 23-year-old woman presented with recurrence of lupus cystitis, which had been in remission under daily administration of a single corticosteroid over a period of 8 years. She was treated with increased doses of corticosteroid and immunosuppressants, i.e., cyclosporin, cyclophosphamide, azathioprine, and salazosulfapyridine, but the cystitis remained active. Since her condition became critical by the complication of intestinal pseudo-obstruction, tacrolimus was administered. This agent induced a remission promptly without significant adverse events in this patient, suggesting an efficacy to lupus cystitis refractory to corticosteroid and other immunosuppressants.

Adrenal Cortex Hormones↗

PubMed2006

Large Cystitis glandularis: a very rare cause of severe obstructive urinary symptoms in an adult.

Cystitis glandularis is a very rare proliferative disorder of the mucus-producing glands within the mucosa and submucosa of urinary bladder epithelium. We report such a case of glandular cystitis with intestinal metaplasia masquerading as a bladder tumor in a young male patient who presented with severe obstructive urinary symptoms. Cystoscopy revealed a tumor well circumscribed, measuring 5 x 4 cm on the trigone. Transurethral resection of the mass was carried out and the histopathology suggested cystitis glandularis. The literature regarding this entity has been reviewed and the differential diagnosis was discussed. Short-term follow-up of the patient with sonography and cystoscopy showed no recurrence.

Adult↗

PubMed1993

Intravesical formalin for hemorrhagic cystitis following irradiation of cancer of the cervix.

OBJECTIVE: To determine the effectiveness of intravesical formalin instillation in hemorrhagic cystitis following irradiation of cancer of the cervix. METHOD: Records were reviewed for 35 patients with hemorrhagic radiation cystitis who underwent treatment with 1% (n = 22), 2% (n = 10), and 4% formalin (n = 4), using Fair's technique. RESULT: Complete response was seen in 31 patients (89%) and partial response in 3 patients (8%) after a single instillation. Minor complications were seen in 19 patients (54%). Major complications occurred in 11 patients (31%), with 5 cases requiring subsequent urinary diversion. One patient died of persistent bleeding and probable formalin toxicity. Hematuria recurred in 7 patients achieving complete response at a mean period of 8 months after treatment. A 1% solution was as effective in controlling hematuria as higher concentrations and was associated with significantly less morbidity. CONCLUSION: Intravesical instillation of 1% formalin is an effective treatment for intractable hematuria secondary to radiation cystitis.

Administration, Intravesical↗

PubMed1979

Late hemorrhagic cystitis following low-dose cyclophosphamide therapy.

Hemorrhagic cystitis is a recognized acute complication of cyclophosphamide (Cytoxan) therapy in the treatment of malignant disease. More recently, lower dose, long-term cyclophosphamide therapy has been used in the treatment of autoimmune diseases including rheumatoid arthritis. In 3 patients hemorrhagic cystitis developed after long-term cyclophosphamide therapy for rheumatoid arthritis. Even in low dosage, this drug may cause hemorrhagic cystitis.

Aged↗

PubMed1981

Busulfan-induced hemorrhagic cystitis.

A case of a busulfan-induced hemorrhage cystitis is reported. Spontaneous resolution occurred following cessation of the drug. The similarity between the histologic appearances of busulfan cystitis and both radiation and cyclophosphamide-induced cystitis is discussed and the world literature reviewed. In view of the known tendency of busulfan to induce cellular atypia and carcinoma in other sites, periodic urinary cytology is suggested in patients on long-term therapy.

Busulfan↗

PubMed1988

The contribution of sensory nerves to xylene-induced cystitis in rats.

The role of capsaicin-sensitive sensory nerves of the rat urinary bladder in xylene-induced cystitis was investigated. Instillation of xylene into the urinary bladder of female rats induced cystitis, e.g. detrusor hyperreflexia and increased vascular permeability. Detrusor hyperreflexia was also observed in rats desensitized to capsaicin as adults (50-125 mg/kg s.c., 4 days before) but only for a short period (1 h) after instillation. When a longer time lag (24 h) was allowed to elapse following instillation, reflex micturition was almost abolished. In rats desensitized to capsaicin as newborns (50 mg/kg s.c. on second day of life) reflex micturition was almost abolished and xylene (given 1 h before measurement) was ineffective. The xylene-induced plasma extravasation was greater in the bladder neck than in the dome. In the bladder neck the "early" response to xylene was reduced but not abolished in rats densensitized to capsaicin as adults or pretreated with compound 48/80 and was abolished in rats desensitized to capsaicin as newborns. The bladder content of substance P-like immunoreactivity decreased at various times following xylene instillation but this change occurred in parallel to the increase in bladder weight. These findings indicate that xylene-induced cystitis involves, at least in part, an irritation of capsaicin-sensitive sensory nerves in the bladder wall. The present results further suggest that xylene acts by stimulating at least two populations of sensory nerves which differ in their sensitivity towards capsaicin.

Animals↗

PubMed2005

Three-day vs longer duration of antibiotic treatment for cystitis in women: systematic review and meta-analysis.

PURPOSE: We performed a meta-analysis to ascertain the efficacy and safety of the currently practiced 3-day antibiotic therapy for cystitis versus prolonged therapy (5 days or longer) to relieve symptoms and to achieve bacteriological cure. METHODS: The Cochrane Library, the Cochrane Renal Group's Register of trials, EMBASE and MEDLINE were searched to identify all randomized controlled trials comparing 3-day oral antibiotic therapy with prolonged therapy (5 days and longer) for uncomplicated cystitis in adult non-pregnant women. Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. Relative risks (RR) with their 95% confidence intervals (CI) were estimated; a fixed effect model was used. An intention-to-treat analysis was performed whenever possible. RESULTS: Thirty-two trials and 9605 patients met inclusion criteria. For symptomatic failure rates no difference between 3-day and prolonged antibiotic regimens was found at short term (RR 1.16, 95% CI: 0.96-1.41) and long-term follow-up (RR 1.17, 95% CI: 0.99-1.38). Three-day treatment was less effective than prolonged therapy in preventing bacteriological failure, relative risk 1.37 (95% CI: 1.07-1.74) for short-term follow-up, and 1.47 (95% CI: 1.22-1.77) for long-term follow-up. Adverse effects were more common in the prolonged therapy group (RR 0.83, 95% CI: 0.79-0.91). The results were consistent for subgroup and sensitivity analyses. CONCLUSION: Antibiotic therapy for 3 days is similar to prolonged therapy in achieving symptomatic cure for cystitis, while the prolonged treatment is more effective in obtaining bacteriological cure.

Administration, Oral↗

PubMed2005

Altered muscarinic receptor subtype expression and functional responses in cyclophosphamide induced cystitis in rats.

In the in vitro study, it was investigated whether the expression of muscarinic receptors and cholinergic responses were altered in the situation of experimental cystitis. Rats were treated with cyclophosphamide intraperitoneally and the bladders were excised 36-100 h later. Immunohistochemistry and immunoblotting showed all subtypes of the muscarinic receptor (M1-M5) to be present in the specimens from inflamed urinary bladders and controls. In the cyclophosphamide-treated rats, the expression of muscarinic M5 receptors was increased by more than 40 times (p<0.01; n=8) both in the smooth muscle and the urothelium. Both the maximal contractile response to carbachol and to a high potassium concentration was approximately halved in cyclophosphamide-treated tissues, whereas the reduction was substantially greater in response to low carbachol concentrations (<EC(50)). The administration of 4-DAMP inhibited the carbachol-induced contractile responses of inflamed strips less potently than of controls, whereas pirenzepine and methoctramine showed equipotency in the two groups. The nitric oxide synthase inhibitor l-NNA increased the contractile effect of carbachol in inflamed detrusor strips, while it had no effect in controls. Immunoblotting showed endothelial nitric oxide synthase (eNOS) to be up-regulated in cystitis, and immunohistochemistry revealed the change to occur in the urothelium and in the suburothelial layer. The alteration of cholinergic detrusor responses in cyclophosphamide-treated rats depends mainly on a general detriment of contractility but also on indirect effects possibly via nitric oxide synthesis. The most prominent histological alterations occurred in the urothelium in which muscarinic M5 receptors increased in particular. The study further underlines that the urothelium may play significant roles in the pathogenesis of urinary bladder disorders such as interstitial cystitis.

Animals↗

PubMed2004

Upregulation of corticotropin-releasing hormone gene expression in the paraventricular nucleus of cyclophosphamide-induced cystitis in male rats.

We examined the effects of cyclophosphamide (CP)-induced cystitis on the expression of corticotropin-releasing hormone (CRH) mRNA in the paraventricular nucleus (PVN) and the serum levels of adrenocorticotropic hormone (ACTH) using in situ hybridization histochemistry and radioimmunoassay. In addition, the expression of AVP heteronuclear (hn) RNA and neuronal nitric oxide synthase (nNOS) mRNA was also examined in the PVN of a CP-induced cystitis model. We found that the levels of CRH mRNA were significantly increased in the PVN at 2 h after intraperitoneal administration of CP compared to those in saline-treated rats. The CRH mRNA levels in the PVN peaked at 12 h after CP administration and the levels were still significantly higher than those in saline-treated group at 24 h after CP administration. The serum ACTH levels in CP-treated group were also significantly higher compared to those in saline-treated group at any of the time points examined. Unlike previous findings showing upregulation of nNOS mRNA and AVP hnRNA under somatic nociceptive states, the levels of nNOS mRNA and AVP hnRNA were unchanged in the PVN following CP-induced cystitis, visceral nociceptive stimulation. These results suggest that visceral nociceptive stimulation as well as somatic nociceptive stimulation may activate the hypothalamo-pituitary axis but the hypothalamic neuroendocrine responses produced by visceral nociceptive stimulation may be different from those produced by somatic nociceptive stimulation.

Adrenocorticotropic Hormone↗

PubMed2004

Caecocystoplasty for intractable interstitial cystitis: long-term results.

OBJECTIVE: To evaluate the role of orthotopic substitution caecocystoplasty in intractable interstitial cystitis refractory to conservative measures by looking at long-term follow-up results. PATIENTS AND METHODS: We present a retrospective review of eleven patients who underwent a trigone-preserving orthotopic substitution caecocystoplasty for intractable classical interstitial cystitis. All patients received conservative treatment for a mean period of three years. They were followed up for a mean period of nine years (range 4-14 years) with evaluation of symptoms, biochemistry, ultrasound scan and flexible cystoscopy. RESULTS: Symptomatic relief was universal with an increase of bladder capacity to normal. There was no mortality and the postoperative morbidity was minimal. Intermittent self-catheterisation due to high residual volumes was necessary in two patients. There was no significant urinary reflux or metabolic complications noted. Two patients required a cystectomy after four and six years respectively due to recurrent trigonal disease in one and urethro-trigonal hypersensitivity following intermittent self-catheterisation in the other patient. One patient developed an advanced adenocarcinoma in the caecal segment seven years following the primary operation. CONCLUSION: A sustained relief of symptoms is noted after trigone-preserving orthotopic substitution caecocystoplasty in intractable classical interstitial cystitis. It may not be appropriate in patients with urethro-trigonal disease or hypersensitivity. There is low long-term morbidity due to the operation but is associated with malignancy in the augmentate. Long-term follow-up is necessary to identify malignant change in the bladder.

Adult↗

PubMed2004

Antimicrobial susceptibility of uropathogens causing acute uncomplicated cystitis in female outpatients in South Korea: a multicentre study in 2002.

The objective of this study was to obtain data on the susceptibility of pathogens responsible for acute uncomplicated cystitis in South Korea to currently used antimicrobial agents. A total of 239 isolates were obtained from female outpatients with acute uncomplicated cystitis. The most prevalent causative organism was Escherichia coli (79.9%), followed by coagulase-negative staphylococci (CNS) (4.2%) and Enterobacteriaceae (8.2%). The mean rates of susceptibility to commonly prescribed drugs are ampicillin 35.5%, cefazolin 89.1%, ciprofloxacin 85.7%, and trimethoprim/sulphamethoxazole (TMP/SMX) 62.1%. Regionally, resistance to TMP/SMX among E. coli now exceeds 30% in all regions. The high prevalence of resistance among uropathogens requires on going surveillance to ensure the provision of effective empirical therapy for acute uncomplicated cystitis.

Acute Disease↗

PubMed2004

A pilot study using synthetic feline facial pheromone for the management of feline idiopathic cystitis.

Synthetic feline facial pheromone (FFP) (Feliway; Ceva Animal Health) was assessed for the management of cats with recurrent feline idiopathic cystitis (FIC). Nine of 12 cats completed the randomised, double-blinded, placebo-controlled, crossover pilot study. They had their environment treated daily with either FFP or placebo for 2 months, after which time the treatment groups were reversed. Owners used visual analogue scales to define the severity of their cat's clinical signs and behavioural changes. Five (56%) of the owners stated that their cat's overall health was better when they were using FFP. Four (44%) of the owners noticed no difference between when using the FFP and when using the placebo. While there were no statistical differences between the two treatment groups there was a trend for the cats exposed to FFP to show fewer days with clinical signs of cystitis (FFP total, mean per cat+/-standard deviation, 30, 4.3+/-6.7; placebo 69, 9.9+/-19.1), a lower overall clinical score (1667, 238+/-476; 2009, 287+/-425), a reduced number of episodes of cystitis (9, 1.3+/-2.0; 10, 1.4+/-2.1) and reduced negative behavioural traits (e.g., less aggression and fear) (-128, -18.3+/-65.8; -73, -10.4+/-35.1).

Animal Husbandry↗

PubMed2005

Virulence characteristics of Escherichia coli strains causing acute cystitis in young adults in Iran.

BACKGROUND: Escherichia coli strains that cause cystitis posses virulence properties that facilitate their colonisation and persistence in the bladder. In Iran, despite the high number of the urinary tract infections, very few studies has been done to determine the role of these virulence properties in the pathogenesis of E. coli cyctitis. PATIENTS AND METHODS: Eighty-seven strains of E. coli, isolated from young adults with cystitis in Shiraz, Iran, were examined for the expression of type 1 and P-fimbriae, mannose resistant haemagglutination, haemolysin production, aerobactin-mediated iron uptake, O:K serotypes, biochemical phenotypes (BPTs) and their antibiotic susceptibility patterns. RESULTS: Seventy-six percent of the strains expressed multiple virulence properties. There was a significant correlation between the presence of aerobactin and the expression of type 1 fimbriae. All P-fimbriated strains produced aerobactin with 50% of them also coexpressing haemolysin. Of the 29 different O:K serotypes identified, 42% belonged to serotypes not commonly found among European serotypes associated with UTI. Strains of O groups 4 and 6 expressed more virulence factors than the others. A high resistance against ampicillin, trimethoprim and cotrimoxasol was observed among the isolates with 53% of the isolates showing multiresistance to these three antibiotics. Certain BPTs were also found among O:K serotypes with some containing strains of the same virulence profile. CONCLUSION: We conclude that certain colonal groups of E. coli are commonly associated with cystitis in young adults in Iran with strains possessing a combination of aerobactin and type 1 fimbriae being the dominant ones and belonging to serotypes not commonly found in Europe. We also conclude that the multiple antibiotic resistant E. coli strains causing cyctitis are highly prevalent in this part of the country.

Acute Disease↗

PubMed2007

Changes in urine markers and symptoms after bladder distention for interstitial cystitis.

PURPOSE: We evaluated changes in urine markers and symptom scores after bladder distention in patients with interstitial cystitis. MATERIALS AND METHODS: Study subjects were 33 new patients who had undergone no prior interstitial cystitis treatment. Urine specimens were taken before and 1 month after bladder distention. University of Wisconsin symptom scores were done the same day as the urine specimen collection. Urine marker levels and symptom scores before and after distention were compared. Changes in markers were tested for associations with changes in symptom scores and other markers. Markers and specific symptoms before distention were tested for their association with post-distention symptom improvement. RESULTS: After distention the median total University of Wisconsin score decreased significantly (28.5 before, 20 after, p <0.001). A total of 12 patients (36%) had at least 30% improvement in University of Wisconsin score, and 8 patients (24%) had at least 50% improvement. No pre-distention markers or symptoms predicted which patients would have a good response. There were 2 urine markers that improved significantly after distention: anti-proliferative factor activity (median -96% before, -17% after, p <0.001) and heparin-binding epidermal growth factor-like growth factor levels (median 0.34 ng/mg creatinine before, 4.1 after, p <0.001). None of the changes in urine markers associated with changes in symptom scores. CONCLUSIONS: The median symptom score for newly diagnosed patients with interstitial cystitis decreased after distention, but only a minority of patients had at least 30% symptom improvement. Bladder distention altered urine anti-proliferative factor activity and heparin-binding epidermal growth factor-like growth factor levels toward normal, but the mechanism of symptom relief after distention is still unknown.

Adult↗

PubMed2007

The dual serotonin and noradrenaline reuptake inhibitor duloxetine for the treatment of interstitial cystitis: results of an observational study.

PURPOSE: We report an observational study to evaluate the efficacy and tolerability of duloxetine for interstitial cystitis. MATERIALS AND METHODS: A total of 48 women were prospectively treated for 2 months following an uptitration protocol to the target dose of 2 x 40 mg duloxetine per day. Patients received the target dose for 5 weeks. The efficacy of duloxetine treatment was assessed at week 8. The primary end point was a change in the overall well-being evaluated by a patient reported global response assessment. Secondary end points were changes in pain and urgency (visual analog scales), frequency and functional bladder capacity (48-hour voiding log), and changes in overall symptom severity (O'Leary-Sant index). RESULTS: There were 5 patients (10.4%) who were identified as responders and 17 patients (35.4%) who dropped out of the study exclusively due to side effects, with nausea present in all dropouts. No severe adverse events were reported. All 5 responders reported onset of symptom improvement but not until they had reached the target dose. Regarding secondary outcome parameters, duloxetine treatment did not result in statistically significant improvement of symptoms. Maximum urinary flow rate and residual volume were influenced more prominently in patients at the target dose, however, the changes did not appear to be clinically meaningful. CONCLUSIONS: Treatment of interstitial cystitis with duloxetine did not result in significant improvement of symptoms. The drug administration was safe but the tolerability of the drug was poor mainly due to nausea occurring with the starting dose of 20 mg per day. Based on the preliminary data of this observational trial we currently cannot recommend duloxetine as a therapeutic approach for interstitial cystitis.

Adrenergic Uptake Inhibitors↗

PubMed2004

Reduced recurrence of late hemorrhagic radiation cystitis by WF10 therapy in cervical cancer patients: a multicenter, randomized, two-arm, open-label trial.

BACKGROUND AND PURPOSE: To evaluate the efficacy and the safety of WF10 as adjunct to standard treatment in the management of late hemorrhagic radiation cystitis compared to standard treatment alone. PATIENTS AND METHODS: Cervical cancer patients with Grade 2 or 3 late hemorrhagic radiation cystitis, were randomized and treated with WF10 0.5 ml/kg body weight, diluted in physiological saline or 5% dextrose water 250 ml, intravenous infusions over 2 h on 5 consecutive days, every 3 weeks for 2 cycles plus standard treatment (WF10 group) or standard treatment alone (control group). Fifty patients in each group were evaluated by questioning; urinalysis and cystoscopy during a 1 year follow up. RESULTS: At week 7, 37 patients (74%) in the WF10 group and 32 patients (64%) in the control group showed complete resolution in objective hematuria (P = 0.28). Significantly lower use of antibiotics (P = 0.002) and antispasmodics (P < 0.001) was found in the WF10 group. Among the responders, 24 patients (77%) in the control group experienced recurrent objective hematuria, whereas in the WF10 group only 17 patients (47%) experienced a recurrence (P = 0.01). Recurrence of objective hematuria occurred significantly faster in the control group as evidenced by Kaplan-Meier and log-rank statistics (P = 0.004), suggesting a long-term effect of WF10. Cystoscopy, at the end of the treatment period and after the one year follow up showed overall improvement without significant difference between two groups. No severe toxicity was monitored. CONCLUSIONS: WF10 therapy is a safe, non-invasive and convenient method in the management of late hemorrhagic radiation cystitis. WF10 therapy, as adjunct to standard treatment, has significantly reduced recurrence of objective hematuria, compared to standard treatment alone, during a one year follow up.

Adult↗

PubMed2004

Botulinum toxin a has antinociceptive effects in treating interstitial cystitis.

OBJECTIVES: To present clinical evidence with botulinum toxin A (BTX-A) suggesting an antinociceptive role in patients with interstitial cystitis (IC). Intriguing evidence in a somatic pain model has suggested that BTX-A injection may have an antinociceptive effect on both acute and chronic (inflammatory) pain. METHODS: Thirteen female patients (6 in the United States and 7 in Poland) with IC according to the criteria of the National Institute of Diabetes, Digestive and Kidney Disease were included. Under short general anesthesia or sedation, 100 to 200 U of Dysport (Polish patients) or Botox (U.S. patients) was injected through a cystoscope into 20 to 30 sites submucosally in the trigone and floor of the bladder. Patients were evaluated with the O'Leary-Sant validated IC questionnaire or with voiding charts and a visual analog pain scale 1 month postoperatively and at subsequent 3-month intervals. The Polish patients also underwent pretreatment and post-treatment urodynamic evaluations. RESULTS: Overall, 9 (69%) of 13 patients noted subjective improvement after BTX-A treatment. The Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index mean scores improved by 71% and 69%, respectively (P <0.05). Daytime frequency, nocturia, and pain by visual analog scale decreased by 44%, 45%, and 79%, respectively (P <0.01). The first desire to void and maximal cystometric capacity increased by 58% and 57%, respectively (P <0.01). CONCLUSIONS: Our results suggest that BTX-A has an antinociceptive effect on bladder afferent pathways in patients with IC, producing both symptomatic and functional (ie, urodynamic) improvements.

Administration, Intravesical↗

PubMed2005

Early hyperbaric oxygen therapy improves outcome for radiation-induced hemorrhagic cystitis.

OBJECTIVES: To assess the clinical factors that affect the efficacy of hyperbaric oxygen (HBO2) therapy in treating radiation-induced hemorrhagic cystitis. HBO2 therapy is an effective treatment for radiation-induced hemorrhagic cystitis, with reported response rates ranging from 76% to 100%. METHODS: The data from patients with radiation-induced hemorrhagic cystitis treated at our institution between May 1988 and December 2001 were reviewed retrospectively. All patients received HBO2 therapy at 2.36 atm absolute pressure, with 90 minutes of 100% oxygen breathing per treatment. The outcome was assessed after at least 12 months of follow-up. We evaluated patient demographics, types of pelvic malignancy and radiotherapy, total radiation dose, onset and severity of hematuria, and prior intravesical management. Clinical improvement was defined as the absence of, or reduction in, macroscopic hematuria. RESULTS: A total of 60 patients (55 men and 5 women), mean age 70 years, received an average of 33 HBO2 treatments (range 9 to 63). Of the 60 patients, 48 (80%) had either total or partial resolution of hematuria. When treated within 6 months of hematuria onset, 96% (27 of 28) had complete or partial symptomatic resolution (P = 0.003). All 11 patients with previous clot retention had clinical improvement if treated within 6 months of hematuria onset (P = 0.007). Prior intravesical chemical instillation did not affect the clinical outcome. Patients who had undergone primary, adjuvant, or salvage external beam pelvic radiotherapy showed response rates of 81%, 83%, and 78%, respectively (P = 0.950). CONCLUSIONS: Our results show that delivery of HBO2 therapy within 6 months of hematuria onset is associated with a greater therapeutic response rate. Treatment efficacy was independent of prior intravesical therapy and the timing of radiotherapy.

Adolescent↗