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PubMed1990

Do women with idiopathic sensory urgency have early interstitial cystitis?

Interstitial cystitis is rarely considered as a cause of urinary symptoms in referrals to gynaecology clinics. Recent concepts in the diagnosis of this condition mean that it is emerging as a much more common entity, with both early and late forms of the disease being described. Mast cell density in the detrusor muscle has been reported to be useful as a disease marker to substantiate the diagnosis of interstitial cystitis where no classical diagnostic features exist. We assessed mast cell counts in bladder biopsies from 27 women with idiopathic sensory urgency and 10 control patients about to undergo a colposuspension procedure for pure genuine stress incontinence; 30% of the study group had a clear increase in the detrusor muscle mast cell population (detrusor mastocytosis). No control patient showed such an increase. Early interstitial cystitis should be considered as a possible cause of lower urinary tract symptoms in patients with apparently idiopathic sensory urgency.

Adult↗
PubMed2004

The management of haemorrhagic cystitis with sodium pentosan polysulphate.

OBJECTIVE: To assess the use of sodium pentosan polysulphate (SPP) for haemorrhagic cystitis (HC), a potentially life-threatening side-effect in patients treated with pelvic radiotherapy or cyclophosphamide, and which can be difficult to manage as patients often have significant comorbidity. PATIENTS AND METHODS: Between September 1991 and December 2000, 60 consecutive patients (24 women and 36 men) with haemorrhagic cystitis were primarily treated with SPP; 53 patients had had radical radiotherapy for pelvic malignancy and seven systemic cyclophosphamide. All patients were screened for blood dyscrasia and residual/primary urothelial malignancy with imaging, urine cytology and cystoscopy. RESULTS: In all, 51 patients were available for follow-up; the median (range) interval between completing treatment and developing haematuria was 4.5 (0.08-39.4) years, the duration of treatment 180 (21-1745) days and patients were followed for 450 (19-4526) days from the onset of haematuria. All patients were started on SPP at an initial dose of 100 mg three times daily. In 21 patients the dose was gradually reduced to a maintenance dose of 100 mg and in 10 further patients SPP was stopped because the haematuria stopped completely. Twenty patients died while on treatment from causes not directly related to their haematuria. CONCLUSION: We recommend the use of SPP as the primary method of managing haemorrhagic cystitis associated with pelvic radiotherapy or systemic chemotherapy.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Cystitis glandularis in children.

OBJECTIVE: To assess the characteristics of cystitis glandularis in children. PATIENTS AND METHODS: Three cases of cystitis glandularis in children are described, occurring in boys aged 9-13 years. The presenting symptoms were gross haematuria in the first patient and frequency and urgency in the second. The third patient was asymptomatic and the lesion appeared as a wide thickening of the bladder wall on follow-up ultrasonography for previous surgery. In all patients, a polypoid bladder mass was found at cystoscopy and diagnosed at histology. The endoscopic resection, with long-term antibiotic prophylaxis, was the treatment of choice, with no recurrence at 12-30 months of follow-up. CONCLUSION: Cystitis glandularis has been rarely described in children, and is probably related to chronic or recurrent infections or an inflammatory reaction. Its potential premalignant significance is still the subject of debate.

Adolescent↗
PubMed2005

Hyperbaric oxygen therapy for radiation-induced haemorrhagic cystitis.

OBJECTIVE: To assess the efficacy of hyperbaric oxygen (HBO) for treating haemorrhagic cystitis. PATIENTS AND METHODS: From February 1997 to April 2004, seven patients with radiation-induced haemorrhagic cystitis were treated with HBO; they received a mean (range) of 30 (18-57) HBO treatments and the follow-up was 24 (3-53) months. RESULTS: The haematuria resolved completely in all seven patients shortly after treatment; one had an improvement but died from complications relating to cancer shortly after completing treatment, and two had recurrence of gross haematuria. They were re-treated with HBO until the haematuria resolved. CONCLUSIONS: Radiation-induced haemorrhagic cystitis can be treated successfully with HBO primarily or after failure of standard regimens. This method was well tolerated even in patients debilitated by advanced cancer and blood loss. Long-term remission is possible in most patients, and re-treatment effectively manages recurrent bleeding.

Adult↗
PubMed1999

Oral methotrexate in the management of refractory interstitial cystitis.

To establish the safety and efficacy of low-dose oral methotrexate in treating refractory interstitial cystitis, 9 women who fulfilled internationally accepted criteria for the diagnosis of interstitial cystitis were enrolled in a prospective study. All had proven unresponsive to conventional treatment modalities. Assessment by pain score and frequency volume charts was performed pretreatment and up to 6 months during therapy. No significant adverse side effects were noted. At the end of follow-up, 4 women had noted a subjective improvement in bladder pain and wished to continue on methotrexate, 4 women noted little change and 1 woman reported a worsening of symptoms. Overall there was a significant reduction in pain score (p = 0.047) posttreatment. However, there was no significant difference in urinary frequency per 24 hours (p = 0.40), maximum voided volume (p = 0.089) or mean voided volume (p = 0.59). Methotrexate significantly improved bladder pain in women with interstitial cystitis, although no significant change was found in voiding pattern.

Adult↗
PubMed1982

Cystitis cystica in childhood: clinical findings and treatment procedures.

During the period 1967 to 1978, 1166 girls were admitted to our department because of urinary tract infection. In 97 of the 439 girls examined by cystoscopy, cystitis cystica was found. The age of the 97 girls varied from 3 to 12 years, mean 7 1/2 years. E. coli was found to be the major pathogenic organism in the urine. All but 3 girls had a history of recurrent urinary tract infection. Urinary tract abnormalities were found with the same frequency as in other studies concerning urinary tract infection in childhood. Vesicoureteric reflux was demonstrated on the cystogram for 33% of the girls. Patients with cystitis cystica are a hard core group requiring long-term treatment and follow-up. Different therapeutic methods are discussed and our experience with chlorhexidine bladder instillation is mentioned. The literature concerning cystitis cystica, especially in childhood, is also discussed.

Adolescent↗
PubMedDate not supplied

Radiographic and ultrasonographic findings of emphysematous cystitis in four nondiabetic female dogs.

The urinary bladder of four dogs with emphysematous cystitis was assessed radiographically. Ultrasonography was also performed using a 7.5-MHz microconvex probe in dorsal recumbency and in a standing position. Ultrasonographically there were bright echoes and reverberations typical of gas in all dogs. This was entrapped in the bladder wall as it appeared in the same location in recumbent and standing positions. Bladder size was reduced and bladder content was echogenic in all dogs. In only one out of the four dogs was a gas stripe seen in the bladder on radiographs. Proteus mirabilis was isolated from the urine of all patients. Diabetes was ruled out on the basis of urine and blood analysis. A small amount of gas can be difficult to detect on radiographs. Ultrasonography appears to be a more sensitive technique for detection of gas within the bladder at an early stage of emphysematous cystitis. Prevalence of emphysematous cystitis may be underestimated if only radiographs are made.

Animals↗
PubMed2003

Interstitial cystitis.

PURPOSE: To describe the pathophysiology, assessment, diagnosis, and management of interstitial cystitis. DATA SOURCES: Selected professional publications and presentations. CONCLUSIONS: Interstitial cystitis (IC) is a chronic and disabling condition. Symptoms include urinary frequency and urgency, pain, dyspareunia, and nocturia. It occurs primarily in women. Onset is predominately in adulthood although IC does occur in childhood. Bladder wall defects, auto-immune disorder, viral and/or bacterial infection, toxin exposure, pelvic floor dysfunction and inflammatory response are possible causes. Diagnosis is by history, physical examination, laboratory tests, and cystoscopic examination. The management of interstitial cystitis includes dietary changes, antihistamines, tricyclic antidepressants, oral and intravesicle glucosaminoglycans, hydrodistention, pain management and emotional support. IMPLICATIONS FOR PRACTICE: Nurse practitioners need to be knowledgeable about the occurrence and debilitating effect of IC. Inclusion of IC into the differential diagnoses related to urgency, frequency, and abdominal pain will help assure the timely and effective diagnosis and management of this unusual disease.

Cystitis, Interstitial↗
PubMed2004

A study of environmental and behavioural factors that may be associated with feline idiopathic cystitis.

The cause of cystitis in many cats remains unknown. The aim of this study was to determine whether or not any environmental or behavioural factors, particularly those that could be considered potentially stressful, were associated with feline idiopathic cystitis (FIC). The questionnaire-based study involved comparing 31 cats with FIC to 24 cats in the same households that did not have cystitis. They were also compared with a control population of 125 clinically healthy cats. Compared with the live-in controls and the control population, the cats with FIC were significantly more likely to be male, overweight and pedigree. Several stress factors were found to be associated with FIC. The factor that stood out most prominently was living with another cat with which there was conflict. The findings support the hypothesis that stress may be implicated in some cases of FIC.

Animal Husbandry↗
PubMed1990

[An in vitro study on the treatment of complicated cystitis using an automatic simulator].

A computer simulation of a Kidney-bladder model was prepared for automatic control of the urine concentration of antibacterial drug administrated. The following results were obtained in an investigation of the problems of complicated cystitis in vitro using ofloxacin. 1) It was suggested that the time required for elimination of the bacteria was prolonged as the level of complication of the disease state in the urinary tract increased. 2) In the model of highly complicated cystitis caused by urinary flow stagnation, recurrences were observed in vitro even with administration of a large dose of ofloxacin. 3) The time required for a elimination of bacteria tended to become shorter as the dose of the antibacterial agent increased. 4) The time until the start of regrowth of the bacteria tended to be prolonged as the dose of the antibacterial agent increased. 5) It was suggested by our in vitro experiment that if the background disease became more complicated, it would be more difficult to treat, as in the case of complicated cystitis.

Computer Simulation↗
PubMed1992

[Clinical efficacy of levofloxacin (LVFX) single-dose therapy in female acute uncomplicated cystitis].

Treatment of infections by the use of antimicrobial agents should be made essentially in a dose close to the minimally required dose. Acute uncomplicated cystitis in female fits as the subject for a single-dose therapy since it is an infection reactive relatively easily to antimicrobial agents. Accordingly, an assessment has been made regarding the therapeutic results of the single-dose therapy in 76 female cases of acute uncomplicated cystitis by the use of LVFX 200 mg which is a new quinolone. The urinary concentration more than MIC90 to Escherichia coli is sustained for about 3 days by this single-dose therapy. As a result of judging the therapeutic results from the reactions of the three clinical findings of pain on micturition, pyuria and bacteriuria, excellent therapeutic results were obtained with effective rates being 100% (76/76) on the day 3, 93.9% (46/49) on the day 7 and 94.4% (34/36) on the day 14. The rate of cystitic symptoms which recurred posed no problem, being 12.5% (5/40) up to three months, as investigated by a questionnaire. As a result of performing close urological examinations such as cystoscopy on six cases with insufficient results or recurrence, we could detect mild underlying conditions which are considered to be intractable factors in the bladder in three cases. From the above results, the single-dose therapy of acute uncomplicated cystitis in the female by LVFX which is a new quinolone was considered to be an excellent therapeutic drug from its characteristics such as its therapeutic results being the same as the conventional therapy by daily administration, excellent drug compliance, low cost, hard selectiveness of resistant strains, less side effects and furthermore it gives the opportunity of detecting a latent and mild underlying condition.

Acute Disease↗
PubMed1992

[Single-dose treatment of tosufloxacin (TFLX) for acute uncomplicated cystitis].

The effectiveness of a single 300-mg dose of tosufloxacin and of 3-day treatment with tosufloxacin (300 mg daily) were compared in a prospective trial in order to clarify the cost-effectiveness of tosufloxacin for acute uncomplicated cystitis. Fifty female patients (25 patients of each group) with acute uncomplicated cystitis received one of these treatment regimens, and the clinical data and follow-up culture results were analyzed. The effectiveness rates of single-dose treatment and 3-day treatment after 3 days were 100% and 96%, respectively. The recurrence rates of single-dose treatment and 3-day treatment after 14 or 28 days were 0% (0/13 patients) and 15% (2/13 patients), respectively. There was no significant difference in the effectiveness rate and the recurrence rate between these two groups, statistically. All isolated strains were eliminated in both regimens. From these results, it is suggested that single-dose treatment of tosufloxacin is effective enough for acute uncomplicated cystitis.

4-Quinolones↗
PubMed1993

Diagnosis of childhood BK virus cystitis by electron microscopy and PCR.

A case of BK virus cystitis in a 5 year old boy is reported. This patient, who was not immunocompromised, had had acute cystitis for two weeks. Many intracytoplasmic inclusions were observed in urinary sediment smears stained by the Papanicolaou method. Electron microscopic examination showed virus particles, presumed to be human polyomavirus, in the nuclei of the degenerated urothelial cells. A DNA sequence of the BK virus was detected in 200-300 urothelial cells in Papanicolaou stained smears by the polymerase chain reaction. BK virus is an unusual cause of symptomatic cystitis in a healthy child.

BK Virus↗
PubMed1995

Clinical, and light and electron microscopical findings in sows with cystitis.

The clinical findings, and urinary and morphological changes in the urinary bladder were investigated in 25 sows with a urinary tract infection. Eubacterium suis was isolated from 12 of the sows but not from the other 13. The clinical signs did not always correlate with the morphological changes. The only clinical sign indicating the beginning of cystitis appeared to be a significant bacteriuria. Other urinary changes occurred later when the inflammatory processes were more severe. In contrast with cystitis due to other bacteria, infection with E suis frequently resulted in a macrohaematuria and urinary pH values above 8.0. However, the light and electron microscopical findings in the bladder mucosa were similar in the sows with and without cystitis due to E suis. The transformation of goblet cells and the development of mucin cysts were probably due to the local bladder defence mechanisms. More severe lesions were observed with E suis infections, which resulted in changes in the ureterovesical junctions and in ascending renal infection and uraemia.

Animals↗
PubMed1998

Clinical response to an oral prostaglandin analogue in patients with interstitial cystitis.

OBJECTIVE: To assess the efficacy of the oral prostaglandin analogue misoprostol in controlling the symptoms of interstitial cystitis in patients with refractory disease. METHODS: Twenty-five patients were commenced on misoprostol 600 micrograms daily for 3 months. Patients who responded to therapy were offered treatment for a further 6 months. Assessment of the response was by a voiding log and an interstitial cystitis symptom score. RESULTS: At 3 months, 14 patients (56%) had significantly improved, and after a further 6 months, 12 patients (48%) had a sustained response. The incidence of adverse drug effects was 64%. Most side effects were minimal, and the response rate in patients who were able to tolerate the drug was 87% at 3 months and 75% at 9 months. CONCLUSIONS: The oral prostaglandin analogue misoprostol is effective in treating the symptoms of interstitial cystitis. It is possible that prostaglandins have a cytoprotective action in the urinary bladder.

Administration, Oral↗
PubMed1998

Combined use of urinary alpha1-microglobulin and 99mTc DMSA scintigraphy in the diagnosis and follow-up of acute pyelonephritis and cystitis in children.

OBJECTIVES: In the absence of specific symptomatology in children and neurogenic bladder disease patients, the early diagnosis of acute pyelonephritis is a challenge. The aim of the present study was to determine if dimercaptosuccinic acid (DMSA) lesion-positive (acute pyelonephritis) patients have elevated urinary alpha1-microglobulin (alpha1-MG) excretion (no false negatives) and if DMSA lesion-negative (cystitis) patients have normal urinary alpha1-MG excretion (no false positives). METHODS: A selected population of 62 children above 3 months of age with a proven urinary tract infection were administered a DMSA scan. A control scan was performed after the acute phase of the illness, and the diagnosis of pyelonephritis (n = 44) was made retrospectively. The urinary alpha1-MG was determined by immunonephelometry. RESULTS: The urinary alpha1-MG-creatinine ratio was highly sensitive (98%) and specific (100%) and correlated with the DMSA scintigraphy images. Only 1 of the 44 patients with pyelonephritis and all of the cystitis patients (n = 18) had a normal urinary alpha1-MG (<10 mg/g). The drop in absolute DMSA uptake correlated significantly (r = 0. 758, p < 0.001) with the urinary alpha1-MG-creatinine ratio. The urinary alpha1-MG-creatinine ratio was significantly higher (p < 0. 02) in bilateral than in unilateral pyelonephritis. CONCLUSION: DMSA lesion-positive (acute pyelonephritis) patients have elevated urinary alpha1-MG excretion and DMSA lesion-negative (cystitis) patients have normal urinary alpha1-MG excretion.

Acute Disease↗
PubMed2000

Diagnosis and management of eosinophilic cystitis: a pooled analysis of 135 cases.

OBJECTIVE: Eosinophilic cystitis is a rare disease. We reviewed the literature for clinical presentation, diagnosis and therapeutic options to establish recommendations for diagnostic and therapeutic management. METHODS: A pooled analysis was performed of 135 patients with eosinophilic cystitis presented in the literature. The evaluation included patient age, sex and race, presenting symptoms, diagnostic examinations, treatment and results, and complications. RESULTS: The mean age at diagnosis was 41.6 years (range 5 days to 87 years). An equal distribution existed between males (44%) and females (35%), but in children (21%) boys were more often affected (14%) than girls (7%). The most common presenting symptoms were frequency (67%), dysuria (62%), gross/microscopic hematuria (68%), suprapubic pain (49%) and urinary retention (10%). All patients had a cystoscopy and biopsy; a biopsy is mandatory to establish the diagnosis. Positive urine cultures were found in 26% of the patients. Periferal eosinophilia was present in 43%. An intravenous urography was performed in 66%, ultrasonography in 15%, cystography in 23% and a CT scan in 10%. The majority of patients was treated with combinations of corticosteroids, antihistaminics and antibiotics (45%), avoiding of the suspected antigen (17%), transurethral resection of the lesions (9%), partial cystectomy (4%) or total cystectomy (4%). The success rates for the different treatments were variable: transurethral resection combined with corticosteroids, antihistaminics or antibiotics seemed most successful, while total cystectomy is reserved for patients with unresponsive disease and hematuria. The most common complications were dilation of the upper urinary tract (27%) and eosinophilic gastroenteritis (4.5%); all other complications occurred in less than 3% of the patients. CONCLUSION: Eosinophilic cystitis is equally distributed among the sexes, but in children boys are affected more often than girls. The presenting symptoms are frequency, dysuria, hematuria, suprapubic pain and urinary retention. The treatment of choice is (radical) transurethral resection of the lesions in the bladder and a combination of corticosteroids and antihistaminics. Antibiotics are given when a urinary tract infection is present, or when dilation of the upper urinary tract exists. Most patients are cured but recurrence is a frequent finding.

Adolescent↗
PubMed2001

Radiation-induced haemorrhagic cystitis.

OBJECTIVES: In this article we review the literature concerning the frequency and management of severe haemorrhagic radiation-induced cystitis. METHODS: A Medline search was performed from 1966 to 1999 for articles in English. A total of 309 references were found. Abstracts and complete articles were reviewed. RESULTS: Severe haemorrhagic cystitis following radiotherapy remains a relatively rare event. However, the fact that it is relentlessly progressive and that treatment options are suboptimal makes it clinically important. The incidence of severe haematuria following pelvic irradiation is difficult to determine from the literature although most studies state an incidence of less than 5% which increases with time since irradiation. Methods of treatment include simple bladder irrigation, cystodiathermy, oral, parenteral and intravesical agent, hyperbaric oxygen therapy, hydrodistension, internal iliac embolisation, urinary diversion and cystectomy. No management strategy is 100% successful and a stepwise progression in treatment intensity is often required. CONCLUSION: The articles available on radiation-induced haemorrhagic cystitis are principally retrospective and involve small numbers of patients who have had several different treatment modalities. In the absence of randomised studies comparing treatments, it is impossible to set definitive rules about management but patients with this condition probably warrant early and aggressive treatment.

Clinical Protocols↗