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PubMed2006

Cidofovir bladder instillation for the treatment of BK hemorrhagic cystitis after allogeneic stem cell transplantation.

We report a case of severe hemorrhagic cystitis after allogeneic transplantation in association with high BK viral load. After failure of aggressive hydration, platelet and blood transfusions, continuous bladder irrigation, and tapering of the immune suppression, we instilled cidofovir into the bladder, which resulted in decreased BK viral load and significant clinical improvement. Our case suggests that local cidofovir therapy for viral hemorrhagic cystitis is effective and well tolerated with no observed side effects.

Administration, Intravesical↗
PubMed1994

Endoscopic neodymium:YAG laser treatment of radiation-induced hemorrhagic cystitis.

Hemorrhagic cystitis is a debilitating complication of radiation therapy for pelvic malignancy. Forty-two such patients with intractable hematuria underwent endoscopic Nd:YAG laser coagulation under local anesthesia between January 1990 and July 1992. The laser power was kept at < or = 30 W and the pulse duration < or = 3 s. Control of bleeding was achieved in 39 patients after one sitting and in 2 patients after two sittings of laser treatment. There were no complications of the procedure and recurrence of bleeding was not seen in any of the patients achieving CR at a mean follow-up period of 14 months. With modifications in the safety guidelines, we recommend laser treatment as the initial procedure of choice in patients with hemorrhagic radiation cystitis.

Adult↗
PubMed2004

Transient ischemic attack after electromotive drug administration for chronic non-infectious cystitis: report of two similar cases.

UNLABELLED: Electromotive drug administration (EMDA) is a new and promising approach for the treatment of chronic non-infectious cystitis. In animal studies utilizing EMDA there was evidence for deep penetration of dyes into the muscular layers of the bladder wall. However, besides minor local irritation no systemic side effects have been reported after translation of EMDA into the clinical setting. AIMS: This article reports for the first time systemic neurological alterations after EMDA for chronic non-infectious cystitis. SUBJECTS AND METHODS: Two male patients, aged 72 and 78 years, respectively, were readmitted to the emergency room within few hours after EMDA showing clinical signs of transient ischemic attacks (TIA). After clinical examination, both patients were observed. RESULTS: Under overnight observation without any specific therapy the symptoms vanished completely in both patients. CONCLUSIONS: In older patients (>70 years of age) undergoing EMDA, cardiac and neurologic function should be monitored. The time of treatment during the first EMDA session should be limited to 15 or 20 min.

Aged↗
PubMed1993

Abnormal pedal thermoregulation in interstitial cystitis.

Isolated cold stress tests were used to evaluate the thermoregulatory capacity in the feet of 19 patients with interstitial cystitis (IC) and of 11 healthy volunteer control subjects. Mean pedal skin temperature fell more rapidly in the IC group as compared with controls; significant differences were found at 10-min (P = 0.002) and 20-min (P = 0.0008) cooling. Mean skin temperature remained lower in the IC group throughout the study. Sixteen feet (42%) in the IC group and five (22%) of the control feet failed to return to within 2 degrees C of baseline temperature during the 20-min recovery period. These findings may reflect abnormal vasomotor control in the IC group and, if so, may be indicative of increased spinal sympathetic activity in interstitial cystitis.

Adult↗
PubMed2006

Bladder augmentation for the treatment of chronic tuberculous cystitis. Clinical and urodynamic evaluation of 25 patients after long term follow-up.

AIMS: Clinical and urodynamic evaluation of the late outcome of 25 patients with chronic tuberculous cystitis who underwent bladder augmentation. PATIENTS AND METHODS: Twenty men and five women with median age of 40 years were evaluated. The tubularized ileocecal segment was used in 8 cases, the detubularized sigmoid in 13, and the tubularized sigmoid in 4. Patients underwent a postoperative clinical and urodynamic evaluation. Miccional diurnal frequency of more than 2 hr together with patient satisfaction as assessed by the quality of life question of the ICSmaleSF questionnaire was considered a good result. RESULTS: The average postoperative follow-up was of 11.1 +/- 9.1 (1 to 36) years. A good result was seen in 80% of the patients. Bad results occurred statistically in the cases using tubularized sigmoid and in patients with prostatitis. Patients with good results showed augmented bladders with normal sensation (P = 0.03) and greater capacity (P < 0.01) and compliance (P < 0.01) than did those with bad results. There was no statistically significant difference in the frequency of involuntary contractions (P = 0.27) but in the good result patients, the contractions started with greater bladder filling volume (P = 0.02). CONCLUSIONS: The sigmoid should be detubularized but the ileocecal segment may be used in its original tubularized form to augment the bladder with chronic tuberculous cystitis. Augmented bladder with capacity of more than 250 ml, good compliance, and normal sensation are necessary for diurnal frequency of more than 2 hr. The presence of involuntary contractions does not lead to a decrease in the diurnal frequency.

Adolescent↗
PubMed2003

Experimental neurogenic cystitis.

Recent advances in basic and clinical research indicate that interstitial cystitis (IC) is a form of neurogenic inflammation, thereby opening new avenues for research into this painful disease. With this in mind, we have recently developed a rat model of neurogenic inflammation of the bladder produced by a central nervous system viral disease. As in IC, the inflammation in this model develops without direct injury or trauma to the bladder, is non-infectious, and is limited to the bladder. Our most recent studies aimed at further testing the similarity of this animal model to IC by assessing the urine content in histamine with the occurrence of mast cell degranulation in the bladder wall. We further verified for a sex difference in the occurrence of the disease. Our results showed increased levels of urine histamine and mast cell activation during the early stages of the disease. We additionally observed that females had a greater degree of plasma extravasation, while males had a greater cellular infiltration together with worse behavioral signs. Gonadectomy prevented the bladder inflammation altogether in both males and females. These findings further validate our model of neurogenic cystitis to study the neurogenic component of IC.

Animals↗
PubMed1993

Clinical experience with multiagent intravesical therapy in interstitial cystitis patients unresponsive to single-agent therapy.

A total of 25 patients with the diagnosis of interstitial cystitis (IC) were involved in this study. All patients had been previously diagnosed with interstitial cystitis and had received treatment with single intravesical agents. Patients were divided into two groups according to their bladder capacity. The bladder capacity was > 350 ml in group I patients and < 350 ml in group II patients. For our study, dimethylsulfoxide (DMSO), methylprednisolone, and heparin sulfate were given every week for a total of 6 weeks. When symptoms recurred, supportive oral pharmacotherapy consisting of anticholinergics and/or tricyclic antidepressants was given. Under anesthesia, patients in group I showed a 99% increase in their bladder capacity; whereas those in group II showed an increase of only 19%. Cystoscopically, Hunner's ulcers were present in 60% of the group II patients but were seen in only 5% of the group I patients. Histopathological examination showed that the inflammatory changes were more frequent and severe in group II than in group I. Mast-cell hyperplasia was present in 100% of the patients in group II, versus only 61% of those in group I. A total of 23 patients (92%) achieved an initial remission averaging 8.1 months. In all, 9 patients (35%) had 1 or more relapses, and all achieved a subsequent remission averaging 8 months. By this combined multiagent approach, the majority of patients with IC obtained relief from their incapacitating symptoms and were socially rehabilitated.

Administration, Intravesical↗
PubMed1979

Intravesical formalin for the control of intractable bladder haemorrhage secondary to radiation cystitis or bladder cancer.

During the last two years, 17 patients with haemorrhage due to radiation cystitis or bladder cancer have been treated by intravesical infusion of 10% Formalin solution. The results were very good in 9 cases, satisfactory in 3, while the remaining 5 cases were disappointing. The control of bleeding by Formalin was safe especially in patients with secondary haemorrhage due to radiation cystitis with no tumour recurrence.

Aged↗
PubMed1976

Vascular absorption of intravesical formalin in cyclophosphamide induced haemorrhagic cystitis.

Haemorrhagic cystitis was induced in dogs by the administration of cyclophosphamide. The bleeding was stopped by intravesical instillation of Formalin. Vascular absorption of formaldehyde was determined by measurement of serum levels. Progressively increasing amounts in apparent relationship to the concentration of Formalin instilled into the bladder were found in all dogs. Higher serum levels were noted in animals with haemorrhagic cystitis induced by cyclophosphamide than in dogs with normal bladders. This study reinforces our clinical impression that formaldehyde is absorbed continuously through the wall of the urinary bladder in dogs and absorption is related to the concentration gradient. These kinetics should be kept in mind when treating patients with intravescial Formalin in order to prevent the systemic effect of the vascular absorption.

Animals↗
PubMed1976

Multiple bladder filling defects in children with cystitis.

Two children with cystitis presented with multiple filling defects in the urinary bladder. They were proven to be cases of cystitis glandularis with proliferative changes of the bladder epithelium. The radiographic findings are described and the differential diagnosis from neoplasms is outlined.

Child↗
PubMedDate not supplied

Activity of the trometamol salt of fosfomycin in an in vitro model of the treatment of bacterial cystitis.

The response to trometamol fosfomycin of four strains of Escherichia coli was studied in an in vitro model in which the hydrokinetic aspects of the treatment of bacterial cystitis can be stimulated. Two strains of E. coli that were fully susceptible to fosfomycin, and a strain of intermediate susceptibility responded well to relatively low concentrations of the trometamol salt: doses achieving peak concentrations of 50 or 250 mg/l suppressed bacterial growth for at least 18 h; however, the emergence of resistance was completely suppressed only when a peak concentration of 2500 mg/l was achieved in the bladder model. A strain of E. coli that was fully resistant to fosfomycin in conventional minimum inhibitory concentration titrations responded to the highest dosage used, but this did not prevent further resistance from emerging. These results were obtained in the absence of the potentiating agent, glucose-6-phosphate, which is commonly used in susceptibility tests of fosfomycin. The implications of the results for fosfomycin dosage in bacterial cystitis and for the interpretation of susceptibility tests is discussed.

Administration, Oral↗
PubMed1986

[Comparative studies of enoxacin and amoxicillin for acute uncomplicated cystitis in women].

120 women suffering from acute uncomplicated bacterial cystitis were treated in an open randomized study either with 1 X 400 mg enoxacin or 1 X 3 g amoxicillin per os. Analysis of midstream urine and bacteriological urine cultures were examined before, two and seven days as well as six weeks after therapy. Treatment with enoxacin resulted in 97.5% (second day), respectively 92.5% (seventh day) bacteriologically sterile urine cultures, whereas the rate of sterile urines following amoxicillin reached only 72.5% (second day), and 65% (seventh day), respectively. Side effects (gastrointestinal, allergic, cardiovascular) were noted in one case in the enoxacin group and in ten cases in the amoxicillin group. The highly active antibiotic derivatives of the 4-quinolone-group (e.g. enoxacin) administered as a single dose achieve high cure rates in carefully selected female patients with acute uncomplicated bacterial cystitis.

Acute Disease↗
PubMed1992

Single dose treatment failure in women with acute cystitis.

Single dose treatment regimens (SDT) are effective, inexpensive alternatives to longer courses of therapy for adult females with acute cystitis or asymptomatic bacteriuria. A number of SDT regimens consistently cure 85 to 100% of women with acute cystitis and 50 to 80% of women with asymptomatic bacteriuria. However, SDT is inherently less effective than longer regimens because many upper tract infections are not cured. Initial SDT studies suggested that most patients with significant renal invasive disease or underlying urological abnormalities fail therapy. As a result, SDT has been proposed as an efficient strategy to diagnose significant upper tract infections with accompanying pathology that merit additional investigation or treatment. Few studies have refuted or supported this hypothesis. Single-dose treatment studies show an association between the site of infection as determined by the antibody-coated bacteria (ACB) test and treatment outcome. Patients with ACB-negative tests have a cure rate of over 90% in almost all studies in which the organism is susceptible to the agent chosen. Patients with positive ACB tests tend to have treatment failure rates of 30 to 50%. However, imaging studies have not been carried out in parallel with these studies and the validity of using single-dose treatment failure to screen women for significant upper tract pathology has still not been established.

Acute Disease↗
PubMedDate not supplied

Rufloxacin once daily versus ofloxacin twice daily for treatment of complicated cystitis and upper urinary tract infections. Italian Multicentre UTI Rufloxacin Group.

The efficacy and safety of rufloxacin once daily was compared with that of ofloxacin b.i.d. for therapy of complicated cystitis and upper urinary tract infections. Eighty-three patients were randomly assigned to receive rufloxacin as a loading dose of 400 mg on the first day, followed by 200 mg s.i.d., and 80 received ofloxacin 300 mg b.i.d. Both agents were administered orally for a median duration of eight days. Bacterial elimination rates after treatment were 90% for rufloxacin and 81% for ofloxacin. Half of the treatment failures occurred in patients with infections caused by uropathogens that became either less sensitive or resistant to the quinolones being studied. At a two-week follow-up, recurrences had not occurred in any of the rufloxacin patients and had occurred in 17% of the ofloxacin patients. Minor adverse reactions were reported by 12 and 13 patients, respectively. Rufloxacin once daily is as effective as ofloxacin b.i.d. for the treatment of complicated cystitis and upper urinary tract infections.

Administration, Oral↗
PubMed1993

Cyclophosphamide-induced cystitis in rats: involvement of capsaicin-sensitive primary afferents.

The involvement of capsaicin-sensitive primary afferent neurons has been investigated in a rat model of cyclophosphamide (CYP)-induced cystitis. CYP (150 mg/kg i.p., 48 h before) was administered in both vehicle- and capsaicin-(50 mg/kg s.c., 4 days before)-treated rats. Some experiments were performed 96 h after bilateral removal of pelvic ganglia (bladder denervation). CYP produced a marked detrusor hyperreflexia which was abolished by capsaicin pretreatment. CYP produced a marked increase in bladder weight and plasma protein extravasation (PPE, measured by Evans blue leakage technique): CYP-induced PPE was reduced by bladder denervation and was aggravated by capsaicin pretreatment. PPE aggravation by capsaicin was abolished by ganglionectomy. The bladder content of calcitonin gene-related peptide, was unaffected CYP. We conclude that CYP-induced decrease in bladder capacity is entirely mediated through stimulation of capsaicin-sensitive bladder afferents. At the time chosen as end point in these experiments, capsaicin-sensitive afferents exert an antiinflammatory influence on CYP-induced cystitis.

Animals↗
PubMed1994

Does the mast cell have an intrinsic role in the pathogenesis of interstitial cystitis?

In order to examine the role of mast cells in the inflammatory bladder disease interstitial cystitis, mast cells isolated from the human bladder of normal and diseased tissue were challenged with a range of secretagogues. Calcium ionophore A23187 and anti-IgE caused histamine release from all bladder mast cells in a dose-related manner. Mast cells from the diseased tissue were far more responsive than those from the normal tissue. Mast cells from the muscle of normal bladder were responsive towards substance P and compound 48/80. However, mast cells from interstitial cystitis bladder did not release significant amounts of histamine with these two secretagogues.

Calcimycin↗
PubMed1980

Treatment of recurrent cystitis in women by internal urethrotomy or antimicrobial agents.

Seventy-one women suffering from recurrent cystitis were analysed. The patients were randomly distributed into two groups, in accordance with the treatment given. Forty-one were treated medically and thirty were subjected to internal urethrotomy with the Otis urethrotome and antimicrobial agents. The results of treatment for urinary infection were:85.4% in the first group and 73.3% in the second group. There was no statistically significant difference between the results of the two groups analysed. The symptomatology showed 65.8% of the cases asymptomatic in the group treated medically and 36.7% in the surgical-medicinal group. The difference between the results of the two groups was statistically significant according to the symptomatology. Therefore, medical treatment of recurring cystitis in women was superior to surgical-medicinal treatment.

Adolescent↗
PubMed1997

Cyclophosphamide cystitis as a model of visceral pain in rats: minor effects at mesodiencephalic levels as revealed by the expression of c-fos, with a note on Krox-24.

The evoked expression of the immediate-early gene-encoded proteins c-Fos and Krox-24 was used to study activation of mesodiencephalic structures as a function of the development of cyclophosphamide (CP) cystitis in behaving rats. This article is the third of a series and completes previously published data obtained at both spinal and hindbrain levels. CP-injected animals received a single dose of 100 mg/kg i.p. under transient volatile anesthesia and survived for 1-4 h in order to cover the entire postinjection period during which the disease develops. Survival times longer than 4 h were not used owing to ethical considerations. Results from CP-injected groups are compared with those from either noninjected controls or saline-injected animals having survived for the same times as CP-injected ones. Quantitative results come from c-fos expression. At mesodiencephalic levels a high and widespread basal c-fos expression was observed in control animals; maximum staining was observed at the midthalamic level. Four groups of nuclei were identified with regard to the density of staining. The first group included nuclei showing clustered, intensely labeled cells; these areas were restricted in extent and related to the maintenance of circadian rythms (intergeniculate leaf, suprachiasmatic nucleus, dorsal parts of either paraventricular thalamic nuclei or central gray), sleep-arousal cycle (supramamillary nucleus), or changes in arterial pressure (laterodorsal tegmental nucleus). The second group included nuclei showing scattered, moderately labeled cells; these areas were widespread at all rostrocaudal levels and related to either autonomic/neuroendocrine regulations (central gray, lateral habenula, hypothalamus) or motor behavior, orienting reflex and oculomotor coordination (unspecific subdivisions of both colliculi and their adjoining mesencephalic regions, zona incerta dorsal). The third group included nuclei with evenly distributed, faintly labeled cells; these areas, which, with few exceptions, covered almost the entire diencephalon, mainly concerned nuclei of multisensory convergence having functions in either discriminative tasks (laterodorsal and lateroposterior thalamic nuclei) or emotional responses (intralaminar and midline thalamic nuclei). The fourth group included nuclei free of labeling; these were areas that received the bulk of unimodal sensory/motor inputs (central inferior colliculus, pretectal optic nuclei, ventral medial geniculate nucleus, ventral anterior pretectal nucleus, dorsal lateral geniculate nucleus, ventrobasal complex; zona incerta ventral, parafascicular thalamic nucleus) and are thus the most discriminative regarding specific modalities. Variations in staining were of the same magnitude in both saline- and CP-injected animals. A sequential study spanning every postinjection hour revealed maximum staining at 1 h postinjection, which was followed by a progressive, time-related decrease. Increases in the number of labeled cells 1 h postinjection were significant in only a restricted number of nuclei showing low basal expression (Edinger-Westphal nucleus and paraventricular, supraoptic, and lateral hypothalamic nuclei); time-related reductions in staining that were correlated to sleep or quiescence behaviors finally resulted in staining equal to or below that seen in control animals. No structures showed significantly increased staining in relation to the full development of cystitis, i.e., with the increase of visceronociceptive inputs. Comparing the present results with those previously obtained at more caudal levels, it appears that subtelencephalic levels primarily driven by visceronociceptive inputs, i.e., those that increase and/or maintain their activity in parallel with the degree of nociception, are confined to brainstem-spinal cord junction levels and only comprise certain subdivisions of the nucleus of the solitary tract (nucleus medialis, nucleus commissuralis, and ventralmost part of area po

Animals↗