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Hyperbaric oxygenation therapy for cyclophosphamide-induced haemorrhagic cystitis.

A 41-year-old female patient undergoing cyclophosphamide therapy for ovarian tumour suffered from haemorrhagic cystitis. Hyperbaric oxygenation (HBO) (100% of oxygen concentration at 2 atmospheric absolute pressures for 60 minutes a day for 30 days) was performed. After treatment the symptom subsided and haematuria disappeared. Cystoscopic findings demonstrated marked improvement. During the course of therapy no side effect was noted. Thus, HBO treatment appeared to have a beneficial effect on cyclophosphamide cystitis.

Adult↗

Interstitial cystitis in men.

Interstitial cystitis is an uncommon disease reported predominantly in females. Recently we were involved in the management of 4 men who had the clinical, endoscopic and pathological features consistent with the diagnosis of interstitial cystitis. The rarity of occurrence of the disease in males prompted us to report these cases.

Cystitis, Interstitial↗

Use of transfer factor for the treatment of recurrent non-bacterial female cystitis (NBRC): a preliminary report.

Results of conventional treatment of female non-bacterial recurrent cystitis (NBRC) are discouraging. Most patients show an unexpected high incidence of vaginal candidiasis, while their cell mediated immunity to Herpes simplex viruses (HSV) and Candida antigens seems impaired, and it is known that the persistence of mucocutaneous chronic candidiasis is mainly due to a selective defect of CMI to Candida antigens. Twenty nine women suffering of NBRC, and in whom previous treatment with antibiotics and non-steroid anti-inflammatory drugs was unsuccessful, underwent oral transfer factor (TF) therapy. TF specific to Candida and/or to HSV was administered bi-weekly for the first 2 weeks, and then once a week for the following 6 months. No side effects were observed during treatment. The total observation period of our cohort was 24379 days with 353 episodes of cystitis recorded and a cumulative relapse index (RI) of 43. The observation period during and after treatment was 13920 days with 108 relapses and a cumulative RI of 23 (P < 0.0001). It, thus, seems that specific TF may be capable of controlling NBRC and alleviate the symptoms.

Adult↗

Cystitis glandularis: an unusual cause of ureteral obstruction.

Cystitis glandularis is an uncommon proliferative disease of the bladder epithelium. Involvement of the trigone, with infiltration of the submucosal ureter, may result in ureteral obstruction. We present 2 patients with biopsy-proven cystitis glandularis who presented with ureteral obstruction.

Cystitis↗

[Isolated neurofibromatosis of the urinary bladder. A rare cause of recurrent cystitis].

Neurofibromas of the urinary bladder occur as isolated phenomena or as part of generalized neurofibromatosis or von Recklinghausen's disease. This benign mesenchymal tumor can be the cause of subvesical obstruction, hematuria or chronic cystitis. The lesion is rare. Our case of isolated extended neurofibromatosis of the urinary bladder was diagnosed in a 19-year-old girl with an 8-year history of chronic cystitis. Two transurethral resections were successful in relieving symptoms. Possible further therapy was delayed because of the patient's desire for children.

Adult↗

[Hemorrhagic cystitis after high dose chemotherapy. An interdisciplinary problem].

Hemorrhagic cystitis is a well known toxic and often life-threatening complication from high-dose chemotherapy with cyclophosphamide. The incidence is particularly high after allogeneic bone marrow transplantation. The morphologic bladder wall changes are associated with gross hematuria, clot formation in the bladder and problems to control the bleeding in up to 70% without preventive measures. Prevention is routinely done and can reduce but not obviate the incidence of hemorrhagic cystitis. Treatment is initiated by forced diuresis and continuous bladder irrigation. When necessary endoscopic cauterisation of bleeding mucosal areas is combined with the instillation of hemostyptic agents. Embolisation of the pelvic vessels or open surgery to control the bleeding is indicated in selected cases in a life-threatening situation.

Antineoplastic Agents, Alkylating↗

[The pathogenesis of interstitial cystitis--many hypotheses, but etiology remains uncertain].

Pathogenic aspects of interstitial cystitis (IC) are reviewed on the basis of the current literature applying the criteria of evidence-based medicine (EBM). Three hundred forty-six peer-reviewed publications of the past 30 years were retrieved via MEDLINE employing the key words "interstitial cystitis and pathogenesis or etiology" and classified according to EBM criteria and subject categories. The papers were then reviewed and summarized and are discussed considering the theory of acute and chronic inflammatory responses. In the literature, nearly all steps of the normal inflammatory response are considered pathogenically important in development of the IC syndrome. Applying EBM criteria, all studies fail to meet the criteria for sound statistical evaluation and to demonstrate reproducibly a reliable pathogenic factor. Most publications report only small numbers of patients. Control groups are frequently lacking or too small. Clinically useful criteria for the diagnosis of IC are not properly defined. There is no commonly accepted animal model in which IC occurs naturally or can be artificially induced. Of the 683 IC papers studied, 346 (50.7%) deal with pathogenic or etiological aspects of IC. The inflationary use of the terms pathogenesis or etiology in one out of every two papers calls for more prudent application of terminology in the future. As yet, none of the published pathogenic factors was found to represent the main trigger of the IC syndrome. Some of them seem to be part of a vicious cycle of the inflammatory reaction present. Detailed knowledge of the process of chronic inflammation can lead to treatments that may interrupt an inflammatory response. This might contribute to solving the pathogenic issue of IC and could be helpful in designing further investigations. Advances in understanding the causes of IC require objective criteria to subclassify the heterogenous patient cohort presently referred to as IC syndrome. Such subclassifications are a predisposition for pathogenic investigations and determining future treatment strategies.

Cystitis, Interstitial↗

Sacral neuromodulation in patients with interstitial cystitis: a multicenter clinical trial.

Female patients with interstitial cystitis (IC) unresponsive to standard oral and intravesical therapy were enrolled at three clinical sites for percutaneous sacral nerve root stimulation (PNS) in a prospective, observational pilot study. Evaluation was in the form of a 3-day voiding diary completed both prior to and following the commencement of sacral nerve root stimulation. Symptoms were also assessed by the O'Leary-Sant Interstitial Cystitis Symptom and Problem Indices (ICSI and ICPI). Baseline and test stimulation values for voiding diary parameters and O'Leary-Sant scores were compared to determine treatment efficacy. A total of 33 patients were enrolled. Statistically significant improvements were seen in frequency, pain, average voided volume and maximum voided volume. Significant improvements were also seen in ICSI and ICPI scores. Subacute PNS appears to be effective in reducing symptom severity and increasing voided volumes in patients with IC previously unresponsive to standard therapy.

Adult↗

Complete transurethral resection of ulcers in classic interstitial cystitis.

Interstitial cystitis (IC) is a chronic disease of obscure etiology. It commonly affects females, who present with symptoms of pain on bladder filling and urinary frequency. There are two types of IC: classic and non-ulcer disease, which differ in many respects, including response to different therapies. In this retrospective study we evaluated the hitherto largest series of patients with classic IC treated by transurethral resection (TUR) of visible ulcers. Altogether 259 TURs of Hunner ulcers were performed on 103 patients: 92 experienced amelioration, and in 40% symptom relief lasted more than 3 years. In the remaining patients, although symptom recurrence was common, the majority responded well to subsequent TUR. In conclusion, TUR has a good outcome in patients with classic interstitial cystitis, and we suggest it as first-line treatment in this patient group.

Aged↗

The effects of cold-restraint stress on urinary bladder wall compared with interstitial cystitis morphology.

Stress is associated with many diseases of unknown aetiology. This study demonstrates the effects of cold-restraint stress on the morphology of the urinary bladder. Additionally, it compares the results obtained with the morphology of the interstitial cystitis. The animals were subjected to three hours of cold-restraint stress and then starved for 48 h. The morphology and histochemistry of the urinary bladder was investigated with light and electron microscopy. The proliferative activity was analysed via flow cytometry. Increased and degranulated mast cells in the mucosa, leucocyte infiltration in the lamina propria, vacuole formation in the urothelial cells, loose tight junction, dilated intercellular spaces and altered proliferative activity were observed in the stress group when compared with the control. The increase in the number of mast cells and especially degranulated mast cells and vacuole formation and the loose tight junction of the urothelium correlated with the histopathological findings of interstitial cystitis.

Animals↗

Experimental autoimmune cystitis: further characterization and serum autoantibodies.

Previously, we described an animal model for interstitial cystitis (IC), experimental autoimmune cystitis (EAC) [Luber-Narod et al. Urol Res 24:367]. Further characterization of animals with EAC indicates that peak and mean urinary frequency are elevated compared with sham-injected controls and that the disease progresses with at least two cycles of exacerbations and remissions. We had shown evidence suggesting EAC to be autoimmune in nature. In this paper, we identify serum autoantibodies from 9/10 EAC animals which bind to a protein specific to rat bladder with a relative molecular weight of 12-kDa. Such autoantibodies are absent in 12/13 normal and sham-injected animals as well as animals which fail to develop EAC despite disease induction. These findings suggest that EAC is a reproducible model of cyclical increases of urinary frequency, and that a 12-kDa antigen is the target of autoantibodies which correlate with those elevations. Identification of this target antigen may explain the pathogenesis of increased urinary frequency in these animals and potentially in IC as well.

Animals↗

Emphysematous cystitis in a patient presenting with paradoxical arterial embolism and intestinal mycobacteriosis without evidence of diabetes.

We describe the case of a 72-year-old woman who displayed massive multiple intramural gas collections of the bladder wall as an incidental finding on CT. The patient presented with critical ischemia of the left leg caused by paradoxical arterial embolism, raised corpuscular sedimentation rate, anemia by gastrointestinal blood loss, hypoproteinemia, diarrhea, malabsorption, and exudative enteropathia caused by mycobacterial ileocolitis. The patient had no dysuria and there was no evidence of diabetes. The intramural gas collections of the bladder wall, as shown by CT, were compatible with emphysematous cystitis. Urine samples proved infection by a multi-resistant strain of E. coli. Emphysematous cystitis is a rare form of bladder infection that can be diagnosed by plain-film radiograms or CT.

Aged↗

Anti-inflammatory effect of an Escherichia coli extract in a mouse model of lipopolysaccharide-induced cystitis.

The bacterial extract, Uro-Vaxom, which consists of immunostimulating components derived from 18 Escherichia coli strains, was used for the prophylaxis of recurrent cystitis. To evaluate the anti-inflammatory effect of E. coli extract, we measured the cytokine levels of bladder tissue after oral administration and analyzed bladder inflammation by histopathologic examination in a model of lipopolysaccharide (LPS)-induced cystitis in mice. After oral administering the E. coli extract for 10 days, the cytokine [interleukin-6 (IL-6), IL-10, monocyte chemoattractant protein-1, interferon-gamma (IFN-gamma), tumor necrosis factor-alpha, IL-12p70] levels present in the bladder of female Balb/C mice were determined using a cytometric bead array. The bladder macrophage inflammatory protein-2 level was also measured using a sandwich enzyme immunoassay. After immunization with the E. coli extract, E. coli LPS was instilled into the bladders intravesically. Twenty-four hours later, the mice were sacrificed and the level of bladder inflammation was quantified using the bladder inflammatory index (BII). Significant changes in the bladder IL-6 and IFN-gamma levels were observed after the E. coli extract treatment. Secretions of the other cytokines were not stimulated by the E. coli extract. The bladder instilled with LPS had high inflammation scores for edema, leukocyte infiltration, and hemorrhage in the saline treated control mice. In contrast, the E. coli extract treated mice exhibited mild inflammation of their bladders with a significant reduction in the BII scores compared with the controls. These findings might explain the anti-inflammatory effect of the E. coli extract demonstrated in clinical studies.

Animals↗

Interstitial cystitis.

Interstitial cystitis is an enigmatic and frustrating condition to manage as a physician and to cope with as a patient. Traditionally, it has been defined as a chronic sterile inflammatory disease of the bladder of unknown aetiology. However, the International Continence Society prefers the term painful bladder syndrome and it has been decided to follow this terminology and refer to the disease as painful bladder syndrome/interstitial cystitis (PBS/IC). The condition is characterized by bladder pain, urinary frequency, urgency and nocturia. The quality of life of patients with PBS/IC is significantly degraded. Its aetiology is unknown, but might involve microbiologic, immunologic, mucosal, neurogenic and other yet unidentified agents. History, physical examination, urine analysis and culture as well as cystoscopy and hydrodistension are useful diagnostic tools but the final diagnosis tends to be a diagnosis of exclusion. This article will review the major theories of aetiology for PBS/IC and discuss diagnosis as well as the current treatment options with relevance to the proposed aetiologies.

Amitriptyline↗

CD34+ fibrocytes in chronic cystitis and noninvasive and invasive urothelial carcinomas of the urinary bladder.

CD34+ fibrocytes are constitutive elements of the connective tissue where they play a role in matrix synthesis and tumor-associated stromal remodeling. Secreted protein, acidic, and rich in cysteine (SPARC) is a pivotal mediator of stromal remodeling precipitated by invasive carcinomas. The present study was undertaken to investigate CD34+ fibrocytes in the stroma of the tumor-free urinary bladder, chronic cystitis, and urothelial carcinomas together with stromal expression of alpha-smooth muscle actin (alpha-SMA), CD117, and SPARC. In tumor-free urinary bladder and chronic cystitis, CD34+ fibrocytes were found in the deep lamina propria and tunica muscularis, whereas the superficial lamina propria disclosed a CD34-negative and alpha-SMA-positive fibrocyte-like cell. Invasive urothelial carcinomas revealed a complete loss of CD34+ fibrocytes and concomitant appearance of alpha-SMA-reactive myofibroblasts which showed strong expression of SPARC. CD117 expression of tumor-free and tumor-associated stroma revealed no differences. We in this study for the first time describe CD34+ fibrocytes in the urinary bladder and an up-to-now unknown population of alpha-SMA-positive fibrocytes exclusively occurring in the superficial lamina propria. Stromal remodeling associated with invasive carcinomas in the urinary bladder is characterized by a loss of CD34+ fibrocytes paralleled by a gain of alpha-SMA-positive myofibroblasts and increased expression of SPARC.

ADAM Proteins↗

Formalin treatment of refractory hemorrhagic cystitis in systemic lupus erythematosus.

Hemorrhagic cystitis is a potentially life-threatening complication in systemic lupus erythematosus (SLE). No safe, effective and conservative treatment exists for patients who fail to respond to standard therapy. We report a 17-year-old girl with SLE who suffered from severe hemorrhagic cystitis. Initially, she received frequent red blood cell and platelet transfusions, continuous bladder irrigation, and blood clots were evacuated. Numerous kinds of treatment were tried, including electrocoagulation of bleeding foci, prostaglandin E1 bladder instillation, and hyperbaric oxygen. However, she remained severely anemic and thrombocytopenic necessitating daily transfusions of blood products. After intravesical formalin instillation was performed twice, the hematuria ceased completely.

Adolescent↗