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PubMed2003

Subsensitivity of P2X but not vanilloid 1 receptors in dorsal root ganglia of rats caused by cyclophosphamide cystitis.

The application of cyclophosphamide to rats was used to induce interstitial cystitis. Behavioural studies indicated a strong pain reaction that developed within 2 h and levelled off thereafter causing a constant pain during the following 18 h. Neurons prepared from L6/S1 dorsal root ganglia innervating the urinary bladder responded to the application of capsaicin or alpha,beta-methylene ATP (alpha,beta-meATP) with an increase of intracellular Ca2+ ([Ca2+]i). The [Ca2+]i responses to capsaicin were identical in the dorsal root ganglion cells of cyclophosphamide- and saline-treated rats, whereas alpha,beta-meATP induced less increase in [Ca2+]i in the cyclophosphamide-treated animals than in their saline-treated counterparts. Hence, alpha,beta-meATP-sensitive P2X3 and/or P2X2/3 receptors of L6/S1 dorsal root ganglion neurons were functionally downregulated during subacute pain caused by experimental cystitis. In contrast, capsaicin-sensitive vanilloid 1 receptors did not react to the same procedure. Thoracal dorsal root ganglia, not innervating the urinary bladder, were also unaltered in their responsiveness to alpha,beta-meATP by cyclophosphamide treatment.

Animals↗
PubMed2000

Interstitial cystitis: bladder training with intravesical oxybutynin.

PURPOSE: We assess the efficacy of intravesical administration of oxybutynin chloride in patients with interstitial cystitis. MATERIALS AND METHODS: The study included 36 women with a mean age of 45 years with a diagnosis of interstitial cystitis. Patients were treated with gradual intravesical instillation of saline oxybutynin solution (oxybutynin group) or gradual filling of simple saline (control group). Evaluation parameters consisted of symptom problem index, voids per day, volume per void, functional bladder capacity, volume at first sensation, cystometric bladder capacity and cystometric volume at first sensation. RESULTS: Statistically significant improvement of all evaluated parameters was found in both groups. When comparing the outcomes statistically significant improvement of parameters favored the oxybutynin group. CONCLUSIONS: Bladder training alone produces a satisfactory result by gradually expanding the bladder, and an additional statistically significant improvement is evident with intravesical oxybutynin.

Administration, Intravesical↗
PubMed1994

Cystitis associated with tiaprofenic acid.

Ten patients with cystitis associated with tiaprofenic acid were reviewed. All patients displayed similar cystoscopic and histological features, and all failed a variety of initial therapies but achieved a dramatic improvement or resolution of symptoms with discontinuation of the tiaprofenic acid. Drug-induced cystitis may be more common than previously recognized.

Aged↗
PubMed1994

Inflammatory mediator profile in urine and bladder wash fluid of patients with interstitial cystitis.

Interstitial cystitis is a syndrome of urinary urgency, frequency and suprapubic pain. We investigated the role of inflammatory mediators in 96 patients with histories and symptoms consistent with interstitial cystitis, and 13 controls from The New York Hospital-Cornell Medical Center, University of Washington and University of California at San Diego. Patients were classified into either group A (meets all criteria of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases for inclusion in research studies), group B (meets all of these criteria but without glomerulations) or an "other" group. A small number of group A patients had detectable interleukin-6 in the urine. Urinary concentrations of tumor necrosis factor, prostaglandins E2, D2 and F2 alpha, and thromboxane B2 were not different among either patient groups or controls. Urine specimens contained inhibitors of the bioactivity of interleukin-6 and tumor necrosis factors but no differences between patients or controls were found. No factors chemotactic for human neutrophils were detected in a small patient sample. Bladder wash fluid concentrations of prostaglandins E2, D2 and F2 alpha, and thromboxane were much lower than urinary levels. Bladder wash fluid interleukin-6 and tumor necrosis factor were not detectable. The results suggest that while a small subset of patients may have elevated levels of interleukin-6 the majority of patients do not appear to have elevated levels of inflammatory mediators in the urine or bladder wash fluid. Evaluation of patient bladder tissue may indicate changes not detectable in urine or bladder wash fluid. Alternatively, other etiologies must be considered in those patients.

Adult↗
PubMed1994

Hemorrhagic cystitis due to adenovirus infection following bone marrow transplantation.

Immunocompromised patients are at significant risk for infection with adenovirus. We report 3 cases of hemorrhagic cystitis in patients following bone marrow transplantation. Of the patients 2 had positive viral urine cultures and 1 had positive stool culture but negative urine culture and biopsy proved viral cystitis. Diagnosis of adenovirus should be considered when gross hematuria follows bone marrow transplantation even when urine culture is negative for adenovirus.

Adenoviridae Infections↗
PubMed1994

Oral conjugated estrogen therapy for treatment of hemorrhagic cystitis.

We report 7 cases of severe hemorrhagic cystitis that required repeated transfusions, surgical intervention and oral conjugated estrogens. Of these 7 cases hematuria resolved completely in 5 during estrogen therapy and decreased sufficiently in 1 to preclude further transfusion. We found conjugated estrogens to be an effective, simple, inexpensive, well tolerated and readily available treatment for hemorrhagic cystitis.

Administration, Oral↗
PubMed1993

Hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis.

From May 1988 through May 1991, 14 patients with radiation-induced hemorrhagic cystitis confirmed by cystoscopy and biopsy, who had failed all other attempts at management and who had no evidence of infection or recurrent malignancy, were treated with hyperbaric oxygen therapy. During followup ranging from 10 to 42 months 8 patients (57%) had complete resolution of symptoms and 2 (14%) had marked improvement, for a total of 10 patients (71%) with a positive outcome. Of 4 patients (29%) with a poor outcome 3 had limited improvement and were later diagnosed as having recurrent malignancy that was not present on biopsy before hyperbaric treatment. One patient was withdrawn from hyperbaric treatment due to illness. The average cost per patient was $10,000 to $15,000, comparing favorably to the cost of multiple conservative treatments to control symptoms. Hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis appears to be an efficacious treatment modality for patients who have failed other forms of management.

Adolescent↗
PubMed1993

Eosinophilic cystitis caused by vesical sparganosis: a case report.

We report a case of eosinophilic cystitis caused by vesical sparganosis. The patient had a history of eating raw frogs and presented with a mass in the bladder associated with peripheral eosinophilia and increased serum antibody titer against sparganum. Pathologically, a characteristic sinuous necrosis representing worm tracks was noted with massive diffuse infiltration of eosinophils in the wall of the bladder. The serum titer of sparganum-specific antibody returned to normal after surgical resection of the lesion. This finding emphasizes the importance of suspecting parasitic origin in cases of eosinophilic cystitis with a history of raw meat ingestion in endemic areas.

Cystitis↗
PubMed1993

Treatment of cyclophosphamide-induced hemorrhagic cystitis with intravesical carboprost tromethamine.

We review our experience with 18 consecutive patients who received intravesical carboprost tromethamine, an F2-alpha prostaglandin, for severe hemorrhagic cystitis following cyclophosphamide chemotherapy. Of the patients 16 were given cyclophosphamide for conditioning before bone marrow transplantation and 2 received the drug as cytotoxic therapy alone (dose range 3.6 to 15.8 gm.). All patients had severe gross hematuria that was refractory to forced diuresis and to continuous saline bladder irrigation. The intravesical prostaglandin therapy was initiated only after significant transfusion requirements (greater than 1 unit packed red blood cells per day) and/or numerous catheter manipulations for relief of clot retention. Eligible patients underwent complete clot evacuation followed by intravesical instillation of 0.4 to 1.0 mg.% carboprost tromethamine for 2 hours 4 times per day, alternating with continuous saline bladder irrigation for 2 hours. Six patients attempted an alternate protocol of 0.8 to 1.0 mg.% carboprost tromethamine given by continuous saline bladder irrigation. Complete resolution of gross hematuria occurred in 9 patients (50%). Eight patients had a partial response, with decreased transfusion requirements noted. However, complete resolution ultimately required an alternative therapy (for example formalin or urinary diversion). One patient (6%) failed to respond and required formalin therapy on day 4 of carboprost tromethamine therapy. Decreased red blood cell transfusion requirements were noted during and after therapy when compared to pretreatment values. No changes in renal or bladder function were noted during the mean followup of 17 weeks (range 1 to 64 weeks). There were 3 cases of recurrent hematuria. Side effects were limited to bladder spasm in 14 of the 18 patients (78%), with no systemic complications. The results suggest that carboprost tromethamine is a useful bedside therapy for hemorrhagic cystitis due to cyclophosphamide, and treatment appears to have minimal toxicity.

Administration, Intravesical↗
PubMed1993

Acute hemorrhagic cystitis caused by adenovirus following renal transplantation: review of the literature.

We report on 4 male patients with acute hemorrhagic cystitis caused by adenovirus following renal transplantation. These patients showed symptoms of gross hematuria, urinary frequency, burning urination and fever. Adenovirus was isolated in all patients and 3 were positive for serotype 11. Complement-fixing antibody was positive for adenovirus in all cases. Acute hemorrhagic cystitis caused by adenovirus was self-limiting and reduction of immunosuppression was not required for its resolution. Clinical presentation of these patients is described and the literature is reviewed.

Acute Disease↗
PubMed1993

Behavioral therapy for the treatment of refractory interstitial cystitis.

The short-term results of behavioral therapy in 42 women with refractory symptoms of interstitial cystitis were retrospectively analyzed. All patients had persistent symptoms at least 2 years in duration despite undergoing a number of empiric therapies. Symptoms included urinary frequency and urgency of at least once every 2 hours during waking hours and persistent pain or discomfort in the suprapubic, perineal or pelvic area. Treatment consisted of diary keeping, timed voiding, controlled fluid intake and pelvic floor muscle training techniques. After a mean of 12 weeks of treatment the inter-voiding interval increased in all patients by a mean of 93 minutes (p < 0.01) and 98% experienced a decrease in the number of micturitions per day by a mean of 9 (p < 0.01). Using a global assessment scale 50% of the patients reported that the symptoms were markedly improved and 38% were improved. These data confirm the short-term efficacy of behavioral therapy in selected patients with symptoms of interstitial cystitis.

Behavior Therapy↗
PubMed1992

Idiopathic reduced bladder storage versus interstitial cystitis.

Idiopathic reduced bladder storage is a term we used to describe a group of patients who have subjective and objective evidence (by cystometrogram) of diminished bladder capacity without a demonstrable cause. We performed a prospective study comparing this condition with interstitial cystitis. We studied the clinical, urodynamic and histological features, and response to therapy in these 2 groups of patients. No statistical difference was found between the incidence of irritative bladder symptoms and/or suprapubic pain. Only minor differences were noted in the maximum cystometric capacity and incidence of bladder instability. Histological and immunofluorescent features were analogous. Also, the reduced bladder storage and interstitial cystitis patients responded similarly to bladder dilation and pharmacological therapy. Augmentation ileocystoplasty used in patients refractory to medical treatment produced comparable results in the short term. Based upon similar findings, it is likely that these 2 conditions represent the same disease entity with the only difference being the cystoscopic findings.

Adult↗
PubMed1992

Control of massive hematuria in idiopathic hemorrhagic cystitis after administration of conjugated estrogen.

A renal transplant patient with severe hemorrhagic cystitis of idiopathic etiology was treated initially with intravenous administration of conjugated estrogen (1 mg./kg.), followed on day 2 and thereafter with 5 mg. per day orally for 3 weeks. Hematuria decreased in intensity within 10 hours and disappeared within 48 hours. Hematuria did not recur by 6 months after completion of oral doses of conjugated estrogen. Complications or other side effects were not observed. In our experience conjugated estrogen controls hematuria in patients with idiopathic hemorrhagic cystitis and this form of treatment must be considered in this condition.

Acute Disease↗
PubMed1992

Recurrent eosinophilic cystitis: a case responsive to steroids.

We report a case of eosinophilic cystitis that was responsive to prednisone but that recurred when the drug was withdrawn. The cause of eosinophilic cystitis remains an enigma but it probably represents a form of allergy. Investigation of etiology and therapeutic options are discussed.

Cystitis↗
PubMed1991

Clinical and immunological response to nifedipine for the treatment of interstitial cystitis.

Nifedipine is a calcium channel antagonist known to inhibit smooth muscle contraction and cell-mediated immunity. The clinical and local immune response to nifedipine was investigated in an open trial with 10 female interstitial cystitis patients, whose disease was diagnosed according to the consensus criteria developed in 1987 at a National Institutes of Health workshop. To evaluate the symptoms and clinical response of the patients objectively we scored the symptoms of frequency, urgency, nocturia, dysuria and suprapubic pain on a scale of 0 to 2. Nifedipine was administered as a single daily dose determined by a dose-titration test. Urinary interleukin-2 inhibitor activity, a marker of cell-mediated inflammation, was measured using a murine interleukin-2 dependent cell line. Before nifedipine therapy the symptom scores (total of the 5 symptoms) ranged between 5 and 9, and after 2 months they ranged between 0 and 6. Of the 9 patients followed for at least 4 months only 1 failed to have a significant clinical improvement, 5 showed at least a 50% decrease in symptom scores and 3 were asymptomatic. Drug side effects were minimal. Urinary interleukin-2 inhibitor activity before nifedipine therapy confirmed the presence of cell-mediated inflammation. After 4 months of therapy interleukin-2 inhibitor activity was normal in 7 of 9 patients regardless of the severity of symptoms, which indicated that nifedipine exerted an immunosuppressive effect. Although our data suggest that nifedipine is an efficacious, well tolerated, convenient oral medication for the treatment of interstitial cystitis, the true value of nifedipine for patients with this disease must be determined by a prospective, randomized trial of nifedipine versus placebo.

Adult↗
PubMed1989

Hyperbaric oxygen: primary treatment of radiation-induced hemorrhagic cystitis.

Of 8 patients with symptoms of advanced cystitis due to pelvic radiation treated with hyperbaric oxygen 7 are persistently improved during followup. All 6 patients treated for gross hematuria requiring hospitalization have been free of symptoms for an average of 24 months (range 6 to 43 months). One patient treated for stress incontinence currently is dry despite little change in bladder capacity, implying salutary effect from hyperbaric oxygen on the sphincter mechanism. One patient with radiation-induced prostatitis failed to respond. This experience suggests that hyperbaric oxygen should be considered the primary treatment for patients with symptomatic radiation-induced hemorrhagic cystitis.

Adult↗
PubMed1989

Stimulation of epithelial hyperplasia in rat urinary bladder by Escherichia coli cystitis.

Using heterotopically transplanted rat urinary bladder, experiments were conducted to develop a reproducible animal model of bacterial cystitis-associated urothelial hyperplasia without calculus formation, and to elucidate which bacterial component(s) might induce urothelial hyperplasia. Bladder instillation of live Escherichia coli (E. coli) resulted in persistent infection and inflammation and also diffuse urothelial hyperplasia. Instillation of killed E. coli also induced diffuse hyperplasia. Hyperplastic changes regressed following withdrawal of the killed E. coli treatment. Urothelial hyperplasia was also induced by repeated instillation of protein-rich lipopolysaccharide (LPS), the endotoxin derived from gram-negative bacterial wall component, but not by protein-free LPS. A finding common to bladders showing hyperplasia was the infiltration of neutrophils into intercellular spaces of the urothelium. We conclude that urothelial hyperplasia is induced by E. coli cystitis, that LPS plays a significant role in the hyperplastic response, and that neutrophils may mediate the response.

Animals↗