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PubMed1990

Treatment of radiation or cyclophosphamide induced hemorrhagic cystitis using conjugated estrogen.

Five patients with severe hemorrhagic cystitis induced by radiation and/or cyclophosphamide were systematically treated with conjugated estrogen. Two patients received conjugated estrogen twice each day (1 mg. per kg.) intravenously, followed on day 3 and thereafter by 5 mg. per day orally. Hematuria decreased markedly 6 to 8 hours after the initial dose and urine color became light yellow within 1 to 3 days. The other 3 patients received 5 mg. conjugated estrogen per day orally and urine color became clear within 4 to 7 days. Hematuria did not recur during 12 to 22 months in 4 patients who received daily conjugated estrogen (1.25 mg.). However, transient episodes of mild hematuria persisted in 1 patient during the 3-month followup despite a higher dose of conjugated estrogen (10 mg. per day). Complications, including thromboembolism and other side effects associated with conjugated estrogen, were not observed in these patients. We postulate that conjugated estrogen controls hematuria in hemorrhagic cystitis by decreasing the fragility of the mucosal microvasculature of the bladder.

Adult↗
PubMed1990

Eosinophilic cystitis in a renal allograft recipient.

Eosinophilic cystitis is an uncommon condition with an unknown etiology. A case of eosinophilic cystitis in a patient with chronic rejection of a cadaveric renal transplant is presented. The pathogenesis of this disease is discussed.

Adult↗
PubMed1990

Nonsteroidal anti-inflammatory drugs in the treatment of eosinophilic cystitis.

A 30-year-old white woman with urinary frequency, left costovertebral angle pain and hematuria had left hydronephrosis, a marked decrease in bladder capacity and severe eosinophilic cystitis on biopsy. She was treated with a nonsteroidal anti-inflammatory drug and an antihistamine, with a dramatic, complete and rapid recovery. The nonsteroidal anti-inflammatory drug was believed to have been responsible for the favorable outcome, since antihistamines have not produced reliable benefits in this disease. Nonsteroidal anti-inflammatory drugs are recommended in cases of eosinophilic cystitis.

Adult↗
PubMed1990

Hemorrhagic cystitis: a review.

Acute, fulminant bladder hemorrhage usually is seen at tertiary care centers in which cancer patients are treated with oxazaphosphorine alkylating agents, particularly cyclophosphamide and isophosphamide. These agents also are used to treat benign conditions, such as lupus erythematosis and Wegener's granulomatosis. Radiation effects from treatment of prostatic or cervical carcinoma can appear for the first time as late as 15 to 20 years after initial treatment. Other iatrogenic causes of bleeding include treatment with penicillins and, rarely, danazol. Occasionally, bladder hemorrhage may be the presenting sign of metabolic disease, such as secondary amyloidosis in rheumatic arthritis. Cases of mild to moderate hemorrhagic cystitis arising in the otherwise healthy patients should lead one to pursue the possibility of environmental toxins, accidental poisoning, recreational drug use or viruses. In all cases the diagnosis should be reserved until more common causes of hematuria, such as bacterial or fungal infection, stones, cysts or tumors, have been ruled out. Prevention of chemotherapeutically induced cystitis ideally will follow careful attention to adequate hydration and the prophylactic use of antitoxins, such as mesna. Treatment, as outlined previously, consists of a series of measures beginning with the most conservative. Intervention thereby is tailored to the gravity of the clinical situation.

Cystitis↗
PubMed1990

Prostaglandin E1 bladder instillations to control severe hemorrhagic cystitis.

Severe hemorrhagic cystitis developed in 6 children after marrow transplantation, 3 of whom had a viral etiology. All 6 patients received instillations of prostaglandin E1 directly into the bladder and 5 of the 6 had complete resolution of hematuria. This finding contrasts with our previous experience with severe hemorrhagic cystitis, particularly the type due to a viral infection, persisting in the face of numerous bladder manipulations. We encourage the use of this nontoxic treatment to gain further information regarding its effect on the bladder epithelium. The mechanism of action remains completely unknown.

Administration, Intravesical↗
PubMed1990

Follicular cystitis in girls with untreated asymptomatic or covert bacteriuria.

Nodular changes of the bladder mucosa, that is cystitis follicularis or cystitis cystica, are found in 2 to 9% of all children with urinary tract infections. The nodules are composed of lymphoid aggregates, resembling Peyer's patches in the intestine. Children with this finding are considered to have a poor short-term prognosis with a marked tendency for recurrent infections. Screening programs for bacteriuria have revealed that a few per cent of the female population are bacteriuric without symptoms of overt disease. Of 59 girls followed with untreated asymptomatic bacteriuria 52 had nodular changes of the bladder mucosa at cystoscopy. Biopsy was performed in 22 girls, and revealed lymphocytic infiltration in 19 and follicular formation in 11. The nodular changes persisted when bacteriuria continued but disappeared in patients who became abacteriuric. This finding demonstrates the reversibility of the changes, and supports the assumption that they are secondary to the presence of bacteria and not a primary lesion.

Bacteriuria↗
PubMed1990

Cystotomy, temporary urinary diversion and bladder packing in the management of severe cyclophosphamide-induced hemorrhagic cystitis.

Severe hemorrhage from cyclophosphamide-induced cystitis sometimes requires aggressive open management when conventional endoscopic and intravesical therapies have failed. We present 2 patients with intractable hematuria who were managed by open cystotomy, temporary urinary diversion via external ureteral stents, and continuous postoperative bladder packing with gauze and hemostatic agents. Both patients had a dramatic improvement in the hematuria immediately postoperatively and 1 with prolonged followup has no urological disability. We suggest that this procedure be considered for management of severe hemorrhagic cystitis as an alternative to more aggressive surgical therapies, such as formal urinary diversion with cystectomy.

Acute Disease↗
PubMed1989

Use of amitriptyline in the treatment of interstitial cystitis.

A total of 25 patients with interstitial cystitis who had failed standard therapy with hydrodistension of the bladder during anesthesia and intravesical dimethyl sulfoxide instillation underwent treatment with the tricyclic antidepressant amitriptyline. The initial dosage of 25 mg. before bed was increased gradually during a 3-week period to 75 mg. at bedtime. Of the patients 20 were able to tolerate the medication for a minimum of 3 weeks and could be evaluated for response. A significant improvement was noted in pain and daytime frequency. Of 9 patients 8 experienced relief of dyspareunia and 11 of 19 reported diminished urinary urgency. Eight patients have experienced virtual total remission of symptoms and have been on the drug for 4 to 28 months. It appears reasonable to consider the use of amitriptyline in patients with interstitial cystitis refractory to standard therapy.

Adult↗
PubMed1988

A controlled study of dimethyl sulfoxide in interstitial cystitis.

To evaluate the effectiveness of dimethyl sulfoxide in the treatment of patients with biopsies suggestive of interstitial cystitis, 33 patients underwent a controlled crossover trial. Patients were allocated randomly to receive 50 per cent dimethyl sulfoxide or placebo (saline). The medication was administered intravesically every 2 weeks for 2 sessions of 4 treatments each. Response was assessed urodynamically and symptomatically. Thirty women and 3 men (mean age 48 years and mean duration of symptoms 5.5 years) were entered into the study. No significant side effects to dimethyl sulfoxide were noted. When assessed subjectively, 53 per cent of dimethyl sulfoxide treated patients were markedly improved compared to 18 per cent of the placebo treated patients. Of the dimethyl sulfoxide group 93 per cent had objective improvement versus 35 per cent of the placebo group. Thus, dimethyl sulfoxide proved to be superior to placebo in the objective and subjective improvement of patients with interstitial cystitis.

Administration, Intravesical↗
PubMed1988

Corynebacterium-induced cystitis with mucosal incrustations.

Alkaline-incrusted cystitis is a rare condition that was first described more than 70 years ago. Since then few cases have been reported. To our knowledge, we report the second such case in the literature in which Corynebacterium D2 was considered as the causative factor of incrusted cystitis.

Adult↗
PubMed1988

Treatment of complications of cyclophosphamide cystitis.

Since 1976, 23 patients with cyclophosphamide-induced cystitis were treated. These patients presented with a variety of urinary problems, including incontinence, hematuria and vesicoureteral reflux. Vesicoureteral reflux was found in 9 patients, hydronephrosis in 4 and a contracted fibrotic bladder in 3. Of the 23 patients 18 had undergone a combination of radiation and cyclophosphamide therapy. Based on this experience a general outline is developed for evaluation and treatment of patients with cyclophosphamide-induced cystitis and its potentially severe complications.

Cyclophosphamide↗
PubMed1988

Emphysematous prostatitis and cystitis secondary to Candida albicans.

Emphysematous cystitis is characterized by gas collection within the bladder wall and lumen. Often it is the result of aerobic urinary tract infections but it may be caused by gastrointestinal fistulas or iatrogenic surgical and diagnostic instrumentation. We report a case of emphysematous cystitis owing to Candida albicans with the incidental finding of emphysematous changes within the prostate gland.

Amphotericin B↗
PubMed1988

Neodymium:YAG laser treatment of cystitis glandularis.

We report a case of severe cystitis glandularis of the entire bladder, which caused a large retrovesical mass and bilateral hydronephrosis. Treatment included whole bladder neodymium:YAG laser therapy, a technique not previously reported for this extent of disease. The etiology, diagnosis, treatment and malignant potential of cystitis glandularis are discussed.

Adult↗
PubMed1987

Cystitis cystica: an electron and immunofluorescence microscopic study.

Cystitis cystica was studied with the aid of electron and immunofluorescence microscopy. By electron microscopy, the epithelium demonstrated morphologic features suggestive of an active metabolism. Secretory-type granules were seen in the cytoplasm just beneath the luminal membrane of surface columnar cells. Microvilli of the plasma membrane also were seen at the luminal surface. Rough endoplasmic reticulum and Golgi apparatuses were present. The cells were rich in mitochondria. By immunofluorescence microscopy, IgA, secretory piece and IgM were localized in the epithelial cells, especially at the luminal surfaces. IgG was occasionally found. These findings contrast markedly with the transitional cells and their relatively scanty content of secretory-type organelles. In addition, they may explain the large amounts of IgA in the urine of patients with cystitis cystica.

Adult↗
PubMed1985

Treatment of radiation-induced cystitis with hyperbaric oxygen.

The effects of hyperbaric oxygen on radiation cystitis have been documented in 3 patients with radiation-induced hemorrhagic cystitis refractory to conventional therapy. Cessation of gross hematuria and reversal of cystoscopic bladder changes were seen in response to a series of hyperbaric oxygen treatments of 2 atmosphere absolute pressure for 2 hours. To our knowledge this is the first report of cystoscopically documented healing of radiation-induced bladder injury.

Aged↗
PubMed1985

Treatment of interstitial cystitis with the neodymium-YAG laser.

Five patients with severe interstitial cystitis that had not responded to conventional means of therapy were treated with the neodymium-YAG laser. Of the 5 patients 4 demonstrated cessation of severe bladder pain and frequency of urination within several days after therapy. These patients also were studied objectively by measuring bladder capacity, which was found to be increased over-all. Complication rates from this modality of therapy were extremely low. The patients have been followed for 3 to 15 months after treatment and to date have had no recurrent symptoms of severe interstitial cystitis, although some have had mild recurrent voiding symptoms.

Aged↗
PubMed1985

Conservative management of chronic interstitial cystitis: transcutaneous electrical nerve stimulation and transurethral resection.

Transcutaneous electrical nerve stimulation was used in a prospective series of 23 patients with classical interstitial cystitis. This treatment reduced pain in 18 patients and urinary frequency returned to normal in 8. Four women with a history of cystitis for 1 or 2 decades had no symptoms during transcutaneous electrical nerve stimulation for 7 or more years and lesions disappeared or were hardly detectable. A 2 to 3-fold increase in bladder capacity with anesthesia also was registered. Complete transurethral resection of visible lesions in 30 patients resulted in initial disappearance of pain in all and a decrease in urinary frequency in 21. The mode of action of the 2 methods and registered complications are discussed.

Aged↗
PubMed1984

Eosinophilic cystitis in children: a self-limited process.

We report a case of eosinophilic cystitis in a 7-year-old boy. Bilateral hydronephrosis and a lesion involving most of the bladder were seen initially. Complete resolution of all symptoms occurred within 3 weeks and the x-ray findings returned to normal in 6 weeks without specific therapy. A review of all reported cases of eosinophilic cystitis in children suggests that, unlike in adults, the disease is self-limited.

Child↗