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PubMed1995

Prostatodynia and interstitial cystitis: one and the same?

OBJECTIVES: To investigate further the observation that men with prostatodynia may represent a subset of patients with interstitial cystitis. METHODS: The charts of 20 patients with the diagnosis of nonbacterial prostatitis or prostatodynia who underwent cystoscopy and bladder hydrodistention were retrospectively reviewed. RESULTS: The primary complaint of all 20 patients was genital or rectal pain, or both. Ten patients reported irritative voiding symptoms. Twelve of the 20 patients developed petechial hemorrhages involving the bladder uroepithelium on hydrodistention. Bladder biopsies revealed no significant histopathologic abnormalities. Nine of the 12 patients who developed petechial hemorrhages reported symptomatic improvement at 2- to 3-week follow-ups compared with none of the 8 patients without petechial hemorrhages. CONCLUSIONS: These findings suggest that the diagnosis of interstitial cystitis should be considered in patients with nonbacterial prostatitis or prostatodynia.

Adult↗
PubMed1997

Do infectious agents cause interstitial cystitis?

The possibility that infectious agents play a role in the etiology of interstitial cystitis (IC) has been investigated for a number of years. Early studies were directed toward attempts to cultivate bacteria and fungi on routine culture media and microscopic examinations of urine or bladder tissue specimens for the presence of microorganisms. In more recent years, this approach has been expanded to include sophisticated culture techniques to search for the presence of fastidious and unusual organisms that would not be detected by routine culture methods. Similarly, the presence of viruses has been sought by incubating specimens from interstitial cystitis patients in mammalian cell cultures to detect cytopathic effects. None of these approaches has provided convincing evidence that micro-organisms or viruses are associated with IC. The latest attempts to search for the presence of bacteria have made use of the polymerase chain reaction (PCR) to amplify bacterial 16S rRNA genes that would be present if bacteria were present in bladder tissue or urine of IC patients. This approach allows bacteria to be detected and even identified without culture. However, the results from the great majority of bladder biopsy samples analyzed by these molecular techniques have been negative. PCR strategies have also been used to search for the presence of certain viruses in IC specimens, again without success. At this time, the results from laboratory culture, light and electron microscopy, and various molecular strategies to detect micro-organisms and viruses in IC specimens all argue against an infectious etiology for IC.

Bacteria↗
PubMed1997

Associations among urodynamic findings and symptoms in women enrolled in the Interstitial Cystitis Data Base (ICDB) Study.

OBJECTIVES: The goal of this study was to correlate the cystometric findings with the presenting symptoms of the 388 women enrolled in the NIH/NIDDK-funded interstitial Cystitis Data Base (ICDB) Study as of December 31, 1995. METHODS: All patients underwent a complete history and physical and completed standardized questionnaires to assess voiding symptoms and quality of life (QOL). A 3-day voiding log was also obtained, followed by a baseline urodynamic exam. All results are expressed as mean values +/- 1 standard deviation, and all reported correlations were significant. RESULTS: A correlation was seen between reported daytime, nighttime, and 24-hour frequency, and both volume at first sensation to void (VFSV) and maximal cystometric capacity (VMCC). Patients with constant severe urgency had smaller VFSV, 63 +/- 59 mL versus 108 +/- 90 mL, and lower VMCC, 163 +/- 102 mL versus 288 +/- 135 mL, than patients without the complaint. A negative trend was seen for both VFSV and VMCC versus the global severity. An inverse trend was seen between minimal and maximal pain scores over the 4 weeks before the exam and VMCC. (No correlation existed between current pain noted during baseline screening visits and VFSV or VMCC). No urodynamics correlates were seen with global measures of body pain and global health. Uninhibited detrusor contractions (UDCs) were seen in 56 of 384 patients (14.6%). A positive correlation was seen between urgency symptoms and the presence of UDCs. Correlations between the VFSV and VMCC were made with both the average voided volume (AVV) and the average maximal voided volume (AMVV) as determined by a 3-day voiding log. Significant positive correlations were seen with each pair-wise comparison (P = 0.001). CONCLUSION: These findings confirm that subjective measurements of symptoms associated with interstitial cystitis can be confirmed objectively with urodynamic studies.

Adult↗
PubMed1997

Associations among cystoscopic findings and symptoms and physical examination findings in women enrolled in the Interstitial Cystitis Data Base (ICDB) Study.

OBJECTIVES: To determine if specific symptoms or physical findings were associated with findings on cystoscopic examination under anesthesia in patients participating in the Interstitial Cystitis Data Base (ICDB) Study. METHODS: Subjects entering the ICDB Study completed symptom questionnaires and underwent physical examinations. Additionally, at the discretion of study investigators, 150 women underwent cystoscopy under anesthesia following a specific protocol of bladder distension at 70 to 80 cm irrigating fluid height and reinspection after capacity was reached and the irrigant drained. RESULTS: Statistically significant (p < 0.01) associations between bodily pain and urinary urgency with the presence of a Hunner's patch, and urinary frequency and urgency with a reduced bladder capacity under anesthesia were seen. Neither the findings of bloody irrigating fluid nor glomerulations were strongly associated with any symptom, and except for an association of urethral tenderness with Hunner's patch, no physical examination finding was associated with any cystoscopic findings. CONCLUSIONS: The strong associations of Hunner's patch and reduced bladder capacity under anesthesia with severe pain and urinary urgency, and urgency and frequency, respectively, indicate not only the importance of these findings in diagnosing interstitial cystitis, but also their potential utility in subclassifying this disease.

Cystitis, Interstitial↗
PubMed1995

Hyperbaric oxygen treatment for haemorrhagic radiation cystitis.

Radiation-induced severe haemorrhagic cystitis is difficult to treat. Conventional treatments may decrease haematuria but do not affect the radiocystitis itself. Hyperbaric oxygen treatment has been reported to do both. We report the results of a prospective study of hyperbaric oxygen (20 sessions of 100% oxygen inhalation at 3 bar for 90 min in a multiplace hyperbaric chamber) to 40 patients with biopsy-proven radiation cystitis and severe haematuria. Haematuria disappeared completely or improved in 37 patients after treatment. Mean follow-up was 23.1 months (range 1-74); and the recurrence rate was 0.12/year. There were no adverse effects. Hyperbaric oxygen treatment should be considered for patients with severe radiation-induced haematuria.

Aged↗
PubMed1996

Interstitial cystitis in cats.

Despite much research on FUS, there still is no consensus regarding its cause, or even its definition. We recently have demonstrated that some cases of FUS are similar to interstitial cystitis in human beings. Exclusion of anatomic defects, behavior abnormalities, neoplasia, urolithiasis, urethral obstruction, and urinary tract infection leads one to the diagnosis of interstitial cystitis in cats. This diagnosis suggests the need for new approaches to treatment, including pain management and environmental modification.

Animals↗
PubMed1990

Emphysematous cystitis: a complication of urinary tract infection occurring predominantly in diabetic women.

The case of a patient with emphysematous cystitis who presented with complaints of lower abdominal pain, dysuria, and pneumaturia is presented. The presenting symptoms, differential diagnosis, and radiographic and cystoscopic appearances of emphysematous cystitis, a rare complication of lower urinary tract infection occurring almost exclusively in diabetics, are reviewed. Treatment consists of urinary drainage, prompt initiation of antibiotic therapy, and strict glucose control. The prognosis usually is excellent.

Combined Modality Therapy↗
PubMed2000

[Intraperitoneal bladder perforation in emphysematous cystitis].

Contribution of one case report of a 69-year old diabetic male patient with neurogenic bladder. The patient developed emphysematous cystitis and peritonitis secondary to intraperitoneal perforation of the bladder. Emphysematous cystitis is an uncommon clinico-radiologic entity more frequent in diabetic and female patients and the elderly. Early diagnosis and treatment may avoid a fatal outcome. The paper includes a review of this condition.

Cystitis↗
PubMedDate not supplied

[Glandular cystic cystitis].

Cystic-glandular cystitis is considered as part of the urothelial pre-neoplastic proliferative abnormalities. This group includes atypical hyperplasia. Von Brunn's nidus, and cystitis cystica. They are a consequence of the changes experienced at the urothelium level in response to inflammation, irritation or carcinogens. Diagnosis is mainly based in the pathoanatomical study of the biopsy obtained following endoscopic resection. The signs and symptoms it presents are varied and show a clear relationship to distribution and extension of cysts. Treatment is based in the removal of irritative factors. Cystectomy with urinary by-pass may be necessary if required by clinical evolution.

Adult↗
PubMed2003

[Pilot study of coadjuvant treatment of recurrent cystitis in women by means of AM3 (Immnoferon)].

OBJECTIVES: The aim is to evaluate the effectiveness of AM3 (Inmunoferon) in the treatment of the recurrent cystitis in women in order to know the rate of good results, previously to design a clinical trial. MATERIAL AND METHODS: Twenty-four women who had been diagnosed of two cystitis episodes in the previous 6 months without cure by antibiotic treatment were admitted to the study. Standard antibiotic treatment and 3 daily grammes of AM3 was given for 9 months. Infection and irritative symptoms during micturition rate were evaluated at the inclusion date and afterwards, at the first, third, sixth and nineth month. RESULTS: Nineteen patients finished the study. The infection rate decreased from 100% at the inclusion date to 26% in the first month and then it became stable about 50%. Irritative symptoms during micturition decreased from 46% at the inclusion date to a rate lower than 10% in the 4 controls running. CONCLUSION: AM3 reduced evident urinary infection in a 50% and irritative symptoms during micturition in a 90%. Control clinical trials are needed to confirm the AM3 effects on this pathology.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Incrusted cystitis after Mitomicin-C].

Incrusted cystitis is an infrequent process characterized by precipitation an incrustation of salts on the vesical mucosa. An alkanine urine is required to this precipitation. The urinary infection with urolithic activity microorganisms can also be a very important factor. We present a case of incrusted cystitis after using Mitomicine as vesical chemotherapy.

Alkylating Agents↗
PubMedDate not supplied

[Encrusted alkaline cystitis and malacoplakia].

Urinary infection due to urea splitting bacteria leads to a rise in urinary pH, favouring the precipitation of calcium salts and struvita crystals. If deposited on the surface of a bladder with chronic inflammation or some other previous lesion, may produce an alkaline encrusted cystitis, now a rare condition. In the case here presented, occurred in a 69-year-old male. Corynebacterium urealyticum grown in the urine, and some foci of malakoplakia were found in the area of encrustation endoscopically excised. This case seems to be the third example of alkaline encrusted cystitis associated with malakoplakia reported in the bibliography. These two conditions share similar clinical signs and may probably have a common aetiopathogenesis.

Aged↗
PubMed2002

Prolonged hydrodistention of the bladder for symptomatic treatment of interstitial cystitis: efficacy at 6 months and 1 year.

OBJECTIVE: To determine the efficacy of hydrodistention of the bladder for symptomatic treatment of interstitial cystitis after 6 months and 1 year of follow-up and to identify a predictive factor. METHODS: The study included 65 consecutive patients (a first retrospective series of 33 and a second prospective series of 32) treated by hydrodistention of the bladder for urinary symptoms attributed to interstitial cystitis. All experienced pain on bladder filling, which was relieved by micturition or bladder voiding, and had more than two nocturias. Glomerulations were detected at short hydrodistention during cystoscopy. No patients were subject to NIH exclusion criteria. Hydrodistention was performed continuously for 3 h without rest intervals under epidural anesthesia using a balloon with a pressure equal to the patient's mean arterial pressure. Efficacy was defined as the disappearance of pain on bladder filling or the persistence of moderate, non-disabling pain for which the patient did not request treatment, and a low frequency of nocturia (zero to two times). The efficacy period was estimated according to Kaplan-Meier methods for survival curves. The second series was used to verify the analytic results of the first series. RESULTS: Treatment efficacy was 12/32 (37.7% CI: 20.7-54.3) at 6 months and 7/32 (21.9% CI: 7.6-36.2) at 1 year for the first series, and 18/30 (60.0% CI: 45.0-75.0) at 6 months and 13/30 (43.3% CI: 25.6-61.1) at 1 year for the second series. In both series, results were better for the subgroup of patients with a bladder capacity > or = 150 ml during cystometry before distention. CONCLUSIONS: This study showed good but transient efficacy in the least developed or least severe forms of the disease.

Adult↗
PubMed1997

Post radiation hemorrhagic cystitis: MR findings.

We report on the magnetic resonance findings in two patients with hemorrhagic cystitis secondary to radiation therapy. One patient's bladder wall was high in signal intensity on T1-weighted fat-suppressed spoiled gradient echo and low in signal intensity on T2-weighted fat-suppressed spin echo images, findings consistent with intracellular methemoglobin in the setting of subacute intramural hemorrhage. The second patient's bladder wall had regions that were low in signal intensity on T1-weighted fat-suppressed spin echo and high in signal intensity on T2-weighted fat-suppressed spin echo, and other regions that were high in signal intensity on T1-weighted fat suppressed spin echo and on T2-weighted fat-suppressed spin echo images, findings that were consistent with active bleeding and late subacute hemorrhage, respectively. Imaging findings correlated with the patients' clinical picture. Our two cases illustrate that magnetic resonance images may demonstrate changes of hemorrhagic cystitis and may permit determination of disease acuity.

Adult↗
PubMed2002

Intravesicle formalin instillation with a modified technique for controlling haemorrhage secondary to radiation cystitis.

OBJECTIVE: Intractable haemorrhage, secondary to radiation cystitis, is a serious complication of radiotherapy for pelvic malignancies. Formalin instillation is often effective for intractable haemorrhage unresponsive to other agents, but carries the risk of significant morbidity. The placement of formalin-soaked pledgets is a modified technique for the treatment of this complication. We compare the effectiveness and complications of both techniques. METHODS: Eleven patients with intractable haemorrhage secondary to radiation cystitis were treated by intravesicle 4% formalin instillation [Group I] and eight were treated by the endoscopic placement of 10% formalin-soaked pledgets on the bleeding points for 15 minutes [Group II]. RESULTS: Cessation of bleeding was 9 of 11 [82%] and 6 of 8 [75%] in Group I and Group II, respectively. One patient in Group II required two treatments, due to recurrent haemorrhage. Four major and several minor complications were found in Group I, and only three minor complications were found in Group II. CONCLUSION: Formalin instillation is effective in controlling severe bladder haemorrhage after radiation of the pelvis, but the complications secondary to the fixative properties are severe. Topical application of formalin-soaked pledgets is as effective in controlling the haemorrhage as conventional intravesicle formalin instillation, with fewer complications. This technique should be the initial treatment for this complication.

Administration, Intravesical↗
PubMed2004

Emphysematous cystitis.

We present a case of emphysematous cystitis in a diabetic patient with a poor glycemic control in the context of alcoholic chronic pancreatitis. A 62-year-old woman was admitted to the emergency department after being found on floor with confusion and vomiting. The clinical examination was unremarkable except she was undernourished, agitated and presented an hepatomegaly. Urine contained 5.104 leukocytes/mm3 and culture grew Escherichia coli, 10(7) Colony Forming Unit/ml. Abdominal plain film showed gas shadows along the wall of urinary bladder. CT scan of the pelvis confirmed the presence of gas, and diffuse thickening of the urinary bladder wall. A Foley catheter was placed and the patient was treated with antibiotics for 6 weeks. She was also treated with insulin, rehydratation, vitamin B1 and B6, and pancreatic enzyme replacement. Emphysematous cystitis is defined by the presence of gas in the urinary bladder wall. It complicates urinary tract infections especially in diabetic patients but other disabled general medical conditions may be present. Because this relatively uncommon disease may present with fairly nonspecific findings, the diagnosis is often made incidentally on X-rays. However, as early diagnosis and treatment improve the outcome, a high index of suspicion for unusual presentations is warranted. Every diabetic patient with a urinary tract infection who seems to be severely ill should have an abdominal X-ray as a minimal screening tool to detect emphysematous complications.

Anti-Bacterial Agents↗
PubMed2005

Unusual gas pattern in emphysematous cystitis: a case report.

We present a case of emphysematous cystitis in a 43-year-old female. The gas pattern was unusual because there was only gas accumulation in the urinary bladder without bladder wall thickening or intramural gas formation. The differential diagnosis included postoperative states, enterovesical fistula, and iatrogenic instrumentation. The prognosis of emphysematous cystitis is good after early diagnosis and prompt treatment with appropriate antibiotics, blood glucose control, and adequate urinary drainage. The patient was discharged on hospital day 5 with one additional week of oral antibiotic therapy. She was quite well at the time of writing and her diabetes was controlled with an oral hypoglycemic agent.

Adult↗