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PubMed2002

Biosynthetic reactions and ultrastructure of urothelial cells in chronic cystitis and cystopathies.

A new form of morphogenesis of pathological process, cystopathy, was distinguished on the basis endoscopy data and morphofunctional analysis of the urinary bladder in chronic cystitis. Cystopathy is characterized by predominance of diffuse degeneration and atrophy of the urothelium, stromal sclerosis, absence of inflammatory cell infiltration, and inhibition of biosynthetic reactions in urothelial cells (compared to chronic cystitis). Cystopathy results from regeneratory and plastic failure. Instability of the bladder epithelium can be a morphological marker of oncological risk.

Adolescent↗
PubMed2004

New theories in interstitial cystitis.

Interstitial cystitis (IC) is a chronic symptom-complex characterized by pathological sensation of the bladder (i.e. bladder pain in addition to augmented sensory signals such as urinary frequency and urgency) without evidence of bacterial cystitis or other identifiable lower urinary tract disease. Patients with IC typically describe feeling the urge to void frequently, as well as pain in the bladder and/or urethra. The painful sensation may be described as burning, pressure, sharp, or aching, and is often difficult for the patient to localize precisely. Multiple theories as to the cause of IC have been proposed with varying degrees of evidence. The current body of literature supports the idea that IC is associated with an intrinsic pathology of the bladder urothelial cells. The identification and complete characterization of antiproliferative factor (APF), which is uniquely expressed by urothelial cells in bladders affected by IC, are major advances in the understanding of IC. Additionally, urothelial cells have been likened to neurons because of their ability to express neuronal receptors and release neurotransmitters. The purinergic pathway has been shown to be upregulated in urothelial cells in bladders affected by IC. These new findings should help to direct the development of newer clinical treatments for IC. A complete understanding of IC will only be possible with parallel advances in both basic and clinical sciences.

Cystitis, Interstitial↗
PubMed1998

Late-onset hemorrhagic cystitis after hematopoietic stem cell transplantation in children.

We analyzed the incidence, complications, and risk factors for late-onset hemorrhagic cystitis (HC) in 256 children undergoing hematopoietic stem cell transplantation (HSCT). Twenty-six recipients (10.2%) developed late-onset HC between 3 and 270 days (median, 33 days) after HSCT. In most patients, the severity of HC was mild to moderate, and spontaneous resolution occurred. Three children developed bladder tamponade, and one required suprapubic cystotomy. Four children died in the early post-transplant period without resolution of HC, but HC was not the direct cause of death in any patient. Twenty-two patients recovered within 6-86 days (median, 16 days) of onset. Three predisposing factors were identified for development of late-onset HC by multivariate analysis: allogeneic HSCT, older age (> or = 7 years), and busulphan for pretransplant conditioning were significantly associated with late-onset HC (P=0.022, P=0.044 and P=0.036, respectively). Excretion of adenovirus type 11 was demonstrated in six of 22 patients at the onset of cystitis. We suspect that reactivation of virus may be a major pathogenic factor in late-onset HC, but several clinical factors are also associated.

Adolescent↗
PubMed1999

Intravesicular instillation of E-aminocaproic acid for patients with adenovirus-induced hemorrhagic cystitis.

Hemorrhagic cystitis (HC) is a known complication of allogenic BMT. We report a case of a 28-year-old female with CML in chronic phase, which was treated with a matched unrelated donor (MUD) transplant, complicated by hemorrhagic cystitis on day +42 after the transplant. Adenovirus was isolated from the urine and she was treated with ribavirin, 1 g twice a day for 8 days. We report the use of Amicar (E-aminocaproic acid), 2.5 g solution as bladder instillation to treat the intractable hematuria.

Adenoviridae Infections↗
PubMed2000

Encouraging results in the treatment of haemorrhagic cystitis with estrogen - report of 10 cases and review of the literature.

Haemorrhagic cystitis (HC) after allogeneic haematopoietic stem cell transplantation (HSCT) or high-dose cyclophosphamide (CP) chemotherapy is a severe side-effect and can cause significant morbidity and mortality. In this report, we describe the clinical courses of 10 patients with HC and review the literature. The patients were treated with oral conjugated estrogen in an attempt to improve severe haemorrhagic cystitis. In seven patients positive effects were seen, haematuria resolved in all, but residual symptoms of dysuria remained for longer periods. In one patient application of estrogen was interrupted because of hepatotoxicity. Two patients failed all treatment modalities including oral estrogen because of terminal illness. We conclude that in the management of HC the administration of oral conjugated estrogen should be considered.

Administration, Oral↗
PubMed2000

Successful treatment of severe hemorrhagic cystitis with cystectomy following matched donor allogeneic hematopoietic cell transplantation.

We report a case of severe hemorrhagic cystitis complicating high-dose cyclophosphamide (CY), total body irradiation and allogeneic hematopoietic stem cell transplantation (HSCT). Supportive care with i.v. hydration, platelet transfusions, continuous bladder irrigation and aluminum irrigation of the bladder was ineffective and the patient developed multiple complications from hemorrhagic cystitis. His condition became critical with persistent bleeding, pulmonary edema and acute renal failure. These problems resolved following successful simple cystectomy and ileal conduit. The patient did not develop any acute or chronic complications following surgery. He is alive with a good quality of life and in third remission after receiving salvage chemotherapy 14 months after his transplantation.

Cyclophosphamide↗
PubMed2006

Treatment of post-hematopoietic stem cell transplantation hemorrhagic cystitis with intravesicular sodium hyaluronate.

Hemorrhagic cystitis (HC) is a well-known complication of HSCT. Its overall incidence has been reported to vary from 7-68%. The spectrum of clinical presentation varies from asymptomatic microhematuria to life-threatening bleeding. Sodium hyaluronate is a glycosaminoglycan present on the bladder mucosa, which serves as an important protective substance against uroepithelial damage. Preparations of this component have been shown to be effective in the treatment of interstitial cystitis. We report our experience in the treatment of post-transplant HC with intravesical instillation of sodium hyaluronate. Five out of the seven patients included in this study achieved complete response, while one patient had only partial response. Sodium hyaluronate administration was not associated with any local or systemic adverse effects. We consider that the results of our study are promising and the efficacy of sodium hyaluronate in the treatment of post-transplant HC should be tested in larger cohorts of patients.

Administration, Intravesical↗
PubMed2003

Interstitial cystitis, gynecologic pelvic pain, prostatitis, and their epidemiology.

AIM: To determine a uniform definition of interstitial cystitis (IC) and to develop a strategy on how to study its epidemiology. METHODS: Initially, the committee reviewed the literature regarding the definition of IC currently being used and information regarding its epidemiology. The committee held three 1-hour hearings and discussions on the opinions of invited IC specialists. The issues were presented and discussed. Consensus was sought when possible. The committee members met and summarized the gist of the three sessions. RESULTS: A consensus emerged as to what constitutes IC. Interstitial cystitis must have the elements of chronic pelvic pain and urinary frequency and/or urgency. It was also the recommendation that the term IC be retained followed by chronic pelvic pain syndrome represented by the acronym IC/CPPS. A strategy on the epidemiologic study of IC/CPPS was also recommended. CONCLUSIONS: A consensus from this workshop has emerged in terms of defining the component of IC, the preferred terminology, and the strategy to study its epidemiology.

Cystitis, Interstitial↗
PubMed2003

Future research needs for the definition/diagnosis of interstitial cystitis.

In Workshop 8 at the International Conference on Interstitial Cystitis (Kyoto March 2003, future research needs for the definition/diagnosis of interstitial cystitis (IC) were discussed by the participants. To structure discussions a study proposal was used. This workshop decided that research should focus on identifying and validating classification criteria for the diagnosis of IC. This might well be done in a (multi-centre) study with a control group of urge-frequency patients without pain (OAB?). However, before doing so standards should be defined as on how to perform and interpret vaginal examination, urodynamic investigation, cystoscopy under anesthesia, potassium sensitivity test, and histopathology in these patients.

Biomedical Research↗
PubMed2003

Use of dexamethasone with mesna for the prevention of ifosfamide-induced hemorrhagic cystitis.

AIM: Hemorrhagic cystitis (HC) is a limiting side-effect of chemotherapy with ifosfamide (IFS). In the study presented here, we investigated the use of dexamethasone in combination with mesna for the prevention of IFS-induced HC. METHODS: Male Wistar rats (150-200 g; 6 rats per group) were treated with saline or mesna 5 min (i.p.) before and 2 and 6 h after (v.o.) administration of IFS. One, two or three doses of mesna were replaced with dexamethasone alone or with dexamethasone plus mesna. Cystitis was evaluated 24 h after its induction by the changes in bladder wet weight and by macroscopic and microscopic analysis. RESULTS: The replacement of the last dose or the last two doses of mesna with dexamethasone reduced the increase in bladder wet weight induced by IFS by 84.79% and 89.13%, respectively. In addition, it almost abolished the macroscopic and microscopic alterations induced by IFS. Moreover, the addition of dexamethasone to the last two doses of mesna was more efficient than three doses of mesna alone when evaluated microscopically. CONCLUSION: Dexamethasone in combination with mesna was efficient in blocking IFS-induced HC. However, the replacement of last two doses of mesna with saline or all of the mesna doses with dexamethasone did not prevent HC.

Animals↗
PubMed1996

Bladder augmentation in the prevention of cyclophosphamide-induced haemorrhagic cystitis in the rat model.

OBJECTIVE: To evaluate the effects of cyclophosphamide on the bowel mucosa of the rat and to determine whether urothelium can be protected from the effects of haemorrhagic cystitis which can occur after treatment with cyclophosphamide. MATERIALS AND METHODS: Thirty Sprague-Dawley rats were divided into three groups, 10 undergoing a control (sham) operation, 10 an ileal bladder augmentation and 10 a colonic bladder augmentation. Each rat underwent the appropriate surgical procedure and after a recovery period of 2 weeks, was injected with cyclophosphamide. Urine specimens were collected 24 h after the injection and analysed for gross and microscopic haematuria. The rats were killed humanely 48 h after injection and the bladders examined for haemorrhage, oedema, attenuation, inflammation and erosion. RESULTS: None of the 20 augmented rats developed gross haematuria and only four developed microscopic haematuria, compared with the control rats where six of 10 developed gross haematuria and nine developed microscopic haematuria. In addition, the control rats had moderate to severe haemorrhage, oedema and attenuation compared with only mild changes in the augmented rats. This protection was significant for both the bowel mucosa and urothelium. CONCLUSIONS: It is possible that the administration of cyclophosphamide in patients with urinary diversion carries little risk of haemorrhagic cystitis. We propose that this protective mechanism is secondary to a substance secreted by the intestinal mucosa that may bind acrolein and render it inactive. Alternatively, this may be secondary to the production of mucus and its ability to coat and protect the epithelium.

Animals↗
PubMed1997

A clinicopathological approach to cystitis--recommendations for simplified pathology reporting.

OBJECTIVE: To assess the accuracy of histopathology reports of bladder biopsy specimens showing chronic cystitis and to develop a standard method of reporting in the form of a template which will aid both clinician and patient in the management of this condition. MATERIALS AND METHODS: Over a 4-year period, the reports of 134 bladder biopsy specimens diagnosed as chronic inflammation of the bladder were examined for clinical details, cystoscopy findings, pathology details and conclusions. Within each of these groups, the common terms were assessed for their relevance to the final outcome. RESULTS: The analysis of each part of these reports revealed no clinical details in 33%, no cystoscopy details in 26% and no histopathology conclusion in 20%. The commonest terms used were: macroscopic haematuria (25%) for clinical details; red patch/ inflamed (40%) for cystoscopic details, morphological site involved (65%) for pathology details; and mild chronic cystitis (37%) for the conclusions. Standardized criteria were devised and after reassessing the reports, 75% were considered to be accurate and complete. CONCLUSIONS: Overall, the histopathology reports examined were more than adequate for the clinicians' use but the spectrum of details provided did not add to the usefulness of the final report. By limiting the terms available, a more standardized report can be produced, benefiting both clinician and patient.

Adult↗
PubMed2000

Neuromodulation reduces urinary frequency in rats with hydrochloric acid-induced cystitis.

OBJECTIVE: To evaluate the effect of sacral neuromodulation on interstitial cystitis (IC) and determine the underlying mechanism of neuromodulation in the treatment of IC. Materials and methods Twenty Sprague-Dawley rats (body weight 220-250 g) were randomly divided into four equal groups; normal controls, a sham treatment (IC induced by 0.4 mol/L HCl, + saline), a second sham treatment (HCl-induced IC + acetic acid) and a stimulated group (HCl-induced IC + acetic acid, with electrical stimulation). In the last group bilateral electrodes were implanted into the S1 dorsal foramina and electrical stimulation applied for 8 h/day for 3 weeks. Acetic acid was instilled into the bladder to induce c-fos expression. After 3 weeks the rats were perfused with 4% paraformaldehyde, spinal segments dissected out and an immunocytochemical method used to stain the segments for fos protein encoded byc-fos. RESULTS: The mean (SEM) micturition frequency (voids/17 h) in the sham groups increased from 10.8 (2.7) to 23.4 (3.4) 3 weeks after the intravesical instillation of HCl. The micturition frequency in the stimulated group, at 16.2 (2.7), was significantly less than in the sham group (P = 0.04) after electrical stimulation for 3 weeks. There was no significant difference in the mean (SEM) number of fos-positive neurones in the L6 spinal cord segment between the stimulated and the sham + acetic acid group, at 43.6 (9.4) and 35.8 (7.8) cells/section, respectively (P = 0.32). CONCLUSIONS: In rats with HCl-induced cystitis, electrical stimulation reduced the micturition frequency, but not by inhibiting afferent c-fibre activity.

Animals↗
PubMed2003

Assessing self-help issues for patients with prostate cancer, interstitial cystitis, erectile dysfunction and urinary diversion.

OBJECTIVE: To determine the prevalence of self-help (which is widely available and can assist clinicians to educate and empower patients) for several urological diseases. PATIENTS AND METHODS: Using a structured interview, the prevalence of self-help use and awareness was assessed in patients with prostate cancer, interstitial cystitis, erectile dysfunction and urinary diversion. Patients were also asked to report levels of support and information they required and to specify how well these needs were being met. Consecutive patients (120, 30 from each group) were recruited from an outpatient urology clinic in a tertiary-care health centre. RESULTS: Patients with interstitial cystitis and erectile dysfunction reported having the greatest need but were least satisfied with the level of support and information they currently receive. Inversely, patients with prostate cancer reported having the least need and were most satisfied. Excluding brochures, the use and awareness of self-help were low in all groups but most patients claimed they would use many types of self-help if they were available. Many patients are not directed to self-help resources by their urologist or family physician. CONCLUSION: Most patients would like to use more self-help but many do not. The low percentage of patients referred to self-help by their physician probably contributes to, or causes, this problem. It is important for clinicians to encourage and refer patients to specific resources to ensure that the patient receives accurate and pertinent information. As most patients read brochures it is logical to use them to provide basic information and to direct them to other more sophisticated forms of self-help. We have used urology patients as a model but consider that many of our findings could be applied to other medical and surgical specialties.

Aged↗
PubMed1975

[Cystitis emphysematosa (author's transl)].

Two cases of cystitis emphysematosa are described and the literature is reviewed. The aetiology, course and diagnosis are discussed, the radiological appearances being of particular importance. The cystoscopic and laboratory findings are mentioned. Cystitis emphysematosa is analogous to other conditions which cause gas to collect in abdominal organs and has similar aetiological factors.

Aged↗
PubMedDate not supplied

[Human fibrin glue as a new therapeutic concept in cyclophosphamide-induced cystitis and macrohematuria].

Successful treatment of hemorrhagic cystitis after systemic chemotherapy with cyclophosphamide yields up great problems up to now, because all therapeutic modalities that have been done were accompanied with severe side-effects. A 16 year old girl presented massive chemical cystitis and severe bleedings of the bladder mucosa after systemic long-term low-dose chemotherapy with cyclophosphamide. In this case bladder lesions could be cured completely by endoscopic application of fibrin adhesive through a cystoscope. Side-effects were not noted.

Administration, Oral↗
PubMed1991

[Acute hemorrhagic cystitis following chlordimeform poisoning ].

A 19-year-old and a 50-year-old man who together had cleaned a water-tank as part of their duties in a tank protection and cleaning firm developed that same evening lower abdominal pain, dysuria and haematuria. Cystoscopy revealed haemorrhagic cystitis in both patients, a finding confirmed by bladder mucosa biopsy. 4-chlor-2 methylaniline (concentration less than 1 mg/l) was found in hydrolysed serum of both. This metabolite of the pesticide chlordimeform was also found in the urine of the 51-year-old patient (16 mg/l). The haematuria regressed within two days of the patients having increased their fluid intake. Dysuria improved within a week. It is likely that chlordimeform had previously been transported in the water-tank. In case of haemorrhagic cystitis possibly caused by occupational or other poisoning, serum and urine should always be obtained for toxicological tests.

Acute Disease↗
PubMed2002

Interstitial cystitis: a guide to recognition, evaluation, and management for nurse practitioners.

Interstitial cystitis (IC) is a chronic disorder of unknown etiology that affects the lower urinary tract of up to 500,000 women and men in the United States. It is characterized by bladder and pelvic pain that varies from moderate discomfort to severe, debilitating pain and related lower urinary tract symptoms including nocturia, diurnal urinary frequency, and urgency. Because the symptoms of IC superficially resemble a urinary tract infection, it is often misdiagnosed and may remain so for months or even years. This article discusses the clinical manifestations of IC, including its differentiation from acute or recurring bacterial cystitis. Options for managing this significant and often debilitating voiding dysfunction are also discussed.

Cystitis, Interstitial↗